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Objective:To explore the clinicopathological characteristics and prognosis of pancreatic gastrointestinal interstitial tumors(pGISTs).Methods:Three cases of pGISTs diagnosed in the Affiliated Tumor Hospital of Guangxi Medical University from August 2015 to October 2019 were analyzed retrospectively. Relevant literatures at home and abroad were searched and reviewed through PubMed, China knowledge Network, Wanfang and VIP databases. The sex, age, tumor size, tumor location, cystic or solid tumor, mode of treatment, mitosis, gene mutation, survival status and survival time were recorded, and the correlation between tumor cystic-solid characteristics and clinicopathological parameters was analyzed. Kaplan-Meier′s method was used to calculate the overall survival (OS) rate and disease-free survival (DFS) rate. Univariate and multivariate Cox regression models were used to analyze the independent risk factors affecting the prognosis of pGISTs.Results:In this group, 3 cases were combined with 71 cases reported in the literature, and a total of 74 cases of pGISTs were included. Among them, 36 cases were male and 38 were female, the age of onset was 55(19-84) years, and the diameter of the tumor was 8 cm(2-35 cm). The tumor location of 71 patients was recorded by literature; 30 cases (42.3%) were located in the head of the pancreas. The solid-cystic characteristics of tumor in 63 patients were recorded by literature, and 33 cases (52.4%) were solid. The mode of treatment of 74 patients was recorded, and 60 cases (81.1%) underwent radical resection. The mitosis figures of 59 patients were recorded, and 33 cases (55.9%) were <5/50 high power field of vision (HPF). The gene mutation of 14 patients was recorded, and 11 cases (78.6%) were c-kit exon gene mutation. Correlation analysis showed that the cystic-solid characteristics of the tumor were significantly correlated with tumor location, tumor diameter and mitosis figures, but not with age, sex, histological type, Ki-67 index and modification National Institutes of Health(mNIH) classification. The 5-year OS rate of 51 patients after radical resection was 88.8%, and the 5-year DFS rate was 60.3%. The 1-year OS rate of patients receiving palliative treatment was 51.9%, and the 1-year fatality rate was 33.3%. Univariate Cox regression analysis showed that male ( P=0.083), mitosis figures >5/50 HPF ( P=0.008)and CD 34 negative ( P=0.055)were risk factors for postoperative recurrence of pGISTs, while multivariate Cox regression analysis showed that mitosis figures >5/50 HPF ( P=0.023)was an independent risk factor for the prognosis of pGISTs. Kaplan-Meier survival analysis showed that patients with mitosis figures ≤5/50 HPF had a higher survival rate ( P=0.0003), but there was no significant difference on prognosis between patients with 10/50 HPF and >10/50 HPF( P=0.3075). Conclusions:pGISTs usually occured in the head of pancreas, and the tumor volume was usually found to be large. The main treatment was radical operation, and the main mutation type was exon mutation of c-kit gene. Nuclear fission image figures >5/50HPF was an independent risk factor for postoperative recurrence.
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Primary liver cancer is one of the most common malignant tumors in the world, and hepatocellular carcinoma accounts for the majority of liver cancer. Hepatectomy is one of the most important treatment methods, but the high postoperative recurrence rate is the leading cause of treatment failure, which seriously reduces the long-term survival rate and reduces quality of life. Therefore, preventing the recurrence of liver cancer is an important part of treatment. At present, there is no standard program for the treatment of hepatocellular carcinoma to prevent recurrence after surgery, most of the treatment programs include transarterial chemoembolization, antiviral therapy, traditional Chinese medicine treatment, targeted therapy, immunity therapy, etc., which has certain clinical significance in preventing recurrence. This paper reviewed the research progress on preventing recurrence of hepatocellular carcinoma after surgery, which may provide guidance for the clinical study.
