Combined Hepatocellular Carcinoma and Cholangiocarcinoma: Clinical Features, Treatment Modalities, and Prognosis

Background

Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is an uncommon subtype of primary liver cancer that has rarely been reported in large-scale clinical studies. The aim of this study was to clarify the clinical features, treatment modalities, and prognosis of cHCC-CC.

Methods

Included in this study were 113 patients who were histologically diagnosed as having Allen type C cHCC-CC, 103 of whom received liver resection, 6 transarterial chemoembolization treatment, 3 radiofrequency ablation, and 1 palliative supportive treatment. Clinicopathologic features and prognosis of 103 cHCC-CC patients after liver resection were compared with those of 6,679 patients with hepatocellular carcinoma (HCC) and 386 patients with intrahepatic cholangiocarcinoma (ICC) who underwent liver resection during the same period.

Results

The proportion of cHCC-CC in primary liver cancers was 1.5?%. The 103 cases of cHCC-CC were characterized by male predominance, infection with hepatitis virus or presence of liver cirrhosis, and elevated alfa-fetoprotein??findings similar to HCC. However, serum CA19-9 elevation, incomplete capsules, and lymph node involvement were similar to ICC. The 1-, 3-, and 5-year overall survival rates after liver resection were 73.9, 41.4, and 36.4?%, respectively, for patients with cHCC-CC versus 77.5, 53.3, and 41.4?% for HCC patients, and 58.0, 29.1, and 22.3?% for ICC patients (??²?=?137.5, P?P?=?0.003) and radical liver resection (hazard ratio 0.31, 95?% confidence interval 0.14?C0.68, P?=?0.004) were independent prognostic factors for overall survival.

Conclusions

cHCC-CC has biological behavior and prognosis that are intermediate between HCC and ICC. Radical liver resection can provide a better outcome for this uncommon malignancy.     

Number and Tumor Size Are Not Sufficient Criteria to Select Patients for Liver Transplantation for Hepatocellular Carcinoma

Background

Hepatocellular carcinoma (HCC) is an indication for liver resection or transplantation (LT). In most centers, patients whose HCC meets the Milan criteria are considered for LT. The first objective of this study was to analyze whether there is a correlation between the pathologic characteristics of the tumor, survival and recurrence rate. Second, we focused our attention on vascular invasion (VI).

Methods

From January 1997 to December 2007, a total of 196 patients who had a preoperative diagnosis of HCC were included. The selection criteria for LT satisfied both the Milan and the San Francisco criteria (UCSF). Demographic, clinical, and pathologic information were recorded.

Results

HCC was confirmed in 168 patients (85.7%). The median follow-up was 74?months. The pathologic findings showed that 106 patients (54.1%) satisfied the Milan criteria, 134 (68.4%) the UCSF criteria of whom 28 (14.3%) were beyond the Milan criteria but within the UCSF criteria, and 34 (17.3%) beyond the UCSF criteria. VI was detected in 41 patients (24%). The 1-, 3-, and 5-year overall survival rates were 90%, 85%, and 77%, respectively, according to the Milan criteria and 90%, 83%, and 76%, respectively, according to the UCSF criteria (P?=?NS). In univariate and multivariate analyses, tumor size and VI were significant prognostic factors affecting survival (P?400?ng/ml and tumor grade G3.

Conclusions

Tumor size and VI were the only significant prognostic factors affecting survival of HCC patients. Primary liver resection could be a potential selection treatment before LT.     

Trends and Patterns of Utilization in Post-treatment Surveillance Imaging Among Patients Treated for Hepatocellular Carcinoma

Background

Little is known about the patterns of utilization of surveillance imaging after treatment of hepatocellular carcinoma (HCC). We sought to define population-based patterns of surveillance and investigate if intensity of surveillance impacted outcome following HCC treatment.

Methods

The Surveillance, Epidemiology, and End Results-Medicare database was used to identify patients with HCC diagnosed between 1998 and 2007 who underwent resection, ablation, or intra-arterial therapy (IAT). The association between imaging frequency and long-term survival was analyzed.

