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Mo A, Zhang Q, Xia F, Huang Z, Peng S, Cao W, Mei H, Ren L, Su Y, Gao H, Chen W. Preoperative transcatheter arterial chemoembolization and prognosis of patients with solitary large hepatocellular carcinomas (≥5 cm): Multicenter retrospective study. Cancer Med 2022; 12:7734-7747. [PMID: 36540041 PMCID: PMC10134378 DOI: 10.1002/cam4.5529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/24/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Large hepatocellular carcinoma (LHCC) is prone to short-term recurrence and poor long-term survival after hepatectomy, and there is still a lack of effective neoadjuvant treatments to improve recurrence-free survival (RFS) and overall survival (OS). We retrospectively analyzed the efficacy of preoperative transcatheter arterial chemoembolization (TACE) in solitary LHCC (≥5 cm). MATERIALS AND METHODS A multicenter medical database was used to analyze preoperative TACE's effects on RFS, OS, and perioperative complications in patients with solitary LHCC who received surgical treatment from January 2005 to December 2015. The patients were divided into Group A (5.0-9.9 cm) and Group B (≥10 cm), with 10 cm as the critical value, and the effect of preoperative TACE on RFS, OS and perioperative complications was assessed in each subgroup. RESULTS In the overall population, patients with preoperative TACE had better RFS and OS than those without preoperative TACE. However, after stratifying the patients into the two HCC groups, preoperative TACE only improved the survival outcomes of patients with Group B (≥10 cm). Multivariate Cox-regression analysis showed that lack of preoperative TACE was an independent risk factor for RFS and OS in the overall population and in Group B but not in Group A. CONCLUSIONS Preoperative TACE is beneficial for patients with solitary HCC (≥10 cm).
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Affiliation(s)
- Ali Mo
- Guangdong Medical University Guangdong China
- Department of Hepatobiliary Surgery Zhongshan People's Hospital Zhongshan City China
| | - Qiao Zhang
- Guangdong Medical University Guangdong China
- Department of Hepatobiliary Surgery Zhongshan People's Hospital Zhongshan City China
| | - Feng Xia
- Department of Hepatic Surgery Center Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology Wuhan China
| | - Zhiyuan Huang
- Department of Hepatic Surgery Center Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology Wuhan China
| | - Shasha Peng
- Department of Hepatobiliary and Pancreatic Surgery,Huangshi Central Hospital of Edong Healthcare Group Hubei Polytechnic University Huangshi China
| | - Wenjing Cao
- Southern Medical University Graduate School Guangzhou City China
| | - Hongliang Mei
- General Surgery General Hospital of Central Theater Wuhan China
| | - Li Ren
- Hepatobiliary Pancreatic Surgery Qinghai University Affiliated Hospital Xining China
| | - Yang Su
- Department of Hepatobiliary Surgery Renmin Hospital of Wuhan University Wuhan China
| | - Hengyi Gao
- Department of Hepatobiliary and Pancreatic Surgery Shenzhen Longhua District People's Hospital Shenzhen City China
| | - Weiqiang Chen
- Guangdong Medical University Guangdong China
- Department of Hepatobiliary Surgery Zhongshan People's Hospital Zhongshan City China
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Nayak A, Baidya Kayal E, Arya M, Culli J, Krishan S, Agarwal S, Mehndiratta A. Computer-aided diagnosis of cirrhosis and hepatocellular carcinoma using multi-phase abdomen CT. Int J Comput Assist Radiol Surg 2019; 14:1341-1352. [PMID: 31062266 DOI: 10.1007/s11548-019-01991-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/25/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE High mortality rate due to liver cirrhosis has been reported over the globe in the previous years. Early detection of cirrhosis may help in controlling the disease progression toward hepatocellular carcinoma (HCC). The lack of trained CT radiologists and increased patient population delays the diagnosis and further management. This study proposes a computer-aided diagnosis system for detecting cirrhosis and HCC in a very efficient and less time-consuming approach. METHODS Contrast-enhanced CT dataset of 40 patients (n = 40; M:F = 5:3; age = 25-55 years) with three groups of subjects: healthy (n = 14), cirrhosis (n = 12) and cirrhosis with HCC (n = 14), were retrospectively analyzed in this study. A novel method for the automatic 3D segmentation of liver using modified region-growing segmentation technique was developed and compared with the state-of-the-art deep learning-based technique. Further, histogram parameters were calculated from segmented CT liver volume for classification between healthy and diseased (cirrhosis and HCC) liver using logistic regression. Multi-phase analysis of CT images was performed to extract 24 temporal features for detecting cirrhosis and HCC liver using support vector machine (SVM). RESULTS The proposed method produced improved 3D segmentation with Dice coefficient 90% for healthy liver, 86% for cirrhosis and 81% for HCC subjects compared to the deep learning algorithm (healthy: 82%; cirrhosis: 78%; HCC: 70%). Standard deviation and kurtosis were found to be statistically different (p < 0.05) among healthy and diseased liver, and using logistic regression, classification accuracy obtained was 92.5%. For detecting cirrhosis and HCC liver, SVM with RBF kernel obtained highest slice-wise and patient-wise prediction accuracy of 86.9% (precision = 0.93, recall = 0.7) and 80% (precision = 0.86, recall = 0.75), respectively, than that of linear kernel (slice-wise: accuracy = 85.4%, precision = 0.92, recall = 0.67; patient-wise: accuracy = 73.33%, precision = 0.75, recall = 0.75). CONCLUSIONS The proposed computer-aided diagnosis system for detecting cirrhosis and hepatocellular carcinoma (HCC) showed promising results and can be used as effective screening tool in medical image analysis.
