肝动脉化疗栓塞对肝癌术后高危复发患者的疗效分析

目的 探讨原发性肝癌切除术后肝动脉化疗栓塞(TACE)的疗效.方法 将86例肝癌术后的高危复发患者分为干预组(TACE治疗组)和对照组(未行TACE治疗组).术后高危复发的标准为:①单发病灶>5 cm;②病灶数≥2处;③术后病理检查有镜下癌栓.符合其中任意一条为术后高危复发患者.干预组术后1～2月行TACE治疗.结果 ...     

肝细胞癌术后复发患者行TACE治疗疗效及影响因素分析

目的探究肝细胞癌(HCC)术后复发患者行经肝动脉介入化疗栓塞术(TACE)治疗疗效及术后复发的影响因素。方法回顾性分析120例HCC术后复发患者的临床资料,依据术后是否接受TACE治疗分为TACE组(n=68)和非TACE组(n=52),统计两组随访生存率,分析患者TACE预后影响因素。结果 TACE组1、2年总体生存率分别为88.2%、80.9%,与非TACE组的86.5%、76.9%比较,差异无统计学意义(P0.05),TACE组术后3年总体生存率67.65%较非TACE组的48.08%高(P0.05)。血管侵犯(OR=1.102,P=0.013,95%CI:1.016～1.382)、最大癌结节直径5 cm(OR=1.433,P=0.005,95%CI:1.012～2.238)是HCC术后复发患者TACE预后的影响因素(P0.05)。结论 HCC术后复发患者行TACE能有效改善预后,或可推荐血管侵犯、最大癌结节直径5 cm的术后复发患者行TACE治疗。     

缺血性脑卒中病人Essen评分复发风险分层分析临床特点及近期预后

目的对缺血性脑卒中(IS)复发病人使用Essen卒中风险评分量表(ESRS)进行危险度分层,探讨脑卒中不同复发危险度病人的临床特点及近期预后。方法研究对象为2008年3月—2010年12月收治的124例急性缺血性脑卒中病人,根据ESRS分为IS复发高危组(ESRS≥3分,高危组)75例和IS复发低危组(ESRS3分,低危组)49例。比较两组人群的卒中危险因素、入院即刻和14 d神经功能缺损程度(NIHSS)、日常生活依赖程度(MRS),分析脑卒中复发高危与低危病人的临床特点和近期预后。结果高危组与低危组病人ESRS相关危险因素,高危组年龄、高血压病、糖尿病、心肌梗死病史、短暂性脑缺血发作(TIA)/脑梗死病史的伴发率显著高于低危组(P0.05)。脑卒中复发高危组较复发低危组NIHSS评分低(6.59±4.52 vs 7.80±4.36;t′=-2.198,P=0.030)。治疗14 d后,低危组NIHSS差值较高危组改善明显(-1.81分±2.19分vs-2.65分±2.32分,P0.05),日常生活不依赖(MRS≤2分)增加人数明显多于高危组(20.4%vs 6.7%,P0.05)。结论两组病人相比较,高危病人卒中危险因素显著多于低危病人,高危病人入院时神经功能缺损程度轻于低危病人,高危病人神经功能缺损改善程度较低危病人差。提示ESRS高危低危各组病人各具临床特点,近期预后不同,对卒中病人进行ESRS高危低危分组有助于卒中疗效及近期预后评估。     

