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Wang G, Wei Z, Wang F, Han X, Jia H, Zhao D, Li C, Liu L, Yang X, Ye X. Clinical outcomes of percutaneous microwave ablation for pulmonary oligometastases from hepatocellular carcinoma: a retrospective, multicenter study. Cancer Imaging 2024; 24:34. [PMID: 38438879 PMCID: PMC10913397 DOI: 10.1186/s40644-024-00679-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Pulmonary oligometastases are common in hepatocellular carcinoma (HCC), however, the existing therapeutic options have several limitations. This study aimed to assess the safety and efficacy of microwave ablation (MWA) in the treatment of HCC-originating pulmonary oligometastases. METHODS A total of 83 patients, comprising 73 males and 10 females with a median age of 57 years, who had pulmonary oligometastases from HCC, underwent MWA treatment at four different medical institutions. Inclusion criteria for patients involved having primary HCC under control and having less than three oligometastases with a maximum diameter of ≤ 5 cm in the unilateral lung or less than five oligometastases with a maximum diameter of ≤ 3 cm in the bilateral lung. A total of 147 tumors were treated with MWA over 116 sessions. The primary endpoints assessed included technical success, treatment efficacy, and local progression rate, while secondary endpoints encompassed complications, clinical outcomes, overall survival (OS), local progression-free survival (LPFS), and prognostic factors. RESULTS The technical success rate for MWA was 100% (116/116 sessions), and the treatment efficacy rate was 82.3% (121/147 tumors). Six months after MWA, the local progression rate was 23.1% (18/147 tumors). Complications were observed in 10.3% (major) and 47.4% (minor) of the 116 sessions, with no cases of ablation-related deaths. The median follow-up period was 21.6 months (range: 5.7-87.8 months). Median OS was 22.0 months, and the 1-, 2-, and 3-year OS rates were 82.6%, 44.5%, and 25.2%, respectively. Median LPFS was 8.5 months. Multivariate Cox regression analysis identified α-fetoprotein (AFP) levels during initial diagnosis and the number of oligometastases as potential independent prognostic factors for OS (p = 0.017 and 0.045, respectively). CONCLUSION Percutaneous MWA is a safe and effective treatment modality for pulmonary oligometastases originating from HCC.
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Affiliation(s)
- Gang Wang
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, 16766 Jingshi Road, 250021, Jinan, Shandong, China
| | - Zhigang Wei
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, 16766 Jingshi Road, 250021, Jinan, Shandong, China
| | - Feihang Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Xiaoying Han
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250014, Jinan, Shandong, China
| | - Haipeng Jia
- Department of Radiology, Qilu Hospital of Shandong University, 250012, Jinan, China
| | - Danyang Zhao
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Chunhai Li
- Department of Radiology, Qilu Hospital of Shandong University, 250012, Jinan, China.
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250014, Jinan, Shandong, China.
| | - Xin Ye
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, 16766 Jingshi Road, 250021, Jinan, Shandong, China.
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Osuga T, Tanaka S, Kubo T, Hamaguchi K, Ito R, Sakurada A, Ishikawa K, Miyanishi K. Pulmonary Metastasectomy after Radiofrequency Ablation of Hepatocellular Carcinoma. Case Rep Oncol 2024; 17:407-416. [PMID: 38435446 PMCID: PMC10907002 DOI: 10.1159/000536498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/23/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Single distant metastases after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) are rare. There are no guidelines for treating patients without liver tumors after resecting lung metastases. Case Presentation Here, we report a patient with HCC recurring as a single lung metastasis 14 months after RFA. A 76-year-old woman with primary biliary cholangitis without hepatitis B virus or hepatitis C virus infection had been treated by RFA for a single 16-mm-sized HCC lesion in liver S8. Fourteen months thereafter, despite lack of intrahepatic recurrence, a single new 26-mm-sized mass was found in S10 of the right lung. The patient underwent right lower lobectomy. The histopathological diagnosis was HCC metastasis. Because no residual disease could be found, she was followed up without any additional treatment after surgery. She remains alive with no signs of recurrence 3 years later. Conclusion HCC patients who relapse with lung metastases but without intrahepatic recurrence after RFA are extremely rare, especially when RFA is used to treat HCC lesions <30 mm. However, it should be noted that, although rare, HCC may recur in the form of extrahepatic metastases after RFA. Furthermore, it is suggested that, as in the presently-described case, at least some patients without intrahepatic recurrence whose lung metastases are completely resected have a good prognosis even without additional treatment for HCC.
