Predictive value of Barcelona clinic liver cancer staging system combined with albumin-indocyanine green score in hepatectomy for hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the predictive value of Barcelona clinic liver cancer (BCLC) staging system combined with albumin-indocyanine green (ALICE) score (ALICE-BCLC) in hepatectomy for hepatocellular carcinoma, and compare it with BCLC staging system combined with Child-Pugh score (CP-BCLC).Methods:The clinical data of 311 patients with hepatocellular carcinoma who underwent hepatectomy at Jinhua Hospital Affiliated to Zhejiang University from April 2012 to June 2021 were analyzed retrospectively. There were 271 males and 40 females, with a median age of 59 years old (range 26 to 92 years old). These patients were divided into two groups based on the ALICE-BCLC: the ALICE-BCLC grade 0 group ( n=63) and the ALICE-BCLC grade A group ( n=248); and another two groups based on the CP-BCLC: the CP-BCLC grade 0 group ( n=58) and the CP-BCLC grade A group ( n=253). The clinical data, including indocyanine green retention rate at 15 min, and albumin were collected and the scores were calculated. Follow-up was conducted by combining outpatient visits with telephone calls. The survival rate was calculated by the life method, and survival curves were drawn by the Kaplan-Meier method. The multivariate Cox regression model was used to determine the main factors affecting prognosis. Weighted Kappa was used to compare consistency of the two staging systems. Results:Multivariate analysis showed that a maximum tumor diameter >5 cm, total bilirubin >18 μmol/L, major hepatectomy, CP-BCLC grade A and ALICE-BCLC grade A to be independent risk factors affecting overall survival of patients with hepatocellular carcinoma after liver resection with curative intent (all P<0.05). The median survival of patients in the CP-BCLC grade 0 group and the CP-BCLC grade A group were 43.0 and 28.0 months, respectively. There was a significant difference between the two groups ( P=0.017). The median survival of patients in the ALICE-BCLC grade 0 group and the ALICE-BCLC grade A group were 41.4 and 28.1 months, respectively. There was a significant difference between the two groups ( P=0.035). The weighted Kappa coefficient of ALICE-BCLC and CP-BCLC was 0.949, showing a strong consistency ( P<0.001). Conclusion:ALICE-BCLC showed a good predictive value for prognosis of hepatocellular carcinoma after liver resection, and it had a similar overall prognostic discrimination ability as CP-BCLC.

Advances in post-operative prognostic models for hepatocellular carcinoma / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Hepatocellular carcinoma (HCC) is one of the most common malignancies and a leading cause of cancer-related death worldwide. Surgery remains the primary and most successful therapy option for the treatment of early- and mid-stage HCCs, but the high heterogeneity of HCC renders prognostic prediction challenging. The construction of relevant prognostic models helps to stratify the prognosis of surgically treated patients and guide personalized clinical decision-making, thereby improving patient survival rates. Currently, the prognostic assessment of HCC is based on several commonly used staging systems, such as Tumor-Node-Metastasis (TNM), Cancer of the Liver Italian Program (CLIP), and Barcelona Clinic Liver Cancer (BCLC). Given the insufficiency of these staging systems and the aim to improve the accuracy of prognostic prediction, researchers have incorporated further prognostic factors, such as microvascular infiltration, and proposed some new prognostic models for HCC. To provide insights into the prospects of clinical oncology research, this review describes the commonly used HCC staging systems and new models proposed in recent years.

Desde la periferia: la noción de espacio social en la movilización sociopolítica de la juventud / From the periphery: The notion of social space in the socio-political mobilization of youth / Da partir da periferia: A noção de espaço social na mobilização sócio-política da juventude

Resumen (analítico) Este artículo pone de manifiesto la existencia de un elemento transversal en la relación de la juventud con la esfera pública, que contribuye a comprender mejor la naturaleza de sus expresiones políticas: la asimilación de una cierta posición periférica impuesta dentro del espacio social. La idea de espacio social, y en particular la de periferia, contribuyen a dar coherencia a determinados fenómenos y tendencias de la movilización sociopolítica de la juventud en su conjunto. Para ello, se analizan tres movimientos juveniles surgidos en Barcelona durante el año 2019, en los que la juventud tuvo especial protagonismo. Las diferencias y similitudes entre los tres movimientos muestran la versatilidad de la noción de periferia, que sirve para visualizar la precariedad vital que identifica a toda una generación, más allá de sus diferencias.