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Affiliation(s)
- Akash Nayak
- Department of Electrical Engineering, Indian Institute of Technology Delhi, New Delhi, India.,IBM Research, Bangalore, India
| | - Esha Baidya Kayal
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
| | - Manish Arya
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
| | - Jayanth Culli
- Department of Electrical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Sonal Krishan
- Department of Radiology, Medanta The Medicity, Gurgaon, India
| | - Sumeet Agarwal
- Department of Electrical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India. .,Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India.
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Chau I, Park JO, Ryoo BY, Yen CJ, Poon R, Pastorelli D, Blanc JF, Kudo M, Pfiffer T, Hatano E, Chung HC, Kopeckova K, Phelip JM, Brandi G, Ohkawa S, Li CP, Okusaka T, Hsu Y, Abada PB, Zhu AX. Alpha-fetoprotein kinetics in patients with hepatocellular carcinoma receiving ramucirumab or placebo: an analysis of the phase 3 REACH study. Br J Cancer 2018; 119:19-26. [PMID: 29808014 PMCID: PMC6035236 DOI: 10.1038/s41416-018-0103-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/04/2018] [Accepted: 04/11/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Post-hoc analyses of AFP response and progression and their relationship with objective measures of response and survival were performed in patients from REACH. METHODS Serum AFP was measured at baseline and every 3 cycles (2 weeks/cycle). Associations between AFP and radiographic progression and efficacy end points were analysed. RESULTS Median percent AFP increase from baseline was smaller in the ramucirumab than in the placebo arm throughout treatment. Time to AFP progression (HR 0.621; P < 0.0001) and to radiographic progression (HR 0.613; P < 0.0001) favoured ramucirumab. Association between AFP and radiographic progression was shown at 6 (OR 6.44, 95% CI 4.03, 10.29; P < 0.0001) and 12 weeks (OR 2.28, 95% CI 1.47, 3.53; P = 0.0002). AFP response was higher with ramucirumab compared with placebo (P < 0.0001). More patients in the ramucirumab arm experienced tumour shrinkage and AFP response compared with placebo. Survival was longer in patients with AFP response (13.6 months) than in patients without (6.2 months), irrespective of treatment (HR 0.457, P < 0.0001). CONCLUSIONS Treatment with ramucirumab prolonged time to AFP progression, slowed AFP increase and was more likely to induce AFP response. Similar benefits in radiographic progression and response correlated with AFP changes.
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Affiliation(s)
- Ian Chau
- Department of Medicine, Royal Marsden Hospital, Sutton, Surrey, SM2 5PT, UK.
