Construction and validation of a nomogram prediction model for early recurrence of patients undergoing radical pancreaticoduodenectomy for pancreatic ductal adenocarcinoma / 中华肝胆外科杂志

Objective:To study the risk factors for early recurrence of patients undergoing radical pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) and construct a normogram model.Methods:Patients undergoing open radical PD for PDAC at Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital from January 2014 to December 2021 were retrospectively screened. A total of 213 patients were enrolled, including 145 males and 68 females, aged (58.4±9.8) years. Patients were divided into the early recurrence group ( n=59, recurrence within 6 months after surgery) and a control group ( n=154, no recurrence within 6 months after surgery). Using minimum absolute value convergence and selection operator regression (LASSO) and multi-factor logistic regression analysis, we screened out the best predictor of early recurrence after PD for PDAC, and then established a nomogram model. The effectiveness of the model was validated by receiver operating characteristic (ROC) curve, calibration curves, and decision analysis curves. Results:Multivariate logistic regression analysis showed that patients with obstructive jaundice, vascular invasion, massive intraoperative bleeding, high-risk tumors (poorly differentiated or undifferentiated), high carbohydrate antigen 19-9 to total bilirubin ratio, and high fibrinogen and neutrophil to lymphocyte ratio scores had a higher risk of early postoperative recurrence. Based on the indexes above, a nomogram prediction model was constructed. The area under the ROC curve was 0.797 (95% CI: 0.726-0.854). Validation of the calibration curve exhibited good concordance between the predicted probability and ideal probability, decision curve analysis showed that the net benefits of the groupings established according to the model were all greater than 0 within the high risk threshold of 0.08 to 1.00. Conclusion:The nomogram for predicting early recurrence after PD for PDAC has a good efficiency, which could be helpful to screen out the high-risk patients for adjuvant or neoadjuvant therapy.

Value of the imaging features of extrapancreatic nerve plexus in predicting the early postoperative recurrence of ductal adenocarcinoma of pancreatic head / 中华肝胆外科杂志

Objective:To study the value of imaging features of extrapancreatic nerve plexus in predicting early postoperative recurrence of ductal adenocarcinoma of pancreatic head.Methods:The clinical, imaging and pathological data of patients with ductal adenocarcinoma of pancreatic head undergoing pancreati-coduodenectomy at the Hepatobiliary Pancreatic Center of Beijing Tsinghua Changgung Hospital, Tsinghua University from January 2014 to April 2022 were retrospectively analyzed. A total of 73 patients were included, including 51 males and 22 females, aged (66.1±9.0) years old. The patients were followed up by telephone or outpatient review, who were divided into two groups according to the recurrence within 6 months after surgery: the recurrence group ( n=26) and the non-recurrence group ( n=47). Streaks or soft-tissue densities in the distribution area of extrapancreatic nerve plexus, difference in CT values between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus, maximum tumor diameter, and regional lymph node enlargement were compared between the two groups. Results:The incidences of streaks or soft-tissue densities showing in the distribution area of extrapancreatic nerve plexus were 80.8%(21/26) in the recurrence group and 51.1%(24/47) in the non-recurrence group, respectively. A CT value difference ≥15 HU between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus occurred in 50.0%(13/26) patients of the recurrence group and 25.5%(27/47) of the non-recurrence group, respectively. Maximum tumor diameter ≥25 mm were found in 80.8% (21/26) patients of the recurrence group and 57.4% (27/47) of the non-recurrence group, respectively. ≥3 reginal lymph node enlargement showed in 65.4% (17/26) patients of the recurrence group and 31.9% (15/47) of the non-recurrence group, respectively (all P<0.05). The risk of early postoperative recurrence increased in patients with a CT value difference ≥15 HU between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus ( OR=3.609, 95% CI: 1.099-11.855), and regional lymph node enlargement ≥ 3 ( OR=4.665, 95% CI: 1.400-15.545) (all P<0.05). And these two independent risk factors were combined to predict early postoperative recurrence of ductal adenocarcinoma of pancreatic head with an area under receiver operating characteristic curve of 0.748, sensitivity of 92.3%, and specificity of 48.9% ( P<0.001). Conclusion:≥ 15 HU CT value difference between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus and ≥ 3 regional lymph node enlargement are independent risk factors for the early postoperative recurrence of pancreatic head ductal adenocarcinoma, which could provide more predictive information preoperatively.

