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Lin KY, Zhang JX, Lin ZW, Chen QJ, Luo LP, Chen JH, Wang K, Tai S, Zhang ZB, Wang SF, Li JD, Wang K, Zheng L, Zheng SM, Wu MM, Lin KC, Yang T, Zeng YY. Serum alpha-fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy: a multicenter retrospective study. Front Immunol 2024; 15:1308543. [PMID: 38433845 PMCID: PMC10904489 DOI: 10.3389/fimmu.2024.1308543] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
Background This study evaluates the efficacy of alpha-fetoprotein (AFP) response as a surrogate marker for determining recurrence-free survival (RFS) in patients with unresectable hepatocellular carcinoma (uHCC) who undergo salvage hepatectomy following conversion therapy with tyrosine kinase inhibitor (TKI) and anti-PD-1 antibody-based regimen. Methods This multicenter retrospective study included 74 patients with uHCC and positive AFP (>20 ng/mL) at diagnosis, who underwent salvage hepatectomy after treatment with TKIs and anti-PD-1 antibody-based regimens. The association between AFP response-defined as a ≥ 80% decrease in final AFP levels before salvage hepatectomy from diagnosis-and RFS post-hepatectomy was investigated. Results AFP responders demonstrated significantly better postoperative RFS compared to non-responders (P<0.001). The median RFS was not reached for AFP responders, with 1-year and 2-year RFS rates of 81.3% and 70.8%, respectively. In contrast, AFP non-responders had a median RFS of 7.43 months, with 1-year and 2-year RFS rates at 37.1% and 37.1%, respectively. Multivariate Cox regression analysis identified AFP response as an independent predictor of RFS. Integrating AFP response with radiologic tumor response facilitated further stratification of patients into distinct risk categories: those with radiologic remission experienced the most favorable RFS, followed by patients with partial response/stable disease and AFP response, and the least favorable RFS among patients with partial response/stable disease but without AFP response. Sensitivity analyses further confirmed the association between AFP response and improved RFS across various cutoff values and in patients with AFP ≥ 200 ng/mL at diagnosis (all P<0.05). Conclusion The "20-80" rule based on AFP response could be helpful for clinicians to preoperatively stratify the risk of patients undergoing salvage hepatectomy, enabling identification and management of those unlikely to benefit from this procedure.
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Affiliation(s)
- Kong-Ying Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian-Xi Zhang
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Hepatobiliary Surgery, Xiamen Hospital, Beijing University of Chinese Medicine, Xiamen, China
| | - Zhi-Wen Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qing-Jing Chen
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Liu-Ping Luo
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jin-Hong Chen
- Department of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Fudan University, Shanghai, China
| | - Kui Wang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Sheng Tai
- Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhi-Bo Zhang
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shi-Feng Wang
- Department of Hepatopancreatobiliary Surgery, Ganzhou Fifth People’s Hospital of Gannan Medical University, Ganzhou, China
| | - Jing-Dong Li
- Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Kai Wang
- Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lu Zheng
- Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Si-Ming Zheng
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Meng-Meng Wu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Ke-Can Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Tian Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Yong-Yi Zeng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Lin KY, Chen QJ, Tang SC, Lin ZW, Zhang JX, Zheng SM, Li YT, Wang XM, Lu Q, Fu J, Guo LB, Zheng LF, You PH, Wu MM, Lin KC, Zhou WP, Yang T, Zeng YY. Prognostic implications of alpha-fetoprotein and C-reactive protein elevation in hepatocellular carcinoma following resection (PACE): a large cohort study of 2770 patients. BMC Cancer 2023; 23:1190. [PMID: 38053048 PMCID: PMC10696803 DOI: 10.1186/s12885-023-11693-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Routine clinical staging for hepatocellular carcinoma (HCC) incorporates liver function, general health, and tumor morphology. Further refinement of prognostic assessments and treatment decisions may benefit from the inclusion of tumor biological marker alpha-fetoprotein (AFP) and systemic inflammation indicator C-reactive protein (CRP). METHODS Data from a multicenter cohort of 2770 HCC patients undergoing hepatectomy were analyzed. We developed the PACE risk score (Prognostic implications of AFP and CRP Elevation) after initially assessing preoperative AFP and CRP's prognostic value. Subgroup analyzes were performed in BCLC cohorts A and B using multivariable Cox analysis to evaluate the prognostic stratification ability of the PACE risk score and its complementary utility for BCLC staging. RESULTS Preoperative AFP ≥ 400ng/mL and CRP ≥ 10 mg/L emerged as independent predictors of poorer prognosis in HCC patients who underwent hepatectomy, leading to the creation of the PACE risk score. PACE risk score stratified patients into low, intermediate, and high-risk groups with cumulative 5-year overall (OS) and recurrence-free survival (RFS) rates of 59.6%/44.9%, 43.9%/38.4%, and 20.6%/18.0% respectively (all P < 0.001). Increased PACE risk scores correlated significantly with early recurrence and extrahepatic metastases frequency (all P < 0.001). The multivariable analysis identified intermediate and high-risk PACE scores as independently correlating with poor postoperative OS and RFS. Furthermore, the PACE risk score proficiently stratified the prognosis of BCLC stages A and B patients, with multivariable analyses demonstrating it as an independent prognostic determinant for both stages. CONCLUSION The PACE risk score serves as an effective tool for postoperative risk stratification, potentially supplementing the BCLC staging system.