| | - Joon Oh Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea
| | - Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Chia-Jui Yen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan
| | - Ronnie Poon
- Departmentof Surgery, The University of Hong Kong, Pokfulam, Hong Kong
| | - Davide Pastorelli
- Department of Oncology, Santa Maria del Prato Hospital, Feltre (Belluno), 32032, Italy
| | - Jean-Frédéric Blanc
- Department of Hepato-Gastroenterology and Medical Oncology, CHU de Bordeaux, Hôpital Haut-Lévêque, 33604, Pessac, France
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, 589-8511, Japan
| | - Tulio Pfiffer
- Department of Medical Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, 01246-000, Brazil
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Hyun Cheol Chung
- Department of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Katerina Kopeckova
- Department of Oncology, University Hospital Motol, 2nd Faculty of Medicine of Charles University, 150 00, Praha, Czech Republic
| | - Jean-Marc Phelip
- Department of Gastroenterology and Digestive Oncology, University Hospital of St Etienne, 42100, Saint Etienne, France
| | - Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, University Hospital S. Orsola, 40138, Bologna, Italy
| | - Shinichi Ohkawa
- Division of Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, Yokohama, 241-0815, Japan
| | - Chung-Pin Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan
- National Yang-Ming University School of Medicine, Taipei, 112, Taiwan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, 104-0045, Japan
| | - Yanzhi Hsu
- Eli Lilly and Company, New York, NY, 10016, USA
| | | | - Andrew X Zhu
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, 02114, USA
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Zhou L, Rui JA, Wang SB, Chen SG, Qu Q. Carbohydrate Antigen 19-9 Increases the Predictive Efficiency of a-Fetoprotein for Prognosis of Resected Hepatocellular Carcinoma. Am Surg 2018. [DOI: 10.1177/000313481808400126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Serum α-fetoprotein (AFP) is a classical biomarker for both diagnosis and prognosis of hepatocellular carcinoma (HCC). However, its predictive efficiency for prognosis remains unsatisfactory. This study explores whether integrating AFP and carbohydrate antigen (CA) 19-9/carcinoembryonic antigen (CEA) increase its prognostic efficiency in HCC. A total of 67 HCC patients with complete record of AFP, CA19-9, and CEA, who underwent radical hepatectomy, were included. The sole and combined evaluations for prognostic significance of the three markers were performed. In the first, it was found by one-factor analysis that AFP was a univariate prognostic indicator for disease-free survival, but not overall survival, whereas CEA and CA19-9 were not statistically significant, although the latter was of marginally predictive significance for disease-free survival. Subsequently, it was revealed that combined evaluation of AFP and CA19-9, rather than AFP and CEA, distinguished overall and disease-free survival more effectively, compared with single ones. However, this combination was not significant in multivariate Cox regression analysis, thus needing further validation, especially in large-scale prospective investigations. The addition of vascular invasion to AFP/CA19-9 combination might provide enhanced predictive power for disease-free survival. Collectively, these results preliminarily suggest that CA19-9 increases the predictive efficiency of AFP for prognosis of HCC after resection.
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Affiliation(s)
- Li Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Jing-An Rui
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Shao-Bin Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Shu-Guang Chen
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Qiang Qu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
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You DD, Kim DG, Seo CH, Choi HJ, Yoo YK, Park YG. Prognostic factors after curative resection hepatocellular carcinoma and the surgeon's role. Ann Surg Treat Res 2017; 93:252-259. [PMID: 29184878 PMCID: PMC5694716 DOI: 10.4174/astr.2017.93.5.252] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/18/2017] [Accepted: 04/25/2017] [Indexed: 02/06/2023] Open
Abstract
Purpose Patient, surgical, and tumor factors affect the outcome after surgical resection for hepatocellular carcinoma (HCC). The surgical factors are only modifiable by the surgeon. We reviewed our experience with curative resection for HCC in terms of surgical factors. Methods After analyses of the prospectively collected clinical data of 256 consecutive patients undergoing surgical resection for HCC, prognostic factors for disease-free survival (DFS) and overall survival (OS) were identified; all patients were stratified by tumor diameters > or <5 cm and their outcomes were compared. Results Multivariate analyses showed that microvascular invasion, estimated blood loss, blood transfusion, and the number of tumors were independent adverse prognostic factors for DFS, whereas microvascular invasion, serum alpha fetoprotein, and tumor diameter were independent adverse prognostic factors for OS. Blood transfusion had borderline significance (P = 0.076). After stratification by tumor diameter, blood transfusion was only associated with poor DFS and OS in patients with tumor diameters > 5 cm. Conclusion Tumor recurrence after liver resection for HCC depends on tumor status, bleeding, and transfusions, which subsequently lead to poor patient survival. Surgeons can help improve the prognosis of patients by minimizing blood loss and transfusion, particularly in patients with larger tumors.
