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Objective:To investigate the long-term outcome of centrally located hepatocellular carcinoma with microvascular invasion(MVI)after radical resection.Methods:A retrospective cohort study was used to collect and analyze the clinical and pathological data of 81 patients with centrally located HCC who underwent surgery in the Cancer Hospital Chinese Academy of Medical Sciences from January 2016 to January 2018. According to the classification of MVI, patients were divided into 41 low-level group (MVI M1) and 40 high-level group (MVI M2). The 1, 3, 5-year OS and relapse free survival were calculated in all patients. The main outcomes were overall survival (OS), disease-free survival (DFS) and postoperative complications. OS and DFS of patients was estimated using Kaplan-Meier method and the difference between groups was assessed using Log-rank test. COX proportional-hazards regression models were used to estimate the association between exposure factors and prognosis. The measurement data of normal distribution were expressed by mean±standard deviation ( ± s), and t-test was used for comparison between the two groups. Measurement data with non-normal distribution were represented by M ( Q1, Q3), and rank sum test was used for comparison between the two groups.Chi-square test was used for comparison between the two groups of count data. Results:The 1-, 3-, 5-year OS and relapse free survival were 88%, 76%, 73%, and 57%, 42%, 27% for all 81 centrally located HCC patients, respectively. The DFS and OS of the MVI M1 group were 26(11, 39) months and 36(25, 53) months, respectively, and the MVI M2 group were 9(4, 29) months and 22(10, 45)months, respectively, and the difference was statistically significant ( P<0.05). In survival analysis, OS and DFS was significantly different in MVI M1 group compared with that in MVI M2 group ( HR=4.69, 95% CI: 1.539-14.286, P=0.0027; HR=1.92, 95% CI: 1.111-3.333, P=0.016). The incidence of postoperative mild complications in the MVI M1 group and the MVI M2 group was 95.1% and 90.0%, respectively. There was no significant difference between the two groups ( P=0.379). Cox analysis showed that MVI M2 was the independent prognostic factors for centrally located HCC in OS and DFS ( P<0.05). Conclusion:Surgical treatment for centrally located HCC with MVI is safe and effective, and MVI classification is an independent risk factor for its prognosis.
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Objective@#To explore a novel method for preoperative precision assessment of centrally located hepatocellular carcinoma(HCC) with blood vessel as axis based on three-dimensional(3D) visualization and virtual reality(VR) technology and its application values.@*Methods@#High-quality thin-layer enhanced CT data were collected from 20 patients with centrally located HCC who treated at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from March 2017 to August 2018 diagnosed by preoperative examination. There were 18 males and 2 females, aged 28 to 69 years, all of Child-Pugh grade A. First of all, 3D reconstruction was performed by a 3D visualization software; then, the reconstructed 3D image was imported into VR development engine for VR research; afterwards, the analysis and evaluation system with blood vessel as axis was established based on 3D visualization classification of centrally located HCC; therefore, the relationship of the tumor to its major peripheral blood vessels was accurately judged and the surgical planning was formulated. Two images were brought into the operating room for navigation in surgery. The assessments results of preoperative data (CT and (or) MRI) and three-dimensional visualization of blood vessels in VR environment were compared; the values of the preoperative and postoperative hemoglobin, serum albumin and bilirubin were recorded and compared. Chi-square test, t-test and non-parametric test were used for the analysis of counting data, continuous measurement data and non-normal distribution measurement data, respectively.@*Results@#3D visualization modeling was completed in all of the 20 patients with centrally located HCC. According to the results of 3D visualization classification of centrally located HCC, there were 3 cases of type Ⅰ,1 case of type Ⅱ,4 cases of type Ⅲ,7 cases of type Ⅳ and 5 cases of type Ⅴ; according to the assessment and classification based on blood vessel as the axis, there were 6 cases of type Ⅰa,2 cases of type Ⅰb,2 cases of type Ⅱa,9 cases of type Ⅱb and 1 case of type Ⅱc. All patients underwent successful resection of tumor under the guidance of 3D visualization and VR technology. There were 15 cases whose assessment results based on preoperative CT/MRI were consistent with intraoperative findings, with a coincidence rate of 75.0%(15/20); while in VR environment, the assessment results of 3D visualization with blood vessel as axis were all consistent with the intraoperative findings, with coincidence rate of 100%(20/20). There was a statistically significant difference between the groups (χ2=5.714, P=0.017). There was no red blood cell transfusion in all patients during the operation. The preoperative hemoglobin was (128.8±14.9)g/L, and it was (119.8±12.5)g/L on postoperative day 1. There was no significant difference between these two sets of data (t=2.07, P=0.054). No death during the perioperative period and no complications such as hepatic failure, hemorrhage and biliary fistula after operation occurred.@*Conclusion@#Preoperative evaluation based on 3D visualization and VR technology with blood vessel as the axis has significant clinical value for preoperative planning and surgical navigation of centrally located HCC.
