Objective:To investigate clinicopathological characteristics of pedunculated hepatocellular carcinoma (PHCC) in different sites and the effects on postoperative intrahepatic recurrence and prognosis.Methods:Clinical data of 87 PHCC patients admitted to The 909th Hospital from January 2017 to June 2019 were retrospectively analyzed. Among them, 51 patients were male and 36 female, aged from 41 to 69 years, with a median age of 54 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the diaphragmatic PHCC (n=39) and visceral PHCC groups (n=48) according to different tumor growth sites. The differences of pathological characteristics were analyzed between two groups. The postoperative 3-year intrahepatic recurrence rate and postoperative survival were also assessed. Univariate analysis and Logistic multivariate regression model were adopted to analyze the influencing factors of postoperative intrahepatic recurrence and prognosis of PHCC.Results:The incidence of clinical symptoms of diaphragmatic PHCC group was 64%(25/39), which was significantly higher than 39%(11/48) of visceral PHCC group (χ2=15.047, P<0.05). In the diaphragmatic PHCC group, there were 32 cases of PHCC diameter >8 cm, 17 cases of incisional margin ≤1 cm and 21 cases of microvascular invasion, and 16, 6, 8 cases in the visceral PHCC group accordingly, and the differences were statistically significant (χ2=5.720, 4.440, 5.228; P<0.05). The postoperative 3-year intrahepatic recurrence rate was 44%(38/87) and the mortality rate was 37%(32/87). Incomplete tumor encapsulation, incisional margin ≤1 cm, microvascular invasion and visceral surface growth were the independent influencing factors of postoperative 3-year intrahepatic recurrence (OR=2.113, 2.866, 3.025, 2.534; P<0.05). Tumor diameter>8 cm, incomplete tumor encapsulation, microvascular invasion and visceral surface growth were the independent influencing factors of postoperative 3-year mortality rate (OR=2.336, 2.857, 3.044, 2.758; P<0.05).Conclusions:Patients with diaphragmatic PHCC present with early clinical symptoms, which can be identified during early stage. However, those with visceral PHCC develop large tumor diameter, high-risk microvascular invasion and low radical resection rate upon diagnosis. Patients with visceral PHCC have high postoperative intrahepatic recurrence and poor postoperative prognosis.
Objective:To investigate the relationship between the expression of arachidonic acid 15-lipoxygenase (ALOX15) in adjacent tissues and clinical prognosis of patients with hepatocellular carcinoma (HCC) after radical resection.Methods:Clinical data of 306 patients with HCC who underwent radical resection in the First Affiliated Hospital of Chongqing Medical University from January 2013 to December 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 259 patients were male and 47 female, aged from 10 to 79 years, with a median age of 52 years. The expression level of ALOX15 in adjacent tissues was determined by immunohistochemical staining and the degree of staining was scored. According to the optimumcut-off value of ALOX15 expression level, all patients were divided into the low (n=222) and high expression groups (n=84). Survival analysis was conducted by Kaplan-Meier method and Log-rank test. The prognostic factors of HCC patients were identified by Cox proportional hazard regression model.Results:ALOX15 staining was mainly observed in cytoplasm and cell membrane of adjacent tissues, and positive cells were primarily distributed in hepatocyte stroma. There were 22 cases with high expression of ALOX15 in adjacent tissues and 84 cases with high expression of ALOX15. The postoperative 1-, 3- and 5-year overall survival rates of patients with low expression of ALOX15 were 91.8%, 83.0% and 77.6%, and 83.7%, 67.3% and 60.9% for the tumor-free survival rates, respectively. The postoperative 1-, 3- and 5-year overall survival rates of those with high expression of ALOX15 were 90.9%, 54.5% and 44.5%, and 65.5%, 40.3% and 22.9% for the tumor-free survival rates, respectively. The postoperative overall survival and tumor-free survival in the low ALOX15 expression group were significantly better than those in the high ALOX15 expression group (χ2=32.223, 36.408; P<0.05). Multivariate Cox analysis showed that the immunoreactive score of ALOX15>27 was an independent risk factor for postoperative overall survival and tumor-free survival (HR=2.986, 2.350; P<0.05).Conclusions:High expression of ALOX15 in adjacent tissues is an independent risk factor for clinical prognosis of HCC patients after radical resection. Patients with high expression of ALOX15 obtain poor prognosis and are prone to postoperative recurrence.