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Affiliation(s)
- Dong Do You
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Dong Goo Kim
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Ho Seo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyung Yoo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Gyu Park
- Department of Medical Life Science, The Catholic University of Korea, Seoul, Korea
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Zhu AX, Park JO, Ryoo BY, Yen CJ, Poon R, Pastorelli D, Blanc JF, Chung HC, Baron AD, Pfiffer TEF, Okusaka T, Kubackova K, Trojan J, Sastre J, Chau I, Chang SC, Abada PB, Yang L, Schwartz JD, Kudo M. Ramucirumab versus placebo as second-line treatment in patients with advanced hepatocellular carcinoma following first-line therapy with sorafenib (REACH): a randomised, double-blind, multicentre, phase 3 trial. Lancet Oncol 2015; 16:859-70. [PMID: 26095784 DOI: 10.1016/s1470-2045(15)00050-9] [Citation(s) in RCA: 591] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND VEGF and VEGF receptor-2-mediated angiogenesis contribute to hepatocellular carcinoma pathogenesis. Ramucirumab is a recombinant IgG1 monoclonal antibody and VEGF receptor-2 antagonist. We aimed to assess the safety and efficacy of ramucirumab in advanced hepatocellular carcinoma following first-line therapy with sorafenib. METHODS In this randomised, placebo-controlled, double-blind, multicentre, phase 3 trial (REACH), patients were enrolled from 154 centres in 27 countries. Eligible patients were aged 18 years or older, had hepatocellular carcinoma with Barcelona Clinic Liver Cancer stage C disease or stage B disease that was refractory or not amenable to locoregional therapy, had Child-Pugh A liver disease, an Eastern Cooperative Oncology Group performance status of 0 or 1, had previously received sorafenib (stopped because of progression or intolerance), and had adequate haematological and biochemical parameters. Patients were randomly assigned (1:1) to receive intravenous ramucirumab (8 mg/kg) or placebo every 2 weeks, plus best supportive care, until disease progression, unacceptable toxicity, or death. Randomisation was stratified by geographic region and cause of liver disease with a stratified permuted block method. Patients, medical staff, investigators, and the funder were masked to treatment assignment. The primary endpoint was overall survival in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01140347. FINDINGS Between Nov 4, 2010, and April 18, 2013, 565 patients were enrolled, of whom 283 were assigned to ramucirumab and 282 were assigned to placebo. Median overall survival for the ramucirumab group was 9·2 months (95% CI 8·0-10·6) versus 7·6 months (6·0-9·3) for the placebo group (HR 0·87 [95% CI 0·72-1·05]; p=0·14). Grade 3 or greater adverse events occurring in 5% or more of patients in either treatment group were ascites (13 [5%] of 277 patients treated with ramucirumab vs 11 [4%] of 276 patients treated with placebo), hypertension (34 [12%] vs ten [4%]), asthenia (14 [5%] vs five [2%]), malignant neoplasm progression (18 [6%] vs 11 [4%]), increased aspartate aminotransferase concentration (15 [5%] vs 23 [8%]), thrombocytopenia (13 [5%] vs one [<1%]), hyperbilirubinaemia (three [1%] vs 13 [5%]), and increased blood bilirubin (five [2%] vs 14 [5%]). The most frequently reported (≥1%) treatment-emergent serious adverse event of any grade or grade 3 or more was malignant neoplasm progression. INTERPRETATION Second-line treatment with ramucirumab did not significantly improve survival over placebo in patients with advanced hepatocellular carcinoma. No new safety signals were noted in eligible patients and the safety profile is manageable. FUNDING Eli Lilly and Co.
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Affiliation(s)
- Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Joon Oh Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Baek-Yeol Ryoo
- Asan Medical Center, University of Ulsan School of Medicine, Seoul, South Korea
| | - Chia-Jui Yen
- National Cheng Kung University Hospital, Tainan City, Taiwan
| | | | | | | | - Hyun Cheol Chung
- Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Ari D Baron
- California Pacific Medical Center, San Francisco, CA, USA
| | | | | | | | - Jorg Trojan
- University Hospital Cancer Center, Frankfurt, Germany
| | | | - Ian Chau
- Royal Marsden Hospital, Surrey, UK
| | | | | | - Ling Yang
- Eli Lilly and Company, Bridgewater, NJ, USA
| | | | - Masatoshi Kudo
- Kinki University School of Medicine, Osaka-Sayama City, Osaka, Japan
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Blank S, Wang Q, Fiel MI, Luan W, Kim KW, Kadri H, Mandeli J, Hiotis SP. Assessing prognostic significance of preoperative alpha-fetoprotein in hepatitis B-associated hepatocellular carcinoma: normal is not the new normal. Ann Surg Oncol 2014; 21:986-94. [PMID: 24232510 DOI: 10.1245/s10434-013-3357-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatitis B (HBV)-associated hepatocellular carcinoma (HCC) is often associated with alpha-fetoprotein (AFP) production. Although serum AFP has been demonstrated to be a prognostic factor for patient survival, optimal cutoff levels remain unclear. METHODS Patients with HBV-associated HCC treated by primary liver resection were prospectively followed at a single institution between 1995 and 2008. AFP level was categorized into quintiles for Kaplan–Meier analysis and multivariable Cox proportional hazards regression models. RESULTS Best 5-year survival after surgery was observed for patients with AFP in the first quintile (1.4-4.1 ng/mL), with progressively worse outcomes for patients in each increasing quintile. AFP was associated with overall survival (HR = 1.61; 95 % CI 1.30-1.98), disease-free survival (HR = 1.26; 95 % CI 1.10-1.44), and 2-year recurrence (HR = 1.30; 95 % CI 1.07-1.57) in multivariate analysis. Noncirrhotic patients (Ishak 1-5) with AFP in quintile 1 had 94 % 5-year survival, compared with 0 % survival for patients with AFP in quintile 5 (2,332.7-327,560.0 ng/mL) and Ishak stage 6 cirrhosis. CONCLUSIONS Preoperative serum AFP is an independent predictor of prognosis among HBV-HCC patients following surgical resection. Categorizing AFP into quintiles creates the opportunity to observe differences in outcomes even at low serum levels within the normal range. Additionally, combining AFP quintiles and fibrosis staging provides a predictive model of prognosis for HCC. Thus, even small differences in AFP within the normal range may impact prognosis and disease progression for HBV-HCC.
