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1.
Medicine (Baltimore) ; 99(41): e22568, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031305

RESUMO

The effect of intraoperative blood transfusion on the immune function and prognosis of hepatocellular carcinoma (HCC) has not been fully investigated. The aim of this study was to evaluate the effects of intraoperative autologous blood transfusion and allogeneic blood transfusion on immune function and prognosis in surgically treated HCC patients. One hundred fourteen primary hepatic carcinoma patients who would undergo selective operations were divided into two groups, 35 patients in the experimental group received intraoperative autologous blood transfusion and 79 patients in the control group received allogeneic blood transfusion. The amount of serum T lymphocyte subsets, natural killer (NK) cells and immunoglobulin before and after operation, as well as the recurrence-free survival (RFS) were compared. Results shown that, there was no significant difference in the level of immunocytes and immunoglobulin between the two groups before treatment (P > .05). At 1 day after surgery, there were significant differences in T lymphocyte, NK cells and immunoglobulin levels before and after transfusion. CD3+, CD4+, CD4+/CD8+, and NK cells in autologous transfusion group were significantly higher than those in allogeneic transfusion group (P < .05); the level of IgG, IgM, and IgA in allogeneic transfusion group were significantly lower than those before operation (P < .05), the level of IgG, IgM, and IgA in autologous transfusion group did not significantly fluctuate, and significantly higher than those of allogeneic transfusion group (P < .05). At 5 days after surgery, all indexes of autologous transfusion group recovered to the preoperative level, the levels of CD3+, CD4+, CD4+/CD8+, NK cells, IgG, IgM, and IgA were significantly higher than those of allogeneic transfusion group (P < .05). The follow-up results showed that the RFS of autologous transfusion group was significantly higher than that of allogeneic transfusion group (P < .05). In conclusion, compared with allogeneic blood transfusion, intraoperative autologous blood transfusion possessed less impact on immune function, it may even improve immune function and RFS in HCC patients after surgery. Therefore, HCC patients should be recommended to receive autologous blood transfusion instead of allogeneic blood transfusion when they need blood transfusion during the perioperative period.


Assuntos
Transfusão de Sangue , Carcinoma Hepatocelular/imunologia , Carcinoma Hepatocelular/cirurgia , Cuidados Intraoperatórios , Neoplasias Hepáticas/imunologia , Neoplasias Hepáticas/cirurgia , Transfusão de Sangue Autóloga , Feminino , Humanos , Imunoglobulinas/imunologia , Células Matadoras Naturais/imunologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Subpopulações de Linfócitos T/imunologia
2.
Nat Commun ; 11(1): 4383, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873799

RESUMO

Mongolia has the highest incidence of hepatocellular carcinoma (HCC) in the world, but its causative factors and underlying tumor biology remain unknown. Here, we describe molecular characteristics of HCC from 76 Mongolian patients by whole-exome and transcriptome sequencing. We present a comprehensive analysis of mutational signatures, driver genes, and molecular subtypes of Mongolian HCC compared to 373 HCC patients of different races and ethnicities and diverse etiologies. Mongolian HCC consists of prognostic molecular subtypes similar to those found in patients from other areas of Asia, Europe, and North America, as well as other unique subtypes, suggesting the presence of distinct etiologies linked to Mongolian patients. In addition to common driver mutations (TP53, CTNNB1) frequently found in pan-cancer analysis, Mongolian HCC exhibits unique drivers (most notably GTF2IRD2B, PNRC2, and SPTA1), the latter of which is associated with hepatitis D viral infection. These results suggest the existence of new molecular mechanisms at play in Mongolian hepatocarcinogenesis.


Assuntos
Biomarcadores Tumorais/genética , Carcinoma Hepatocelular/genética , Regulação Neoplásica da Expressão Gênica , Hepatite D/genética , Neoplasias Hepáticas/genética , Idoso , Carcinogênese/genética , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/virologia , Análise Mutacional de DNA , Feminino , Perfilação da Expressão Gênica , Hepatectomia , Hepatite D/epidemiologia , Hepatite D/cirurgia , Hepatite D/virologia , Vírus Delta da Hepatite/isolamento & purificação , Humanos , Incidência , Fígado/patologia , Fígado/cirurgia , Fígado/virologia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Mongólia/epidemiologia , Mutação , Prognóstico , Sequenciamento Completo do Exoma
3.
Anticancer Res ; 40(10): 5823-5828, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988911