Abstract (analytical) This article highlights the existence of a transversal element in the relationship of youth with the public sphere, which contributes to a better understanding of the nature of their political expressions: the internalization of a certain imposed peripheral position within the social space. The idea of social space, and in particular the idea of periphery, contributes to give coherence to some phenomena and trends on the sociopolitical mobilization of youth as a whole. To do this, three youth movements emerged in Barcelona during 2019 are analyzed, in which the youth played a special role. The differences and similarities between the three movements show the versatility of the notion of periphery, which serves to visualize the vital precariousness that identifies an entire generation, beyond their internal differences.

Resumo (analítico) Este artigo tem como objetivo destacar a existência de um elemento transversal na relação dos jovens com a esfera pública, o que contribui para a melhor compreensão da natureza de suas expressões políticas: a assimilação de uma determinada posição periférica imposta dentro do espaço social. A ideia de espaço social e, em particular, de periferia, contribui para dar coerência a certos fenômenos e tendências na mobilização sócio-política da juventude como um todo. Para isso, são analisados três movimentos juvenis surgidos em Barcelona em 2019, nos quais os jovens tiveram protagonismo especial. As diferenças e semelhanças entre os três movimentos mostram a versatilidade da noção de periferia, que serve para visualizar a precariedade vital que identifica uma geração inteira, além de suas diferenças internas.

Transarterial chemoembolization combined with microwave ablation and apatinib in patients with Barcelona clinic liver cancer Stage C hepatocellular carcinoma: A propensity score matching analysis

Context and Aims: Apatinib combined with transarterial chemoembolization (TACE) has shown promising results in cases of Barcelona clinic liver cancer Stage C (BCLC C) hepatocellular carcinoma (HCC). This study aimed to investigate the efficacy and safety of TACE in combination with microwave ablation (MWA) and apatinib. Materials and Methods: A retrospective, single.center study was undertaken using a one.to.one propensity score matching (PSM) analysis design and involved BCLC C HCC patients who underwent treatment with TACE.MWA.apatinib or TACE alone between January 2013 and June 2018. The patients were recommended to administer 500mg apatinib per day, combined with MWA and TACE. The adverse effects of apatinib, MWA. and TACE.related complications, progression.free survival (PFS), and overall survival (OS) were assessed. Results: Of the 149 patients with BCLC C HCC who underwent TACE.MWA.apatinib or TACE alone, 131 were included in our study. Among them, 21 (16.0%) received TACE.MWA.apatinib and 110 (84.0%) underwent TACE alone. After PSM, twenty pairs were enrolled into different treatment groups. Patients in the TACE.MWA.apatinib group had a significantly longer median PFS than patients in the TACE.alone group on both before (median, 8.9 vs. 1.7 months, P = 0.0002) and after PSM (median, 5.4 vs. 2.1 months, P = 0.001). They also had a significantly longer median OS than patients in the TACE.alone group on before (median, 24.4 vs. 5.8 months, P = 0.000007) and after PSM (median, 24.4 vs. 5.4 months, P = 0.00005). Conclusions: The combination of apatinib, TACE, and MWA in BCLC C HCC patients is safe and effective. Toxicity is manageable by adjusting the apatinib dosage

Independência catalã, identidade e globalização no Fútbol Club Barcelona / Catalan independence, identity and globalization at the Fútbol Club Barcelona / Independencia catalana, identidad y globalización en el Fútbol Club Barcelona

A Catalunha enfrenta uma histórica crise política e econômica, acentuada nos últimos anos. O futebol local tangenciou esses desdobramentos que afetaram a dinâmica estrutural e a identidade dos clubes na região, especialmente, o FC Barcelona. Tencionando as abordagens históricas, políticas e o dualismo entre o global e o local, este estudo visou analisar o impacto da identidade catalã, independentismo catalão e a globalização no FC Barcelona. Para tanto, utilizou-se referencial bibliográfico, fontes históricas documentais, reportagens. Concluiu-se que a identidade do Clube é reconstruída continuamente, de acordo com as ações e posições de seus distintos grupos diretivos em relação à situação política e econômica local. Todavia, as questões esportivas e financeiras são o fio condutor nas tomadas de decisão do clube atualmente, em detrimento de sua representatividade social na região.

