Radical Resection Of Hepatocellular Carcinoma Research Articles

An Overview of Traditional Chinese Medicine in the Treatment After Radical Resection of Hepatocellular Carcinoma.

According to the Barcelona Clinic Liver Cancer (BCLC) system, radical resection of early stage primary hepatocellular carcinoma (HCC) mainly includes liver transplantation, surgical resection, and radiofrequency ablation (RFA), which yield 5-year survival rates of about 70-79%, 41.3-69.5%, and 40-70%, respectively. The tumor-free 5-year rate for HCC patients undergoing radical resection only reach up to 13.7 months, so the prevention of recurrence after radical resection of HCC is very important for the prognosis of patients. The traditional Chinese medicine (TCM) takes the approach of multitarget and overall-regulation to treat tumors, it can also independently present the "component-target-pathway" related to a particular disease, and its systematic and holistic characteristics can provide a personalized therapy based on symptoms of the patient by treating the patient as a whole. TCM as postoperative adjuvant therapy after radical resection of HCC in Barcelona Clinic liver cancer A or B stages, and the numerous clinical trials confirmed that the efficacy of TCM in the field of HCC has a significant effect, not only improving the prognosis and quality of life but also enhancing patient survival rate. However, with the characteristics of multi-target, multi-component, and multi-pathway, the specific mechanism of Chinese medicine in the treatment of diseases is still unclear. Because of the positive pharmacological activities of TCM in combating anti-tumors, the mechanism studies of TCM have demonstrated beneficial effects on the regulation of immune function, chronic inflammation, the proliferation and metastasis of liver cancer cells, autophagy, and cell signaling pathways related to liver cancer. Therefore, this article reviews the mechanism of traditional Chinese medicine in reducing the recurrence rate of HCC after radical resection.

Correlation between preoperative systemic immune inflammation index, nutritional risk index, and prognosis of radical resection of liver cancer.

Radical surgery is the most commonly used treatment for hepatocellular carcinoma (HCC). However, the surgical effect remains not ideal, and prognostic evaluation is insufficient. Furthermore, clinical intervention is rife with uncertainty and not conducive to prolonging patient survival. To explore correlations between the systemic immune inflammatory index (SII) and geriatric nutritional risk index (GNRI) and HCC operation prognosis. This retrospective study included and collected follow up data from 100 HCC. Kaplan-Meier survival curves were used to analyze the correlation between SII and GNRI scores and survival. SII and GNRI were calculated as follows: SII = neutrophil count × platelet count/lymphocyte count; GNRI = [1.489 × albumin (g/L) + 41.7 × actual weight/ideal weight]. We analyzed the predictive efficacy of the SII and GNRI in HCC patients using receiver operating characteristic (ROC) curves, and the relationships between the SII, GNRI, and survival rate using Kaplan-Meier survival curves. Cox regression analysis was utilized to analyze independent risk factors influencing prognosis. After 1 year of follow-up, 24 patients died and 76 survived. The area under the curve (AUC), sensitivity, specificity, and the optimal cutoff value of SII were 0.728 (95% confidence interval: 0.600-0.856), 79.2%, 63.2%, and 309.14, respectively. According to ROC curve analysis results for predicting postoperative death in HCC patients, the AUC of SII and GNRI combination was higher than that of SII or GNRI alone, and SII was higher than that of GNRI (P < 0.05). The proportion of advanced differentiated tumors, tumor maximum diameter (5-10 cm, > 10 cm), lymph node metastasis, and TNM stage III-IV in patients with SII > 309.14 was higher than that in patients with SII ≤ 309.14 (P < 0.05). The proportion of patients aged > 70 years was higher in patients with GNRI ≤ 98 than that in patients with GNRI > 98 (P < 0.05). The 1-year survival rate of the SII > 309.14 group (compared with the SII ≤ 309.14 group) and GNRI ≤ 98 group (compared with the GNRI > 98 group) was lower (P < 0.05). The prognosis after radical resection of HCC is related to the SII and GNRI and poor in high SII or low GNRI patients.

