Impact of overweight and obesity on the risk of hepatocellular carcinoma: a prospective cohort study in 14.3 million Koreans.

BACKGROUND: Whether obesity and being overweight, defined by body mass index (BMI), increase hepatocellular carcinoma (HCC) has been less apparent in Asian populations. METHODS: Overall, 14,265,822 Korean adults who underwent routine health examinations during 2003-2006 were followed up for HCC. Multivariable-adjusted hazard ratios (HRs) associated with BMI were calculated. RESULTS: During 13.7 years (mean) of follow-up, 47,308 individuals developed HCC. HRs of HCC associated with BMIs of 25.0-26.4, 26.5-27.9, 28.0-29.4, 29.5-30.9 and ≥31 kg/m² compared to those for 23.5-24.9 kg/m² were 1.05, 1.20, 1.39, 1.59 and 2.13, respectively. For BMI < 25 kg/m², linear associations were not apparent. For BMI ≥ 25 kg/m2, the HR per 5 kg/m2 increase in BMI was 1.60 (total), 1.60 (men), and 1.59 (women). The corresponding HRs were 1.56, 1.61 and 1.60 for individuals aged <45, 45-64 and ≥65 years, respectively. Further adjustment for alanine transaminase (ALT) levels substantially reduced the HRs for high BMI, especially in men and younger adults. CONCLUSIONS: Overweight and obesity clearly increase HCC risk in Koreans. ALT levels are a mediator of the impact of obesity, but it may not accurately predict high BMI-induced liver damage that can potentially progress to HCC, especially in women and older adults.

The influence of adipose tissue volume can significantly affect the metabolic activity of reference organs in 18F-FDG PET/CT studies of a normal healthy population.

OBJECTIVE: This study investigated whether fluorine-18-fluorodeoxyglucose (18F-FDG) uptake of reference organs can be affected by subjects' factors in positron emission tomography/computed tomography (PET/CT) in a healthy population. SUBJECTS AND METHODS: A total of 208 normal healthy subjects without diabetes or dyslipidemia were included. Adipose tissue volume was measured by CT images from a dedicated PET/CT scan. Uptake of 18F-FDG of reference organs was measured from liver, blood pool, and muscle, and was normalized by lean body anthropometric data and adipose tissue volume. RESULTS: Of 208 participants, 118 were metabolically healthy lean (MHL); with body mass index (BMI) <25kg/m2 and 90 were metabolically healthy obese (MHO) with; BMI≥25kg/m2 . These subjects had significantly higher values of liver, blood pool, and muscle than did the MHL subjects (P<0.001 for both). Among subjects' factors, adipose tissue volume revealed strongest correlation with standardized uptake value multiplied by lean body weight divided by body weight (SUL) of liver (r=0.754, P<0.001), of blood pool (r=0.756, P<0.001) and of muscle (r=0.635, P<0.001). On regression analysis, adipose tissue volume was determined to be a common independent predictor for SUL of liver, blood pool and muscle (P<0.001) and furthermore was serum C-reactive protein level for SUL of the liver and also age and serum insulin level for SUL of blood pool. CONCLUSION: Adipose tissue volume can significantly affect SUL of liver, blood pool, and muscle in a healthy population. Liver and blood pool may have limited roles as reference organs for normalization of 18F-FDG uptake of the lesion.

Development of a Risk Score to Predict Short-term Smoking Relapse Following an Inpatient Smoking Cessation Intervention.

This study aimed to investigate the factors affecting smoking relapse and to develop predictive models among Korean national 5-day smoking cessation program participants. The subjects were 518 smokers and follow-up was continued for 6 months after discharge. A predictive logistic model and risk score were developed from the multivariate logistic models and compared using the area under the receiver operating characteristic curve (area under the curve [AUC]). The smoking relapse rate within 6 months after program participation was 38.4%. The AUCs of the logistic regression model and risk score model were similar (odds ratio [OR] = 0.69; 0.69, respectively) in the development data set, and those of the risk score model were similar between the development and validation data sets (OR = 0.68). The risk score used by the six risk factors could predict smoking relapse among participants who attended a 5-day inpatient smoking cessation program.

Correction: The Correlation Between NAFLD and Serum Uric Acid to Serum Creatinine Ratio.

[This corrects the article DOI: 10.1371/journal.pone.0288666.].