RESUMO

AIM: Our aim was to confirm the utility of Indocyanine green (ICG) fluorescence imaging for intraoperative detection of adrenal hepatocellular carcinoma (HCC) metastasis. CASE REPORT: An 83-year-old man with a right adrenal HCC metastasis was admitted after complete remission of primary HCC and a metachronous left adrenal metastasis. He was treated with ICG fluorescence-guided limited resection to preserve adrenal function. ICG was administered intravenously at a dose of 0.5 mg/kg, 6 days before the operation. After removal of the entire suspicious metastatic HCC, ICG fluorescence imaging clearly demonstrated two illuminated lesions. The lesions were separately resected using an energy device. Finally, there were no ICG fluorescent lesions which meant residual tumor. Histopathological examination confirmed adrenal metastasis of moderately differentiated HCC in the initial specimen and the additional resected specimens. Three months after the operation, adrenal function was well preserved without recurrence of HCC. CONCLUSION: ICG fluorescence imaging is essential for complete resection of adrenal HCC metastasis.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Imagem Óptica , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/secundário , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Humanos , Verde de Indocianina/administração & dosagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Metástase Neoplásica , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia
4.
Medicine (Baltimore) ; 99(36): e22077, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899078

RESUMO

RATIONALE: Hepatic epithelioid hemangioendothelioma (HEH) is a rare vascular tumor of the liver with malignant potential. It can be of solitary type, multifocal type, or diffuse type. Although there are some characteristic features on radiologic imaging, the definitive diagnosis of HEH is based on histopathology. The surgical treatment of HEH includes liver resection and transplant. PATIENT CONCERNS: A middle-aged woman presented with easy fatiguability and anorexia for 1 month was found to have multifocal lesions on radiological imaging. DIAGNOSIS: HEH was diagnosed by needle biopsy. It can be seen from imaging that this case is a multifocal form. The largest lesion increased from 3 to 3.3 cm within 2 months, with an increase of 9.45%; no other relevant literatures have been reported. INTERVENTIONS: The possibility of liver transplantation was suggested to the patient. However, the patient refused transplantation and was successfully treated by radical right hepatectomy and resection of the left lobe lesion. OUTCOMES: She remained disease-free throughout a year follow-up period. CONCLUSION: HEH is a rare disease with characteristic radiological and pathological features. Although liver transplantation is the preferred treatment for multifocal HEH, surgical excision represents one alternative when the lesions can be guaranteed to be completely excised.


Assuntos
Hemangioendotelioma Epitelioide/patologia , Neoplasias Hepáticas/patologia , Feminino , Hemangioendotelioma Epitelioide/cirurgia , Hepatectomia , Humanos , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade
5.
Medicine (Baltimore) ; 99(32): e21454, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769872

RESUMO

The impact of different antiviral regimen on prognosis of chronic hepatitis B (CHB) related hepatocellular carcinoma (HCC) remains to be explored.A total of 479 CHB-related HCC patients after curative liver resection were enrolled receiving tenofovir (TDF, TDF group) or lamivudine, telbivudine, and entecavir (non-TDF group). Both the overall survival and diseases-free survival were analyzed and compared.A total of 242 patients received TDF treatment and 237 patients received other antiviral regimen. Child-Pugh score, serum α-fetoprotein (AFP) level, total bilirubin level, status of hepatitis B e antigen (HBeAg), and cirrhosis were compared between groups. Kaplan-Meier analysis revealed that patients with TDF treatment had significantly longer overall survival than those of patients with other regimen (P = .015). Similarly, compared with patients with non-TDF treatment, disease-free survival time was longer (P = .042) in those with TDF treatment. Multivariate analysis showed that TDF treatment (P = .04), AFP level (P = .03) were significant independent factors associated with overall survival of CHB-related HCC patients. While TDF treatment (P = .04) and serum AFP level (P = .03) were independent factors associated with disease-free survival.Anti-virus treatment with TDF benefits for both overall survival and disease-free survival of CHB-related patients than other Nucleos(t)ide analogues.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/complicações , Hepatectomia , Hepatite B Crônica/tratamento farmacológico , Neoplasias Hepáticas/complicações , Tenofovir/uso terapêutico , Adulto , Carcinoma Hepatocelular/cirurgia , China , Estudos de Coortes , Feminino , Hepatite B Crônica/etiologia , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Resultado do Tratamento
6.
Zhonghua Yi Xue Za Zhi ; 100(31): 2457-2461, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32819063