Predictive value of preoperative abdominal adipose tissue measurement for early recurrence after resection of hepatocellular carcinoma / 中华消化外科杂志

Objective:To investigate the predictive value of preoperative abdominal adipose tissue measurement for early recurrence after resection of hepatocellular carcinoma (HCC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 238 patients with HCC who underwent surgical resection from January 2018 to January 2020 in 2 medical centers in China were collected, including 46 cases in the First Affiliated Hospital of Chongqing Medical University and 192 cases in the First Affiliated Hospital of Army Medical University. There were 207 males and 31 females, aged 51(48,65)years. All patients underwent abdominal computed tomography (CT) and/or magnetic resonance imaging (MRI) before surgery. Observation indicators: (1) measure-ment of abdominal adipose tissue; (2) follow-up; (3) analysis of influencing factors for early recurrence after resection of HCC; (4) prediction of early recurrence after resection of HCC. Follow-up was conducted by outpatient examinations and telephone interview to detect the postoperative survival of patients up to February 2022. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was performed by the t test. Measurement data with skewed distribution was represented by M(range) or M( Q1, Q3), and comparison between groups was performed by the Mann-Whitney U test. Count data were expressed as absolute numbers or percen-tages, and the chi-square test was used for comparison between groups. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was performed using the Logistic regression model advance method. The receiver operating characteristic curve was drawn, and the area under curve was used to evaluate the efficacy. Results:(1) Measure-ment of abdominal adipose tissue. Of the 238 patients, the total abdominal adipose tissue, visceral adipose tissue, subcutaneous adipose tissue, total adipose tissue index, visceral adipose tissue index, subcutaneous adipose tissue index were 292(198,355)cm 2, 153(99,194)cm 2, 128(95,154)cm 2, 106(76,130)cm 2/m 2, (57±27)cm 2/m 2, 46(34,58)cm 2/m 2 for 139 patients with early postoperative recur-rence, versus 174(114,251)cm 2, 78(50,110)cm 2, 88(55,127)cm 2, 64(42,91)cm 2/m 2, (30±16)cm 2/m 2, 31(19,46) cm 2/m 2 for 99 patients without early recurrence, respectively, showing significant diffe-rences between them ( Z=?7.39, ?7.87, ?5.03, ?7.25, t=?9.46, Z=?5.00, P<0.05). (2) Follow-up. All the 238 patients were followed up according to the plan. The survival time of 238 patients was 26(8,44)months. The survival time was 11(5,18)months for patients with postoperative early recur-rence, versus 36(32,43)months for patients without early recurrence, respectively. (3) Analysis of influencing factors for early recurrence after resection of HCC. Results of univariate analysis showed that body mass index, total adipose tissue, visceral adipose tissue, subcutaneous adipose tissue, total adipose tissue index, visceral adipose tissue index and subcutaneous adipose tissue index were related factors for early recurrence after resection of HCC ( t=?5.88, Z=?7.39, ?7.87, ?5.03, ?7.25, t=?9.46, Z=?5.00, P<0.05). Results of multivariate analysis showed that visceral adipose tissue index was an independent influencing factor for early recurrence after resection of HCC ( odds ratio=1.06, 95% confidence interval as 1.04?1.08, P<0.05). (4) Prediction of early recurrence after resection of HCC. According to the results of multivariate analysis, the receiver operating characteris-tic curve showed that the area under curve of visceral adipose tissue index was 0.80 (95% confidence interval as 0.75?0.86, P<0.05), with the sensitivity and specificity as 75.5% and 71.7%. Conclusions:Visceral adipose tissue index is an independent influencing factor for early recurrence after resection of HCC. The risk of early recurrence increases with the increase of visceral adipose tissue index.

Analysis of risk factors and prediction model establishment for early postoperative recurrence in glioma patients / 国际肿瘤学杂志

