Alpha fetoprotein changes predict hepatocellular carcinoma survival beyond the Milan criteria after hepatectomy.

BACKGROUND: Assessing the outcomes of surgeries for hepatocellular carcinoma (HCC) patients who exceed the Milan criteria is necessary. Some studies have demonstrated that preoperative or postoperative alpha fetoprotein (AFP) can predict HCC patients' prognoses. METHODS: A total of 280 HCC patients who were positive for AFP and received curative resection were retrospectively analyzed. The patients were classified into three groups according to their preoperative and postoperative AFP levels (group A: normalized AFP; group B: AFP decreases >50%, but continued abnormality; and group C: AFP decreases <50%). Disease-free survival and overall survival rates were analyzed using the Kaplan-Meier method. The factors associated with AFP changes were evaluated by logistic regression. RESULTS: AFP dynamic changes were independently associated with disease-free survival and overall survival rates. Group A had better 3- and 5-y survivals than groups B or C (58.7% and 39.5% versus 31.3% and 14.9% versus 17.1% and 8.8%, P < 0.001). Preoperative AFP, tumor differentiation, tumor diameter, microvascular invasion, and satellite nodules remained significant risk factors that were associated with AFP changes. Furthermore, in group A, the disappearances of AFP within and beyond 8 wk resulted in similar overall survival rates (P > 0.05). Among those with HCC recurrence, the patients treated with resurgery or radiofrequency ablation achieved the best recurrence to death survivals. Those treated with transcatheter arterial chemoembolization achieved the next best survivals. CONCLUSIONS: AFP changes predicted the prognoses of patients with HCC beyond the predictions of the Milan criteria. Preoperative AFP (>400 ng/mL), tumor differentiation, tumor diameter, and satellite nodules were the risk factors related to AFP normalization. The regular follow-up and early detection of recurrent HCCs that are suitable for curative therapies, such as resurgery and radiofrequency ablation, might improve the prognoses. Other therapies, such as transcatheter arterial chemoembolization, might also be effective.

Liver resection versus liver resection plus TACE for patients with hepatocellular carcinoma beyond Milan criteria.

BACKGROUND: The recurrence of patients with hepatocellular carcinoma (HCC) beyond the Milan criteria after liver resection (LR) is common. This study aimed to clarify whether LR plus postoperative adjuvant transcatheter arterial chemoembolization (TACE) could improve the outcomes of patients with HCC beyond the Milan criteria after LR. METHODS: A total of 754 consecutive patients with HCC beyond the Milan criteria who received LR alone (n = 459) or LR + TACE (n = 295) were included. A propensity scoring matched model (PSM) was used to adjust for the baseline differences between the groups. RESULTS: The 1, 3, and 5-y recurrence-free survival (76.7%, 40.4%, and 30.8%, respectively, for the LR-alone group versus 78.3%, 50.5%, and 46.2%, respectively, for the LR + TACE group; P = 0.004) and overall survival (94.1%, 58.3%, and 36.3%, respectively, for the LR-alone group versus 95.3%, 71.3%, and 54.9%, respectively, for the LR + TACE group; P < 0.001) rates of patients who underwent LR alone were much lower than in the LR + TACE group. Multivariate Cox proportional hazards regression analysis showed that LR alone was an independent risk factor for postoperative recurrence and poor long-term survival. After one-to-one PSM, 284 patients who underwent LR alone and 284 patients who underwent LR + TACE were selected for further analyses. Similar results were observed in the PSM model. CONCLUSIONS: This study showed that LR + TACE may be beneficial for patients with HCC beyond the Milan criteria. Postoperative adjuvant TACE should be considered to patients with HCC beyond the Milan criteria.

Microvascular invasion patterns affect survival in hepatocellular carcinoma patients after second hepatectomy.