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Affiliation(s)
- Takahiro Osuga
- Department of Medical Oncology, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Shingo Tanaka
- Department of Medical Oncology, Sapporo Medical University School of Medicine, Hokkaido, Japan
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Tomohiro Kubo
- Department of Medical Oncology, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Kota Hamaguchi
- Department of Medical Oncology, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Ryo Ito
- Department of Medical Oncology, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Akira Sakurada
- Gastroenterology, Otaru Ekisaikai Hospital, Hokkaido, Japan
| | | | - Koji Miyanishi
- Department of Medical Oncology, Sapporo Medical University School of Medicine, Hokkaido, Japan
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Milana F, Polidoro MA, Famularo S, Lleo A, Boldorini R, Donadon M, Torzilli G. Surgical Strategies for Recurrent Hepatocellular Carcinoma after Resection: A Review of Current Evidence. Cancers (Basel) 2023; 15:cancers15020508. [PMID: 36672457 PMCID: PMC9856445 DOI: 10.3390/cancers15020508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/17/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, and both liver resection and liver transplantation are considered potentially curative options. However, high recurrence rates affect the prognosis depending both on the primary HCC pathology characteristics or on the type and time of the relapse. While great attention has been usually posted on treatment algorithms for the first HCC, treatment algorithms for recurrent HCC (rHCC) are lacking. In these cases, surgery still represents a curative option with both redo hepatectomy and/or salvage liver transplantation, which are considered valid treatments in selected patients. In the current era of personalised medicine with promises of new systemic-targeted immuno-chemotherapies, we wished to perform a narrative review of the literature on the role of surgical strategies for rHCC.
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Affiliation(s)
- Flavio Milana
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Michela Anna Polidoro
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Simone Famularo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Internal Medicine, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Renzo Boldorini
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, NO, Italy
- Department of Pathology, University Maggiore Hospital, 28100 Novara, NO, Italy
| | - Matteo Donadon
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, NO, Italy
- Department of General Surgery, University Maggiore Hospital, 28100 Novara, NO, Italy
- Correspondence:
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
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Long HY, Huang TY, Xie XY, Long JT, Liu BX. Treatment strategies for hepatocellular carcinoma with extrahepatic metastasis. World J Clin Cases 2021; 9:5754-5768. [PMID: 34368295 PMCID: PMC8316954 DOI: 10.12998/wjcc.v9.i21.5754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/20/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
Extrahepatic metastasis (EHM) of hepatocellular carcinoma (HCC) has increasingly been seen due to improved survival with effective management of intrahepatic lesions. The presence of EHM indicates an advanced stage of HCC, for which systemic therapy serves as the standard treatment modality. Since the approval of Sorafenib as the first systemic agent in 2007, it took almost a decade to show its efficacy in both first and further lines of setting until the landscape of systemic drugs was finally expanded. Moreover, with inspiring results from immunotherapy trials in HCC, it appears that the introduction of immunotherapy may lead to an evolution in the portfolio of HCC treatment. Although the locoregional approach in the management of EHM is not recommended for advanced-stage HCC, efforts have been made to demonstrate its efficacy in symptom relief and potential benefit for overall survival. This review provides a summary of recent updates of the systemic agents in the treatment of advanced HCC, with an emphasis on aggressive locoregional management of EHM by various treatment modalities.
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Affiliation(s)
- Hai-Yi Long
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Tong-Yi Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Jian-Ting Long
- Department of Medical Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Bao-Xian Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
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Yuan Z, Liu B, Hu C, Li Z, Zheng J, Li W. Clinical outcomes of percutaneous thermal ablation for pulmonary metastases from hepatocellular carcinoma: a retrospective study. Int J Hyperthermia 2021; 37:651-659. [PMID: 32546040 DOI: 10.1080/02656736.2020.1775899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: To determine the effectiveness of ablation for pulmonary metastases (PM) from hepatocellular carcinoma (HCC).Methods: Between 2010 and 2017, the study analyzed 39 patients who had a median age of 59 years. Primary HCC was under control and the number of PM was less than 5 (median: 2), with a maximum diameter of ≤60 mm (median: 15 mm). The primary endpoints were overall survival (OS) and local tumor progression-free survival (LTPFS). Secondary endpoints included technique success (TS), complication and tumor response. TS referred to PM treated using the treatment protocol. Multivariate analysis using the Cox proportional hazard model was conducted on the potential risk factors (univariate: p < 0.5) to determine the independent factors (multivariate: p < 0.05).Results: The TS rate was 100%. Major complications included pneumothorax (n = 3) requiring chest tube placement and pleural effusion requiring drainage (n = 2). Complete ablation was achieved in 32/38 patients (valid percent: 84.2%) at 1 month after ablation. The 1-, 3- and 5-year OS rates were 79.8, 58 and 30.9%, respectively. The 1-, 3- and 5-year LTPFS rates were 60.7, 34.2 and 22.8%, respectively. The extent (unilateral vs. bilateral) of PM (hazard ratio (HR): 0.197, 95% confidence interval (CI): 0.043-0.890, p = 0.035) and the number (≤2 vs. >2) of PM (HR: 0.555, 95% CI: 0.311-0.991, p = 0.047) were found to be the independent risk factors for predicting OS.Conclusion: Percutaneous thermal ablation is a safe and effective treatment for PM from HCC.
