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Lin ZP, Huang DB, Zou XG, Chen Y, Li XQ, Zhang J. Percutaneous microwave ablation and transcatheter arterial chemoembolization for serum tumor markers and prognostics of middle-late primary hepatic carcinoma. World J Gastrointest Surg 2023; 15:2783-2791. [PMID: 38222024 PMCID: PMC10784823 DOI: 10.4240/wjgs.v15.i12.2783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/17/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Primary hepatic carcinoma (PHC) has an insidious onset and is usually diagnosed in the middle and late stages. Although transcatheter arterial chemoembolization (TACE) is the preferred option for treating middle- and advanced-stage PHC, it has limited efficacy in killing tumor cells and poor long-term efficacy. TACE plus percutaneous microwave coagulation therapy (PMCT) is more effective than interventional therapy alone and can improve survival time. However, there are few reports on the effects of TACE and PMCT on serum marker levels and the prognosis of patients with advanced PHC. AIM To investigate the effect of PMCT + TACE on serum tumor markers and the prognosis of middle-late PHC. METHODS This retrospective study included 150 patients with middle-late PHC admitted to Zhongshan People's Hospital between March 2018 and February 2021. Patients were divided into a single group (treated with TACE, n = 75) and a combined group (treated with TACE + PMCT, n = 75). Before and after treatment, the clinical efficacy and serum tumor marker levels [carbohydrate antigen 19-9 (CA19-9), alpha-fetoprotein (AFP), and carcinoembryonic antigen (CEA)] of both groups were observed. The 1-year survival rates and prognostic factors of the two groups were analyzed. RESULTS The combined group had 21 and 35 cases of complete remission (CR) and partial remission (PR), respectively. The single group had 13 and 25 cases of CR and PR, respectively. After 4 wk of treatment, the serum CA19-9, CEA, and AFP levels in the single and combined groups decreased, with the decrease in the combined group being more significant (P < 0.05). The 1-year survival rate of the combined group (80.00%) was higher than that of the single group (60.00%) (P < 0.05). The average survival time within 1 year in the combined group was 299.38 ± 61.13 d, longer than that in the single group (214.41 ± 72.97 d, P < 0.05). COX analysis revealed that tumor diameter, tumor number, and the treatment method were prognostic factors for patients with middle-late PHC (P < 0.05). CONCLUSION TACE + PMCT is effective in treating patients with mid-late PHC. It reduces the levels of tumor markers, prolongs survival, and improves prognosis.
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Affiliation(s)
- Zhi-Peng Lin
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Da-Bei Huang
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Xu-Gong Zou
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Yuan Chen
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Xiao-Qun Li
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Jian Zhang
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
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Tu X, Zhang J, Li M, Lu F, Wang T, Gong W, Xiang B. Development and Validation of a Prediction Model for Hepatitis B Virus-Related Hepatocellular Carcinoma Patients Receiving Postoperative Adjuvant Transarterial Chemoembolization. J Hepatocell Carcinoma 2023; 10:1881-1895. [PMID: 37901717 PMCID: PMC10612509 DOI: 10.2147/jhc.s422565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) patients who are at significant risk of tumor recurrence and mortality can benefit from postoperative adjuvant transarterial chemoembolization (PA-TACE). However, the benefits of PA-TACE remain unclear. Herein, we aimed to develop a model for predicting the prognosis of HBV-related patients who undergo PA-TACE and endeavored to guide individualized clinical treatment. Methods We included 432 HBV-related patients who underwent PA-TACE after curative resection were included. The dataset was divided into a training set (n=216) and an internal validation set (n=216). For identifying independent risk factors, the least absolute shrinkage and selection operator and univariate and multivariate Cox analyses were performed. We derived a prognostic model from the training set that was internally validated. The concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and risk stratification were used to evaluate the performance of the nomogram. Results Patients undergoing PA-TACE had significantly longer overall survival (OS) than those who did not undergo PA-TACE. Age, albumin levels, macrovascular invasion, tumor size, and, stages of Barcelona Clinic Liver Cancer were identified as independent risk variables and concluded into the nomogram to predict the OS of HBV-related patients who received PA-TACE. The nomogram's C-index values OS were 0.710 and 0.652 in the training and internal validation sets, respectively. Both time-dependent AUC and the calibration curve showed good discrimination and model fitness. The risk score -0.12 was kept as the cut-off value that would accurately divide patients into high-risk and low-risk groups; furthermore, the Kaplan-Meier curve showed a high discriminative ability of the model. Conclusion We developed a predictive model. comprising a formula and nomogram to predict the OS and provide risk stratification for HBV-related patients undergoing PA-TACE, which could contribute to suitable treatment options for this patient population.
