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1.
Lei Liang Hao Xing Han Zhang Jianhong Zhong Chao Li Wan Yee Lau Mengchao Wu Feng Shen Tian Yang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(2):110-119
Background & objective
Transarterial chemoembolization (TACE) is recommended as the first-line therapy for intermediate stage hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer (BCLC) algorithm. However, in clinical practice, many such patients undergo surgical resection. A meta-analysis with a systematic search of the medical literature was conducted to compare these two procedures for BCLC intermediate stage HCC.Methods
PubMed, Embase, Medline and Cochrane library were searched for studies comparing surgical resection with TACE for BCLC intermediate stage HCC that were published before December 2016. The primary outcome was overall survival, and the secondary outcomes were postoperative complications and 30-day mortality.Results
This meta-analysis included 9 studies with 2619 patients (surgical resection, n = 1204 (46%) and TACE, n = 1415 (54%)). When compared with the TACE group, the pooled hazard ratio (HR) for the 1, 3 and 5-year OS rates in patients who underwent surgical resection were 0.62 (95% CI 0.51–0.75, P = 0.39; I2 = 6%, P < 0.001), 0.58 (95% CI 0.51–0.67, P = 0.25; I2 = 22%, P < 0.001) and 0.59 (95% CI 0.54–0.64, P = 0.18; I2 = 20%, P < 0.001). No significant differences in the pooled odds ratios (OR) were found between surgical resection and TACE in postoperative complications and 30-day mortality [OR 1.23 (95% CI 0.87 to 1.74, P = 0.390; I2 = 0%, P = 0.240) and OR 1.11 (95% CI 0.60 to 2.04, P = 0.89; I2 = 0%, P = 0.740), respectively].Conclusion
This meta-analysis on studies on Asian HCC patients demonstrated surgical resection had better overall survival than TACE for patients with intermediate stage HCC, without any significant increase in postoperative complication or 30-day mortality rates. Further studies are needed to validate these results on Western patients, moreover, a reappraisal of the recommended treatments for BCLC intermediate stage HCC should be considered. 相似文献2.
Lei Liang Ting-Hao Chen Chao Li Hao Xing Jun Han Ming-Da Wang Han Zhang Wan Yee Lau Meng-Chao Wu Feng Shen Tian Yang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(12):1119-1129
Background
The prognosis of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) is very poor. According to most HCC guidelines, sorafenib, transarterial chemoembolization (TACE) or other non-surgical treatments are recommended as the first-line therapy for these patients. However, selected patients with HCC and PVTT can undergo surgical resection (SR). The aim of this meta-analysis was to compare the outcomes of SR with Non-SR for such patients.Methods
The PubMed, Embase, Medline and Cochrane library were searched for studies which compared SR with Non-SR for HCC and PVTT published before December 2017.Results
4810 patients from 7 studies who were enrolled in this meta-analysis were divided into the SR group (n = 2 344, 49%) and the Non-SR group (n = 2 476, 51%). The pooled hazard ratios (HRs) for the 1-, 3- and 5-year OS rates of the SR group when compared with the Non-SR group, were 0.57 (95% CI 0.48–0.67, P < 0.001), 0.66 (95% CI 0.56–0.77, P < 0.001) and 0.68 (95% CI 0.57–0.81, P < 0.001), respectively. On subgroup analysis, the pooled HRs for the 1-, 3- and 5-year OS rates of the SR group when compared with the TACE group, were 0.62 (95% CI 0.54–0.71, P < 0.001), 0.74 (95% CI 0.66–0.83, P < 0.001) and 0.78 (95% CI 0.70–0.87, P < 0.001), respectively.Conclusion
This meta-analysis showed SR resulted in better OS than TACE, or other Non-SR treatments, for patients with HCC and PVTT. SR should be considered in selected patients with resectable HCC and PVTT. 相似文献3.