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Affiliation(s)
- Zhuhui Yuan
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Bozhi Liu
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Caixia Hu
- Center of Interventional Oncology and Liver Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Zhen Li
- Department of Critical Care Medicine of Liver Disease, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Jiasheng Zheng
- Center of Interventional Oncology and Liver Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Lee HP, Yun JK, Jung HS, Moon DH, Lee GD, Choi S, Kim YH, Kim DK, Park SI, Kim HR. Surgical outcomes of pulmonary metastasectomy in hepatocellular carcinoma patients according to approach method: thoracoscopic versus open approach. World J Surg Oncol 2021; 19:33. [PMID: 33516218 PMCID: PMC7847567 DOI: 10.1186/s12957-021-02138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/19/2021] [Indexed: 12/05/2022] Open
Abstract
Background The role of surgical intervention as a treatment for pulmonary metastasis (PM) from hepatocellular carcinoma (HCC) has not been established. In this study, we investigated the clinical outcomes of pulmonary metastasectomy. Using propensity score matching (PSM) analysis, we compared the results according to the surgical approach: video-assisted thoracic surgery (VATS) versus the open method. Methods A total of 134 patients (115 men) underwent pulmonary metastasectomy for isolated PM of HCC between January 1998 and December 2010 at Seoul Asan Medical Center. Of these, 84 underwent VATS (VATS group) and 50 underwent thoracotomy or sternotomy (open group). PSM analysis between the groups was used to match them based on the baseline characteristics of the patients. Results During the median follow-up period of 33.4 months (range, 1.8–112.0), 113 patients (84.3%) experienced recurrence, and 100 patients (74.6%) died of disease progression. There were no overall survival rate, disease-free survival rate, and pulmonary-specific disease-free survival rate differences between the VATS and the open groups (p = 0.521, 0.702, and 0.668, respectively). Multivariate analysis revealed local recurrence of HCC, history of liver cirrhosis, and preoperative alpha-fetoprotein level as independent prognostic factors for overall survival (hazard ratio, 1.729/2.495/2.632, 95% confidence interval 1.142–2.619/1.571–3.963/1.554–4.456; p = 0.010/< 0.001/< 0.001, respectively). Conclusions Metastasectomy can be considered a potential alternative for selected patients. VATS metastasectomy had outcomes comparable to those of open metastasectomy.
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Affiliation(s)
- Han Pil Lee
- Department of Thoracic & Cardiovascular Surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Jae Kwang Yun
- Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Suk Jung
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, Seoul, Republic of Korea
| | - Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Geun Dong Lee
- Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Il Park
- Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Three risk factors for pulmonary metastasectomy in patients with hepatocellular carcinoma. Gen Thorac Cardiovasc Surg 2019; 67:782-787. [PMID: 30820914 DOI: 10.1007/s11748-019-01082-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/03/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The outcomes of surgically treating pulmonary metastases from hepatocellular carcinoma remain unclear. Therefore, we aimed to evaluate patients with hepatocellular carcinoma who underwent pulmonary metastasectomy to assess their survival outcome and prognostic factors. METHODS This retrospective single-center study included 30 patients who underwent pulmonary metastasectomy for hepatocellular carcinoma between January 1980 and December 2016 at the National Cancer Center Hospital. RESULTS The 1-, 3-, and 5-year overall survival rates after pulmonary metastasectomy were 86.7%, 46.2%, and 33.6%, respectively (median survival time: 25.0 months). The univariate prognostic factors were viral hepatitis (P = 0.019), number of pulmonary metastases (P = 0.002), and other site recurrence before metastasectomy (P = 0.048). Multivariate analysis using a Cox proportional hazards model revealed viral hepatitis (hazard ratio: 3.611, 95% confidence interval: 1.226-10.64; P = 0.02) and ≥ 2 pulmonary metastases (hazard ratio: 4.031, 95% confidence interval: 1.594-10.19; P = 0.003) to be independent prognostic factors. Subgroup analyses of the three risk factors (viral hepatitis, number of pulmonary metastases, and other site recurrence before metastasectomy) revealed that the median survival times after pulmonary metastasectomy were 66.0 and 15.5 months for patients with 0-1 risk factors and those with 2-3 risk factors, respectively (P < 0.001). CONCLUSIONS For patients who underwent pulmonary metastasectomy for hepatocellular carcinoma, median survival time was 25.0 months and decreased with three risk factors which included viral hepatitis, multiple number of pulmonary metastases, and the presence of other site recurrence before metastasectomy.