BACKGROUND: Microvascular invasion (MVI) is an important risk factor for survival of patients with hepatocellular carcinoma (HCC) after hepatectomy. However, its impact on patients with recurrent HCC who receive a second hepatectomy is unknown. METHODS: We enrolled 167 patients with HCC who underwent a second hepatectomy because of intrahepatic recurrences. We compared the patients' demographic, tumor, and pathologic characteristics with 766 cases of original hepatectomy. We analyzed the possible risk factors for survival after the first and second hepatectomies and the influence of different MVI patterns on patients' survival after the second hepatectomy. RESULTS: The median overall survival was comparable between the first and second hepatectomy groups, 34 (3-84) mo versus 27 (3-57) mo, P = 0.09. For patients who underwent a first hepatectomy, the presence of macro-VI or MVI, an early recurrence pattern, and a total tumor diameter >5 cm were independent risk factors. For survival after the second hepatectomy, MVI patterns that were positive-positive or negative-positive and a total recurrent tumor diameter >5 cm were significant risk factors for survival. CONCLUSIONS: A second hepatectomy provides satisfying survival for patients with intrahepatic recurrence of HCC after the initial operation. Different MVI patterns affect survival after the second hepatectomy. Because MVI represents the biological behavior of HCC, we place a high premium on the clinical value of MVI after each hepatectomy.

Liver transplantation for hepatolithiasis: Is terminal hepatolithiasis suitable for liver transplantation?

Hepatolithiasis, originally as oriental cholangiohepatitis, especially prevails in Asia, but globalization and intercontinental migration have also converted the endemic disease dynamics around the world. Characterized by its high incidence of ineffective treatment and recurrence, hepatolithiasis, always, poses a therapeutic challenge to global doctors. Although the improved surgical and non-surgical techniques have evolved over the past decade, incomplete clearance and recurrence of calculi are always so common and disease-related mortality from liver failure and concurrent cholangiocarcinoma still exists in the treatment of hepatolithiasis. In the late stage of hepatolithiasis, is it suitable for liver transplantation (LT)? Herein, we propose a comprehensive review and analysis of the LTx currently in potential use to treat hepatolithiasis. In our subjective opinion, and as is objective from the literatures so far, also given the strict indications, LT remains one of the definitive treatments for terminal hepatolithiasis.

Prognostic value of the platelet to lymphocyte ratio change in liver cancer.

BACKGROUND: There is limited evidence concerning the postoperative platelet to lymphocyte ratio change (ΔPLR) in relation to the prognosis of hepatocellular carcinoma (HCC). This study was designed to evaluate the prognostic value of ΔPLR in patients with hepatitis B virus (HBV)-related small HCC who underwent liver resection. MATERIALS AND METHODS: We retrospectively reviewed 219 patients with HBV-related small HCC who underwent liver resection between February 2007 and April 2013. The patients were divided into two groups as follows: group A (ΔPLR ≥2.875, n = 94) and group B (ΔPLR <2.875, n = 125), according to receiver operating characteristic analysis. Demographic, clinical, and follow-up data were analyzed, and multivariate analysis was used to identify prognostic factors. RESULTS: The 1-, 3-, and 5-y overall survival (OS) rates were 90.5%, 72.3%, and 42.1%, respectively, in group A and 98.1%, 89.5%, and 86.4%, respectively, in group B (P < 0.001). Correspondingly, the 1-, 3-, and 5-y recurrence-free survival (RFS) rates were 57.5%, 36.1%, and 22.8%, respectively, in group A and 84.3%, 62.4%, and 55.4%, respectively, in group B (P < 0.001). Multivariate analysis showed that ΔPLR was an independent prognostic factor for both OS (P < 0.001, hazard ratio = 5.452, 95% confidence interval 2.592-11.467) and RFS (P < 0.001, hazard ratio = 2.191, 95% confidence interval 1.4611-3.288). CONCLUSIONS: ΔPLR was an independent prognostic factor for OS and RFS in patients with HBV-related small HCC who underwent liver resection.

