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Chang YC, Yen KC, Liang PC, Ho MC, Ho CM, Hsiao CY, Hsiao CH, Lu CH, Wu CH. Automated liver volumetry and hepatic steatosis quantification with magnetic resonance imaging proton density fat fraction. J Formos Med Assoc 2024:S0929-6646(24)00212-2. [PMID: 38643056 DOI: 10.1016/j.jfma.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Preoperative imaging evaluation of liver volume and hepatic steatosis for the donor affects transplantation outcomes. However, computed tomography (CT) for liver volumetry and magnetic resonance spectroscopy (MRS) for hepatic steatosis are time consuming. Therefore, we investigated the correlation of automated 3D-multi-echo-Dixon sequence magnetic resonance imaging (ME-Dixon MRI) and its derived proton density fat fraction (MRI-PDFF) with CT liver volumetry and MRS hepatic steatosis measurements in living liver donors. METHODS This retrospective cross-sectional study was conducted from December 2017 to November 2022. We enrolled donors who received a dynamic CT scan and an MRI exam within 2 days. First, the CT volumetry was processed semiautomatically using commercial software, and ME-Dixon MRI volumetry was automatically measured using an embedded sequence. Next, the signal intensity of MRI-PDFF volumetric data was correlated with MRS as the gold standard. RESULTS We included the 165 living donors. The total liver volume of ME-Dixon MRI was significantly correlated with CT (r = 0.913, p < 0.001). The fat percentage measured using MRI-PDFF revealed a strong correlation between automatic segmental volume and MRS (r = 0.705, p < 0.001). Furthermore, the hepatic steatosis group (MRS ≥5%) had a strong correlation than the non-hepatic steatosis group (MRS <5%) in both volumetric (r = 0.906 vs. r = 0.887) and fat fraction analysis (r = 0.779 vs. r = 0.338). CONCLUSION Automated ME-Dixon MRI liver volumetry and MRI-PDFF were strongly correlated with CT liver volumetry and MRS hepatic steatosis measurements, especially in donors with hepatic steatosis.
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Affiliation(s)
- Yuan-Chen Chang
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taiwan
| | - Kuang-Chen Yen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taiwan
| | - Ming-Chih Ho
- Departments of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Center for Functional Image and Interventional Image, National Taiwan University, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Cheng-Maw Ho
- Departments of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Yang Hsiao
- Departments of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chiu-Han Hsiao
- Research Center for Information Technology Innovation, Academia Sinica, Taiwan
| | - Chia-Hsun Lu
- Department of Radiology, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Horng Wu
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taiwan; Hepatits Research Center, National Taiwan University Hospital, Taipei, Taiwan; Center of Minimal-Invasive Interventional Radiology, National Taiwan University Hospital, Taipei, Taiwan.
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Hsiao CY, Ren Y, Chng E, Tai D, Huang KW. Potential of using qFibrosis analysis to predict recurrent and survival outcome of patients with hepatocellular carcinoma after hepatic resection. Oncology 2024:000538456. [PMID: 38527441 DOI: 10.1159/000538456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND There remains a lack of studies addressing the stromal background and fibrosis features and its prognostic value in liver cancer. qFibrosis can identify, quantify and visualize the fibrosis features from biopsy samples. In this study, we aim to demonstrate the prognostic value of histological features by using qFibrosis analysis in liver cancer patients. METHODS Liver specimen from 201 patients with hepatocellular carcinoma underwent curative resection were imaged and assessed using qFibrosis system, and generated a total of 33 and 156 collagen parameters from tumor part and non-tumor liver tissue, respectively. We used these collagen parameters on patients to build two combined indexes, RFS-index and OS-index, in order to differentiate patients with early recurrence and early death, respectively. The models were validated using leave-one-out method. RESULTS Both combined indexes had significant prediction value of patients' outcome. The RFS-index of 0.52 well differentiates patients with early recurrence (p < 0.001), and the OS-index of 0.73 well differentiates patients with early death during follow-up (p = 0.02). CONCLUSIONS Combined index calculated with qFibrosis from digital readout of fibrotic status of peri-tumor liver specimen in patients with HCC have prediction values for their disease and survival outcomes. These results demonstrated the potentials to transform histopathological features into quantifiable data that could be used to correlate with clinical outcome.
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Hsiao CY, Lu CY, Su HJ, Huang KW. Plasma Cell-Free Adenomatous Polyposis Coli Gene Promoter Methylation as a Prognostic Biomarker for Hepatocellular Carcinoma. Oncology 2024:000538455. [PMID: 38527449 DOI: 10.1159/000538455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is a leading cause of cancer death worldwide. Lack of biomarkers for follow-up after treatment is a clinical challenge. DNA methylation has been proposed to be a potential biomarker in HCC. However, there is still lacking of evidence of its clinical use. This study aims to evaluate the value of using plasma Adenomatous Polyposis Coli promoter methylation level (APC-MET) as a potential biomarker in HCC treatment. METHOD A total of 96 patients with HCC at BCLC stage B underwent local tumor ablation treatment were prospectively included in this study. APC-MET was examined from the plasma of each patient before and 1 months after treatment. The prediction value of APC-MET for survival outcome and disease status after treatment were analyzed, and adjusted with alpha-fetoprotein and protein induced by vitamin K absence-II using cox regression analysis. RESULTS Univariate cox regression analysis showed preoperative APC-MET >0 (HR, 2.9, 95% CI 1.05-8.05, p=0.041) and postoperative APC-MET >0 (HR, 3.47, 95% CI 1.16-10.4, p=0.026) were both predictors of death, and preoperative APC-MET >0 was a predictor of disease progression after treatment (HR, 2.04, 95% CI 1.21-3.44, p=0.007). In multivariate models, pre-op APC-MET >0 was a significant predictor of disease progression after adjusting with other two traditional biomarkers (HR, 1.82, 95% CI 1.05-3.17, p=0.034). CONCLUSIONS Hypermethylation of APC promoter appears to be a potential biomarker that could predict patient survival and disease progression outcome in patients with intermediate stage HCC after local ablation treatment.
