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Yu Y, Wang XH, Hu WJ, Chen DH, Hu ZL, Li SQ. Patterns, Risk Factors, and Outcomes of Recurrence After Hepatectomy for Hepatocellular Carcinoma with and without Microvascular Invasion. J Hepatocell Carcinoma 2024; 11:801-812. [PMID: 38737385 PMCID: PMC11088842 DOI: 10.2147/jhc.s438850] [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: 09/06/2023] [Accepted: 04/24/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose The patterns and risk factors of postsurgical recurrence of patient with hepatocellular carcinoma (HCC) with microvascular invasion (MVI) are not clarified. This study aimed to decipher and compare the postoperative recurrent patterns and the risk factors contributing to recurrence between MVI positive (MVI(+)) and MVI negative (MVI(-)) HCC after hepatectomy. Patients and methods Patients with HCC who underwent hepatectomy in three Chinese academic hospitals between January 1, 2009, and December 31, 2018, were enrolled. Recurrent patterns included early (≤2 years) or late (>2 years) recurrence, recurrent sites and number, and risk factors of recurrence were compared between the MVI(+)and MVI(-) groups by propensity score-matching (PSM). Results Of 1756 patients included, 581 (33.1%) were MVI(+), and 875 (49.8%) patients developed early recurrence. Compared with the MVI(-) group, the MVI(+) group had a higher 2-year recurrence rate in the PSM cohort (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.59-2.10; P < 0.001), and more patients with multiple tumor recurrence. Patients with early recurrence in the MVI(+) group had a worse overall survival (OS) than those in the MVI(-) group (HR, 1.24; 95% CI, 1.02-1.50; P = 0.034). Resection margin (RM) ≤1.0 cm is a surgical predictor of early recurrence for the MVI(+) group (HR, 0.68; 95% CI, 0.54-0.87; P = 0.002), but not for the MVI(-) group. Conclusion Compared to MVI(-) HCC, MVI(+) HCC tends to be early, multiple recurrence and lung and lymph node metastasis after resection. RM ≤1.0 cm is a surgical risk factor of early recurrence for patient with MVI.
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Affiliation(s)
- Yang Yu
- Hepatic Pancreatobiliary Surgery Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China
| | - Xiao-Hui Wang
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University) Changsha, Hunan Province, 410005, People’s Republic of China
| | - Wen-Jie Hu
- Hepatic Pancreatobiliary Surgery Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China
| | - De-Hua Chen
- Hepatic Pancreatobiliary Surgery Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China
| | - Zi-Li Hu
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangdong, 510060, Guangzhou, People’s Republic of China
| | - Shao-Qiang Li
- Hepatic Pancreatobiliary Surgery Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China
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Lu Z, Ni H, Yang X, Tan L, Zhuang H, Mo Y, Wei X, Qi L, Xiang B. Prognostic potential of preoperative circulating tumor cells to predict the early progression recurrence in hepatocellular carcinoma patients after hepatectomy. BMC Cancer 2023; 23:1150. [PMID: 38012581 PMCID: PMC10680336 DOI: 10.1186/s12885-023-11629-0] [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: 07/10/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The role of circulating tumor cells (CTCs) in prognosis prediction has been actively studied in hepatocellular carcinoma (HCC) patients. However, their efficiency in accurately predicting early progression recurrence (EPR) is unclear. This study aimed to investigate the clinical potential of preoperative CTCs to predict EPR in HCC patients after hepatectomy. METHODS One hundred forty-five HCC patients, whose preoperative CTCs were detected, were enrolled. Based on the recurrence times and types, the patients were divided into four groups, including early oligo-recurrence (EOR), EPR, late oligo-recurrence (LOR), and late progression recurrence (LPR). RESULTS Among the 145 patients, 133 (91.7%) patients had a postoperative recurrence, including 51 EOR, 42 EPR, 39 LOR, and 1 LPR patient. Kaplan-Meier survival curve analysis indicated that the HCC patients with EPR had the worst OS. There were significant differences in the total-CTCs (T-CTCs) and CTCs subtypes count between the EPR group with EOR and LOR groups. Cox regression analysis indicated that the T-CTC count of > 5/5 mL, the presence of microvascular invasion (MVI) and satellite nodules were the independent risk factors for EPR. The efficiency of T-CTCs was superior as compared to those of the other indicators in predicting EPR. Moreover, the combined model demonstrated a markedly superior area under the curve (AUC). CONCLUSIONS The HCC patients with EPR had the worst OS. The preoperative CTCs was served as a prognostic indicator of EPR for HCC patients. The combined models, including T-CTCs, MVI, and satellite nodules, had the best performance to predict EPR after hepatectomy.