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Affiliation(s)
- Xinyue Tu
- Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Jie Zhang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Minjun Li
- Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Fei Lu
- Department of Radiotherapy, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Ting Wang
- Department of Radiotherapy, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Wenfeng Gong
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Bangde Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
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Wu Z, Cui L, Qian J, Luo L, Tu S, Cheng F, Yuan L, Zhang W, Lin W, Tang H, Li X, Li H, Zhang Y, Zhu J, Li Y, Xiong Y, Hu Z, Peng P, He Y, Liu L, He K, Shen W. Efficacy of adjuvant TACE on the prognosis of patients with HCC after hepatectomy: a multicenter propensity score matching from China. BMC Cancer 2023; 23:325. [PMID: 37029339 PMCID: PMC10080834 DOI: 10.1186/s12885-023-10802-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 04/01/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND The survival benefit of adjuvant transarterial chemoembolization (TACE) in patients with hepatectomy for hepatocellular carcinoma (HCC) after hepatectomy remains controversial. We aimed to investigate the survival efficacy of adjuvant TACE after hepatectomy for HCC. METHODS 1491 patients with HCC who underwent hepatectomy between January 2018 and September 2021 at four medical centers in China were retrospectively analyzed, including 782 patients who received adjuvant TACE and 709 patients who did not receive adjuvant TACE. Propensity score matching (PSM) (1:1) was performed to minimize selection bias, which balanced the clinical characteristics of the two groups. RESULTS A total of 1254 patients were enrolled after PSM, including 627 patients who received adjuvant TACE and 627 patients who did not receive adjuvant TACE. Patients who received adjuvant TACE had higher disease-free survival (DFS, 1- ,2-, and 3-year: 78%-68%-62% vs. 69%-57%-50%, p < 0.001) and overall survival (OS, 1- ,2-, and 3-year: 96%-88%-80% vs. 90%-77%-66%, p < 0.001) than those who did not receive adjuvant TACE (Median DFS was 39 months). Among the different levels of risk factors affecting prognosis [AFP, Lymphocyte-to-monocyte ratio, Maximum tumor diameter, Number of tumors, Child-Pugh classification, Liver cirrhosis, Vascular invasion (imaging), Microvascular invasion, Satellite nodules, Differentiation, Chinese liver cancer stage II-IIIa], the majority of patients who received adjuvant TACE had higher DFS or OS than those who did not receive adjuvant TACE. More patients who received adjuvant TACE accepted subsequent antitumor therapy such as liver transplantation, re-hepatectomy and local ablation after tumor recurrence, while more patients who did not receive adjuvant TACE accepted subsequent antitumor therapy with TACE after tumor recurrence (All p < 0.05). CONCLUSIONS Adjuvant TACE may be a potential way to monitor early tumor recurrence and improve postoperative survival in patients with HCC.