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Li SH, Guo ZX, Xiao CZ, Wei W, Shi M, Chen ZY, Cai MY, Zheng L, Guo RP. Risk factors for early and late intrahepatic recurrence in patients with single hepatocellular carcinoma without macrovascular invasion after curative resection. Asian Pac J Cancer Prev 2014; 14:4759-63. [PMID: 24083739 DOI: 10.7314/apjcp.2013.14.8.4759] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prognostic factors of postoperative early and late recurrence in patients with hepatocellular carcinoma (HCC) undergoing curative resection remain to be clarified. The aim of this study was to identify risk factors for postoperative early (≤ 2 year) and late (> 2 year) intrahepatic recurrences in patients with single HCCs without macrovascular invasion. METHODS A total of 280 patients from December 2004 to December 2007 were retrospectively included in this study. Intrahepatic recurrence was classified into early (≤ 2 year) and late (> 2 year) and the Chi-Square test or Fisher's exact test and multivariate logistic regression analysis were performed to determine significant risk factors. RESULTS During the follow-up, 124 patients had intrahepatic recurrence, early and late in 82 and 42 patients, respectively. Multivariate logistic regression analysis showed that microvascular invasion (p=0.006, HR: 2.397, 95% CI: 1.290-4.451) was the only independent risk factor for early recurrence, while being female (p = 0.031, HR: 0.326, 95% CI: 0.118-0.901), and having a high degree of cirrhosis (P=0.001, HR: 2.483, 95% CI: 1.417-4.349) were independent risk factors for late recurrence. CONCLUSIONS Early and late recurrence of HCC is linked to different risk factors in patients with single HCC without macrovascular invasion. This results suggested different emphases of strategies for prevent of recurrence after curative resection, more active intervention including adjuvant therapy, anti-cirrhosis drugs and careful follow-up being necessary for patients with relevant risk factors.
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Affiliation(s)
- Shu-Hong Li
- Department of Hepatobiliary Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China E-mail :
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Clinical characteristics and surgical prognosis of hepatocellular carcinoma with bile duct invasion. Gastroenterol Res Pract 2014; 2014:604971. [PMID: 24723944 PMCID: PMC3958710 DOI: 10.1155/2014/604971] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 01/15/2014] [Indexed: 12/14/2022] Open
Abstract
Objectives. Bile duct invasion (BDI) is a rare event in hepatocellular carcinoma (HCC). The present study aimed at investigating clinical characteristics and surgical outcome of HCC patients with bile duct invasion. Methods. 413 patients with HCC undergoing curative surgery were divided into two groups with (B(+)) and without BDI (B(-)). BDI was further classified as central type (B1) and peripheral type (B2). Survival was compared, and risk factors affecting prognosis were identified. Results. 35 (8.5%) patients were diagnosed BDI. Total bilirubin was significantly higher in B(+) group than in B(-) group (P < 0.001). Multiple lesions and large nodules (>5 cm) were predominantly identified in B(+) group (P < 0.01, resp.). Portal vein invasion was more frequently observed in B(+) than in B(-) group (P = 0.003). Univariate and multivariate analyses identified central BDI as a significant factor affecting prognosis of HCC patients (risk 1.3, 95% CI 1.1-2.2, P = 0.015). The gross overall survival of patients in B(+) was significantly worse than in B(-) (P = 0.001), which, however, was not different between B2 and B(-) (P > 0.05). Conclusions. Central but not peripheral BDI was associated with poorer prognosis of HCC patients. Curative surgical resection of tumors and invaded bile duct supplies the only hope for long-term survival of patients.