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Grants
- 81960450 National Outstanding Youth Science Fund Project of National Natural Science Foundation of China
- 81960450 National Outstanding Youth Science Fund Project of National Natural Science Foundation of China
- 2017ZX10203207 the National Major Special Science and Technology Project
- 2017ZX10203207 the National Major Special Science and Technology Project
- AA18221001, AB18050020, and 2020AB34006 the High-Level Innovation Team and Outstanding Scholar Program in Guangxi Colleges and Universities, "139" Projects for Training of High-Level Medical Science Talents from Guangxi, the Key Research and Development Project of Guangxi
- AA18221001, AB18050020, and 2020AB34006 the High-Level Innovation Team and Outstanding Scholar Program in Guangxi Colleges and Universities, "139" Projects for Training of High-Level Medical Science Talents from Guangxi, the Key Research and Development Project of Guangxi
- GKE2017-ZZ02, GKE2018-KF02, and GKE2019-ZZ07 the Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumors of the Ministry of Education, Guangxi Independent Research Project
- GKE2017-ZZ02, GKE2018-KF02, and GKE2019-ZZ07 the Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumors of the Ministry of Education, Guangxi Independent Research Project
- S2019039 Development and Application of Medical and Health Appropriate Technology in Guangxi
- the High-Level Innovation Team and Outstanding Scholar Program in Guangxi Colleges and Universities, “139” Projects for Training of High-Level Medical Science Talents from Guangxi, the Key Research and Development Project of Guangxi
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Affiliation(s)
- Zhan Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, 71# Hedi Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumors, Ministry of Education, Nanning, People's Republic of China
- Guangxi Medical University, Nanning, People's Republic of China
| | - Hanghang Ni
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, 71# Hedi Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumors, Ministry of Education, Nanning, People's Republic of China
- Guangxi Medical University, Nanning, People's Republic of China
| | - Xihua Yang
- Department of Surgical Oncology, Chenzhou No. 1 People's Hospital, Chenzhou, People's Republic of China
| | - Lihao Tan
- Guangxi Medical University, Nanning, People's Republic of China
| | - Haixiao Zhuang
- Guangxi Medical University, Nanning, People's Republic of China
| | - Yunning Mo
- Guangxi Medical University, Nanning, People's Republic of China
| | - Xingyu Wei
- Guangxi Medical University, Nanning, People's Republic of China
| | - Lunan Qi
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, 71# Hedi Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China.
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumors, Ministry of Education, Nanning, People's Republic of China.
- Guangxi Medical University, Nanning, People's Republic of China.
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, People's Republic of China.
| | - Bangde Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, 71# Hedi Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China.
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumors, Ministry of Education, Nanning, People's Republic of China.
- Guangxi Medical University, Nanning, People's Republic of China.
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, People's Republic of China.
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Qiu Z, Qi W, Wu Y, Li L, Li C. Insurance status impacts survival of hepatocellular carcinoma patients after liver resection. Cancer Med 2023; 12:17037-17046. [PMID: 37455560 PMCID: PMC10501234 DOI: 10.1002/cam4.6339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND This study intends to examine the effect of public insurance status on survival outcomes of HCC patients after liver resection in China. METHODS We divided 2911 HCC patients after liver resection included in our study into the Urban Employed-based Medical Insurance group (UEBMI group, n = 1462) and the non-Urban Employed-based Medical Insurance group (non-UEBMI group, n = 1449). A propensity score matching (PSM) analysis was used to control confounding factors. Overall survival (OS) was estimated by Kaplan-Meier curves and Cox proportional hazard models based on variables screened by Lasso regression. Competing risk analysis was used to analyze cancer-specific survival (CSS). RESULTS UEBMI group had more male patients (p = 0.031), patients in the UEBMI group were older (p < 0.001) and had lower Charlson Comorbidity Index scores (CCI score, p < 0.001). Meanwhile, patients in the UEBMI group had better liver function (albumin-bilirubin grade I [ALBI I], p < 0.001) and lower tumor burden (α-fetoprotein [AFP], p = 0.009; Barcelona Clinic Liver Cancer stage [BCLC], p = 0.026; Milan criteria, p < 0.001; tumor size, p < 0.001; microvascular invasion [MVI], p = 0.030; portal vein tumor thrombosis [PVTT], p = 0.002). More patients in the UEBMI group received laparoscopic surgery (p = 0.024) and adjuvant transarterial chemoembolization (TACE, p < 0.001). After PSM, patients in the two matched groups had similar characteristics. Patients with recurrent HCC in the UEBMI were more likely to receive curative therapy (p < 0.001) and less likely to receive supportive care (p < 0.001). HCC patients after liver resection in the non-UEBMI group had a worse OS before (p < 0.0001) and after PSM (p = 0.002). [Correction added on August 16, 2023 after first online publication. The p value has been updated in the preceding sentence.] In our Lasso-Cox risk regression model, public health insurance status was an independent factor linked with OS (non-UEBMI vs. UEBMI, hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 1.12-1.46; p < 0.001). In the competing risk analysis, patients in the UEBMI group had a lower cumulative incidence of CSS before (p < 0.001) and after PSM (p = 0.001), and public insurance status of HCC patients after liver resection remained independently associated with CSS (non-UEBMI vs. UEBMI; HR:1.36; 95% CI: 1.18-1.58; p < 0.001). CONCLUSIONS Underinsured HCC patients after liver resection had worse survival outcomes. Less access to care for underinsured patients may explain the difference in survival, but the corresponding conclusions need to be further explored.
