BackgroundPatients with hepatocellular carcinoma (HCC) undergoing surgical resection still have a high 5-year recurrence rate (~ 60%). With the development of laparoscopic hepatectomy (LH), few studies have compared the efficacy between LH and traditional surgical approach on HCC. The objective of this study was to establish a nomogram to evaluate the risk of recurrence in HCC patients who underwent LH.MethodsThe clinical data of 432 patients, pathologically diagnosed with HCC, underwent LH as initial treatment and had surgical margin > 1 cm were collected. The significance of their clinicopathological features to recurrence-free survival (RFS) was assessed, based on which a nomogram was constructed using a training cohort (n = 324) and was internally validated using a temporal validation cohort (n = 108).ResultsHepatitis B surface antigen (hazard ratio [HR], 1.838; P = 0.044), tumor number (HR, 1.774; P = 0.003), tumor thrombus (HR, 2.356; P = 0.003), cancer cell differentiation (HR, 0.745; P = 0.080), and microvascular tumor invasion (HR, 1.673; P =0.007) were found to be independent risk factors for RFS in the training cohort, and were used for constructing the nomogram. The C-index for RFS prediction in the training cohort using the nomogram was 0.786, which was higher than that of the 8th edition of the American Joint Committee on Cancer TNM classification (C-index, 0.698) and the Barcelona Clinic Liver Cancer staging system (C-index, 0.632). A high consistency between the nomogram prediction and actual observation was also demonstrated by a calibration curve. An improved predictive benefit in RFS and higher threshold probability of the nomogram were determined by receiver operating characteristic curve analysis, which was also confirmed in the validation cohort compared to other systems.ConclusionsWe constructed and validated a nomogram able to quantify the risk of recurrence after initial LH for HCC patients, which can be clinically implemented in assisting the planification of individual postoperative surveillance protocols.
Existing data on folate status and hepatocellular carcinoma (HCC) prognosis are scarce. We prospectively examined whether serum folate concentrations at diagnosis were associated with liver cancer-specific survival (LCSS) and overall survival (OS) among 982 patients with newly diagnosed, previously untreated HCC, who were enrolled in the Guangdong Liver Cancer Cohort (GLCC) study between September 2013 and February 2017. Serum folate concentrations were measured using chemiluminescent microparticle immunoassay. Cox proportional hazards models were performed to estimate hazard ratios (HR) and 95 % CI by sex-specific quartile of serum folate. Compared with patients in the third quartile of serum folate, patients in the lowest quartile had significantly inferior LCSS (HR = 1·48; 95 % CI 1·05, 2·09) and OS (HR = 1·43; 95 % CI 1·03, 1·99) after adjustment for non-clinical and clinical prognostic factors. The associations were not significantly modified by sex, age at diagnosis, alcohol drinking status and Barcelona Clinic Liver Cancer (BCLC) stage. However, there were statistically significant interactions on both multiplicative and additive scale between serum folate and C-reactive protein (CRP) levels or smoking status and the associations of lower serum folate with worse LCSS and OS were only evident among patients with CRP > 3·0 mg/l or current smokers. An inverse association with LCSS were also observed among patients with liver damage score ≥3. These results suggest that lower serum folate concentrations at diagnosis are independently associated with worse HCC survival, most prominently among patients with systemic inflammation and current smokers. A future trial of folate supplementation seems to be promising in HCC patients with lower folate status.
The present study is the first investigation of the chemical composition and antimicrobial activitys of Marsdenia koi Tsiang essential oils. A total of forty-five compounds were identified, representing about 94.9% of the studied oil.The essential oil exhibited antibacterial activity against B.subtilis, S.aureus and S. albus with the MIC values of 50 μg/ml, 100μg/ml and 100μg/ml respectively.
Comparing intraprocedural pre and post ablation PET images, the mean SUVratio (tumor-to-normal-liver) increased from 4.9 to 7.1, or 44% (p < 0.001). The mean tumor diameter decreased from 22.5mm to 16.4mm, or 27% (p < 0.001). The mean tumor volume decreased from 10.5 cm 3 to 5.9 cm 3 , or 44% (p < 0.001). For the three centrally necrotic tumors, the mean tumor diameter decrease was only 11% (p < 0.05) and the mean tumor volume decrease (20%) was not significant (p ¼ 0.13). No significant changes in mean tumor diameter (p ¼ 0.42) and mean tumor volume (p ¼ 0.65) were seen in the three unablated tumors. Conclusions: Intraprocedural PET images of FDG-avid liver tumors allow visualization and quantification of the tissue contraction effects of microwave ablation during FDG PET/CT-guided procedures. The ability to visualize the contracted tumor may be relevant when intraprocedural PET/CT imaging techniques are used to assess the ablation margin.
Purpose: The BALAD score, a risk index combining threshold values for bilirubin, albumin, a-fetoprotein (AFP), des-g-carboxy prothrombin (DCP), and Lens culinaris agglutinin-reactive afetoprotein (AFP-L3), has been useful in predicting survival and recurrence risk in hepatocellular carcinoma (HCC). This study seeks to correlate BALAD score with durable locoregional treatment response to doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE). Materials: A single-center, prospective analysis was performed on patients undergoing liver transplant evaluation with HCC who were selected for down-staging or bridge-to-transplantation LRT with DEB-TACE. Blood was collected immediately prior to DEB-TACE in all patients. Plasma levels of AFP, DCP, and AFP-L3 were measured using the μTASWako i30 autoanalyzer. DEB-TACE was performed with 100-300μ LC beads mixed with 50mg Doxorubicin to near-complete stasis. Tumor response to DEB-TACE was calculated by mRECIST at 30-day and 3-month follow-up imaging. Results: Cohort demographics were median age of 60, 69% male, 78% hepatitis C cirrhosis etiology, 88% within Milan criteria with an average MELD-Na score of 10. Median BALAD components were as follows: bilirubin 1.5 mg/dL, albumin 3.2 g/dL, AFP 7 ng/ mL, AFP L3% 8, and DCP 2.8 ng/mL. Median follow up imaging for durable tumor response was 112 days. Fifty-percent of cohort had a complete response to DEB-TACE. Univariate analysis revealed BALAD score was associated with response to DEB-TACE (P¼0.04), with 73% of patients with BALAD 2 not responding to DEB-TACE. BALAD component analysis revealed tumor biomarker thresholds poorly modeled to the dataset. The BALAD biomarker cutoffs were modified from AFP 400ng/mL to 20ng/mL, AFP-L3% from 15% to 10%, and DCP 1.9ng/mL to 7.5ng/mL decreasing the corresponding P-value (0.04 to 0.02) between BALAD and treatment response. Waitlist dropout after DEB-TACE for patients with modified-BALAD 1 was 5%. Conclusions: By combining metrics for liver synthetic function with biomarkers of HCC aggressiveness, the BALAD can identify HCC resistance to embolization therapy and risk of waitlist dropout.
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