ABSTRACT
Objective To develop a new model for predicting recurrence after liver transplantation for hepatocellular carcinoma (HCC) beyond Milan criteria based on related preoperative and postoperative indicators. Methods A retrospective analysis was performed for the clinical data of the patients with HCC beyond Milan criteria who underwent orthotopic liver transplantation for the first time in Tianjin First Central Hospital from August 2014 to July 2018, and according to the presence or absence of recurrence during follow-up, the patients were divided into recurrence group and no-recurrence group. The t -test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison of survival curves. Univariate and multivariate Cox proportional hazards regression analyses were used to identify the risk factors for recurrence-free survival after surgery. A new model was developed for recurrence after liver transplantation in the patients with HCC beyond Milan criteria based on the risk factors identified. The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive performance, and the Hosmer-Lemeshow test was used to assess the goodness of fit of the model. Results A total of 117 patients with HCC beyond Milan criteria were enrolled in this study, with a median follow-up time of 24 (1-74) months. A total of 53 patients (45.3%) experienced recurrence after surgery, among whom 52 (98.1%) had recurrence within 3 years after surgery, with a median time to recurrence of 6 (1-52) months. The Cox proportional hazards regression analysis showed that preoperative serum alpha-fetoprotein (AFP) >769 ng/mL, neutrophil-lymphocyte ratio (NLR) >3.75, and ki67 index >0.25 were independent risk factors for recurrence-free survival after liver transplantation. The model established based on these three risk factors had an AUC of 0.843, with good sensitivity (88.7%) and specificity (70.3%). The optimal cut-off value was selected according to the maximization of Youden index, and then the patients were divided into low-risk group (0-1 point) and high-risk group (1.5-4 points). The log-rank test showed that the low-risk group had significantly higher 3-and 5-year recurrence-free survival rates than the high-risk group (84.1%/72.0% vs 10.9%/10.9%, χ 2 =29.425, P < 0.001). Conclusion Liver transplantation for HCC beyond Milan criteria should be performed with caution, and the predictive model established based on preoperative AFP, NLR, and ki67 index can accurately assess the indication for liver transplantation in such patients.
ABSTRACT
Purpose To evaluate the left ventricular systolic and diastolic function in patients with pulmonary hypertension (PH) using three-dimensional speckle tracking imaging (3D-STI) combined with two-dimensional ultrasound (2D ultrasound),and to investigate the effects of different-degree PH on left ventricular function.Materials and Methods Fifty-two patients who were diagnosed as PHin the First Hospital of Jilin University from September 2011 to November 2015 were retrospectively analyzed,and based on pulmonary artery systolic pressure (PASP),they were assigned into mild group (PASP 36-49 mmHg,n=20),moderate group (PASP 50-70 mmHg,n=18) and severe group (PASP＞70 mmHg,n=14).Besides,healthy volunteers were selected as control group (n=30).All the subjects accepted 2D and 3D imaging,their left ventricular diastolic diameter (LVDd),left ventricular ejection fraction (LVEF),left atrial maximum volume index (LAVI),PASP,e',E/e',etc.,were obtained by 2D ultrasound,and their left ventricular global longitudinal strain (GLS),left ventricular global radial strain (GRS),left ventricular global circumferential strain (GCS),left ventricular global area strain (GAS),etc.,were obtained by 3D-STI.The data of different groups were compared,and the correlation between PASP with left ventricular systolic and diastolic function was analyzed.Results E/e'and LAVI in moderate group and severe group were significantly higher than those in control group,and the differences were statistically significant (P＜0.05);the absolute values of GLS and GAS in moderate group were lower than those in control group (P＜0.05);the absolute values of GLS,GRS,GCS and GAS in severe group were all lower than those in control group,and the differences were statistically significant (P＜0.05).The correlation analysis showed that among 2D parameters,the correlation between LAVI and PASP was better (r=0.56,P＜0.01);among 3D strain values,the correlation between GLS absolute value and PASP was better (r=0.60,P＜0.01).Conclusion 3D-STI combined with 2D ultrasound can effectively assess the left ventricular systolic and diastolic dysfunction in patients with PH,which provides theoretical support for early clinical intervention.