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Hsiao CY, Ho CM, Ho MC, Cheng HY, Wu YM, Lee PH, Hu RH. Risk factors, patterns, and outcome predictors of late recurrence in patients with hepatocellular carcinoma after curative resection: A large cohort study with long-term follow-up results. Surgery 2024:S0039-6060(24)00069-2. [PMID: 38519406 DOI: 10.1016/j.surg.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Late recurrence of hepatocellular carcinoma after curative resection significantly influences long-term patient survival outcomes, and yet it remains understudied. This study aims to explore the risk factors and patterns of late recurrence and predictors of subsequent outcome. METHODS This single-center retrospective study analyzed 1,701 consecutive patients who achieved a disease-free survival period exceeding 2 years after curative resection for hepatocellular carcinoma between 2001 and 2018. Univariate and multivariate analyses of factors associated with late recurrence and death after recurrence were conducted using Cox's models. RESULTS The mean age of patients was 60.2 years, with 76.8% being male. During a median follow-up of 8.1 years, 653 patients (38.4%) experienced late recurrence, with median time to recurrence being 4.0 years (interquartile range, 2.7-6.0). Factors such as age >60, chronic hepatitis C, cirrhosis, high albumin-bilirubin grade, absence of family history, multiple tumors, satellite nodules, alpha-fetoprotein levels <400 ng/mL, and minor hepatic resection were identified as risk factors for late recurrence. Among patients with late recurrence, 131 (20.1%) underwent surgical treatment, 272 (41.7%) received radiofrequency ablation, and 27 (4.1%) exhibited extrahepatic lesions. A higher-high albumin-bilirubin grade, recurrent tumor >3 cm, and nonsurgical treatment emerged as predictors of death after late recurrence. CONCLUSION Over one-third of patients who remain disease-free for more than 2 years postresection will experience late recurrence during subsequent follow-up. For 2-year disease-free survivors, risk factors for late recurrence differ from early recurrence. Treating underlying hepatitis is of paramount importance, given its association with both the risk of late recurrence and survival outcomes post-recurrence.
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Affiliation(s)
- Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu County, Taiwan
| | - Hou-Ying Cheng
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Surgery, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
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Hsiao YW, Hsiao CY, Huang J, Lai PS, Chen PY. Surgical Outcomes and Quality of Care Among Adult Appendicitis Patients: A Comparative Study of Tertiary Care Hospitals and Regional Hospitals. World J Surg 2023; 47:3149-3158. [PMID: 37851067 DOI: 10.1007/s00268-023-07219-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Acute appendicitis is one of the most common abdominal emergencies, with management approaches that vary depending on the available resources and setting. However, there is a lack of studies on the differences of surgical outcomes and quality of care between tertiary care hospitals and regional hospitals. METHODS This multicenter retrospective study included 2158 consecutive adult patients between January 2014 and June 2018 at three hospitals. The patient cohort was divided into regional hospital group (N = 1223) and tertiary care hospital group (N = 935). Baseline characteristics and perioperative outcomes were compared, and factors associated with surgical delay and postoperative complication were investigated. RESULTS Patients in tertiary care hospital group had longer surgical waiting time (17.3 vs. 12.0 h, p < 0.001), higher risks of surgical delay exceeding 24 h (OR = 2.94, 95% CI 2.17-4.01, p < 0.001), longer operation time (64 vs. 50 min, p < 0.001), more appendix perforation (22.4 vs. 13.3%, p < 0.001), and higher hospital cost compared with regional hospital group. In multivariate analysis, factors associated with surgical delay were tertiary care hospital (OR = 2.94, 95% CI 2.18-4.01, p < 0.001) and delay diagnosis (OR = 18.7, 95% CI 11.7-30.1, p < 0.001), while those associated with postoperative complications were older age (OR = 1.02, 95% CI 1.00-1.04, p = 0.013), male sex (OR = 2.38, 95% CI 1.11-5.52, p = 0.031), surgical delay (OR = 2.99, 95% CI 1.30-6.47, p = 0.007), and appendix perforation (OR = 5.61, 95% CI 2.72-11.85, p < 0.001). CONCLUSIONS Patients at tertiary care hospitals had longer waiting time, more surgical delays, and appendix perforations, and these were risk factors of postoperative complications. Establishing an effective referral system to redirect appendicitis patients with less complex medical histories from tertiary care hospitals to regional hospitals may enhance the quality of patient care and outcomes, while also reducing medical costs.
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Affiliation(s)
- Ya-Wen Hsiao
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhongzheng District, Taipei, Taiwan
| | - Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhongzheng District, Taipei, Taiwan.
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - John Huang
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhongzheng District, Taipei, Taiwan
| | - Peng-Sheng Lai
- Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan
| | - Po-Yen Chen
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu County, Taiwan
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Lu CY, Hsiao CY, Peng PJ, Huang SC, Chuang MR, Su HJ, Huang KW. DNA Methylation Biomarkers as Prediction Tools for Therapeutic Response and Prognosis in Intermediate-Stage Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:4465. [PMID: 37760434 PMCID: PMC10527266 DOI: 10.3390/cancers15184465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Alfa-fetoprotein (AFP), as the main serum tumor marker of hepatocellular carcinoma (HCC), is limited in terms of specificity and ability to predict outcomes. This study investigated the clinical utility of DNA methylation biomarkers to predict therapeutic responses and prognosis in intermediate-stage HCC. METHODS This study enrolled 72 patients with intermediate-stage HCC who underwent locoregional therapy (LRT) between 2020 and 2021. The immediate therapeutic response and disease status during a two-year follow-up were recorded. Analysis was performed on 10 selected DNA methylation biomarkers via pyrosequencing analysis of plasma collected before and after LRT. RESULTS Analysis was performed on 53 patients with complete responses and 19 patients with disease progression after LRT. The mean follow-up duration was 2.4 ± 0.6 years. A methylation prediction model for tumor response (MMTR) and a methylation prediction model for early progression (MMEP) were constructed. The area under the curve (AUC) for sensitivity and specificity of MMTR was 0.79 for complete response and 0.759 for overall survival. The corresponding AUCs for sensitivity and specificity of AFP and protein induced by vitamin K absence-II (PIVKA-II) were 0.717 and 0.708, respectively. Note that the MMTR index was the only significant predictor in multivariate analysis. The AUC for sensitivity and specificity of the MMEP in predicting early progression was 0.79. The corresponding AUCs for sensitivity and specificity of AFP and PIVKA-II were 0.758 and 0.714, respectively. Multivariate analysis revealed that platelet count, beyond up-to-7 criteria, and the MMEP index were strongly correlated with early tumor progression. Combining the indexes and serum markers further improved the predictive accuracy (AUC = 0.922). Multivariate analysis revealed the MMEP index was the only independent risk factor for overall survival. DISCUSSION/CONCLUSIONS This study indicates that these methylation markers could potentially outperform current serum markers in terms of accuracy and reliability in assessing treatment response and predicting outcomes. Combining methylation markers and serum markers further improved predictive accuracy, indicating that a multi-marker approach may be more effective in clinical practice. These findings suggest that DNA methylation biomarkers may be a useful tool for managing intermediate-stage HCC patients and guiding personalized treatment, particularly for those who are at high risk for close surveillance or adjuvant treatment after LRT.
