Portal Invasion Research Articles

Novel treatment strategy for advanced hepatocellular carcinoma: combination of conventional transcatheter arterial chemoembolization and modified method with portal vein occlusion for cases with arterioportal shunt: a preliminary study.

Background A novel strategy to combine conventional transcatheter arterial chemoembolization (TACE) and TACE during portal vein occlusion (TACE-PVO) in the presence of high-flow arterioportal shunt (APS) has been developed to treat hepatocellular carcinoma (HCC) with portal invasion. Purpose To evaluate the efficacy of this strategy. Material and Methods Twenty-five cases of HCC with portal invasion, treated between April 2006 and December 2015, were evaluated. Balloon occlusion of the portal venous outlet was performed in eight cases of high-flow APS when performing TACE. Conventional TACE was performed in the other 17 cases. The primary endpoint was overall survival. Adverse events and deterioration of liver function were also evaluated. Results The median survival time (MST) was 12 months. One-, two-, and three-year survival rates were 48.0%, 39.3%, and 26.2%, respectively. Subgroup analysis and multivariate analysis revealed the CLIP score as prognostic factor. MST was 2.5 months in the subgroup with CLIP score ≥4 and 26.0 months in the subgroup with CLIP score ≤3 (hazard ratio = 7.7, 95% confidence interval = 2.3-25.8). Transient elevations of the levels of transaminase and bilirubin were observed; however, deterioration of liver function was infrequent; upgrading of Child-Pugh class in 9.1% of cases. Conclusion A novel strategy, combining conventional TACE and TACE-PVO, is effective for HCC with portal invasion. The CLIP score may be useful for considering treatment indication.

Evaluation and proposal of novel resectability criteria for pancreatic cancer established by the Japan Pancreas Society

The guidelines for the classification of the resectability of pancreatic cancer established by the National Comprehensive Cancer Network can be difficult to utilize in clinical practice. We evaluated novel criteria proposed by the Japan Pancreas Society. We analyzed 382 patients with pancreatic cancer between 2001 and 2015 for survival differences among subgroups classified according to the Japan Pancreas Society classification. Overall survival and disease-free survival were expressed as median values and compared with data based on the National Comprehensive Cancer Network classification, and differences in initial patterns of recurrence were analyzed. Overall survival times according to the Japan Pancreas Society criteria were 34.2, 29.7, 17.3, 14.3, and 15.8months for the groups defined as resectable, resectable with portal vein invasion, borderline resectable with portal vein invasion, borderline resectable with arterial invasion, and unresectable by locally advanced disease respectively. The overall survival of the resectable group was better than those of the borderline resectable with portal vein invasion or borderline resectable with arterial invasion groups (P<.0001); however, the borderline resectable with portal vein invasion, borderline resectable with arterial invasion, and unresectable by locally advanced groups showed no differences in overall survival. The resectable group showed a tendency toward better survival than the resectable with portal vein invasion group (P=.058). The median overall survival times according to the classic 2012 National Comprehensive Cancer Network criteria were 30.5, 20.5, 15.8, and 13.8months for the resectable, portal invasion, common hepatic artery and superior mesenteric artery invasion groups, respectively. Each survival curve was clearly separate. The borderline resectable with arterial invasion and unresectable by locally advanced groups exhibited high local recurrence rates (42.0% and 44.8%, respectively). The Japan Pancreas Society criteria, which are simpler, predicted survival differences between the resectable group and the other subgroups. Our data suggest that cancer patients with borderline resectable pancreatic cancer (borderline resectable with portal vein invasion and borderline resectable with arterial invasion) can be managed as a single subset.