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Objective:To investigate the clinical impact factors of liver regeneration after hemihepatectomy in patients with hepatocellular carcinoma (HCC).Methods:Patients who underwent hemihepatectomy due to HCC from Sep 2013 to Sep 2018 were included in the study. Liver volumes were calculated by perioperative simulations to analyze the influencing factors of postoperative liver regeneration, and to compare the albumin bilirubin (ABLI) score and the end-stage liver disease (MELD) score at weeks 1, 5, 9, and 13 after operation.Results:A total of 163 patients were included, of which 13 developed postoperative liver failure. The median liver regeneration rates at 1, 5, 9 and 13 weeks after operation were 22.0%, 32.2%, 33.7% and 35.4%, respectively. Multivariate analysis showed that remnant liver volume (RLV) <611.1 cm 3, %RLV and liver cirrhosis were the influencing factors of liver regeneration. ALBI score and MELD score were lower in the low regeneration group compared to the high regeneration group in the first 5 weeks after operation. Conclusion:RLV and cirrhosis are influential factors in postoperative liver regeneration. Liver regeneration proceeded rapidly within 1 week and slowed down until week 5.
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ObjectiveTo investigate the safety and efficacy of re-hepatic resection (rHR) versus radiofrequency ablation (RFA) in the treatment of recurrent hepatocellular carcinoma (RHCC) in Asia through a meta-analysis. MethodsPubMed, CNKI, and Wanfang Data were searched for related studies published up to June 15, 2020. Two reviewers independently searched for the articles and extracted related data, and RevMan 5.4.1 was used to perform the meta-analysis. ResultsA total of 2 randomized controlled trials and 18 retrospective cohort studies met the inclusion criteria and involved 2903 patients with RHCC from Asian countries. The mortality rate in the perioperative period was 2% in the rHR group and 0 in the RFA group, and the incidence rate of perioperative complications was 22.4% in the rHR group and 3.3% in the RFA group. The 1-, 3-, and 5-year overall survival rates were 92.3%, 66.3%, and 51.1%, respectively, in the rHR group and 91.4%, 69.2%, and 39.9%, respectively, in the RFA group. The 1-, 3-, and 5-year disease-free survival rates were 67.9%, 48.3%, and 34.4%, respectively, in the rHR group and 57.5%, 27.9%, and 14.0%, respectively, in the RFA group. The Meta-analysis showed that there was no significant difference in overall survival rate between the two groups (hazard ratio ［HR］=089, 95% confidence interval ［CI］: 0.77-1.02, P=0.10), while the rHR group had a significantly higher disease-free survival rate than the RFA group (HR=0.79, 95% CI: 0.72-0.87, P＜0.001). ConclusionCurrent evidence shows that rHR may help to achieve a higher disease-free survival rate than RFA in the treatment of RHCC, while rHR and RFA have a similar overall survival rate.
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Objective:To study the impact of preoperative serum HBV DNA levels on prognosis of hepatocellular carcinoma (HCC) patients undergoing hepatectomy with curative intent.Methods:The clinical data of patients with HCC treated by hepatectomy with curative intent at the Guangxi Medical University Cancer Hospital from January 2010 to December 2016 were retrospectively analyzed. According to the preoperative serum HBV DNA levels, patients were divided into three groups: the control group (HBV DNA negative), the low load group (<10 4 copy/ml) and the high load group (≥10 4 copy/ml). The clinical data of these patients were collected and long-term survival outcomes of these patients were followed-up. The Kaplan-Meier method was used to compare the overall survival (OS) and recurrence-free survival (RFS) rates among the three groups. Using the Barcelona clinic liver cancer classification (BCLC), patients with different serum HBV DNA levels were further divided into three subgroups: stage 0/A, stage B and stage C. The OS and RFS rates of patients in each of these subgroups were compared. Results:Of 1 180 patients who were enrolled in the study, there were 1 024 males and 156 females, aged (48.6±10.8) years. The 1-, 3- and 5-year OS rates for patients in the control group ( n=258) were 91.5%, 79.3% and 74.9%, respectively; while those in the low load group ( n=289) were 87.2%, 68.6% and 61.6%, respectively; and those in the high load group ( n=633) were 85.4%, 68.9% and 60.7%, respectively. The 1-, 3- and 5-year OS rates in the control group were significantly better than those in the low load group and the high load group ( P<0.05). The 1-, 2- and 3-year RFS rates in the control group were significantly higher than those in the high load group ( P<0.05). Subgroup analysis showed that in the BCLC 0/A subgroup ( n=786) the 1-, 3- and 5-year OS rates in the control group were significantly better than those in the high load group ( P<0.05). In the BCLC B subgroup ( n=181), the 1-, 2- and 3-year RFS rates in the control group were significantly higher than those in the high load group ( P<0.05). In the BCLC C subgroup ( n=214), there were no significant differences in the 1-, 3- and 5-year OS and 1-, 2- and 3-year RFS rates among the three groups ( P>0.05). Conclusion:For HCC patients undergoing hepatectomy with curative intent, the higher the preoperative serum HBV-DNA level, the worse the long-term survival outcomes.