Results

Of the 1,467 patients, most underwent ablation only (41.5 %), while fewer underwent liver resection only (29.6 %) or IAT only (18.3 %). Most patients had at least one CT scan (92.7 %) during follow-up, while fewer had an MRI (34.1 %). A temporal trend was noted with more frequent surveillance imaging obtained in post-treatment year 1 (2.5 scans/year) vs. year 5 (0.9 scans/year; P?=?0.01); 34.5 % of alive patients had no imaging after 2 years. Frequency of surveillance imaging correlated with procedure type (total number of scans/5 years, resection, 4.7; ablation, 4.9; IAT, 3.7; P?<?0.001). Frequency of surveillance imaging was not associated with a survival benefit (three to four scans/year, 49.5 months vs. two scans/year, 71.7 months vs. one scan/year, 67.6 months; P?=?0.01)

Conclusion

Marked heterogeneity exists in how often surveillance imaging is obtained following treatment of HCC. Higher intensity imaging does not confer a survival benefit.     

The Improvement of Surgical Treatment for Patients with Gallbladder Cancer: Analysis of 208 Consecutive Cases Over the Past Decade

Objectives

The aim of this study was to determine if there has been improvement in survival for patients with gallbladder cancer treated with surgical procedures.

Methods

A retrospective review of all patients with gallbladder cancer admitted during the past 11?years was conducted. The patients were categorized into two periods: period 1, from 1 January 2000 to 31 December 2005 (group 1, n?=?77); and period 2, from 1 January 2006 to 31 December 2010 (group 2, n?=?131).

Results

The two groups have similar age, sex distribution, and symptoms. There were more patients with advanced stage in group 2 (P?=?0.001). And patients in group 2 were treated with more aggressive surgical procedures compared with group 1. Patients of group 2 had a better surgical outcomes and longer 5-year overall survival (9?% vs. 19?%, P?=?0.040) and disease-free survival (P?=?0.017). Median survival in group 1 was 14.7?months, while in group 2 it was 22.3?months. Patients underwent R0 resection in group 2 had better survival than that in group 1 (P?=?0.009), while they had similar survival for those who underwent non-R0 resection in both periods (P?=?0.108).

Conclusions

A significant improvement of disease-free survival and long-term survival results was observed in the past decade.     

Predicting Pathological Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Using 18FDG-PET/CT

Background

Pathologic complete response (pCR) after neoadjuvant chemoradiation (CRT) has been observed in 15?C30% of patients with locally advanced rectal cancer (LARC). The objective of this study was to determine whether PET/CT can predict pCR and disease-free survival in patients receiving CRT with LARC.

Methods

This is a retrospective review of patients with EUS-staged T3?CT4, N?+?rectal tumors treated with CRT, who underwent pre/post-treatment PET/CT from 2002?C2009. All patients were treated with CRT and surgical resection. Standardized uptake value (SUV) of each tumor was recorded. Logistic regression was used to analyze the association of pre-CRT SUV, post-CRT SUV, %SUV change, and time between CRT and surgery, compared with pCR. Kaplan?CMeier estimation evaluated significant predictors of survival.

Results

Seventy patients (age 62?years; 42M:28F) with preoperative stage T3 (n?=?61) and T4 (n?=?9) underwent pre- and post-CRT PET/CT followed by surgery. The pCR rate was 26%. Median pre-CRT SUV was 10.8, whereas the median post-CRT SUV was 4 (P?=?0.001). Patients with pCR had a lower median post-CRT SUV compared with those without (2.7 vs. 4.5, P?=?0.01). Median SUV decrease was 63% (7.5?C95.5%) and predicted pCR (P?=?0.002). Patients with a pCR had a greater time interval between CRT and surgery (median, 58 vs. 50?days) than those without (P?=?0.02). Patients with post-CRT SUV?P?=?0.03). Patients with SUV decrease ??63% had improved overall survival at median follow-up of 40?months than those without (P?=?0.006).