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Affiliation(s)
- Chang-Yi Lu
- Phalanx Biotech Group, Hsinchu 300, Taiwan; (C.-Y.L.); (S.-C.H.); (H.-J.S.)
| | - Chih-Yang Hsiao
- Department of Surgery and Hepatitis Research Center, National Taiwan University Hospital, Taipei 100, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Traumatology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Pey-Jey Peng
- Phalanx Biotech Group, Hsinchu 300, Taiwan; (C.-Y.L.); (S.-C.H.); (H.-J.S.)
| | - Shao-Chang Huang
- Phalanx Biotech Group, Hsinchu 300, Taiwan; (C.-Y.L.); (S.-C.H.); (H.-J.S.)
| | - Meng-Rong Chuang
- Phalanx Biotech Group, Hsinchu 300, Taiwan; (C.-Y.L.); (S.-C.H.); (H.-J.S.)
| | - Hung-Ju Su
- Phalanx Biotech Group, Hsinchu 300, Taiwan; (C.-Y.L.); (S.-C.H.); (H.-J.S.)
| | - Kai-Wen Huang
- Department of Surgery and Hepatitis Research Center, National Taiwan University Hospital, Taipei 100, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Center for Functional Image and Interventional Therapy, National Taiwan University, Taipei 100, Taiwan
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Cheng HY, Hu RH, Hsiao CY, Ho MC, Wu YM, Lee PH, Ho CM. Hepatitis C treatment and long-term outcome of patients with hepatocellular carcinoma after resection. J Gastroenterol Hepatol 2023; 38:1618-1628. [PMID: 37402607 DOI: 10.1111/jgh.16276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/28/2023] [Accepted: 06/15/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND AIM This study aimed to investigate the survival outcomes of antiviral agents (direct-acting antivirals [DAAs] or interferon [IFN]) in patients with hepatitis C virus who underwent liver resection for primary hepatocellular carcinoma. METHODS This retrospective single-center study included 247 patients, between 2013 and 2020, being treated with DAAs (n = 93), IFN (n = 73), or no treatment (n = 81). Overall survival (OS), recurrence-free survival (RFS), and risk factors were analyzed. RESULTS After a median follow-up time of 50.4 months, the rates of 5-year OS and RFS in the IFN, DAA, and no treatment groups were 91.5% and 55.4%, 87.2% and 39.8%, and 60.9% and 26.7%, respectively. One hundred and twenty-eight (51.6%) patients developed recurrence; recurrence was mostly (86.7%) intrahepatic, and 58 (23.4%) developed early recurrence, most of which received no antiviral treatment. The OS and RFS were similar between patients who received antiviral treatment before (50.0%) and after surgery, but longer survival was observed in patients achieving sustained virologic response. In multivariate analysis, antiviral treatment was protective for OS (hazard ratio [HR] 0.475, 95% confidence interval [CI]: 0.242-0.933) with significance but not RFS, in contrast to microvascular invasion (OS HR 3.389, 95% CI: 1.637-7.017; RFS HR 2.594, 95% CI: 1.520-4.008). In competing risk analysis, DAAs (subdistribution HR 0.086, 95% CI: 0.007-0.991) were protective against hepatic decompensation events but not recurrence events. CONCLUSION In patients with hepatitis C virus, antiviral treatment suggested OS benefit for primary hepatocellular carcinoma after resection, and DAAs might be protective against hepatic decompensation. Following adjustment for oncological factors, IFN and DAA treatment was not significantly advantageous relative to the other.
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Affiliation(s)
- Hou-Ying Cheng
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Cheng HY, Hu RH, Hsiao CY, Ho MC, Wu YM, Lee PH, Ho CM. Viral Status and Treatment Efficacy in Recurrent Hepatocellular Carcinoma After Primary Resection. J Gastrointest Surg 2023; 27:1594-1610. [PMID: 37231242 DOI: 10.1007/s11605-023-05691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/22/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The impact of viral background on long-term effectiveness of different treatment modalities for recurrent hepatocellular carcinoma (HCC) was not fully analyzed. METHOD Consecutive 726 patients who developed intrahepatic recurrence after primary hepatectomy for HCC between 2008 and 2015 were retrospectively studied. Post-recurrence survival (PRS) and rerecurrence-free survival (R-RFS) and risk factors were analyzed. RESULTS After a median follow-up period of 56 months, the 5-year PRS rates of the patients who underwent rehepatectomy, radiofrequency ablation (RFA), and transarterial chemoembolization (TACE) were 79.4%, 83.0%, and 54.6%, respectively. The treatment benefit for PRS was consistently observed in patients with hepatitis B virus (HBV) and non-B, non-C subgroups, but not hepatitis C virus (HCV). For patients with late recurrence of HCC, R-RFS was superior in HBV subgroup and HCV subgroup which received antiviral treatment (compared to naïve HCV subgroup). Survival difference triaged by viral status was lost in the counterpart with early recurrence. Overall, RFA improved PRS and R-RFS in patients receiving antiviral treatment. CONCLUSION To achieve long-term survival after HCC recurrence, rehepatectomy and RFA were comparably effective, particularly among those with HBV. Antiviral treatment complemented survivals of patients with HCV after RFA, particularly in late first recurrence.
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Affiliation(s)
- Hou-Ying Cheng
- Department of Surgery, National Taiwan University Hospital and College of Medicine, 7, Chung-Shan S. Road, Taipei, 10002, Taiwan
- Department of Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, 7, Chung-Shan S. Road, Taipei, 10002, Taiwan
| | - Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital and College of Medicine, 7, Chung-Shan S. Road, Taipei, 10002, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital and College of Medicine, 7, Chung-Shan S. Road, Taipei, 10002, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, 7, Chung-Shan S. Road, Taipei, 10002, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital and College of Medicine, 7, Chung-Shan S. Road, Taipei, 10002, Taiwan
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital and College of Medicine, 7, Chung-Shan S. Road, Taipei, 10002, Taiwan.