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Objective:To analyze the impact of gender on prognosis in patients with primary hepatocellular carcinoma (HCC) after hepatectomy.Methods:The data of 1 796 patients with HCC who underwent liver resection at the Guangxi Medical University Cancer Hospital from January 2010 to December 2016 were retrospectively analyzed. There were 1 548 males and 248 females, the average age were 49.6 years. Patients were followed up for recurrence and survival. After propensity score matching, the postoperative survival rates of male and female patients were compared. Univariate and multivariate Cox regression was used to analyze independent factors affecting prognosis of patients with HCC after hepatectomy. The age and menopause were analyzed by subgroup analyses.Results:The 1-, 3- and 5-years cumulative overall and recurrence-free survival rates of male patients were significantly lower than that of female patients (all P<0.05). Multivariate analysis showed that female was an independent protective factor affecting postoperative recurrence ( HR=0.777, 95% CI: 0.615-0.982) and overall survival ( HR=0.669, 95% CI: 0.520-0.856). Using a cut-off value of 50 years old, the patients were divided into <50 years old ( n=915) and ≥50 years old ( n=881). In patients who were less than 50 years old, the 1-, 3- and 5-years cumulative overall and recurrence-free survival rates of male patients were significantly lower than those of female patients (all P<0.05). In patients ≥50 years old, there were no significant difference in the cumulative overall and recurrence-free survival rates between male and female patients (all P>0.05). Female patients were then divided into the postmenopausal group ( n=152) and the premenopausal group ( n=96). There were no significant differences in the cumulative overall and cumulative recurrence-free survival rates between the two groups ( P>0.05). Conclusion:The prognosis of female patients with HCC after hepatectomy was significantly better than that of male patients.
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Objective To study the correlation between serum prealbumin level before liver resection and prognosis of patients with primary hepatocellular carcinoma (HCC).Methods The clinical data of patients with HCC who underwent liver resection at the Affiliated Tumor Hospital of Guangxi Medical University from August 2007 to October 2016 were retrospectively analyzed.The previous albumin of 200 mg/L and the pre-albumin as predicted by the maximum selection rank statistic method were used as the bounding group,and reduced groups and the correlation between pre-operative serum pre-albumin levels and clinicopathological characteristics were analyzed.The Kaplan-Meier method was used to calculate the overall survival rate of patients with the different cutoff levels.The Cox proportional regression model was used to analyze,and cirrhosis,alpha-fetoprotein levels and Barcelona Clinic Liver Cancer staging were used to adjust the relationship between serum prealbumin and prognosis of liver resection for HCC patients.Analysis of stratified variables was performed and their interactions with serum prealbumin were analyzed.Results Of the 2 022 patients included in this study,there were 1 739 males and 283 females.Their age was 49.5 ± 11.2 years.The median follow-up was 37.4 months.The optimal cutoff value of prealbumin predicted by the maximum selection rank statistic method was 166 mg/L.Regardless of the cutoff values of previous albumin 200 mg/L or prealbumin 166 mg/L,multivariate analysis showed that preoperative serum prealbumin level was an independent prognostic risk factor for patients (P ＜0.05).The prognosis of patients with ＞200 mg/L (＞ 166 mg/L) serum prealbumin before surgery was significantly better than that of patients with ≤200 mg/L (≤166 mg/L) prealbumin,the differences were significant (all P ＜ 0.05).After adjusting for confounding factors,the prealbumin level correlated with prognosis of patients with HCC [cutoff value 200 mg/L:HR (95％ CI) was 1.59 (1.35-1.86),cutoff value 166 mg/L:HR (95％ CI) was 1.69 (1.44-1.98),all P ＜ 0.05].The results of stratified analysis showed that the relationship between prealbumin levels and the prognosis of HCC patients became more robust.Conclusions Preoperative serum prealbumin was an independent risk factor for prognosis of HCC patients,and it had predictive value on prognosis of HCC patients.