Catalonia faces a historic political and economic crisis, aggravated in recent years. Local football touched on these developments that affected the structural dynamics and identity of the clubs in the region, especially FC Barcelona. With a focus on historical, political and dualism between the global and the local, this study aimed to analyze the impact of Catalan identity, Catalan independence and globalization in FC Barcelona. For that, bibliographic references, historical documentary sources and reports were used. It was concluded that the identity of the Club is continually rebuilt, according to the actions and positions of its different governing groups in relation to the local political and economic situation. However, sporting and financial issues are the guiding principle in the club's decision-making today, to the detriment of its social representation in the region.

Cataluña enfrenta una histórica crisis política y económica, acentuada en los últimos años. El fútbol local tangenció esos desdoblamientos que afectaron la dinámica estructural y la identidad de los clubes en la región, especialmente el FC Barcelona. Teniendo en cuenta los enfoques históricos, políticos y el dualismo entre lo global y lo local, este estudio tuvo como objetivo analizar el impacto de la identidad catalana, independentismo catalán y la globalización en el FC Barcelona. Para ello, se utilizó referencial bibliográfico, fuentes históricas documentales, reportajes. Se concluyó que la identidad del Club es reconstruida continuamente, de acuerdo con las acciones y posiciones de sus distintos grupos directivos en relación a la situación política y económica local. Sin embargo, las cuestiones deportivas y financieras son el hilo conductor en las tomas de decisiones del club actualmente, en detrimento de su representatividad social en la región

El " específico homeopático ": legitimación comercial de la homeopatía en Barcelona (1902-1910) / The " homeopathic specific: " commercial legitimization of homeopathy in Barcelona (1902-1910)

Resumen El cambio en la posición que ocupaban los remedios homeopáticos en el mercado de la salud, derivado del emergente paradigma farmacológico, fue clave en la popularización de la homeopatía en España. La introducción de los específicos y sus técnicas de publicidad originó un aumento en la legitimación popular de la homeopatía y encontró en las pugnas entre diferentes profesionales un terreno abonado para la divulgación y la promoción de esta doctrina. El artículo analiza un caso de estudio contextualizado en Barcelona a principios del siglo XX, aproximándose desde diferentes perspectivas al nuevo rol del farmacéutico y el medicamento como divulgadores de la homeopatía y centrándose en las estrategias de la popularización de los remedios homeopáticos en España.

Abstract The change in position of homeopathic remedies in the health market produced by the emerging pharmacological paradigm was key to the popularization of homeopathy in Spain. The introduction of specifics and their marketing strategies led to a rise in popular legitimization of homeopathy, and the battles between different professionals created fertile ground for explaining and promoting this doctrine. This article analyzes a contextualized case in Barcelona in the early twentieth century, and explores from different perspectives the new role of pharmacists and medications in spreading homeopathy, centering on strategies for popularizing homeopathic remedies in Spain.

A Proposal for Modification of the Barcelona Clinic Liver Cancer Staging System Considering the Prognostic Implication of Performance Status

BACKGROUND/AIMS: Barcelona Clinic Liver Cancer (BCLC) C stage demonstrates considerable heterogeneity because it includes patients with either symptomatic tumors (performance status [PS], 1–2) or with an invasive tumoral pattern reflected by the presence of vascular invasion (VI) or extrahepatic spread (EHS). This study aimed to derive a more relevant staging system by modification of the BCLC system considering the prognostic implication of PS. METHODS: A total of 7,501 subjects who were registered in the Korean multicenter hepatocellular carcinoma (HCC) registry database from 2008 to 2013 were analyzed. The relative goodness-of-fit between staging systems was compared using the Akaike information criterion (AIC) and integrated area under the curve (IAUC). Three modified BCLC (m-BCLC) systems (#1, #2, and #3) were devised by reducing the role of PS. RESULTS: As a result, the BCLC C stage, which includes patients with PS 1–2 without VI/EHS, was reassigned to stage 0, A, or B according to their tumor burden in the m-BCLC #2 model. This model was identified as the most explanatory and desirable model for HCC staging by demonstrating the smallest AIC (AIC=70,088.01) and the largest IAUC (IAUC=0.722), while the original BCLC showed the largest AIC (AIC=70,697.17) and the smallest IAUC (IAUC=0.705). The m-BCLC #2 stage C was further subclassified into C1, C2, C3, and C4 according to the Child-Pugh score, PS, presence of EHS, and tumor extent. The C1 to C4 subgroups showed significantly different overall survival distribution between groups (p<0.001). CONCLUSIONS: An accurate and relevant staging system for patients with HCC was derived though modification of the BCLC system based on PS.

