RESUMO
Previous clinic models for patients with hepatocellular carcinoma (HCC) receiving transarterial chemoembolization (TACE) mainly focused on the overall survival, whereas a simple-to-use tool for predicting the response to the first TACE and the management of risk classification before TACE are lacking. Our aim was to develop a scoring system calculated manually for these patients. A total of 437 patients with hepatocellular carcinoma (HCC) who underwent TACE treatment were carefully selected for analysis. They were then randomly divided into two groups: a training group comprising 350 patients and a validation group comprising 77 patients. Furthermore, 45 HCC patients who had recently undergone TACE treatment been included in the study to validate the model's efficacy and applicability. The factors selected for the predictive model were comprehensively based on the results of the LASSO, univariate and multivariate logistic regression analyses. The discrimination, calibration ability and clinic utility of models were evaluated in both the training and validation groups. A prediction model incorporated 3 objective imaging characteristics and 2 indicators of liver function. The model showed good discrimination, with AUROCs of 0.735, 0.706 and 0.884 and in the training group and validation groups, and good calibration. The model classified the patients into three groups based on the calculated score, including low risk, median risk and high-risk groups, with rates of no response to TACE of 26.3%, 40.2% and 76.8%, respectively. We derived and validated a model for predicting the response of patients with HCC before receiving the first TACE that had adequate performance and utility. This model may be a useful and layered management tool for patients with HCC undergoing TACE.
RESUMO
BACKGROUND: Thoracoscopic anterior release has been shown that it can effectively improve spinal flexibility in animal and human cadaveric studies, and has been advocated for use in patients with scoliosis. This prospective case series aims to investigate the improvement of the spinal flexibility and the effectiveness in deformity correction by anterior thoracoscopic release and posterior spinal fusion. METHODS: Eleven patients with stiff idiopathic thoracic scoliosis underwent anterior thoracoscopic release followed by posterior instrumentation. The average number of discs excised was five. Spinal flexibility was assessed by the fulcrum bending technique. Cobb angle before and after the anterior release was compared. RESULTS: The patients were followed for an average of 5.6 years (range 2.2 to 8.1 years). Fulcrum bending flexibility was increased from 39% before the thoracoscopic anterior spinal release to 54% after the release. The average Cobb angle before anterior release was 74 degrees on the standing radiograph and 45 degrees with the fulcrum-bending radiograph. This reduced to 34 degrees on the fulcrum-bending radiograph after the release, and highly corresponded to the 31 degrees measured at the post-operative standing radiograph. CONCLUSION: It was demonstrated in patients with stiff idiopathic thoracic scoliosis that thoracoscopic anterior spinal release can effectively improve the spinal flexibility and increase the correction of the spinal deformity.