RESUMO

Objective: To analyze the clinical efficacy and safety of cyberknife in the treatment of patients with primary large hepatocellular carcinoma over 70 years old. Methods: A total of 82 patients (58 males and 24 females) with large hepatocellular carcinoma aged over 70 years (70 to 85 years, (75±4) years) with a median tumor diameter of 6.7 cm (5.0~10.0 cm) were retrospectively collected. All patients were diagnosed by pathology or radiography in the Cancer Radiotherapy Center of the Fifth Medical Center of the PLA General Hospital from March 2014 to December 2018, and treated with cyberknife stereotactic radiotherapy. Progression free survival rate (PFS), local control rate (LC), overall survival rate (OS) and adverse reactions were observed at 1, 2 and 3 years. Kaplan-Meier was used for survival analysis, and Cox regression model was used to analyze survival-related factors. Results: All 82 patients successfully completed radiation therapy with a median survival time of 20 months, a median PFS of 10 months, an objective response rate of 64.63% (53/82), and a disease control rate of 85.37% (70/82). After treatment, the PFS at 1, 2, and 3 years were 39.0% (32/82), 22.1% (18/82), and 17.1% (14/82), respectively; the LC at 1, 2, and 3 years were 95.1% (78/82), 92.3% (76/82), and 92.3% (76/82), respectively; and the OS at 1, 2, and 3 years were 68.3% (56/82), 48.8% (40/82) and 31.7% (26/82), respectively. Nine patients suffered from radiation-induced liver disease (RILD), and there were no deaths due to RILD. Cox regression analysis showed that alpha-fetoprotein (AFP) was an independent risk factor for OS (HR=2.304, 95%CI 1.118-4.747;P<0.05). Conclusion: Cyberknife treatment for patients with primary large hepatocellular cancer over 70 years old has higher LC and OS, better curative effect, and less treatment-related adverse reactions.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Radiocirurgia , Idoso , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(31): e21605, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756216

RESUMO

INTRODUCTION: A meningeal hemangiopericytoma (MHPC) is an aggressive tumor characterized by a high rate of local recurrence and late distant metastasis. The objective of this study was to share our experience with the treatment of a MHPC and how to distinguish this tumor from a meningioma. PATIENT CONCERNS: A 62-year-old woman presented with symptoms of hypomnesia, hyperopia, and double vision for 1 month. Complete tumor excision was performed 6 years before. A biopsy sample was diagnosed as an atypical meningioma. DIAGNOSIS: MHPC with late delayed hepatic metastasis. INTERVENTION: Hepatic resection was performed initially, followed by secondary neurosurgery for complete excision of the bilateral frontal lesion 1 month later. OUTCOME: Based on the tumor pathology and consensus of oncologic surgeons, radiation therapy was initiated. Adjuvant therapy was well-tolerated and the patient remained recurrence-free at 6 months after surgery. CONCLUSION: Here, we report a case of local brain tumor recurrence and multiple hepatic metastases from a MHPC. Craniotomy combined with radical metastasectomy may be useful in such cases. Detailed immunohistochemical staining is helpful to distinguish a MHPC from a meningioma. Long-term follow-up is recommended.


Assuntos
Hemangiopericitoma/patologia , Neoplasias Hepáticas/secundário , Neoplasias Meníngeas/patologia , Feminino , Hemangiopericitoma/cirurgia , Humanos , Neoplasias Hepáticas/cirurgia , Neoplasias Meníngeas/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia
8.
Medicine (Baltimore) ; 99(32): e21630, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769926