Hepatic Resection Provides Survival Benefit for Selected Intermediate-Stage (BCLC-B) Hepatocellular Carcinoma Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The intermediate stage of hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer [BCLC] B) comprises a highly heterogeneous population, and the treatment strategy is still controversial. Because of the heterogeneity, a subclassification of intermediate-stage HCCs was put forward by Bolondi according to the ‘beyond Milan and within up-to-7' criteria and Child-Pugh score. In this study, we aim to analyze the prognosis of BCLC-B stage HCC patients who received hepatic resection according to the Bolondi's subclassification. MATERIALS AND METHODS: One thousand and one hundred three patients diagnosedwith HCC and treatedwith hepatic resectionwere enrolled in our hospital between 2006 and 2012. According to Bolondi's subclassification, the BCLC-B patients were divided into four groups. Recurrence-free survival (RFS) and overall survival (OS) were analyzed. RESULTS: According to Bolondi's subclassification, the BCLC-B patients were divided into four groups: B1 (n=41, 18.7%), B2 (n=160, 73.1%), B3 (n=11, 5.0%), and B4 (n=7, 3.2%). Significant difference was observed between B1 and other groups (B1 vs. B2, p=0.022; B1 vs. B3, p < 0.001; B1 vs. B4, p < 0.001), but no difference for B2 vs. B4 (p=0.542) and B3 vs. B4 (p=0.542). In addition, no significant differences were observed between BCLC-A and BCLC-B1 group for both RFS (p=0.087) and OS (p=0.643). In multivariate analysis, BCLC-B subclassification was not a risk factor for both OS (p=0.263) and RFS (p=0.892). CONCLUSION: In our study, HCC patients at B1 stagewere benefited from hepatic resection and had similar survival to BCLC-A stage patients. Our study provided rationality of hepatic resection for selected BCLC-B stage HCC patients instead of routine transarterial chemoembolization.

Survival analysis of patients with different sub-stages of Barcelona clinic liver cancer classification stage B hepatocellular carcinoma after TACE / 中国介入影像与治疗学

Objective: To investigate the necessity of sub-classification for Barcelona clinic liver cancer (BCLC) classification stage B hepatocellular carcinoma (HCC), and to analyze the curative effect and survival of patients with different substages HCC after TACE. Methods: Clinical and follow-up data of 133 patients with BCLC classification stage B HCC treated with TACE were retrospectively analyzed. There were 31 cases of substage B1, 77 of substage B2, 15 of substage B3 and 10 cases of substage B4. The curative effect and survival of patients were evaluated. Results: Totally 567 times of TACE treatments were performed on 133 patients. There was no statistical difference of the TACE treatment times among patients with different substages (F=1.702, P=0.170). One month after the first time TACE, partial response was achieved in 47 cases, while stable disease and progressive disease were found in 74 cases and 12 cases respectively according to modified response evaluation criteria in solid tumors criteria. No statistical difference of curative effect was detected among patients with different substages (χ2=2.121, P=0.908). The overall survival of patients with different substages HCC after TACE was statistically different (χ2=10.846, P=0.013). The survival time of patients with substage B1 was significantly longer than that of patients with substage B3 (P=0.020) and B4 (P=0.033), respectively. Conclusion: The overall survival of patients with BCLC classification stage B HCC after TACE are different. This sub-classification is beneficial for clinic to formulate specific treatment plan.

Influence of gelatin sponge microparticles-TACE on myeloid-derived suppressor cells in peripheral blood of patients with Barcelona clinic liver cancer classification stage B hepatocellular carcinoma / 中国介入影像与治疗学