Upper abdominal shape as a risk factor of extended operation time and severe postoperative complications in HCC hepatectomy through subcostal incision.

BACKGROUND: Subcostal incision is the most widely used approach in open surgery for patients with hepatocellular carcinoma (HCC). Body shape is recognised to be a factor influencing the difficulty of surgery; however, the exact impact of the increased difficulty on the patients' operation as well as the outcome has not been analysed. In this study, we retrospectively studied the possible influence of patients' body shape, tumour burden and varied surgical methods on the operation procedure and postoperative complications. METHODS: From January 2009 to December 2013, 651 patients with HCC were included in the study. We studied the patients' sex, age, body mass index, upper abdominal body shape described by the depth-to-width ratio for the trunk at the celiac axis on CT/MRI, Child-Pugh classification, tumour burden and a different liver dissection method before the surgery and used a regression model for analysis. RESULTS: Prolonged operation time is associated with advanced tumour stage, large CA ratio, previous abdominal surgery, selective hepatic vascular occlusion and dissecting with Cavitron ultrasonic surgical aspirator rather than clamp crushing. Surgical blood loss is associated with operation time, liver function and a different liver dissection method. The incidence of severe postoperative complication was 17.5% (114/651) and was associated with larger CA ratio, Child-Pugh stage B liver function and greater blood loss. CONCLUSIONS: Large upper abdominal shape is a risk factor of both prolonged operation time and severe postoperative complication. CA ratio combined with liver function and surgical blood loss has an acceptable power to predict severe postoperative complications.

Neutrophil to lymphocyte ratio changes predict small hepatocellular carcinoma survival.

BACKGROUND: There is limited information available concerning the delta neutrophil to lymphocyte ratio (ΔNLR) in hepatocellular carcinoma (HCC). The present study was designed to evaluate the predictive value of dynamic change of NLR in patients who undergo curative resection for small HCC. METHODS: A retrospective cohort study was performed to analyze 189 patients with small HCC who underwent curative resection between February 2007 and March 2012. Patient data were retrieved from our prospectively maintained database. Patients were divided into two groups: group A (NLR increased, n = 80) and group B (NLR decreased, n = 109). Demographic and clinical data, overall survival (OS), and recurrence-free survival (RFS) were statistically compared and a multivariate analysis was used to identify prognostic factors. RESULTS: The 1, 3, and 5-y OS in group A was 92.7, 70.0, and 53.0%, respectively, and 96.2, 87.5, and 75.9%, respectively, for group B (P = 0.003); The corresponding 1, 3, and 5-y RFS was 58.7, 37.9, 21.8, and 81.2%, 58.5% and 53.8% for groups A and B, respectively (P <0.001). Multivariate analysis suggested that ΔNLR was an independent prognostic factor for both OS (P = 0.004, Hazard Ratio (HR) = 2.637, 95% confidence interval (CI) 1.356-5.128) and RFS (P <0.001, HR = 2.372, 95% CI 1.563-3.601). CONCLUSIONS: Increased NLR, but not high preoperative NLR or postoperative NLR, helps to predict worse OS and RFS in patients with small HCC who underwent curative resection.

Thirty-five consecutive pediatric living donor liver transplantation: experiences and lessons learned from a single center.

