Background This study explored the diagnostic power of preoperative circulating tumor cells (CTCs) for the presence of microvascular invasion (MVI) and the relationship between dynamic changes in postoperative CTCs and prognosis. Methods A total of 137 patients were recruited for the study. Preoperative blood samples were collected from all patients to detect CTCs. The time points for blood collection were before the operation, during the operation, and at 1 week, 1 month, 2 months, 3 months, 6 months, and 1 year after surgery. The predictive power of CTC count for the presence of MVI was analyzed by receiver operating characteristic (ROC) curve analysis. According to recurrence status, 137 patients were divided into three groups: no recurrence, early recurrence, and non-early recurrence groups. Results A threshold CTC count of 5 showed the most significant power for predicting the existence of MVI. In multivariate analysis, the parameters of preoperative CTC count, alpha-fetoprotein (AFP) and tumor diameter were independent predictors of MVI (P < 0.05). A CTC count greater than or equal to 5 had better predictive value than AFP > 400 μg/L and tumor diameter > 5 cm. The number of intraoperative CTCs in the three groups did not increase compared to that before surgery (P > 0.05). The number of CTCs in the nonrecurrence group and the non-early recurrence group decreased significantly 1 week after surgery compared with the intraoperative values (P < 0.001), although there was no significant difference in the early recurrence group (P = 0.95). Patients with mean CTC count ≥5 had significantly worse long-term outcomes than those with mean CTC count < 5 (P < 0.001). Conclusion The preoperative CTC counts in the peripheral blood of patients with HCC are closely correlated with MVI. The intraoperative manipulation of the lesion by the surgeon does not increase the number of CTCs in peripheral blood. Surgical removal of the tumor decreases the number of CTCs. The persistence of CTCs at a high level (≥ 5) after surgery suggests a risk of early recurrence. Clinical trial registration Registration number is ChiCTR-OOC-16010183, date of registration is 2016-12-18.
Background: The number of preoperative circulating tumor cell (CTC) was correlated with the presence of microvascular invasion (MVI). The change of postoperative CTC count can predict the prognosis of patients. But the change trend of postoperative CTC is controversial.Methods: A total of 137 patients were recruited for the study. Preoperative blood samples of all patients were collected to detect CTC. The time points for blood collection were before the operation, during operation, and at one week, one month, two months, three months, six months, and one year after surgery. The power of predicting the presence of MVI was analyzed by the receiver operating characteristic curve (ROC). According to the survival status, 137 patients were divided into three groups: no recurrence, early recurrence, and non-early recurrence. Results: A threshold CTC value of 5 showed the most significant power to predict the existence of MVI. In a multivariate analysis, the parameters of preoperative CTCs, alpha-fetoprotein (AFP) and tumor diameter were independent predictors of MVI (P < 0.05). A CTC value greater than or equal to 5 has better predictive value than AFP > 400μg/L or tumor diameter > 5 cm. The number of intraoperative CTCs in the three groups did not increase compared to before surgery (P > 0.05). The number of CTC in the non-recurrent group and the non-early recurrent group decreased significantly one week after surgery compared with intraoperative values (P < 0.001), although there was no statistical significance in the group with early recurrence (P = 0.95). Patients with mean CTC ≥ 5 had significantly worse long-term outcome than those with mean CTC < 5 (P <0.001). Conclusion: The preoperative CTC counts in peripheral blood of patients with HCC is closely correlated to MVI. Intraoperative manipulation for the lesion by the surgeon does not increase the number of CTC in peripheral blood. Surgical removal of the tumor decreases the number of CTC. The persistence of CTC at a high level (≥ 5) after surgery suggests a risk of early recurrence.
The spleen plays an important role in tumor progression and the curative effects of splenectomy before hepatectomy for hypersplenism and hepatocellular carcinoma (HCC) are not clear. We investigated whether splenectomy before hepatectomy increases survival rate among patients with HCC and hypersplenism compared with that of patients who underwent synchronous hepatectomy and splenectomy or hepatectomy alone. Between January 2011 and December 2016, 266 patients who underwent hepatectomy as a result of HCC and portal hypertension secondary to hepatitis were retrospectively analyzed. Their perioperative complications and survival outcome were evaluated. Patients underwent synchronous hepatectomy and splenectomy (H-S group) and underwent splenectomy before hepatectomy (H-preS group) exhibited significantly higher disease-free survival (DFS) rates than those of patients underwent hepatectomy alone (H-O group). The DFS rates for patients in the H-S group, H-preS group, and H-O group were 74.6%, 48.4%, 39.8%, and 80.1%, 54.2%, 40.1%, and 60.5%, 30.3%, 13.3%, at 1, 3, and 5 years after surgery, respectively. Tumor size, tumors number, and levels of alpha fetoprotein (AFP) were independent risk factors for DFS. Gender and tumor size were independent prognostic factor for overall survival (OS). The preoperative white blood cell (WBC) and platelet (PLT) counts were significantly higher in the H-preS group than in those of the H-S group and the H-O group. After operation, the WBC and PLT counts in the H-S group and H-preS groups were significantly higher compared to those of the H-O group. No matter splenectomy before hepatectomy or synchronous hepatectomy and splenectomy, hepatectomy with splenectomy may improve DFS rates in patients with HCC and hypersplenism, and splenectomy before hepatectomy alleviates hypersplenism without an increased surgical risk.
Background Although immune checkpoint inhibitors (ICIs) therapy has improved the prognosis of unresectable hepatocellular carcinoma (HCC), it has also resulted in the unique immune-related adverse events (irAE). The relationship between irAE and treatment outcomes in ICIs-treated advanced HCC patients remains unknown. Methods From March 2019 to February 2021, a total of 190 unresectable HCC (BCLC C) patients receiving Pembrolizumab treatment were retrospectively reviewed. Overall survival (OS) was the primary endpoint. objective response rate (ORR), disease control rate (DCR) and time to progression (TTP) were secondary evaluation indexes. We assessed demographics, irAE and outcomes by retrospective review. Results One hundred and forty-three male and 47 female were included in the study. The ORR and DCR were 12.1% (23/190) and 52.1% (99/190) respectively. The median OS was 376 days (95% CI 340 -411 days) and the median TTP was 98 days (95% CI 75 -124 days). The overall incidence of treatment-related adverse events was 72.6% (138/190) and 10.0% of them were severe irAEs (grade ≥ 3). Child-Pugh B class, PVTT, extrahepatic metastasis, and hypothyroidism were the independent risk factors of survival. Patients with hypothyroidism were observed a longer OS than those without irAE (517 days [95% CI 423-562] vs. 431 days, [95% CI 412-485], P=0.011) and a longer TTP (125 [95% CI 89-154] vs. 87 days [95% CI 61-98], P=0.004). Conclusion Unresectable HCC patients experienced hypothyroidism indicated a bettertherapeutic effect.Hypothyroidism, an immune-related adverse event may be used as a clinical evaluation parameter of HCC response to ICIs.
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