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Affiliation(s)
- Kong-Ying Lin
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Qing-Jing Chen
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Shi-Chuan Tang
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Zhi-Wen Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Jian-Xi Zhang
- Department of Hepatobiliary Surgery, Xiamen Hospital, Beijing University of Chinese Medicine, Xiamen, 361000, China
| | - Si-Ming Zheng
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Ningbo University, Ningbo, 315000, China
| | - Yun-Tong Li
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China
| | - Xian-Ming Wang
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University, Shandong, 250014, China
| | - Qiang Lu
- Department of Hepatopancreatobiliary Surgery, Third Hospital of Zhangzhou, Zhangzhou, 363000, China
| | - Jun Fu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Luo-Bin Guo
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Li-Fang Zheng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Peng-Hui You
- Biobank in Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Meng-Meng Wu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Ke-Can Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Wei-Ping Zhou
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, 200000, China
| | - Tian Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, 200000, China.
| | - Yong-Yi Zeng
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China.
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China.
- Liver Disease Research Center of Fujian Province, Fuzhou, 350000, China.
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, 350025, China.
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Huang M, Zhang H, Wu ZP, Wang XP, Li DS, Liu SJ, Zheng SM, Yang LJ, Liu BB, Li GX, Jiang YC, Chen H, Ren J. Whole-genome resequencing reveals genetic structure and introgression in Pudong White pigs. Animal 2021; 15:100354. [PMID: 34543995 DOI: 10.1016/j.animal.2021.100354] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022] Open
Abstract
Pudong White (PDW) pigs, historically originating from Shanghai, are the only Chinese indigenous pigs characterised by their completely white coats, with the exception of Rongchang pigs. However, there is limited information concerning their overall genetic structure or relationship with other breeds, especially the East Chinese (ECN) and European pigs. To uncover the genetic structure, selection signatures, and potential exotic introgression in PDW pigs, we sampled 15 PDW pigs using whole-genome sequencing (~20×). We then conducted in-depth population genetic analyses in 320 pigs from 27 global pig groups, namely, European wild boars, Chinese wild boars, and outgroup. Neighbour-joining tree and principal component analysis confirmed that PDW pigs belonged to the ecotype of ECN pigs. Both f3, D-statistics, and structure analysis showed that PDW pigs shared apparent alleles with Large White (LW) pigs. Three statistics, rIBD, a haplotype heat map and copy number variation, further indicated that PDW pigs shared apparent alleles with LW pigs at the KIT Proto-Oncogene, Receptor Tyrosine Kinase (KIT) and PARG-MARCHF8 loci, suggesting that the lineage of European pigs in PDW originated from LW pigs. After further detecting the KIT mutations in different pig breeds, PDW was confirmed to have the same duplication region 1, duplication region 2, and the splicing mutation on intron 17 of KIT as LW pigs that determine the white coat colour phenotype in European white pigs. We hypothesised that LW pigs were imported to China ∼110-160 years ago according to the admixture time estimate and then crossed with ECN pigs, resulting in the introgression of the KIT alleles that produce the white coat colour phenotype in the PDW pig breed. To our knowledge, this study presents the first thorough description of the genetic structure of PDW pigs via whole-genome resequencing data; moreover, the results provide a basis for the national project for the conservation of this unique Chinese local population.
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Affiliation(s)
- M Huang
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong Province, China
| | - H Zhang
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong Province, China
| | - Z P Wu
- Zhongkai University of Agriculture and Engineering, Guangzhou, Guangdong Province, China
| | - X P Wang
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong Province, China
| | - D S Li
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong Province, China
| | - S J Liu
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong Province, China
| | - S M Zheng
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong Province, China
| | - L J Yang
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong Province, China
| | - B B Liu
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong Province, China
| | - G X Li
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong Province, China
| | - Y C Jiang
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong Province, China
| | - H Chen
- College of Life Science, Jiangxi Science & Technology Normal University, Nanchang, Jiangxi Province, China.