Objective:To investigate the related factors of early postoperative recurrence of glioma patients and to establish a prediction model for early recurrence.Methods:A total of 94 patients with pathologically diagnosed glioma treated at Affiliated Hospital of Xuzhou Medical University from August 2014 to July 2016 were retrospectively analyzed. Kaplan-Meier method was used for survival analysis and log-rank test was carried out. Cox proportional risk regression model was used to analyze the clinical factors influencing early postoperative recurrence of glioma patients, and the prediction model of early recurrence was established.Results:The recurrence rates were 26.6% (25/94) and 39.4% (37/94) at 12 months and 24 months after operation, respectively. Univariate analysis showed that age ( χ2=9.59, P=0.008), degree of tumor resection ( χ2=14.26, P<0.001), Karnofsky performance status (KPS) score ( χ2=19.41, P<0.001), radiochemotherapy ( χ2=5.10, P=0.024) and pathological grade ( χ2=5.83, P=0.016) were significantly associated with early postoperative recurrence in glioma patients. Multivariate Cox proportional hazards regression model analysis showed that pathological grade ( OR=2.64, 95% CI: 1.75-3.97, P<0.001), degree of resection ( OR=0.34, 95% CI: 0.19-0.62, P<0.001) and radiochemotherapy ( OR=2.58, 95% CI: 1.34-4.99, P=0.005) were independent factors influencing early postoperative recurrence in glioma patients. The risk function model expression of early recurrence in glioma patients was h(t)=h 0exp(0.970X 1-1.081X 2+ 0.949X 3). X 1, X 2 and X 3 represented pathological grade, resection degree and radiochemotherapy respectively. Conclusion:High grade pathology and the absence of radiochemotherapy are independent predictors of early recurrence in glioma patients, and complete tumor resection can reduce the risk of early recurrence and improve the prognosis. The model of early recurrence prediction can provide some reference for clinical diagnosis and treatment.

A prediction model based on contrast-enhanced MRI radiomics and clinical features for early recurrence of hepatocellular carcinoma after radical resection / 中华肝胆外科杂志

Objective:To develop a prediction model based on imaging features by contrast-enhanced MRI radiomics combined with clinical features for early recurrence of hepatocellular carcinoma (HCC) after radical resection.Methods:A retrospective study was carried out on 109 HCC patients who underwent radical resection at the Fifth Affiliated Hospital of Wenzhou Medical University from January 2015 to December 2020. Of 109 patients enrolled in this study, there were 96 males and 13 females, aged (58.3±10.7) years. Based on whether there was recurrence within 12 months after operation, the patients were divided into the early recurrence group ( n=31) and the control group ( n=78). These 109 patients were then randomly divided into the validation set ( n=23) and the training set ( n=86) at a ratio of 1∶4. Based on preoperative multi-phase contrast-enhanced MRI scanning, the tumor lesions were delineated on the Radcloud platform, and 1 409 quantitative radiomic features were extracted. Dimension reduction and screening of these features were carried out using variance threshold, SelectKBest and LASSO. Combined with clinical features (alpha fetoprotein, tumor size), several prediction model were established through machine learning. The predictive efficiencies of these models were evaluated using the area under the receiver operating characteristic (ROC) curve, accuracy rate, recall rate and balanced F score. Results:The proportions of irregular tumor shape and unclear tumor boundary, as well as maximum tumor diameter in the early recurrence group were significantly higher than that in the control group, but the proportion of pseudocapsule was significantly lower than that in the control group (all P<0.05). A total of 465 features were screened from the 1 409 features using the variance threshold method, followed by 38 features were screened using the method of SelectKBest. Finally 7 optimal radiomic features were screened based on the LASSO method. When combined with clinical features, 5 prediction models were established through machine learning. These models were support vector machine, Gaussian naive bayes, logistic regression, Multinomial naive bayes and K-nearest neighbor (KNN), respectively. Among these 5 models, the prediction efficiency of the KNN model was relatively highest, with the area under the ROC curve, accuracy rate, recall rate and balanced F score being 0.90, 0.98, 0.74 and 0.84 in the training set, and 0.76, 0.92, 0.75 and 0.83 in the verification set, respectively. Thus, the KNN model was selected as the best prediction model in this study. Conclusion:The prediction model of KNN was developed for early recurrence of HCC after radical resection based on preoperative contrast-enhanced MRI radiomics combined with clinical features.

A novel model in predicting very early recurrence after surgical resection of hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the risk factors of very early recurrence (VER, within 3 months) after R 0 resection of hepatocellular carcinoma (HCC), and to establish a predictive model. Methods:Of 427 HCC patients [with 368 males, 59 females, aged (52.7±12.1) years] who developed early recurrence (within 2 years) after R 0 resection from January to December 2008 at Zhongshan Hospital, Fudan University were enrolled in the test cohort. Another 590 patients [with 525 males, 65 females, aged (54.7±11.0) years] who underwent R 0 resection from January to June 2009 were enrolled in the validation cohort. Risk factors were investigated and a predictive model was established. Results:In the test cohort, 126 patients (29.5%) developed VER and their survival outcomes were extremely poor. Serum α-fetoprotein (AFP) level >827 μg/L, multiple tumors, microvascular invasion (MVI) and tumor number were independent risk factors for VER. A new predictive model (0.809·AFP+ 1.262·tumor number+ 0.983·MVI) was established by logistic regression in predicting VER after surgery. The receiver operating characteristic curve showed that the area under the curve (AUC) in predicting VER was 0.722 (95% CI: 0.669-0.774, P<0.001). In the validation cohort, the AUC of this model was 0.785 (95% CI: 0.715-0.855, P<0.001). Conclusions:A high AFP level, multiple tumors, and MVI were independent risk factors for VER of HCC after R 0 resection. The prediction model consisting of these three factors demonstrated robustness and it has the potential in clinical application.