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Wahab MA, Shehta A, Hamed H, El Nakeeb A, Salah T. Predictors of recurrence in hepatitis C virus related hepatocellular carcinoma after hepatic resection: a retrospective cohort study. Eurasian J Med 2014; 46:36-41. [PMID: 25610292 PMCID: PMC4261437 DOI: 10.5152/eajm.2014.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/05/2013] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Egypt is one of the hot spots in the international map of Hepatocellular carcinoma (HCC), which is where hepatitis C virus (HCV) infection is the major risk factor in development of HCC (80%). Due to low organ donation rates and lack of deceased liver transplantation, hepatic resection is the main line of treatment for HCC patients with sufficient liver reserve. We introduce our experience with patients who had HCV related HCC who underwent hepatic re-section to determine various predictors of tumour recurrence in this group. This is the first study to come from a country where chronic HCV hepatitis is endemic. MATERIALS AND METHODS This is a retrospective cohort study of 208 cases of HCC in hepatitis C virus positive patients with cirrhotic livers who underwent first-time liver resection, in Gastroenterology Surgical Centre, Mansoura University, Egypt during the period from January 2002 to December 2011. Shapiro-Wilk test was used to assess normality of data. Predictors of HCC recurrence were assessed by bivariate correlation tests, univariate analysis using the chi-square and t-test and binary logistic regression analysis. A P value <0.05 was considered statistically significant. RESULTS Tumour recurrence occurred in 88 patients (42.3%). Most of the recurrences occurred within the first year 55 patients (62.5%). The most common site for recurrence was the liver (n=68, 77.3%). Based on the univariate analysis; significant variables predicting tumor recurrence were alpha feto-protein (AFP), blood transfusion, multi-focality, cut margin, microvascular invasion, lack of capsule, tumour grade and stage. Based on multivariate analysis, the main variables predicting tumor recurrence were blood transfusion, cut margin, tumour capsule and microvascular invasion. CONCLUSION Although the predictors of recurrence are the same for both HBV and HCV related HCC, the rate and aggressiveness of recurrence are higher in HCV related HCC.
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Affiliation(s)
- Mohamed Abdel Wahab
- Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Dakahlia, Egypt
| | - Ahmed Shehta
- Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Dakahlia, Egypt
| | - Hosam Hamed
- Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Dakahlia, Egypt
| | - Ayman El Nakeeb
- Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Dakahlia, Egypt
| | - Tarek Salah
- Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Dakahlia, Egypt
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Zhang XF, Wei T, Liu XM, Liu C, Lv Y. Impact of cigarette smoking on outcome of hepatocellular carcinoma after surgery in patients with hepatitis B. PLoS One 2014; 9:e85077. [PMID: 24454795 PMCID: PMC3893178 DOI: 10.1371/journal.pone.0085077] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/21/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cigarette smoking is a potential risk factor for hepatocellular carcinoma (HCC) initiation, partially through interaction with hepatitis B virus (HBV). We examined the hypothesis that cigarette smoking might be associated with HBV-related HCC recurrence and patient survival after curative surgery. PATIENTS AND METHODS Data of 302 patients with HBV infection who had undergone curative resection for HCC were prospectively collected from 2008 to 2011. Smoking status and smoking quantity (pack-years, PY) were asked at admission. Factors affecting recurrence-free survival (RFS) were examined. RFS and liver-specific mortality (LSM) stratified by risk factors were compared with log-rank test. RESULTS 109 were current smokers. Current smokers were not different from non-smokers in tumor burden and surgical procedure. Univariate and multivariate analysis identified that heavy smoking (PY ≥ 20) was the most significant factor associated with HBV-related HCC recurrence after curative surgical resection (p = 0.001), followed by anti-HBV treatment (p<0.01), current smoking (p = 0.028), surgical margin <1 cm (p = 0.048) and blood transfusion >600 ml (p = 0.028). The median RFS in non-smokers, ex-smokers and current smokers was 34 months, 24 months and 26 months, respectively (p = 0.033). Current smokers had significantly worse RFS rate and increased 5-year cumulative LSM than non-smokers (p = 0.024, and p<0.001, respectively). Heavy smokers had significantly worse RFS than non- and light smokers (0 CONCLUSIONS Smoking history and quantity appears to be risk factors for HBV-related HCC recurrence and LSM of patients after surgery. For smokers, continued smoking postoperatively might accelerate tumor recurrence and patient death. Therefore, smoking abstinence should be strongly recommended to patients pre- and postoperatively.