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Objective To analyze the risk factors of postoperative recurrence and metastasis of of BCLC stage A (BCLC-A) hepatocellular carcinoma (HCC).Methods Data of 210 cases of liver resection for HCC were retrospectively analyzed from Nov 2013 to June 2016.Multivariate logistic regression analysis was used to analyze the risk factors for postoperative recurrence.The cumulative survival rates were calculated using the Kaplan-Meier method and the diffrences of the related factors between various groups were analyzed by Log-rank test.Results Univariate analysis showed that alpha-fetoprotein (AFP),neutrophil-lymphocyte ratio (NLR),hepatitis B virus surface antigen (HBsAg) positive and intraoperative transfusion were associated with early recurrence and metastasis after hepatectomy (P ＜ 0.05).Multivariate analysis showed that AFP ＞ 400 ng/ml is an independent risk factor for early postoperative recurrence and metastasis (P =0.008).HBV DNA positive can affect the disease-free survival rate after HCC resection (P =0.030).Conclusion AFP is an independent risk factor for early postoperative recurrence and metastasis.Preoperative HBV DNA positive significantly decreases the disease-free survival rate in HCC patients.
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Objective To establish and evaluate a novel and non-invasive diagnostic model using routine laboratory serological indexes in cirrhotic patients.Methods A retrospective study was conducted on 1044 consecutive patients with hepatocellular carcinoma (HCC) treated by hepatectomy in the Affiliated Tumor Hospital of Guangxi Medical University from September 2013 to December 2016.These patients were divided into a training cohort (n =783) and a validation cohort (n =261) using the 3 ∶ 1 matching principle.Logistic regression analysis was used to identify independent risk factors related to occurrence of cirrhosis in the training cohort,and then a PPH score was established.The accuracy of the model in predicting cirrhosis in two groups was evaluated respectively by the area under the receiver operating characteristic curve (AUC) and goodness of fit,and compared with the following commonly used predictive systems:the model for endstage liver disease (MELD) score,fibrosis index based on 4 factor score (FIB-4),Forns score and aspartate aminotransferase to platelet ratio index score (APRI).Results Univariate and multivariate Logistic regression analysis in the training cohort showed prothrombin time,platelet count and hepatitis B surface antigen positivity were closely related to occurrence of cirrhosis.The accuracy of the PPH score (AUC =0.705) in diagnosing cirrhosis in the training cohort was significantly better than the MELD score (AUC =0.557),APRI score (AUC =0.598),FIB-4 score (AUC =0.597) and Forns score (AUC =0.665).Similar results were obtained in the validation cohort (AUC:0.702 vs 0.554 vs 0.624 vs 0.634 vs 0.580).The goodness of fit indicated that there was no significant difference between the actual and predicted values of cirrhosis in the two cohorts,and the model was in good agreement.Conclusions A novel and non-invasive model for the diagnosis of cirrhosis was successfully established.The accuracy of this model in diagnosing cirrhosis was better than the MELD,APRI,Fib-4 and Forns scores.This model has significance in guiding clinical treatment decision in HCC patients with cirrhosis.