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Long-Term Survival and Prognostic Factors of Pulmonary Metastasectomy in Liver Cancer: A Systematic Review and Meta-Analysis. World J Surg 2018; 42:2153-2163. [PMID: 29435629 DOI: 10.1007/s00268-017-4431-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lung is the most common extrahepatic metastatic organ of liver cancer. Surgical resection is a common local treatment for pulmonary metastasis. But the long-term prognosis of pulmonary metastasectomy varies greatly due to the small sample size and different results of previous studies. Therefore, we conducted this meta-analysis to evaluate the combined 5-year overall survival (OS) rate and prognostic factors after pulmonary metastasectomy in liver cancer. METHODS Key words such as liver cancer pulmonary metastasis and metastasectomy were retrieved firstly in PubMed, Cochrane Library, Embase and Chinese Wanfang databases. Eligible studies were identified by manual searches. Each included study should report 5-year OS rate and/or prognostic factors of pulmonary metastasectomy. Newcastle-Ottawa Scale was used for quality assessment, and heterogeneity was estimated by I2. We calculated the combined 5-year survival rates and determined the prognostic factors for OS by the hazard ratios (HR) and number of events. RESULTS Seventeen cohort studies with a total of 513 patients were included in this meta-analysis. The combined 5-year survival rates after pulmonary metastasectomy were 33% [95% confidence interval (95% CI) 29-37%]. The poor prognostic factors were disease-free interval (DFI) < 12 months (HR = 2.421 95% CI 1.384 4.236) and existence of cirrhosis (HR = 1.936 95% CI 1.031 3.636). CONCLUSION The 5-year OS rate of patients with pulmonary metastasectomy after resection of primary liver cancer is 33%. DFI < 12 months and existence of cirrhosis are probably poor prognostic factors.
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Yamada M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Mizuno T, Yamaguchi J, Nagino M. Pulmonary Metastasis After Resection of Cholangiocarcinoma: Incidence, Resectability, and Survival. World J Surg 2018; 41:1550-1557. [PMID: 28105527 DOI: 10.1007/s00268-017-3877-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are few reports on pulmonary metastasis from cholangiocarcinoma; therefore, its incidence, resectability, and survival are unclear. METHODS Patients who underwent surgical resection for cholangiocarcinoma, including intrahepatic, perihilar, and distal cholangiocarcinoma were retrospectively reviewed, and this study focused on patients with pulmonary metastasis. RESULTS Between January 2003 and December 2014, 681 patients underwent surgical resection for cholangiocarcinoma. Of these, 407 patients experienced disease recurrence, including 46 (11.3%) who developed pulmonary metastasis. Of these 46 patients, 9 underwent resection for pulmonary metastasis; no resection was performed in the remaining 37 patients. R0 resection was achieved in all patients, and no complications related to pulmonary metastasectomy were observed. The median time to recurrence was significantly longer in the 9 patients who underwent surgery than in the 37 patients without surgery (2.5 vs 1.0 years, p < 0.010). Survival after surgery for primary cancer and survival after recurrence were significantly better in the former group than in the latter group (after primary cancer: 66.7 vs 0% at 5 years, p < 0.001; after recurrence: 40.0 vs 8.7% at 3 years, p = 0.003). Multivariate analysis identified the time to recurrence and resection for pulmonary metastasis as independent prognostic factors for survival after recurrence. CONCLUSION Resection for pulmonary metastasis originating from cholangiocarcinoma can be safely performed and confers survival benefits for select patients, especially those with a longer time to recurrence after initial surgery.
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Affiliation(s)
- Mihoko Yamada
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sugawara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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10
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Therapeutic significance and indications of pulmonary metastasectomy for hepatocellular carcinoma following liver resection. Int J Surg 2017; 48:23-31. [DOI: 10.1016/j.ijsu.2017.09.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/26/2017] [Indexed: 12/12/2022]
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Kuo TM, Chang KM, Cheng TI, Kao KJ. Clinical Factors Predicting Better Survival Outcome for Pulmonary Metastasectomy of Hepatocellular Carcinoma. Liver Cancer 2017; 6:297-306. [PMID: 29234633 PMCID: PMC5704702 DOI: 10.1159/000477134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND In patients with lung metastasis of hepatocellular carcinoma (HCC), it remains uncertain how a better survival outcome can be predicted after metastasectomy. This study aims to identify clinical factors that may be used to guide patient selection for such a therapeutic modality. A total of 28 patients who received pulmonary metastasectomy for HCC between 1993 and 2012 were identified. All relevant clinical factors were extracted from medical records up to September 2015. Patients were classified into high- and low-risk groups according to survival outcome after metastasectomy. All pertinent clinical factors were analyzed for correlation with survival outcome. SUMMARY The overall survival of 28 patients after pulmonary metastasectomy was studied first. The survival curve was biphasic and reached a plateau at 40 months after metastasectomy. The results indicate the presence of 2 groups of patients with a different survival outcome. Among all clinical parameters, remission status in the liver before pulmonary metastasectomy and distant metastasis-free interval between the last treatment of HCC and the occurrence of lung metastasis were found to be significantly associated with excellent survival outcome after pulmonary metastasectomy (p = 0.019 and 0.007 by Fisher exact test, and p = 0.002 and 0.0002 by Cox regression analysis).