Clinical impact of myosteatosis measured by magnetic resonance imaging on long-term outcomes of hepatocellular carcinoma after radical hepatectomy

AimsA variety of factors have been reported to affect long-term outcomes after radical resection of hepatocellular carcinoma (HCC). However, the indicators remain controversial. The purpose of this study was to evaluate the relationship between myosteatosis of the multifidus muscle and long-term outcomes after radical surgery for HCC.MethodsWe retrospectively analyzed clinicopathological data for 187 patients with HCC who underwent radical surgery at Tokushima University between January 2009 and December 2020 and measured the density of fat in the multifidus muscle at L3 on their preoperative magnetic resonance images (MRI). Associations of myosteatosis and clinicopathological factors with long-term outcomes were evaluated.ResultsThe patients were divided into a myosteatosis-negative group (n = 122) and a myosteatosis-positive group (n = 65). The cancer-specific survival rate after hepatectomy was significantly worse in the myosteatosis-positive group than in the myosteatosis-negative group (p = 0.03). Univariate analysis identified multiple tumors, stage III/IV disease, an alfa-fetoprotein level ≥ 10 ng/ml, PIVKA-II ≥ 400 AU/ml, vp(+) status, and myosteatosis to be prognostic factors for cancer-specific survival. Multivariate analysis revealed multiple tumors, an alfa-fetoprotein level ≥ 10 ng/ml, and myosteatosis to be independent prognostic factors.ConclusionsMyosteatosis measured by MRI is a simple and useful predictor of the long-term outcome after radical surgery for HCC.

Safety and efficacy of postoperative adjuvant therapy with atezolizumab and bevacizumab after radical resection of hepatocellular carcinoma

BackgroundThe effects of postoperative adjuvant therapy for high-risk recurrent hepatocellular carcinoma (HCC) in immunotherapy are still under investigation. This study evaluated the preventive effects and safety of postoperative adjuvant therapy, including atezolizumab, and bevacizumab, against the early recurrence of HCC with high-risk factors. MethodsThe complete data of HCC patients who underwent radical hepatectomy with or without postoperative adjuvant therapy after two-year follow-up were analyzed retrospectively. The patients were divided into high-risk or low-risk groups based on HCC pathological characteristics. High-risk recurrence patients were divided into postoperative adjuvant treatment and control groups. Due to the difference in approaches in postoperative adjuvant therapies, they were divided into transarterial chemoembolization (TACE), atezolizumab, and bevacizumab (T + A), and combination (TACE+T + A) groups. The two-year recurrence-free survival rate (RFS), overall survival rate (OS), and associated factors were analyzed. ResultsThe RFS in the high-risk group was significantly lower than that in the low-risk group (P = 0.0029), and the two-year RFS in the postoperative adjuvant treatment group was significantly higher than that in the control group (P = 0.040). No severe complications were observed in those who received atezolizumab and bevacizumab or other therapy. ConclusionPostoperative adjuvant therapy was related to two-year RFS. TACE, T + A, and the combination of these two approaches were comparable in reducing the early recurrence of HCC without severe complications.

Comparison of different adjuvant therapy regimen efficacies in patients with high risk of recurrence after radical resection of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) has a high recurrence rate even after radical surgery. Postoperative adjuvant transhepatic arterial chemoembolization (PA-TACE), postoperative adjuvant hepatic arterial infusion chemotherapy (PA-HAIC), postoperative adjuvant radiotherapy (PA-RT), and postoperative adjuvant molecular targeted therapy have been demonstrated to be effective in reducing the postoperative recurrence rate. The present network meta-analysis was conducted to compare the effects of PA-TACE, PA-HAIC, PA-RT and postoperative adjuvant molecular targeted therapy on the overall survival (OS) and disease-free survival (DFS) in HCC patients after radical resection and to determine the optimal treatment strategy. Network meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Cochrane Library, and Web of Science were used to collect eligible studies up to December 25, 2022. Studies related to PA-TACE, PA-HAIC, and postoperative adjuvant molecular targeted therapy after radical HCC resection was included. The endpoints were OS and DFS, and the effect size was determined using hazard ratio with a 95% confidence interval. R software and "gemtc" package were employed to analyze the results. A total of 38 studies involving 7079 patients with HCC after radical resection were ultimately enrolled to be analyzed. Four postoperative adjuvant therapy measures and two oncology indicators were evaluated. In this study, OS-related investigations validated that PA-Sorafenib and PA-RT markedly enhanced the OS rates in patients after radical resection when compared to PA-TACE and PA-HAIC. However, statistical analysis revealed no significant difference between PA-Sorafenib and PA-RT, as well as PA-TACE and PA-HAIC. In the DFS-related investigations, PA-RT demonstrated superior efficacy over PA-Sorafenib, PA-TACE, and PA-HAIC. Additionally, PA-Sorafenib displayed better efficacy than PA-TACE. Nevertheless, there was no statistical significance between PA-Sorafenib and PA-HAIC, as well as PA-TACE and PA-HAIC. We also performed a subgroup analysis of studies focusing on HCC complicated by microvascular invasion after radical resection. In terms of OS, both PA-RT and PA-Sorafenib demonstrated a noteworthy improvement over PA-TACE, whereas no statistical significance was detected between PA-RT and PA-Sorafenib. Likewise, for DFS, both PA-Sorafenib and PA-RT exhibited superior efficacy compared to PA-TACE. In patients with HCC after radical resection and a high risk of recurrence, both PA-Sorafenib and PA-RT significantly improved OS and DFS when compared to PA-TACE and PA-HAIC. Notably, PA-RT exhibited superior efficacy over PA-Sorafenib, PA-TACE, and PA-HAIC in terms of DFS. Similarly, PA-Sorafenib appeared to be more effective than PA-TACE for DFS.