Irregular Defects in Hepatocellular Carcinomas During the Kupffer Phase of Contrast-Enhanced Ultrasonography with Perfluorobutane Microbubbles: Pathological Features and Metastatic Recurrence After Surgical Resection

The present study aimed to elucidate the association between post-vascular–phase (Kupffer-phase) images from contrast-enhanced ultrasonography (CEUS) with perfluorobutane microbubbles and metastatic recurrences after the resection of hepatocellular carcinoma (HCC). The study examined 73 patients with solitary HCC ≤5 cm in diameter who underwent CEUS before resection. HCC was defined as irregular type (including an irregular defect on Kupffer-phase images) or non-irregular type. Intrahepatic metastatic recurrence was defined as >3 intrahepatic recurrences. Metastatic recurrence included both extrahepatic and intrahepatic recurrences. Frequencies of microscopic portal invasion and intrahepatic metastasis were significantly higher in the irregular group than in the non-irregular group. Cumulative 5-y metastatic recurrence rates in the irregular and non-irregular groups were 43% and 7% (p = 0.028), respectively. Multivariate analyses identified Kupffer-phase findings as a factor significantly related to metastatic recurrence. In conclusion, HCCs with an irregular defect during Kupffer-phase CEUS are characterized by more frequent microscopic vascular invasion and intrahepatic metastasis and are significantly associated with metastatic recurrence after resection.

The outcome of sorafenib monotherapy on hepatocellular carcinoma with portal vein tumor thrombosis.

Sorafenib is not recommended for advanced hepatocellular carcinoma (HCC) patients with Vp4 (portal invasion at the main trunk) by the Japan Society of Hepatology (JSH) due to a risk of hepatic failure. This study aimed to elucidate the safety and efficacy of sorafenib monotherapy on HCC with macro-vascular invasion (MVI). A total of 415 consecutive advanced HCC patients received sorafenib in our hospital. Patients with only MVI and sorafenib monotherapy were retrospectively enrolled. We enrolled 113 (27.2%) patients, including 56 (49.5%) Vp3 (portal invasion at the first branch) and 57 (50.5%) Vp4. Their median intervals of follow-up and sorafenib-use were 7.8months and 2.7months respectively. Using sorafenib, more Vp4 had hepatic decompensation (HD) (37% VS 18.2%, p=0.028) than Vp3 patients. The multivariate analysis showed Vp4 (Odds ratio: 2.91; 95% CI: 1.02-8.3, p=0.041) and baseline alpha-fetoprotein (AFP)≥200ng/ml were associated with HD. Dividing our patients into four subgroups as Vp3+AFP<200ng/ml, Vp3+AFP≥200ng/ml, Vp4+AFP<200ng/ml and Vp4+AFP≥200ng/ml, the proportions of HD were 16.7%, 19.4%, 16.7% and 55.2% respectively (p=0.002). The overall survival rates were distributed with a significant decreasing trend as 10.2±4.4months, 6.5±1.0months, 6.0±1.3months and 2.5±0.5months (p=0.001). We found only Vp4 plus AFP≥200ng/ml could induce more HD and a poorer prognosis than Vp3 patients. Hence, in Vp4 patients with higher AFP, sorafenib should not be the first-line treatment due to its limited survival benefit.

Expression of vascular endothelial growth factor and endothelial growth factor receptor related Lnc RNA HOTAIR in hepatocellular carcinoma and their clinical significance

Objective To study the mechanism of the signaling pathway-related LncHOTAIR on the invasion and metastasis of hepatocellular carcinoma(HCC) and provide experimental basis for the treatment of liver cancer with target gene level. Methods Thirty specimens of liver cancer and tissue adjacent to carcinoma on liver and gallbladder surgery surgical resection were collected in the People′s Liberation Army General Hospital from September 2012 to June 2013.Expression of LncHOTAIR, vascular endothelial growth factor(VEGF) and endothelial growth factor receptor(VEGFR) in Hepatocellular Carcinoma and Paracancerous Tissues were detected by Real-time Quantitative Real-time PCR, the relationship between the pathological features and the pathological features of the patients with HCC was analyzed. Results The expression of LncRNA HOTAIR, VEGF and VEGFR were higher in HCC tissues than that in adjacent tissues, which was closely related to tumor size(P=0.512, 0.003, 0.008), TNM staging(P=0.094, 0.001, 0.014), portal vein thrombosis(P=0.065, 0.046, 0.031), invasion and metastasis (P=0.002, 0.046, 0.031) and 2-year recurrence((P=0.001, 0.003, 0.021). Conclusion Lnc HOTAIR-related VEGF signal pathways are closely related to the development of liver cancer, si-HOTAIR is expected to become a new focus in the clinical treatment of liver cancer in the future. Key words: Long non-cording RNA; HOX transcript antisense RNA; Hepatocellular carcinoma; Endothelial growth factor; Endothelial growth factor receptor; Signaling pathways

