Hospital Curry Cabral (Portuguese pronunciation: [ɔʃ.piˈtaɫ ku.ˈʁi kɐˈβɾaɫ], "Curry Cabral Hospital") is a public Central Hospital serving the Greater Lisbon area as part of the Central Lisbon University Hospital Centre (CHULC), a state-owned enterprise.Originally devised in the early 20th century as a specialised hospital for infectious diseases, Curry Cabral Hospital currently offers many other specialities: it is perhaps best known as the national reference centre on liver transplantation and hepato-bilio-pancreatic diseases, and as the only public physical medicine and rehabilitation inpatient care service in the Lisbon Metropolitan Area.It is named after José Curry da Câmara Cabral (1844–1920), eminent clinician and medical researcher who was instrumental in the creation of the hospital in 1906..
Borderline resectability in perihilar cholangiocarcinoma (pCCA) has largely been defined anatomically, although anatomy alone may not capture oncologic risk. This study evaluated whether biologic burden improves recurrence stratification after curative-intent resection of pCCA. Using an international, multi-institutional database, patients undergoing resection without neoadjuvant therapy for non-metastatic pCCA were identified. Literature-based borderline resectability was defined as lymph node metastasis with portal vein/hepatic artery involvement or Bismuth type IV disease. Using a 200-U/mL carbohydrate antigen (CA19-9) cutoff, a three-tier anatomic-biologic borderline resectable (AB-BR) grouping (low, intermediate, high) was derived. The outcome of interest was recurrence-free survival (RFS). Among 239 patients (median age, 67.0 years, interquartile range [IQR], 58.0–74.0 years), 38.9
Accurate preoperative nodal staging remains challenging in gallbladder cancer (GBC), and a substantial proportion of patients presumed to be clinically node-negative have nodal metastasis at surgery. This study aimed to quantify the burden of occult nodal disease (OND)—defined as pathologic node-positive disease among clinically node-negative patients—and to identify preoperative factors associated with OND. Patients who underwent upfront curative-intent resection with regional lymphadenectomy for GBC were identified from an international multi-institutional database. Among patients staged as clinically node-negative (cN0) on preoperative imaging, multivariable logistic regression was used to identify preoperative predictors of OND. CA19-9 and the systemic immune-inflammation index (SII) were log-transformed for modeling purposes. Among 187 patients, 142 (75.9
INTRODUCTION:The oncologic impact of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (iCCA) remains unclear. We hypothesized that the prognostic relevance of LND may vary according to tumor burden. Therefore, this study sought to evaluate the interaction between tumor burden and adequate LND among patients who underwent curative-intent resection for iCCA. METHODS:Patients who underwent curative-intent liver resection for iCCA were identified from a large international multi-institutional database. Overall survival (OS) was evaluated using multivariable Cox regression models that included an interaction term between tumor burden score (TBS) and adequate LND. RESULTS:Among 1,558 patients, 872 (56.0%) underwent LND and 322 (20.7%) underwent adequate LND, defined as retrieval of at least six lymph nodes. The median TBS was 6.1 (interquartile range [IQR] 4.1-8.6). On multivariable Cox regression analysis, a significant interaction was observed between TBS and adequate LND (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.87-0.95, p < 0.001). Among 542 (34.8%) patients with TBS < 5.0, adjusted OS did not differ according to adequate LND status (HR 1.23, 95% CI 0.86-1.76, p = 0.265). In contrast, among 1,016 (65.2%) patients with TBS ≥ 5.0, adequate LND was associated with improved adjusted OS (HR 0.65, 95% CI 0.51-0.82, p < 0.001). Similar findings were observed for recurrence-free survival (RFS). CONCLUSIONS:The prognostic relevance of adequate LND in patients undergoing curative-intent resection for iCCA appears to vary according to tumor burden. Adequate LND was associated with improved OS and RFS among patients with high TBS, but not among those with low TBS.
BACKGROUND:Bilateral hepatocellular carcinoma represents a biologically heterogeneous disease with uncertain optimal surgical selection criteria. Although hepatic resection can provide survival benefit in selected patients, outcomes remain variable, and phenotypic determinants of prognosis have not been clearly defined. METHODS:Patients who underwent curative-intent hepatectomy for bilateral hepatocellular carcinoma from a multi-institutional database from 2000 to 2023 were reviewed. k-means clustering to identify phenotypic subgroups. Overall survival and recurrence-free survival were evaluated using Kaplan-Meier product-limit methods and multivariable Cox regression. RESULTS:Among 347 patients, unsupervised clustering identified 2 distinct phenotypes: cluster 1 (n = 95) characterized by larger tumors, higher tumor burden, non-cirrhotic livers, and frequent major hepatectomy; and cluster 2 (n = 252) characterized by multiple smaller lesions, treated with greater use of minimally invasive surgery and concomitant ablation. Cluster 1 demonstrated more aggressive pathologic features and worse survival (5-year overall survival 34.9 vs 63.2%; P < .001) and higher early recurrence (53.7 [n = 51] vs. 38.1% [n = 96]; P = .02). Cluster classification remained independently associated with overall survival (hazard ratio [HR], 2.15; 95% CI, 1.48-3.13; P < .001) and recurrence-free survival (HR 1.52; 95% CI, 1.11-2.06; P < .01) even after adjustment for margin status and microvascular invasion. CONCLUSIONS:Bilateral hepatocellular carcinoma encompasses 2 clinically relevant phenotypes with distinct tumor burden, operative strategies, and outcomes. Phenotype-based stratification using preoperative clinical and radiologic variables may help refine surgical selection. Low-burden multifocal disease achieved favorable survival, whereas dominant plus satellites disease had inferior prognosis, supporting multimodal strategies for this subgroup.