Prognostic factors and an innovative nomogram model for patients with hepatocellular carcinoma treated with postoperative adjuvant transarterial chemoembolization

Purpose The purpose of this study was to estimate the clinical efficacy and identify the best beneficiaries of postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) in hepatocellular carcinoma (HCC). Patients and methods A total of 749 HCC patients who underwent surgical resection (380 underwent PA-TACE, 369 had resection only) with a high risk of recurrence were reviewed retrospectively. Patients receiving PA-TACE were randomly split into development and validation cohorts. Univariate and multivariate analyses were performed in the development cohort. A novel model for PA-TACE-insensitivity prediction was built based on univariate and multivariate analysis and was multi-dimensionally validated in the validation set and all samples. Results After propensity score matching (PSM), in the early-recurrence group, no significant improvement in RFS was achieved with PA-TACE compared to radical hepatic resection alone. PA-TACE insensitive patients were considered as the PA-TACE non-benefit population and were associated with six clinicopathological factors: AFP, node number, tumor capsule, Ki-67 index, MVI, and complications in the development cohort. These factors were incorporated into a nomogram model, which reliably predicted PA-TACE insensitivity, with concordance indices of 0.874 and 0.897 for the development and validation cohort, respectively. In the overall sample, PA-TACE did not significantly improve patients’ RFS and OS in the high-score group, while the low-score group had statistical significance. Recurrence pattern diversity was also found to be a factor leading to PA-TACE insensitivity. Conclusion We constructed a new PA-TACE-insensitivity prediction model with potential clinical value. The good predictive performance and availability would allow this model to effectively screen PA-TACE beneficiaries. KEY MESSAGES The independent influencing factors of PA-TACE insensitivity in patients who received PA-TACE were analyzed to construct a predictive model and its clinical application performance was verified with multi-dimensional methods. PA-TACE treatment should be avoided for patients with high scores according to this model, while it should be cautiously recommended for patients with low scores after multiple considerations. Compared with other related models, this model has obvious advantages in versatility and effectiveness. It can effectively screen the best benefit population of PA-TACE and provide a reliable reference for the selection of precise treatment plans for patients after radical resection of hepatocellular carcinoma.

Adjuvant transarterial chemoembolization timing after radical resection is an independent prognostic factor for patients with hepatocellular carcinoma.

It has been reported that postoperative adjuvant TACE (PA-TACE) treatment decreases recurrence and significantly improves the survival of patients who undergo radical resection of hepatocellular carcinoma (HCC) with high-risk recurrence factors. However, when to perform PA-TACE has not been fully studied. We retrospectively collected the clinicopathologic characteristics of the patients with HCC between October 2013 and June 2020. The optimal cutoff value for PA-TACE time was determined based on the R package "maxstat". Logistic regression and Cox regression analysis were used to determine the effect of the choice of PA-TACE timing on prognosis. The analysis was performed on 789 patients with HCC, and 484 patients were finally involved and were divided into training cohort (378) and validation cohort (106). The PA-TACE timing was found to be associated with survival outcomes. Multivariate logistic analysis found independent predictors of the PA-TACE timing, including gender and history of HBV. Multivariate Cox analysis showed that Ki-67, tumor size, MVI and the PA-TACE timing were independent prognostic factors for RFS in HCC patients. Based on this study, HCC patients with high-risk recurrence factors can receive personalized assistance in undergoing PA-TACE treatment and improve their survival outcomes.

Individual and joint influence of cytokeratin 19 and microvascular invasion on the prognosis of patients with hepatocellular carcinoma after hepatectomy

Background and objectivesTo evaluate the individual and combined associations of cytokeratin 19 (CK19) and microvascular invasion (MVI) with prognosis of patients with hepatocellular carcinoma (HCC).MethodsClinicopathological data on 352 patients with HCC who underwent radical resection at our hospital between January 2013 and December 2015 were retrospectively analyzed. Patients were divided into four groups: CK19(−)/MVI(−), CK19(−)/MVI(+), CK19(+)/MVI(−), and CK19(+)/MVI(+).ResultsOf the 352 HCC patients, 154 (43.8%) were CK19(−)/MVI(−); 116 (33.0%), CK19(−)/MVI(+); 31 (8.8%), CK19(+)/MVI(−); and 51 (14.5%), CK19(+)/MVI(+). The disease-free survival of CK19(−)/MVI(−) patients was significantly higher than that of CK19(−)/MVI(+) patients and CK19(+)/MVI(+) patients. Similar results were observed for overall survival. CK19(+)/MVI(+) patients showed significantly lower overall survival than the other three groups.ConclusionsCK19 expression and MVI predict poor prognosis after radical resection of HCC, and the two markers jointly contribute to poor OS. Combining CK19 and MVI may predict post-resection prognosis better than using either factor on its own.