Glasgow prognostic score predicts therapeutic outcome after hepatic resection for hepatocellular carcinoma

Systemic inflammation, as evidenced by the Glasgow prognostic score (GPS), predicts cancer-specific survival in various cancer types. The aim of this study was to evaluate the significance of the GPS in the therapeutic outcome of the patient following surgical resection for hepatocellular carcinoma. In total, 144 patients underwent surgical resection for hepatocellular carcinoma. For the assessment of systemic inflammatory response using the GPS, patients were classified into three groups: Patients with normal serum albumin (<3.5 g/dl) and normal serum C-reactive protein (CRP) (≤1.0 mg/dl) were classified as GPS 0 (n=76), those with low serum albumin (<3.5 g/dl) or elevated serum CRP (>1.0 mg/dl) were classified as GPS 1 (n=58), and those with low serum albumin (<3.5 g/dl) and elevated serum CRP (>1.0 mg/dl) were classified as GPS 2 (n=10). Retrospectively, the relationship between patient characteristics including GPS, disease-free as well as overall survival were investigated. In disease-free survival, GPS 2 (P=0.019), with a tumor number ≥3 (P=0.004), and positive portal or venous invasion (P=0.034) were independent predictors of cancer recurrence in multivariate analysis. In overall survival, GPS 1 (P=0.042), GPS 2 (P<0.001) and positive portal or venous invasion (P<0.001) were independent predictors of poor patient outcome according to multivariate analysis. To conclude, the GPS in patients with hepatocellular carcinoma is an independent prognostic predictor after hepatic resection.

Huge hepatocellular carcinoma greater than 10 cm in diameter worsens prognosis by causing distant recurrence after curative resection.

This study aimed to evaluate the impact of huge (≥10 cm) hepatocellular carcinoma (HCC) to the recurrence pattern and the prognosis after hepatectomy. 574 patients who underwent hepatectomy by 17 surgeons (Open 536 and Laparoscopic 38) for HCC without major vascular invasion from 1990 to 2013 at single institute were retrospectively analyzed. Huge tumor, age, HCV, multiple tumors and microscopic portal invasion are independent risk factors for overall survival (OS), and huge tumor, ICGR15 ≥16%, multiple tumors, moderate/poor histology, microscopic portal invasion and a positive pathological margin are risk factors for relapse-free survival (RFS). The 5-year OS and RFS of patients with huge HCC (n = 53) (42.9 and 14.2%) were significantly worse than those of patients with HCC <10 cm (n = 521) (71.3 and 33.1%). Huge tumor is an independent risk factor for initial extra-hepatic recurrence (Hazard ratio 7.86, P < 0.0001). The 5-year OS of patients with initial extra-hepatic recurrence (n = 55) was significantly worse than patients with intra-hepatic recurrence (n = 338) (16.8 vs. 50.5%). Huge HCC (≥10 cm) is an independent risk factor due to a high risk for initial extra-hepatic recurrence. Future systemic adjuvant therapy is needed for these patients. J. Surg. Oncol. 2017;115:324-329. © 2016 Wiley Periodicals, Inc.

SAT-090 - Extent of portal invasion in patients with hepatocellular carcinoma: the more, the worse?

SAT-090 - Extent of portal invasion in patients with hepatocellular carcinoma: the more, the worse?

Prognosis of hepatocellular carcinoma with bile duct tumor thrombus after R0 resection: a matched study

Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare. The present study aimed to determine post-surgical prognoses in HCC patients with BDTT, as outcomes are currently unclear. We compared the prognoses of 110 HCC patients without BDTT (group A) to 22 cases with BDTT (group B). The two groups were matched in age, gender, tumor etiology, size, number, portal vascular invasion, and TNM stage. Additionally, 28 HCC patients with BDTT were analyzed to identify prognostic risk factors. The 1-, 3-, and 5-year overall survival rates were 90.9%, 66.9%, and 55.9% for group A and 81.8%, 50.0%, and 37.5% for group B, respectively. The median survival time in groups A and B was 68.8 and 31.4 months, respectively (P=0.043). The patients for group B showed higher levels of serum total bilirubin, alanine aminotransferase and gamma-glutamyl transferase, a larger hepatectomy range, and a higher rate of anatomical resection. In subgroup analyses of patients with BDTT who underwent R0 resection, TNM stage III-IV was an independent risk factor for overall survival; these patients had worse prognoses than those with TNM stage I-II after R0 resection (hazard ratio=6.056, P=0.014). Besides, univariate and multivariate analyses revealed that non-R0 resection and TNM stage III-IV were independent risk factors for both disease-free survival and overall survival of 28 HCC patients with BDTT. The median overall survival time of patients with BDTT who underwent R0 resection was longer than that of patients who did not undergo R0 resection (31.0 vs 4.0 months, P=0.007). R0 resection prolonged survival time in HCC patients with BDTT, although prognosis remains poor. For such patients, R0 resection is an important treatment that determines long-term survival.

Primary Liver Cancer, Ultrasound and CT scan Aspects

1.1.Introduction:Primary malignant tumors have an important place in the liver disease in Burkina Faso. Objectives: To describe aspects in ultrasound and CT scan of primary liver cancer at Ouagadougou. 1.2.Materials and Methods:Retrospective study conducted on 7 years in 4 referral health centers in Ouagadougou. Patients witch present liver cancer with radio-biological and / or histological evidence was included. 1.3.Results:We collected 233 primary malignant liver tumors. The average age was 46 years. Male dominance was marked with a sex ratio of 3.9. The alpha-fetal protein level was greater than 400 IU / l in 75.7% of cases and HBs Ag was positive in 80.4% of cases. Abdominal ultrasound had found multiple nodules in 65.5% of cases with an average size of 107.3 mm and a portal invasion in 34.7% of cases. Enhancement of lesions in the liver CT scanner was highly suggestive in 77% of cases. Histological confirmation was made in 44 cases (18.8%) in liver biopsies. There were 42 cases of hepatocellular carcinoma (95.5%). Conclusion:The primary liver cancers are common in our context and diagnosed at a late stage. Viral hepatitis B often seems concerned. Awareness is essential to improve the prevention and access to surgery.

소라페닙 및 방사선 병합 치료 후 좋은 반응을 보인 간문맥 침윤을 동반한 진행성 간세포암종 1예

소라페닙 및 방사선 병합 치료 후 좋은 반응을 보인 간문맥 침윤을 동반한 진행성 간세포암종 1예

Portal Vein Embolization Followed by Right-Side Hemihepatectomy for Hepatocellular Carcinoma Patients: A Japanese Multi-Institutional Study

Portal vein embolization (PVE) is useful to expand the indications of major hepatectomy; however, its oncologic effects are not fully understood. This study aimed to confirm the efficacy of preoperative PVE for hepatocellular carcinoma patients. Between 2000 and 2012, five hundred and ten patients with hepatocellular carcinoma undergoing right-side hemihepatectomy were enrolled (PVE group, n= 162 and non-PVE group, n= 348). To equalize background factors, one-to-one propensity case-matched analysis and multivariate analysis were performed. Short- and long-term outcomes were evaluated. Propensity score-matched patients, 148 in each group, were selected. The percentage of resected liver volume on admission was significantly greater in the PVE group (60.5% vs 48.3%; p < 0.001), but decreased considerably after PVE, from 60.5% to 50.3% (p<0.001). The 5-year cumulative recurrence-free survival (36.4% vs 35.3%) and overall survival (58.6% vs 52.8%) rates were comparable. Extrahepatic recurrences were less common in the PVE group (18.1% vs 38.8%; p= 0.004). Independent prognostic factors for recurrence-free survival were morbidity (hazard ratio [HR]= 1.56), multiple tumors (HR= 1.97), red cell concentrate administration (HR= 1.57), older age (HR= 2.09), and massive portal invasion (HR= 2.33); and those for overall survival were morbidity (HR= 2.37), multiple tumors (HR= 1.71), and massive hepatic venous invasion (HR= 3.49). Even though hepatocellular carcinoma patients who underwent preoperative PVE and right-side hemihepatectomy had a significantly larger resected liver volume on admission, they have a comparable long-term prognosis as patients with up front hepatectomy. In addition, PVE might decrease extrahepatic recurrences.

