Thymosin alpha-1 therapy improves postoperative survival after curative resection for solitary hepatitis B virus-related hepatocellular carcinoma: A propensity score matching analysis

Thymosin alpha-1 (Tα1) is an immunomodulatory and antiviral agent with potential effects on chronic hepatitis B and liver cancer. Its impact on solitary hepatocellular carcinoma (HCC) remains controversial, so we aimed to investigate the efficacy of Tα1 in solitary HBV-related HCC patients after curative resection.Between May 2010 and April 2016, 468 patients with solitary HBV-related HCC after curative resection were analyzed. Propensity score matching (PSM) was used to minimize confounding variables. Risk factors were identified by the Cox proportional hazards model. Recurrence-free survival (RFS) rates, overall survival (OS) rates, immunological, and virologic response were compared.The median follow up was 60.0 months. Immunological response improved in the Tα1 group compared with the control group (P < .001) but the virologic response was similar between 2 groups after 24 months. Patients with Tα1 therapy had better RFS and OS before (P = .018 and P < .001) and after (P = .006 and P < .001) propensity matching. Multivariate analysis revealed that Tα1 therapy was an independent prognostic factor for both OS (P < .001, HR = 0.308, 95% CI: 0.175–0.541) and RFS (P < .001, HR = 0.381, 95% CI: 0.229–0.633).Tα1 as an adjuvant therapy improves the prognosis of solitary HBV-related HCC patients after curative liver resection.     

Hepatic resection compared to percutaneous ethanol injection for small hepatocellular carcinoma using propensity score matching

BACKGROUND: Several surgical and non-surgical therapeutic modalities have been used for the treatment of hepatocellular carcinoma (HCC). There have been several studies comparing hepatic resection (HR) and percutaneous ethanol injection (PEI) for the treatment of HCC. However, there is still disagreement about the best treatment modality. METHODS: From 130 patients undergoing HR, 116 patients were individually matched to 116 controls from 249 patients undergoing PEI using propensity score matching to overcome possible biases in non-randomized study. Survival analyses were undertaken to compare these propensity score-matched groups. RESULTS: After matching by propensity score, the major clinical outcomes in the HR (n = 116) and the PEI (n = 116) groups were found to be similar. The 1-, 3- and 5-year overall survival rates were higher in the HR group (94.8%, 76.5% and 65.6%) compared to the PEI group (95.7%, 73.5% and 49.3%) (P = 0.059). The cumulative 1-, 3- and 5-year disease-free survival rates showed the same trend (HR: 76.1%, 50.6% and 40.6%; PEI: 62.6%, 25.5% and 19.1%) (P < 0.001). However, when stratified by Child-Pugh classification, it was no longer the case in the Child B patients. Single intrahepatic recurrence was the most common pattern of tumor recurrence after both treatments. CONCLUSIONS: Patients undergoing HR had a better survival profile than those undergoing PEI. However, when considering which technique to use for optimal HCC management, the individual patient's hepatic function must be considered.     

腹腔镜与开腹肝切除术治疗区域型肝胆管结石病的倾向性评分匹配研究

目的比较腹腔镜与开腹肝切除术治疗区域型肝胆管结石病的临床疗效。方法选取2010年1月-2017年6月咸阳市第一人民医院收治的87例肝胆管结石病患者,其中38例行腹腔镜肝切除术(腹腔镜组),49例行开腹肝切除术(开腹组)。利用倾向性评分匹配,均衡2组患者的混杂因素,比较匹配后的围手术期相关指标。计量资料2组间比较采用t检验,计数资料2组间比较采用χ~2检验或Fisher精确检验。结果共27对患者匹配成功。2组患者的肝切除类型、联合胆总管探查术、术中肝门阻断率、手术时间、术中输血率、术中结石清除率及术后结石清除率﹑术后总并发症及严重并发症发生率比较,差异均无统计学意义(P值均>0.05)。但腹腔镜组患者的手术出血量和住院时间均低于开腹组[(126.4±18.7)ml vs(143.2±24.1)ml;(11.7±2.3)d vs(13.4±1.9)d],差异均有统计学意义(t值分别为2.862、2.961,P值分别为0.006、0.004)。结论腹腔镜肝切除术治疗区域型肝胆管结石病效果与开腹手术相当,且具有术中出血量少、术后恢复快等优势。     

Left-hand-assisted laparoscopic resection of hepatocellular carcinoma in an accessory liver

We report a left‐hand‐assisted laparoscopic resection of hepatocellular carcinoma that developed in an accessory liver in a 47‐year‐old man. Preoperative assessment of the location of the tumor and the feeder vessels by combined selective angiography and computed tomography studies predicted the feasibility of laparoscopic procedures for complete removal of the tumor. In an attempt to avoid direct contact of the tumor capsule with rigid instruments during the operation, left‐hand‐assisted procedures were attempted. The encapsulated mass, 6 × 5 × 3 cm in size, was located on the posterior side of the left diaphragm, and a thin stalk between the tumor and the margin of the left lateral segment of the liver proper was recognized. Hand‐assisted procedures ensured the complete mobilization of the lesion with an adequate margin, without any unexpected capsular tear. Left‐hand‐assisted laparoscopic procedures would be feasible for the easy and safe resection of localized hepatocellular carcinoma developing in an accessory liver.     