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Cheng HY, Ho CM, Hsiao CY, Ho MC, Wu YM, Lee PH, Hu RH. Interval dynamics of transplantability for hepatocellular carcinoma after primary curative resection: risk factors for nontransplantable recurrence. HPB (Oxford) 2023; 25:218-228. [PMID: 36376221 DOI: 10.1016/j.hpb.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/07/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND To investigate the changes in transplantability between primary and recurrent Hepatocellular carcinoma (HCC) after hepatic resection (HR) and the risk factors for nontransplantable recurrence (NTR). METHODS Consecutive 3122 patients who received HR for primary HCC between 2001 and 2019 were analyzed for changes in transplantability. Predictors of survival and NTR were evaluated using a competing risk analysis. RESULTS After a median follow-up of 78.3 months, the 5-year overall survival rate was 82.6%. Also, 58.2% of them developed recurrence after a median of 45.6 months. Recurrence occurred in 1205 and 611 patients with primary transplantable and nontransplantable HCC, respectively, of whom 26.1% and 63.2%, respectively, had NTR. Tumor diameter >3 cm [subdistribution hazard ratios (95% CI), 2.00 (1.62-2.48)], major resection [1.20 (1.00-1.43)], pathological grade >2 [1.28 (1.07-1.52)], microvascular invasion [1.74 (1.45-2.08)], and early recurrence (<1 year) [9.22 (7.83-10.87)] were associated with NTR. The overall transplantable pool increased from 72.3% to 77.5%. CONCLUSION Microvascular invasion and early recurrence were risk factors for NTR. Nonetheless, the transplantable pool increased after HR, 41.8% of the patients had no recurrence and may not require liver transplantation. If the patient's liver function is acceptable, HR should be considered the treatment of choice for HCC.
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Affiliation(s)
- Hou-Ying Cheng
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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Wong TH, Ho CM, Hsiao CY, Wu YM, Ho MC, Lee PH, Hu RH. Delayed recurrence of hepatocellular carcinoma after liver transplantation: case series. Korean Journal of Transplantation 2021. [DOI: 10.4285/atw2021.op-1051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ta-Hsiang Wong
- Department of School of Medicine, College of Medicine, National Taiwan University, Taiwan
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital, Taiwan
| | - Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital, Taiwan
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Hsiao CY, Yang PC, Huang KW. Linear radiofrequency ablation using dual switching-control mode achieves rapid and bloodless liver resection, an experimental research. Int J Hyperthermia 2021; 38:357-362. [PMID: 33641575 DOI: 10.1080/02656736.2021.1892215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Radiofrequency (RF)-assisted devices are widely used for hemostasis during liver resection. This study compared the use of dual switching (DS) versus single switching (SS) control modes for RF-based liver resections in a pig model. METHODS The RF-based system comprised a 200-W generator and three electrodes with 4-cm tips arranged in a linear configuration using an adaptor. Eight Lanyu pigs were used to assess ablation outcomes with electrode spacing of 2 or 3 cm, and ablation durations of 1.5, 2 or 3 min. All combinations were tested in DS and SS modes. Procedures were performed on left lateral, caudal and right anterior liver lobes, and after which transections were performed using a scalpel. Blood loss, complete ablation rate and ablation speed were compared. RESULTS DS mode was shown to induce significantly less blood loss than SS mode when the electrode spacing was set at 2 cm and the ablation duration was 2 min or 3 min (p=.010 and .012, respectively). Extended ablation duration and narrow electrode spacing tended to induce less blood loss, regardless of operating mode. Bloodless resection was achieved using DS mode with electrode spacing of 2 cm and ablation duration of 2-3 min. The highest rate of complete ablation (11.3 cm2/min) was achieved using DS mode with electrode spacing of 2 cm and ablation duration of 1.5 min. CONCLUSION RF-based hepatic resection using DS mode is safe and feasible, resulting in less blood loss than SS mode with a higher rate of complete ablation (i.e., superior ablation efficiency).
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Affiliation(s)
- Chih-Yang Hsiao
- College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chih Yang
- College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.,Center for Organ Transplantation and Liver Disease Treatment, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Kai-Wen Huang
- College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.,Centre of Mini-invasive Interventional Oncology, National Taiwan University Hospital, Taipei, Taiwan
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12
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Yang PC, Chen YJ, Li XY, Hsiao CY, Cheng BB, Gao Y, Zhou BZ, Chen SY, Hu SQ, Zeng Q, Huang KW. Irreversible Electroporation Treatment With Intraoperative Biliary Stenting for Unresectable Perihilar Cholangiocarcinoma: A Pilot Study. Front Oncol 2021; 11:710536. [PMID: 34277454 PMCID: PMC8278819 DOI: 10.3389/fonc.2021.710536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Treating perihilar cholangiocarcinoma (PHCC) is particularly difficult due to the fact that it is usually in an advanced stage at the time of diagnosis. Irreversible electroporation treatment (IRE) involves the local administration of a high-voltage electric current to target lesions without causing damage to surrounding structures. This study investigated the safety and efficacy of using IRE in conjunction with intraoperative biliary stent placement in cases of unresectable PHCC. Methods This study enrolled 17 patients with unresectable Bismuth type III/IV PHCC who underwent IRE in conjunction with intraoperative biliary stent placement (laparotomic) in two medical centers in Asia between June 2015 and July 2018. Analysis focused on the perioperative clinical course, the efficacy of biliary decompression, and outcomes (survival). Results Mean total serum bilirubin levels (mg/dL) on postoperative day (POD) 7, POD30, and POD90 were significantly lower than before IRE (respectively 3.46 vs 4.54, p=0.007; 1.21 vs 4.54, p<0.001; 1.99 vs 4.54, p<0.001). Mean serum carbohydrate antigen 19-9 (CA19-9, U/ml) levels were significantly higher on POD3 than before the operation (518.8 vs 372.4, p=0.001) and significantly lower on POD30 and POD90 (respectively 113.7 vs 372.4, p<0.001; 63.9 vs 372.4, p<0.001). No cases of Clavien-Dindo grade III/IV adverse events or mortality occurred within 90 days post-op. The median progression-free survival was 21.5 months, and the median overall survival was 27.9 months. All individuals who survived for at least one year did so without the need to carry percutaneous biliary drainage (PTBD) tubes. Conclusions It appears that IRE treatment in conjunction with intraoperative biliary stent placement is a safe and effective approach to treating unresectable PHCC. The decompression of biliary obstruction without the need for PTBD tubes is also expected to improve the quality of life of patients.