The correlation between NAFLD and serum uric acid to serum creatinine ratio.

BACKGROUND: With the prevalence of non-alcoholic fatty liver disease (NAFLD) increasing worldwide, many noninvasive techniques have been used to improve its diagnosis. Recently, the serum uric acid/creatinine (sUA/sCr) ratio was identified as an indicator of fatty liver disease. Therefore, we examined the relationship between sUA/sCr levels and ultrasound-diagnosed NAFLD in Korean adults. METHODS: This study included 16,666 20-year-olds or older who received health checkups at a university hospital's health promotion center from January to December 2021. Among them, 11,791 non-patients with and without NAFLD were analyzed, excluding those without abdominal ultrasound, those without data on fatty liver, cancer, or chronic kidney disease severity, those with a history of alcohol abuse, and those with serum hs-CRP <5 mg/L. The odds ratio (OR) and 95% confidence interval (CI) of the sUA/sCr ratio according to the presence or absence of fatty liver disease and severity were calculated after correcting for confounding variables using logistic regression analysis. The receiver operating characteristic (ROC) curve and area under the curve (AUC) of the sUA/sCr ratio confirmed and compared the sensitivity and specificity of NAFLD and serum uric acid. RESULTS: sUA/sCr increased with fatty liver severity, and the post-correction OR in the NAFLD group was 1.183 (95% CI: 1.137-1.231) compared to the group without NAFLD. Concerning the fatty liver severity, the post-correction OR in the mild NAFLD group increased to 1.147 (95% CI: 1.099-1.196), and that in the moderate-to-severe NAFLD group increased to 1.275 (95% CI: 1.212-1.341) compared to the group without NAFLD. The sensitivity of sUA/sCr to fatty liver severity was 57.9% for the non-NAFLD group, 56.7% for the mild NAFLD group, and 59.0% for the moderate-to-severe NAFLD group; the specificity of sUA/sCr to fatty liver severity 61.4% for the non-NAFLD group, 57.3% for the mild NAFLD group, and 65.2% for the moderate-to-severe NAFLD group. CONCLUSION: NAFLD severity is associated with sUA/sCR.

Impact of diabetes, obesity, and dyslipidemia on the risk of hepatocellular carcinoma in patients with chronic liver diseases.

Despite the increasing prevalence of metabolic disorders, the potential effects of metabolic factors on hepatocellular carcinoma (HCC) development in individuals with chronic liver diseases (CLDs) are not well understood. For a metabolic factor to be identified as a risk factor for HCC in patients with CLDs, such as hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, there should be a strong synergistic interaction between the carcinogenic mechanisms of the metabolic factor and the CLD itself. This review aims to comprehensively summarize the published data on the relationship between metabolic factors such as diabetes mellitus (DM), obesity, and blood lipids and the risk of HCC in patients with CLDs. DM consistently increases the risk of HCC in patients with CLD. When associated with DM, the risk of HCC seems to be highest in HCV and non-alcoholic fatty liver disease (NAFLD), followed by alcoholic liver disease (ALD) and HBV. Obesity may increase the risk of HCC. Among CLDs, the evidence is relatively consistent and clear for ALD, while clear evidence is limited in other CLDs including HBV, HCV, and NAFLD. Total cholesterol, potentially low-density lipoprotein cholesterol and triglyceride, seems to have strong inverse associations with HCC in individuals with CLDs. Despite evidence from observational studies, statins had no effect in preventing HCC in randomized controlled trials. Whether statins have a preventive effect against HCC is unclear. A better understanding and management of metabolic factors may be beneficial to reduce the risk of HCC in patients with CLDs.

Insulin levels are associated with risk of colon adenoma and not nonadenomatous polyps: A retrospective, hospital-based study.