Prediction of early recurrence of hepatocellular carcinoma after resection based on Gd-EOB-DTPA enhanced magnetic resonance imaging: a preliminary study.

Early recurrence (ER) after radical resection of hepatocellular carcinoma (HCC) affects the prognosis of patients. Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) can improve the detection rate of small HCC. This study innovatively introduces a new quantitative index combined with qualitative index to compare the differences in clinical and imaging characteristics between ER and non-ER groups and evaluate the feasibility of Gd-EOB-DTPA-enhanced MRI in predicting ER. A total of 68 patients with HCC confirmed by operation and pathology in the Shandong Cancer Hospital and Institute were included retrospectively. All participants were examined by Gd-EOB-DTPA-enhanced MRI within 3 weeks before surgery. Regular follow-up was performed every 2 months within 1 year after operation. Among them, 18 cases with new lesions were in ER group, and 50 cases without new lesions were in non-ER group. The clinical and imaging data of the 2 groups were collected, and the differences of clinical data and preoperative MRI signs between the ER group and non-ER group were compared. The predictive factors of ER after HCC were analyzed by multivariate logistic regression. The quantitative parameter lesion-to-liver contrast enhancement ratio (LLCER) can predict the pathological grade of HCC (P=0.023). The results of univariate analysis between the ER group and non-ER group showed that there were significant differences in pathological grade (P=0.008), lesion morphology (P=0.011), peritumoral low signal intensity in hepatobiliary phase (HBP) (P<0.001), satellite nodules (P<0.001), and LLCER (P<0.001) between the 2 groups. Multivariate logistic regression analysis showed that HBP peritumoral low signal intensity [odds ratio (OR) =7.214, 95% confidence interval (CI): 1.230-42.312, P=0.029], satellite nodules (OR =9.198, 95% CI: 1.402-60.339, P=0.021), and parameter LLCER value (OR =0.906, 95% CI: 0.826-0.995, P=0.039) were independent predictors of ER of HCC after resection. Preoperative Gd-EOB-DTPA enhanced MRI has important predictive value for early recurrence after radical resection of hepatocellular carcinoma.

Prediction of Microvascular Invasion and Its M2 Classification in Hepatocellular Carcinoma Based on Nomogram Analyses.

Background and AimsAs a key pathological factor, microvascular invasion (MVI), especially its M2 grade, greatly affects the prognosis of liver cancer patients. Accurate preoperative prediction of MVI and its M2 classification can help clinicians to make the best treatment decision. Therefore, we aimed to establish effective nomograms to predict MVI and its M2 grade.MethodsA total of 111 patients who underwent radical resection of hepatocellular carcinoma (HCC) from January 2017 to December 2019 were retrospectively collected. We utilized logistic regression and least absolute shrinkage and selection operator (LASSO) regression to identify the independent predictive factors of MVI and its M2 classification. Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were calculated to select the potential predictive factors from the results of LASSO and logistic regression. Nomograms for predicting MVI and its M2 grade were then developed by incorporating these factors. Area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were respectively used to evaluate the efficacy, accuracy, and clinical utility of the nomograms.ResultsCombined with the results of LASSO regression, logistic regression, and IDI and NRI analyses, we founded that clinical tumor-node-metastasis (TNM) stage, tumor size, Edmondson–Steiner classification, α-fetoprotein (AFP), tumor capsule, tumor margin, and tumor number were independent risk factors for MVI. Among the MVI-positive patients, only clinical TNM stage, tumor capsule, tumor margin, and tumor number were highly correlated with M2 grade. The nomograms established by incorporating the above variables had a good performance in predicting MVI (AUCMVI = 0.926) and its M2 classification (AUCM2 = 0.803). The calibration curve confirmed that predictions and actual observations were in good agreement. Significant clinical utility of our nomograms was demonstrated by DCA.ConclusionsThe nomograms of this study make it possible to do individualized predictions of MVI and its M2 classification, which may help us select an appropriate treatment plan.

The Phenomenon of Gene Rearrangement is Frequently Associated with TP53 Mutations and Poor Disease-Free Survival in Hepatocellular Carcinoma.

