Establishment and validation of a prognostic model for hepatocellular carcinoma after radical liver resection.

PURPOSE: The prognostic factors related to survival of primary hepatocellular carcinoma (HCC) after radical resection were analyzed in order to establish a new prognostic model for HCC patients and to shed light on personalized treatments. METHODS: 141 patients pathologically diagnosed with HCC were enrolled. The independent prognostic factors affecting overall survival were identified, and a prognostic mathematical model was established. Independent samples of 21 cases were used to validate the model's ability to predict prognosis of HCC patients. RESULTS: The median survival time was 34 months, and the 1-, 3-, and 5-year overall survival rates were 93.2%, 80%, and 68.9%, respectively. Univariate analysis showed that alpha fetoprotein (AFP) serum level, tumor size, tumor capsule, liver cirrhosis, neutrophil-to-lymphocyte ratio (NLR), and total bilirubin (TBIL) were significantly correlated with overall survival (p<0.05). Cox multivariate analysis indicated that the independent prognostic factors were AFP serum level, liver cirrhosis, tumor size, tumor capsule, and NLR. The prognostic mathematical model was: Prognostic Index (PI)=1.725 * liver cirrhosis + 0.783 * NLR + 1.046 * AFP + 0.595 * tumor size - 0.811 * tumor capsule. Based on the PI quartiles, 3.933 (25%), 4.716 (50%), and 5.195 (75%), the patients were divided into 4 groups: low risk (PI﹤3.933), moderate-risk (3.933 ≤ PI < 4.716), high-risk (4.761 ≤ PI < 5.195), and very high-risk (PI ≥ 5.195) group. The median survival times were 60, 34, 32, and 20 months, respectively. The 1-, 2-, 3-, and 5-year cumulative survival rates were 100%, 96%, 96%, 86%; 89%, 75%, 68%, 68%; 77%, 68%, 57%, 44%; 50%, 34%, 29%, 29%, separately. The predictions of the prognostic model demonstrated good consistency with the actual results. The total accuracy rate was 80.9%, and the Kappa consistency coefficient was 0.571 (p=0.009). CONCLUSIONS: The higher the PI, the lower the postoperative cumulative survival rate and the worse the prognosis. This model can be used as an effective method to assess the prognosis of HCC patients after resection.

rs895819 in microRNA-27a increase stomach neoplasms risk in China: A meta-analysis.

BACKGROUND: Across the globe, gastric cancer is a significant public health problem. This meta-analysis was conducted to investigate the association of microRNA-27a (miRNA-27a) rs895819 with gastric cancer risk. METHODS: The search of databases updated on October 10, 2018 included Pubmed, Embase, Cochrane Library and Web of science. Odds ratio (ORs) and 95% confidence interval (CIs) were calculated to assess the risk of tumor. RESULTS: Overall meta-analysis suggested the miRNA-27a rs895819 was not related to the gastric carcinogenesis among all model including allele contrast (G vs A, pooled OR: 1.096, 95% CI: 0.962-1.249, P = 0.196), codominant model (GG vs AA, pooled OR: 1.124, 95% CI: 0.794-1.592, P = 0.590; AG vs AA, pooled OR: 1.101, 95% CI: 0.966-1.217, P = 0.060), dominant model (AG + GG vs AA, pooled OR: 1.123, 95% CI: 0.964-1.307, P = 0.136) and recessive model (GG vs AG + AA, pooled OR: 0.927, 95% CI: 0.673-1.278, P = 0.644). Interestingly, among different ethnicity group, significant relation between rs895819 and gastric cancer was observed in co-dominant model among Chinese population (AG vs AA, pooled OR: 1.158, 95% CI: 1.038-1.291, P = 0.008) but not some regions of European population (AG vs AA, pooled OR: 0.852, 95% CI: 0.632-1.148, P = 0.179). CONCLUSIONS: Our results find that rs895819 contributed to occurrence of gastric cancer in co-dominant model in Chinese population.