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Liang-He Yu Wen-Long Yu Teng Zhao Meng-Chao Wu Xiao-Hui Fu Yong-Jie Zhang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(4):321-326
Background
Post-hepatectomy Liver Failure (PHLF) remains the primary cause of perioperative death. The kinetics of transaminase levels are usually measured as markers of hepatocellular injury following partial hepatectomy, but their correlation with PHLF and post-operative mortality is unclear. The aim of study was to compare the post-operative transaminase kinetics with short term survival in those patients that developed PHLF.Methods
A retrospective review of patients with HBV-related HCC and who developed PHLF was performed. Logistic regression analysis was conducted to analyze risk factors for postoperative delayed elevation of ALT (PDE-ALT) PHLF and lethal PHLF.Result
Of the 69 patients who developed PHLF 36 (52%) died. In those patients who died the mean ± SD ALT and AST rose from day (POD) 1–3 and continued to fluctuate with highly abnormal levels beyond day 3 with a mean ± SD peak ALT level beyond POD 3 of 1851 ± 1644 U/L (p < 0.001).Conclusions
The kinetics of the post-operative transaminases were significantly correlated with perioperative mortality in those patients who developed PHLF. PDE-ALT indicates an increased risk of death in HBV-related HCC patients with PHLF. 相似文献6.
7.
Jianwei Liu Han Zhang Yong Xia Tian Yang Yuzhen Gao Jun Li Yeye Wu Feng Shen 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(1):1-13
Background
Whether clinically significant portal hypertension (CSPH) is a contraindication of partial hepatectomy for patients with hepatocellular carcinoma (HCC) remains controversial. The aim was to assess the impact of CSPH on surgical morbidity, mortality and long-term survival of HCC patients who underwent partial hepatectomy.Methods
A systematic review and meta-analysis was conducted through analyzing the data published before October 2016 on outcomes following partial hepatectomy for HCC patients with CSPH from the Medline, Embase and CENTRAL databases and related literature.Results
A total of 16 studies involving 4029 patients met the inclusion criteria. HCC patients with CSPH had increased incidences of severe postoperative complications (pooled odds ratio [OR]: 1.66; 95% CI: 1.31–2.10), surgical mortality (2.56, 1.77–3.70) and 5-year mortality (1.29, 1.11–1.50) compared with patients without CSPH. Subgroup analysis suggested that CSPH had no impact on peri-operative mortality and long-term survival for European HCC patients whose CSPH was diagnosed by the standard surrogate criteria (1.95, 0.96–3.96; 1.24, 0.98–1.55).Conclusions
CSPH had a negative impact on short- and long-term prognoses for HCC patients undergoing partial hepatectomy. However, CSPH did not affect the prognoses in a subgroup of European HCC patients whose CSPH was diagnosed by the standard surrogate criteria. 相似文献8.
Xiu-Ping Zhang Yu-Zhen Gao Ya-Bo Jiang Kang Wang Zhen-Hua Chen Wei-Xing Guo Jie Shi Yao-Jun Zhang Min-Shan Chen Wan Y. Lau Shu-Qun Cheng 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):335-344
Background
Lymph node metastasis (LNM)has widely been recognized as a poor prognostic indicator for hepatocellular carcinoma (HCC) patients. Preoperative prediction of LNM is important for clinicians to decide on treatment. This study was designed to develop a simple and convenient system to predict LNM.Methods
Consecutive HCC patients who were suspected to have LNM were divided into a training, an internal validation and an external validation cohort. The receiver operating characteristic (ROC) analysis was used to determine the threshold value of the preoperative serological variables. A nomogram visualization system model was then established.Result
Of the 287 patients, there were 31 patients who had LNM (10.8%), and 21 of 203 patients (10.3%) were in the training cohort and 10 of 84 patients (11.9%) in the internal validation cohort. Sixteen of 176 patients (9.1%) in the external validation cohort had LNM. The serological indices including neutrophil/lymphocyte rate, age, platelet, prothrombin time, and total protein, were included in the nomogram. The areas of the ROC curve were 0.846, 0.679 and 0.738 in predicting LNM in the training cohort, the internal validation cohort and the external validation cohort, respectively.Conclusion
The scoring system constructed using the preoperative serological variables predicted LNM in HCC patients. 相似文献9.