PurposeGene rearrangements (GRs) have been reported to be related to adverse prognosis in some tumours, but the relationship in hepatocellular carcinoma (HCC) remains less studied. The objective of our study was to explore the clinicopathological characteristics and prognosis of HCC patients (HCCs) with GRs (GR-HCCs).Patients and MethodsThis retrospective study included 297 HCCs who underwent hepatectomy and had their tumours sequenced by next-generation sequencing. Categorical variables between groups were compared by the chi-square test. The impact of variables on disease-free survival (DFS) and survival after relapse (SAR) was analysed by the Kaplan–Meier method and Cox regression.ResultsWe observed four repetitive GR events in 297 HCCs: BRD9/TERT, ARID2/intergenic, CDKN2A/intergenic and OBSCN truncation. GR-HCCs frequently presented with low tumour differentiation, tumour necrosis, microvascular invasion, elevated AFP and gene mutations (TP53, NTRK3 and BRD9). The 1-, 2-, and 3-year cumulative DFS rates in GR-HCCs were 45.1%, 31.9%, 31.9%, respectively, which were significantly lower than those of GR-negative HCCs (NGR-HCCs) (72.5%, 57.9%, and 49.0%, respectively; P = 0.001). GR was identified as an independent risk factor for inferior DFS in HCCs (HR = 1.980, 95% CI = 1.246–3.147; P = 0.004). However, there was no significant difference in SAR between GR-HCCs and NGR-HCCs receiving targeted therapy or immunotherapy.ConclusionGR is frequently associated with TP53 mutations and significantly affects DFS following radical resection for HCC. We recommend that GR-HCCs should be closely followed up as a high-risk group for postoperative recurrence.

Expression and Prognostic Value of Tumor-Infiltrating Lymphocytes and PD-L1 in Hepatocellular Carcinoma.

AimTo explore the difference in tumor-infiltrating lymphocytes (TILs) and programmed death-ligand (PD-L1) in primary hepatocellular carcinoma (HCC) and its adjacent tissues, and to evaluate their effect on HCC prognosis.MethodsLiver cancer and paracancerous tissue samples were collected from 72 patients who underwent radical hepatectomy between December 15, 2017 and January 9, 2019. Flow cytometry was used to detect the distribution of TILs and PD-L1, analyze the correlation between the expression of CD8/CD3 and PD-L1 and clinical-pathological parameters, and evaluate their effect on the prognosis of HCC patients.ResultsThe distribution proportion of CD3+T cells, CD4+T cells, and PD-L1 in liver cancer were significantly higher than in paracancerous tissues, while the distribution proportion of CD8+T cells was significantly lower (all P<0.05). In HCC, the distribution proportion of CD8+T cells was related to tumor size and stage, while the PD-L1 expression was related to the tumor stage only (all P < 0.05). Univariate analysis showed that tumor differentiation, TNM stage, expression of CD8/CD3, and PD-L1 in tumor tissue were related to disease-free survival (DFS)(P < 0.05); multivariate Cox regression analysis showed that tumor differentiation, TNM stage, CD8/CD3, and PD-L1 expression were independent influencing factors of postoperative DFS (P < 0.05). Kaplan–Meier survival curve analysis showed that the DFS of CD8/CD3 high expression group was significantly higher than that of the low expression group, and the DFS of PD-L1 low expression group was significantly higher than that of the high expression group (all P < 0.05).ConclusionThere are significant differences in the distribution of TILs and PD-L1 in HCC and paracancerous tissues. The expression of CD8/CD3 and PD-L1 in tumor-infiltrating lymphocytes in HCC may help evaluate the immunological indexes of prognosis after radical resection of HCC and to further the study of immunotherapy in patients with HCC.

Impact of perioperative allogeneic blood transfusion on the long-term prognosis of patients with different stage tumors after radical resection for hepatocellular carcinoma

BackgroundWe previously reported that perioperative allogeneic blood transfusion (PABT) did not affect long-term survival after radical resection for hepatocellular carcinoma (HCC). This study aimed to investigate the effects of PABT on the prognosis of HCC patients with different stage tumors. MethodsPatients with primary HCC who underwent curative liver resection between 2003 and 2012 were retrospectively enrolled and divided into the early-stage (stage I) and non-early-stage (stages II, III and IV) groups. The impacts of PABT on the long-term prognosis of patients in different groups after resection were investigated using propensity score matching (PSM) and multivariable Cox regression analyses. ResultsWe enrolled 426 HCC patients, including 53 matched pairs of patients with early-stage tumors and 51 matched pairs of patients with non-early-stage tumors. Survival analyses of the patients with early-stage tumors showed that the recurrence-free survival (RFS) and overall survival (OS) rates of the transfusion group were significantly worse than those of the nontransfusion group both before and after PSM. Multivariable Cox analyses identified that PABT was an independent predictor of RFS and OS of the patients with early-stage tumors. However, survival analyses of the propensity-matched patients with non-early-stage tumors showed no significant differences in RFS and OS rates between the transfusion and nontransfusion groups (p = 0.296; p = 0.472). ConclusionsThis study demonstrates that PABT has negative impacts on the long-term prognosis of patients with early-stage tumors after radical resection of HCC but has no impact on the long-term prognosis of patients with non-early-stage tumors.