Objective:To evaluate the survival benefit of combined splenectomy in patients with liver cancer complicated with portal hypertension after radical resection.Methods:Clinical data of 138 patients with liver cancer complicated with portal hypertension who underwent radical resection in Beijing You'an Hospital Affiliated to Capital Medical University from March 2011 to May 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 84 patients were male and 54 female, aged from 26 to 76 years, with a median age of 55 years. According to different surgical methods and liver cancer stages, all patients were divided into radical resection combined with splenectomy group (HS group, n=96), including 48 cases of T1 stage liver cancer (HS1 group), 39 cases of T2 stage (HS2 group) and 9 cases of T3 stage (HS3 group). 42 patients withT1 stage liver cancer who received radical resection alone were used as controls (HA1 group). Survival analysis was performed by Kaplan-Meier method and Log-rank test. Perioperative status between two groups was compared by t test, Mann-Whitney U test or Chi-square test.Results:The median RFS and OS in the HS groupwere 22.3 and 46.0 months. The postoperative 1-, 2-, 5-year RFS were 90.2%, 76.5%, 51.0% in the HS1 group,48.6%, 24.3%, 10.8% in the HS2 group, and 42.9%, 28.6%, 28.6% in the HS3 group, respectively. The differences were statistically significant in the postoperative 1-, 2-, 5-year RFS among three groups (χ2=22.276, 26.206, 17.124; P<0.05). The postoperative 1-, 2-, 5-year OS were 95.8%, 79.2%, 47.9% in the HS1 group, 84.6%, 69.2%, 25.6% in the HS2 group, and 77.7%, 55.6%, 33.3% in the HS3 group, respectively. The differences in the postoperative 5-year OS were statistically significant among three groups (χ2=11.416, P<0.05). In the HS1 and HA1 groups, the postoperative 1- and 2-year RFS were 95.0%, 81.0% and 81.3%, 66.7% respectively, and the differences were statistically significant (χ2=6.378, 4.944; P<0.05). In the HS1 and HA1 groups,20 and 2 patients had a history of varicose vein rupture and bleeding, and the difference was statistically significant (χ2=14.581, P<0.05). The median Hb before operation was 115(49) and 126(20) g/L, PTA was 73%(12%) and 78%(7%), liver stiffness was 19(12) and 15(10) kPa, intraoperative blood loss was 300(275) and 150(100) ml, operation time was 4.1(2.3) and 3.5(1.6) h, respectively. The differences were statistically significant (Z=-2.115, -2.768, 2.374, 3.171, 2.804; P<0.05). No patient died early after surgery in two groups.Conclusions:Combined splenectomy can improve early RFS of patients with T1 stage liver cancer complicated with portal hypertension after radical resection. A high proportion of preoperative gastrointestinal bleeding history, poor coagulation and high grade of liver cirrhosis are observed in these patients. Although combined splenectomy increases operation time and intraoperative bleeding, it is generally safe.
Objective:To evaluate the diagnostic value of bedside contrast-enhanced ultrasound (CEUS) for early hepatic artery thrombosis (HAT) after liver transplantation (LT).Methods:585 recipients undergoing LT in the Third Affiliated Hospital of Sun Yat-sen University from March 2016 to March 2020 were enrolled in this prospective study. Among them, 516 patients were male and 69 female, aged from 0.5 to 78.0 years, with a median age of 48.1 years. The informed consents of all recipients and/or their guardians were obtained and the local ethical committee approval was received. Bedside color Doppler ultrasound (CDUS) and CEUS were performed on the 1st, 2nd and 3rd days after LT. For the recipients who stayed in ICU at postoperative 4 d, ultrasound examinations were more frequently performed according to clinical requirements. Digital subtraction angiography (DSA) or CT angiography (CTA) was the gold standard for the diagnosis of HAT. The diagnostic value was evaluated by the ROC curve.Results:Among 585 recipients of LT, CDUS showed no intra- and extra-hepatic arteries in 21 cases, CEUS found no contrast perfusion in the intra- and extra-hepatic arteries of 12 recipients. The diagnosis of HAT was confirmed by DSA. In the remaining 9 cases, CEUS revealed contrast perfusion in the hepatic arteries, avoiding DSA. CDUS could display extrahepatic arteries and unilateral intrahepatic arteries in 11 recipients. Among 11 cases, CEUS could display intrahepatic arteries in 4 cases, whereas CEUS failed to clearly display unilateral intrahepatic arteries in the remaining 7 cases. Ultrasound during subsequent follow-up could display these intrahepatic arteries. CTA, ultrasound and clinical follow-up confirmed that neither bedside CDUS nor CEUS missed the diagnosis of HAT. The sensitivity, specificity, Youden's index, positive predictive value and negative predictive value of CDUS in diagnosing HAT were 1.00, 0.98, 0.98, 0.57, 1.00, and 1.00, 1.00, 1.00, 1.00, 1.00 for CEUS, respectively. The area under the ROC curve (AUC) of bedside CDUS and CEUS was respectively 0.992 and 1.000, and the difference was statistically significant (Z=3.021, P=0.003).Conclusions:Bedside CEUS can correct the false positive diagnosis of CDUS, improve the diagnostic accuracy of early HAT after LT, and avoid DSA and alternative invasive examinations.
Objective:To evaluate the effect of the number of dissected lymph nodes on the safety and prognosis of pancreaticoduodenectomy for distal cholangiocarcinoma.Methods:Clinical data of 104 patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy in Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2015 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 60 patients were male and 44 female, aged from 29 to 84 years, with a median age of 66 years. The effect of the number of dissected lymph nodes on perioperative complications and survival was evaluated. The threshold value of lymph node number was determined by X-tile software. All patients were divided into two groups according to the threshold value. The number of lymph nodes between two groups was compared by t test, and the incidence of complications was compared by Chi-square test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.Results:The number of dissected lymph nodes was 3-45. According to the threshold value of 24 lymph nodes, all patients were divided into the <24 (n=80) and ≥24 groups (n=24). The number of dissected lymph nodes in the <24 group and ≥24 group was 15±5 and 31±6, and the difference was statistically significant (t=-13.101, P<0.05). The incidence of postoperative complications and perioperative mortality rate in two groups were 21%(5/24), 4%(1/24) and 21%(26/80), 5%(4/80), and the differences were not statistically significant (χ2=1.201, 0.142; P>0.05). The postoperative 1-, 3- and 5-year overall survival rates of patients in two groups were 72.6%, 33.2%, 25.9% and 87.1%, 63.7%, 63.7%, respectively, and the differences were statistically significant (χ2=6.170, P<0.05).Conclusions:For patients with distal cholangiocarcinoma undergoing pancreatoduodenectomy, the number of dissected lymph nodes ≥24 can significantly improve clinical prognosis without sacrificing perioperative safety.