Recently, the prevalence of colorectal cancer has been increasing in Korea. Several studies have reported that adenomatous polyps, known as precancerous lesions, are associated with increased blood insulin levels. The principal objective of the present study was to examine the correlation between insulin levels and colon polyps in subjects without a history of diabetes or colorectal cancer. From January 2, 2018 to December 31, 2019, 3277 adults who visited the University Hospital Health Examination Center and underwent colonoscopy were included in this study. Insulin, glycated hemoglobin (HbA1c), and fasting blood glucose levels were measured, and past medical history, alcohol consumption, smoking, and physical activity were assessed using self-administered questionnaires. Among the 3277 subjects, the prevalence of adenomatous and nonadenomatous lesions were 22.2% and 11.5%, respectively. The mean values of insulin, HbA1c, and fasting blood glucose were significantly increased in the adenomatous and nonadenomatous polyp groups compared to the normal group. Logistic regression analysis showed that the risk of adenoma (odds ratio [OR] 1.483; 95% confidence interval [CI], 1.170-1.878) and nonadenomatous polyps (OR 1.415; 95% CI, 1.038-1.929) were increased in the high insulin level group (≥7.36 uIU/mL), and only the risk of adenoma (OR 1.312; 95% CI, 1.003-1.718) was significantly higher after adjustment for disturbance variables. This study suggests that an increase in insulin levels is a significant risk factor for colon adenoma.

Stereotactic body radiotherapy versus radiofrequency ablation as initial treatment of small hepatocellular carcinoma.

BACKGROUND/AIM: Stereotactic body radiotherapy (SBRT) may be an alternative treatment for patients with small (≤3 cm) hepatocellular carcinomas (HCCs) who were not indicated for resection or local ablation therapy. This study compared the therapeutic effects of radiofrequency ablation (RFA) and SBRT in patients with small (≤3 cm) HCCs. METHODS: Data of HCC patients who underwent SBRT or RFA as an initial treatment at four tertiary referral hospitals between March 2011 and February 2017 were reviewed. The patient inclusion criteria were a single nodule measuring ≤3 cm in size and not suitable for resection. RESULTS: SBRT and RFA were performed for 72 (SBRT group) and 134 (RFA group) patients, respectively. The 1-, 3-, and 5-year overall survival (OS) rates were 97.0%, 80.3%, and 80.3%, respectively, in the SBRT group compared with 98.5%, 83.9%, and 80.8%, respectively, in the RFA group, with no significant differences between the groups (P = 0.81). The estimated five-year local control (LC) rate was 68.1% in the SBRT group and 73.1% in the RFA group (P = 0.81). In the SBRT group analysis, both SBRT alone (n = 34) and SBRT combined with transarterial chemoembolization (n = 38) showed no difference with RFA in OS (P = 0.72 and P = 0.90) or LC rate (P = 0.95 and P = 0.68), respectively. CONCLUSION: SBRT is an effective and safe treatment method for small HCCs, with survival and tumor recurrence rates similar to those of RFA.

The Association Between Smoking Cessation Period and Metabolic Syndrome in Korean Men.

The association between smoking cessation period and metabolic syndrome (MS) is currently unknown. We studied 6032 men aged >19 years who participated in the Korean National Health and Nutrition Examination Surveys between 2010 and 2012. The risk of MS according to the amount of smoking and duration of smoking cessation was examined, and adjusted for age, amount of alcohol consumed, physical activity, body mass index, income, and education levels. Compared with never-smokers, there was a significant increase in the risk of MS among current smokers >10 pack-years and former smokers with a history of pack-years >30. The odds ratio for MS increased with smoking amount in both current and former smokers. But the risk of MS in former smokers was no longer significant after 20 years of smoking cessation adjusted for past smoking amount. Thus, to prevent MS, current smokers should quit smoking early and former smokers should continue quitting.

Donor sex and donor-recipient sex disparity do not affect hepatocellular carcinoma recurrence after living donor liver transplantation

Purpose@#Studies have yielded contradictory results on whether donor sex and donor-recipient sex disparity affect hepatocellular carcinoma (HCC) recurrence after living donor liver transplantation (LDLT). The present study assessed whether donor sex or donor-recipient sex disparity affects HCC recurrence after LDLT at a high-volume center. @*Methods@#This study included 772 HCC patients who underwent LDLT between January 2006 and December 2015 at Asan Medical Center. Patients were divided into 4 groups based on the sex of the donor and recipient: male-to-male (n = 490, 63.5%), male-to-female (n = 75, 9.7%), female-to-male (n = 170, 22.0%), and female-to-female (n = 37, 4.8%). @*Results@#Disease-free survival (DFS; P = 0.372) and overall survival (OS; P = 0.591) did not differ significantly among the 4 groups. DFS also did not differ significantly between LDLT recipients with male and female donors (P = 0.792) or between male and female recipients (P = 0.084). After patient matching with an α-FP/des-γ-carboxy prothrombin/tumor volume score cutoff of 5logs, donor-recipient sex disparity did not significantly affect DFS (P = 0.598) or OS (P = 0.777). There were also no differences in DFS in matched LDLT recipients with male and female donors (P = 0.312) or between male and female recipients (P = 0.374). @*Conclusion@#Neither donor sex nor donor-recipient sex disparity significantly affected posttransplant HCC recurrence.