新型胃癌筛查评分系统与血清学新ABC法在胃癌及癌前病变筛查中的比较研究

目的比较新型胃癌筛查评分系统与血清胃蛋白酶原(pepsinogen,PG)联合胃泌素-17(gastrin-17,G-17)(新ABC法)在胃癌及癌前病变筛查中的价值。方法纳入2017年12月至2019年12月因胃部不适在嘉兴市第一医院行胃镜检查的患者共576例。其中男275例、女301例,年龄40~72(52±10)岁,内镜检查前根据患者年龄、性别、血清幽门螺杆菌(helicobacter pylori,H.pylori)抗体、PGⅠ/PGⅡ的比值(PGR)及G-17检测结果,按照血清学新ABC法和新型胃癌筛查评分系统各自将人群分成低危、中危、高危三组。分析两种不同方法胃癌及萎缩性胃炎检出情况,评价两种不同方法在胃癌及癌前病变筛查中的价值。统计学方法采用卡方检验以及Gamma系数检验分析模型。结果576例患者中,根据血清学新ABC法,低危组382例,中危组170例,高危组24例。三组胃癌检出情况分别为低危组1例(0.3%),中危组8例(4.7%),高危组3例(12.5%)。萎缩性胃炎检出情况分别为低危组89例(23.3%),中危组94例(55.3%),高危组18例(75.0%)。根据新型胃癌筛查评分系统,低危组336例,中危组205例,高危组35例。其中胃癌检出情况分别为低危组1例(0.3%),中危组6例(2.9%),高危组5例(14.3%)。萎缩性胃炎检出情况分别为低危组41例(12.2%),中危组134例(65.4%),高危组26例(74.3%)。两种方法中,胃癌检出率均随着分组等级的升高逐渐上升(χ²=22.509,P<0.01;χ²=24.156,P<0.01);萎缩性胃炎,新筛查评分系统在低危组中萎缩性胃炎的检出率明显低于新ABC法(χ²=14.844,P<0.01),但在中危组中检出率更高(χ²=3.955,P=0.047)。最后,Gamma系数检验显示两种方法的分组等级与胃镜病理、胃黏膜萎缩程度之间均存在着较强的相关性(P<0.01)。结论两种方法均适用于胃癌及癌前病变筛查,而其中新评分系统在胃癌筛查及癌前病变早期干预方面中可能具有更高价值。     

中国早期胃癌筛查流程专家共识意见 在广东地区的应用

目的探讨“中国早期胃癌筛查流程专家共识意见”在广东地区胃癌风险人群中的应用价值。方法纳入2018年3月—2019年3月在广东地区进行早期胃癌筛查的居民,采用量化的新型胃癌筛查评分系统进行胃癌初筛,根据初筛结果将患者分为高危组、中危组和低危组,比较各组精查胃镜下早期胃癌、癌前疾病、癌前病变的检出率,统计学分析采用卡方检验。结果完成精查胃镜检查共545例,其中高危组32例,中危组184例,低危组329例。精查胃镜结果显示,早期胃癌检出率方面,高危组(12.5%)>中危组(1.1%)>低危组(0),差异有统计学意义（χ2＝41.85,P<0.01）;癌前疾病检出率方面,高危组(60.9%)>中危组(52.4%)>低危组(34.3%),差异有统计学意义（χ2＝18.00,P<0.01）;癌前病变检出率分别为17.9%、8.8%及8.8%,差异无统计学意义（χ2＝2.58,P＝0.28）。内镜病变检出阳性率组间比较,高危组(71.9%)>中危组(57.1%)>低危组(40.1%),差异有统计学意义（χ2＝21.54,P<0.01）。结论“中国早期胃癌筛查流程专家共识意见”在广东地区胃癌风险人群的早期胃癌及癌前疾病筛查中具有较好的应用价值。     

射波刀联合经导管肝动脉化疗栓塞治疗原发性肝癌的疗效及预后分析

目的探讨射波刀联合经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗原发性肝癌(直径≥5 cm)的生存率及影响因素。方法研究对象为我院2011年1月—2013年5月收治的110例原发性肝癌患者,55例采用射波刀联合TACE治疗(治疗组),55例单独接受TACE治疗(对照组),均随访至2015年5月1日,比较2组的局部控制率、临床获益率、中位总生存时间(m OS)、中位肿瘤无进展生存时间(m PFS)及术后6、12、18、24个月的生存情况,分析生存率的影响因素。结果在肿瘤病灶局部控制率方面,治疗组为90.91%,显著优于对照组的63.64%(P=0.001)。2组生存曲线差异有统计学意义,术后6、12、18和24个月生存率方面,治疗组分别为96.36%、85.45%、58.18%、38.18%,对照组分别为78.18%、38.18%、30.91%、23.64%。治疗组和对照组的m OS分别为19个月和10个月,m PFS分别为7.0个月和2.5个月。Cox回归模型分析发现,治疗组肿瘤大小和有无腹水是生存率的影响因素。结论对于大肝癌患者,射波刀联合TACE可增加肿瘤局部控制率,有效延缓肿瘤复发,提高生存率,明显优于单纯TACE治疗,可作为直径≥5 cm肝癌治疗选择之一。而肿瘤大小和腹水可能影响既往接受射波刀患者的生存情况。     