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Affiliation(s)
- Zhancheng Qiu
- Division of Liver Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Weili Qi
- Division of Liver Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Youwei Wu
- Division of Liver Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Lingling Li
- Department of Information Management CenterWest China Hospital, Sichuan UniversityChengduChina
| | - Chuan Li
- Division of Liver Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
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Yang YQ, Wen ZY, Liu XY, Ma ZH, Liu YE, Cao XY, Hou L, Xie H. Current status and prospect of treatments for recurrent hepatocellular carcinoma. World J Hepatol 2023; 15:129-150. [PMID: 36926237 PMCID: PMC10011906 DOI: 10.4254/wjh.v15.i2.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/13/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023] Open
Abstract
Owing to its heterogeneous and highly aggressive nature, hepatocellular carcinoma (HCC) has a high recurrence rate, which is a non-negligible problem despite the increasing number of available treatment options. Recent clinical trials have attempted to reduce the recurrence and develop innovative treatment options for patients with recurrent HCC. In the event of liver remnant recurrence, the currently available treatment options include repeat hepatectomy, salvage liver transplantation, tumor ablation, transcatheter arterial chemoembolization, stereotactic body radiotherapy, systemic therapies, and combination therapy. In this review, we summarize the strategies to reduce the recurrence of high-risk tumors and aggressive therapies for recurrent HCC. Additionally, we discuss methods to prevent HCC recurrence and prognostic models constructed based on predictors of recurrence to develop an appropriate surveillance program.
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Affiliation(s)
- Yu-Qing Yang
- Department of Epidemiology and Biostatistics, Jilin University, Changchun 130021, Jilin Province, China
| | - Zhen-Yu Wen
- Department of Occupational and Environmental Health, Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Yan Liu
- Senior Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Zhen-Hu Ma
- Senior Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Yan-E Liu
- Department of Epidemiology and Biostatistics, Jilin University, Changchun 130021, Jilin Province, China
| | - Xue-Ying Cao
- Senior Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Li Hou
- Senior Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Hui Xie
- Senior Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
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Guo B, Chen Q, Liu Z, Chen X, Zhu P. Adjuvant therapy following curative treatments for hepatocellular carcinoma: current dilemmas and prospects. Front Oncol 2023; 13:1098958. [PMID: 37139151 PMCID: PMC10149944 DOI: 10.3389/fonc.2023.1098958] [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: 11/15/2022] [Accepted: 04/04/2023] [Indexed: 05/05/2023] Open
Abstract
Curative surgical treatments, mainly liver resection, are still one of the optimal options for patients with early-, mid-, and even progression-stage hepatocellular carcinoma (HCC). However, the recurrence rate within 5 years after surgery is as high as 70%, especially in patients with high risk factors for recurrence, most of whom experience early recurrence within 2 years. Effective adjuvant therapy may improve prognosis, previous studies found that adjuvant transarterial chemoembolization, antiviral, and traditional Chinese medicine et al. were helpful in preventing HCC recurrence. Nevertheless, due to controversial results or lack of high-level evidence, there is no standardized postoperative management protocol worldwide at present. Continued exploration of effective postoperative adjuvant treatments to improve surgical prognosis is necessary.