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Affiliation(s)
- Tse-Ming Kuo
- Division of Gastroenterology and Hepatobiliary Disease, Department of Medicine, Taipei, Taiwan, ROC,*Tse-Ming Kuo, MD, Koo Foundation Sun Yat-Sen Cancer Center, 125 Lih-Der Road, Peitou District, Taipei 11259, Taiwan (ROC), E-Mail
| | - Kai-Ming Chang
- Department of Research, Koo Foundation Sun-Yat Sen Cancer Center, Taipei, Taiwan, ROC
| | - Tsun-I Cheng
- Division of Gastroenterology and Hepatobiliary Disease, Department of Medicine, Taipei, Taiwan, ROC
| | - Kuo-Jang Kao
- Department of Research, Koo Foundation Sun-Yat Sen Cancer Center, Taipei, Taiwan, ROC
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Chelimeda S, Bejarano T, Lowe R, Soliman M, Zhao Q, Hartshorn KL. Long-Term Survival after Resection of Lung Metastases from Hepatocellular Cancer: Report of a Case and Review of the Literature. Case Rep Oncol 2016; 9:559-564. [PMID: 27790121 PMCID: PMC5075740 DOI: 10.1159/000448653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Hepatocellular cancer (HCC) is increasing dramatically in incidence in Europe and the United States due mainly to the hepatitis C epidemic and, to a lesser extent, increased body mass index of the population. In the fairly recent past, HCC was largely considered as untreatable due to detection mainly at late stages and lack of effective drugs for treatment. Several advances have led to changes in the prognosis of HCC. Screening of high-risk populations has allowed for earlier detection in some studies. If found at an early stage, liver transplantation not only cures the usual underlying cirrhosis but has cure rates for HCC in the range of 60% in recent series. Larger lesions can sometimes be cured by partial hepatic resection assuming the remaining liver is not too damaged to sustain liver functions after surgery. Vaccination for hepatitis B has led to reduction in the incidence of HCC. Significant improvements in antiviral treatments for both hepatitis B and hepatitis C may be having an impact on the incidence of HCC as well. It is still generally held that a finding of metastases precludes cure of HCC. We here report the case of a patient who presented with a large HCC in the context of occult hepatitis C infection. The primary tumor was resected. Over a year later, he developed a lung metastasis that was resected as well. He has not shown recurrence for 6 years since the metastasectomy. We review the recent literature on resection of lung metastases from HCC.
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Affiliation(s)
- Sneha Chelimeda
- Section of Hematology Oncology, Boston University School of Medicine, Boston, Mass., USA
| | - Teresa Bejarano
- Section of Hematology Oncology, Boston University School of Medicine, Boston, Mass., USA
| | - Robert Lowe
- Section of Gastroenterology, Boston University School of Medicine, Boston, Mass., USA
| | - Mahmoud Soliman
- Department of Pathology, Boston University School of Medicine, Boston, Mass., USA
| | - Qing Zhao
- Section of Hematology Oncology, Boston University School of Medicine, Boston, Mass., USA
| | - Kevan L Hartshorn
- Section of Hematology Oncology, Boston University School of Medicine, Boston, Mass., USA
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13
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Mizejewski GJ. Does alpha-fetoprotein contribute to the mortality and morbidity of human hepatocellular carcinoma? A commentary. J Hepatocell Carcinoma 2016; 3:37-40. [PMID: 27703963 PMCID: PMC5036612 DOI: 10.2147/jhc.s114198] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The fifth most common cancer worldwide is hepatocellular carcinoma (HCC), while being the third leading cause of global cancer-related deaths. Although HCC incidence is less frequent in North America, it is a common malignancy in Asia and Africa associated with a high rate of mortality and morbidity due to ineffective therapies against cancer growth, invasion, and metastasis. It is well established that serum alpha-fetoprotein (AFP) is the "gold standard" biomarker for liver cancer; however, less known are the biological activities of AFP regarding carcinogenesis, growth, proliferation, and metastasis. Clinicians are well aware that increasing AFP serum levels parallel disease progression of HCC patients, but many are less knowledgeable in the lethal growth-promoting properties of AFP as an autocrine stimulator of hepatoma cell proliferation. This commentary addresses the mortality and morbidity concerning AFP in the genesis, growth, progression, and spread of HCC and emphasizes the perilous consequences of AFP-supported growth in human liver cancer even after liver resection and transplantation. Thus, AFP is not just a biomarker for HCC but also an ardent promoter of liver cancer growth and progression.