Objective: To investigate the influence of gelatin sponge microparticles-TACE (GSMs-TACE) on myeloid-derived suppressor cells (MDSCs) in peripheral blood of patients with Barcelona clinic liver cancer (BCLC) classification stage B hepatocellular carcinoma (HCC). Methods: Five patients with clinically diagnosed BCLC B-stage HCC (HCC group) underwent GSMs-TACE. Flow cytometry was used to detect the frequency of MDSCs (the proportion of MDSCs clusters to HLA-DR-cell) in the peripheral blood of patients before GSMs-TACE and 10 days as well as 30 days after operation, respectively. Seven healthy volunteers (normal control group) were enrolled. The MDSCs frequency of normal control group was detected simultaneously with HCC group before GSMs-TACE. Statistical analysis was performed to compare the differences of the frequency of MDSCs in HCC patients before and after GSMs-TACE. And the frequency of MDSCs of HCC group was compared with that of normal control group. Results: The frequency of MDSCs in peripheral blood of patients with HCC before GSMs-TACE was (30.26±12.12)%, which decreased to (10.22±3.79)% after 10 days and decreased to (7.33±3.38)% after 30 days (P<0.001). Pairwise comparison showed that the frequency of MDSCs at 30 days (P<0.001) and 10 days (P=0.011) after GSMs-TACE was lower than that before operation,respectively. The frequency of preoperative MDSCs of HCC group was statistically higher than that of normal control group ([30.26±12.12]% vs [3.41±1.89]%, t=5.876, P<0.001). Conclusion: The frequency of MDSCs in peripheral blood of patients with BCLC B-stage HCC significantly reduced after GSMs-TACE treatment. GSMs-TACE treatment has positive regulation effect on the immune function of patients.

Can More Aggressive Treatment Improve Prognosis in Patients with Hepatocellular Carcinoma? A Direct Comparison of the Hong Kong Liver Cancer and Barcelona Clinic Liver Cancer Algorithms

BACKGROUND/AIMS: In addition to the globally endorsed Barcelona Clinic Liver Cancer (BCLC) staging system, other algorithms or staging systems have been developed, including the Hong Kong Liver Cancer (HKLC) staging system. This study aimed to validate the HKLC staging system relative to the BCLC staging system for predicting survival for hepatocellular carcinoma (HCC) patients in Korea. METHODS: From 2004 to 2013, 2,571 patients newly diagnosed with HCC were consecutively enrolled at three Korea University medical centers. RESULTS: Both staging systems differentiated survival well (p < 0.001). However, 1-year and 3-year survival were predicted better using the HKLC system than the BCLC system (area under the receiver operating characteristic curve: 0.869 vs 0.856 for 1 year, p=0.002; 0.841 vs 0.827 for 3 years, p=0.010). In hypothetical survival curves, the HKLC system exhibited better median overall survival than the BCLC system (33.1 months vs 19.2 months). In evaluations of prognosis according to either BCLC or HKLC treatment guidelines, risk of death was reduced in the group following only HKLC guidelines compared with the group following only BCLC guidelines (hazard ratio, 0.601; 95% confidence interval, 0.443 to 0.816; p=0.001). CONCLUSIONS: Although both staging systems predicted and discriminated HCC prognoses well, the HKLC system showed more encouraging survival benefits than the BCLC system.

Risk factors of intrahepatic recurrence after resection for Barcelona Clinic Liver Cancer stage 0 hepatocellular carcinoma / 中华肝胆外科杂志

Objective To investigate the risk factors of intrahepatic recurrence after resection for Barcelona Clinic Liver Cancer (BCLC) stage 0 hepatocellular carcinoma (HCC).Methods 58 patients with pathologically confirmed BCLC stage 0 HCC treated with liver resection at the Zhongshan Hospital,Fudan University from January to December 2011 were included in this study.The male/female ratio was 50/8.The age ranged from 31 to 72 years.The clinical,pathological and MR imaging features of these patients were analyzed.The recurrence-free survival rates between patients with HCC ≤ 1.5 cm (n=27) and ＞ 1.5 cm (n=31) were compared.The risk factors of intrahepatic recurrence for HCCs were compared using the Cox regression analysis.Results Intrahepatic recurrence was identified in 25 patients,and the median recurrence time was 33 months.The 3-and 5-year cumulative recurrence-free survival rates were 73.0％ (95％CI:60.7％～85.3％) and 52.3％ (95％CI:37.2％～67.4％).No significant differences were found in the recurrence-free survival rates between tumors ≤ 1.5 cm and ＞ 1.5 cm (P＞0.05).Multivariate analyses demonstrated that serum alpha-fetoprotein level ＞20 g/L (HR 3.773,95％CI:1.628～8.745;P＜0.05) and irregular tumor shape (HR 4.584,95％CI:1.485～ 14.155;P＜0.05) were independent risk factors of intrahepatic recurrence.Conclusions Elevated serum alpha-fetoprotein level and irregular tumor shape were associated with an increased risk of intrahepatic recurrence for BCLC stage 0 HCC patients after resection.They could be used as early prognostic indicators in clinical practice.