Conclusions

PET/CT can predict response to CRT in patients with LARC. Posttreatment SUV, %SUV decrease, and greater time from CRT to surgery correlate with pCR. Post-CRT, SUV?相似文献   

Prognostic Significance of Alpha-fetoprotein Status in the Outcome of Hepatocellular Carcinoma after Treatment of Transarterial Chemoembolization

Background

Alpha-fetoprotein (AFP) has been used as a diagnostic biomarker for hepatocellular carcinoma (HCC), but its prognostic significance is not well defined. This study was performed to classify the prognostic significance of AFP status in HCC patients after transarterial chemoembolization (TACE).

Methods

Four hundred forty-one HCC patients from a prospective maintained database with pathologic confirmation including 139 with normal AFP levels and 302 with elevated AFP levels were retrospectively studied for prognostic significance of AFP in treatment response and survival after TACE. Univariate and multivariate analyses were used to identify the prognostic factors.

Results

There were significant differences in overall survival (OS) after TACE between AFP-negative and AFP-positive HCC patients when the AFP cutoff value was defined as 20?ng/ml (P?P?=?0.093). Multivariate analysis revealed that AFP status for AFP-negative or positive was an independent prognostic factor for HCC patients after TACE (P?=?0.001), along with ??-glutamyltransferase (GGT) level (P?=?0.004) and tumor diameter (P?Conclusions Compared with AFP-positive HCC patients, patients with AFP-negative status have a better treatment response and prognosis after TACE.     

Assessment of ISGLS Definition of Posthepatectomy Liver Failure and Its Effect on Outcome in Patients with Hepatocellular Carcinoma

Background

Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy. As there was no standardized definition, the International Study Group of Liver Surgery (ISGLS) defined PHLF as increased international normalized ratio and hyperbilirubinemia on or after postoperative day 5 in 2010. We evaluated the impact of the ISGLS definition of PHLF on hepatocellular carcinoma (HCC) patients.

Methods

We retrospectively analyzed 210 consecutive HCC patients who underwent curative hepatectomy at our facility from 2005 to 2010. The median follow-up period after hepatectomy was 35.2 months.

Results

Thirty-nine (18.6 %) patients fulfilled the ISGLS definition of PHLF. Overall survival (OS) rates at 1, 3, and 5 years in patients with/without PHLF were 69.1/93.5, 45.1/72.5, and 45.1/57.8 %, respectively (P?=?0.002). Recurrence-free survival (RFS) rates at 1, 3, and 5 years in patients with/without PHLF were 40.9/65.9, 15.7/38.3, and 15.7/20.3 %, respectively (P?=?0.003). Multivariate analysis revealed that PHLF was significantly associated with both OS (P?=?0.047) and RFS (P?=?0.019). Extent of resection (P?<?0.001), intraoperative blood loss (P?=?0.002), and fibrosis stage (P?=?0.040) were identified as independent risk factors for developing PHLF.

Conclusion

The ISGLS definition of PHLF was associated with OS and RFS in HCC patients, and long-term survival will be improved by reducing the incidence of PHLF.     

Surgical Outcomes and Prognostic Factors for T2 Gallbladder Cancer Following Surgical Resection

Background

Depth of tumor invasion is an important prognostic factor for gallbladder cancer. The aim of this study was to investigate the clinicopathological prognostic factors of T2 gallbladder cancer.

Methods

We retrospectively reviewed the clinicopathological data and survival for 83 patients with T2 gallbladder cancers who underwent surgical resection between January 1995 and December 2007.

Results

The overall survival rates were 48.9% at 3 years and 29.3% at 5 years. Univariate analysis revealed that R0 resection (P?<?0.001), extended surgery (P?=?0.028), lymph node dissection (P?=?0.024), non-infiltrative tumors (P?=?0.001), well differentiation (P?=?0.001), absence of lymphatic (P?=?0.025), perineural (P?=?0.001), and vascular (P?=?0.025) invasion, absence of lymph node metastasis (P?=?0.001), negative resection margin (P?=?0.016), and stage (P?=?0.002) were significantly better predictors for survival. A significant difference in survival between Rx and R1 was not found. R0 resection, lymph node dissection, well differentiation, and absence of perineural and vascular invasion were significantly independent prognostic factors for overall survival. Recurrence occurred in 48 patients (57.8%). Age older than 65 years, R0 resection, non-infiltrative tumors, and good differentiation were significant independent predictors of disease-free survival by multivariate analysis.