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Objective@#To compare the prognosis of radiofrequency ablation (RFA) for postoperative recurrent hepatocellular carcinoma and primary hepatocellular carcinoma(HCC).@*Methods@#The clinical data of 179 patients with recurrent HCC (recurrent group) and primary HCC (primary group) treated by RFA from 2009 to 2015 were retrospectively analyzed. Overall survival rate (OS) and disease-free survival rate (DFS) were analyzed by Kaplan-meier log-rank test. The prognostic factors of RFA for recurrent HCC were analyzed by COX proportional hazard regression.@*Results@#The 1, 3 and 5year′s OS of the recurrent group were 93%, 73%, 61%, respectively and 85%, 75%, 61% for the primary group(χ2=0.017, P=0.896). The corresponding 1, 3 and 5year′s DFS were 61%, 39%, 21% and 79%, 64%, 46% respectively (χ2=3.899, P=0.048). The independent risk factors affecting the OS of the recurrent group were the interval between hepatectomy to recurrence≤12 months (HR=0.264, 95% CI=0.077-0.901, P=0.033) and the Child-Pugh grading B before RFA (HR=4.501, 95% CI=1.426-14.208, P=0.01).@*Conclusions@#The DFS of patients with recurrent HCC were shorter than that with primary HCC treated by RFA. The interval between hepatectomy to recurrence and the Child-Pugh grading before RFA were independent risk factors for OS of the recurrent group.
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Objective@#To study the clinicopathological characteristics and prognosis of young patients with hepatocellular carcinoma (HCC).@*Methods@#The clinical data of 1091 HCC patients receiving hepatectomy at Cancer Hospital of Guangxi Medical University from Jan 2006 to Jan 2011 were retrospectively analyzed. Patients were divided into young group (237 cases) and middle and old aged group (854 cases) with the cut-off value of 40 years old. After the data among the correction groups were balanced by tendentious analysis, patients were paired in a 1: 1 ratio. The clinicopathological features and overall survival and recurrence rates after hepatectomy were compared between the two groups.@*Results@#Young patients had a higher rate of hepatitis B virus (HBV) infection, better liver function and a higher rate of vascular invasion. The overall survival and disease-free survival of young patients were shorter than those of middle-aged and elderly patients, but the difference was not statistically significant. The 1′, 3′ and 5′ year overall survival rates were 80%, 58%, 53%, and 87%, 66%, 55% (χ2=2.895, P=0.089) in the young group and the elderly group, respectively, and the recurrence rates were 53%, 80%, 88% and 47%, 71%, 85% (χ2=2.886, P=0.089). There was no significant difference in prognosis between the two groups by either subgroup analysis or propensity matching analysis (P>0.05).@*Conclusion@#Young HCC patients have characteristically clinicopathological features, and age is not a risk factor determining the prognosis of HCC patients.
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Objective@#To investigate the impact of perioperative allogeneic red blood cells transfusion on the early recurrence of patients with hepatocellular carcinoma (HCC) after liver resection.@*Methods@#Retrospective analysis was made on 999 patients who underwent surgical resection for HCC, and these patients were divided into two groups according to whether or not received perioperative allogeneic red blood cells transfusion. Differences between groups were balanced using propensity score matching (PSM). The Kaplan-Meier method was used for comparing the differences in early recurrence (within 2 years) between the two groups and the multivariate COX analysis regression was used to identify independent risk factors for early recurrence.@*Result@#There were 100 patients in red cell transfusion group and 899 patients in non-red cell transfusion group. After PSM, 85 pairs of patients were successfully matched, and there was no significant difference in baseline data between groups. Before PSM, the early recurrence rate of the red blood cell group was significantly higher than that of the non-red blood cell group (P<0.05). However, there was no significant difference in early recurrence rates between the two groups after PSM (P=0.346). Multivariate analysis showed that perioperative allogeneic red blood cells transfusion was not an independent risk factor of early recurrence for patients with HCC after liver resection (P=0.153).@*Conclusion@#Perioperative allogeneic red blood cells transfusion has no impact on the early recurrence of patients with HCC after liver resection.