早期胃癌内镜黏膜下剥离术后eCura危险评分系统的临床验证研究

目的验证早期胃癌内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）非治愈性切除术后淋巴结转移风险评估系统——“eCura system”的临床适用性。方法2012年1月—2018年3月，因早期胃癌在南京大学医学院附属南京鼓楼医院行ESD治疗，且术后病理提示ESD非治愈性切除的155例病例被纳入回顾性分析，根据eCura评分系统对病例进行评分，按评分结果分成3组，低危组（0～1分）100例、中危组（2～4分）46例、高危组（5～7分）9例，观察各组随访期内淋巴结转移情况及预后。结果155例随访时间（25±15.0）个月，其中低危组中位随访25个月，中危组中位随访23个月，高危组中位随访34个月。低危组追加外科手术57例，其中3例[5.26%（3/57）]淋巴结转移；中危组追加外科手术29例，其中2例[6.90%（2/29）]淋巴结转移；高危组9例，均追加外科手术，4例淋巴结转移。多因素Logistic回归分析提示高危组淋巴结转移风险明显高于低危组(P=0.003，OR=14.499,95%CI：2.513～97.214)，而中危组淋巴结转移风险较低危组略高(P=0.767，OR=1.326,95%CI：0.165～8.594)。随访过程中，低危组无远处转移及肿瘤相关死亡，43例未追加外科手术者中发现3例[6.98%（3/43）]复发。中危组17例未追加外科手术者中发现1例[5.88%（1/17）]复发，2例[11.76%（2/17）]远处转移，其中1例[5.88%（1/17）]死于脑转移；29例追加外科手术者在随访期间无复发、远处转移及肿瘤相关死亡。高危组9例在ESD术后均追加了外科手术，随访期间无复发、远处转移及肿瘤相关死亡。结论eCura评分系统可用于早期胃癌ESD非治愈性切除病例的淋巴结转移风险预测，低危患者追加外科手术的获益有限，而中、高危患者追加外科手术可有效改善预后。     

短暂性脑缺血发作患者ABCD2评分与颅内动脉狭窄的相关性研究

目的探讨短暂性脑缺血发作(TIA)患者ABCD2评分与颅内动脉狭窄的关系。方法选取2010年8月—2013年5月我院收治的行经颅多普勒(TCD)超声检查的TIA患者75例,根据ABCD2评分将患者分为低危组(16例)、中危组(37例)、高危组(22例)。分析3组患者颅内动脉狭窄的发生情况。结果高危组颅内动脉狭窄发生率为86.4%(19/22),中危组颅内动脉狭窄发生率为40.5%(15/37),低危组颅内动脉狭窄发生率为31.2%(5/16)。高危组颅内动脉狭窄发生率高于低、中危组(P0.05)。39例颅内动脉狭窄的TIA患者中,颅内受累血管为大脑中动脉25例(64.1%),颈内动脉颅内段10例(25.6%)。结论 ABCD2评分≥6分时颅内动脉狭窄发生率增高,可能是高危TIA患者进展为脑梗死的原因之一。     

海岛居民前列腺癌患者同分级患者术后康复对比及其危险因素

目的对海岛居民前列腺癌患病情况进行分析,讨论其主要危险因素以及不同分级病患术后康复情况。方法选取2012年1月1日至2017年1月1日期间,来我院就诊的前列腺癌病患30例。根据Gleason评分和前列腺特异抗原(PSA)值将病患划分为三组,分别为高危组12例、中危组10例,低危组8例;按照所搜集病患一般资料,对海岛居民前列腺癌患者危险因素进行分析,并对比讨论不同分级患者术后康复情况。结果体质量指数(OR=1.021、P=0.006)、年龄(OR=2.343,P=0.008)、前列腺炎(OR=3.561、P=0.007)均对前列腺癌患者生存质量有较强解释能力,为主要危险因素。前列腺患者的保护因素包括:首次性生活时间(OR=0.776、P=0.003)和首次遗精时间(OR=0.321、P=0.005)。低危组病患预后康复情况较为理想,并预后康复情况和Gleason评分之间呈现出明显的反比例关系。高危组术后复发率为57.63%、中危组术后复发率为27.78%、低危组组术后复发率为13.79%,可明显看出低危组患者复发率相对于高危组和中危组复发率明显偏低(χ~2=6.253、7.142,P0.01);高危组术后病死率为11.86%、中危组术后病死率为5.56%、低危组组术后病死率为3.45%,可见高危组术后病死率水平明显高于其他两组(χ~2=8.214、7.142,P0.01)。结论体重质量超标、年龄偏大、前列腺炎是临床上前列腺病患的主要危险因素;而保护因素包括首次性生活时间较晚、首次遗精时间晚。一般情况下,低危组在术后康复情况方面明显优于高危组和中危组病患,而病死率水平则明显低于两组。前列腺分级对海岛居民的前列腺癌临床治疗工作的开展有着重要的积极意义。     