BACKGROUND/AIMS: In the last 10 years, the early patient outcome of liver transplantation in children have significantly improved. Now the overall outcomes of pediatric LT are promising. METHODOLOGY: In this study, we review the outcome of all pediatric liver transplants performed at our center and analyze our experiences with pediatric liver transplant. Of the 34 liver transplant recipients, 26 were highly urgent (19.7%). RESULTS: Actuarial patient survival rates at 6, 12, and 36 months was 82.9%, 79.8% and 72.2%, respectively. Indications for liver transplant were biliary atresia (n = 22), Wilson's disease (n = 4), glycogen storage disease (n = 3), portal vein cavernous transformation (PVCT) (n = 3), fulminant liver failure (n = 1), and cryptogenic cirrhosis (n = 1). The main complications were surgical complications (including biliary complications, portal vein or arterial complications, intestinal perforation, postoperative bleeding, of which 20% required reoperation) and infections. Cyclosporine was the primary immunosuppressive agent used in 70.6% of patients, with a 26.5% incidence of acute allograft rejection within the first six months. One children underwent re-transplant as a result of hepatic artery thrombosis. Nine children died during followup. They were related to portal vein thrombosis (one), chronic rejection (one), sepsis (one), post-transplant lymphoproliferative disease (one) and so on. CONCLUSIONS: The overall outcomes of pediatric liver transplantation at our center are promising. Advances in post-transplant care and monitoring of the recipients, technical refinements enable these results.

Short-term and long-term outcomes of surgical treatment for HCC within Milan criteria with cirrhotic portal hypertension.

BACKGROUND/AIMS: To compare and assess the outcomes of liver resection, radiofrequency ablation and liver transplantation for patients with hepatocellular carcinoma (HCC) within Milan criteria and cirrhotic portal hypertension. METHODOLOGY: 248 patients with HCC within Milan criteria and cirrhotic portal hypertension who underwent surgical treatments (liver resection, radiofrequency ablation and liver transplantation were reviewed in this study. Patients were divided into three groups according to different surgical strategies: RST Group, RFA Group and LT Group. Pre- and intra-operative parameters were statistically analyzed. Postoperative outcomes including Hematological data and tumor data, complications, long-term survival rates and recurrence-free survival rates were compared. RESULTS: The incidence of postoperative complications that were classified according to Clavien-Dido Classification were 16.22% for RST Group, 9.09% for RFA Group and 53.85% for LT Group. The 1-, 2- and 3-year recurrence-free survival rate of three groups were 88%, 74%, 68% for RST Group, 60%, 39%, 35% for RFA Group and 97%, 89%, 87% for LT Group, respectively. CONCLUSION: Although the postoperative recurrence rate following RFA was higher than that of RST and LT, the long-term survival rates of three managements for patients with HCC within Milan criteria and portal hypertension were similar.

Genetic variants of p21 and p27 and hepatocellular cancer risk in a Chinese Han population: a case-control study.

The p21 (Cip1/CDKN1A) and p27 (Kip1/CDKN1B) are members of the Cip/Kip family of cyclin-dependent kinase inhibitors, which can arrest cell proliferation and serve as tumour suppressors. We hypothesized that genetic variants in p21 and p27 may modify individual susceptibility to hepatocellular carcinoma (HCC). To test this hypothesis, we evaluated the associations of the polymorphisms of Ser31Arg and C+20T in p21 and C-79T and Gly109Val in p27, as well as their combinations, with HCC risk in a case-control study of 476 HCC cases and 526 cancer-free controls in a Chinese population. The matrix-assisted laser desorption ionisation time-of-flight (MALDI-TOF) mass spectrometry method was performed to detect these polymorphisms. We found that the variant genotypes of p21 Ser31Arg and p27 C-79T were individually associated with a significantly increased risk of HCC, but no associations were observed for other variant genotypes. Moreover, the combined variant genotypes of the four loci were associated with a significantly increased HCC risk (adjusted OR = 2.24, 95% CI = 1.72, 2.91 among subjects carrying 3 or more variant alleles), especially among HbsAg-positive individuals (adjusted OR = 3.09, 95% CI = 1.86, 5.14). Furthermore, the combined variant genotypes of the four loci (carrying three or more variant alleles) increased a 1.93-fold (95% CI = 1.20, 3.09) and 1.76-fold (95% CI = 1.17, 2.64) risk of HCC among smokers and nonsmokers. The variant genotypes of the two genes in this study have negative correlation with the clinicopathologicals observed. These results suggest that p21 polymorphisms individually or in combination with p27 polymorphisms increases risk of HCC, particularly among HbsAg-positive individuals.