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Affiliation(s)
- Zhao Wu
- Department of General Surgery, The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, No.1 Minde Road, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Lifeng Cui
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology), No. 1017, Dongmen North Road, Luohu District, Shenzhen City, 518020, Guangdong Province, China
- Maoming People's Hospital, Mao Ming Shiy, China
| | - Junlin Qian
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), No. 2, Sunwen East Road, Shiqi District, Zhongshan City, 528400, Guangdong Province, China
| | - Laihui Luo
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Clinical Medical College of Nanchang University, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Shuju Tu
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Clinical Medical College of Nanchang University, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Fei Cheng
- Department of General Surgery, The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, No.1 Minde Road, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Lebin Yuan
- Department of General Surgery, The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, No.1 Minde Road, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - WenJian Zhang
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology), No. 1017, Dongmen North Road, Luohu District, Shenzhen City, 518020, Guangdong Province, China
| | - Wei Lin
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), No. 2, Sunwen East Road, Shiqi District, Zhongshan City, 528400, Guangdong Province, China
| | - Hongtao Tang
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), No. 2, Sunwen East Road, Shiqi District, Zhongshan City, 528400, Guangdong Province, China
| | - Xiaodong Li
- Department of General Surgery, The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, No.1 Minde Road, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Hui Li
- School of Public Health, Nanchang University, Nanchang, China
| | - Yang Zhang
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Clinical Medical College of Nanchang University, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Jisheng Zhu
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Clinical Medical College of Nanchang University, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Yong Li
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Clinical Medical College of Nanchang University, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Yuanpeng Xiong
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Clinical Medical College of Nanchang University, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Zemin Hu
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), No. 2, Sunwen East Road, Shiqi District, Zhongshan City, 528400, Guangdong Province, China
| | - Peng Peng
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), No. 2, Sunwen East Road, Shiqi District, Zhongshan City, 528400, Guangdong Province, China
| | - Yongzhu He
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Clinical Medical College of Nanchang University, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang City, 330006, Jiangxi Province, China.
| | - Liping Liu
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology), No. 1017, Dongmen North Road, Luohu District, Shenzhen City, 518020, Guangdong Province, China.
| | - Kun He
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), No. 2, Sunwen East Road, Shiqi District, Zhongshan City, 528400, Guangdong Province, China.
| | - Wei Shen
- Department of General Surgery, The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, No.1 Minde Road, Donghu District, Nanchang City, 330006, Jiangxi Province, China.
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Luo L, Shan R, Cui L, Wu Z, Qian J, Tu S, Zhang W, Xiong Y, Lin W, Tang H, Zhang Y, Zhu J, Huang Z, Li Z, Mao S, Li H, Hu Z, Peng P, He K, Li Y, Liu L, Shen W, He Y. Postoperative adjuvant transarterial chemoembolisation improves survival of hepatocellular carcinoma patients with microvascular invasion: A multicenter retrospective cohort. United European Gastroenterol J 2023; 11:228-241. [PMID: 36905230 PMCID: PMC10039794 DOI: 10.1002/ueg2.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/30/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND We aimed to investigate the efficacy of postoperative adjuvant transarterial chemoembolisation (PA-TACE) in patients with hepatocellular carcinoma (HCC) complicated by microvascular invasion (MVI). METHODS A retrospective analysis of 1505 patients with HCC who underwent hepatectomy at four medical centers, including 782 patients who received PA-TACE and 723 patients who did not receive adjuvant PA-TACE, has been conducted. Propensity score matching (PSM) (1:1) was performed on the data to minimise selection bias, which resulted in a balanced clinical profile between groups. RESULTS After PSM, 620 patients who received PA-TACE and 620 patients who did not receive PA-TACE were included. Disease-free survival (DFS, 1-, 2-, and 3-year: 88%-68%-61% vs. 70%-58%-51%, p < 0.001) and overall survival (OS, 1-, 2-, and 3-year: 96%-89%-82% vs. 89%-77%-67%, p < 0.001) were significantly higher in patients who received PA-TACE than in those who did not. Patients with MVI who received PA-TACE had significantly higher DFS (1-, 2-, and 3-year: 68%-57%-48% vs. 46%-31%-27%, p < 0.001) and OS (1-, 2-, and 3-year: 96%-84%-77% vs. 79%-58%-40%, p < 0.001) than those who did not receive PA-TACE. Among the six different liver cancer stages, MVI-negative patients did not have significant survival outcomes from PA-TACE (p > 0.05), whereas MVI-positive patients achieved higher DFS and OS from it (p < 0.05). Liver dysfunction, fever, and nausea/vomiting were the most common adverse events in patients receiving PA-TACE. There was no significant difference in grade 3 or 4 adverse events between the groups (p > 0.05). CONCLUSIONS Postoperative adjuvant transarterial chemoembolisation has a good safety profile and may be a potentially beneficial treatment modality for survival outcomes in patients with HCC, especially those with concomitant MVI.