The factors associated with Vitamin D deficiency in community dwelling elderly in Korea.

BACKGROUND/OBJECTIVES: Recent studies showed vitamin D deficiency is linked to chronic diseases in addition to skeletal metabolism which could threaten the elderly. We analyzed health conditions and socio-demographic factors associated with vitamin D deficiency in community dwelling people aged 65 years and older. SUBJECTS/METHOD: Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010 to 2012 were obtained. A total of 2,687 subjects aged 65 years and older were participated. The cutoff value of the Vitamin D deficiency was considered as serum 25-hydroxyvitamin D [25(OH)D] ≤ 20 ng/mL (50 nmol/L). RESULTS: The overall prevalence rate of vitamin D deficiency in the elderly was 62.1%. The factors such as female, obesity, metabolic syndrome, current smoker, and skipping breakfast were positively associated with vitamin D deficiency, but high intensity of physical activity and more than 9 hours of sleep duration were negatively associated with vitamin D deficiency (all P < 0.05). CONCLUSIONS: It is important that health professions know that the factors proved in this study are connected to vitamin D deficiency thus provide information and intervention strategies of vitamin D deficiency to old aged people.

Prognostic impact of serum soluble PD-1 and ADV score for living donor liver transplantation in patients with previously untreated hepatocellular carcinoma

Purpose@#The programmed death protein 1 (PD-1) pathway is the critical mechanism in development of hepatocellular carcinoma (HCC). The present study analyzed the prognostic impact of pretransplant serum soluble PD-1 (sPD-1) concentration and α-FP–des-γ- –tumor volume (ADV) score in patients with previously untreated HCC undergone liver transplantation (LT). @*Methods@#This retrospective single-center study enrolled 100 patients with HCC who underwent living donor LT from 2010 to 2016. Concentrations of sPD-1 were measured in stored serum samples. @*Results@#Receiver operating characteristic curve analysis of 2-year tumor recurrence resulted in an sPD-1 cutoff of 177.1 µg/mL, which was associated with higher rates of tumor recurrence (P = 0.022), but not with overall patient survival (P = 0.460). The derived cutoff for pretransplant ADV score was 5.4log, which was associated with higher tumor recurrence rate (P 177.1 µg/mL (hazard ratio [HR], 2.26; P = 0.020) and pretransplant ADV score of >5.4log (HR, 3.56; P < 0.001) were independent risk factors for posttransplant HCC recurrence. The combination of these 2 factors enabled the stratification of patients into 3 groups, with groups having 0, 1, and 2 risk factors differing significantly in the prognosis of tumor recurrence (P < 0.001) and overall patient survival (P = 0.006). @*Conclusion@#Both sPD-1 concentration and ADV score have prognostic impacts in patients who underwent LT for untreated HCCs. These factors, both individually and combined, can help in predicting posttransplant prognosis.

Diagnostic and prognostic impact of fluorodeoxyglucosepositron emission tomography in diagnosing intraductal papillary neoplasms of the bile duct of the liver