A novel remnant liver-first strategy for liver autotransplantation in patients with end-stage hepatic alveolar echinococcosis: a retrospective case series.

BACKGROUND: Ex vivo liver resection combined with autotransplantation is an effective therapeutic strategy for unresectable end-stage hepatic alveolar echinococcosis (HAE). However, ex vivo liver resection combined with autotransplantation is a technically demanding and time-consuming procedure associated with significant morbidity and mortality. The authors aimed to present our novel remnant liver-first strategy of in vivo liver resection combined with autotransplantation (IRAT) technique for treating patients with end-stage HAE. METHODS: This retrospective study included patients who underwent IRAT between January 2014 and December 2020 at two institutions. Patients with end-stage HAE were carefully assessed for IRAT by a multidisciplinary team. The safety, feasibility, and outcomes of this novel technique were analyzed. RESULTS: IRAT was successfully performed in six patients, with no perioperative deaths. The median operative time was 537.5 min (range, 501.3-580.0), the median anhepatic time was 59.0 min (range, 54.0-65.5), and the median cold ischemia time was 165.0 min (range, 153.8-201.5). The median intraoperative blood loss was 700.0 ml (range, 475.0-950.0). In-hospital complications occurred in two patients. No Clavien-Dindo grade III or higher complications were observed. At a median follow-up of 18.6 months (range, 15.4-76.0) , all patients were alive. No recurrence of HAE was observed. CONCLUSION: The remnant liver-first strategy of IRAT is feasible and safe for selected patients with end-stage HAE. The widespread adoption of this novel technique requires further studies to standardize the operative procedure and identify patients who are most likely to benefit from it.

Higher tacrolimus blood concentration is related to hyperlipidemia in living donor liver transplantation recipients.

BACKGROUND: The arrival of tacrolimus has drastically improved AALDLT recipients' survival. However, little data of tacrolimus have been reported concerning its effects on lipid metabolism for AALDLT recipients. AIM: Out aim was to investigate the relationship between tacrolimus blood concentration and lipid metabolism in AALDLT recipients. METHODS: The pre and postoperative data of 77 adult patients receiving AALDLT between 2002 and December 2007 were retrospectively reviewed. The postoperative immune suppressive regimen was prednisone with tacrolimus ± mycophenolate mofetil. Prednisone was withdrawn within the first postoperative month. Blood lipids and tacrolimus concentration were detected at the first, third, and sixth month during follow-up. Episodes of acute rejection were diagnosed based on biopsy. RESULTS: Overall prevalence of post-transplantation hyperlipidemia was 29.9% (23/77) at the sixth postoperative month. The patients were divided into two groups, the hyperlipidemia group and the ortholipidemia group. In the 23 patients with hyperlipidemia, 15 (65%) were hypercholesterolemia, five (22%) were hypertriglyceridemia, and three (13%) patients had both hypercholesterolemia and hypertriglyceridemia. In univariate analysis, only tacrolimus blood concentration at the third and sixth post-transplantation months showed significant difference (8.7 ± 2.1 vs. 6.9 ± 3.2, p = 0.013; 9.2 ± 2.7 vs. 7.3 ± 3.8, p = 0.038, respectively). In multivariate logistic analysis, only two factors appear to be risk factors, namely, tacrolimus blood concentration at the third and sixth post-transplantation months (8.7 ± 2.1 vs. 6.9 ± 3.2, p = 0.043; 9.2 ± 2.7 vs. 7.3 ± 3.8 p = 0.035, respectively). CONCLUSIONS: Higher tacrolimus blood concentration was related to hyperlipidemia at an early postoperative period. This indicates that tacrolimus blood concentration should be controlled as low as possible in the premise that there is no risk of rejection to minimize post-transplant hyperlipidemia after AALDLT.

Safety of synchronous hepatectomy and splenectomy for patients with hepatocellular carcinoma and hypersplenism.