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14
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Doreille A, N'Kontchou G, Halimi A, Bouhafs F, Coderc E, Sellier N, Seror O. Percutaneous treatment of extrahepatic recurrence of hepatocellular carcinoma. Diagn Interv Imaging 2016; 97:1117-1123. [PMID: 27138073 DOI: 10.1016/j.diii.2015.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 11/07/2015] [Accepted: 11/24/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The goal of this study was to retrospectively evaluate the results of imaging-guided percutaneous ablation in patients with controlled intrahepatic hepatocellular carcinoma (HCC) with limited extrahepatic disease. MATERIALS AND METHODS Eleven patients with limited extrahepatic disease and/or potential short-term clinical manifestations with controlled primary intrahepatic HCC were included into the study. There were nine men and two women, with a mean age of 67.4 years±10.2 (SD) (range: 54-85 years). All patients had extrahepatic disease treated by either radiofrequency ablation or electroporation. Extrahepatic disease consisted of lymph node metastases (5 patients), tumor seeding along a needle tract (3 patients), adrenal gland metastasis, bone metastasis and pulmonary metastasis (one patient each). RESULTS Response to treatment was complete in 7/11 patients (64%). The mean survival time after treatment was 18.8±12.7 (SD) months (median, 16 months; range: 4-42 months). No severe complications associated with percutaneous treatment were observed. CONCLUSION Our results suggest that imaging-guided percutaneous ablation techniques should be considered as a useful option for the treatment of extrahepatic disease in patients with HCC. Further studies are needed, however to fully determine the potential role of these techniques in this elective application.
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Affiliation(s)
- A Doreille
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France
| | - G N'Kontchou
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service d'Hépatologie, 93140 Bondy, France
| | - A Halimi
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France; Université Paris 13, COMUE Sorbonne Paris Cité, UFR SMBH, 93000 Bobigny, France
| | - F Bouhafs
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France; Université Paris 13, COMUE Sorbonne Paris Cité, UFR SMBH, 93000 Bobigny, France
| | - E Coderc
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France
| | - N Sellier
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France; Université Paris 13, COMUE Sorbonne Paris Cité, UFR SMBH, 93000 Bobigny, France
| | - O Seror
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France; Université Paris 13, COMUE Sorbonne Paris Cité, UFR SMBH, 93000 Bobigny, France; Inserm, UMR 1162, Génomique fonctionnelle des Tumeurs solides, 75010 Paris, France.
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15
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Lu Y, Zhu M, Li W, Lin B, Dong X, Chen Y, Xie X, Guo J, Li M. Alpha fetoprotein plays a critical role in promoting metastasis of hepatocellular carcinoma cells. J Cell Mol Med 2016; 20:549-58. [PMID: 26756858 PMCID: PMC4759472 DOI: 10.1111/jcmm.12745] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/23/2015] [Indexed: 12/29/2022] Open
Abstract
A high level of serum alpha fetoprotein (AFP) is positively associated with human hepatocellular carcinoma (HCC) carcinogenesis and metastasis; however, the function of AFP in HCC metastasis is unknown. This study has explored the effects of AFP on regulating metastatic and invasive capacity of human HCC cells. Forty-seven clinical patients' liver samples were collected and diagnosed; HCC cells line, Bel 7402 cells (AFP-producing) and liver cancer cell line cells (non-AFP-producing) were selected to analyse the role of AFP in the metastasis of HCC cells. The results indicated that high serum concentration of AFP was positively correlated with HCC intrahepatic, lymph nodes and lung metastasis. Repressed expression of AFP significantly inhibited the capability of migration and invasion of Bel 7402 cells, expression of keratin 19 (K19), epithelial cell adhesion molecule (EpCAM), matrix metalloproteinase 2/9 (MMP2/9) and CXC chemokine receptor 4 (CXCR4) were also down-regulated in Bel 7402 cells; migration and invasion, expression of K19, EpCAM, MMP2/9 and CXCR4 were significantly enhanced when HLE cells were transfected with AFP-expressed vector. The results demonstrated that AFP plays a critical role in promoting metastasis of HCC; AFP promoted HCC cell invasion and metastasis via up-regulating expression of metastasis-related proteins. Thus, AFP may be used as a novel therapeutic target for treating HCC patients.