RESUMO

RATIONALE: Hepatocellular carcinoma (HCC) with intracavitary metastasis extending to the heart, also known as inferior vena cava (IVC) tumor thrombus, is an extremely rare late-stage disease with no effective treatment. In fact, the median survival is reportedly less than 2 months; thus, there is an urgent need for better treatment. PATIENT CONCERNS: In this study, a 48-year-old patient was admitted to our hospital to seek medical treatment for advanced primary HCC with right atrial metastasis. DIAGNOSIS: The patient was diagnosed as primary HCC with a large mass in the right lobe of the liver and intracavitary metastasis to the right atrium. INTERVENTIONS: A new surgical treatment of right hemihepatectomy, complete resection of the involved IVC and the right atrium thrombus, plus reconstruction of the resected IVC using autologous pericardial tube graft were undertaken and successfully performed. OUTCOMES: The patient recovered rapidly, and 14 days after the surgical procedures, he was discharged from the hospital. Notably, serum levels of alpha-fetoprotein dropped to normal range and no clinical signs of recurrence were observed during follow-up. LESSONS: This report highlights an unusual case of right atrial metastasis from HCC. The surgical treatment appeared to be suitable and effective, together with postoperative administration of lenvatinib, a tyrosine kinase multitarget inhibitor selected by performing whole-exome sequencing. These therapies have offered favorable clinical outcomes such as prevention of recurrence and prolongation of patient survival. In addition, clinicians may benefit from our experience for their future treatment of patients with similar clinical conditions.


Assuntos
Carcinoma Hepatocelular/cirurgia , Átrios do Coração/anormalidades , Metástase Neoplásica/diagnóstico , Carcinoma Hepatocelular/complicações , Átrios do Coração/cirurgia , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/fisiopatologia , Metástase Neoplásica/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Veia Cava Inferior/cirurgia
9.
Medicine (Baltimore) ; 99(34): e20748, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846750

RESUMO

INTRODUCTION: Obesity represents a risk factor in case of major hepatectomy, because the future liver remnant (FLR) must be proportional with body weight. To avoid post-hepatectomy liver failure, and further increase the ratio between FLR and body weight, we performed a bariatric procedure in the first stage of the ALPPS technique. PATIENT CONCERNS: Fifty-four-year-old woman, with morbid obesity (BMI 58.5) and type II diabetes mellitus, was scheduled for a major hepatectomy due to multiple colorectal liver metastases DIAGNOSIS:: Six months before, the patient was diagnosed with colorectal cancer and synchronous liver metastases. She was initially treated with sigmoidectomy and chemotherapy. After partial response of the liver metastases, we considered a liver resection but the FLR was very low, especially in relation to her BMI. INTERVENTION: We planned a novel approach and, for the first time, we performed a sleeve gastrectomy during the first stage of Tourniquet ALPPS (T-ALPPS). After achieving an adequate FLR, we successfully completed the major hepatectomy during the second stage of T-ALPPS. OUTCOME: The association between sleeve gastrectomy and T-ALPPS produced an increase of FLR/body weight ratio up to 0.8 that allowed completing a right trisectionectomy in the second stage of ALPPS. The major hepatectomy was performed without severe complications, and several months after surgery the patient is still alive without any recurrence Conclusion: Despite obesity represents a risk factor involved in the carcinogenesis, the role of the bariatric surgery in the oncological setting is not well established. In this clinical case, we benefited from the weight loss produced by bariatric surgery combined with an effective hypertrophy technique and chemotherapy. These findings suggest that bariatric surgery could be useful for obese patients with liver malignancy and need for extended hepatectomy.


Assuntos
Gastrectomia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Obesidade Mórbida/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Neoplasias do Colo Sigmoide/patologia
10.
Cancer Radiother ; 24(6-7): 513-522, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32830055

RESUMO

Stereotactic radiotherapy is a fundamental change from the conventional fractionated radiotherapy and represents a new therapeutic indication. Stereotactic radiotherapy is now a standard of care for inoperable patients or patients who refuse surgery. The results are encouraging with local control and survival rates very high in selected populations. The rate of late toxicity remains acceptable. Good tolerability makes it appropriate even for elderly and frail patients. In these fragile patients or in certain specific clinical situations, different surgical, radiotherapy or interventional radiology attitudes can be discussed on a case-by-case basis. These situations are considered in this article for the pulmonary, hepatic and prostatic localizations.