BACKGROUND/AIMS: To assess the surgical safety of synchronous hepatic resection and splenectomy for patients with hepatocellular carcinoma (HCC) and hypersplenism. METHODOLOGY: Patients with HCC and hypersplenism who underwent surgical treatment were included in this study. According to the difference of operations, patients were divided into two groups (group A, patients who underwent hepatic resection; group B, patients who underwent synchronous hepatic resection and hypersplenism). Pre- and intra-operative parameters were statistically analyzed. Postoperative outcomes including white blood cell and platelet count changes, surgical complications and long-term survival rates were compared. RESULTS: The pre- and intra-operative parameters of two groups were comparable except for preoperative white blood cell and platelet counts. The incidences of postoperative surgical complication were 53.33% for group A and 35.48% for group B (p=0.161). The 1- and 3-year survival rates of the two groups were 83%, 42% and 82%, 54%, respectively (p=0.313). CONCLUSIONS: Synchronous hepatic resection and splenectomy could increase the postoperative WBC and platelet level for patients with hepatocellular carcinoma and hypersplenism without increasing surgical risks.

Using a small-for-size graft might attribute to the future use of left-lobe living graft in adult to adult living donor liver transplantation.

BACKGROUND/AIMS: Adult to adult living donor liver transplantation (AALDLT) is performed worldwide. The aim of this study was to evaluate using a graft with graft to body weight ratio (GBWR) less than 0.8 in right-lobe AALDLT recipients. METHODOLOGY: Clinical data of 127 patients who had right-lobe AALDLT from January 2002 to November 2009 were retrospectively analyzed. Patients were divided into two groups according to GBWR (group A: 0.6 ≤ GBWR < 0.8, group B: GBWR ≥ 0.8). Preoperative characteristics, postoperative complications graded by the Clavien score and patient survival time were recorded and analyzed. RESULTS: GBWR between the two groups were significantly different (0.67 ± 0.05 vs. 0.97 ± 0.17, p = 0.000). There was no significant difference in preoperative demographic data as well as postoperative liver function data. Complication rate, median ICU stay and small-for-size syndrome incidence were similar in both groups. In univariate analysis, only MELD emerged as independent risk factor for small-for-size syndrome (p = 0.045). Patient survival was similar in both groups at 1, 3 and 5 years as well. CONCLUSIONS: Using a GBWR of less than 0.8 is safe in selected recipients. To some extent, this result may attribute to the wide use of left-lobe living graft in AALDLT in future.

Impact of graft steatosis on the post-transplantation biliary complications for living donor liver transplant recipients in China.

BACKGROUND/AIMS: After living donor liver transplantation (LDLT), the prevalence of complications related to the biliary system is 6-35%. In spite of great improvements in both surgical techniques and postoperative and long-term medical treatment, the biliary complications are still considered a relatively high risk for LDLT. The aim of this retrospective study was to analyze the incidence of biliary complications and identify predisposing risk factors. METHODOLOGY: The clinical and follow-up data of 175 adult patients receiving LDLT (right lobe or left lobe) between 2002 and December 2008 were collected and retrospectively analyzed. Patients were divided into 2 groups: with biliary complications (n=30) and without biliary complications (n=145). RESULTS: Thirty patients (17.1%) had post-transplantation biliary complications. Eight patients (4.6%) were diagnosed with bile leakage, while 24 patients (13.7%) developed biliary stricture. Percentage of steatosis of the graft and hepatic artery thrombosis after LDLT were two factors upon univariate analysis (p=0.034, p=0.01, respectively). In multivariate logistic analysis, 20-50% macrovesicular steatosis emerged as a new defined risk factor by us (p=0.001). There was no difference in patient survival rate in different groups and sorts of graft steatosis (p>0.05). CONCLUSIONS: We consider that using a graft with macro-vesicular steatosis in 20-50% should be put on the table carefully, balancing both sides of positive and negative.