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Affiliation(s)
- Laihui Luo
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Renfeng Shan
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Lifeng Cui
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen City, Guangdong Province, China
- Maoming People's Hospital, Maoming, China
| | - Zhao Wu
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Junlin Qian
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Shuju Tu
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - WenJian Zhang
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Yuanpeng Xiong
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Wei Lin
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Hongtao Tang
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Yang Zhang
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Jisheng Zhu
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Zeyu Huang
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Zhigang Li
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Shengping Mao
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Hui Li
- School of Public Health, Nanchang University, Nanchang, China
| | - Zemin Hu
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Peng Peng
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Kun He
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
| | - Yong Li
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Liping Liu
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen City, Guangdong Province, China
| | - Wei Shen
- Department of General Surgery, the Second Affiliated Hospital of Nanchang University (The Second Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
| | - Yongzhu He
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, The First Affiliated Hospital of Nanchang University (The First Clinical Medical College of Nanchang University), Nanchang City, Jiangxi Province, China
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan City, Guangdong Province, China
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Xu JX, Qin SL, Wei HW, Chen YY, Peng YC, Qi LN. Down-regulation of ALDOB during metabolic reprogramming mediates malignant behavior in hepatocellular carcinoma and insensitivity to postoperative adjuvant transarterial chemoembolization. Clin Sci (Lond) 2023; 137:303-316. [PMID: 36749124 DOI: 10.1042/cs20220661] [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: 10/12/2022] [Revised: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Postoperative transarterial chemoembolization (PA-TACE) is an effective adjuvant therapy for preventing early postoperative recurrence of hepatocellular carcinoma (HCC); however, many patients are insensitive to it. Therefore, the present study aimed to explore the in-depth reasons for PA-TACE resistance and provide a reliable basis for selecting patients who will benefit the most from PA-TACE. METHODS The unique gene expression profiles of primary tumors from PA-TACE-sensitive or -insensitive patients were analyzed using microarray data. Combined differential expression analysis, gene set enrichment analysis (GSEA), and weighted correlation network analysis (WGCNA) were used to screen for potential drivers of PA-TACE insensitivity. The expression of ALDOB was silenced or overexpressed in hepatoma cell lines, and changes in glycolytic activity, cycle, apoptosis, and malignant biological phenotypes were observed under normoxia and hypoxia. Finally, an animal model was constructed to verify the effects of ALDOB dysregulation on the tumorigenic ability of HCC cells in vivo. RESULTS The inhibition of ALDOB promoted the up-regulation of Ki67 expression, and glycolytic activity was significantly enhanced. Moreover, the proliferation, invasion, and migration capabilities were increased in HCC cells and even worse in hypoxia. This advantage of malignant behavior was also validated using in vivo models. CONCLUSION Down-regulation of ALDOB may underlie the metabolic reprogramming observed in HCC by promoting the malignant behavior of HCC cells. Hypoxia and ALDOB down-regulation acted additively, which was closely related to PA-TACE insensitivity. The use of ALDOB and Ki67 as a combined marker has the potential to identify the 'PA-TACE beneficiary population'.