Hepatitis B surface antigen levels in hepatitis B virus-related hepatocellular carcinoma: a retrospective cross-sectional study / 中华传染病杂志

Objective To investigate the distribution of serum hepatitis B surface antigen (HBsAg) levels in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).Methods A total of 226 cases of HBV-related HCC were collected from June 2009 to December 2013.Demographic characteristics of patients with different barcelona clinica liver cancer (BCLC) stages,the status of cirrhosis and HBsAg levels with different virological indicators were compared.HBsAg quantification was tested by chemiluminescence.The statistical analysis was conducted by t test,x2 test,Kruskal-Wallis H rank sum test and Mann-Whitney U rank sum test.Results A total of 226 cases were included with 201male patients and 25 female patients.HBsAg levels in HBV-related HCC patients with different ages were significantly different (x2=12.30,P =0.015),but with no statistical difference in those with different gender (Z=-0.35,P＞0.05).The HBsAg levels were not significantly different between patients with or without liver cirrhosis (Z =-0.80,P =0.419).HBsAg levels in liver cirrhosis cases with different liver function stages were not significant different (x2=2.15,P=0.341).HBsAg levels in HBeAg-positive group or HBV DNA positive group were significantly higher than those in HBeAg-negative group or HBV DNA negative group,respectively (Z =-3.67 and-4.80,respectively,both P＜0.01).The HBsAg levels in patients with different BCLC stages were not significantly different (x2 8.05,P =0.09).No significant differences were found in HBsAg levels between patients with or without portal vein violation,lymph node transfer or distant transfer (Z=-0.65,-0.03 and-1.24,respectively,all P＞ 0.05).The constituent ratios of patients with different HBsAg levels in different BCLC stages were statistically different (x2 =28.17,P-0.005).Conclusions There are no significant differences of HBsAg levels in patients with different BCLC stages,indicating that HBsAg may not be a contributor for disease progression after emergence of HCC.

Predictors of Micrometastases in Patients with Barcelona Clinic Liver Cancer Classification B Hepatocellular Carcinoma

PURPOSE: Transarterial chemoembolization (TACE) is indicated for Barcelona Clinic Liver Cancer (BCLC) B hepatocellular carcinoma (HCC). Whether TACE provides any long-term survival benefits remains unclear. We aimed to investigate micrometastases predictors with which to identify patients who would benefit from surgical resection (SR). MATERIALS AND METHODS: First, we analyzed risk factors of micrometastases, microvascular invasion, and poor histologic grade in 38 patients with newly diagnosed resectable BCLC stage B HCC limited to one or two segments with well-preserved liver function and who underwent SR between January 2006 and December 2013. Second, we validated identified risk factors in 54 newly diagnosed resectable BCLC B HCC patients with well-preserved liver function who underwent TACE during the same period to determine their influence on survival. RESULTS: Risk factors of micrometastases in SR patients were α-fetoprotein (AFP) ≥110 [hazard ratio (HR)=5.166; 95% confidence interval (CI), 1.031–25.897; p=0.046] and prothrombin induced by vitamin K absence-II (PIVKA-II) ≥800 (HR=5.166; 95% CI, 1.031–25.897; p=0.046). The cumulative probability of tumor recurrence (p=0.009) after SR differed according to levels of AFP and PIVKA-II. After validation of these risk factors in the TACE group, patients with SR and AFP <110 and PIVKA-II <800 had superior survival outcomes than other patients (HR=0.116; 95% CI, 0.027–0.497; p=0.004). CONCLUSION: AFP and PIVKA-II levels predict micrometastases and survival. Therefore, they should be considered when selecting SR for BCLC B HCC.

Clinical value of liver cancer staging in predicting the survival time in Chinese patients after receiving TACE: comparison of Hong Kong liver cancer staging system with Barcelona clinic liver cancer staging system / 介入放射学杂志

Objective To compare the prognostic ability of Hong Kong Liver Cancer (HKLC) staging system with that of Barcelona Clinic Liver Cancer (BCLC) staging system for Chinese patients with hepatocellular carcinoma (HCC) after receiving transarterial chemoembolization (TACE).Methods The clinical data of 180 Chinese patients with primary HCC,who were treated with TACE during the period from August 2008 to December 2015,were retrospectively analyzed.HCC staging of each patient was scored by two staging methods separately.Kaplan-Meier analysis was adopted to separately calculate the median survival time of each stage that was judged by the two staging methods.The likelihood ratio (LR) x2 values,the Akaike information criterion (AIC) value and Harrell's C value of the two staging methods were calculated.Results Statistically significant differences in the survival time of each period existed between the two staging systems.AIC value,LRx2 value and Harrell's C value of HKLC staging system were 1360,66.6,and 0.813 respectively,while those of BCLC staging system were 1365,61.8,and 0.772 respectively.Conclusion Compared with BCLC staging,HKLC staging is more suitable for predicting the survival time of Chinese patients with primary liver cancer treated with TACE.