Assuntos
Neoplasias Hepáticas/radioterapia , Neoplasias Pulmonares/radioterapia , Neoplasias da Próstata/radioterapia , Radiocirurgia , Humanos , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/cirurgia , Masculino , Guias de Prática Clínica como Assunto , Neoplasias da Próstata/cirurgia
11.
Zhonghua Gan Zang Bing Za Zhi ; 28(6): 488-493, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32660177

RESUMO

Objective: To investigate the blood flow change status in early stage tumor-related areas of hepatocellular carcinoma and its clinical significance after radiofrequency ablation using multi-slice spiral CT whole-liver perfusion imaging technology. Methods: 21 cases of primary liver cancer that underwent CT-guided radiofrequency ablation were included. CT perfusion scans were divided into four groups according to the time points of CT scans (before surgery, immediately after surgery and 1 and 3 month after surgery), and then blood perfusion parameters of the corresponding areas of the tumor were measured. Statistical analysis was performed using two independent samples of non-parametric Wilcoxon rank-sum test. The differences of blood perfusion parameters between tumor or ablation lesion and background liver parenchyma, paratumor tissue or inflammatory response zone were compared before, immediately and 1 and 3 months after surgery, respectively. Results: (1) The hepatic arterial perfusion (HAP) and hepatic arterial perfusion index (HPI) of cancerous liver tumors and background liver parenchyma was significantly increased (P < 0.01). The total liver perfusion (TLP) was higher than the background liver parenchyma (P = 0.01 < 0.05). The time to peak (TTP) was significantly lower than background liver parenchyma (P < 0.01); (2) The perfusion parameters of HAP, PVP and TLP were lower than the background liver parenchyma in the complete ablation lesions immediately after radiofrequency ablation and 1 and 3 months after surgery, and the difference was statistically significant (P < 0.05); (3) The inflammatory response zone of ablation lesions of HAP, HPI, and TLP were gradually decreased with the extended postoperative time and TTP was gradually increased, while PVP did not change significantly; (4) HAP, HPI, and TTP were compared between the tumor and the tumor inflammatory response zone immediately after surgery, and 1 and 3 months after surgery, and the difference was statistically significant (P < 0.01). However, there was no statistically significant difference between PVP and TLP (P > 0.05). Conclusion: CT whole-liver perfusion imaging can precisely evaluate the early stage blood flow change status in peritumor and tumors before and after radiofrequency ablation and then objectively evaluate tumor's blood supply and therapeutic effect on hepatocellular carcinoma.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Estadiamento de Neoplasias , Imagem de Perfusão , Tomografia Computadorizada Espiral
12.
Anticancer Res ; 40(8): 4343-4349, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32727762

RESUMO

BACKGROUND: We retrospectively investigated factors predictive for ascites after hepatic resection to treat hepatocellular carcinoma (HCC). PATIENTS AND METHODS: The data of 114 patients with HCC who underwent curative hepatic resection were reviewed. The patients were assigned to two groups according to the presence or not of postoperative ascites. RESULTS: Ascites occurred in 16 patients (14.0%), and refractory ascites in four (3.5%). A MAC2-binding protein glycosylation isomer (M2BPGi) cutoff index of 1.61 [sensitivity=75.0%, specificity 67.9%, area under the curve (AUC)=0.745] and virtual touch tissue quantification (VTQ) of 2.62 (sensitivity=68.8%, specificity=89.8%, AUC=0.827) were the best cut-off values. Patients with ascites had lower serum albumin levels, higher serum creatinine levels, higher albumin-bilirubin (ALBI) grade, higher M2BPGi, higher VTQ, and longer operative time. ALBI grade 2 and both M2BPGi>1.61 and VTQ>2.62 were independent predictors of postoperative ascites. CONCLUSION: We demonstrated retrospectively that ALBI grade 2 and both high M2BPGi and VTQ were independent predictors of postoperative ascites in patients undergoing hepatic resection for HCC.


Assuntos
Ascite/etiologia , Carcinoma Hepatocelular/cirurgia , Hepatectomia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias , Humanos , Estudos Retrospectivos
13.
Chirurgia (Bucur) ; 115(3): 410-413, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614298

RESUMO

The invasion of the inferior vena cava (IVCI) due to hepatocellular carcinoma (HCC) is an unusual but aggressive entity. When it hap pens, the disease is considered to be in a very advanced stage, and the proposed treatment is palliative chemotherapy. However, there are recent studies that support radical surgical treatment as a therapeutic option, so their results show longer survivals than chemotherapy without major surgical complications. We present the clinical case of a patient with HCC and IVCI treated by hepatic resection and inferior vena cava (IVC) replacement with disease-free survival of 8 months after surgery.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/cirurgia , Hepatectomia , Humanos , Neoplasias Hepáticas/cirurgia , Resultado do Tratamento , Veia Cava Inferior
14.
Anticancer Res ; 40(7): 3873-3882, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620627