Conclusions

For T2 tumors, radical surgery including lymph node dissection should be performed to achieve R0 resection. Tumors with infiltrative types and suspicious lymph node metastasis in the intraoperative findings were candidates for aggressive surgical management to improve patient survival.     

Role of Operative Therapy in Non-cirrhotic Patients with Metastatic Hepatocellular Carcinoma

Introduction

We investigated the role of operative therapy in non-cirrhotic patients who developed metastatic hepatocellular carcinoma (HCC).

Methods

This retrospective cohort study included consecutive non-cirrhotic patients with metastatic HCC after a prior hepatectomy treated between 1990 and 2009. Patients were stratified by operative therapy (resection, ablation, transcatheter therapy). Kaplan?CMeier analyses with log-rank comparisons tested effects of operative therapy on overall survival (OS) and progression-free survival (PFS).

Results

Of 195 non-cirrhotic patients treated for HCC during the study period, 98 [median age 65, interquartile range (IQR) 53?C71; 55?% male] subsequently developed metastatic HCC (55 intrahepatic only). Median time to development of metastases after the index operation was 10?months (IQR 5?C20?months); median number of metastases was 3 (IQR 2?C7). Half of these patients (n?=?50) underwent operative treatment of metastases; 20 (40?%) underwent metastasectomy, 18 (36?%) ablation, and 12 (24?%) transcatheter therapy. Operative therapy was associated with improved OS (p?p????0.006). Nine patients (seven resection, two ablation) are disease free at a median of 50?months (IQR 24?C80?months) posttreatment.

Conclusions

Resection and ablation are associated with an improved PFS and long-term OS and should be considered in select patients with metastatic HCC.     

Risk Factors of Peritoneal Recurrence and Outcome of Resected Peritoneal Recurrence After Liver Resection in Hepatocellular Carcinoma: Review of 1222 Cases of Hepatectomy in a Tertiary Institution

Background

Reports on the risk factors of peritoneal recurrence (PR) after liver resection for hepatocellular carcinoma are lacking. We examined the risk factors of PR after hepatectomy and the outcome of resected PR at our institution.

Methods

We retrospectively reviewed the data from 1,222 patients who underwent hepatectomies for hepatocellular carcinoma in Samsung Medical Center from January 2006 to August 2010. We identified patients with PR and studied the risk factors and outcomes of resected PR.

Results

The rate of PR was 3.0% (n?=?36). The mean?±?SD age of patients was 54.0?±?10.2?years. Among those with PR, 23 patients (63.9%) had unresectable disease and 13 patients (36.1%) had resectable disease. Multivariate analysis found that tumor size >50?mm, presence of microvascular invasion, bile duct invasion, and positive margins were significant risk factors of PR after liver resection. The median overall survival (OS) for resectable PR was 33.0 (28.0?C61.6) months compared to 14.0 (6.8?C21.2) months for unresectable PR (P?=?0.009). Cox regression analysis demonstrated that resected PR [hazard ratio (HR) 0.042, P?=?0.001] and interval between hepatectomy and PR (>6months) (HR 0.195, P?=?0.016) were positive prognostic factors for OS, while alfa-fetoprotein >200?ng/dl at detection of PR (HR 11.321, P?=?0.015) and serosal involvement of primary hepatocellular carcinoma (HR 25.616, P?=?0.007) were negative prognostic factors for OS.

Conclusions

We found that tumor size >50?mm, presence of microvascular invasion, bile duct invasion, and positive resection margins were significant risk factors of PR after liver resection. Selected patients with resected PR had significantly better OS.     

Surgical Resection versus Open-Approach Radiofrequency Ablation for Small Hepatocellular Carcinomas within Milan Criteria after Successful Transcatheter Arterial Chemoembolization

Aims

The aim of this study was to compare the effectiveness and safety of hepatic resection versus open-approach RFA (ORFA) for small hepatocellular carcinomas (HCC) within Milan criteria after successful downstaging therapy by transcatheter arterial chemoembolization.