Hepatectomy combined with splenectomy in patients with hepatocellular carcinoma with Barcelona Clinic Liver Cancer Stage A and portal hypertension / 中华肝胆外科杂志

Objective To evaluate the peri-operative and survival outcomes of hepatectomy combined with splenectomy in patients with hepatocellular carcinoma with Barcelona Clinic Liver Cancer Stage A and portal hypertension.Methods We retrospectively analyzed the data on patients with hepatocellular carcinoma with Barcelona Clinic Liver Cancer Stage A and portal hypertension who underwent surgery at the Shengli Oilfield Central Hospital between July 2008 and June 2015.According to the operative method,the patients were classified as the experimental group (hepatectomy combined with splenectomy) and the control group (hepatectomy).We compared and analyzed the clinical data between these two groups,which included the operation time,blood loss,duration of hepatic portal occlusion,width of surgical resection margin,liver function,PLT,HBV reactivation,time to remove drainage tube,complications,upper gastrointestinal hemorrhage rate and survival outcomes.Results (1) The operation time,blood loss,PLT at 1 week and 1 month after surgery in the experimental group were all significantly higher than the control group [(161.4 ± 38.3) min vs.(119.2±36.4) min,(268.7±72.1) vs.(201.3±61.3) ml,(189.2±51.3) ×109/L vs.(81.9±32.2) ×109/L,(327.4±69.1) ×109/L vs.(84.5±28.5) × 109/L (all P＜0.05),respectively].The time to remove drainage tube,duration of hepatic portal occlusion,width of resection surgical margin,TBil,complications and upper gastrointestinal hemorrhage rates of the two groups were not significantly different (all P ＞ 0.05).The HBV reactivation rate,ALT and AST in the experimental group were significantly lower than the control group [3.9％ (2/51) vs.18.2％ (12/66),(45.7 ± 11.4) U/L vs.(58.3±14.7) U/L,(48.1±12.4) U/Lvs.(61.3±15.1) U/L (allP＜0.05),respectively].(2) The 1,3 and 5-year recurrence free survival rates were not significantly different between the experimental and control groups [84.3 ％,34.1％,27.3 ％ vs.78.8 ％,42.1％,9.7 ％ (all P ＞ 0.05),respectively].The 1,3 and 5-year overall survival rates in the experimental Group were significantly higher than the control group [94.1％,66.3 ％,33.5 ％ vs.90.9％,46.7％,16.1％ (all P ＜ 0.05),respectively].Conclusion Combined liver and spleen resection was a safe and efficacious modality to treat patients with BCLC A hepatocellular carcinoma,which reduced the incidence of HBV reactivation and improved the overall survival.

Prognostic and subgroup analysis of 162 patients with Barcelona Clinical Liver Cancer (BCLC)stage B hepatocellular carcinoma after hepatectomy / 中华肝胆外科杂志

Objectives To analyze prognosis and risk factors of Barcelona Clinical Liver Cancer (BCLC) stage B hepatocellular carcinoma patients treated with hepatectomy.Methods Clinical data of 162 BCLC stage B patients who underwent hepatectomy at Tianjin Medical University Cancer Institute & Hospital and the Second Hospital of Tianjin Medical University from June 2007 to December 2013 were retrospectively studied.The correlations between factors (age,gender) and long-term outcome were analyzed to determine independent risk factors.Subsequently,subgroup analysis of BCLC stage B hepatocellular carcinoma was performed.Results Multiple tumors,maximum tumor diameter ＞ 10 cm and AFP ＞ 100 μg/L were con firmed as independent risk factors of overall survival in postoperative BCLC B patients.Based on the risk factors,patients were divided into two groups,namely low-risk subgroup (≤ 1 risk factor) and high-risk subgroup (≥ 2 risk factors).In low-risk subgroup,1,3 and 5-year overall survival (OS) rates were 91.6％,65.5％,61.9％ respectively,and mean OS was 72 months.By contrast,1,3 and 5-year OS rates in high-risk subgroup were 67.4％,25.6％,10.8％ respectively,and mean OS was 29 months.Further more,1,3 and 5-year OS rates of all patients were 85.2％,54.9％,48.0％ respectively,and mean OS was 61 months.Conclusions Relatively favorable long-term outcomes could be yielded in BCLC stage B hepatocellular carcinoma patients treated with liver resection.The independent risk factors including multiple tumors,maximum tumor diameter ＞ 10 cm and AFP ＞ 100 μg/L were closely correlated with overall survival.BCLC stage B hepatocellular carcinoma patients could be divided into low-risk and high-risk subgroups based on the risk factors mentioned above.Survival rates in low-risk subgroup are remarkably superior to those in high-risk subgroup.