Prognostic impact of the site of portal vein invasion in patients with surgically resected perihilar cholangiocarcinoma

The aim of this study was to determine the impact of the site of portal vein invasion on survival after hepatectomy for perihilar cholangiocarcinoma. This study classified 168 patients undergoing resection for perihilar cholangiocarcinoma histologically as without portal vein resection or tumor invasion to the portal vein (PV0), with tumor invasion to unilateral branches of the portal vein (PVt3), or with tumor invasion to the main portal vein or its bilateral branches, or to unilateral second-order biliary radicals with contralateral portal vein involvement (PVt4). Patients in PVt4 were subclassified into the A-M group (cancer invasion limited to the tunica adventitia or media) or the I group (cancer invasion reaching the tunica intima). Of the patients, 121 were in PV0, 21 were in PVt3, and 26 were in PVt4. There was no difference in survival between the PV0 and PVt3 groups (P=.267). The PVt4 group had a worse prognosis than the PVt3 group (P=.046). In addition, the A-M (n=19) and I subgroups (n=7) of PVt4 had worse prognoses than the PV0 or PVt3 groups (P=.005 and<.001, respectively). All patients in the I subgroup of PVt4 died within 9months after resection. On multivariate analysis, PVt4 (P=.029) was identified as an independent prognostic factor. In perihilar cholangiocarcinoma, postoperative survival was no different between patients with and without ipsilateral portal vein invasion, although patients with tumor invasion to the main or contralateral branches of the portal vein, especially with tunica intima invasion, had extremely poor prognoses.

An alternatively spliced variant of CXCR3 mediates the metastasis of CD133+ liver cancer cells induced by CXCL9.

Metastasis of liver cancer is closely linked to tumor microenvironment, in which chemokines and their receptors act in an important role. The CXCR3, the receptor of chemokine CXCL9, belongs to a superfamily of rhodopsin-like seven transmembrane GPCRs and CXCR subfamily. In HCC tissues, CXCR3 was frequently upregulated and correlated with tumor size, tumor differentiation, portal invasion and metastasis. In the study, CXCR3-A isoform that was bound by CXCL9 was found to cause significant change of ERK1/2 phosphorylation level in the MAPK signaling pathway, consequently upregulating the MMP2 and MMP9 expression and promoting invasion and metastasis of CD133+ liver cancer cells. Also, CXCR3-A suppressed the adhesion ability of CD133+ liver cancer cells that stimulated by CXCL9 for 24h. These findings suggest that CXCR3 and its ligand CXCL9 could promote the metastasis of liver cancer cells and might be a potential target for the intervention of liver cancer metastasis.

Predictive factors of pathological vascular invasion in hepatocellular carcinoma within 3cm and three nodules without radiological vascular invasion.

The aim of this study was to determine the predictive factors of pathological vascular invasion as contra-indicators for ablation therapy in patients with hepatocellular carcinoma (HCC) within 3cm and three nodules without radiological vascular invasion. Two hundred and seventeen patients with HCC within 3cm and three nodules without radiological vascular invasion who underwent hepatic resection were retrospectively investigated. Pathological vascular invasion was positive in 46 patients, consisting of 38 portal vein invasions, three hepatic vein invasions, two hepatic artery invasions, one hepatic duct invasion and two with portal and hepatic vein invasions. In univariate analysis, patients with α-fetoprotein (AFP) of more than 100ng/mL had higher rates of pathological vascular invasion than those without. In addition, patients with protein induced by vitamin K absence (PIVKA-II) of more than 100mAU/mL had higher rates of pathological vascular invasion than those without. Multivariate analysis revealed that AFP of more than 100ng/mL and PIVKA-II of more than 100mAU/mL were independent predictive factors for pathological vascular invasion. As these patients were treated with hepatic resection, cumulative 5-year recurrence-free and overall survivals were not significantly different between the pathological vascular invasion negative and positive cases. AFP of more than 100ng/mL and PIVKA-II of more than 100mAU/mL can predict pathological vascular invasion in patients with HCC within 3cm and three nodules without radiological vascular invasion. In treating such cases, hepatic resection rather than local ablation therapy is recommended.