Meta-Analysis for the Therapeutic Effect of Neoadjuvant Therapy in Resectable Esophageal Cancer.

We aimed to review the therapeutic effects of neoadjuvant chemoradiotherapy (NCRT), chemotherapy (NCT), and radiotherapy (NRT) on patients with resectable Esophageal cancer (EsC) by comparison with surgery alone (SA). PubMed, EMBASE and Cochrane were searched for eligible studies published up to March 2015. Cochrane reviews were used for quality assessment. Eight primary outcomes were analyzed. Risk ratios (RRs)/ hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) were calculated using the random- or fixed- effects model. Heterogeneity was assessed using the Chi-square-based Q statistic and the I 2 test. Publication bias was examined by the Begg's funnel plot. Totally 24 articles including 4718 EsC cases were eligible for this meta-analysis. The quality of the literatures was relatively high. Significant difference was found in five-year survival rate (RR = 1.45, 95% CI: 1.17-1.79, P < 0.01) between patients treated with NCT and SA, while the eight enrolled primary outcomes were all statistically different between NCRT and SA, and significant difference was identified in three-year survival between NCRT and NCT (RR = 1.35, 95% CI: 1.14-1.60, P < 0.01). No obvious publication bias was observed. NCRT and NCT provide an obvious benefit for EsC treatment over SA, and NCRT possesses a clear advantage compared with NCT.

Primary hepatic malignant melanoma: a case report.

Primary hepatic malignant melanoma is a very rare disease. In order to provide clues concerning diagnosis, differential diagnosis and pathogenesis of the disease, a case of a 49 year-old female patient with primary hepatic malignant melanoma is presented. B-mode ultrasound and Contrast-enhanced abdominal computerized tomography (CT) examinations revealed that nodules of varying sizes are diffusely distributed in her enlarged liver. Pathological examination revealed that tumor cells with poor differentiation were located in nests with prominent melanin deposition. Immuno-histochemical staining showed that the tumor cells were positive for HMB-45 and S-100 protein. No evidence for primary malignant melanoma of other sites had been found by comprehensive examinations. Therefore, the patient was diagnosed with primary malignant melanoma of liver. Our case showed that primary malignant melanoma of liver is of histological heterogeneity, and immunohistochemical staining may aid in differential diagnosis between it and other hepatic neoplasms.

Analysis of the causes and clinical characteristics of jejunoileal hemorrhage in China: a multicenter 10 year retrospective survey.

BACKGROUND: A retrospective study was performed to assess the causes, diagnostic methods for, and clinical features of, jejunoileal hemorrhage in Shandong province, China and to derive recommendations for management of this condition from these data. METHODS: We performed a retrospective systematic collection of data from between January 1999 and December 2008 in seven cities in Shandong province, China, identified 72 patients with jejunoileal hemorrhage and analyzed the relevant clinical data. RESULTS: Overall, tumors were the most common cause of jejunoileal hemorrhage (42 patients, 58.3%). The causes of this condition were significantly different (P < 0.05) in male and female patients. In male patients, the commonest factors were tumor (52.2%), enteritis (17.4%) and angiopathy (15.2%). However, in female patients, tumors accounted for a greater proportion of cases (18/26, 69.2%). In 38 cases (52.8%) the diagnosis was made by intraoperative enteroscopy or laparotomy, in 14 by capsule endoscopy and in the remainder by radiological methods. The most frequent presentation was melena (62.7%), followed by maroon stools (26.9%) and hematochezia (9.0%). Of the 72 patients,laparotomy is the main treatment method. CONCLUSION: Tumor, enteritis and angiopathy and diverticular disease are the most common causes of jejunoileal hemorrhage in Shandong province, China. The main clinical manifestations are bloody stools, most commonly in the form of melena, with or without abdominal pain. We recommend that female patients over the age of 40 with jejunoileal hemorrhage accompanied by abdominal pain should undergo urgent further assessment because of the strong probability of jejunoileal tumor.