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Affiliation(s)
- Jing-Xuan Xu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Province, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, Guangxi Province, China
| | - Shui-Lin Qin
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Province, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, Guangxi Province, China
| | - Hao-Wen Wei
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Province, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, Guangxi Province, China
| | - Yuan-Yuan Chen
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Yu-Chong Peng
- Department of General Surgery, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, Chongqing, China
| | - Lu-Nan Qi
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Province, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, Guangxi Province, China
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning 530021, Guangxi Province, China
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Feng GY, Shi ZR, Zhao YF, Chen K, Tao J, Wei XF, Cheng Y. Therapeutic effect of postoperative adjuvant transcatheter arterial chemoembolization based on the neutrophil-to-lymphocyte ratio. Front Surg 2023; 9:1072451. [PMID: 36684128 PMCID: PMC9852644 DOI: 10.3389/fsurg.2022.1072451] [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: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023] Open
Abstract
Aim To evaluate the feasibility of the preoperative neutrophil-to-lymphocyte ratio (NLR) as an index to guide postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) in patients with liver cancer. Methods We recruited a total of 166 patients with liver cancer who underwent surgery alone or surgery plus PA-TACE between January 2013 and June 2017 and compared the 1, 2, and 3-year recurrence-free survival (RFS) and overall survival (OS) between patients with high and low NLRs, surgery and surgery plus PA-TACE groups, and relevant subgroups using the Kaplan-Meier method. We also evaluated the independent factors affecting the prognosis of liver cancer after surgery using a Cox risk ratio model and correlation between NLR levels and high-risk recurrence factors of liver cancer with logistic regression analysis. Results The 1, 2, and 3-year RFS rates were all significantly higher in the low-NLR group compared to the high-NLR group (P < 0.05). However, the 1, 2, and 3-year OS rates were similar in the low- and high-NLR groups (P > 0.05). After propensity score matching, the 1, 2, and 3-year RFS and OS rates were significantly better in patients treated with surgery plus PA-TACE compared with surgery alone (P < 0.05). The 1, 2, and 3-year RFS and OS rates were also significantly better in the surgery plus PA-TACE subgroup compared with the surgery-alone subgroup in the high-NLR group (P < 0.05), but there was no significant difference in RFS or OS between the surgery plus PA-TACE and surgery-alone subgroups at 1, 2, and 3 years in the low-NLR group (P > 0.05). Multivariate analysis in the high-NLR group showed that a poorly differentiated or undifferentiated tumor was an independent risk factor for postoperative RFS. Multiple tumors were an independent risk factor for postoperative OS (P < 0.05), while PA-TACE was an independent protective factor for postoperative RFS and OS (P < 0.05). In the low-NLR group, AFP > 400 µg/L was an independent risk factor for postoperative OS (P < 0.05). Multivariate logistic regression indicated that patients with a maximum tumor diameter of >5 cm were at increased risk of having high NLR levels compared to patients with a maximum tumor diameter of <5 cm (P < 0.05). Conclusion PA-TACE can improve the prognosis of patients with a high preoperative NLR (≥2.5), but has no obvious benefit in patients with low preoperative NLR (<2.5). This may provide a reference for clinical selection of PA-TACE.
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Affiliation(s)
- Guo-Ying Feng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Zheng-Rong Shi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-Fei Zhao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Tao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu-Fu Wei
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Cheng
- Nursing Department, University-Town Hospital of Chongqing Medical University, Chongqing, China
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Xia Z, Zhao Y, Zhao H, Zhang J, Liu C, Lu W, Wang L, Chen K, Yang J, Zhu J, Zhao W, Shen A. Serum alanine aminotransferase to hemoglobin ratio and radiological features predict the prognosis of postoperative adjuvant TACE in patients with hepatocellular carcinoma. Front Oncol 2022; 12:989316. [PMID: 36185225 PMCID: PMC9523401 DOI: 10.3389/fonc.2022.989316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the prognostic value of radiological features and serum indicators in patients treated with postoperative adjuvant transarterial chemoembolization (PA-TACE) and develop a prognostic model to predict the overall survival (OS) of patients with hepatocellular carcinoma (HCC) treated with PA-TACE. Method We enrolled 112 patients (75 in the training cohort and 37 in the validation cohort) with HCC treated with PA-TACE after surgical resection at the Affiliated Hospital of Nantong University between January 2012 and June 2015. The independent OS predictors were determined using univariate and multivariate regression analyses. Decision curve analyses and time-dependent receiver operating characteristic curve analysis was used to verify the prognostic performance of the different models; the best model was selected to establish a multi-dimensional nomogram for predicting the OS of HCC patients treated with PA-TACE. Result Multivariate regression analyses indicated that rim-like arterial phase enhancement (IRE), peritumor capsule (PTC), and alanine aminotransferase to hemoglobin ratio (AHR) were independent predictors of OS after PA-TACE. The combination of AHR had the best clinical net benefit and we constructed a prognostic nomogram based on IRE, PTC, and AHR. The calibration curve showed good fit between the predicted nomogram’s curve and the observed curve. Conclusion Our preliminary study confirmed the prognostic value of AHR, PTC, and IRE and established a nomogram that can predict the OS after PA-TACE treatment in patients with HCC.