窦性心率震荡在不稳定型心绞痛患者危险分层中的作用

目的：评价窦性心率震荡指标在不稳定型心绞痛（UAP）的患者危险分层中的作用。方法：对63例确诊为UAP的患者（UAP组）和49例健康体检者（健康对照组）行24h动态心电图检查,比较其窦性心率震荡（HRT）指标;根据GRACE评分UAP患者被进一步分为UAP低危组、中危组、高危组,比较各分组间HRT指标的差异和HRT异常的发生率。结果：UAP组震荡初始（TO）明显高于健康对照组[（1.30±1.53）%∶（0.08±1.79）%,P〈0.01];震荡斜率（TS）明显低于健康对照组[（1.90±0.56）∶（4.22±3.77）,P=0.001]。UAP组不同危险分层亚组中,与低危组比较,中危组有TO增大、TS减小的趋势,但差异无显著性。高危组TO则显著增大[（0.55±1.61）%∶（2.05±1.21）%,P〈0.01]、TS显著减小[（2.20±0.59）∶（1.71±0.44）,P〈0.01]。与低危组比较,中危组HRT2异常率有升高的趋势,差异无显著性（x2=2.385,P=0.063）,高危组HRT2异常率显著升高（x2=9.227,P=0.01）。结论：结果提示窦性心率震荡指标可作为不稳定型心绞痛高危分层的一项新的心电学筛选指标。     

Lipiodolized transarterial chemoembolization in hepatocellular carcinoma patients after curative resection

Purpose

To explore the effect of lipiodolized transarterial chemoembolization (lip-TACE) in hepatocellular carcinoma (HCC) patients at different risk of recurrence after curative resection.

Methods

One thousand nine hundred and twenty-four consecutive HCC patients who underwent curative resection were retrospectively analyzed. Patients who underwent resection only were classified into control group, while those received adjuvant lip-TACE were classified into intervention group. Patients were further stratified into 4 groups, that is, tumor ≤5 cm with low or high risk factors, as well as tumor >5 cm with low or high risk factors for recurrence. Tumor number and microscopic tumor thrombus were defined as risk factors for recurrence. The effect of adjuvant lip-TACE on early (<2 year) or late (≥2 year) recurrence was evaluated.

Results

There was no significant difference in recurrence curve between intervention group and control group in each stratum. Adjuvant lip-TACE showed an overall survival benefit in patients with tumor >5 cm and presenting high risk factors, mainly for those with time to recurrence (TTR) <2 years after operation. For them, the median survival was 17 months in the intervention group and 11 months in the control group (P = 0.010). For patients who were confirmed to be recurrence-free at 2 years after operation, it had the negative effect for survival (HR = 1.75, P = 0.004).

Conclusion

Adjuvant lip-TACE had no preventive effect on recurrence, but may be of benefit to detect early recurrence.     

Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor:A retrospective control study