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Affiliation(s)
- Yan Lu
- Hainan Provincial Key Laboratory of Carcinogenesis and Intervention, Hainan Medical College, Haikou, Hainan Province, China.,Key Laboratory of Molecular Biology, Hainan Medical College, Haikou, Hainan Province, China
| | - Mingyue Zhu
- Hainan Provincial Key Laboratory of Carcinogenesis and Intervention, Hainan Medical College, Haikou, Hainan Province, China.,Key Laboratory of Molecular Biology, Hainan Medical College, Haikou, Hainan Province, China
| | - Wei Li
- Hainan Provincial Key Laboratory of Carcinogenesis and Intervention, Hainan Medical College, Haikou, Hainan Province, China.,Key Laboratory of Molecular Biology, Hainan Medical College, Haikou, Hainan Province, China
| | - Bo Lin
- Hainan Provincial Key Laboratory of Carcinogenesis and Intervention, Hainan Medical College, Haikou, Hainan Province, China.,Key Laboratory of Molecular Biology, Hainan Medical College, Haikou, Hainan Province, China
| | - Xu Dong
- Hainan Provincial Key Laboratory of Carcinogenesis and Intervention, Hainan Medical College, Haikou, Hainan Province, China.,Key Laboratory of Molecular Biology, Hainan Medical College, Haikou, Hainan Province, China
| | - Yi Chen
- Hainan Provincial Key Laboratory of Carcinogenesis and Intervention, Hainan Medical College, Haikou, Hainan Province, China.,Key Laboratory of Molecular Biology, Hainan Medical College, Haikou, Hainan Province, China
| | - Xieju Xie
- Hainan Provincial Key Laboratory of Carcinogenesis and Intervention, Hainan Medical College, Haikou, Hainan Province, China.,Department of Pathophysiology, Hainan Medical College, Haikou, Hainan Province, China
| | - Junli Guo
- Hainan Provincial Key Laboratory of Carcinogenesis and Intervention, Hainan Medical College, Haikou, Hainan Province, China.,Key Laboratory of Molecular Biology, Hainan Medical College, Haikou, Hainan Province, China
| | - Mengsen Li
- Hainan Provincial Key Laboratory of Carcinogenesis and Intervention, Hainan Medical College, Haikou, Hainan Province, China.,Key Laboratory of Molecular Biology, Hainan Medical College, Haikou, Hainan Province, China.,Institution of Tumor, Hainan Medical College, Haikou, Hainan Province, China
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16
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Yamashita YI, Yoshida Y, Kurihara T, Itoh S, Harimoto N, Ikegami T, Yoshizumi T, Uchiyama H, Shirabe K, Maehara Y. Surgical results for recurrent hepatocellular carcinoma after curative hepatectomy: Repeat hepatectomy versus salvage living donor liver transplantation. Liver Transpl 2015; 21:961-8. [PMID: 25772591 DOI: 10.1002/lt.24111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 02/26/2015] [Accepted: 03/03/2015] [Indexed: 02/07/2023]
Abstract
The aims of this study were to evaluate the efficacy of repeat hepatectomy (Hx) and salvage living donor liver transplantation (LDLT) for recurrent hepatocellular carcinoma (HCC). A retrospective cohort study was performed to analyze the surgical results of repeat Hx and salvage LDLT for patients with recurrent HCC within the Milan criteria from 1989 to 2012. A total of 159 patients were divided into 2 groups: a repeat Hx group (n = 146) and a salvage LDLT group (n = 13). Operative results and patient prognoses were compared between the 2 groups. The operative invasiveness, including the operation time (229.1 ± 97.7 versus 862.9 ± 194.4 minutes; P < 0.0001) and blood loss (596.3 ± 764.9 versus 24,690 ± 59,014.4 g; P < 0.0001), were significantly higher in the salvage LDLT group. The early surgical results, such as morbidity (31% versus 62%; P = 0.0111) and the duration of hospital stay (20 ± 22 versus 35 ± 21 days; P = 0.0180), were significantly worse in the salvage LDLT group. There was no significant difference in the overall survival (OS) rate, but the disease-free survival rate of the salvage LDLT group was significantly better (P = 0.0002). The OS rate of patients with grade B liver damage in the repeat Hx group was significantly worse (P < 0.0001), and the 5-year OS rate was quite low, that is, 20% (liver damage A, 77% for the repeat Hx group and 75% for the salvage LDLT group). The prognosis of patients with grade B liver damage after repeat Hx for recurrent HCC is poor, and salvage LDLT would be a potent option for such patients.
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Affiliation(s)
- Yo-Ichi Yamashita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Yoshida
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Kurihara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Norifumi Harimoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideaki Uchiyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Shirabe
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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17
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The tumor marker score is an independent predictor of survival in patients with recurrent hepatocellular carcinoma. Surg Today 2014; 45:1513-20. [DOI: 10.1007/s00595-014-1102-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 11/25/2014] [Indexed: 01/03/2023]
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18
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Chok KSH, Yau TCC, Cheung TT, Poon RTP, Lo CM. Retrospective study of metachronous lung metastases from primary hepatocellular carcinoma. ANZ J Surg 2014; 86:289-93. [PMID: 25267256 DOI: 10.1111/ans.12859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 01/13/2023]
Affiliation(s)
| | - Thomas C. C. Yau
- Department of Surgery; The University of Hong Kong; Hong Kong China
| | - Tan To Cheung
- Department of Surgery; The University of Hong Kong; Hong Kong China
| | | | - Chung Mau Lo
- Department of Surgery; The University of Hong Kong; Hong Kong China
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19
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Surgical outcomes of pulmonary metastases from esophageal carcinoma diagnosed by both pathological and clinical criteria. Surg Today 2014; 45:1127-33. [PMID: 25231941 DOI: 10.1007/s00595-014-1036-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 09/03/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE This investigation was performed to examine the surgical outcomes of pulmonary metastases from esophageal carcinoma (EC) diagnosed by both pathological and clinical criteria. METHODS Based on the pathological criteria, we identified 22 patients who had undergone pulmonary metastasectomy for EC between 1997 and 2011. Thehistological type of EC was squamous cell carcinoma (SCC) in all patients. After specific clinical criteria were applied, seven patients suspected of having primary lung SCC were excluded. The surgical outcomes of the remaining 15 patients were reviewed. The overall survival (OS) was calculated as the period from pulmonary resection until death or the date of the last follow-up. RESULTS The 1-, 3- and 4-year OS rates of the 15 patients were 93, 44 and 0% respectively, with a median OS of 32 months. A larger diameter of the pulmonary metastasis was marginally associated with a poorer OS (p = 0.087); however, none of the parameters were significant prognostic factors. CONCLUSIONS The median OS of patients who underwent surgical resection for pulmonary metastases from EC was comparable to that in previous reports, even after excluding patients clinically suspected of having a second primary lung SCC. The poor long-term survival might indicate that our clinical criteria are helpful in selecting true metastatic patients, considering the aggressive clinical course of metastatic EC.