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Affiliation(s)
- Po-Chih Yang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yan-Jun Chen
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Xiao-Yong Li
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Chih-Yang Hsiao
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Surgery & Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Bing-Bing Cheng
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Yu Gao
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Bai-Zhong Zhou
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Sheng-Yang Chen
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Shui-Quan Hu
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Quan Zeng
- Endoscopic Center, the Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Kai-Wen Huang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Surgery & Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
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13
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Hsiao CY, Teng X, Su TH, Lee PH, Kao JH, Huang KW. Improved second harmonic generation and two-photon excitation fluorescence microscopy-based quantitative assessments of liver fibrosis through auto-correction and optimal sampling. Quant Imaging Med Surg 2021; 11:351-361. [PMID: 33392034 DOI: 10.21037/qims-20-394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Second harmonic generation (SHG)/two-photon excited fluorescence (TPEF) microscopy is commonly used for the quantitative assessment of liver fibrosis; however, the accuracy is susceptible to sampling error and count error due to disturbances induced by some forms of collagen in liver specimens. In this study, we sought to improve the accuracy of quantitative assessments by removing the effects of this disturbing collagen and optimizing the sampling protocol. Methods Large liver resection samples from 111 patients with chronic hepatitis B were scanned using SHG/TPEF microscopy with multiple adjacent images. During the quantitative assessment, we then removed SHG signals associated with three types of extraneous physiological collagen: large patches of collagen near the boundary of the capsule, collagen around tubular structures, and collagen associated with distorted vessel walls. The optimal sampling protocol was identified by comparing scans from regions of interest of various sizes (3×3 tiles and 5×5 tiles) with full scans of the same tissue. Results The proposed auto-correction algorithm detected 88 of 97 (90.7%) disturbing collagen on the images from the validation set. Removing these signals of disturbing collagen improved the correlation between Metavir stage and quantification of all 41 proposed collagen features. Through optimal sampling, five scans of 5×5 tiles or ten scans of 3×3 tiles were sufficient to minimize the mean error rate to around 2% of collagen percentage quantification and to achieve similar correlations around 0.27 with Metavir stage as using full tissue scans. Conclusions Our results demonstrate that the quantitative assessments of liver fibrosis can be greatly enhanced in terms of accuracy and efficiency through optimal sampling and the automated removal of disturbing collagen signals. These types of image processing could be integrated in next-generation SHG/TPEF microscopic systems.
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Affiliation(s)
- Chih-Yang Hsiao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei.,Department of Surgery, National Taiwan University Hospital, Taipei.,Department of Traumatology, National Taiwan University Hospital, Taipei
| | | | - Tung-Hung Su
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei.,Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Hepatitis Research Center, National Taiwan University Hospital, Taipei
| | - Po-Huang Lee
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei.,Department of Surgery, National Taiwan University Hospital, Taipei
| | - Jia-Horng Kao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei.,Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Hepatitis Research Center, National Taiwan University Hospital, Taipei
| | - Kai-Wen Huang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei.,Department of Surgery, National Taiwan University Hospital, Taipei.,Hepatitis Research Center, National Taiwan University Hospital, Taipei
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14
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Hsiao CY, Yang PC, Li X, Huang KW. Clinical impact of irreversible electroporation ablation for unresectable hilar cholangiocarcinoma. Sci Rep 2020; 10:10883. [PMID: 32616770 PMCID: PMC7331634 DOI: 10.1038/s41598-020-67772-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/08/2020] [Indexed: 02/08/2023] Open
Abstract
Irreversible electroporation (IRE) is a non-thermal ablation modality that has been shown to be safe and effective in its application to tumors that are close to risky areas. This study aims to assess the safety and efficacy of IRE for unresectable hilar cholangiocarcinoma. Nine patients from two medical centers in Asia received IRE treatment between June 2015 and July 2017. Before IRE treatment, percutaneous biliary decompressions had been performed on eight patients, and internal stenting had been performed on one patient. All patients tolerated the procedure well without high-grade complications. The ablated tumors had constant size without contrast enhancement for more than three months in eight patients and the level of CA19-9 decreased significantly in all patients. The percutaneous biliary drainage tube was removed from two patients with recanalization of the bile duct. The internal stent in one patient was removed without further stenting. The median overall survival period was 26 months, and the progression-free survival was 18 months. Bile ducts remained narrow in the majority (2/3) of the treated patients. Nevertheless, IRE ablation of unresectable hilar cholangiocarcinoma involving vital structures is a safe and feasible primary treatment for local tumor control and is effective in prolonging survival.
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Affiliation(s)
- Chih-Yang Hsiao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei City, 10002, Taiwan.,Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC.,Department of Traumatology, National Taiwan University Hospital, Taipei City, 10002, Taiwan
| | - Po-Chih Yang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei City, 10002, Taiwan.,Center for Organ Transplantation and Liver Disease Treatment, Fu Jen Catholic University Hospital, New Taipei City, 24352, Taiwan
| | - Xiaoyong Li
- Department of Hepatopancreatobiliary Surgery, The Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Kai-Wen Huang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei City, 10002, Taiwan. .,Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC. .,Hepatitis Research Center, National Taiwan University Hospital, Taipei City, 10002, Taiwan.
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15
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Hsiao CY, Chen PD, Huang KW. A Prospective Assessment of the Diagnostic Value of Contrast-Enhanced Ultrasound, Dynamic Computed Tomography and Magnetic Resonance Imaging for Patients with Small Liver Tumors. J Clin Med 2019; 8:E1353. [PMID: 31480576 PMCID: PMC6780634 DOI: 10.3390/jcm8091353] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/25/2019] [Accepted: 08/29/2019] [Indexed: 12/27/2022] Open
Abstract
AIM This prospective study assessed the diagnostic value of contrast-enhanced ultrasound (CEUS) using long Kupffer phase enhancement for adults with liver tumor size of less than 3 cm. Performance comparisons were also conducted with dynamic computed tomography (CT) and magnetic resonance imaging (MRI). BACKGROUND CEUS has emerged as a reliable image modality, since the development of second-generation contrast medium with long Kupffer phase enhancement. Nonetheless, dynamic CT and MRI are currently the standard imaging tools for the diagnosis of liver cancers, and the diagnostic value of CEUS for liver cancer has yet to be universally accepted. METHODS Sixty-six adult patients suspected of having liver tumors smaller than 3 cm underwent CEUS, dynamic CT, and MRI examinations independently. Subsequent tumor biopsies were used to verify the diagnostic performance of the three imaging modalities. RESULTS The diagnostic odds ratio (DOR, 95% CI) for hepatocellular carcinoma were as follows: CEUS (52.8, 11.4-243), CT (29.29, 7.36-116), and MRI (19.43, 5.44-69.4); for metastasis: CEUS (200, 19.1-2095), CT (24, 5.05-114), and MRI (32, 6.56-156); and all liver malignancy: CEUS (260, 12.7-5310), CT (2.57, 0.55-12.1), and MRI (5.22, 1.25-21.8). CEUS achieved the best differentiation performance. CONCLUSIONS CEUS outperformed dynamic CT and MRI in terms of diagnostic performance when dealing with small liver tumors (<3 cm).
