Predictors and long-term prognosis of early and late recurrence for patients undergoing hepatic resection of hepatocellular carcinoma: a large-scale multicenter study.

Background: Recurrence is common among patients undergoing hepatic resection for hepatocellular carcinoma (HCC), which greatly limits long-term survival. We aimed to identify predictors and long-term prognosis of early and late recurrence after HCC resection. Methods: Multicenter data of patients who underwent HCC resection between 2002 and 2016 were analyzed. Recurrence was divided into early (≤2 years) and late recurrence (>2 years after surgery). Predictors of early and late recurrence, and prognostic factors of post-recurrence survival (PRS) were identified by univariate and multivariate analyses. Results: Among 1,426 patients, 554 (38.8%) and 348 (24.4%) developed early and late recurrence, respectively. Independent predictors associated with early recurrence included preoperative alpha-fetoprotein level >400 µg/L, resection margin <1 cm, and tumor size >5.0 cm, multiplicity, macrovascular and microvascular invasion, and satellites of the initial tumor at the first diagnosis of HCC; independent predictors associated with late recurrence included male, cirrhosis, and tumor size >5.0 cm, multiplicity, macrovascular and microvascular invasion, and satellites of the initial tumor. Patients with early recurrence had a lower likelihood of undergoing potentially curative treatments for recurrence (37.2% vs. 48.0%, P<0.001) and a worse median PRS (13.5 vs. 36.6 months, P<0.001) vs. patients who had late recurrence. Multivariate analysis revealed that early recurrence and irregular postoperative surveillance were independently associated with worse PRS [hazard ratio (HR) =1.250, 95% CI: 1.016-1.538, P=0.035; and HR =1.983, 95% CI: 1.677-2.345, P<0.001]. Conclusions: Predictors associated with early and late recurrence after curative resection for patients with HCC were generally same, although several did differ. Patients with late recurrence had better long-term survival than patients with early recurrence.

Comparison of acquisition rate and agreement of axial length with two swept-source optical coherence tomographers and a partial coherence interferometer.

PURPOSE: To assess the acquisition rate and agreement of axial length (AL) measurements with the OA-2000, Anterion, and IOLMaster 500 in cataractous patients. METHODS: In total, 298 eyes of 191 cataractous patients were enrolled and scanned with the three devices in random order. The success rate of AL measurements per device was calculated and a chi-square test was utilized to identify the differences in acquisition rate between the three devices. Logistic regression analysis was applied to evaluate the association of different cataract types and severity with the AL measurement acquisition rate. Bland-Altman plots were mapped to appraise the agreement of AL values. RESULTS: AL measurements were successfully achieved in 288 eyes (96.64%) with the OA-2000, in 282 eyes (94.30%) with the Anteiron, and in 246 eyes (82.55%) with the IOLMaster 500. Significant differences in the acquisition rate were found between either of the SS-OCT devices and IOLMaster 500 by chi-square analysis (P < 0.001). No significant difference was noted between OA-2000 and Anterion. Increasing severity of posterior subcapsular cataract was associated with a higher failure rate with the IOLMaster 500. Bland-Altman analysis identified good agreement between the three biometers with narrow 95% limits of agreement. CONCLUSIONS: The OA-2000 and Anterion showed similarly higher acquisition rate of AL measurements than IOLMaster 500 in cataractous patients. Good agreement for AL values was found between the three biometers in cataractous patients.

Development and validation of an individualized prediction calculator of postoperative mortality within 6 months after surgical resection for hepatocellular carcinoma: an international multicenter study.

BACKGROUND: Evidence-based decision-making is critical to optimize the benefits and mitigate futility associated with surgery for patients with malignancies. Untreated hepatocellular carcinoma (HCC) has a median survival of only 6 months. The objective was to develop and validate an individualized patient-specific tool to predict preoperatively the benefit of surgery to provide a survival benefit of at least 6 months following resection. METHODS: Using an international multicenter database, patients who underwent curative-intent liver resection for HCC from 2008 to 2017 were identified. Using random assignment, two-thirds of patients were assigned to a training cohort with the remaining one-third assigned to the validation cohort. Independent predictors of postoperative death within 6 months after surgery for HCC were identified and used to construct a nomogram model with a corresponding online calculator. The predictive accuracy of the calculator was assessed using C-index and calibration curves. RESULTS: Independent factors associated with death within 6 months of surgery included age, Child-Pugh grading, portal hypertension, alpha-fetoprotein level, tumor rupture, tumor size, tumor number and gross vascular invasion. A nomogram that incorporated these factors demonstrated excellent calibration and good performance in both the training and validation cohorts (C-indexes: 0.802 and 0.798). The nomogram also performed better than four other commonly-used HCC staging systems (C-indexes: 0.800 vs. 0.542-0.748). CONCLUSIONS: An easy-to-use online prediction calculator was able to identify patients at highest risk of death within 6 months of surgery for HCC. The proposed online calculator may help guide surgical decision-making to avoid futile surgery for patients with HCC.