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Affiliation(s)
- Bin Guo
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hepatobiliary Surgery Department, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Zhicheng Liu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- *Correspondence: Peng Zhu,
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Chen ZH, Zhang XP, Feng JK, Li LQ, Zhang F, Hu YR, Zhong CQ, Wang K, Chai ZT, Wei XB, Shi J, Guo WX, Wu MC, Lau WY, Cheng SQ. Patterns, treatments, and prognosis of tumor recurrence after resection for hepatocellular carcinoma with microvascular invasion: a multicenter study from China. HPB (Oxford) 2022; 24:1063-1073. [PMID: 34961677 DOI: 10.1016/j.hpb.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 10/15/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Microvascular invasion (MVI) is a risk factor of post-hepatectomy tumor recurrence for hepatocellular carcinoma (HCC). The patterns, treatments, and prognosis have not been documented in HCC patients with MVI. METHODS A multicenter database of patients with HCC and MVI following resection was analyzed. The clinicopathological and initial operative data, timing and first sites of recurrence, recurrence management, and long-term survival outcomes were analyzed. RESULTS Of 1517 patients included, the median follow-up was 39.7 months. Tumor recurrence occurred in 928 patients, with 49% within 6 months of hepatectomy and 60% only in the liver. The incidence of intrahepatic only recurrence gradually increased with time after 6 months. Patients who developed recurrence within 6 months of hepatectomy had worse survival outcomes than those who developed recurrence later. Patients who developed intrahepatic only recurrence had better prognosis than those with either extrahepatic only recurrence or those with intra- and extrahepatic recurrence. Repeat resection of recurrence with curative intent resulted in better outcomes than other treatment modalities. CONCLUSION Post-hepatectomy tumor recurrence in patients with HCC and MVI had unique characteristics and recurrence patterns. Early detection of tumor recurrence and repeat liver resection with curative intent resulted in improved long-term survival outcomes.
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Affiliation(s)
- Zhen-Hua Chen
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of General Surgery, Zhejiang Provincial Armed Police Corps Hospital, Hangzhou, Zhejiang, China
| | - Xiu-Ping Zhang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of Hepatopancreatobiliary Surgical Oncology, Military Institution of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jin-Kai Feng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Fan Zhang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou, Shandong, China
| | - Yi-Ren Hu
- Department of General Surgery, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
| | - Cheng-Qian Zhong
- Department of Hepatobiliary Surgery, LongYan First Hospital, Affiliated to Fujian Medical University, Longyan, Fujian, China
| | - Kang Wang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Zong-Tao Chai
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xu-Biao Wei
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wei-Xing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Meng-Chao Wu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wan Y Lau
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
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Lou SJ, Hou MF, Chang HT, Lee HH, Chiu CC, Yeh SCJ, Shi HY. Breast Cancer Surgery 10-Year Survival Prediction by Machine Learning: A Large Prospective Cohort Study. BIOLOGY 2021; 11:biology11010047. [PMID: 35053045 PMCID: PMC8773427 DOI: 10.3390/biology11010047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 02/07/2023]
Abstract
Machine learning algorithms have proven to be effective for predicting survival after surgery, but their use for predicting 10-year survival after breast cancer surgery has not yet been discussed. This study compares the accuracy of predicting 10-year survival after breast cancer surgery in the following five models: a deep neural network (DNN), K nearest neighbor (KNN), support vector machine (SVM), naive Bayes classifier (NBC) and Cox regression (COX), and to optimize the weighting of significant predictors. The subjects recruited for this study were breast cancer patients who had received breast cancer surgery (ICD-9 cm 174-174.9) at one of three southern Taiwan medical centers during the 3-year period from June 2007, to June 2010. The registry data for the patients were randomly allocated to three datasets, one for training (n = 824), one for testing (n = 177), and one for validation (n = 177). Prediction performance comparisons revealed that all performance indices for the DNN model were significantly (p < 0.001) higher than in the other forecasting models. Notably, the best predictor of 10-year survival after breast cancer surgery was the preoperative Physical Component Summary score on the SF-36. The next best predictors were the preoperative Mental Component Summary score on the SF-36, postoperative recurrence, and tumor stage. The deep-learning DNN model is the most clinically useful method to predict and to identify risk factors for 10-year survival after breast cancer surgery. Future research should explore designs for two-level or multi-level models that provide information on the contextual effects of the risk factors on breast cancer survival.