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Objective@#To study the clinical application of three-dimensional (3D) visualization technology in liver resection of complicated liver cancer.@*Methods@#A retrospective analysis of 28 patients with complicated liver cancer treated from June 2017 to June 2018 in the Department of Hepatobiliary Surgery, the Affiliated Tumor Hospital of Guangxi Medical University. There were 26 males and 2 females, aged (46±10) years old. A treatment plan on how to perform liver resection for these patients was developed under the guidance of 3D visualization technology. The actual surgical procedures, operation time, intraoperative blood loss, and postoperative complications were documented. The virtual resected liver volume was compared with the actual resected liver volume. The virtual surgical resection margin was also compared with the actual surgical resection margin.@*Results@#All the 28 patients with complicated liver cancer completed the 3D visualization analysis with the location, shape and quantity of tumor being clearly shown. Of the 27 patients who underwent liver resection, 13 underwent anatomical hepatectomy, and 14 underwent non-anatomical hepatectomy. The operation time ranged from 145 to 350 min (median 240 min). The intraoperative blood loss ranged from 100 to 1 500 ml (median 300 ml). The incisional wound healed slowly in 4 patients, pleural effusion developed in 8 patients, and ascites in 2 patients. There were no significant differences in the virtual resected liver volume compared with the actual resected liver volume (P>0.05). There was an excellent positive correlation between the patient's virtual resected liver volume and the actual resected liver volume (r=0.986, P<0.05). There was no significant difference between the virtual surgical resection margin and the actual surgical resection margin (P>0.05). There was an excellent positive correlation between virtual surgical resection margin and the actual surgical resection margin (r=0.983, P<0.05).@*Conclusion@#Three-dimensional visualization technology accurately assessed the liver status, optimized surgical procedures, and played an important role in liver resection of complex liver cancer.
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Objective To study the clinical application of three-dimensional (3D) visualization technology in liver resection of complicated liver cancer.Methods A retrospective analysis of 28 patients with complicated liver cancer treated from June 2017 to June 2018 in the Department of Hepatobiliary Surgery,the Affiliated Tumor Hospital of Guangxi Medical University.There were 26 males and 2 females,aged (46± 10) years old.A treatment plan on how to perform liver resection for these patients was developed under the guidance of 3D visualization technology.The actual surgical procedures,operation time,intraoperative blood loss,and postoperative complications were documented.The virtual resected liver volume was compared with the actual resected liver volume.The virtual surgical resection margin was also compared with the actual surgical resection margin.Results All the 28 patients with complicated liver cancer completed the 3D visualization analysis with the location,shape and quantity of tumor being clearly shown.Of the 27patients who underwent liver resection,13 underwent anatomical hepatectomy,and 14 underwent nonanatomical hepatectomy.The operation time ranged from 145 to 350 min (median 240 min).The intraoperative blood loss ranged from 100 to 1 500 ml (median 300 ml).The incisional wound healed slowly in 4 patients,pleural effusion developed in 8 patients,and ascites in 2 patients.There were no significant differences in the virtual resected liver volume compared with the actual resected liver volume (P ＞ 0.05).There was an excellent positive correlation between the patient's virtual resected liver volume and the actual resected liver volume (r =0.986,P ＜ 0.05).There was no significant difference between the virtual surgical resection margin and the actual surgical resection margin (P ＞ 0.05).There was an excellent positive correlation between virtual surgical resection margin and the actual surgical resection margin (r =0.983,P ＜ 0.05).Conclusion Three-dimensional visualization technology accurately assessed the liver status,optimized surgical procedures,and played an important role in liver resection of complex liver cancer.