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Affiliation(s)
- Chih-Yang Hsiao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 10048, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan
- Department of Traumatology, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Po-Da Chen
- Department of Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Kai-Wen Huang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 10048, Taiwan.
- Department of Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan.
- Hepatitis Research Center, National Taiwan University Hospital, Taipei 10048, Taiwan.
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16
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Hsiao CY, Ho CM, Wu YM, Ho MC, Hu RH, Lee PH. Biliary Complication in Pediatric Liver Transplantation: a Single-Center 15-Year Experience. J Gastrointest Surg 2019; 23:751-759. [PMID: 30632007 DOI: 10.1007/s11605-018-04076-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence and several risk factors of biliary complication (BC) following pediatric liver transplantation (LT) are widely known, but data on long-term outcomes and management is limited. This retrospective study aimed to investigate the incidence, associated risk factors, management, and outcomes of early and late BC in pediatric LT. METHODS This study enrolled 134 pediatric patients (< 18 years old) who underwent LT at a tertiary care center in Taiwan between January 2001 and December 2015. Diagnosis of BC was based on clinical, biochemical, and radiologic examinations. Clinical data and chart records were reviewed and compared between the groups. RESULTS Among the 134 children, 21 children (15.7%) had BC after LT. Nine children had early complications, including leakage plus stricture (n = 2), stricture only (n = 2), and leakage only (n = 5). Twelve children had late BC; all of whom had anastomotic stricture. Of the 21 patients with BC, 11 patients (52.4%) were treated without surgery. The median time of first treatment for BC was 6.5 months (range, 11 days to 6.2 years). Five of the 9 patients with early complications and two of the 12 patients with late complications died of biliary tract infection. The major risk factors of BC in pediatric LT were (1) recipient age > 2 years, (2) Kasai portoenterostomy revision, and (3) hepatic artery thrombosis. CONCLUSIONS Several risk factors of BC in pediatric LT were identified. Children with early BC appeared to have relatively unfavorable outcomes. However, late BC treated by either radiological or surgical methods appeared to have a relatively good long-term prognosis.
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Affiliation(s)
- Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliou City of Yun-Lin County, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. .,College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan.
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
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17
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Hsiao CY, Huang KW. Irreversible Electroporation: A Novel Ultrasound-guided Modality for Non-thermal Tumor Ablation. J Med Ultrasound 2017; 25:195-200. [PMID: 30065492 PMCID: PMC6029329 DOI: 10.1016/j.jmu.2017.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/10/2017] [Indexed: 12/18/2022] Open
Abstract
Ultrasound-guided tumor ablation techniques have been proven to be highly effective and minimally invasive in the treatment of many diseases. Traditional approaches to ablation include microwave and radiofrequency techniques, cryotherapy, and high-intensity focused ultrasound. However, these methods are prone to heat-sink effects that can diminish the effectiveness of treatment and damage adjacent structures, such as bile ducts, blood vessels, the gallbladder, or bowel. Irreversible electroporation (IRE) is a non-thermal ablation modality that induces cell apoptosis through the application of high-voltage current. IRE is not limited by many of the limitation which affects conventional tumor ablation techniques, and is particularly useful in treating sensitive areas of the body. The article reviews the basics of ultrasound-guided technology, including its clinical applications and effectiveness in the treatment of tumors.
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Affiliation(s)
- Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Kai-Wen Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
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18
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Hsiao CY, Yang CY, Wu JM, Kuo TC, Tien YW. Utility of the 2006 Sendai and 2012 Fukuoka guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas: A single-center experience with 138 surgically treated patients. Medicine (Baltimore) 2016; 95:e4922. [PMID: 27661043 PMCID: PMC5044913 DOI: 10.1097/md.0000000000004922] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study aimed to evaluate the utility of the 2006 Sendai and 2012 Fukuoka guidelines for differentiating malignant intraductal papillary mucinous neoplasm (IPMN) of the pancreas from benign IPMN.Between January 2000 and March 2015, a total of 138 patients underwent surgery and had a pathologically confirmed pancreatic IPMN. Clinicopathological parameters were reviewed, and all patients were classified according to both the 2006 Sendai and 2012 Fukuoka guidelines. Univariate and multivariate analyses were used for identifying significant factors associated with malignancy in IPMN.There were 9 high-grade dysplasia (HGD) and 37 invasive cancers (ICs) in the 138 patients. The positive predictive value (PPV) and negative predictive value (NPV) of the Sendai and Fukuoka guidelines for HGD/IC was 35.1%, 43.3%, 100%, and 85.4%, respectively. Of the 36 patients with worrisome features using the Fukuoka guideline, 7 patients had HGD/IC in their IPMNs. According to the multivariate analysis, jaundice, tumors of ≥3 cm, presence of mural nodule on imaging, and aged <65 years were associated with HGD/IC in patients with IPMN.The Sendai guideline had a better NPV, but the Fukuoka guideline had a better PPV. We suggest that patients with worrisome features based on the Fukuoka guideline be aggressively managed.
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Affiliation(s)
| | | | | | | | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Correspondence: Yu-Wen Tien, Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei 10002, Taiwan, ROC (e-mail: )
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Abstract
Endo-retractors are convenient devices for exposure and traction during minimally invasive surgery and are widely used in laparoscopic cholecystectomy (LC). Complications associated with the use of this device are rare. We present a patient with symptomatic gallstones who underwent LC and developed a diaphragmatic laceration as a result of the inappropriate use of an endo retractor. Although the incidence of complications with endo retractors is low, this report indicates the potential risk of diaphragmatic injury while using the retractors for exposure and traction during minimally invasive surgery.