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Affiliation(s)
- Shi-Jer Lou
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan;
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Ming-Feng Hou
- Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Surgery, Division of Breast Oncology and Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Hong-Tai Chang
- Department of Surgery, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan;
| | - Hao-Hsien Lee
- Department of General Surgery, Chi Mei Medical Center, Liouying 73658, Taiwan;
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan;
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80420, Taiwan
| | - Hon-Yi Shi
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan;
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80420, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-7-3211101 (ext. 2648); Fax: +886-7-3137487
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8
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Hu J, Cai D, Zhao Z, Zhong GC, Gong J. Suppression of Heterogeneous Nuclear Ribonucleoprotein C Inhibit Hepatocellular Carcinoma Proliferation, Migration, and Invasion via Ras/MAPK Signaling Pathway. Front Oncol 2021; 11:659676. [PMID: 33937074 PMCID: PMC8087488 DOI: 10.3389/fonc.2021.659676] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC), the most common malignant tumor, has high fatality and recurrence rates. Accumulating evidence shows that heterogeneous nuclear ribonucleoprotein C (HNRNPC), which is mainly involved in RNA splicing, export, and translation, promotes progression and metastasis of multiple tumor types; however, the effects of HNRNPC in HCC are unknown. In the present study, high levels of HNRNPC were detected in tumor tissues compared with para-tumor tissues by immunohistochemical and western blot assays. Furthermore, Cox proportional hazards regression models, the Kaplan–Meier method, and clinicopathologic features analysis showed that HNRNPC was not only an independent prognostic factor for both overall and disease-free survival in HCC but also a predictor of large tumor size and advanced tumor stage. Functional experiments revealed that silencing of HNRNPC not only led to arrest of more HCC cells at G0/G1 phase to inhibit their proliferation, but also suppressed EMT process to block their invasion, and migration in vitro; this was related to the Ras/MAPK signaling pathway. In addition, blocking of HCC cell proliferation regulated by HNRNPC silencing was observed in vivo. Finally, rescue tests showed that after recovery of Ras/MAPK signaling pathway activity by treatment with Ras agonists, the proliferation, migration, and invasion suppression of Huh-7 and Hep 3B cell lines caused by HNRNPC knockdown was partially reversed. Taken together, these results indicate that HNRNPC knockdown inhibits HCC cell proliferation, migration and invasion, in part via the Ras/MAPK signaling pathway. Thus, HNRNPC may have an important role in the progression of HCC and represents a promising biomarker for evaluation of prognosis and a potential therapeutic target in HCC patients.
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Affiliation(s)
- Jiejun Hu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Cai
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhibo Zhao
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guo-Chao Zhong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jianping Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Fung AK, Cheng NM, Chong CC, Lee KF, Wong J, Cheung SY, Lok HT, Lai PB, Ng KK. Single-center experience on actual mid-term (≥5 years) and long-term (≥10 years) survival outcome in patients with hepatocellular carcinoma after curative hepatectomy: A bimodal distribution. Medicine (Baltimore) 2020; 99:e23358. [PMID: 33235106 PMCID: PMC7710257 DOI: 10.1097/md.0000000000023358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Analysis for actual mid-term (≥5 years) and long-term (≥10 years) survivors with hepatocellular carcinoma (HCC) following curative hepatectomy are rarely reported in the literature.This retrospective study aims to study the mid- and long-term survival outcome and associated prognostic factors following curative hepatectomy for HCC in a tertiary referral center.The clinical data of 325 patients who underwent curative hepatectomy for HCC were reviewed. They were stratified into 3 groups for comparison (Group 1, overall survival <5 years; Group 2, overall survival ≥5, and <10 years; Group 3, overall survival ≥10 years). Favorable independent prognostic factors for mid- and long-term survival were analyzed.A bimodal distribution of actual survival outcome was observed, with short-term (<5 years) survival of 52.7% (n = 171), mid-term survival of 18.1% (n = 59), and long-term survival of 29.2% (n = 95). Absence of microvascular invasion (OR 3.690, 95% CI: 1.562-8.695) was independent good prognostic factor for mid-term survival. Regarding long-term overall survival, young age (OR 1.050, 95% CI: 0.920-0.986), ASA grade ≤2 (OR 3.746, 95% CI: 1.325-10.587), high albumin level (OR 1.008, 95% CI: 0.920-0.986), solitary tumor (OR 3.289, 95% CI: 1.149-7.625) and absence of microvascular invasion (OR 4.926, 95% CI: 2.192-11.111) were independent good prognostic factors.Curative hepatectomy results in bimodal actual survival outcome with favorable long-term survival rate of 29.2%. Favorable independent prognostic factors (age, ASA grade, albumin level, tumor number, and microvascular invasion) are identified for overall survival.