AIM:To evaluate the effect of postoperative adjuvanttranscatheter arterial chemoembolization(TACE)on theprognosis of hepatocellular carcinoma(HCC)patients withor without risk factors for the residual tumor.METHODS:From January 1995 to December 1998,549consecutive HCC patients undergoing surgical resectionwere included in this research.There were 185 patientswho underwent surgical resection with adjuvant TACE and364 patients who underwent surgical resection only.Tumorswith a diameter more than 5 cm,multiple nodules,andvascular invasion were defined as risk factors for residualtumor and used for patient stratification.Kaplan-Neiermethod was used to analyze survival curve and Coxproportional hazard model was used to evaluate theprognostic significance of adjuvant TACE.RESULTS:In the patients without any risk factors for theresidual tumor,the 1-,3-,5-year survival rates were 93.48%,75.85%,62.39% in the control group and 97.39%,70.37%,50.85% in the adjuvant TACE group,respectively.Therewas no significant difference in the survival between twogroups(P=0.3956).However,in the patients with riskfactors for residual tumor,postoperative adjuvant TACEsignificantly prolonged the patients' survival.There was astatistically significant difference in survival between twogroups(P=0.0216).The 1-,3-,5-year survival rates were69.95%,49.86%,37.40% in the control group and 89.67%,61.28%,44.36% in the adjuvant TACE group,respectively.Cox proportional hazard model showed that tumor diameterand cirrhosis,but not the adjuvant TACE,were the significantlyindependent prognostic factors in the patients without riskfactors for residual tumor.However,in the patients withrisk factors for residual tumor adjuvant TACE,and alsotumor diameter,AFP level,vascular invasion,were thesignificantly independent factors associated with thedecreasing risk for patients'death from HCC.CONCLUSION:Postoperative adjuvant TACE can prolongthe survival of patients with risk factors for residual tumor,but can not prolong the survival of patients without riskfactors for residual tumor.     

Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor： A retrospective control study

AIM: To evaluate the effect of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on the prognosis of hepatocellular carcinoma (HCC) patients with or without risk factors for the residual tumor. METHODS: From January 1995 to December 1998, 549 consecutive HCC patients undergoing surgical resection were included in this research. There were 185 patients who underwent surgical resection with adjuvant TACE and 364 patients who underwent surgical resection only. Tumors with a diameter more than 5 cm, multiple nodules, and vascular invasion were defined as risk factors for residual tumor and used for patient stratification. Kaplan-Meier method was used to analyze survival curve and Cox proportional hazard model was used to evaluate the prognostic significance of adjuvant TACE.RESULTS: In the patients without any risk factors for the residual tumor, the 1-, 3-, 5-year survival rates were 93.48%,75.85%, 62.39% in the control group and 97.39%, 70.37%,50.85% in the adjuvant TACE group, respectively. There was no significant difference in the survival between two groups (P = 0.3956). However, in the patients with risk factors for residual tumor, postoperative adjuvant TACE significantly prolonged the patients‘ survival. There was a statistically significant difference in survival between two groups (P= 0.0216). The 1-, 3-, 5-year survival rates were 69.95%, 49.86%, 37.40% in the control group and 89.67%,61.28%, 44.36% in the adjuvant TACE group, respectively. Cox proportional hazard model showed that tumor diameter and cirrhosis, but not the adjuvant TACE, were the significantly independent prognostic factors in the patients without risk factors for residual tumor. However, in the patients with risk factors for residual tumor adjuvant TACE, and also tumor diameter, AFP level, vascular invasion, were the significantly independent factors associated with the decreasing risk for patients‘ death from HCC. CONCLUSION: Postoperative adjuvant TACE can prolong the survival of patients with risk factors for residual tumor,but can not prolong the survival of patients without risk factors for residual tumor.     

Novel biomarkers GEP/ABCB5 regulate response to adjuvant transarterial chemoembolization after curative hepatectomy for hepatocellular carcinoma

Background: Transarterial chemoembolization(TACE) is the most commonly used adjuvant therapy for hepatocellular carcinoma(HCC) after curative resection. Responses to TACE are variable due to tumor and patient heterogeneity. We had previously demonstrated that expression of Granulin-epithelin precursor(GEP) and ATP-dependent binding cassette(ABC)B5 in liver cancer stem cells was associated with chemoresistance. The present study aimed to evaluate the association between GEP/ABCB5 expression and response to adjuvant TACE after curative resection for HCC. Methods: Patients received adjuvant TACE after curative resection for HCC and patients received curative resection alone were identified from a prospectively collected database. Clinical samples were retrieved for biomarker analysis. Patients were categorized into 3 risk groups according to their GEP/ABCB5 status for survival analysis: low(GEP-/ABCB5-), intermediate(either GEP +/ABCB5-or GEP-/ABCB5 +) and high(GEP +/ABCB5 +). Early recurrence(recurrence within 2 years after resection) and disease-free survival were analyzed. Results: Clinical samples from 44 patients who had followed-up for more than 2 years were retrieved for further biomarker analysis. Among them, 18 received adjuvant TACE and 26 received surgery alone. Patients with adjuvant TACE in the intermediate risk group was associated with significantly better overall survival and 2-year disease-free survival than those who had surgery alone( P = 0.036 and P = 0.011, respectively). Adjuvant TACE did not offer any significant differences in the early recurrence rate, 2-year disease-free survival and overall survival for patients in low and high risk groups. Conclusions: Adjuvant TACE can only provide survival benefits for patients in the intermediate risk group(either GEP +/ABCB5-or GEP-/ABCB5 +). A larger clinical study is warranted to confirm its role in patient selection for adjuvant TACE.     