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Affiliation(s)
- Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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20
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Hsiao CY, Ho CM, Wu YM, Ho MC, Hu RH, Lee PH. Management of early hepatic artery occlusion after liver transplantation with failed rescue. World J Gastroenterol 2015; 21:12729-12734. [PMID: 26640351 PMCID: PMC4658629 DOI: 10.3748/wjg.v21.i44.12729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/23/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatic artery thrombosis is a serious complication after liver transplantation which often results in biliary complications, early graft loss, and patient death. It is generally thought that early hepatic artery thrombosis without urgent re-vascularization or re-transplantation almost always leads to mortality, especially if the hepatic artery thrombosis occurs within a few days after transplantation. This series presents 3 cases of early hepatic artery thrombosis after living donor liver transplantation, in which surgical or endovascular attempts at arterial re-vascularization failed. Unexpectedly, these 3 patients survived with acceptable graft function after 32 mo, 11 mo, and 4 mo follow-up, respectively. The literatures on factors affecting this devastating complication were reviewed from an anatomical perspective. The collective evidence from survivors indicated that modified nonsurgical management after liver transplantation with failed revascularization may be sufficient to prevent mortality from early hepatic artery occlusion. Re-transplantation may be reserved for selected patients with unrecovered graft function.
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21
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Hsiao CY, Lan CF, Chang PL, Li IC. Development of the psychometric property of a Minimum Data-Set-Based Depression Rating Scale for use in long-term care facilities in Taiwan. Aging Ment Health 2015; 19:129-35. [PMID: 24896835 DOI: 10.1080/13607863.2014.920294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Our aim is to develop the psychometric property of the Minimum Data-Set-Based Depression Rating Scale (MDS-DRS) to ensure its use to assess service needs and guide care plans for institutionalized residents. METHODS 378 residents were recruited from the Haoran Senior Citizen Home in northern Taiwan. The MDS-DRS and GDS-SF were used to identify observable features of depression symptoms in the elderly residents. RESULTS A total of 378 residents participated in this study. The receiver operating characteristic (ROC) curve indicated that the MDS-DRS has a 43.3% sensitivity and a 90.6% specificity when screening for depression symptoms. The total variance, explained by the two factors 'sadness' and 'distress,' was 58.1% based on the factor analysis. CONCLUSIONS Reliable assessment tools for nurses are important because they allow the early detection of depression symptoms. The MDS-DRS items perform as well as the GDS-SF items in detecting depression symptoms. Furthermore, the MDS-DRS has the advantage of providing information to staff about care process implementation, which can facilitate the identification of areas that need improvement. Further research is needed to validate the use of the MDS-DRS in long-term care facilities.
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Affiliation(s)
- C Y Hsiao
- a Department of Nursing , School of Nursing, National Yang-Ming University , Taipei , Taiwan
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22
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Hsiao CY, Kuo TC, Lai HS, Yang CY, Tien YW. Obstructive jaundice as a complication of a right hepatic artery pseudoaneurysm after laparoscopic cholecystectomy. J Minim Access Surg 2015; 11:163-4. [PMID: 25883462 PMCID: PMC4392495 DOI: 10.4103/0972-9941.144097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 08/25/2014] [Indexed: 11/16/2022] Open
Abstract
A hepatic artery pseudoaneurysm is a rare, but a potentially life-threatening complication after laparoscopic cholecystectomy (LC). Obstructive jaundice owing to a hepatic artery pseudoaneurysm after LC has never been reported. We report a patient with a hepatic artery pseudoaneurysm after LC who presented with tarry stools, bloody drainage and obstructive jaundice.
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Affiliation(s)
- Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ting-Chun Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Yao Yang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Abstract
We aim to determine the incidence of malignancy after liver transplantation (LT) compared to general population. The records of patients who received LTs at our center from October 1989 and November 2012 were retrospectively reviewed. The standardized incidence ratio (SIR) of cancer in the patients was compared to general population using the data from the Taiwan Cancer Registry. Survival was estimated using the Kaplan-Meier method. A total of 444 patients were included. Malignancy was found in 46 (28 de novo and 19 recurrent malignancies) patients (10.4%) with the median follow up of 4.2±4.2 years. The median time of cancer occurrence after transplant was 1.2±1.9 years (range, 0.2-9.1 years). Post-transplant lymphoproliferative disorder was the most frequent de novo malignancy (57.1% [16/28]). The cumulative incidence rates of all malignancies were 5.1%, 10.4%, 12.8%, 15.8%, and 15.8% at 1, 3, 5, 10, and 15 years, respectively. The cumulative incidence rates of de novo malignancies were 3.4%, 5.97%, 7.7%, 10.9%, and 10.9 % at 1, 3, 5, 10, and 15 years. Compared to general population, transplant recipients had significantly higher incidence of all de novo cancers (SIR: 3.26, 95% confidence interval [CI]: 2.17-4.72), hematologic (SIR: 58.4; 95% CI, 33.3-94.8), and bladder (SIR: 10.2, 95% CI: 1.1-36.7) cancers. The estimated mean survivals after transplantation in cancer-free, de novo cancer, and recurrent cancer patients were 17.7±0.5, 11.3±1.2, and 3.6±0.6 years, respectively. There is a significantly increased risk of malignancies after LT in the Taiwanese population.
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Affiliation(s)
- Chih-Yang Hsiao
- From the Department of Surgery (CYH, PHL, CMH, YMW, MCH, RHH) and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (PHL, CMH)
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Hsiao CY, Yang CY, Lai IR, Chen CN, Lin MT. Laparoscopic resection for large gastric gastrointestinal stromal tumor (GIST): intermediate follow-up results. Surg Endosc 2014; 29:868-73. [PMID: 25052129 DOI: 10.1007/s00464-014-3742-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/08/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Laparoscopic wedge resection has become a widely accepted treatment for small gastrointestinal stromal tumor (GIST) of the stomach. However, its feasibility as treatment for large gastric GIST is not known. In this retrospective study, the perioperative and oncologic outcomes of laparoscopic wedge resection for gastric GIST (5-8 cm) were reviewed. METHODS Between November 2002 and December 2012, a total of 39 patients with primary gastric GIST sized 5-8 cm underwent surgery at a tertiary care center, including 18 patients who underwent laparoscopic wedge resection of the stomach (Lap group) and 21 patients who underwent open wedge resection of the stomach (Open group). Clinicopathological parameters were reviewed and compared between the groups. RESULTS The demographics including age, gender, and body weight were similar between groups. The operative outcomes including blood loss, hospital stay, and surgical complications were also similar, except that operative time was longer in the Lap group (146.6 ± 50.2 vs. 113.3 ± 42.9 min in the Open group, p = 0.03). There was no tumor rupture, conversion of procedures, or major surgical morbidity in either group. The overall median follow-up time was 3.6 years (1.0-11.1). Only one patient in the Lap group had liver metastasis (4 months postoperatively). This patient remains alive 5 years later under imatinib treatment. One patient in the Open group and three patients in the Lap group have died of GIST-unrelated diseases. CONCLUSIONS Laparoscopic wedge resection of the stomach for primary gastric GIST (5-8 cm) appears to be safe and feasible, with operative and oncological outcomes comparable to those of the open method.