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Affiliation(s)
- Andrew K.Y. Fung
- Department of Surgery, Prince of Wales Hospital, New Territories
| | | | - Charing C.N. Chong
- Department of Surgery, Prince of Wales Hospital, New Territories
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Kit-Fai Lee
- Department of Surgery, Prince of Wales Hospital, New Territories
| | - John Wong
- Department of Surgery, Prince of Wales Hospital, New Territories
| | | | - Hon-Ting Lok
- Department of Surgery, Prince of Wales Hospital, New Territories
| | - Paul B.S. Lai
- Department of Surgery, Prince of Wales Hospital, New Territories
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Kelvin K.C. Ng
- Department of Surgery, Prince of Wales Hospital, New Territories
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
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10
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Wu Y, Shen L, Qi H, Cao F, Chen S, Xie L, Huang T, Zhou D, Mo J, Fan W. Surveillance Strategy for Patients With BCLC Stage B Hepatocellular Carcinoma After Achieving Complete Remission: Data From the Real World. Front Oncol 2020; 10:574804. [PMID: 33117712 PMCID: PMC7550758 DOI: 10.3389/fonc.2020.574804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose: There is a lack of consensus on the surveillance strategy for Barcelona Clinic liver cancer (BCLC) stage B hepatocellular carcinoma (HCC) patients with complete remission (CR). We performed a real-world, retrospective analysis of the surveillance strategy for BCLC stage B HCC patients after radical therapy with CR to support clinical decision-making. Materials and Methods: We analyzed 546 BCLC stage B HCC patients with CR after radical treatments (surgery/ablation) at Sun Yat-sen University Cancer Center, from January 2007 to December 2019. The intensity of surveillance interval was defined as the mean of surveillance interval within 2 years. The primary endpoint of the study was overall survival (OS) and extra-Milan criteria relapse. Results: During a median follow-up time of 23.9 months (range = 3.1–148.3 months), there were 11.9% of patients died, 56.6% of patients developed recurrence, the vast majority of patients experienced recurrence within 2 years, and 27.8% patients developed extra-Milan criteria recurrence. The median disease-free survival and OS were 33.6 and 60.0 months, respectively. Patients were divided into regular surveillance group (RS) (≤4.3 months) and irregular surveillance (IRS) group (>4.3 months) based on the optimal cutoff value of the intensity of surveillance interval. The RS group owned a lower incident of extra-Milan criteria relapse and smaller and fewer tumors at recurrence than IRS group, which contributed to the prolonged OS. Besides, the cutoff values of surveillance interval that could lead to significant differences in the incidence of extra-Milan criteria relapse during 0–6, 6–12, and 12–18 months after CR were 2.6, 2.9, and 3 months, respectively. Conclusions: The average surveillance interval for patients with BCLC stage B HCC achieved CR should not exceed 4.3 months during the first 2 years' follow-up. During three different phases of the initial 18 months after CR, individualized surveillance showed intervals no more than 3 months were required to reduce the incidence of extra-Milan criteria relapse.
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Affiliation(s)
- Ying Wu
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Han Qi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Fei Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Shuanggang Chen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Lin Xie
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Tao Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Danyang Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jinqing Mo
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
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11
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Qi C, Li S, Zhang L. Development and Validation of a Clinicopathological-Based Nomogram to Predict the Survival Outcome of Patients with Recurrent Hepatocellular Carcinoma After Hepatectomy Who Underwent Microwave Ablation. Cancer Manag Res 2020; 12:7589-7600. [PMID: 32904581 PMCID: PMC7457390 DOI: 10.2147/cmar.s266052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/02/2020] [Indexed: 01/27/2023] Open
Abstract
Aim To develop and validate a nomogram for predicting the overall survival (OS) in patients with recurrent hepatocellular carcinoma (HCC) after hepatectomy who underwent microwave ablation (MWA). Methods The training cohort included 299 patients with recurrent HCCs after hepatectomy who met the Milan criteria and received MWA from April 2007 to December 2017. Baseline characteristics were collected to identify risk factors for the determination of death after MWA. A multivariate Cox proportional hazards model based on significant risk factors was used to develop the nomogram, which was then assessed for its predictive accuracy using Harrell’s C-index and the area under the curve (AUC). The nomogram was validated by internal (n = 240) and external cohorts (n = 205) from another hospital. Results After a median follow-up of 32.3 months, 38.8% (116/299) of patients had died. Multivariate Cox proportional hazards analyses showed that comorbid disease, early recurrence, and albumin-bilirubin (ALBI) grades 2–3 were independent prognostic factors for poor OS. This nomogram accurately stratified patients into subgroups with low or high risk. The 1-, 3- and 5-year OS rates in the low-risk subgroup were 99.4%, 97.2%, and 86.1%, respectively, and they were 92.8%, 70.3%, and 45.8% in the high-risk subgroup (P < 0.001). The nomogram predicted OS in the training cohort with a C-index score of 0.801 (95% CI 0.761–0.841). The nomogram was validated by internal and external cohorts, with C-index scores of 0.792 (95% CI 0.738–0.846) and 0.744 (95% CI 0.703–0.785), respectively. Conclusion The nomogram provides individualized risk estimates for long-term OS for patients with recurrent HCC after hepatectomy who underwent MWA.