Adjuvant transarterial chemoembolization after curative resection of hepatocellular carcinoma: Propensity score analysis

AIM: To compare survival and recurrence in hepatocellular carcinoma (HCC) patients who did or did not receive adjuvant transarterial chemoembolization (TACE).METHODS: A consecutive sample of 229 patients who underwent curative resection between March 2007 and March 2010 in our hospital was included. Of these 229 patients, 91 (39.7%) underwent curative resection followed by adjuvant TACE and 138 (60.3%) underwent curative resection alone. In order to minimize confounds due to baseline differences between the two patient groups, comparisons were conducted between propensity score-matched patients. Survival data and recurrence rates were compared using the Kaplan-Meier method. Independent predictors of overall survival and recurrence were identified using Cox proportional hazard regression.RESULTS: Among 61 pairs of propensity score-matched patients, the 1-, 2-, and 3-year overall survival rates were 95.1%, 86.7%, and 76.4% in the TACE group and 86.9%, 78.5%, and 73.2% in the control group, respectively. At the same time, the TACE and control groups also showed similar recurrence rates at 1 year (13.4% vs 24.8%), 2 years (30.6% vs 32.1%), and 3 years (40.1% vs 34.0%). Multivariate Cox regression identified serum alpha-fetoprotein level ≥ 400 ng/mL and tumor size > 5 cm as independent risk factors of mortality (P < 0.05).CONCLUSION: As postoperative adjuvant TACE does not improve overall survival or reduce recurrence in HCC patients, further study is needed to clarify its clinical benefit.     

Adjuvant transarterial chemoembolization for patients with hepatocellular carcinoma after radical hepatectomy: a real world study

Abstract

Objective: To investigate the clinical value of the adjuvant transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) after radical resection, and identify the potential beneficiaries.

Methods: Patients were identified through the primary liver cancer big data (PLCBD) between 2012 and 2015. Overall survival (OS) between adjuvant TACE group and non-TACE was evaluated by Kaplan-Meier before and after propensity scoring match (PSM). Subgroup analysis was conducted stratified by risk factors.

Results: A total of 2066 HCC patients receiving radical resection were identified. Patients with multiple tumors, tumor diameter >5?cm, satellite, and advanced stage were more likely to accept adjuvant TACE. Before PSM, the 1-, 3-, and 5-year OS rates in the TACE group and non-TACE group were 89%, 58%, 17%, and 88%, 53%, 13% (p?=?.43), respectively. While, the corresponding rates were 89%, 58%, 17%, and 86%, 49%, 11%, (p?=?.038), respectively after 1:1 PSM. In addition, patients were found to significantly benefit from adjuvant TACE if they had age ≥50?years, no cirrhosis, AFP ≤ 200?ng/ml, surgical margin <1?cm, tumor diameter >5?cm, no capsule, no satellite, or CN stage Ib/IIa (all p?<?.05), but patients with age < 50?years, tumor size ≤5?cm, or CN stage Ia were found to significantly benefit from radical resection in DFS (all p?<?.05).

Conclusion: Currently, we concluded that not all of patients with HCC would benefit from adjuvant TACE. Patients with age ≥50?years, tumor size >5?cm, or CN stage Ib/IIa were strongly recommended to receive adjuvant TACE.     