Repeat hepatectomy for patients with early and late recurrence of hepatocellular carcinoma: A multicenter propensity score matching analysis.

BACKGROUND: Repeat hepatectomy is a feasible treatment modality for intrahepatic recurrence after hepatectomy of hepatocellular carcinoma, yet the survival benefit remains ill-defined. The objective of the current study was to define long-term, oncologic outcomes after repeat hepatectomy among patients with early and late recurrence. METHODS: Patients undergoing curative-intent repeat hepatectomy for recurrent hepatocellular carcinoma were identified using a multi-intuitional database. Early and late recurrence was defined by setting 1 year after initial hepatectomy as the cutoff value. Patient clinical characteristics, overall survival, and disease-free survival were compared among patients with early and late recurrence before and after propensity score matching. RESULTS: Among all the patients, 81 had early recurrence and 129 had late recurrence from which 74 matched pairs were included in the propensity score matching analytic cohort. Before propensity score matching, 5-year overall survival and disease-free survival after resection of an early recurrence were 41.7% and 17.9%, respectively, which were worse compared with patients who had resection of a late recurrence (57.0% and 39.4%, both P < .01). After propensity score matching, 5-year overall survival and disease-free survival among patients with early recurrence were worse compared with patients with late recurrence (41.0% and 19.2% vs 64.3% and 43.2%, both P < .01). After adjustment for other confounding factors on multivariable Cox-regression analysis, early recurrence remained independently associated with decreased overall survival and disease-free survival (hazard ratio 2.22, 95% confidence interval 1.35-3.34, P = .001; hazard ratio 1.86, 95% confidence 1.26-2.74, P = .002). CONCLUSION: Repeat hepatectomy for early recurrence was associated with worse overall survival and disease-free survival compared with late recurrence. These data may help inform patients and selection of patients being considered for repeat hepatectomy of recurrent hepatocellular carcinoma.

Typical subdural contrast effusion secondary to endovascular treatment of a pediatric pial arteriovenous fistula.

Subdural contrast effusion secondary to endovascular treatment is exceptionally rare and might be mistaken as subdural hematoma because of similar hyperattenuation on computer tomography. The authors present the case of a 13-month-old girl with a history of increased head circumference and developmental retardation. Cerebral digital subtraction angiography showed a high-flow pial arteriovenous fistula fed by multiple arteries on the right cerebellar surface, with occlusion of the right sigmoid sinus and severe stenosis of the left sigmoid sinus. Staged endovascular treatments were performed to eliminate the fistula. Follow-up head computer tomography scans performed 3 h after both procedures demonstrated typical high-density subdural effusion with computer tomography attenuation value similar to hemorrhage. These effusions did not aggravate the condition and disappeared spontaneously 32 h after the first treatment and 29 h after the second, respectively.

Long-term survival and recurrence after curative resection for hepatocellular carcinoma in patients with chronic hepatitis C virus infection: a multicenter observational study from China.

BACKGROUND: Hepatocellular carcinoma (HCC) is a recognized sequalae of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. This study aimed to identify long-term survival and prognostic factors after curative resection for HCC among patients with chronic HCV infection. METHODS: From a Chinese multicenter database, the data of consecutive patients with HCV infection undergoing curative liver resection for initial HCC between 2006 and 2015 were retrospectively reviewed. Postoperative 30-day mortality and morbidity, long-term overall survival (OS) and recurrence-free survival (RFS) were evaluated. RESULTS: Among 382 HCC patients with HCV infection, 68 (18%) had concurrent HBV infection and 110 (29%) had portal hypertension. Postoperative 30-day morbidity and mortality rates were 45% and 2.9%, respectively. The 5-year OS and RFS rates were 45% and 34%, respectively. Multivariable Cox-regression analyses identified that concurrent HBV infection, presence of portal hypertension, largest tumor size > 5 cm, and macrovascular and microvascular invasion were independently associated with worse OS and RFS, while postoperative regular anti-HCV therapy was independently associated with better OS. CONCLUSION: Long-term prognosis after HCC resection among patients with HCV infection was worse in those with concurrent HBV infection and concomitant portal hypertension. Postoperative regular anti-HCV therapy was associated with better OS.

Identification of Actual 10-Year Survival After Hepatectomy of HBV-Related Hepatocellular Carcinoma: a Multicenter Study.