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Objective: To analyze clinical features and prognosis of hepatocellular carcinoma (cHCC) patients after liver resection, so as to clarify the prognostic risk factors. Methods: We retrospectively reviewed the data of patients who underwent mesohepatectomy for cHCC at Tianjin Medical University Cancer Hospital and Chinese Academy of Medical Sciences Cancer Hospital between October 2006 and December 2014. The patients were assigned into three subgroups according to disease-free survival (DFS): high risk (DFS≤1 year), middle risk (1 year<DFS≤3 years), and low risk (DFS>3 years). Clinicopathological characteristics were compared and prognostic factors were evaluated using univariate and multivariate analyses. Results: In total, 173 patients were reviewed. The median overall survival (OS) in the high-risk group was 13.5 months compared with 24.0 months in the middle-risk group and 45.5 months in the low-risk group. Univariate analysis showed that liver capsule invasion (P=0.022), tumors adjacent to major vascular vessels (<1 cm) (P<0.01), HCC size>50 mm (P=0.012), presence of microvascular invasion (P<0.001), tumor invasive growth (P<0.001), and preoperative transarterial chemoembolization (TACE; P=0.028) were significant risk factors for recurrence. The main risk factors for OS were male gender (P=0.013), alpha-fetoprotein >200 ng/mL (P=0.005), tumor size >50 mm (P=0.013), adjacent to major vascular vessels (P<0.001), high Edmondson-Steiner differentiation grade (P=0.003), preoperative TACE (P=0.010), and tumor invasive growth (P=0.001). Cox multivariate analysis demonstrated that tumors adjacent (<1 cm) to major vascular trunks and tumor invasive growth were inde-pendent prognostic factors for both DFS and OS. In total, 40.5% patients in the high-risk group had both risk factors; this percentage was 13.4% in the middle-risk group and 3.1% in the low-risk group (P=0.001). A prognostic model including the above 9 factors were created based on Logistic regression to predict the percentage of patients belonging to the high-risk group. The results showed that the prediction accuracy continued to increase with the number of more factors added. When all the 9 factors were included, the pre-dictive percentage was 82.1%. Conclusions: cHCC patients in the high-risk group had more risk factors than those in the middle-and low-risk groups. A prognostic model containing these factors may provide accurate prediction of survival or risk stratification, and cHCC patients with these risk factors should be candidates for aggressive following-up and adjuvant therapy.
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PURPOSE: The aim of this study is to determine the prognosis after surgical resection for centrally located hepatocellular carcinoma (HCC) and to analyze the safety and effectiveness of systematic central hepatectomies for treating centrally located HCC. METHODS: A retrospective study was performed on 130 patients who suffered with centrally located HCC and who underwent liver resection from January 1998 to December 2002. These patients were divided into 3 groups according to the extent of hepatic resection; central hepatectomy group (n=42, 32.3%), hemihepatectomy group (n=19, 14.6%) and partial hepatectomy group (n=69, 53.1%). RESULTS: There were 108 males and their mean age was 52 years. There were no differences in demographic and clinical characteristics among 3 groups. The tumor size was smallest and the operation time was shortest in partial hepatectomy group. The widest resection margin was obtained in hemihepatectomy group. Transfusion was most frequently required in central hepatectomy group. Postoperative complication occurred in 23 patients(17.7%) and 1(8%) patient succumbed to in-hospital mortality. The overall 1, 3 and 5-year survival rates were 95.4%, 79.0%, and 70.0%, respectively. Disease-free 1, 3, and 5-year survival rates were 77.3%, 57.6% and 43.1%, respectively. Multivariate analysis revealed that anti-hepatitis C antibody, ICG R15, microvascular invasion, tumor stage and morbidity were risk factors for patient survival, whereas anti-hepatitis C antibody, total bilirubin level, ICG R15, tumor size, resection margin and tumor stage were risk factors for disease-free survival. There were no differences in the overall 5-year survival and disease-free survival rates among 3 groups. CONCLUSIONS: Although central hepatectomy for treating centrally located HCC appeared to be technically difficult, it showed a favorable outcome that was comparable to that of other liver resection groups. When centrally located HCC patients have a limited hepatic functional reserve, parenchymal-sparing central hepatectomy can be safely applied for performing systematic curative resection.