Material and Methods

Between February 2005 and February 2008, a total of 110 patients with advanced HCC met the Milan criteria after successful downstaging therapy; 58 patients then underwent hepatic resection and 52 received ORFA. Outcomes, including short- and long-term morbidity, 1-, 3-, and 5-year mortality and HCC-free survival, were analyzed and compared between the two groups.

Results

Patients in the hepatic resection and ORFA groups showed similar baseline characteristics and downstaging protocols. The ORFA group showed less blood loss, lower hospital costs, shorter surgical time, and fewer hospital stay days (P?<?0.05). The 1-, 3-, and 5-year overall survival rates were 94.8, 86.2, and 79.3 %, respectively, with liver resection and 96.2, 82.7, and 76.9 % with ORFA (P?=?0.772). The 1-, 3-, and 5-year recurrence-free survival rates were 93.1, 81.0, and 77.6 % with resection and 94.2, 76.9, and 73.1 % with ORFA (P?=?0.705). The ORFA patients suffered fewer postoperative complications (P?=?0.09), particularly among the cases of central HCC (P?=?0.015).

Conclusion

Resection and ORFA achieved similar survival benefits in the management of HCC within Milan criteria after successful downstaging. The decreased blood loss, hospital costs, surgical time, and hospital stay days, and lower complication rates in central cases render ORFA a preferred treatment option.     

Presentation and Management of Gastrointestinal Stromal Tumors of the Duodenum: A Multi-Institutional Analysis

Background

Duodenal gastrointestinal stromal tumors (GISTs) are a small subset of GISTs, and their management is poorly defined. We evaluated surgical management and outcomes of patients with duodenal GISTs treated with pancreaticoduodenectomy (PD) versus local resection (LR) and defined factors associated with prognosis.

Methods

Between January 1994 and January 2011, 96 patients with duodenal GISTs were identified from five major surgical centers. Perioperative and long-term outcomes were compared based on surgical approach (PD vs LR).

Results

A total of 58 patients (60.4?%) underwent LR, while 38 (39.6?%) underwent PD. Patients presented with gross bleeding (n?=?25; 26.0?%), pain (n?=?23; 24.0?%), occult bleeding (n?=?19; 19.8?%), or obstruction (n?=?3; 3.1?%). GIST lesions were located in first (n?=?8, 8.4?%), second (n?=?47; 49?%), or third/fourth (n?=?41; 42.7?%) portion of duodenum. Most patients (n?=?86; 89.6?%) had negative surgical margins (R0) (PD, 92.1 vs LR, 87.9?%) (P?=?0.34). Median length of stay was longer for PD (11?days) versus LR (7?days) (P?=?0.001). PD also had more complications (PD, 57.9 vs LR, 29.3?%) (P?=?0.005). The 1-, 2-, and 3-year actuarial recurrence-free survival was 94.2, 82.3, and 67.3?%, respectively. Factors associated with a worse recurrence-free survival included tumor size [hazard ratio (HR)?=?1.09], mitotic count >10 mitosis/50 HPF (HR?=?6.89), AJCC stage III disease (HR?=?4.85), and NIH high risk classification (HR?=?4.31) (all P?Conclusions Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. PD was associated with longer hospital stays and higher risk of perioperative complications. When feasible, LR is appropriate for duodenal GIST and PD should be reserved for lesions not amenable to LR.     

Prognostic Factors in Patients with Node-Negative Gastric Cancer: A Single Center Experience from China

Background and Objectives

Lymph node metastasis was the most important prognostic factor in gastric cancer. Patients with node-negative gastric cancer presented better survival. However, some of them would die of the disease. The aim of this study was to evaluate the prognostic factors of patients with node-negative gastric cancer.

Methods

From 1996 to 2007, 4,426 patients had undergone curative D2 gastrectomy for gastric cancer at the Fudan University Shanghai Cancer Center. Patients with node-negative gastric cancer who underwent curative D2 gastrectomy with more than 15 lymph nodes dissected were selected into this study. The prognostic value of pathological features was investigated.