| | - J Ren
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong Province, China
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Zhao LY, Niu JH, Gao XL, Liu CN, Liu SM, Jiang N, Lv XP, Zheng SM. Development and application of isothermal amplification methods for rapid detection of F4 fimbriae producing Escherichia coli. Pol J Vet Sci 2021; 23:143-152. [PMID: 32233297 DOI: 10.24425/pjvs.2020.132758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Enterotoxigenic Escherichia coli (ETEC) is the causative agent of a wide range of diseases, which are the important cause of illness and mortality in piglets. ETEC strains expressing F4 fimbriae are frequently associated with post-weaning diarrhea (PWD) and lead to great economic losses in swine production industry worldwide. The aim of this study was to establish a rapid and effective isothermal amplification method for detection of F4 fimbriae. Loop-mediated isothermal amplification (LAMP), Polymerase spiral reaction (PSR) and cross-priming ampli- fication (CPA) were used to develop and optimize the detection method first time. Subsequently, the specificity and sensitivity of these methods were evaluated, and the clinical samples were detected with these methods. All the F4-positive samples could produce ladder-like amplifica- tions products and lead the chromogenic substrate SYBR Green I produce green fluorescence, while in blank control and negative samples lack of this pattern or remained orange. The sensi- tivity of LAMP and CPA were 10 times higher than PSR method. Meanwhile, these three methods were validated with clinical samples, 7 were found positive, while 125 samples were negative, the testing results were consisted with the real-time PCR method. These findings suggested that the isothermal amplification based on the F4 fimbriae is a rapid, effective and sensitive method under resource constrains.
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Affiliation(s)
- L Y Zhao
- College of Veterinary Medicine, Northeast Agricultural University, Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, NO.600 Changjiang Street Xiang-fang District, Harbin, Heilongjiang,150030, P. R. China.,Drug Safety Evaluation Center of Heilongjiang University of Chinese Medicine, No. 24 Heping Road, Xiangfang District, Harbin, Heilongjiang, 150040, P. R. China
| | - J H Niu
- College of Veterinary Medicine, Northeast Agricultural University, Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, NO.600 Changjiang Street Xiang-fang District, Harbin, Heilongjiang,150030, P. R. China
| | - X L Gao
- College of Veterinary Medicine, Northeast Agricultural University, Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, NO.600 Changjiang Street Xiang-fang District, Harbin, Heilongjiang,150030, P. R. China
| | - C N Liu
- College of Veterinary Medicine, Northeast Agricultural University, Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, NO.600 Changjiang Street Xiang-fang District, Harbin, Heilongjiang,150030, P. R. China
| | - S M Liu
- Drug Safety Evaluation Center of Heilongjiang University of Chinese Medicine, No. 24 Heping Road, Xiangfang District, Harbin, Heilongjiang, 150040, P. R. China
| | - N Jiang
- College of Life Science and Technology, Dalian University, No. 10 Xuefu Street, Dalian Economic Technological Development Zone, Dalian, Liaoning, 116622, P. R. China
| | - X P Lv
- College of Veterinary Medicine, Northeast Agricultural University, Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, NO.600 Changjiang Street Xiang-fang District, Harbin, Heilongjiang,150030, P. R. China
| | - S M Zheng
- College of Veterinary Medicine, Northeast Agricultural University, Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, NO.600 Changjiang Street Xiang-fang District, Harbin, Heilongjiang,150030, P. R. China
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Zhou HT, Peng CB, Han Y, Lu CD, Zheng SM. Quantitative analysis of three-dimensional reconstruction data to guide the selection of methods for laparoscopic distal pancreatectomy. J Hepatobiliary Pancreat Sci 2020; 28:659-670. [PMID: 33053264 DOI: 10.1002/jhbp.849] [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] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/08/2020] [Accepted: 09/20/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND/PURPOSE To explore the risk factors of splenic vessel preservation in laparoscopic distal pancreatectomy (LDP) and to guide with the appropriate selection of surgical methods through three-dimensional (3D) reconstruction. METHODS Patients suffering from benign or low-grade malignant tumors of pancreatic body and tail having undergone LDP in Ningbo Medical Center Lihuili Hospital from January 2014 to September 2019 were selected for quantitative analysis of the anatomical data of patients' pancreas, tumors, splenic vessels and spleens by 3D reconstruction. According to the final surgical methods, the patients were divided into the laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation (lap-SVP) group and the non-lap-SVP group. Clinical data of the two groups were compared to assess the risk factors for surgical failure of lap-SVP and logistic regression model was applied to predict the choice of surgical methods. RESULTS A total of 218 patients were included in the study, including 144 in the lap-SVP group and 74 in the non-lap-SVP group. Multivariate analysis confirms that large tumor volume, large contact area between the pancreas to be resected and the splenic vein, and large maximum ratio of the circumference of the splenic vessel embedded in the pancreas to be resected to the circumference of the splenic vessel are independent risk factors for surgical failure of lap-SVP (OR > 1, P < .05). The prediction accuracy of lap-SVP operation by the logistic regression reaches up to 80.9%. CONCLUSIONS 3D reconstruction can provide essential basis for the surgical method selection of laparoscopic distal pancreatectomy.