BACKGROUND: Hepatitis B virus (HBV) infection is the leading cause of hepatocellular carcinoma (HCC) worldwide. The aim of the study was to identify the incidence and predictive factors of actual 10-year survival following liver resection of HBV-related HCC. METHODS: A Chinese multicenter database of patients undergoing curative hepatectomy of HBV-related HCC was reviewed. Patients who survived ≥ 10 years and patients who died < 10 years after surgery were compared and analyzed. Univariable and multivariable regression analyses were performed to identify predictive factors associated with 10-year survival. RESULTS: Among all enrolled 1016 patients, the actuarial 10-year survival rate was 24.1%, while the actual 10-year survival rate was 16.6%. There were 169 patients who survived at least 10 years after surgery and 688 who died within 10 years from surgery. These patients constituted the study population of this study. Multivariable regression analysis revealed that cirrhosis, preoperative HBV viral load > 104 copies/mL, maximum tumor size > 5 cm, multiple tumors, macroscopic and microscopic vascular invasion, postoperative HBV reactivation, and early recurrence (< 2 years after surgery) were independent risk factors associated with actual 10-year survival, while postoperative antiviral therapy, regular recurrence surveillance, and curative treatments for initial recurrence were independent protective factors. CONCLUSIONS: The actual 10-year survival after curative resection of HBV-related HCC was calculated to be 16.6%. Postoperative antiviral therapy and regular recurrence surveillance were independent protective factors associated with actual 10-year survival after liver resection of HBV-related HCC.

Tissue and serum metabolite profiling reveals potential biomarkers of human hepatocellular carcinoma.

BACKGROUND AND AIMS: Metabolomics serves as an important tool in distinguishing changes in metabolic pathways and the diagnosis of human disease. Hepatocellular carcinoma (HCC) is a malignance present of heterogeneous metabolic disorder and lack of effective biomarker for surveillance and diagnosis. In this study, we searched for potential metabolite biomarkers of HCC using tissue and serum metabolomics approach. METHODS: A total of 30 pairs of matched liver tissue samples from HCC patients and 90 serum samples (30 HCC patients, 30 liver cirrhosis patients, and 30 healthy individuals) were assessed. Metabolomics was performed through ultra performance liquid chromatography-mass spectrometry in conjunction with multivariate and univariate statistical analyses. RESULTS: A total of six differential metabolites including chenodeoxycholic acid (CDCA), glycocholic acid (GCA), LPC20:5, LPE18:0, succinyladenosine and uridine were present in HCC tissue and serum samples. CDCA, LPC20:5, succinyladenosine and uridine were used to construct a diagnostic model based on logistic regression. The four-metabolite panel discriminated HCC from liver cirrhosis with an AUC score of 0.938, sensitivity of 93.3% and specificity of 86.7%. For all HCC and cirrhosis patients, the diagnostic accuracy increased to 96.7% and 90.0%, respectively. CONCLUSION: The combination of CDCA, LPC20:5, succinyladenosine and uridine can be used as a biomarker panel to improve HCC sensitivity and specificity. This panel significantly benefits HCC diagnostics and reveals new insight into HCC pathogenesis.

Gut bacterial community diversity in Carposina sasakii and Grapholitha molesta.

To clarify the community structure and diversity of larval gut bacteria in Carposina sasakii and Grapholitha molesta, the V4 regions of the 16S rDNA genes of intestinal bacteria of C. sasakii and G. molesta larvae which fed by golden delicious apple, were amplified and sequenced by Illumina HiSeq technique. The results showed that a total of 229043 high quality reads of gut bacteria in C. sasakii larvae were obtained and clustered to 2112 OTUs, which were annotated into 27 phyla, 65 classes, 124 orders, 205 families and 281 genera. 240389 reads of G. molesta were produced and clustered to 957 OTUs, which were annotated into 22 Phyla, 46 Classes, 89 Orders, 145 Families and 180 Genera. C. sasakii was dominated by the Proteobacteria (87.98%±5.29%), Firmicutes (3.91%±1.19%), Actinobacteria (1.04%±0.47%), and G. molesta was mainly dominated by Proteobacteria (50.06%±19.56%), Firmicutes (32.02%±8.48%) and Cyanobacteria (25.24%±10.28%). All of Phylum, Class, Order, Family, Genus, Species of the bacteria were significantly different between C. sasakii and G. molesta. Those results suggested that the gut bacteria community in these two fruit-boring pests was notably different, although they were both fed by apple fruit. The bacteria communities were more complex in C. sasakii than in G. molesta, which might account for different feeding and digestion mechanisms. The results could lay a foundation to reveal the association of the intestinal bacteria with these two fruit borers.