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Affiliation(s)
- Zicong Xia
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Yulou Zhao
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Hui Zhao
- Department of Interventional Radiology, Afiliated Hospital of Nantong University, Nantong, China
| | - Jing Zhang
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Cheng Liu
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Wenwu Lu
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Lele Wang
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Kang Chen
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Junkai Yang
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Jiahong Zhu
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Wenjing Zhao
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
- *Correspondence: Aiguo Shen, ; Wenjing Zhao,
| | - Aiguo Shen
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
- *Correspondence: Aiguo Shen, ; Wenjing Zhao,
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Sun A, Chen S, Lin M, Zhou D, Zhang H, Sun C, Wang P. Efficacy of TACE+Radiofrequency Ablation+Sorafenib in the Treatment of Patients with Recurrent Liver Cancer and Construction of Prediction Model. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6879035. [PMID: 36118840 PMCID: PMC9473901 DOI: 10.1155/2022/6879035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 02/05/2023]
Abstract
Objective This study is aimed at exploring the efficacy of transarterial chemotherapy embolization (TACE)+radiofrequency ablation+sorafenib in the treatment of patients with recurrent liver cancer and at constructing its prediction model. Methods A total of 60 patients with recurrent liver cancer treated in our hospital from March 2020 to March 2022 were enrolled and divided into two groups according to treatment methods, with 30 patients in each group. Group A adopted TACE+radiofrequency ablation+sorafenib therapy while group B adopted TACE+radiofrequency ablation therapy. Clinical efficacy, complications, and adverse reactions of the two groups were observed. A total of 30 patients with nonrecurrent liver cancer in the same period were enrolled. 60 patients with recurrent liver cancer and 30 patients with nonrecurrent liver cancer were taken as the recurrence group and the nonrecurrence group, respectively. The baseline data and clinical data of the patients were queried by the Hospital Information System. The data included age, gender, Child-Pugh grade, HBV/HCV infection, portal vein tumor thrombus, degree of differentiation, vascular invasion, serum alpha fetal protein (AFP) level, number of tumors, maximum diameter of tumors, and number of nodules. The logistic regression analysis was used to analyze the independent risk factors for liver cancer recurrence. The Hosmer-Lemeshow test was used to analyze the degree of fitting between the prediction model and the standard curve. The ROC curve was used to analyze the predictive value of the model for liver cancer recurrence. Results The objective effective rate and disease control rate in group A (33.33% and 70.00%) were higher than those in group B (10.00% and 43.33%), and the differences were statistically significant (both P < 0.05). There were no significant differences in the incidence of complications such as embolism syndrome, hand and foot skin reaction, gastrointestinal reaction, hypertension, diaphragmatic injury and bleeding, and biliary leakage and fever between the two groups (all P > 0.05). The proportions of patients in the recurrence group with portal vein tumor thrombus (PVTT), medium and high degree of differentiation, combined with vascular invasion, serum AFP level ≥ 400 ng/dL, multiple tumors, maximum tumor diameter ≥ 5 cm, combined with cirrhosis, and polynodules were all higher than those in the nonrecurrence group; the differences were statistically significant (all P < 0.05). Complication of PVTT, the degree of medium and high differentiation, and the maximum tumor diameter ≥ 5 cm were independent risk factors for recurrence of liver cancer (all P < 0.05). The prediction model of liver cancer recurrence was obtained by multiple regression analysis, P = 1/[1 + e -(-5.441 + 6.154∗PVTT + 3.475∗differentiateddegree + 3.001∗maximumdiameteroftumor)]. The Hosmer-Lemeshow test showed that χ 2 = 1.558 (P = 0.992). According to the ROC curve analysis, the AUC, SE, and 95% CI value of the prediction model for liver cancer recurrence were 0.977, 0.012, and 0.953-1.000, respectively. Conclusion TACE+radiofrequency ablation+sorafenib is effective in the treatment of recurrent liver cancer, and the prediction model established based on the risk factor has high predictive value for patients with recurrent liver cancer.