IFN-γ+874 A/T polymorphism and cancer risk: an updated analysis based on 32 case-control studies.

IFN-γ is a T-helper 1 cytokine and plays important roles in modulating almost all the immune responses, such as hematopoiesis, T-cell differentiation, antiproliferative, antiviral, and antitumor activities. A single nucleotide polymorphism (+874A/T) which is located in the first intron of the human IFN-γ gene can putatively influence the secretion of IFN-γ. Results from previous studies on the association of +874A/T polymorphism with different cancer types remained contradictory. In order to derive a more precise estimation of the relationship, a meta-analysis was performed by searching PubMed, Embase, CNKI, and Chinese Biomedicine Database. Thirty two studies including 4524 cases and 5684 controls were collected for IFN-γ+874 A/T polymorphism. Summary odds ratios (OR) and corresponding 95% confidence intervals (CIs) for IFN-γ polymorphism and cancer were estimated using fixed- and random-effects models when appropriate. Overall, no evidence indicated that individuals carrying TT or AT genotypes had significantly increased cancer risk when compared with AA genotype carriers. However, stratified analysis by cancer types indicated a significantly increased risk of breast cancer (TT vs AA: OR=1.58, 95% CI=1.10-2.27, Pheterogeneity=0.26; TT vs AT/AA: OR=1.53, 95%CI=1.14-2.06, Pheterogeneity=0.19). Moreover, significantly elevated risks were observed in African and European populations when population is concerned. Interestingly, when stratified separately by population-based studies and hospital-based studies, significantly elevated risk was found among population-based studies. This meta-analysis suggests that the IFN-γ+874 T allele is a low-penetrant risk factor for cancer development.

p73 G4C14-A4T14 polymorphism and cancer risk: a meta-analysis based on 27 case-control studies.

p73 G4C14-A4T14 polymorphism has been hypothesised to be associated with the risk of cancer development by many epidemiological studies, however, the available results were conflicting. To derive a more precise estimation of association between the p73 G4C14-A4T14 polymorphism and risk of cancer, we performed a meta-analysis based on 8017 cancer cases and 11610 controls from 25 publications with 27 individual case-control studies. The odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the strength of the association. Overall, We found that the variant AT/AT homozygote was associated with a significantly increased risk of all types of cancer (homozygote comparison: OR = 1.35, 95% CI = 1.11-1.65; recessive model comparison: OR = 1.32, 95% CI = 1.11-1.58). In the subgroup analyses by ethnicity/country, the results suggested that AT/AT genotype was significantly associated with risk of cancer development among Caucasians and Asians, especially for the Americans and Japanese. Moreover, when stratifying by types of cancer, significantly increased cancer risks were observed for colorectal cancer, 'head and neck cancers' and 'other cancers'. Interestingly, when stratifying by source of controls, a significantly elevated risk was found among hospital-based studies but not among population-based studies. Limiting the analysis to the studies within Hardy-Weinberg equilibrium, the results were persistent and robust. No publication bias was found in the present study. This meta-analysis suggests that the p73 -AT allele may be a low-penetrant risk factor for cancer development.

Recurrence of hepatocellular carcinoma after liver transplantation: recurrence characteristics and risk factors.