Comparison of the prognosis of liver resection and transcatheter arterial chemoembolization for patients with Barcelona clinic liver stage C and portal vein tumor thrombus / 局解手术学杂志

Objective To investigate the long time prognosis of liver resection or transcatheter arterial chemoembolization(TACE) of Barcelona clinic liver cancer stage C(BCLC-C) patients who have portal vein tumor thrombsis.Methods Totally 86 BCLC-C patients who satisfied our including criteria from our surgical database of People's Hospital of Yichang City from January 2000 to September 2015 were selected as the research object.According to different treatment,86 patients were divided into liver resection group(n=50) and TACE group(n=36).The general information of two groups were compared.Cox multi-factors analysis and overall survival rate were calculated.ResultsThe long-term prognosis of liver resection group was better than that of TACE group(5-year OS:26% vs.0,P40 IU/L(HR:0.615,95%CI[0.488,1.206],P=0.013) as well as HBV-DNA>1 000(HR:1.204,95%CI:[0.920,2.540],P=0.038)were adverse factors for prognosis.ConclusionLiver resection is better than TACE for BCLC-C patients with portal vein tumor thrombosis.However,randomized controlled trial still need to be used to further confirm our conclusion.

Subclassification of Hepatocellular Carcinoma with Barcelona Clinic Liver Cancer Intermediate Stage

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) with Barcelona Clinic Liver Cancer (BCLC) intermediate stage includes a highly heterogeneous population. Here, we aimed to sub-classify hepatocellular carcinoma with BCLC intermediate stage for better prognostification. METHODS: Between 2003 and 2008, 325 patients who were newly diagnosed as HCC with BCLC intermediate stage were considered eligible. Tumor factor and liver function were used for sub-classification. Overall survival (OS) was analyzed using Kaplan-Meier method with a comparison by log-rank test. RESULTS: A total of 325 patients with intermediate stage HCC were analyzed. Patients with tumor size ≥7 cm, tumor number ≥4 and Child-Pugh class B had the worse OS compared to those with tumor size <7 cm, tumor number <4 and Child-pugh class A, respectively (all P<0.05). These three variables affected the OS independently from multivariate Cox regression analysis (all P<0.05). So, using these three variables, patients were finally sub-classified as those with fulfilling none of three factors (B-a), one of three factors (B-b), two of three factors (B-c) and all of three factors (B-d) with the median OS of 39.2, 20.6, 12.0 and 8.3 months with statistical significances (all P<0.05 between B-a and B-b, between B-b and B-c, and between B-c and B-d), respectively. CONCLUSIONS: Sub-classification of HCC with BCLC intermediate stage may be useful in not only prognostification but also guidance of treatment strategies.

Evaluation of the Outcome after Transarterial Chemoembolization; Refinement of Barcelona Clinic Liver Cancer Stage-B from Eastern Point of View

Transarterial chemoembolization (TACE) is recommended as the first line treatment option for the patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), however, treatment strategy and evaluation of effects after TACE has not been fully established. Recently, sub-stage of BCLC stage B has been proposed and validated, but it should be validated including a large number of the patients and its refinement should be discussed. We have validated the sub-stage of BCLC stage B (B1-B4) by comparing overall survival after TACE, and there was no statistically significant difference in overall survival after TACE between B1 and B2. After excluding the patients with Child-Pugh point 7 from B1, the overall survival was significantly better than that of B2. Therefore, up-to-seven criteria is shown to be a reliable tool for the treatment strategy in the patients with intermediate stage of HCC. Refinement of sub-stage of BCLC stage B has been proposed by some other institutes, and it is important to establish novel treatment strategy for the patients with BCLC stage B after TACE to improve the prognosis of the patients after TACE, and to define the best timing for conversion to sorafenib or liver transplantation should be discussed.