Research Progress of Early Recurrence and Cut-off Time of Hepatocellular Carcinoma after Radical Hepatectomy / 肿瘤防治研究

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. Surgery is the most important way to treat HCC currently. The high recurrence rate after hepatectomy is the most important reason to affect its prognosis, and it is also the key clinical problem to be solved. According to the recurrence time, the recurrence can be divided into early recurrence and late recurrence. The prognosis of patients with early recurrence is worse than that of patients with late recurrence. Therefore, it is very important for surgical decision-making to identify the two kinds of recurrence. This article reviews the research progress of early recurrence cut-off time of hepatocellular carcinoma after radical hepatectomy.

Value of preoperative magnetic resonance imaging features in predicting early recurrence of hepatocellular carcinoma after surgical resection / 中国肿瘤临床

Objective: To assess the value of preoperative clinical data and magnetic resonance (MR) imaging features in predicting early recurrence (recurrence in two years) after surgical resection of hepatocellular carcinoma (HCC). Methods: This retrospective study included 244 patients with HCC who underwent a surgical resection between January 2015 and January 2018 at Tianjin Medical University Cancer Institute and Hospital. The role of preoperative clinical data and MR imaging features on early recurrence after surgical tumor resection were evaluated using univariate and multivariate analyses. All patients were followed up regularly after discharge. The endpoint was considered to be intrahepatic recurrence within 2 years. Results: In the univariate analyses, the maximum diameter of the tumor, tumor capsule, peritumoral parenchyma enhancement, rim enhancement, two-trait predictor of venous invasion (TTPVI), tumor necrosis, satellite nodules, dynamic enhancement pattern, diffusion-weighted imaging (DWI) /T2WI mismatch and other MR imaging features, as well as alpha-fetoprotein (AFP), TNM stage, alanine aminotransferase (ALT), glutamatergic aminotransferase (AST), direct bilirubin (DBIL), γ-glutamyl transferase (γ-GT) and other clinical data were correlated with the early recurrence of HCC. In the multivariate Cox regression analysis, the tumor capsule (HR=0.372, P400 μg/L (HR=2.234, P400 μg/L were found to be independent factors of the early postoperative recurrence of HCC. This research has established a predictive model for the early recurrence of HCC after surgical resection using a non-invasive method, which can help clinicians to develop individualized treatment protocols and improve patient outcomes.

Correlation between preoperative serum alpha-fetoprotein (AFP) level and early recurrence of patients with hepatocellular carcinoma after partial hepatectomy / 中华肝胆外科杂志

Objective To study the relationship between preoperative serum a-fetoprotein (AFP) level and early recurrence of patients with hepatocellular carcinoma (HCC) after partial hepatectomy.Methods 267 patients with hepatocellular carcinoma who underwent partial hepatectomy in Xijing Hospital,the Fourth Military Medical University from January 2011 to November 2015 were retrospectively studied.The patients were divided into the AFP-negative group (AFP ≤20 μg/L) and the AFP-positive group (AFP ＞ 20 μg/L) according to the preoperative serum AFP levels.The risk factors of early recurrence of HCC in patients after partial hepatectomy were studied by multivariate regression analysis.The recurrence-free survival rates during 24 months after surgery between the AFP-negative group and the AFP-positive group were compared.Results In 267 patients,97 patients had low or negative AFP levels (AFP≤20 μg/L) and 170 patients had high or positive AFP levels (AFP ＞ 20 μg/L).Patients in the AFP-positive group had significantly more well differentiated HCC on tumor histology when compared with patients in the AFP-negative group (x2 =17.050,P ＜ 0.05).The proportion of patients with liver cirrhosis in the AFP-positive group was significantly higher than that of the AFP-negative group (x2 =4.374,P ＜ 0.05).On the other hand,the numbers of patients with adjacent tissue invasion (x2 =4.374,P ＜ 0.05) and early HCC recurrence (x2 =7.595,P ＜ 0.05) in the AFP-positive group were significantly less than those of the AFP-negative group.Survival analysis showed that the recurrence-free survival rates in the AFP-positive and negative groups were 35.3％,52.6％,respectively.The results on univariate analysis showed that portal vein tumor thrombus,HBsAg positivity,tumor number,tumor diameter,tumor tissue differentiation,preoperative serum AFP level and adjacent tissue invasion were significantly associated with early recurrence of liver cancer (P ＜ 0.05).Cox multivariate regression analysis revealed that serum AFP positivity (HR =1.605,P ＜ 0.05),portal vein tumor thrombosis (HR =3.936,P ＜ 0.05),HBsAg positivity (HR =1.621,P ＜0.05),tumor diameter (HR =1.977,P ＜ 0.05) and tumor number (HR =1.991,P ＜ 0.05) were significantly correlated with early recurrence of liver cancer after partial hepatectomy.Conclusion The preoperative serum AFP level had an important predictive value for early recurrence of primary hepatocellular carcinoma in patients after partial hepatectomy.