Staging Hepatocellular Carcinoma with Gadolinium Ethoxybenzyl Diethylenetriaminepentaacetic Acid -Enhanced Magnetic Resonance Imaging: A Comparison with Multi-Detector Row Computed Tomography

Aim: To explore if gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI provides more accurate information than multi-detector row computed tomography (MDCT) for staging hepatocellular carcinoma (HCC). Methods: We retrospectively investigated 112 patients with HCC who underwent MDCT and Gd-EOB-DTPA enhanced MRI within one month before treatment. Two experienced radiologists reviewed the size, number, and boundaries of the HCC lesions, portal invasion, and tumor metastasis on MDCT and MRI images in consensus. Then the performance of Gd-EOB-DTPA-enhanced MRI and MDCT on staging HCC lesions was compared through statistical analysis. The classification of the Barcelona Clinic Liver Cancer (BCLC) stage was also evaluated. Results: HCC lesions in five patients were detected on Gd-EOB-DTPA-enhanced MRI only. Of the other 107 patients, 21 (19.6%) were in BCLC stage 0, 49 (45.8%) in BCLC stage A, 14 (13.1%) in BCLC stage B, and 23 (21.5%) in BCLC stage C on MDCT. On Gd-EOB-DTPA-enhanced MRI, 12 (11.2%), 48 (44.9%), 17 (15.9%), and 30 (28.0%) patients were classified as BCLC stages 0, A, B, and C, respectively. The two methods differed significantly in staging HCC patients (χ2=16.444, P=0.006). Conclusion: This study suggests that Gd-EOB-DTPA-enhanced MRI provides more accurate information than MDCT for characterizing and staging HCC which will help to choose accurate treatment strategy.

A rare case of hepatocellular carcinoma with right atrial invasion

An elderly male came with h/o loss of appetite and weight loss since 3 months. On evaluation, prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) values were high. Hepatitis B surface antigen (HbSAg) screening was reactive and serum alfa-fetoprotein (AFP) was raised. Ultrasound examination revealed a hepatic mass with inferior vena caval extension and direct invasion of the right atrium. Computed tomography (CT) scan of the lower thorax and abdomen was performed, which confirmed the ultrasound diagnosis. The patient had a brief stay in the hospital and got discharged against medical advice; he was not available for follow-up. Hepatocellular carcinomas (HCCs) commonly metastasizes to the lung, bone, brain, and adrenal glands. About 70% of the patients with HCCs have hepatic and portal vein invasions but encroachment into the right atrium is very rare. The most common symptoms of cardiac metastasis include asymptomatic cases, bilateral lower leg edema, and exertional dyspnea in that order. Typical complications of intravascular tumor extension lead to secondary Budd-Chiari syndrome, right heart insufficiency, or massive pulmonary embolism. The prognosis of HCC with atrial invasion is poor, with median survival ranging from 1 month to 4 months. HCC in these cases may be more aggressive, with a shorter doubling time. The risk for cardiopulmonary collapse is higher, with heart failure or sudden death. Surgical interventions as well as nonsurgical approaches have been used in the treatment of patients with symptomatic inferior vena cava (IVC)/right atrial tumor thrombi. There are few reports of en bloc hepatectomy and resection of the right atrial thrombus under cardiopulmonary bypass. Routine screening in patients with HCC, such as including chest imaging as part of surveillance computed tomographic scans, may facilitate earlier detection and treatment.

Hypointense hepatocellular carcinomas on apparent diffusion coefficient mapping: Pathological features and metastatic recurrence after hepatectomy.