Results

This study included 234 patients with node-negative gastric cancer. The 5-year overall survival in these patients was 85?%. The factors correlating significantly with overall survival on univariate analysis included age (P?=?0.016), depth of invasion (P?=?0.000), tumor size (P?=?0.013), tumor site (P?=?0.000), histological grade (P?=?0.009), lymphatic tumor emboli (P?=?0.014), vascular tumor emboli (P?=?0.005), and nervous invasion (P?=?0.033). Multivariate analysis showed that lymphatic tumor emboli (hazard ratio (HR)?=?7.270), vascular tumor emboli (HR?=?3.010), and depth of invasion (HR?=?2.735) were defined as independent prognostic factors.

Conclusion

Among patients with node-negative gastric cancer and higher risk for recurrence, the use of adjuvant therapies should be considered.     

The Value of Mammography Within 1 Year of Conservative Surgery for Breast Cancer

Introduction

Guidelines for screening mammography have been established by numerous medical societies. Guidelines have not been established for follow-up mammography for patients who have been treated with breast-conserving surgery. Many radiologists recommend mammography of the treated breast 6?months after completion of treatment. The purpose of this study was to determine the value of interval mammography.

Methods

Patients were identified by searching the breast cancer database for the diagnoses of ductal carcinoma in situ, infiltrating ductal carcinoma and infiltrating lobular carcinoma. Postoperative mammogram dates and results were obtained. Patients with mammography within 8?months of surgery were included in the study.

Results

Ductal carcinoma in situ, infiltrating ductal carcinoma, and infiltrating lobular carcinoma were found in 1,000 patients who underwent breast-conserving surgery, and 789 patients had complete mammographic follow-up data available. Postoperative interval mammography was performed in 169 patients (21?%), including 23 patients who had preradiation mammography. Ninety percent of the interval mammograms were BI-RADS 1 to 3 and 10?% were BI-RADS 4 or 5. Two cancers were found on interval mammography (1.2?% of 169) and 4 of 620 (0.6?%) patients who did not have interval mammography were found to have malignancy within 1?year of surgery (1.2?% vs. 0.6?%, P?=?0.614). The use of interval mammography was not related to the mammographic findings at diagnosis. Interval mammography did not affect local and distant disease-free survival.

Conclusions

The likelihood of obtaining a significant finding on short interval follow-up mammography after conservative surgery for breast cancer is 1.2?%.     

The Implications of Positive Peritoneal Lavage Cytology in Potentially Resectable Pancreatic Cancer

Background

The clinical implications of peritoneal lavage cytology (CY) status in patients with potentially resectable pancreatic cancer have not been established.

Method

We retrospectively reviewed clinical data from 254 consecutive patients who underwent macroscopically curative resection for pancreatic cancer from February 2003 to December 2010 in our institution. Correlations between CY status and survival and clinicopathological findings were investigated.

Results

Of the 254 patients, 20 were CY+ (7.9?%). There were no significant differences between CY+ and CY? patients in background data (age, sex, the level of preoperative tumor marker, and adjuvant chemotherapy). Patients with positive serosal invasion were more likely to be CY+ than those with negative serosal invasion (P?P?=?0.302). The median recurrence-free survival of CY+ and CY? patients was 8.1?months (95?% CI?=?0.0–17.9) and 13.5?months (95?% CI?=?11.5–15.5), respectively (P?=?0.089).

Conclusion

CY+ status without other distant metastasis does not necessarily preclude resection in patients with pancreatic cancer.     

Evolution of Long-Term Outcome of Liver Resection for Colorectal Metastases: Analysis of Actual 5-Year Survival Rates over Two Decades

Background

Liver resection (LR) is the only potentially curative treatment of colorectal liver metastases (CRLM). Its outcome over the past 2 decades was studied using actual 5-year survival rates.

Methods

Data of 393 consecutive patients who underwent LR for CRLM at Mauriziano Umberto I (Turin) until June 2005 were analyzed. Excluding R2 resections (n?=?4) or incomplete 5-year follow-up (n?=?13), 376 patients were divided according to LR date into groups A (before 1995: 90 patients), B (1995?C2000: 94 patients), C (2001?C2005: 192).