Zhijian Wen Anfeng Si Jue Yang Pinghua Yang Xinwei Yang Hu Liu Xingzhou Yan Wengang Li Baohua Zhang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(11):951-956
Aims
The aim of this study was to determine whether a combination of the tumour markers carcinoembryonic (CEA) and carbohydrate antigen 19-9 (CA19-9) would be helpful in predicting the prognosis of patients with gallbladder carcinoma (GBC) who underwent resection.Methods
A retrospective analysis of clinico-pathological features and survival of 390 patients with GBC who were treated between January 2003 and December 2013. Time-dependent receiver operating characteristic (ROC) was used to evaluate the prognostic ability of tumour markers. Combinations of preoperative CEA and CA19-9 were tested as potential prognostic factors.Results
The evaluation of preoperative CEA and CA19-9 showed that patients with both tumour markers within the normal range had the best prognosis with a median survival of 27 months and R0 rate of 86%. Patients with both tumour markers elevated had the poorest prognosis and lower R0 rate (p < 0.001). The combination of CEA and CA19-9 was an independent risk factor for overall survival. The AUROC at 5 years of combination of CEA and CA19-9 was 0.798, which was similar to CEA (0.765) or CA19-9 (0.771) alone (p = 0.103, p = 0.147).Conclusions
A combination of an elevated preoperative CEA and CA19-9 was associated with a worse prognosis for patients with GBC who underwent resection. 相似文献10.
Liang-He Lu Yong-Fa Zhang Anna Kan Xiao-Ping Zhong Jie Mei Yi-Hong Ling Shao-Hua Li Ming Shi Wei Wei Rong-Ping Guo 《Digestive and liver disease》2019,51(10):1430-1437
Background and aimsThe liver function reserve in Child-Pugh (C-P) grade A hepatocellular carcinoma (HCC) patients varies widely, and the value of platelet-albumin-bilirubin (PALBI) grade in predicting posthepatectomy liver failure (PHLF) grade B/C and overall survival (OS) remains unknown.MethodsFrom Dec 2004 to Dec 2013, 2038 C-P grade A HCC patients after resection were enrolled. Univariate and multivariate analyses were performed to clarify the risk factors for PHLF grade B/C and OS.ResultsThe PALBI grade had higher area under the curve values than albumin-bilirubin (ALBI) and C-P grade in predicting PHLF grade B/C (0.693, 0.683, 0.529 in the entire cohort; 0.677, 0.646, 0.516 in patients who underwent major resection). PALBI grade differentiated C-P grade A patients into three groups with distinct prognoses (P < 0.001), whereas ALBI grade differentiated C-P grade A patients into two groups (P < 0.001). Furthermore, PALBI grade identified three groups with clearly different prognoses in ALBI grade 1 patients (P = 0.032). Multivariate analyses showed that PALBI grade was one of the independent and significant prognostic factors of PHLF grade B/C and OS.ConclusionsPALBI grade offers a simple, objective and discriminatory method for risk stratification of PHLF grade B/C and OS in C-P grade A HCC patients following resection. 相似文献
11.
Zhongran Man Qing Pang Lei Zhou Yong Wang Xiaosi Hu Song Yang Hao Jin Huichun Liu 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(10):888-895
Background
To date, epidemiological evidence of the association between preoperative prognostic nutritional index (PNI) and the prognosis of hepatocellular carcinoma (HCC) remains controversial.Methods
A literature search was performed in the databases of PubMed, Embase, and Web of Science. Hazard ratio (HR), odds ratio (OR), and 95% confidence interval (CI) were extracted to estimate the association of preoperative PNI with overall survival (OS), disease-free survival (DFS), and postoperative recurrence of HCC, respectively. A random-effects model was used to calculate the pooled effect size.Results
Thirteen studies with a total of 3,738 patients with HCC met inclusion criteria for this meta-analysis. It indicated that a lower level of preoperative PNI was a significant predictor of worse OS (HR = 1.82, 95%CI: 1.44-2.31) and DFS (HR = 1.49, 95% CI: 1.06-2.07). In addition, risk of postoperative recurrence was significantly higher in patients with a lower preoperative PNI (OR = 1.92, 95% CI: 1.33-2.76). Subgroup analysis based on therapeutic intent demonstrated a significant positive association between preoperative low PNI and worse OS for those patients undergoing surgical resection and for those undergoing TACE or non-surgical treatment.Conclusion
The current meta-analysis demonstrates that preoperative PNI is a prognostic marker in HCC. 相似文献12.