Effect of prophylactic TACE on 5-year survival of patients with hepatocellular carcinoma after hepatectomy.

The aim of the present study was to establish a prediction index (PI) model for the 5-year survival rate of patients with hepatitis B-related hepatocellular carcinoma (HCC) after radical resection, and to evaluate the effect of prophylactic transcatheter arterial chemoembolization (TACE). A total of 201 patients with hepatitis B-related HCC who had undergone radical hepatic resection at The First Affiliated Hospital of Xinjiang Medical University (Xinjiang, China) were enrolled, and the clinical, pathological and complete follow-up data were collected. Univariate and multivariate Cox regression analyses were performed to identify which clinicopathological factors were considered significant risk factors and the PI model was established based on these factors. The receiver operating characteristic curve was generated, and the area under the curve (0.841) and the cut-off value for PI were calculated. A Kaplan-Meier plot was used for survival analysis and the log-rank test was used to determine differences in survival. Cox regression analysis demonstrated that there were seven independent factors that may have affected the 5-year survival of HCC patients: Neutrophil-to-lymphocyte ratio (NLR), maximum size of tumor (MTS), tumor histological grade (HG), positive resection margin (PRM), microvascular invasion (MVI), the amount of tumor (AT), and antivirus therapy (AVT). A PI model on 5-year survival was established based on these factors, which was PI=0.32 × NLR + 0.39 × HG (high=1, medium=2, low=3) + 0.92 × PRM (yes=1, no=0) + 0.87 × MVI (yes=1, no=0) + 0.73 × AT (single=0, many=1) + 0.53 × MTS (≥5 cm=1, <5 cm=0)-0.87 × AVT (yes=1, no=0). PI was an independent predictor for survival, with a cut-off value of 2.75. For low-risk patients (PI <2.75), there was no significant difference in cumulative survival between TACE and non-TACE. For high-risk patients (PI >2.75), the cumulative survival rates showed significant differences among patients who had received ≥3 TACE procedues, patients who had received <3 TACE procedures, and patients who had not undergone TACE. The PI model predicts the 5-year survival rate of patients with hepatitis B-related HCC. For high-risk patients with a PI >2.75, if they had received ≥3 prophylactic TACE procedures, they demonstrated a more favorable outcome. For low-risk patients (PI <2.75) with 1 or 2 risk factors, TACE is recommended 1–2 times after surgery. TACE treatment is not required for low-risk patients without any risk fctors. These results may contribute to the decision-making process for whether prophylactic intervention is recommended after radical resection of HCC.

Clinical efficacy of parenchymal-sparing hepatectomy for Barcelona clinic liver cancer stage A hepatocellular carcinoma and prognostic factors analysis

Clinical efficacy of parenchymal-sparing hepatectomy for Barcelona clinic liver cancer stage A hepatocellular carcinoma and prognostic factors analysis

Application of fluorescence-guided laparoscopy in radical resection of hepatocellular carcinoma

Objective To investigate the clinical application value of fluorescence laparoscopy in radical resection of hepatocellular carcinoma (HCC). Methods Data of totally 113 patients with HCC in Henan Provincial People's Hospital between June 2016 to June 2018 were retrospectively analyzed. Among the 113 patients, 46 patients underwent laparoscopic hepatectomy (LLR), and 67 patients underwent fluorescence guided laparoscopic hepatectomy (FLLR). Results No significant differences were observed between LLR group and FLLR group in terms of age, male proportion, liver function classification, surgical resection methods, and operation time (P>0.05). The positive ratio of specimen surgical margin in LLR group was significantly higher than that in FLLR group, 13.0% vs. 3.0%, and the difference was statistically significant (P 0.05). Conclusion Fluorescence laparoscopy has certain advantages in hepatectomy, and can display the boundary of hepatocellular carcinoma in real time to ensure the safe margin of tumor resection. Key words: Carcinoma, hepatocellular; Hepatectomy; Indocyanine green; Fluorescence imaging

Risk factors analysis and prognosis of the microvascular invasion of hepatocellular carcinoma