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Affiliation(s)
- Xu-Feng Zhang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
| | - Tao Wei
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
| | - Xue-Min Liu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
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Adjuvant radiotherapy in centrally located hepatocellular carcinomas after hepatectomy with narrow margin (<1 cm): a prospective randomized study. J Am Coll Surg 2013; 218:381-92. [PMID: 24559953 DOI: 10.1016/j.jamcollsurg.2013.11.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/24/2013] [Accepted: 11/27/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although radiotherapy (RT) provides potential benefits for patients with hepatocellular carcinomas (HCCs) that are unsuitable for operation, the specific role of adjuvant RT in HCC after hepatectomy remains ill defined. The current study's aim was to evaluate the safety and efficacy of adjuvant RT for centrally located HCCs after narrow-margin (<1 cm) hepatectomy. STUDY DESIGN The study included 119 patients with centrally located HCCs who underwent narrow-margin hepatectomy between July 2007 and March 2012. Patients were prospectively randomized to receive adjuvant RT (n = 58) or were assigned to a control group (n = 61). Surgical outcomes, safety, and survival rates were evaluated. RESULTS Hepatectomy was successfully performed in all patients. No cases of radiation-induced liver disease were observed. One-, 3-, and 5-year recurrence-free survival rates were 78.1%, 56.5%, and 36.9% in the adjuvant RT group and 72.4%, 40.1%, and 16.0% in the control group, respectively (p = 0.06, log-rank test). Corresponding overall survival rates were 96.2%, 72.6%, 48.4%, and 89.6%, 74.5%, 37.2%, respectively (p = 0.48, log-rank test). One-, 3-, and 5-year recurrence-free survival rates in patients with small-diameter tumors (≤5 cm) were 88.8%, 67.4%, 42.9% in the adjuvant RT group and 82.3%, 42.9%, 21.5% in the control group (p = 0.03, log-rank test). Corresponding overall survival rates were 97.5%, 75.3%, 75.3%, and 94.7%, 84.1%, 65.4%, respectively (p = 0.92, log-rank test). CONCLUSIONS Adjuvant RT for centrally located HCCs after narrow-margin hepatectomy was technically feasible and relatively safe. No significant between-group difference was observed in recurrence-free and overall survival. The post-hoc subgroup comparison showed that adjuvant RT improved recurrence-free survival considerably, but not overall survival, in patients with small HCCs (≤5 cm). More in-depth studies are needed to validate this finding.
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Low expression of PAI-2 as a novel marker of portal vein tumor thrombosis and poor prognosis in hepatocellular carcinoma. World J Surg 2013. [PMID: 23188538 DOI: 10.1007/s00268-012-1866-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Plasminogen activator inhibitor (PAI)-2 was previously shown to be less frequently expressed in hepatocellular carcinoma (HCC). The present study was designed to investigate the clinical, pathological, and prognostic significance of PAI-2 expression in HCC. METHODS Expression of PAI-2 was detected immunohistochemically for specimens from 78 patients with HCC after hepatic resection and correlated with clinicopathological features and patient survival. Risk factors of portal vein tumor thrombosis (PVTT) were also analyzed. RESULTS Positive PAI-2 staining was observed in tumor and non-tumor tissues from 21 (26.9%) and 56 (71.8%) patients, respectively. Plasminogen activator inhibitor-2 negativity in tumor tissues was significantly associated with PVTT, with a high sensitivity not only in univariate analysis but also in multivariate analysis. In addition, positive PAI-2 staining was related to smaller tumor size and prolonged patient survival. The Cox regression model identified intratumoral PAI-2 staining as an independent prognosticator in patients with HCC after resection. CONCLUSIONS Our data demonstrated that low expression of PAI-2 serves as a novel marker of PVTT and poor prognosis in HCC.
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Clinical characteristics and outcome of hepatocellular carcinoma in children and adolescents. Pediatr Surg Int 2013; 29:763-70. [PMID: 23794023 DOI: 10.1007/s00383-013-3334-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) rarely occurs in children and adolescents and has been reported to be highly hepatitis B related more than 10 years ago. However, after global vaccination for hepatitis B virus (HBV), the characteristics and outcome of pediatric HCC remain undefined. METHODS Patients with HCC admitted from 2004 to 2010 were retrospectively reviewed in a large tertiary hospital. RESULTS 45 (1.97 %) pediatric HCC were diagnosed (age ≤18 years), with predominantly male patients (93.3 %). 32 (71.1 %) children were HBV positive, 30 of whom had vertical transmission from their mothers. HBV positivity was associated with liver cirrhosis and portal vein invasion, and thus compromised survival. Advanced disease prevented surgical resection due to large tumor size (>10 cm, 66.7 %), early metastasis (24.4 %), bilateral involvement (57.8 %) and portal vein invasion (46.7 %). The median survival for resectable, transarterial chemotherapy and embolization and untreated patients was 28.6, 4 and 5 months, respectively (p < 0.001). Patients with distal metastasis had significantly poorer survival rate than those without metastasis (p < 0.001). CONCLUSION Screening of children whose mothers are HBV carriers is important in early detection of pediatric HCC. HBV-associated HCC in pediatric patients, especially in endemic areas, should be detected earlier for more resectability and improvement of surgical prognosis.