Yanming Zhou Lupeng Wu Dong Xu Tao Wan Xiaoying Si 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(9):768-774
Background
Limited data are currently available to address the safety and efficacy of combined resection of the liver and inferior vena cava (IVC) for hepatic malignancies.Methods
A systematic review was performed to identify relevant studies. Pooled individual data were examined for the clinical outcome of combined resection of the liver and IVC for hepatic malignancies.Results
A total of 258 patients were described in 38 articles eligible for inclusion. Resections were performed for colorectal liver metastasis (CLM) [n = 128 (50%)], intrahepatic cholangiocarcinoma (ICC) [n = 51 (20%)], hepatocellular carcinoma (HCC) [n = 48 (19%)], and other pathologies [n = 31 (11%)]. There were 14 (5%) perioperative deaths. The median survival duration was 34 months, and the 1-, 3- and 5-year overall survival (OS) rate was 79%, 46% and 33%, respectively. The 5-year OS rate was 26% for CLM, 37% for ICC, and 30% for HCC.Conclusion
Combined resection of the liver and IVC for hepatic malignancies is safe and applicable, and offers acceptable survival outcomes. 相似文献13.
Bo Zhu Jinju Wang Hui Li Xing Chen Yong Zeng 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):133-147
Background
The outcomes of living donor liver transplantation (LDLT) versus deceased donor liver transplantation (DDLT) for HCC patients were not well defined and it was necessary to reassess.Methods
A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, Google Scholar and WanFang database for eligible studies. Perioperative and survival outcomes of HCC patients underwent LDLT were pooled and compared to those underwent DDLT.Results
Twenty-nine studies with 5376 HCC patients were included. For HCC patients underwent LDLT and DDLT, there were comparable rates of overall survival (OS) (1-year, RR = 1.04, 95%CI = 1.00–1.09, P = 0.03; 3-year, RR = 1.03, 95%CI = 0.96–1.11, P = 0.39; 5-year, RR = 1.04, 95%CI = 0.95–1.13, P = 0.43), disease free survival (DFS) (1-year, RR = 1.00, 95%CI = 0.95–1.05, P = 0.99; 3-year, RR = 1.00, 95%CI = 0.94–1.08, P = 0.89; 5-year, RR = 1.01, 95%CI = 0.93–1.09, P = 0.85), recurrence (1-year, RR = 1.41, 95%CI = 0.72–2.77, P = 0.32; 3-year, RR = 0.89, 95%CI = 0.57–1.39, P = 0.60; and 5-year, RR = 0.85, 95%CI = 0.56–1.31, P = 0.47), perioperative mortality within 3 months (RR = 0.89, 95%CI = 0.50–1.59, p = 0.70) and postoperative complication (RR = 0.99, 95%CI = 0.70–1.39, P = 0.94). LDLT was associated with better 5-year intention-to-treat patient survival (ITT-OS) than DDLT (RR = 1.11, 95% CI = 1.01–1.22, P = 0.04).Conclusion
This meta-analysis suggested that LDLT was not inferior to DDLT in consideration of comparable perioperative and survival outcomes. However, in terms of 5-year ITT-OS, LDLT was a possibly better choice for HCC patients. 相似文献14.
Ruo-fan Sheng Li Yang Kai-pu Jin He-qing Wang Hao Liu Yuan Ji Cai-xia Fu Meng-su Zeng 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(4):305-312
Background
To investigate the diagnostic value of diffusion kurtosis imaging (DKI) and diffusion-weighted imaging (DWI) in assessing liver regeneration after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) compared with portal vein ligation (PVL).Methods
Thirty rats were divided into the ALPPS, PVL, and control groups. DKI and DWI were performed before and 7 days after surgery. Corrected apparent diffusion (D), kurtosis (K) and apparent diffusion coefficient (ADC) were calculated and compared, radiologic–pathologic correlations were evaluated.Results
The volume of the right median lobe increased significantly after ALPPS. There were larger cellular diameters after ALPPS and PVL (P = 0.0003). The proliferative indexes of Ki-67 and hepatocyte growth factor were higher after ALPPS (P = 0.0024/0.0433). D, K and ADC values differed between the groups (P = 0.021/0.0015/0.0008). A significant correlation existed between D and the hepatocyte size (r = ?0.523), no correlations existed in ADC and K (P = 0.159/0.111). The proliferative indexes showed moderate negative correlations with ADC (r = ?0.484/?0.537) and no correlations with D and K (P = 0.100–0.877).Discussion
Liver regeneration after ALPPS was effective and superior to PVL. DKI, especially the D map, may provide added value in evaluating the microstructure of liver regeneration after ALPPS, but this model alone may perform no better than the standard monoexponential model of DWI. 相似文献15.