The impact of anatomical resection for hepatocellular carcinoma with microvascular invasion on early tumor recurrence / 中华肝胆外科杂志

Objective To study the impact of anatomical resection (AR) for hepatocellular carcinoma with microvascular invasion on early tumor recurrence.Methods 178 consecutive patients with solitary hepatocellular carcinoma who underwent liver resection at the Affiliated Tumor Hospital of Guangxi Medical University from January 2012 to December 2015 were retrospectively studied.These patients were divided into four groups according the types of resection (anatomical resection AR or non-anatomical resection NAR) and the surgical margins (narrow or wide margin).All the patients were followed up until the tumor recurred or two years after surgery.The recurrence-free survival and the types of recurrence for the 4 different groups were compared.Results The 6 months,1-,2-year disease-free survival rates in the AR (n =55) and NAR groups (n =123) were 87.0％,79.2％,74.5％ and 78.5％,61.3％,45.7 ％,respectively,(P ＜ 0.05).Through pair-wise comparisons of the four groups,there were no significant differences in early recurrence between the narrow surgical margin group and the wide surgical margin group,regardless of the types of surgery.The early recurrence rates of the AR groups were significantly lower than that of the NAR groups,regardless of the widths of the surgical margins.Multivariate analysis showed that AR was a protective factor of early recurrence (HR =0.417,95％ CI 0.229 ～ 0.761).Further analysis of the recurrence patterns of AR and NAR showed that the recurrence types were mainly sohtary for AR (solitary,61.5％;multiple 30.8％) and multiple recurrence for NAR (solitary,32.2％;multiple 61.0％).Conclusion AR improved early recurrence-free survival of patients with microvascular invasion.

Clinical significance and predictive factors of early massive recurrence after radiofrequency ablation in patients with a single small hepatocellular carcinoma

BACKGROUND/AIMS: Radiofrequency ablation (RFA) is one of the most frequently applied curative treatments in patients with a single small hepatocellular carcinoma (HCC). However, the clinical significance of and risk factors for early massive recurrence after RFA—a dreadful event limiting further curative treatment—have not been fully evaluated. METHODS: In total, 438 patients with a single HCC of size ≤3 cm who underwent percutaneous RFA as an initial treatment between 2006 and 2009 were included. Baseline patient characteristics, overall survival, predictive factors, and recurrence after RFA were evaluated. In addition, the incidence, impact on survival, and predictive factors of early massive recurrence, and initial recurrence beyond the Milan criteria within 2 years were also investigated. RESULTS: During the median follow-up of 68.4 months, recurrent HCC was confirmed in 302 (68.9%) patients, with early massive recurrence in 27 patients (6.2%). The 1-, 3-, and 5-year overall survival rates were 95.4%, 84.7%, and 81.8%, respectively, in patients with no recurrence, 99.6%, 86.4%, and 70.1% in patients with recurrence within the Milan criteria or late recurrence, and 92.6%, 46.5%, and 0.05% in patients with early massive recurrence. Multivariable analysis identified older age, Child-Pugh score B or C, and early massive recurrence as predictive of poor overall survival. A tumor size of ≥2 cm and tumor location adjacent to the colon were independent risk factors predictive of early massive recurrence. CONCLUSIONS: Early massive recurrence is independently predictive of poor overall survival after RFA in patients with a single small HCC. Tumors sized ≥2 cm and located adjacent to the colon appear to be independent risk factors for early massive recurrence.