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Objective To compare the prognosis of radiofrequency ablation (RFA) for postoperative recurrent hepatocellular carcinoma and primary hepatocellular carcinoma(HCC).Methods The clinical data of 179 patients with recurrent HCC (recurrent group) and primary HCC (primary group) treated by RFA from 2009 to 2015 were retrospectively analyzed.Overall survival rate (OS) and disease-free survival rate (DFS) were analyzed by Kaplan-meier log-rank test.The prognostic factors of RFA for recurrent HCC were analyzed by COX proportional hazard regression.Results The 1,3 and 5year's OS of the recurrent group were 93％,73％,61％,respectively and 85％,75％,61％ for the primary group(x2 =0.017,P =0.896).The corresponding 1,3 and 5year's DFS were 61％,39％,21％ and 79％,64％,46％ respectively (x2 =3.899,P =0.048).The independent risk factors affecting the OS of the recurrent group were the interval between hepatectomy to recurrence ≤ 12 months (HR =0.264,95％ CI =0.077-0.901,P =0.033) and the Child-Pugh grading B before RFA (HR =4.501,95％ CI =1.426-14.208,P =0.01).Conclusions The DFS of patients with recurrent HCC were shorter than that with primary HCC treated by RFA.The interval between hepatectomy to recurrence and the Child-Pugh grading before RFA were independent risk factors for OS of the recurrent group.
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Objective To study the clinicopathological characteristics and prognosis of young patients with hepatocellular carcinoma (HCC).Methods The clinical data of 1091 HCC patients receiving hepatectomy at Cancer Hospital of Guangxi Medical University from Jan 2006 to Jan 2011 were retrospectively analyzed.Patients were divided into young group (237 cases) and middle and old aged group (854 cases) with the cut-off value of 40 years old.After the data among the correction groups were balanced by tendentious analysis,patients were paired in a 1:1 ratio.The clinicopathological features and overall survival and recurrence rates after hepatectomy were compared between the two groups.Results Young patients had a higher rate of hepatitis B virus (HBV) infection,better liver function and a higher rate of vascular invasion.The overall survival and disease-free survival of young patients were shorter than those of middle-aged and elderly patients,but the difference was not statistically significant.The 1',3'and 5'year overall survival rates were 80％,58％,53％,and 87％,66％,55％ (x2 =2.895,P =0.089) in the young group and the elderly group,respectively,and the recurrence rates were 53％,80％,88％ and 47％,71％,85％ (x2 =2.886,P--0.089).There was no significant difference in prognosis between the two groups by either subgroup analysis or propensity matching analysis (P ＞ 0.05).Condusion Young HCC patients have characteristically clinicopathological features,and age is not a risk factor determining the prognosis of HCC patients.
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Objective To investigate the impact of perioperative allogeneic red blood cells transfusion on the early recurrence of patients with hepatocellular carcinoma (HCC) after liver resection.Methods Retrospective analysis was made on 999 patients who underwent surgical resection for HCC,and these patients were divided into two groups according to whether or not received perioperative allogeneic red blood cells transfusion.Differences between groups were balanced using propensity score matching (PSM).The Kaplan-Meier method was used for comparing the differences in early recurrence (within 2 years) between the two groups and the multivariate COX analysis regression was used to identify independent risk factors for early recurrence.Result There were 100 patients in red cell transfusion group and 899 patients in non-red cell transfusion group.After PSM,85 pairs of patients were successfully matched,and there was no significant difference in baseline data between groups.Before PSM,the early recurrence rate of the red blood cell group was significantly higher than that of the non-red blood cell group (P ＜ 0.05).However,there was no significant difference in early recurrence rates between the two groups after PSM (P =0.346).Multivariate analysis showed that perioperative allogeneic red blood cells transfusion was not an independent risk factor of early recurrence for patients with HCC after liver resection (P =0.153).Conclusion Perioperative allogeneic red blood cells transfusion has no impact on the early recurrence of patients with HCC after liver resection.
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Objective To evaluate ultrasound assisted virtual MRI guided radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) adjacent to gastrointestinal tract with artificial ascites.Methods A total of 33 HCC lesions in 32 patients adjacent to gastrointestinal tract in our hospital were collected.After the establishment of artificial ascites,they were treated with radiofrequency ablation guided by ultrasound-guiding fusion and virtual MRI navigation.The curative effect and complication rate were compared with the control group (non-hollow GI tract abutting HCC lesions).Results All 33 lesions were completely ablated without residual.After 1 month and 3 months follow-up,the reexamination of contrast-enhanced ultrasound and MRI showed no activity and no new lesions.All cases had no serious complications such as gastrointestinal injury.There were no statistically significant differences in tumor complete inactivation rate,complication rate and recurrence rate between the two groups.Conclusion Ultrasound-guiding fusion and virtual MRI guided radiofrequency ablation with artificial ascites is safe and effective in the treatment of liver cancer adjacent to gastrointestinal tract.