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Guanghua Liu Qiang Ouyang Fang Xia Guoping Fan Juming Yu Caiyuan Zhang Dengbin Wang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(1):107-113
Background
To investigate the clinical value of the alpha-fetoprotein (AFP) response following transcatheter arterial chemoembolization (TACE) in intermediate-stage hepatocellular carcinoma (HCC).Methods
Data on patients with Barcelona Clinic Liver Cancer B staging system were analyzed. An AFP response was defined as a decrease in AFP of more than 20% after a TACE session. The association between AFP response and treatment outcome regarding imaging response and overall survival (OS) was explored. Cox proportional hazards models were applied to identify independent risk factors for OS after TACE.Results
Of the enrolled 376 patients with elevated serum AFP >20 ng/mL, 214 (57%) with AFP responses were identified. AFP responders had improved median survival than non-responders (20 vs. 12 months, P = 0.002). AFP response was significantly correlated with imaging response (P < 0.001). The Cox proportional hazards model revealed that AFP response was an independent factor for OS (hazard ratio, 0.59; 95% confidence interval, 0.45–0.78; P < 0.001). In stratified analyses, an AFP response achieved improved survival in patients with tumor diameters ≤5 cm, diameters >5 cm, tumor number ≤3 and without underlying cirrhosis.Conclusions
The AFP response indicates enhanced survival after TACE in patients with intermediate-stage BCLC. 相似文献18.
Xi-Tai Huang Chen-Song Huang Jian-Hui Li Jian-Peng Cai Wei Chen Xiao-Yu Yin 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(12):1215-1222
Background
This study aimed to clarify the prognostic significance of neutrophil/prealbumin ratio index (NPRI) for overall survival (OS) and recurrence free survival (RFS) of ICC after curative surgery.Methods
Two-hundred and seventy-six ICC patients who underwent curative resection from December 2006 to April 2017 were recruited and analyzed retrospectively. The correlations between clinicopathological features and NPRI were analyzed. OS and RFS were calculated using Kaplan–Meier curve, and cox univariate and multivariate analyses were used to identify the prognostic factors.Results
The optimal cut-off value of NPRI determined by ROC curve was 1.74 and the patients were divided into high-value and low-value groups. High-value NPRI was associated with higher risk of postoperative complications (p = 0.035) and longer hospitalization (p = 0.004).Univariate and multivariate cox analyses demonstrated that NPRI was an independent predictor for OS (p = 0.015) and RFS (p = 0.004) in ICC after curative resection. Furthermore, NPRI was also a significant predictor for OS and RFS in different subgroups of ICC, including CA19-9<35U/mL, single tumor, no vascular invasion, no local invasion and AJCC stages I + II.Conclusions
NPRI was an independent prognostic predictor for ICC after curative resection. It would have high clinical values due to its convenience. 相似文献19.
Ze-Xin Zhu Xiao-Xue Wang Ke-Fei Yuan Ji-Wei Huang Yong Zeng 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(9):795-802
Background
Hepatocellular carcinoma (HCC) is the most common malignancy in liver. Transarterial chemoembolization (TACE) is recommended as an effective treatment in advanced HCC patients. Recent studies showed iodine-125 seed (a low-energy radionuclide) can provide long-term local control and increase survival for HCC patients. The aim of the study was to evaluate the outcome of TACE plus iodine-125 seed in comparison with TACE alone for HCC.Methods
A comprehensive search of studies among PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews was conducted with published date from the earliest to January 10th, 2018. No language restrictions were applied, while only prospective randomized controlled trials (RCTs) or non-randomized controlled trials (non-RCTs) were eligible for a full-text review. The primary outcome was overall survival (OS), response rate (the rate of partial atrophy or complete clearance of the tumor lesion) and adverse events (AEs). The odds ratios (ORs) were combined using either fixed-effects model or random-effects model. All statistical analyses were performed using the Stata 12.0 software.Results
9 studies were included, involving 894 patients. Among them, 473 patients received combined therapy of TACE plus iodine-125 implantation, compared with 421 patients with TACE alone. Patients receiving combined therapy of TACE plus iodine-125 showed significantly improvement in 1-year OS (OR = 4.47, 95% confidence intervals (CI): 2.97–6.73; P < 0.001), 2-year OS (OR = 4.72, 95% CI: 2.63–8.47; P < 0.001). No significant publication bias was observed in any of the measured outcomes.Conclusions
Based on these findings, TACE plus iodine-125 implantation achieves better clinical efficacy compared with TACE alone in the treatment of HCC. 相似文献20.