The Effect of Alternating Occlusion Therapy in Patients with Early Recurrence after Intermittent Exotropia Surgery

PURPOSE: To analyze the effect of occlusion therapy in patients with early recurrence after intermittent exotropia surgery. METHODS: The present study included 36 patients with an exodeviated angle of 10 prism diopters (PD) or more within 3 months after intermittent exotropia surgery. Eighteen patients (treatment group) performed alternating occlusion therapy for 3 hours per day for 6 months and the other 18 patients (control group) were followed up without any therapy. Age, visual acuity, deviated angle (before operation, at recurrence, and 3 and 6 months after recurrence), and binocularity were retrospectively analyzed in both groups. RESULTS: Differences between the two groups in terms of age, visual acuity, score of binocularity, association with vertical strabismus or dissociated vertical deviation, period of recurrence and exodeviated angle at recurrence were not observed. Significant differences in change of deviated angle at a far distance were found 3 months after recurrence; 0.00 ± 3.69 PD in the treatment group and +2.88 ± 2.97 PD in the control group (p = 0.014) and at a near distance -1.33 ± 5.13 PD in the treatment group and +3.22 ± 3.99 PD in the control group (p = 0.005). Significant differences in the change of deviated angle were found after 6 months from recurrence at a far distance; +0.11 ± 5.78 PD in the treatment group and +4.50 ± 4.94 PD in the control group (p = 0.020), -0.56 ± 5.71 PD in the treatment group and +3.94 ± 6.46 PD in the control group at a near distance (p = 0.034). The binocularity index was not different between the two groups. CONCLUSIONS: Although in the present study, the mean angle of deviation was not decreased, alternating occlusion therapy 3 hours per day for 6 months may be helpful in reducing the amount of exodrift in patients with early recurrence within 3 months after intermittent exotropia surgery.

Is a Preoperative Assessment of the Early Recurrence of Pancreatic Cancer Possible after Complete Surgical Resection?

BACKGROUND/AIMS: The prognosis of pancreatic adenocarcinoma (PAC) is poor. The serum carbohydrate antigen 19-9 (CA 19-9) level has been identified as a prognostic indicator of recurrence and reduced overall survival. The aim of this study was to identify preoperative prognostic factors and to create a prognostic model able to assess the early recurrence risk for patients with resectable PAC. METHODS: A series of 177 patients with PAC treated surgically at the St. Andrea Hospital of Rome between January 2003 and December 2011 were reviewed retrospectively. Univariate and multivariate analyses were utilized to identify preoperative prognostic indicators. RESULTS: A preoperative CA 19-9 level >228 U/mL, tumor size >3.1 cm, and the presence of pathological preoperative lymph nodes statistically correlated with early recurrence. Together, these three factors predicted the possibility of an early recurrence with 90.4% accuracy. The combination of these three preoperative conditions was identified as an independent parameter for early recurrence based on multivariate analysis (p=0.0314; hazard ratio, 3.9811; 95% confidence interval, 1.1745 to 15.3245). CONCLUSIONS: PAC patient candidates for surgical resection should undergo an assessment of early recurrence risk to avoid unnecessary and ineffective resection and to identify patients for whom palliative or alternative treatment may be the treatment of choice.

Expression and clinical significance of miR-96-5p in primary hepatocellular carcinoma at early recurrence after radical surgery / 实用医学杂志

Objective To investigate the expression and clinical significance of miR-96-5p in primary hepatocellular carcinoma (HCC) at early recurrence after radical surgery. Methods 61 HCC eryopreservation tissue samples from the liver carcinoma specimens data obtained after radical surgery and banked in our hospital were divided into 2 groups: early recurrence group (33 cases) and non-early recurrence group (28 cases). Aquantitative real-time polymerase chain reaction (qRT-PCR) was performed to detect the expression of miR-96-5p. Results Compared with the non-early recurrence group , the expression of miR-96-5p was observably down-regulated [(0.634 ± 0.783) vs (5.182 ± 11.321), P = 0.043]. The expression of miR-96-5p was correlated to tumor diameter, early recurrence and vascular invasion (P<0.05). Conclusions miR-96-5p are significantly related to early liver cancer recurrence and metastasis. miR-96-5p may be a molecular marker of HCC at early recurrence as well as a target for targeted therapy of liver cancer in future.

Clinical efficacy of early recurrence after skin grafting of lower eyelid ectropion by aptos thread / 中华医学美学美容杂志

Objective To investigate the long-time effects of early recurrence treated by aptos thread after skin grafting of lower eyelid ectropion.Methods Eight eyelids of 6 patients with early recurrence after skin grafting of lower eyelid ectropion were reviewed.They were operated between January 2009 and January 2013.Surgeries were done under local anesthesia.Aptos thread was fixed on the deep temporal fascia above the outer canthus and implanted under the orbicularis oculi muscle.Then aptos thread was fixed with the periorbit of inner canthus.Results 8 eyes of 6 patients were followed for 6～12 months.All the patients were satisfied with the good closure function,ideal cosmetic outcome and non-recurrences of lower eyelids extropion.Conclusions The technique of deep temporal fascia and periorbit fixed by aptos thread is an effective method for early recurrence after skin grafting of lower eyelid ectropion.It would be helpful to obtain a lasting post-operative effects.