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Affiliation(s)
- Chunhou Qi
- Department of Interventional Medicine, Linyi City Central Hospital, Yishui, Shandong, People's Republic of China
| | - Shankai Li
- Department of Interventional Medicine, Linyi City Central Hospital, Yishui, Shandong, People's Republic of China
| | - Lei Zhang
- Department of Interventional Radiology, Shandong Medical Imaging Research Institute, Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
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12
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Nakahashi K, Ebata T, Yokoyama Y, Igami T, Mizuno T, Yamaguchi J, Onoe S, Watanabe N, Nagino M. How long should follow-up be continued after R0 resection of perihilar cholangiocarcinoma? Surgery 2020; 168:617-624. [PMID: 32665142 DOI: 10.1016/j.surg.2020.04.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Although several studies have been conducted on the patterns of recurrence in resected perihilar cholangiocarcinoma, the appropriate follow-up period after resection is still controversial. METHODS Consecutive patients who underwent an R0 resection of perihilar cholangiocarcinoma between 2001 and 2014 were reviewed retrospectively, focusing on the time and site of initial recurrence. A Cox proportional hazards model was used for multivariate analysis. RESULTS During the study period, 404 patients underwent R0 resection, of whom 242 patients (59.9%) developed a recurrence. The most common site of recurrence was locoregional, followed by peritoneum and liver. Approximately 70% of patients were asymptomatic when recurrence was detected. The median survival time in all cohorts was 4.8 years, and the estimated cumulative probability of recurrence was 54.3% at 5 years and 65.7% at 10 years. Multivariate analyses revealed that lymph node metastasis (hazard ratio 2.80, P < .001) and microscopic venous invasion (hazard ratio, 1.70, P < .001) were independent risk factors for recurrence-free survival. The cumulative probability of recurrence in 84 patients with 2 risk factors was nearly 90% at 5 years; even in the 178 patients without risk factors, the probability at 5 years was 30%, and thereafter, the probability of recurrence gradually increased, reaching nearly 50% at 10 years. No trends in the time and site of recurrence were detected. CONCLUSION Approximately 60% of patients with perihilar cholangiocarcinoma experience recurrence after R0 resection. Even in patients without an independent risk for recurrence, the recurrence probability is high, reaching nearly 50% at 10 years. Thus, close surveillance for 10 years is necessary even after R0 resection of perihilar cholangiocarcinoma.
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Affiliation(s)
- Koichi Nakahashi
- 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
| | - 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
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Watanabe
- 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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13
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Wang H, Yu H, Qian YW, Cao ZY, Wu MC, Cong WM. Impact of Surgical Margin on the Prognosis of Early Hepatocellular Carcinoma (≤5 cm): A Propensity Score Matching Analysis. Front Med (Lausanne) 2020; 7:139. [PMID: 32478080 PMCID: PMC7232563 DOI: 10.3389/fmed.2020.00139] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
Aim: The influence of surgical margin on the prognosis of patients with early solitary hepatocellular carcinoma (HCC) (≤5 cm) is undetermined. Methods: The data of 904 patients with early solitary HCC who underwent liver resection were collected for recurrence-free survival (RFS) and overall survival (OS). Propensity score matching (PSM) was performed to balance the potential bias. Results: Log-rank tests showed that 2 mm was the best cutoff value to discriminate the prognosis of early HCC. Liver resection with a >2 mm surgical margin distance (wide-margin group) led to better 5-year RFS and OS rate compared with liver resection with a ≤2 mm surgical margin distance (narrow-margin group) among patients both before (RFS: 59.1% vs. 39.6%, P < 0.001; OS: 85.3% vs. 73.7%, P < 0.001) and after PSM (RFS: 56.3% vs. 41.0%, P < 0.001; OS: 83.0% vs. 75.0%, P = 0.010). Subgroup analysis showed that a wide-margin resection significantly improved the prognosis of patients with microvascular invasion (RFS: P < 0.001; OS: P = 0.001) and patients without liver cirrhosis (RFS: P < 0.001; OS: P = 0.001) after PSM. Multivariable Cox regression analysis revealed that narrow-margin resection is associated with poorer RFS [hazard ratio (HR) = 1.781, P < 0.001), OS (HR = 1.935, P < 0.001], and early recurrence (HR = 1.925, P < 0.001). Conclusions: A wide-margin resection resulted in better clinical outcomes than a narrow-margin resection among patients with early solitary HCC, especially for those with microvascular invasion and without cirrhosis. An individual strategy of surgical margin should be formulated preoperation according to both tumor factors and background liver factors.