The present study aimed to evaluate pathological features of hepatocellular carcinomas (HCC) appearing hypointense on the apparent diffusion coefficient (ADC) map, and to elucidate the association between the signal intensity on the ADC map and metastatic recurrences after hepatectomy. In total, 52 consecutive patients with initial hypervascular HCC (solitary lesion ≤5cm in diameter) without vascular invasion on imaging were examined by diffusion-weighted magnetic resonance imaging before hepatectomy. The signal intensities of HCC on the ADC map were visually compared with the surrounding liver and categorized as hypointense or non-hypointense. Intrahepatic metastatic recurrence was defined as more than three intrahepatic recurrences. The 52 HCC were evaluated as 26 hypointense and 26 non-hypointense tumors. No significant differences between the hypointense and non-hypointense groups were seen for age, sex, etiology, tumor size and tumor marker levels. However, in resected specimens, significant differences between the two groups were noted for histological grade and microscopic portal invasion. The percentages of poorly differentiated HCC and microscopic portal invasion in the hypointense group were significantly higher than those in the non-hypointense group. The cumulative 3-year metastatic recurrence rates of the hypointense and non-hypointense groups on the ADC map were 56% and 13% (P = 0.001), respectively. Multivariate analyses indicated that hypointensity on the ADC map was the only independent factor related to metastatic recurrence. Hypointense HCC on ADC mapping are characterized by poor histological differentiation and more frequent microscopic portal invasion, and are significantly associated with metastatic recurrences after hepatectomy.

Evaluation of ART Scores for Repeated Transarterial Chemoembolization in Japanese Patients with Hepatocellular Carcinoma

Objective: Transarterial chemoembolization (TACE) is recommended as a first-line therapy for hepatocellular carcinoma (HCC) patients ineligible for curative therapy and without portal invasion. The Assessment for Retreatment with TACE (ART) scoring system was recently proposed for identifying patients who would not show sufficient survival benefit from repeated TACE. We reevaluated the performance of ART in HCC patients treated in Japan, where selective TACE is commonly used. Methods: Between 2000 and 2013, 988 patients with HCC underwent TACE at Kinki University Hospital, and 627 received ≥2 sessions of TACE. Seventy-six patients who underwent ≥2 TACE sessions within 90 days were investigated for their performance of the ART score in the context of overall survival (OS). Results: Only 12% (76/627) of patients underwent ≥2 TACE sessions within 90 days. Of those, 52 patients showed a low ART score (0-1.5), and 24 had a high ART score (≥2.5); the median OS was 20.2 and 37.6 months, respectively (p = 0.8207). Conclusion: The ART scoring system did not demonstrate a sufficiently predictive impact on OS among the patients who underwent ≥2 TACE sessions within 90 days. Application of the ART score should be carefully considered because differences in TACE procedures and post-TACE treatment can affect the results while evaluating OS.

The clinical value of pancreatic fistula risk predicting system after pancreaticoduodenectomy

To evaluate the clinical value of a preoperative predictive scoring system which was established by the National Cancer Center Hospital (NCCH) for the postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. The clinical data of 269 patients who underwent pancreaticoduodenectomy at the Affiliated Provincial Hospital of Anhui Medical University from February 2008 to February 2014 were studied retroprospectively. The five indexes which including gender, portal invasion, pancreatic cancer, main pancreatic duct index and intra abdominal fat thickness were calculated in the NCCH predictive score system. Patients with a score over 4 were defined as high risk of POPF, and those with score less than 4 were defined as low risk of POPF. Then the factors associated with POPF were analyzed by Logistic regression test. The enumeration data and measurement data were compared with χ2 test and t test. Risk factors for postoperative pancreatic fistula were analyzed through single factor and multiple factors Logistic regression analysis. The sensitivity and specificity of the predictive scoring system were determined by receiver operating characteristic (ROC) curve analysis. A total of 33 patients were diagnosed as POPF, including 15 in grade A, 11 in grade B and 7 in grade C. The univariate analysis showed that the factors associated with POPF are gender, total serum bilirubin level, pancreatic cancer, portal invasion, the pancreatic texture, main pancreatic duct diameter and the pancreaticojejunostomy. The multivariate analysis showed that gender, pancreatic texture, portal invasion and main pancreatic duct diameter were the independent risk factor of POPF. The rate of pancreatic fistula of high risk group was 53.8% (14/26), and the rate of pancreatic fistula of the low risk group was 7.8% (19/243). There were significant differences in the pancreatic fistula rate between the high risk and low risk of POPF (χ2=46.231, P<0.01). The results of ROC curve analysis showed that the sensitivity and specificity of the predictive scoring system were 87.9% and 94.1%, respectively. The area under the curve was 0.946 (95% CI: 0.895-0.997). The NCCH preoperative predictive scoring system could accurately predict the occurrence of POPF. While large, multicenter prospective randomized controlled trials is still needed to further confirm it.