The study of early recurrence factors of cerebral watershed infarction / 中国综合临床

Objective To investigate clinical features and the early recurrence factors of watershed infarction(WSI).Methods Two hundred and eighty-three patients with acute anterior circulation vascular infraction confirmed by CT or MRI were collected in Heilongjiang Province Hospital from January 2010 to December 2012.Patients' information including gender,sex,risk factors for stroke and vascular stenosis was colleced.Patients were divided into the lacunar infarction group (n =83),large infarction group(n =60) and the WSI group (n =140).All patients were followed up for 6 months to observe cerebral infarction recurrence status.The national institutes of health stroke scale(NIHSS) test of all patients was performed.Meanwhile the information including disease stage was collected and analysed.Results (1) The recurrent rate in WSI group,large infarction group and lacunar infarction group were 40.0％ (56/140),30.0％ (18/60),9.6％ (8/83)respectively.The difference between recurrent rate and lacunar infarction group was statistically significant(x2 =23.5,x2 =9.7,P ＜ 0.05),and the recurrent rate of WSI was highest.(2)The symptoms of patients with WSI were relatively mild in most patients after the initial stroke.75.7％ (106/140)WSI patients were 0-4 points regarding of NIHSS score,22.9％ (32/140) for 5-9 points and only 1.4％ (2/140) for more than 10 points.The clinical symptoms aggravated obviously in recurrent WSI patients.Of recurrent patients,28.6％ (16/56) were with high NIHSS score (score ≥ 10 points).(3)The difference between recurrent group and unrecurrent group in terms of unstable plaque,baseline systolic blood pressure,degree of stenosis ≥ 70％ was statistically significant(P ＜ 0.05).Conclusion The recurrent rate is higher in WSI group than other infarction type.The clinical symptoms are relatively mild in most of the WSI patients after the initial stroke,but the symptoms turn serious when stoke recurrent and the prognosis is poor.The unstable plaque,baseline systolic blood pressure,degree of stenosis ≥ 70％ may be the risk factors of stroke recurrence.

Recurrence after anatomic versus nonanatomic resection for hepatocellular carcinoma: a Meta-analysis / 中华肝胆外科杂志

Objective To compare anatomic resection (AR) and non-anatomic resection (NAR)for hepatocellular carcinoma (HCC) as a factor in preventing intra-hepatic recurrence and local recurrence after the initial surgical procedure.Methods A systematic review and Meta-analysis of nonrandomized trials comparing anatomic resection with non-anatomic resection for HCC published from 1990to 2010 in PubMed and Medline,Coehrane Library,Embase,and Science Citation Index were searched.Intra-hepatic recurrence,including early and late recurrence,and local recurrence were primary outcomes.5-year survival and 5-year disease-free survival were secondary outcomes.Pooled effect was calculated by utilizing either fixed effects model or random effects model.Result Eleven nonrandomized studies including 1576 patients were identified and analyzed.810 patients were in the AR group and 766 were in the NAR group.Patients in the AR group were characterized by lower prevalence of cirrhosis,more favorable hepatic function,and larger tumor size and higher prevalence of macrovascular invasion compared with patients in the NAR group.Anatomic resection significantly reduced the risks of local recurrence (OR,0.27; 95％ CI,-0.17～0.43; P＜0.001) and achieved a better 5-year disease-free survival (OR,2.10; 95％ CI,-1.41 ～3.12; P=0.001) in HCC patients.Also,anatomic resection was marginally effective in decreasing early intra-hepatic recurrence.However,anatomic resection was not advantageous in preventing late intra-hepatic recurrence.No significant differences were found between the AR and NAR groups with respect to postoperative morbidity,mortality,and length of hospitalization.Conclusion Anatomic resection was recommended to be superior to non-anatomic resection in reducing the risks of local recurrence,early intra-hepatic recurrence and achieving a better 5-year disease-free survival in HCC patients.