Efficacy of postoperative adjuvant transcatheter arterial chemoembolization in hepatocellular carcinoma patients with microvascular invasion

AIM To investigate the efficacy and safety of postoperative adjuvant transcatheter arterial chemoembolization(PA-TACE) in preventing tumor recurrence and improving survival in Barcelona Clinic Liver Cancer(BCLC) early(A) and intermediate(B) stage hepatocellular carcinoma(HCC) patients with microvascular invasion(MVI).METHODS A total of 519 BCLC A or B HCC patients treated by liver resection alone or followed by PA-TACE between January 2012 and December 2015 were studied retrospectively. Univariate and multivariate analyses were performed to investigate the risk factors for recurrence-free survival(RFS) and overall survival(OS). Multiple logistic regression was used to identify the clinicopathological characteristics associated with MVI. The rates of RFS and OS were compared among patients with or without MVI treated with liver resection alone or followed by PA-TACE. RESULTS Univariate and multivariate analyses demonstrated that serum AFP level 400 ng/m L, tumor size 5 cm, tumor capsule invasion, MVI, and major hepatectomy were risk factors for poor OS. Tumor capsule invasion, MVI, tumor size 5 cm, HBV-DNA copies 1 x 104 IU/m L, and multinodularity were risk factors for poor RFS. Multiple logistic regression identified serum AFP level 400 ng/m L, tumor size 5 cm, and tumor capsule invasion as independent predictors of MVI. Both OS and DFS were significantly improved in patients with MVI who received PA-TACE as compared to those who underwent liver resection alone. Patients without MVI did not show a significant difference in OS and RFS between those treated by liver resection alone or followed by PA-TACE.CONCLUSION PA-TACE is a safe adjuvant intervention and can efficiently prevent tumor recurrence and improve the survival of BCLC early-and intermediate-stage HCC patients with MVI.     

Predictive value of tumor markers in patients with recurrent hepatocellular carcinoma in different vascular invasion pattern

BACKGROUND: Four tumor markers for hepatocellular carcinoma(HCC), alpha-fetoprotein(AFP), glypican-3(GPC3), vascular endothelial growth factor(VEGF) and des-gammacarboxy prothrombin(DCP), are closely associated with tumor invasion and patient's survival. This study estimated the predictability of preoperative tumor marker levels along with pathological parameters on HCC recurrence after hepatectomy.METHODS: A total of 140 patients with HCC who underwent hepatectomy between January 2012 and August 2012 were enrolled. The demographics, clinical and follow-up data were collected and analyzed. The patients were divided into two groups: patients with macroscopic vascular invasion(Ma VI +) and those without Ma VI(Ma VI-). The predictive value of tumor markers and clinical parameters were evaluated by univariate and multivariate analysis.RESULTS: In all patients, tumor size(8 cm) and Ma VI were closely related to HCC recurrence after hepatectomy. For Ma VI+ patients, VEGF(900 pg/m L) was a significant predictor for recurrence(RR=2.421; 95% CI: 1.272-4.606; P=0.007). The 1- and 2-year tumor-free survival rates for Ma VI+ patients with VEGF ≤900 pg/m L versus for those with VEGF 900 pg/m L were 51.5% and 17.6% versus 19.0% and 4.8%(P0.001). For Ma VI- patients, DCP 445 m Au/m L and tumor size 8 cm were two independent risk factors for tumor recurrence(RR=2.307, 95% CI: 1.132-4.703, P=0.021; RR=3.150, 95% CI: 1.392-7.127, P=0.006; respectively). The 1- and 2-year tumor-free survival rates for the patients with DCP ≤445 m Au/m L and those with DCP 445 m Au/m L were 90.4% and 70.7% versus 73.2% and 50.5% respectively(P=0.048). The 1-and 2-year tumor-free survival rates for the patients with tumor size ≤8 cm and 8 cm were 83.2% and 62.1% versus 50.0% and 30.0%, respectively(P=0.003).CONCLUSIONS: The Ma VI+ patients with VEGF ≤900 pg/m L had a relatively high tumor-free survival than those with VEGF 900 pg/m L. In the Ma VI- patients, DCP 445 m Au/m L and tumor size 8 cm were predictive factors for postoperative recurrence.     

Is inconsistency of α-fetoprotein level a good prognosticator for hepatocellular carcinoma recurrence?

AIM: To identify the clinical outcomes of hepato-cellular carcinoma (HCC) patients with inconsistent α-fetoprotein (AFP) levels which were initially high and then low at recurrence.METHODS: We retrospectively included 178 patients who underwent liver resection with high preoperative AFP levels (≥ 200 ng/dL). Sixty-nine HCC patients had recurrence during follow-up and were grouped by their AFP levels at recurrence: group Ⅰ, AFP ≤ 20 ng/dL (n = 16); group Ⅱ, AFP 20-200 ng/dL (n = 24); and group Ⅲ, AFP ≥ 200 n...