BACKGROUND/AIMS: The aim of this study was to investigate tumor recurrence characteristics of hepatocellular carcinoma (HCC) after liver transplantation (LT), including recurrence sites, time and risk factors, and to provide a basis for predicting and preventing tumor recurrence. METHODOLOGY: Data from 224 consecutive patients with HCC who underwent LT between Feb 1999 and December 2008 at our center had been retrospectively analyzed. Tumor-unrelated, perioperative and in hospital deaths were excluded (n = 39). All the cases were followed-up regularly. According to recurrence or not, the cases were divided into recurrence group (n = 103) and non-recurrence group (n = 99). The data were analyzed statistically. RESULTS: Extrahepatic and single site recurrences were more common in early postoperative days, especially in the lung. No significant relation was observed between recurrence sites and time. Exceeding Milan criteria (MC), macrovascular invasion, liver capsule invasion, satellite lesions and Tumor-Node-Metastasis (TNM) classification of UICC were observed significant different in univariate analysis. TNM classification and macrovascular invasion were considered 2 independent risk factors in multivariate analysis. Macrovascular invasion was a independent risk factor for very early recurrences (6 months). CONCLUSIONS: Recurrence of HCC after LT was not frequent at intrahepatic but extrahepatic sites. The recurrence time was mainly in early operative days. TNM classification and macrovascular invasion are risk factors. Macrovascular invasion is associated with early recurrence.

[Comparison of the metastatic characteristics of HCCLM3 cells and SMCC-7721 cells in nude mice model].

OBJECTIVE: To compare the metastatic characteristics of HCCLM3 cells and SMCC-7721 cells in nude mice model. METHODS: Nude mice were divided into two groups (n = 8, each), mice were transplanted with HCCLM3 cells (group A) and SMMC-7721 cells (group B). Tumor size, metastasis rate and other clinical parameters were compared between the two groups. Statistical analysis was performed with the help of SPSS 16.0 for Windows computer software (SPSS, Inc., Chicago, IL). P values of less than 0.05 were considered statistically significant. RESULTS: Intrahepatic metastases rate was 100% (8 / 8), mean intrahepatic primary tumor volume was (6954+/-1945) mm(3) in group A, Intrahepatic metastases rate was 62.5% (5/8), and mean intrahepatic primary tumor volume was (6034+/-2035) mm(3) in the group B. There was no statistical difference in the primary liver tumor size and intrahepatic metastases rate (P = 0.20; t = 6.38, P = 0.37, respectively). The numbers of intrahepatic metastases and the involved lobes, and the volume of tumor were 4.5 (median), 3, and 975 mm(3) (median) respectively, in group A, and these were 1 (median), 1 and 274 mm(3) (median) respectively in group B. The difference between two groups was statistically significant (Z values, -2.818, -2.289, and -1.975, respectively).The rate of lung metastasis and other organ metastasis in the A group was significantly higher than that in group B (P less than 0.001, P less than 0.041, respectively). CONCLUSION: HCCLM3 cells have higher metastatic potential than SMMC-7721 cells in nude mice.

Quantitative estimation of the degree of hepatic macrovesicular steatosis in a disease-free population: a single-center experience in mainland China.

The aim of this study was to derive a simple equation to enable the extent of hepatic macrovesicular steatosis (HMS) to be predicted quantitatively from data obtained noninvasively and hence avoid unnecessary liver biopsies. One hundred sixty-seven potential living liver donors and 45 subjects suspected of having nonalcoholic fatty liver disease (NAFLD) underwent percutaneous liver biopsy to evaluate HMS quantitatively. Their hepatic unenhanced computed tomography (CT) attenuation, body mass index (BMI), and indices of serum lipids were reviewed. Logistic regression analysis was undertaken to screen for independent predictors of HMS. Linear regression analysis was then used to plot the relationship between the severity of histologically confirmed HMS and identified independent predictors of HMS. For potential donors with HMS of severity > or = 5% by histological assessment, the following equation was derived: HMS = 47.7 + 1.48BMI - 1.14CT (R2 = 0.74)The calculated HMS for potential donors with histologically confirmed HMS of severity < 5% seemed to be unreliable (R(2) = = 0.230, P < 0.3). In addition, in subjects suspected of having NAFLD, there was a close agreement between values for histologically confirmed HMS and calculated values for HMS derived from the equation (intraclass correlation coefficient = 0.88). Hepatic CT imaging in conjunction with other noninvasive clinical data may enable the extent of HMS to be accurately predicted with the equation derived from potential donors with appreciable degrees of histologically confirmed HMS.