Correlation of Early Systemic Recurrence with In Vitro Adenosine Triphosphate-Based Chemotherapy Response Assay in Stage II and III Breast Cancer Patients Treated with Doxorubicin-Based Chemotherapy / 한국유방암학회지

PURPOSE: An in vitro adenosine triphosphate-based chemotherapy response assay (ATP-CRA) was designed to require only a limited number of cells and shorten test turnaround time with a high success rate. This study investigated the correlation between in vitro doxorubicin sensitivity of tumor cells and early systemic recurrence, defined as recurrence within 2 years after surgery. METHODS: From January 2004 to March 2007, the ATP-CRA for doxorubicin was tested in 128 patients among breast cancer patients treated at Gangnam Severance Hospital, Seoul, Korea. The American Joint Committee on Cancer stages for all patients were II and III. All patients received doxorubicin-based chemotherapy. Selected patients were divided into a chemosensitive group and a non-chemosensitive group, according to a 40% cell death rate as a cut-off value. We analyzed the relationship between chemosensitivity and early systemic recurrence in patients with breast cancer. RESULTS: The mean age of the patients investigated was 44.6-years-old, the mean follow-up period was 39.9 months, and recurrence free survival was 38.6 months. Thirteen recurrences were observed during follow-up. Among 13 patients with a recurrence, eight had a recurrence within 2 years (early recurrence). All of the early recurring patients belonged to the non-sensitive group. Doxorubicin sensitivity results measured by ATP-CRA were related with early recurrence free survival in patients with breast cancer (p=0.030). The mean cell death rate derived from the ATP-CRA for the early recurrence group tended to be lower than that of the non-early recurrence group, but the difference was not statistically significant (p=0.05). CONCLUSION: Doxorubicin sensitivity measured by ATP-CRA was well correlated with in vivo drug responsibility to predict early recurrence against doxorubicin-based adjuvant chemotherapy in patients with breast cancer.

Clinicopathologic Evaluation of Patients with Recurrence of Gastric Cancer within 6 Months after Curative Resection

PURPOSE: Evaluation of the clinicopathologic characteristics of recurred gastric cancer after curative resection is useful for detection of the recurrence and care thereof. The aim of this study was evaluating the characteristics of recurrence that occur less than 6 months after curative resection for gastric cancer. METHODS: The study included 199 patients who recurred after curative gastrectomy that was performed in Kyung-Hee University Medical Center, from January 2000 to January 2008. Clinicopathologic findings were compared between 18 patients who recurred within 6 months after gastrectomy (early recurrence group) and 56 patients who recurred 2 years later (late recurrence group). RESULTS: When compared with the late recurrence group, the early recurrence group was characterized by extended lymph node metastasis (P=0.005), advanced stage of disease (P=0.022), shorter survival period after recurrence (P=0.001), and more hepatic metastasis (P=0.008). CONCLUSION: Patients with more advanced stages of disease or those with extended lymph node metastasis have a risk of early recurrence after curative gastrectomy. Clinicopathologic characteristics related to recurrence time of gastric cancer are important in detection and effective care of recurred gastric cancer.

Preoperative Radiologic and Postoperative Pathologic Risk Factors for Early Intra-Hepatic Recurrence in Hepatocellular Carcinoma Patients Who Underwent Curative Resection

PURPOSE: The risk of hepatocellular carcinoma (HCC) recurrence must be considered ahead of surgery. This study was undertaken to identify pre-operative risk factors for early intrahepatic recurrence of HCC after curative resection in a large-scale. MATERIALS AND METHODS: We retrospectively reviewed the preoperative three-phase multi-detector CT (MDCT) and laboratory data for 240 HCC patients who underwent curative resection; tumor size, number, gross shape, capsule integrity, distinctiveness of tumor margin, portal vein thrombosis (PVT), alpha-fetoprotein level (AFP), and protein induced by vitamin K absence-II (PIVKA-II) levels were assessed. Surgical pathology was reviewed; tumor differentiation, capsule, necrosis, and micro-vessel invasion were recorded. RESULTS: HCC recurred in 61 patients within six months (early recurrence group), but not in 179 patients (control group). In univariate analysis, large tumor size (p = 0.018), shape (p = 0.028), poor capsule integrity (p = 0.046), elevated AFP (p = 0.015), and PIVKA-II (p = 0.008) were significant preoperative risk factors. Among the pathologic features, PVT (p = 0.023), Glisson's capsule penetration (p = 0.033), microvascular invasion (p < 0.001), and poor differentiation (p = 0.001) showed statistical significance. In multivariate analysis, only the histopathologic parameters of microvascular invasion and poor differentiation achieved statistical significance. CONCLUSION: Preoperative CT and laboratory parameters showed limited value, while the presence of microscopic vascular tumor invasion and poorly differentiated HCC correlated with higher risk of early recurrence after curative resection.