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20
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Zhou YM, Zhang XF, Yu F, Liu XB, Wu LP, Li B, Yang JM. Efficacy of surgical resection for pulmonary metastases from hepatocellular carcinoma. Med Sci Monit 2014; 20:1544-9. [PMID: 25172966 PMCID: PMC4156333 DOI: 10.12659/msm.890853] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The lung is one of the most common sites for extrahepatic metastasis from hepatocellular carcinoma (HCC). This study aimed to assess the efficacy of surgical resection for pulmonary metastases from HCC. Material/Methods The medical records of 9 patients who underwent pulmonary metastasectomy from HCC at 2 institutions were retrospectively studied, together with a review of studies reporting the outcomes of at least 5 patients in the Chinese and English languages. Results There were no perioperative deaths or major complications. The 1-, 3-, and 5-year overall survival rate after surgery was 100%, 44.4%, and 33.3%, respectively. A total of 19 studies involving 443 patients who underwent pulmonary metastasectomy for metastasis of HCC were included in the literature review. The median mortality rate was 0% (range, 0–7.1%). The median survival ranged from 10.7 to 77 (median=33.2) months, and the 5-year overall survival rate ranged from 11.5% to 75% (median=36%). Conclusions Surgical resection is a safe and effective treatment in selected patients with pulmonary metastases from HCC.
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Affiliation(s)
- Yan-Ming Zhou
- Department of Hepatobiliary and Pancreatovascular Surgery, Oncologic Center of Xiamen, First affiliated Hospital of Xiamen University, Xiamen, China (mainland)
| | - Xiao-Feng Zhang
- Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Feng Yu
- Department of Hepatobiliary Surgery, 101th Hospital of Chinese PLA, Wuxi, China (mainland)
| | - Xiao-Bin Liu
- Department of Hepatobiliary and Pancreatovascular Surgery, Oncologic Center of Xiamen, First affiliated Hospital of Xiamen University, Xiamen, China (mainland)
| | - Lu-Peng Wu
- Department of Hepatobiliary and Pancreatovascular Surgery, Oncologic Center of Xiamen, First affiliated Hospital of Xiamen University, Xiamen, China (mainland)
| | - Bin Li
- Department of Hepatobiliary and Pancreatovascular Surgery, Oncologic Center of Xiamen, First affiliated Hospital of Xiamen University, Xiamen, China (mainland)
| | - Jia-Mei Yang
- Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China (mainland)
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21
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Schweiger T, Lang G, Klepetko W, Hoetzenecker K. Prognostic factors in pulmonary metastasectomy: spotlight on molecular and radiological markers. Eur J Cardiothorac Surg 2014; 45:408-416. [DOI: 10.1093/ejcts/ezt288] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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22
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Abstract
PURPOSE Pulmonary metastases from gastric cancer are rare, and the role of surgery is unclear. The purpose of this study was to determine which patients with metachronous metastatic gastric cancer (MGC) might benefit from pulmonary resection. METHODS Between 1998 and 2011, 12 patients underwent 14 pulmonary resections for MGC. We reviewed their clinical courses and evaluated their radiological findings. RESULTS Solitary pulmonary lesions were identified for 11 metastases, and the remaining three showed multiple pulmonary lesions. Six patients received treatment for the metastases before pulmonary resection. Lobectomy was performed for five lesions and wedge resection was performed for the remaining nine lesions. At the median follow-up time of 23.0 months, four patients were alive without disease, and the median DFS following pulmonary resection was 6.6 months. The overall 5-year survival rate following pulmonary resection was 58.4 %. In a univariate analysis, the number of lesions and the tumor doubling time (TDT) were significant predictors of the DFS, although prior treatment was not a significant predictor of the DFS. CONCLUSION Pulmonary resection for MGC might be an effective therapeutic option when there is a solitary metastatic lesion that has a long TDT, even if the patient has been previously treated for metastases.
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