Results

Group C presented increased multiple and bilobar metastases compared with combined group A and B (C vs AB: 54.7% vs 40.2%, P?=?0.005; 28.1% vs 19.0%, P?=?0.038, respectively), decreased metastases diameter (C vs AB: 32 vs 40?mm, P?=?0.0001). The 5-year overall survival, calculated excluding 4 operative mortalities (group AB), increased over the years (A, 20.5%; B, 32.6%; C, 46.4%; P?P?=?0.015). Recurrence-free 5-year survival improved (C vs AB: 23.4% vs 13.9%, P?=?0.019) linked to decreased liver recurrences (C vs AB: 26.8% vs 37.4%, P?=?0.023). Resection rate (59% overall for liver recurrence) increased along with 5-year survival after recurrence (A, 4.0%; B, 14.2%; C, 21.4%; P?P?=?0.003) and synchronous metastases (P?=?0.008), N+ tumors (P?=?0.005), and in patients without chemotherapy (P?=?0.001).

Conclusions

Long-term outcome of LR for CRLM improved over 20?years, even in patients with negative prognostic factors, linked to hepatic recurrences reduction and increased survival after recurrence.     

Predictors for Microinvasion of Small Hepatocellular Carcinoma ≤2?cm

Background

Hepatocellular carcinoma (HCC) ??2?cm in diameter is considered to have a low potential for malignancy.

Methods

A retrospective review was undertaken of 149 patients with primary solitary HCC ??2?cm who underwent initial hepatic resection between 1994 and 2010. The independent predictors of the microinvasion (MI) such as portal venous, hepatic vein, or bile duct infiltration and/or intrahepatic metastasis were identified by multivariate analysis. Prognosis of patients with HCC ??2?cm accompanied by MI was compared to that of patients with HCC ??2?cm without MI.

Results

Forty-three patients with HCC ??2?cm had MI in patients (28.9%). Three independent predictors of the MI were revealed: invasive gross type (simple nodular type with extranodular growth or confluent multinodular type), des-??-carboxy prothrombin (DCP) >100?mAU/ml, and poorly differentiated. Disease-free survival rates of patients with HCC ??2?cm with MI (3?year 44%) were significantly worse than those for HCC ??2?cm without MI (3?year 72%). This disadvantage of disease-free survival rate of patients with HCC ??2?cm with MI could be dissolved by hepatic resection with a wide tumor margin of ??5?mm (P?=?0.04).

Conclusions

Even in cases of HCC ??2?cm, patients who are suspected of having invasive gross type tumors in preoperative imaging diagnosis or who have a high DCP level (>100?mAU/ml) are at risk for MI. Therefore, in such patients, hepatic resection with a wide tumor margin should be recommended.     

Prognostic Value of a Positive-to-negative Change in Hormone Receptor Status after Neoadjuvant Chemotherapy in Patients with Hormone Receptor–positive Breast Cancer

Background

To investigate the prognostic value of positive-to-negative changes in hormone receptor (HR) status after neoadjuvant chemotherapy (NCT) in patients with HR-positive breast cancer.

Methods

Data from 224 stage II?CIII breast cancer patients with positive HR status before NCT who had residual disease in the breast after NCT were collected. HR status of the residual tumors was retested after NCT. A survival analysis was performed in 214 patients with adjuvant endocrine therapy regardless of post-NCT HR status. The survival analysis also examined other clinical and pathologic variables.

Results

In total, 15.2?% of patients had a positive-to-negative change in HR status after NCT, and this change was observed more frequently in HER-2-positive tumors than HER-2-negative tumors (P?=?0.001). In 214 patients who had been treated with adjuvant endocrine therapy regardless of post-NCT HR status, the alteration in HR status was an independent factor for the prediction of a poorer disease-free survival (P?=?0.026) and overall survival (P?P?=?0.003 and P?=?0.001).

Conclusions

The switch of HR status after NCT is remarkable for HR-positive tumors. An HR-negative switch may identify patients who would benefit from alternative systemic therapies.