RESUMO

BACKGROUND/AIM: This study investigated the use of near-infrared fluorescent imaging for securing safe margins during liver resection. PATIENTS AND METHODS: This study included 125 patients who underwent liver tumor resection in 2014-2018. Indocyanine green testing was performed 2-14 days before surgery. Histopathological specimens of hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) were evaluated using fluorescent microscopy. RESULTS: Fluorescence microscopy identified signals in 26/53 (49.0%) and 36/72 (50%) cases of HCC and CRLM, respectively. HCC demonstrated total, partial, rim, and combined fluorescence patterns; CRLM uniformly demonstrated rim fluorescence. Although rim fluorescence was seen in both HCC and CRLM, no malignancy was confirmed pathologically in the peritumoral area demonstrating fluorescence. The median widths of fluorescence from the tumor edge in HCC and CRLM were 1227.5 µm and 1608 µm, respectively, with no significant difference. CONCLUSION: Near-infrared fluorescent imaging can reliably detect safe surgical margins intraoperatively during liver resection.


Assuntos
Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Margens de Excisão , Microscopia de Fluorescência , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Espectroscopia de Luz Próxima ao Infravermelho/métodos
15.
Lancet Oncol ; 21(7): 947-956, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32615109

RESUMO

BACKGROUND: Indications for liver transplantation for hepatocellular carcinoma are evolving and so-called expanded criteria remain debated. Locoregional therapies are able to downstage hepatocellular carcinoma from beyond to within the Milan criteria. We aimed to investigate the efficacy of liver transplantation after successful hepatocellular carcinoma downstaging. METHODS: We did an open-label, multicentre, randomised, controlled trial designed in two phases, 2b and 3, at nine Italian tertiary care and transplantation centres. Patients aged 18-65 years with hepatocellular carcinoma beyond the Milan criteria, absence of macrovascular invasion or extrahepatic spread, 5-year estimated post-transplantation survival of at least 50%, and good liver function (Child-Pugh A-B7) were recruited and underwent tumour downstaging with locoregional, surgical, or systemic therapies according to multidisciplinary decision. After an observation period of 3 months, during which sorafenib was allowed, patients with partial or complete responses according to modified Response Evaluation Criteria in Solid Tumors were randomly assigned (1:1) by an interactive web-response system to liver transplantation or non-transplantation therapies (control group). A block randomisation (block size of 2), stratified by centre and compliance to sorafenib treatment, was applied. Liver transplantation was done with whole or split organs procured from brain-dead donors. The control group received sequences of locoregional and systemic treatment at the time of demonstrated tumour progression. The primary outcomes were 5-year tumour event-free survival for phase 2b and overall survival for phase 3. Analyses were by intention to treat. Organ allocation policy changed during the course of the study and restricted patient accrual to 4 years. This trial is registered with ClinicalTrials.gov, NCT01387503. FINDINGS: Between March 1, 2011, and March 31, 2015, 74 patients were enrolled. Median duration of downstaging was 6 months (IQR 4-11). 29 patients dropped out before randomisation and 45 were randomly assigned: 23 to the transplantation group versus 22 to the control group. At data cutoff on July 31, 2019, median follow-up was 71 months (IQR 60-85). 5-year tumour event-free survival was 76·8% (95% CI 60·8-96·9) in the transplantation group versus 18·3% (7·1-47·0) in the control group (hazard ratio [HR] 0·20, 95% CI 0·07-0·57; p=0·003). 5-year overall survival was 77·5% (95% CI 61·9-97·1) in the transplantation group versus 31·2% (16·6-58·5) in the control group (HR 0·32, 95% CI 0·11-0·92; p=0·035). The most common registered grade 3-4 serious adverse events were hepatitis C virus recurrence (three [13%] of 23 patients) and acute transplant rejection (two [9%]) in the transplantation group, and post-embolisation syndrome (two [9%] of 22 patients) in the control group. Treatment-related deaths occurred in four patients: two (8%) of 23 patients in the transplantation group (myocardial infarction and multi-organ failure) versus two (9%) of 22 patients in the control group (liver decompensation). INTERPRETATION: Although results must be interpreted with caution owing to the early closing of the trial, after effective and sustained downstaging of eligible hepatocellular carcinomas beyond the Milan criteria, liver transplantation improved tumour event-free survival and overall survival compared with non-transplantation therapies Post-downstaging tumour response could contribute to the expansion of hepatocellular carcinoma transplantation criteria. FUNDING: Italian Ministry of Health.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/mortalidade , Recidiva Local de Neoplasia/cirurgia , Adolescente , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Taxa de Sobrevida , Adulto Jovem
17.
Anticancer Res ; 40(7): 4165-4171, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620666