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Objective To establish a preoperative nomogram model in predicting microvascular invasion (MVI) and to test its predictive effectiveness in hepatocellular carcinoma (HCC).Methods This retrospective study was conducted on 798 patients with HCC,including 690 males and 108 females,aged (49.8± 10.9) years old who underwent curative hepatectomy in the Guangxi Medical University Affiliated Tumor Hospital between January 2014 and December 2017 were retrospectively analyzed.The patients were divided into the model group (n=579) and the validation group (n=219) according to the periods of the operation time.Independent risk factors of MVI were identified by univariate and multivariate logistic regression analysis in the model group,and a nomogram model was established according to the independent risk factors.The accuracy of the nomogram model in predicting MVI was detected in the two groups by the computer consistency coefficient (C-index) and calibration graph method.The predictive value was evaluated by receiver operating characteristic curve.Results Histopathological diagnosis revealed 278 patients with MVI and no MVI in the 301 patients of HCC out of the 579 patients in the model group.In the validation group,there were 119 patients with MVI and 100 patients with no MVI out of the 219 patients.Total bilirubin ＞15 μmol/L(OR=1.519,95％ CI:1.041 ～ 2.217),alkaline phosphatase ＞60 U/L(OR =1.681,95％CI:1.059～2.670),alpha-fetoprotein ＞200 ng/L (OR=2.192,95％CI:1.531 ～3.134) and tumor maximum diameter (OR =1.120,95％CI:1.057 ～ 1.187) were the independent risk factors of MVI on multivariate analysis.After establishment of the nomogram model using the independent risk factors,the C-indexes were 0.680 and 0.773 respectively in the model group and the validation group.In the calibration graph,the standard curve properly fitted with the predicting calibration curve.The predicted value of MVI obtained was in good agreement with the observed value.The ROC curve analysis nomogram model predicted the low performance of MVI.Conclusion The nomogram model in predicting MVI in patients with HCC was successfully established.The model offered certain guiding significance in the clinical treatment of HCC.
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Objective The objective of this study was to investigate the effect of depression on serum levels of C-reactive protein(CRP)and high-sensitivity C-reactive protein(hs-CRP),and prognosis in liver cancer patients. Methods A total of 251 patients with liver cancer undergoing hepatectomy were enrolled. The hospital anxiety and depression scale( HADS-D) and 9-item patients health questionnaire(PHQ9) were assessed for depression before 3 days for surgery. Patients were divided into depression group(n=95)and non-depression group(n=156) according to the scores. Preoperative serum levels of CRP,hs-CRP,ALT and AST were measured and compared between the depression and non-depression groups. Survival analysis Kaplan-Meier method was used to compare the disease-free survival(DFS)and total survival(OS)between the two groups. Results The serum levels of CRP, hs-CRP,ALT and AST in the depression group were significantly higher than those in the non-depression group(P<0. 05). The follow-up of 3. 5-year showed that 164 patients(65 in depression group and 99 in non-depression group)had recurrence or metas-tasis and 47 patients(22 in depression group and 25 in non-depression group) died. The DFS and OS in the depression group were significantly lower than those in the non-depression group(P< 0. 05). Cox multiple regression analysis showed that liver function grading,BCLC staging and depression were independent risk factors for the prognosis of liver cancer. Spearman correlation analysis showed that patients′degree of depression was positively correlated with serum levels of CRP and hs-CRP(P<0. 05),DFS and OS were negatively correlated with serum levels of CRP and hs-CRP(P<0. 05). Conclusion Depression may mediate elevated serum levels of CRP and hs-CRP,maintain inflammatory response in patients,lead to increased liver function damage,elevate levels of ALT and AST,and thus adversely affect the prognosis of patients with liver cancer.