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Affiliation(s)
- Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Hsiao CY, Huang APH. Cervical necrotising fasciitis with descending mediastinitis. Emerg Med J 2013; 32:339. [PMID: 24317289 DOI: 10.1136/emermed-2013-203313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Abel Po-Hao Huang
- Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
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Hsiao CY, Wu HD, Lai JS, Kuo HW. A longitudinal study of the effects of long-term exposure to lead among lead battery factory workers in Taiwan (1989-1999). Sci Total Environ 2001; 279:151-158. [PMID: 11712592 DOI: 10.1016/s0048-9697(01)00762-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The objective of this study was to assess the relationship between blood-lead levels (BLL), hematological, liver and renal indicators among workers in a lead battery factory in Taiwan over a 10-year period. Blood samples were taken periodically from 30 workers and BLL, HGB (hemoglobin), RBC (red blood cells), WBC (white blood cells) and HCT (hematocrit) were measured. Levels of GPT (alanine aminotransferase) and Crea (creatinine) in the blood were assessed to indicate liver and renal function, respectively. The results showed that there was a general decrease in BLL over the 10-year period (except for 1993). There was a similar trend for HCT, RBC and Crea. There was no significant trend for the other health indicators. Four generalized estimating equation (GEE) models [correlation model (A), threshold correlation model (B), instant change model (C) and lag change model (D)] were set up to demonstrate the causal relationship between BLL and the other health indicators. Models A and C showed that BLL correlated positively with RBC, but negatively with Crea. Model B showed that BLL correlated positively with GPT. There were no significant correlations of BLL with the other indicators. Models C and D, (GEE with logit link function to analyze the association between changes BLL and the other health indicators) showed that when BLL increased, RBC and HCT increased, both longitudinally and cross-sectionally. The authors conclude that long-term exposure to lead stimulates production of RBC and HCT, but the effect on liver and renal function was unclear.
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Affiliation(s)
- C Y Hsiao
- Institute of Environmental Health, China Medical College, Taichung, Taiwan, PR China
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Huang MC, Lee LS, Ho DM, Cheng H, Chung WY, Huang CI, Hsiao CY, Pan DH. A metastatic pituitary carcinoid tumor successfully treated with gamma knife radiosurgery. Zhonghua Yi Xue Za Zhi (Taipei) 2001; 64:414-8. [PMID: 11584580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Intracranial metastasis occurs in a certain number of patients with carcinoid tumor. However, carcinoid tumor with metastasis to the pituitary gland is extremely rare. Up to the present, no effective treatment for either a metastatic intracranial carcinoid tumor or a metastatic pituitary lesion of any origin has been documented. We have treated a case of metastatic carcinoid tumor of the pituitary gland with transsphenoidal tumor resection followed by gamma knife radiosurgery. A 59-year-old man presented with headache and left oculomotor palsy. He was treated at the same hospital for bronchial atypical carcinoid tumor one and a half years ago. Magnetic resonance image of the brain showed a pituitary tumor. There were no signs of recurrent or metastatic lesion elsewhere despite thorough investigation. Transsphenoidal approach for removal of tumor was done and the pathology turned out to be a metastatic carcinoid tumor. Subsequent gamma knife radiosurgery was given for residual tumor. The oculomotor palsy improved after radiosurgery. No neurological deficit occurred. Follow-up CT scan of the brain showed complete resolution of the tumor. We concluded that gamma knife radiosurgery could be used to treat a metastatic intracranial carcinoid tumor. It can also be used to treat a metastatic lesion of the pituitary gland without causing neurological deficit.
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Affiliation(s)
- M C Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan.
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Jones-Webb R, Hsiao CY, Hannan P, Caetano R. Predictors of increases in alcohol-related problems among black and white adults: results from the 1984 and 1992 National Alcohol Surveys. Am J Drug Alcohol Abuse 1997; 23:281-99. [PMID: 9143639 DOI: 10.3109/00952999709040947] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We examined increases in self-reported alcohol-related problems among black and white adult drinkers using data from the 1984 and 1992 National Alcohol Surveys. The objectives of the study were to determine whether alcohol consumption, drinking norm, or socioeconomic status were related to increases in alcohol-related problems. Two types of self-reported alcohol-related problems were analyzed using regression methods: drinking consequences and alcohol dependence symptoms. Results indicated that increases in alcohol consumption were associated with increased drinking consequences for white men, but increased consumption had little affect for black men. Changes in drinking norms regarding non-social drinking were associated with increased in drinking consequences among black men, such norms showed little affect on drinking consequences for white men. Despite substantial increases in alcohol consumption among black women from 1984 to 1992, there were no significant racial/ethnic differences in drinking consequences or alcohol dependence symptoms among women. Changes in socioeconomic status were however related to increases in drinking consequences and alcohol dependence symptoms in women, but not in men. Findings suggest that liberal drinking norms may have greater long term consequences for black than white men. Socioeconomic status, on the other hand, may have greater explanatory power in predicting increases in alcohol-related problems in women than in men.
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Affiliation(s)
- R Jones-Webb
- University of Minnesota, School of Public Health, Division of Epidemiology, Minneapolis 55454-1015, USA
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Abstract
We sought to examine the relationships between socioeconomic status and drinking problems within the Black and White male populations. A two-way interactions of social class with race/ethnicity, and with drinking consequences and alcohol dependence symptoms was hypothesized among drinkers. Drinking problems were regressed on social class, race/ethnicity, age, alcohol consumption, and drinking settings. Social class was based on a composite of respondent's income, education, and main wage earner's occupation. Two types of drinking problems were analyzed: drinking consequences and alcohol dependence symptoms. Our hypothesis was partially confirmed. Interactions of social class with race/ethnicity and with drinking problems were observed. Less affluent Black men reported greater numbers of drinking consequences and total drinking problems than less affluent White men; the reverse was true for affluent Black and White men. Results suggest that the relationships between socioeconomic status and drinking problems may vary by race/ethnicity.
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Affiliation(s)
- R J Jones-Webb
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA
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