RESUMO

BACKGROUND/AIM: The Geriatric Nutritional Risk Index (GNRI) is a prognostic indicator for several cancers; however, the association between the GNRI and colorectal liver metastasis (CRLM) remains unknown. PATIENTS AND METHODS: Eighty patients who underwent hepatectomy for synchronous CRLM were divided into two groups based on the GNRI. RESULTS: The preoperative CA19-9 levels were significantly higher in the low (GNRI ≤98; n=30) than the normal GNRI group (GNRI >98; n=50). Patients in the low GNRI group had poorer outcomes than those in the normal GNRI group. A low GNRI was an independent prognostic factor for recurrence-free survival and overall survival. Among 50 patients who experienced recurrence, only 16 of 22 patients (72.7%) in the low GNRI group could receive intensive treatment and 27 of 28 patients (96.4%) in the normal GNRI group. CONCLUSION: The GNRI is a simplified prognostic factor for patients with CRLM.


Assuntos
Neoplasias Colorretais , Neoplasias Hepáticas , Estado Nutricional , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Feminino , Avaliação Geriátrica , Hepatectomia , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco
18.
Zhonghua Wai Ke Za Zhi ; 58(7): 499-504, 2020 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-32610418

RESUMO

Liver metastases is the most common distant metastases of pancreatic neuroendocrine neoplasms, and it is also one of the main factors affecting the prognosis of patients. With the development of treatment technology and the rise of a multidisciplinary treatment model, the treatment plan for patients with liver metastases has gradually evolved into a comprehensive treatment plan including surgery, intervention, medicine, and radiation therapy. Radical surgery is still the only treatment currently available to cure patients with pancreatic neuroendocrine tumors and liver metastases. Very few selected patients can also benefit from liver transplantation. For most patients who are unable to undergo surgery can choose intervention, medicine and radiation therapy which can improve the patient's prognosis to a certain extent. Targeted therapy and immunotherapy have good development prospects, and further research is still needed. With multidisciplinary treatment, individualized treatment can help patients obtain the best treatment results.


Assuntos
Neoplasias Hepáticas/terapia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/terapia , Hepatectomia , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Tumores Neuroendócrinos/secundário , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Equipe de Assistência ao Paciente , Prognóstico
19.
Zhonghua Wai Ke Za Zhi ; 58(7): 555-557, 2020 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-32610427

RESUMO

An estimate of about 50% of new liver cancer cases worldwide occur in China every year.Surgical resection is still the major treatment choice for longer survival of patients with hepatocellular carcinoma. Blocking hepatic blood flow and reducing intraoperative bleeding ensure the success of the operation. Anatomic separation of hepatic hilar region is the precondition of hepatic inflow occlusion. The hepatic hilar plate system involves a thick layer of connective tissue covering the hepatic inflow ducts of hepatic hilar region. The descending part of hilar plate assists in reducing the anatomical difficulty of the hepatic hilar region. The "forth porta hepatis" that is hidden in the hepatic hilar plate system involves the accumulation area of "short hepatic portal veins" .The communicating branch vessels between the hepatic inflow vessels form the anatomical basis in reducing the indocyanine green fluorescence stain effect.The relatively fixed position of the hepatic portal plate is considered as a positioning marker for accurate liver resection. The intrahepatic Glisson sheath is connected with thick connective tissue of the hepatic portal panel system, and is regarded as the physical barrier in limiting the proliferation and hypertrophy of hepatocytes and continuation of hepatic portal panel system in the liver.This paper summarizes the anatomy and application of hepatic hilar plate system during hepatobiliary surgery.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Fígado/anatomia & histologia , Fígado/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , China , Tecido Conjuntivo/anatomia & histologia , Tecido Conjuntivo/cirurgia , Hepatectomia/efeitos adversos , Humanos , Fígado/irrigação sanguínea , Veia Porta/anatomia & histologia , Veia Porta/cirurgia
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