Sublethal Concentration of Beta-Cypermethrin Influences Fecundity and Mating Behavior of Carposina sasakii (Lepidoptera: Carposinidae) Adults.

The purpose of this study was to evaluate the sublethal effects of the beta-cypermethrin on calling behavior and fecundity of a major fruit-boring pest of apple, Carposina sasakii Matsumura. The mating rate, fertility (total number of eggs laid per female), and adult longevity of adults were remarkably decreased as compared with that in control when the adults were exposed to 10% lethal concentrations (LC10) of beta-cypermethrin (LC10♀ × LC10♂), and the age-specific survival rate (lx) was also negatively affected by sublethal beta-cypermethrin especially for the LC10â™€× LC10♂ mating combination. However, the age-specific fecundity (mx) was stimulated particularly in the combination of CKâ™€× LC10♂. Furthermore, the oviposition period was prolonged and the number of eggs was significantly increased for combinations of CKâ™€× LC10♂ and LC10â™€× CK♂. In the mating experiments, males in control or LC10-beta-cypermethrin treatments preferred to mate with females in control. It might be because of lower calling rate of female survivors treated with sublethal beta-cypermethrin. Our data indicate that treatment of beta-cypermethrin had a sublethal effect on the development and production of C. sasakii, and their mating behavior changes in surviving adults that may contribute to assortative mating.

[Influence of relative humidity on the Adoxophyes orana experimental population].

In order to explore the effects of relative humidity (RH) on the population growth of summer fruit tortrix moth Adoxophyes orana, the development, survival, fecundity and longevity of A. orana were assessed at 6 different constant humidities (40%, 50%, 60%, 70%, 80% and 90%), (25 +/- 1) degrees C and a photoperiod of 12L:12D in the laboratory. The results showed that immature developmental time was gradually shortened with the increasing humidity at 40%-90% RH, ranged from 30.31 d at 40% RH to 25.87 d at 90% RH. However, the survival rate for immature moth was gradually increased from 40% RH to 90% RH. Hatchability was inhibited significantly by low humidity and the lowest was 39.3% at 40% RH. And at 80% RH, the longevity of adults was the longest, the oviposition was the most (110.8 eggs per female) , and the survival rates for eggs and larvae were the highest. It resulted in the highest net reproductive rate (R0=26.46) and intrinsic rate of increase (r(m) = 0.1018). In conclusion, the development and fecundity of A. orana were promoted and improved at the higher humidity.

Age-stage two-sex life tables of Panonychus ulmi (Acari: Tetranychidae), on different apple varieties.

To understand the influence of different apple varieties on the development and reproduction of the European red mite, Panonychus ulmi (Koch) (Acari: Tetranychidae), age-stage two-sex life tables of P. ulmi on 'Fuji,' 'Starkrimson Delicious,' 'Golden Delicious,' and 'Granny Smith' varieties were constructed under laboratory conditions at 23 +/- 1 degrees C, 75 +/- 5% relative humidity, and a photoperiod of 16:8 (L:D) h. Results showed that total development time of immature females was shorter on Fuji than on the other varieties, and this was because of its shorter egg duration. Immature survival of P. ulmi was 74.51-78.00% among four apple varieties, and no significant differences were found. The total fecundity per female was significantly higher on Golden Delicious (34.12 eggs per female) than that on Fuji (27.15 eggs per female), Starkrimson Delicious (25.15 eggs per female), and Granny Smith (20.62 eggs per female). Based on the intrinsic rate of population increase, Fuji and Golden Delicious were more suitable than Starkrimson Delicious and Granny Smith.

[Host preference and fitness of aphis citricola (Hemiptera: Aphididae) to mature and young apple leaves].

In order to understand the differences of Aphis citricola in its original and final selectivity to the apple leaves with different leaf age, and to ascertain the effects of mature and young apple leaves on the growth and development, survival, and fecundity of A. citricola, this paper studied the host preference of A. citricola to mature and young apple leaves, with the related age-stage two-type life tables constructed. A. citricola more preferred to oviposit on the young leaves. There existed differences in the behaviors between oriented selectivity and penetration selectivity, and the latter was the key factor determining whether A. citricola fed and oviposited on the host. The total development time of immature A. citricola on the mature leaves was significantly longer than that on the young leaves, and the survival rate was also lower, with the aphids died at the first and fourth instar stages and at mature stage. As compared with those on the young leaves, the apterae rate of A. citricola adults on the mature leaves was lower, and the longevity and fecundity were significantly shorter and lower. The population dynamic parameters suggested that the population growth of A. citricola was quicker on the young leaves than on the mature leaves, and it was difficult for A. citricola to establish a stable population on the mature leaves.