Purpose@#Malignant intraductal papillary neoplasm of the bile duct of the liver (IPNB-L) cannot readily be diagnosed through preoperative CT or MRI, but fluorodeoxyglucose (FDG)-PET is a viable alternative. This study evaluated the diagnostic and prognostic impacts of FDG-PET in patients with IPNB-L. @*Methods@#This was a retrospective single-center study of 101 IPNB-L patients who underwent hepatectomy between 2010 and 2019. @*Results@#Mean age was 64.4 ± 8.3 years and 76 (75.2%) were male. Anatomical hepatic resection was performed in 99 (98.0%). Concurrent bile duct resection and pancreaticoduodenectomy were performed in 41 (40.6%) and 1 (1.0%), respectively. R0 and R1 resections were performed in 88 (87.1%) and 13 (12.9%), respectively. Low-grade intraepithelial neoplasia and high-grade neoplasia/invasive carcinoma were diagnosed in 19 (18.8%) and 82 (81.2%), respectively. Median FDG-PET maximal standardized uptake values (SUVmax) in low-grade neoplasia and high-grade neoplasia/carcinoma were 3.6 (range, 1.7–7.6) and 5.2 (range, 1.5–18.7) (P = 0.019), respectively. Receiver operating characteristic curve analysis of SUVmax showed area under the curve of 0.674, with sensitivity of 84.2% and specificity of 47.4% at SUVmax cutoff of 3.0. This cutoff had no significant influence on tumor recurrence (P = 0.832) or patient survival (P = 0.996) in patients with IPNB-L of high-grade neoplasia or invasive carcinoma. @*Conclusion@#IPNB-L is a rare type of biliary neoplasm and encompasses a histological spectrum ranging from benign disease to invasive carcinoma. An FDG-PET SUVmax cutoff of 3.0 appears to effectively discern high-grade neoplasia/ carcinoma from low-grade neoplasia, which will assist with the surgical strategy for these cases.

Effects of Voice Therapy Using Gliding and Humming in Dysphonic Patients With Glottal Gap

Background and Objectives@#Therapies have been reported to treat the glottal gap previously. However, these voice therapies showed the limits because many techniques focused only on one among breathing, resonance and phonation. In addition patients often have difficulties visiting hospital frequently. ‘Gliding and humming’ is vocal training technique that readjusts total vocal patterns such as breathing, resonance and phonation. This technique can be easily applied during short term sessions. The purpose of this study is to evaluate the efficiency of voice therapy with ‘gliding and humming’ for patients with glottic gap during short-term treatment sessions.Materials and Method Twenty-three patients with glottal gap were selected. Of all patients, 14 patients had sulcus vocalis and 12 patients had muscle tension dysphonia (MTD). Voice therapies were performed 1.9 sessions in average. GRBAS, jitter, shimmer, noise to harmonic ratio, semitone range, closed quotient_vowel and maximum phonation time were compared before and after the therapies. In addition, changes of glottal gap and MTD severity were evaluated. @*Results@#Statistically significant improvement was observed. MTD improvement was observed only among the patients with glottal gap improvement. Also sulcus vocalis group showed the statistically significant improvement. @*Conclusion@#‘Gliding and humming’ was effective to the patients with glottic gap and sulcus vocalis. Also, among patients who have both glottic gap and MTD, the data suggests that voice therapy for glottic gap also makes improvement in MTD.

Effects of Voice Therapy Using Gliding and Humming in Dysphonic Patients With Glottal Gap

Background and Objectives@#Therapies have been reported to treat the glottal gap previously. However, these voice therapies showed the limits because many techniques focused only on one among breathing, resonance and phonation. In addition patients often have difficulties visiting hospital frequently. ‘Gliding and humming’ is vocal training technique that readjusts total vocal patterns such as breathing, resonance and phonation. This technique can be easily applied during short term sessions. The purpose of this study is to evaluate the efficiency of voice therapy with ‘gliding and humming’ for patients with glottic gap during short-term treatment sessions.Materials and Method Twenty-three patients with glottal gap were selected. Of all patients, 14 patients had sulcus vocalis and 12 patients had muscle tension dysphonia (MTD). Voice therapies were performed 1.9 sessions in average. GRBAS, jitter, shimmer, noise to harmonic ratio, semitone range, closed quotient_vowel and maximum phonation time were compared before and after the therapies. In addition, changes of glottal gap and MTD severity were evaluated. @*Results@#Statistically significant improvement was observed. MTD improvement was observed only among the patients with glottal gap improvement. Also sulcus vocalis group showed the statistically significant improvement. @*Conclusion@#‘Gliding and humming’ was effective to the patients with glottic gap and sulcus vocalis. Also, among patients who have both glottic gap and MTD, the data suggests that voice therapy for glottic gap also makes improvement in MTD.

The effect of acupuncture on postoperative nausea and vomiting after pediatric tonsillectomy: A meta-analysis and systematic review.