Objective To explore the risk factors and prognosis of the microvascular invasion of hepato-cellular carcinoma (HCC). Methods The retrospective case-control study was conducted. The clinicopathological data of 220 patients with HCC who were admitted to the Nanfang Hospital of Southern Medical University from July 2012 to July 2015 were collected. Among 220 patients, 63 were confirmed with microvascular invasion of HCC by postoperative pathological examination after radical resection of HCC and 157 were not confirmed with microvascular invasion of HCC. Observation indicators: (1) univariate and multivariate analyses affecting microvascular invasion of HCC; (2) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect patients′ survival and tumor recurrence up to July 2016. The univariate and multivariate analyses were done using the Logistic regression model. The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method, and the Log-rank test was used for survival analysis. Results (1) Univariate and multivariate analyses affecting microvascular invasion of HCC: the results of univariate analysis showed that maximum diameter of tumor, preoperative alpha-fetoprotein (AFP) and preoperative platelet (PLT) were related factors affecting microvascular invasion of HCC [OR=4.542, 1.576, 3.655, 95% confidence interval (CI): 2.433-8.470, 1.084-2.292, 1.985-6.831, P<0.05]. The results of multivariate analysis showed that maximum diameter of tumor, preoperative AFP and preoperative PLT were independent factors affecting microvascular invasion of HCC (RR=3.386, 1.563, 2.247, 95%CI: 1.703-6.729, 1.054-2.318, 1.135-4.451, P<0.05). (2) Follow-up and survival situations: 220 patients were followed up for 12-48 months, with a median time of 26 months. The postoperative overall 1- and 2-year survival rates, postoperative 1- and 2-year tumor-free survival rates were 77.3%, 50.0%, 47.3%, 38.0% in 63 patients with microvascular invasion of HCC and 92.4%, 77.2%, 74.5%, 69.4% in 157 patients without microvascular invasion of HCC, with statistically significant differences (χ2=10.480, 19.605, 14.677, 18.461, P<0.05). Conclusion The maximum diameter of tumor, preoperative AFP and preoperative PLT are independent factors affecting microvascular invasion of HCC, and patients with microvascular invasion of HCC have poor clinical prognosis. Key words: Carcinoma, hepatocellular; Microvascular invasion; Prognosis

Expression and clinical significance of hexokinase 2 in tissues of hepatocellular carcinoma

Objective To investigate the expressions of hexokinase 2 (HK2) in tissues of hepatocellular carcinoma (HCC) and adjacent tissues, and its relationships with the clinicopathologic factors of HCC and prognosis of patients. Methods The retrospective cohort and case-control study was conducted. The clinicopathological data of 204 patients with HCC who were admitted to the First Affiliated Hospital of Fujian Medical University from August 2010 to January 2013 were collected. The expressions of HK2 in cancer tissues and adjacent tissues were detected using Western blot. Observation indicators: (1) the expressions of HK2 in cancer tissues and adjacent tissues; (2) relationship between the expression of HK2 in cancer tissues and clinico-pathologic factors; (3) risk factors affecting tumor recurrence and metastasis after radical resection of HCC; (4) relationship between the expression of HK2 and prognosis of patients. Follow-up using outpatient examination and telephone interview was performed up to December 31, 2015. Imaging examination, laboratory examination and emission computed tomography (ECT) examination were applied to patients once every 2 months within 1 year postoperatively and once every 3 months after 1 year postoperatively. Suspected patients received enhanced scan of computed tomography (CT) and ultrasound examination for confirming intrahepatic and extrahepatic tumor recurrence and (or) metastasis. A specific time of tumor recurrence and (or) metastasis was done by imaging examination. Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed using the rank sum test. The relationship between the expression of HK2 and clinicopathologic factors was analyzed by the chi-square test. The univariate analysis and multivariate analysis were done using the COX regression model. The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method, and the Log-rank test was used for survival analysis. Results (1) The expressions of HK2 in cancer tissues and adjacent tissues: results of Western blot test showed that relative expressions of HK2 in cancer tissues and adjacent tissues were 4.51 (range, 1.48-11.58) and 0.28 (range, 0.18-0.49), respectively, with a statistically significant difference (Z=-6.816, P 4.51 was respectively set as low expression and high expression due to a median of relative expression of HK2 in cancer tissues of 4.51. (2) Relationship between the expression of HK2 in cancer tissues and clinicopathologic factors: asymptomatically physical findings and symptomatic findings were respectively detected in 49 and 53 patients with high expression of HK2 in cancer tissues. Tumor diameter ≤2 cm, 2 cm 10cm were respectively detected in 1, 14, 52 and 35 patients. Ninety-one patients had 1 tumor and 11 had more than or equal to 2 tumors. Fifty-six patients had vascular tumor thrombi under endoscopy and 46 didn't have vascular tumor thrombi under endoscopy. There were significant differences in above indicators (χ2=5.090, 47.087, 5.082, 3.842, P<0.05). (3) Risk factors analysis affecting tumor recurrence and metastasis after radical resection of HCC: results of univariate analysis showed that finding mode, tumor diameter, tumor with capsule, postoperative pathological differentiation, vascular tumor thrombi under endoscopy, peak value of postoperative TBil and expression of HK2 were risk factors affecting rate of 2-year tumor recurrence and metastasis after radical resection of HCC [HR=1.663, 3.159, 1.516, 0.426, 2.705, 1.419, 2.786, 95% confidence interval (CI): 0.119-2.472, 2.105-4.740, 0.989-2.322, 0.260-0.698, 1.851-3.952, 0.951-2.117, 1.819-4.269, P<0.05]. Results of multivariate analysis showed that symptomatic findings, vascular tumor thrombi under endoscopy and high expression of HK2 were independent risk factors affecting rate of 2-year tumor recurrence and metastasis after radical resection of HCC (HR=2.702, 2.117, 6.908, 95%CI: 1.417-5.151, 1.386-3.233, 3.920-12.174, P<0.05). (4) Relationship between the expression of HK2 and prognosis of patients: all the 204 patients were followed up for 23-64 months with a median time of 45 months. The 1-, 3-, 5-year survival rates after radical resection of HCC were 88.0%, 71.9%, 52.6% in patients with low expression of HK2 and 79.6%, 50.2%, 30.3% in patients with high expression of HK2, respectively, with a significant difference in survival (χ2=13.841, P<0.05). Conclusion The elevated expression of HK2 in tissues of HCC may be used as an effective molecular marker to predict tumor recurrence and metastasis after radical resection of HCC. Key words: Carcinoma, hepatocellular; Hepatectomy; Recurrence; Metastasis; Hexokinase-2