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Affiliation(s)
- Hai-Tao Zhou
- Medical School of Ningbo University, Ningbo, China
| | - Cheng-Bin Peng
- College of Information Science and Engineering, Ningbo University, Ningbo, China
| | - Yue Han
- College of Information Science and Engineering, Ningbo University, Ningbo, China
| | - Cai-De Lu
- Department of Hepato-Biliary-Pancreatic Surgery, Ningbo University Affiliated Lihuili Hospital, Ningbo, China
| | - Si-Ming Zheng
- Department of General Surgery, Ningbo First Hospital, Ningbo, China
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Zheng SM, Li H, Li GC, Yu DS, Ying DJ, Zhang B, Lu CD, Zhou XH. Risk factors, treatment and impact on outcomes of bile leakage after hemihepatectomy. ANZ J Surg 2015; 87:E26-E31. [PMID: 25880020 DOI: 10.1111/ans.13073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Risk factors for bile leakage after hemihepatectomy are unknown. METHODS A prospectively maintained database review identified patients undergoing hemihepatectomy between 1 January 2009 and 30 September 2014. Patients were divided into B/C and non-B/C bile leakage groups. Risk factors for bile leakage were predicted and assessments of their impact on patients were made. RESULTS Bile leakage occurred in 91 of the 297 patients (30.6%); 64 cases were classified as grade B bile leakage (21.5%) and three cases as grade C bile leakage (1.0%). Multivariate analysis confirmed that elevated preoperative alanine transaminase (ALT), positive bile culture during surgery, hilar bile duct plasty, bilioenteric anastomosis and laparoscopic surgery were risk factors for B/C grade bile leakage (P < 0.05). Percutaneous transhepatic biliary drainage (PTBD) and endoscopic nasobiliary drainage (ENBD) were protective factors for B/C grade bile leakage (P < 0.05). PTBD, ENBD and Kehr's T-tube drainage could reduce the drainage volume and duration of drainage after bile leakage (P < 0.05). The incidence of wound infection, abdominal infection, major complications and the Clavien classification system score in the B/C bile leakage group were higher than those in the non-B/C bile leakage group (P < 0.05). Patients in the B/C bile leakage group also required prolonged hospitalization (P < 0.05). The mortality of two groups was similar (P > 0.05). CONCLUSION Patient with elevated preoperative ALT, positive bile cultures during surgery, hilar bile duct plasty, bilioenteric anastomosis and laparoscopic surgery are more likely to complicate bile leakage. We should use biliary drainage such as preoperative PTBD, ENBD or intraoperative Kehr's T-tube drainage to reduce and treat bile leakage in patients with high risk of bile leakage.
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Affiliation(s)
- Si-Ming Zheng
- Department of General Surgery, Ningbo Li Huili Hospital, Medical School of Ningbo University, Ningbo, China
| | - Hong Li
- Department of General Surgery, Ningbo Li Huili Hospital, Medical School of Ningbo University, Ningbo, China
| | - Gen-Cong Li
- Department of General Surgery, Ningbo Li Huili Hospital, Medical School of Ningbo University, Ningbo, China
| | - Dan-Song Yu
- Department of General Surgery, Ningbo Li Huili Hospital, Medical School of Ningbo University, Ningbo, China
| | - Dong-Jian Ying
- Department of General Surgery, Ningbo Li Huili Hospital, Medical School of Ningbo University, Ningbo, China
| | - Bin Zhang
- Department of General Surgery, Ningbo Li Huili Hospital, Medical School of Ningbo University, Ningbo, China
| | - Cai-De Lu
- Department of General Surgery, Ningbo Li Huili Hospital, Medical School of Ningbo University, Ningbo, China
| | - Xin-Hua Zhou
- Department of General Surgery, Ningbo Li Huili Hospital, Medical School of Ningbo University, Ningbo, China
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Abstract
Isolated hepatic perfusion (IHP) involves a method of complete vascular isolation of the liver to take the advantage of directed intensive chemotherapy that has minimal systemic toxicity. Recent clinical studies mainly employed melphalan with or without tumor necrosis factor alpha (TNF-α), or with hyperthermia in IHP. The results of these studies showed that higher response rates and survival rates could be achieved by IHP than by traditional therapeutics for non-resectable liver tumors. In this article, we discussed the current status, recent developments and future perspectives of drug selection in IHP.
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Zheng SM. Magnetic properties of disordered Ising systems with various probability distributions of the exchange integrals. Phys Rev B Condens Matter 1995; 52:7260-7266. [PMID: 9979668 DOI: 10.1103/physrevb.52.7260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Affiliation(s)
- S M Zheng
- Heart Institute, Hospital of the Good Samaritan, Los Angeles, CA 90017-2395
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