The prognostic significance of serum HBeAg on the recurrence and long‐term survival after hepatectomy for hepatocellular carcinoma: A propensity score matching analysis

The effects of serum hepatitis B e antigen (HB eAg) on the prognosis of hepatocellular carcinoma (HCC ) patients after hepatectomy remain controversial. Our aim was to explore the prognostic significance of serum HB eAg on the prognosis of patients with HCC using a propensity matching model. Between January 2009 and March 2015, 953 patients with HCC who underwent hepatectomy in West China Hospital were analysed. Propensity matching analysis was applied, and survival analysis was performed using the Kaplan‐Meier method. Risk factors were identified by the Cox proportional hazards model. All patients with HCC were classified into an HB eAg(?) group (n = 775, 81.3%) or an HB eAg(+) group (n = 178, 18.7%). Patients with positive serum HB eAg had poorer recurrence‐free survival and overall survival before and after propensity matching. Similar results were found in patients within the Milan criteria. For patients beyond the Milan criteria, the HB eAg(+) group had poor overall survival before and after propensity matching. In term of recurrence‐free survival, there was no statistically significant impact after propensity matching (P  = .055), although there was a trend for HB eAg(+) patient to have reduced recurrence‐free survival. Positive serum HB eAg, positive HBV ‐DNA load, largest tumour size, multiple tumours, microvascular invasion and a high serum level of preoperative alpha‐fetoprotein were risk factors for recurrence. Our propensity model confirmed that positive serum HB eAg had a negative impact on the recurrence and long‐term survival irrespective of tumour stages. HB eAg seroconversion might be beneficial for reducing the rate of recurrence.     

Current status of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma: A systematic literature review

Background:Laparoscopic hepatectomy (LH) was first introduced in the 1990s and has now become widely accepted for the treatment of hepatocellular carcinoma (HCC). Laparoscopic liver resection (LLR) is considered a safe and effective approach for liver disease. However, the role of laparoscopic hepatectomy in HCC with cirrhosis remains controversial and needs to be further assessed, and the present literature review aimed to review the surgical and oncological outcomes of Laparoscopic hepatectomy (LH). According to Hong and colleagues laparoscopic resection for liver cirrhosis is a very safe and feasible procedure for both ideal cases and select patients with high risk factors [29]. The presence of only 1 of these factors does not represent an absolute contraindication for LH.Methods and results:We selected 23 studies involving about 1363 HCC patients treated with LH. 364 (27%) patients experienced major resections. The mean operative time was 244.9 minutes, the mean blood loss was 308.1 mL and blood transfusions were required in only 4.9% of patients. There were only 2 (0.21%) postoperative deaths and overall morbidity was 9.9%. Tumor recurrence ranged from 6 to 25 months. The 1-year, 3-year, and 5-year disease free Survival (DFS) rates ranged from 71.9% to 99%, 50.3% to 91.2%, and 19% to 82% respectively. Overall survival rates ranged from 88% to 100%, 73.4% to 94.5%, and 52.6% to 94.5% respectively.Conclusions:In our summery LH is lower risk and safer than conventional open liver surgery and is just as efficacious. Also, the LH approach decreased blood-loss, operation time, postoperative morbidity and had a lower conversion rate compared to other procedures whether open or robotic. Finally, LH may serve as a promising alternative to open procedures.     

Propensity score analysis demonstrated the prognostic advantage of anatomical liver resection in hepatocellular carcinoma

AIM:To compare the prognoses of hepatocellular carcinoma(HCC)patients that underwent anatomic liver resection(AR)or non-anatomic liver resection(NAR)using propensity score-matched populations.METHODS:Between January 2002 and December2010,268 consecutive HCC patients,including 110 and158 patients that underwent AR and NAR,respectively,were retrospectively enrolled in this study.Forty-four patients from each group were selected and matched using logistic multivariate analysis followed by propensity score analysis.RESULTS:In the whole analysis set,the histological background of the liver,liver function,and tumor marker levels differed significantly among the groups.Although the overall survival(OS)and recurrence-free survival rates of the two groups did not differ significantly in the whole analysis set,the OS of the AR group was significantly longer than that of the NAR group after propensity matching(76.2±6.3 mo vs 58.9±6.3mo;P=0.0039).Although AR(HR=0.456,P=0.039)was found to be a prognostic factor in the univariate analysis,only vascular invasion(HR=0.228,P=0.002)and the hepatocyte growth factor level(HR=52.366,P=0.035)were subsequently found to be independent prognostic factors.CONCLUSION:AR conveys a survival advantage over NAR in specific subpopulations of HCC patients with tumors of less than 5 cm in diameter,single tumor,and good liver function.     

Efficacy of hepatic resection vs transarterial chemoembolization for solitary huge hepatocellular carcinoma

AIM: To compare the efficacy of hepatic resection (HR) and transarterial chemoembolization (TACE) for patients with solitary huge (≥ 10 cm) hepatocellular carcinoma (HCC).METHODS: Records were retrospectively analyzed of 247 patients with solitary huge HCC, comprising 180 treated by HR and 67 by TACE. Long-term overall survival (OS) was compared between the two groups using the Kaplan-Meier method, and independent predictors of survival were identified by multivariate analysis. These analyses were performed using all patients in both groups and/or 61 pairs of propensity score-matched patients from the two groups.RESULTS: OS at 5 years was significantly higher in the HR group than the TACE group, across all patients (P = 0.002) and across propensity score-matched pairs (36.4% vs 18.2%, P = 0.039). The two groups showed similar postoperative mortality and morbidity. Multivariate analysis identified alpha-fetoprotein ≥ 400 ng/mL, presence of vascular invasion and TACE treatment as independent predictors of poor OS.CONCLUSION: Our findings suggest that HR can be safe and more effective than TACE for patients with solitary huge HCC.