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Affiliation(s)
- Aimin Sun
- Department of Oncology, Qingdao Chengyang District People's Hospital, Qingdao, Shandong 226001, China
| | - Shumei Chen
- Department of Outpatient, Qingdao Chengyang District People's Hospital, Qingdao, Shandong 226001, China
| | - Minggang Lin
- Department of Oncology, Qingdao Chengyang District People's Hospital, Qingdao, Shandong 226001, China
| | - Dapeng Zhou
- Department of Interventional Medicine, Qingdao University, Qingdao, Shandong 226001, China
| | - Hongyan Zhang
- Department of Oncology, Qingdao Chengyang District People's Hospital, Qingdao, Shandong 226001, China
| | - Cheng Sun
- Department of Oncology, Qingdao Chengyang District People's Hospital, Qingdao, Shandong 226001, China
| | - Pan Wang
- Department of 3D Medical Printing Center, Qingdao Chengyang District People's Hospital, Qingdao Shandong 226001, China
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Bao D, Yang Z, Chen S, Li K, Hu Y. Construction of a Nomogram Model for Predicting Peritoneal Dissemination in Gastric Cancer Based on Clinicopathologic Features and Preoperative Serum Tumor Markers. Front Oncol 2022; 12:844786. [PMID: 35719995 PMCID: PMC9198602 DOI: 10.3389/fonc.2022.844786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background Peritoneal dissemination (PD) is the most common mode of metastasis for advanced gastric cancer (GC) with poor prognosis. It is of great significance to accurately predict preoperative PD and develop optimal treatment strategies for GC patients. Our study assessed the diagnostic potential of serum tumor markers and clinicopathologic features, to improve the accuracy of predicting the presence of PD in GC patients. Methods In our study, 1264 patients with GC at Fudan University Shanghai Cancer Center and Wenzhou people’s hospital from 2018 to 2020 were retrospectively analyzed, including 316 cases of PD and 948 cases without PD. All patients underwent enhanced CT scan or magnetic resonance imaging (MRI) before surgery and treatment. Clinicopathological features, including tumor diameter and tumor stage (depth of tumor invasion, nearby lymph node metastasis and distant metastasis), were obtained by imaging examination. The independent risk factors for PD were screened through univariate and multivariate logistic regression analyses, and the results were expressed with 95% confidence intervals (CIs). A model of PD diagnosis and prediction was established by using Cox proportional hazards regression model of training set. Furthermore, the accuracy of the prediction model was verified by ROC curve and calibration plots. Results Univariate analysis showed that PD in GC was significantly related to tumor diameter (odds ratio (OR)=12.06, p<0.0006), depth of invasion (OR=14.55, p<0.0001), lymph node metastases (OR=5.89, p<0.0001), carcinoembryonic antigen (CEA) (OR=2.50, p<0.0001), CA125 (OR=11.46, p<0.0001), CA72-4 (OR=4.09, p<0.0001), CA19-9 (OR=2.74, p<0.0001), CA50 (OR=5.20, p<0.0001) and CA242 (OR=3.83, p<0.0001). Multivariate analysis revealed that clinical invasion depth and serum marker of CA125 and CA72-4 were independent risk factors for PD. The prediction model was established based on the risk factors using the R program. The area under the curve (AUC) of the receiver operating characteristics (ROC) was 0.931 (95% CI: 0.900–0.960), with the accuracy, sensitivity and specificity values of 90.5%, 86.2% and 82.2%, respectively. Conclusion The nomogram model constructed using CA125, CA72-4 and depth of invasion increases the accuracy and sensitivity in predicting the incidence of PD in GC patients and can be used as an important tool for preoperative diagnosis.
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Affiliation(s)
- Dandan Bao
- Department of General Surgery, The Third Clinical Institute Affiliated to Wenzhou Medical University, The Third Affiliated hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, China
| | - Zhangwei Yang
- Department of General Surgery, The Third Clinical Institute Affiliated to Wenzhou Medical University, The Third Affiliated hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, China
| | - Senrui Chen
- Department of General Surgery, The Third Clinical Institute Affiliated to Wenzhou Medical University, The Third Affiliated hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, China
| | - Keqin Li
- Department of General Surgery, The Third Clinical Institute Affiliated to Wenzhou Medical University, The Third Affiliated hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, China
| | - Yiren Hu
- Department of General Surgery, The Third Clinical Institute Affiliated to Wenzhou Medical University, The Third Affiliated hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, China.,Department of General Surgery, Medical College of Soochow University, Soochow, China
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