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ObjectiveTo investigate the prognostic value of the enhancement pattern in arterial phase of preoperative Gd-EOB-DTPA enhanced magnetic resonance imaging （MRI） in evaluating the disease-free survival （DFS） and overall survival （OS） in patients undergoing curative resection for intrahepatic cholangiocarcinoma （ICC）. MethodsA retrospective analysis was done on the clinical， preoperative MRI findings and postoperative follow-up results of 93 pathologically confirmed ICC patients undergoing surgery in our hospital between January 2018 and December 2021. Kaplan-Meier survival curves and log-rank test were used to compare the DFS and OS of three groups with different arterial enhancement patterns. Cox regression analysis was used to identify the factors affecting DFS and OS. ResultsThere were significant differences in DFS and OS among the 3 groups （log-rank test， P < 0.05）. The arterial enhancement pattern was an independent predictive factor for DFS （using diffuse hyperenhancement as a reference， peripheral rim enhancement： HR = 3.550； 95%CI： 1.16 ~ 10.8； P = 0.026；diffuse hypoenhancement： HR = 3.430； 95%CI： 1.04 ~ 11.3； P = 0.042）. The arterial enhancement pattern and tumor location were predictive factors for OS （（using diffuse hyperenhancement as a reference， diffuse hypoenhancement， HR = 8.500； 95%CI： 1.09-66.3； P = 0.041； using tumor distal location as a reference， tumor perihilar location HR=2.583，95%CI： 1.14-5.83， P =0.022）. The AUC of arterial enhancement patterns in predicting 1-， 2-， and 3- year DFS were 0.722， 0.748， and 0.617， respectively； in OS， 0.720， 0.704， and 0.730， respectively， which showed better prognostic efficacy than AJCC-TNM staging system. ConclusionArterial-phase enhancement pattern of preoperative Gd-EOB-DTPA enhanced MRI is an independent predictive factor for DFS and OS of ICC patients， with a better prognostic value than AJCC-TNM staging system， and can be used for the clinical management of ICC patients.
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Objective To analyse the clinical data of 77 patients with unsuspected gallbladder carcinoma,and to determine the impact of TNM stage and the timing of the second operation on postoperative survival.Methods A retrospectively analysis of 77 patients operated between January 2008 and January 2013 in our hospital for unsuspected gallbladder carcinoma was carried out.The case inclusion criteria was in strict accordance with the medical records which described without preoperative diagnosis,or cholecystectomy for benign gallbladder diseases,or intraoperative or postoperative pathological diagnosis of gallbladder cancer.References to previous published medical literature and the intervals from initial cholecystectomy to further treatment were analyzed to see whether the prognosis and survival varied depending on the TNM staging and whether secondary radical surgery was carried out.Results For the 77 patients in this study,they all had high risk factors associated with gallbladder cancer which included:women,aged ＞ 50 and gallbladder stones.The initial surgery included laparoscopic cholecystectomy (n =53),and open cholecystectomy (n =24).In 26 patients,intraoperative frozen section confirmed the diagnosis and they were treated according to the TNM staging (radical operation n =7,palliative surgery n =17).The postoperative 1-,2-,3-year cumulative survival rates were 65％,45％ and 20％,respectively.For the 54 patients who underwent radical or extended radical cholecystectomy within a short interval from the first operation,the 1-,2-,3-year cumulative survival rates were 82.5％,62.5％ and 45.7％,respectively.Conclusions For resectable gallbladder cancer,the prognosis of unsuspected gallbladder carcinoma was related not only to the clinical staging,but also to the timing of the radical operation.The shorter time interval,the longer the survival,and the better the prognosis.There was no significant difference in prognosis for the group of patients with time intervals between the two operations of less than two weeks when compared with the group with immediate radical surgery.For advanced stages of gallbladder cancer,palliative surgery should be given according to the patient's general condition,aiming to improve quality of life.
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BACKGROUND: Pulmonary hypertension (PH) associated with end stage liver disease is rare but the risk of hemodynamic deterioration during liver transplantation may be high. This study was done to characterize the pulmonary hemodynamics during liver transplantation and to seek the relationship between pulmonary artery pressure (PAP) and other hemodynamic variables. METHODS: One hundred patients undergoing liver transplantation were chosen and we divided patients into normal and PH groups (mean pulmonary artery pressure [MPAP] > 25 mmHg). Hemodynamic data was collected throughout the surgery. Studied variables between groups were analyzed with an unpaired t-test. The relationship between MPAP and other hemodynamic variables was analyzed with a linear regression test. Survival analysis was performed by cumulative survival analysis (Logrank test). RESULTS: Incidence of PH during liver transplantation was 34%, and true PH (pulmonary vascular resistance index [PVRI] > 150 dyne.sec/cm5/m2, MPAP > 25 mmHg) was 7%. MPAP, systemic vascular resistance index, cardiac index, right ventricular ejection fraction, maximum elastance, central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP), and right ventricular end-diastolic volume index were significantly higher in the PH group. In the PH group, right ventricular function curve was abnormal. MPAP correlated significantly with PAOP, and CVP (P < 0.01). One year survival rate showed no significant difference between groups (Logrank test P = 0.49). CONCLUSIONS: Episodes of increased pulmonary artery pressure during liver transplantation was not infrequent. PAP was more dependent on preloads. In patients with high PAP, RV diastolic dysfunction was usually observed. Early mortality rate after liver transplantation was not associated with PH.