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Affiliation(s)
- Han Wang
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Hua Yu
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - You-Wen Qian
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Zhen-Ying Cao
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Meng-Chao Wu
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Wen-Ming Cong
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
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14
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Liu H, Yan Y, Chen R, Zhu M, Lin J, He C, Shi B, Wen K, Mao K, Xiao Z. Integrated nomogram based on five stage-related genes and TNM stage to predict 1-year recurrence in hepatocellular carcinoma. Cancer Cell Int 2020; 20:140. [PMID: 32368186 PMCID: PMC7189530 DOI: 10.1186/s12935-020-01216-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/16/2020] [Indexed: 12/24/2022] Open
Abstract
Background The primary tumor, regional lymph nodes and distant metastasis (TNM) stage is an independent risk factor for 1-year hepatocellular carcinoma (HCC) recurrence but has insufficient predictive efficiency. We attempt to develop and validate a nomogram to predict 1-year recurrence in HCC and improve the predictive efficiency of the TNM stage. Methods A total of 541 HCC patients were enrolled in the study. The risk score (RS) model was established with the logistic least absolute shrinkage and selector operation algorithm. The predictive nomogram was further validated in the internal testing cohort and external validation cohort. The area under the receiver operating characteristic curves (AUCs), decision curves and clinical impact curves were used to evaluate the predictive accuracy and clinical value of the nomogram. Results In the training cohort, we identified a RS model consisting of five stage-related genes (NUP62, EHMT2, RANBP1, MSH6 and FHL2) for recurrence at 1 year. The 1-year disease-free survival of patients was worse in the high-risk group than in the low-risk group (P < 0.0001), and 1-year recurrence was more likely in the high-risk group (Hazard ratio: 3.199, P < 0.001). The AUC of the nomogram was 0.739, 0.718 and 0.693 in the training, testing and external validation cohort, respectively, and these values were larger than the corresponding AUC of the TNM stage (0.681, 0.688 and 0.616, respectively). Conclusions A RS model consisting of five stage-related genes was successfully identified for predicting 1-year HCC recurrence. Then, a novel nomogram based on the RS model and TNM stage to predict 1-year HCC recurrence was also developed and validated.
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Affiliation(s)
- Haohan Liu
- 1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China.,2Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Yongcong Yan
- 1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China.,2Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Ruibing Chen
- 1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China.,2Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Mengdi Zhu
- 1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Jianhong Lin
- 1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China.,2Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Chuanchao He
- 2Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Bingchao Shi
- 2Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Kai Wen
- 2Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Kai Mao
- 2Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Zhiyu Xiao
- 2Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
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15
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Hojo H, Raturi V, Nakamura N, Arahira S, Akita T, Mitsunaga S, Nakamura M, Motegi A, Kageyama SI, Zenda S, Okumura M, Ikeda M, Akimoto T. Impact of Proton Beam Irradiation of an Anatomic Subsegment of the Liver for Hepatocellular Carcinoma. Pract Radiat Oncol 2019; 10:e264-e271. [PMID: 31585204 DOI: 10.1016/j.prro.2019.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The objective of this research was to elucidate the impact on the prognosis, including the survival prognosis, resulting from proton beam irradiation of an anatomic subsegment of the liver (ASPT) for the treatment of hepatocellular carcinoma (HCC). METHODS AND MATERIALS A total of 110 patients who received a diagnosis of HCC were analyzed in this retrospective study. Definitive proton beam therapy was delivered at a dose of 76 Gy (relative biological effectiveness) in 20 fractions between January 2008 and December 2015. When the HCC widely abutted blood vessels or when multiple HCC tumors occurred within the same liver subsegment, the clinical target volume was outlined as an anatomic subsegment of the liver, according to the portal territory, containing the tumor. In the remaining cases, the clinical target volume was delineated by adding a 5-mm margin around the gross tumor volume. The overall survival (OS), progression-free survival (PFS), and local control rates and adverse events were assessed. A review of the medical charts assessed adverse events that occurred during and after the treatment and were classified according to the Common Terminology Criteria for Adverse Events version 4.0. RESULTS The median follow-up duration was 36.5 months (range, 1-90.6 months). The median age of the patients was 73 years (range, 48-90 years). ASPT was performed in 31 patients (28%). Three-year OS, PFS, and local control rates were 74.2%, 40.4%, and 91.7%, respectively. Multivariate analysis identified ASPT as a factor that significantly improved PFS (P = .049) but not OS (P = .79). No association was found between ASPT and the frequency of grade ≥3 acute/late adverse events. CONCLUSIONS ASPT was associated with a reduction in the rate of tumor progression and no significant toxicity but was not associated with OS.
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Affiliation(s)
- Hidehiro Hojo
- Division of Radiation Oncology and Particle Therapy.
| | - Vijay Raturi
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | | | | | | | - Shuichi Mitsunaga
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | | | | | | | | | | | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
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