Clinical analyses of hepatocellular carcinoma and nasopharyngeal multiple primary cancers

To explore the clinicopathological characteristics, diagnosis, treatment outcomes and survival of hepatocellular carcinoma (HCC) and nasopharyngeal multiple primary cancers. The clinical data of 12 male patients with hepatocellular and nasopharyngeal multiple primary cancers were retrospectively analyzed. Second primary cancer was diagnosed with a median age of 54.5 years. Hepatitis B surface antigen (HBsAg) was detected in 7 patients (58.3%) and 6 cases (50.0%) had a family history of cancer. The treatments included radiochemotherapy (n = 5), radiotherapy (n = 6) and non-therapy (n = 1). And the interventions included hepatic surgery (n = 6), interventional treatment (n = 4) and conservative (n = 2). The 1, 3 and 5-year overall survival rates were 90.9%, 81.8% and 58.4% and the HCC-specific survival rates 80.0% at 1 year and 57.1% at 3 years respectively. The HCC-specific survival rates of surgery group were significantly better than those of the non-surgical group. The 1, 3-year HCC-specific survival rates were 100.0%, and 100.0%vs 50.0% and 0 respectively (P = 0.002). HCC and nasopharyngeal multiple primary cancers are not rare and careful follow-ups are necessary . The co-existence of HCC and nasopharyngeal multiple primary cancers does not imply a worse prognosis. And radical resection of HCC is considered.

Hepatic resection for hepatocellular carcinoma with or without postoperative adjuvant transarterial chemoembolization: a comparative study

Objective To explore the efficacy of postoperative adjuvant transarterial chemoembolization (TACE) on the survival of patients after radical resection for hepatocellular carcinoma (HCC).Methods Between March 2007 and March 2010,229 HCC patients who underwent radical resection were retrospectively studied.Patients who underwent resection alone were used as the control group (138 patients) while those who received post-operative adjuvant TACE was used as the interventional group.In order to balance the covariates between the groups,a matched comparison of the patients was done by selecting patients using the propensity score matching (PSM).Then,the efficacy of adjuvant TACE upon survival was evaluated.Results After PSM,we obtained 67 pairs of patients.The survival time for the interventional and the control groups were 32.1 months and 28.3 months respectively.The survival rates at year 1,2,3 post-resection were 94.0％,84.8％ and 75.3％ in the interventional group versus 83.6％,69.9％ and 61.5％ in the control group respectively.There were no significant differences between the two groups (P =0.062).Univariate analysis showed the serum level of AFP,tumor size,number of tumor,BCLC stage,and adjuvant TACE significantly affected the survival of HCC patients who received radical resection (P ＜0.05).Cox model suggested that AFP≥400 μg/L and tumor diameter ＞ 5 cm were independent risk factors of survival for HCC patients who received radical resection (P ＜ 0.05).Conclusion Postoperative adjuvant TACE had no positive effect on survival,and AFP level ≥ 400 μg/L and tumor size ＞5 cm were independent risk factors of survival of HCC patients who received radical resection. Key words: Hepatocellular carcinoma; Survival rate ; Transarterial chemoembolization; Propensity score matching