OBJECTIVES/HYPOTHESIS: Tonsillectomy is one of the most frequently performed pediatric surgical procedures worldwide. The complications of this procedure include postoperative nausea and vomiting (PONV) and pain; therefore, both the treatment and prevention of PONV are important. Classical antiemetics include drug therapies such as ondansetron, which are undesirable because they often carry a high cost and several side effects. Therefore, in this study we aimed to evaluate the antiemetic effect of acupuncture after pediatric tonsillectomy. METHODS: We searched for eligible articles that reported on the antiemetic effects of acupuncture after tonsillectomy using the three databases, MEDLINE, Embase, and Cochrane, through July 2015. We included full-length original articles with adequate data for evaluating the antiemetic effects on pediatric tonsillectomy in the form of a relative ratio. The Newcastle-Ottawa scale was used to assess the quality of case control and cohort studies, and the Cochrane risk of bias tool was employed for randomized controlled trials (RCTs). RESULTS: The search identified 415 publications. After screening, we selected eight articles for review (4 RCTs, 3 prospective cohorts, and 1 pilot study). A meta-analysis of acupuncture in pediatric tonsillectomy revealed that the number of patients with PONV was significantly reduced with acupuncture compared to the control group, with a risk ratio of 0.77 (95% confidence interval: 0.63-0.94, P < 0.05). CONCLUSION: When acupuncture at PC6 (neiguan) was used to prevent PONV after pediatric tonsillectomy, the risk ratio was significantly lower compared to that of conventional drug therapy. Although further randomized controlled trials are needed, acupuncture at PC6 is considered an economic and effective treatment for emesis after pediatric tonsillectomy. Laryngoscope, 126:1761-1767, 2016.

Prediction of Post-resection Prognosis Using the ADV Score for Huge Hepatocellular Carcinomas ≥13 cm

Background/Aims@#Multiplication of α-fetoprotein, des-γ-carboxy prothrombin, and tumor volume (ADV score) is a surrogate marker for post-resection prognosis of hepatocellular carcinoma (HCC). This study aimed to validate the predictive power of the ADV score-based prognostic prediction model for patients with solitary huge HCC. @*Methods@#Of 3,018 patients, 100 patients who underwent hepatic resection for solitary HCC ≥13 cm between 2008 and 2012 were selected. @*Results@#The median tumor diameter and tumor volume were 15.0 cm and 886 mL, respectively. Tumor recurrence and overall survival (OS) rates were 70.7% and 66.0% at one year and 84.9% and 34.0% at five years, respectively. Microvascular invasion (MVI) was the only independent risk factor for disease-free survival (DFS) and OS. DFS and OS, stratified by ADV score with 1-log intervals, showed significant prognostic contrasts (P=0.007 and P=0.017, respectively). DFS and OS, stratified by ADV score with a cut-off of 8-log, showed significant prognostic contrasts (P=0.014 and P=0.042, respectively). The combination of MVI and ADV score with a cut-off of 8-log also showed significant prognostic contrasts in DFS (P<0.001) and OS (P=0.001) considering the number of risk factors. Prognostic contrast was enhanced after combining the MVI and ADV score. @*Conclusions@#The prognostic prediction model with the ADV score could reliably predict the risk of tumor recurrence and long-term patient survival outcomes in patients with solitary huge HCC ≥13 cm. The results of this study suggest that our prognostic prediction models can be used to guide surgical treatment and post-resection follow-up for patients with huge HCCs.

Prediction of Post-resection Prognosis Using the ADV Score for Huge Hepatocellular Carcinomas ≥13 cm

Background/Aims@#Multiplication of α-fetoprotein, des-γ-carboxy prothrombin, and tumor volume (ADV score) is a surrogate marker for post-resection prognosis of hepatocellular carcinoma (HCC). This study aimed to validate the predictive power of the ADV score-based prognostic prediction model for patients with solitary huge HCC. @*Methods@#Of 3,018 patients, 100 patients who underwent hepatic resection for solitary HCC ≥13 cm between 2008 and 2012 were selected. @*Results@#The median tumor diameter and tumor volume were 15.0 cm and 886 mL, respectively. Tumor recurrence and overall survival (OS) rates were 70.7% and 66.0% at one year and 84.9% and 34.0% at five years, respectively. Microvascular invasion (MVI) was the only independent risk factor for disease-free survival (DFS) and OS. DFS and OS, stratified by ADV score with 1-log intervals, showed significant prognostic contrasts (P=0.007 and P=0.017, respectively). DFS and OS, stratified by ADV score with a cut-off of 8-log, showed significant prognostic contrasts (P=0.014 and P=0.042, respectively). The combination of MVI and ADV score with a cut-off of 8-log also showed significant prognostic contrasts in DFS (P<0.001) and OS (P=0.001) considering the number of risk factors. Prognostic contrast was enhanced after combining the MVI and ADV score. @*Conclusions@#The prognostic prediction model with the ADV score could reliably predict the risk of tumor recurrence and long-term patient survival outcomes in patients with solitary huge HCC ≥13 cm. The results of this study suggest that our prognostic prediction models can be used to guide surgical treatment and post-resection follow-up for patients with huge HCCs.