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Witjes CDM, Willemssen FEJA, Verheij J, van der Veer SJ, Hansen BE, Verhoef C, de Man RA, Ijzermans JNM. Histological differentiation grade and microvascular invasion of hepatocellular carcinoma predicted by dynamic contrast-enhanced MRI. J Magn Reson Imaging 2012; 36:641-7. [PMID: 22532493 DOI: 10.1002/jmri.23681] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 03/16/2012] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To explore the potential use of magnetic resonance imaging (MRI) in predicting the outcome for patients with hepatocellular carcinoma (HCC), imaging characteristics were correlated with pathological findings and clinical outcome. MATERIALS AND METHODS With permission from the Ethical Board, clinical data and tissues of resected HCC patients were collected, including the preoperative MRI. The role of MRI characteristics on recurrence and survival were evaluated with univariate and multivariate analyses. RESULTS Between January 2000 and December 2008, 87 patients with 104 HCCs were operated on. Microvascular invasion was present in 55 lesions (53%). HCC was characterized as well differentiated in 15 lesions (14%), as moderate in 50 lesions (48%), and as poorly differentiated in 34 lesions (33%). Due to preoperative treatment in five lesions (5%) no vital tumor was left. In 85 lesions (88%) washout of contrast was noted. Of the 87 patients, 28 (32%) with 37 lesions developed HCC recurrence; these patients had microvascular invasion significantly more often and a moderate or poorly differentiated tumor (P < 0.001 and P = 0.025, respectively). MRI more often showed washout when HCC was moderately or poorly differentiated (P < 0.001) or microvascular invasion was present (P = 0.032). CONCLUSION Differentiation grade and microvascular invasion are significantly associated with the presence of washout demonstrated on dynamic contrast-enhanced MRI.
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Affiliation(s)
- Caroline D M Witjes
- Department of Hepatobiliary and Transplantation Surgery, Erasmus University Medical Centre, 's Gravendijkwal 230, Rotterdam, the Netherlands.
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Choi KK, Kim SH, Choi SB, Lim JH, Choi GH, Choi JS, Kim KS. Portal venous invasion: the single most independent risk factor for immediate postoperative recurrence of hepatocellular carcinoma. J Gastroenterol Hepatol 2011; 26:1646-51. [PMID: 21592228 DOI: 10.1111/j.1440-1746.2011.06780.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Despite improvements of treatment in hepatocellular carcinoma (HCC), the recurrence rate after curative hepatic resection still remains remarkably high. An immediate recurrence of HCC after surgery is frustrating. We tried to clarify risks of immediate postoperative recurrence of HCC; that is, within 4 months after curative hepatic resection. METHODS A total of 167 patients with HCC underwent hepatic resection; 60 had immediate postoperative recurrences (IPR group), and 107 had disease-free survival for more than 5 years (DFS group). Variables were compared between the two groups. RESULTS Univariate analysis showed the following variables were significant risk factors for immediate postoperative recurrence of HCC: male sex, elevated serum aspartate aminotransferase level, greater amount of blood loss, longer operation time, worse tumor differentiation, higher tumor node metastasis stage, and presence of any of the following: intrahepatic metastasis, tumor-rupture, portal venous invasion, or microvascular invasion. In multivariate analysis, only portal venous invasion was a significant risk factor (odds ratio=3.2, P=0.03, standard error=0.5, Logistic regression analysis). CONCLUSIONS Portal venous invasion may be the most significant risk factor for immediate postoperative recurrence of HCC. However, accurate assessment of this risk factor may require histological examination, limiting its utility as a preoperative predictor. Further research is necessary to definitively identify preoperative predictors.
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Affiliation(s)
- Kang Kook Choi
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Zhang XF, Qi X, Meng B, Liu C, Yu L, Wang B, Lv Y. Prognosis evaluation in alpha-fetoprotein negative hepatocellular carcinoma after hepatectomy: Comparison of five staging systems. Eur J Surg Oncol 2010; 36:718-24. [DOI: 10.1016/j.ejso.2010.05.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 05/12/2010] [Accepted: 05/17/2010] [Indexed: 12/13/2022] Open
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Tsim NC, Frampton AE, Habib NA, Jiao LR. Surgical treatment for liver cancer. World J Gastroenterol 2010; 16:927-33. [PMID: 20180230 PMCID: PMC2828596 DOI: 10.3748/wjg.v16.i8.927] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Revised: 12/20/2009] [Accepted: 12/27/2009] [Indexed: 02/06/2023] Open
Abstract
Primary liver cancer is amongst the commonest tumors worldwide, particularly in parts of the developing world, and is increasing in incidence. Over the past three decades, surgical hepatic resection has evolved from a high risk, resource intensive procedure with limited application, to a safe and commonly performed operation with a range of indications. This article reviews the approach to surgical resection for malignancies such as hepatocellular cancer, metastatic liver deposits and neuroendocrine tumors. Survival data after resection is also reviewed, as well as indications for curative resection.
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