Postresection prognosis of combined hepatocellular carcinoma-cholangiocarcinoma according to the 2010World Health Organization classification: single-center experience of 168 patients

Purpose@#Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) has wide histologic diversity. This study investigated the effects of cHCC-CC histology, according to the 2010 World Health Organization (WHO) classification, on patient prognosis. @*Methods@#The medical records of patients who underwent surgical resection for cHCC-CC at our institution between July 2012 and June 2019 were retrospectively evaluated. @*Results@#During the study period, 168 patients, 122 males (72.6%) and 46 females (27.4%), underwent surgical resection for cHCC-CC, including 159 patients (94.6%) who underwent R0 resection. Mean tumor diameter was 4.4 ± 2.8 cm, and 161 patients (95.8%) had solitary tumors. Histologically, 86 patients (51.2%) had classical type, and 82 (48.8%) had tumors with stem cell (SC) features, including 33 (19.6%) with intermediate-cell and 23 (13.7%) each with typical SC and cholangiolocellular features; 3 tumors (1.8%) were unclassifiable. At 1, 3, and 5 years, tumor recurrence rates were 31.9%, 49.6%, and 58.1%, respectively, and patient survival rates were 91.0%, 70.2%, and 60.3%, respectively. Univariate analysis showed that tumor size of >5 cm, microscopic and macroscopic vascular invasion, lymph node metastasis, 8th edition of the American Joint Committee on Cancer (AJCC) tumor stage, and 2010 WHO classification were significantly prognostic. Multivariate analysis showed that the 8th AJCC tumor stage and 2010 WHO histologic classification were independently prognostic for tumor recurrence and patient survival. There were no significant prognostic differences among the 3 SC subtypes. @*Conclusion@#Postresection outcomes are better in patients with SC-type than with classical-type cHCC-CC.

Postresection prognosis of combined hepatocellular carcinoma-cholangiocarcinoma according to the 2010World Health Organization classification: single-center experience of 168 patients

Purpose@#Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) has wide histologic diversity. This study investigated the effects of cHCC-CC histology, according to the 2010 World Health Organization (WHO) classification, on patient prognosis. @*Methods@#The medical records of patients who underwent surgical resection for cHCC-CC at our institution between July 2012 and June 2019 were retrospectively evaluated. @*Results@#During the study period, 168 patients, 122 males (72.6%) and 46 females (27.4%), underwent surgical resection for cHCC-CC, including 159 patients (94.6%) who underwent R0 resection. Mean tumor diameter was 4.4 ± 2.8 cm, and 161 patients (95.8%) had solitary tumors. Histologically, 86 patients (51.2%) had classical type, and 82 (48.8%) had tumors with stem cell (SC) features, including 33 (19.6%) with intermediate-cell and 23 (13.7%) each with typical SC and cholangiolocellular features; 3 tumors (1.8%) were unclassifiable. At 1, 3, and 5 years, tumor recurrence rates were 31.9%, 49.6%, and 58.1%, respectively, and patient survival rates were 91.0%, 70.2%, and 60.3%, respectively. Univariate analysis showed that tumor size of >5 cm, microscopic and macroscopic vascular invasion, lymph node metastasis, 8th edition of the American Joint Committee on Cancer (AJCC) tumor stage, and 2010 WHO classification were significantly prognostic. Multivariate analysis showed that the 8th AJCC tumor stage and 2010 WHO histologic classification were independently prognostic for tumor recurrence and patient survival. There were no significant prognostic differences among the 3 SC subtypes. @*Conclusion@#Postresection outcomes are better in patients with SC-type than with classical-type cHCC-CC.