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Hong JH, Yong CH, Heng HL, Chan JY, Lau MC, Chen J, Lee JY, Lim AH, Li Z, Guan P, Chu PL, Boot A, Ng SR, Yao X, Wee FYT, Lim JCT, Liu W, Wang P, Xiao R, Zeng X, Sun Y, Koh J, Kwek XY, Ng CCY, Klanrit P, Zhang Y, Lai J, Tai DWM, Pairojkul C, Dima S, Popescu I, Hsieh SY, Yu MC, Yeong J, Kongpetch S, Jusakul A, Loilome W, Tan P, Tan J, Teh BT. Integrative multiomics enhancer activity profiling identifies therapeutic vulnerabilities in cholangiocarcinoma of different etiologies. Gut 2024; 73:966-984. [PMID: 38050079 DOI: 10.1136/gutjnl-2023-330483] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/13/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES Cholangiocarcinoma (CCA) is a heterogeneous malignancy with high mortality and dismal prognosis, and an urgent clinical need for new therapies. Knowledge of the CCA epigenome is largely limited to aberrant DNA methylation. Dysregulation of enhancer activities has been identified to affect carcinogenesis and leveraged for new therapies but is uninvestigated in CCA. Our aim is to identify potential therapeutic targets in different subtypes of CCA through enhancer profiling. DESIGN Integrative multiomics enhancer activity profiling of diverse CCA was performed. A panel of diverse CCA cell lines, patient-derived and cell line-derived xenografts were used to study identified enriched pathways and vulnerabilities. NanoString, multiplex immunohistochemistry staining and single-cell spatial transcriptomics were used to explore the immunogenicity of diverse CCA. RESULTS We identified three distinct groups, associated with different etiologies and unique pathways. Drug inhibitors of identified pathways reduced tumour growth in in vitro and in vivo models. The first group (ESTRO), with mostly fluke-positive CCAs, displayed activation in estrogen signalling and were sensitive to MTOR inhibitors. Another group (OXPHO), with mostly BAP1 and IDH-mutant CCAs, displayed activated oxidative phosphorylation pathways, and were sensitive to oxidative phosphorylation inhibitors. Immune-related pathways were activated in the final group (IMMUN), made up of an immunogenic CCA subtype and CCA with aristolochic acid (AA) mutational signatures. Intratumour differences in AA mutation load were correlated to intratumour variation of different immune cell populations. CONCLUSION Our study elucidates the mechanisms underlying enhancer dysregulation and deepens understanding of different tumourigenesis processes in distinct CCA subtypes, with potential significant therapeutics and clinical benefits.
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Affiliation(s)
- Jing Han Hong
- Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore
| | - Chern Han Yong
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
- Department of Computer Science, National University of Singapore, Singapore
| | - Hong Lee Heng
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Mai Chan Lau
- Singapore Immunology Network, Agency for Science Technology and Research (A*STAR), Singapore
- Bioinformatics Institute (BII), Agency for Science Technology and Research (A*STAR), Singapore
| | - Jianfeng Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing Yi Lee
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Abner Herbert Lim
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Zhimei Li
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Peiyong Guan
- Genome Institute of Singapore, Agency for Science Technology and Research (A*STAR), Singapore
| | - Pek Lim Chu
- Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore
| | - Arnoud Boot
- Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore
- Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Sheng Rong Ng
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research (A*STAR), Singapore
| | - Xiaosai Yao
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research (A*STAR), Singapore
| | - Felicia Yu Ting Wee
- Institute of Molecular and Cell Biology, Integrative Biology for Theranostics Lab, Agency for Science Technology and Research (A*STAR), Singapore
| | - Jeffrey Chun Tatt Lim
- Institute of Molecular and Cell Biology, Integrative Biology for Theranostics Lab, Agency for Science Technology and Research (A*STAR), Singapore
| | - Wei Liu
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
| | - Peili Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rong Xiao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xian Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yichen Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Joanna Koh
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research (A*STAR), Singapore
| | - Xiu Yi Kwek
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
| | - Cedric Chuan Young Ng
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Poramate Klanrit
- Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yaojun Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong
| | - Jiaming Lai
- Department of Pancreaticobiliary Surgery, Sun Yat-sen University, Guangzhou, China
| | - David Wai Meng Tai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Chawalit Pairojkul
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Simona Dima
- Center of Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucuresti, Romania
| | - Irinel Popescu
- Center of Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucuresti, Romania
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Joe Yeong
- Institute of Molecular and Cell Biology, Integrative Biology for Theranostics Lab, Agency for Science Technology and Research (A*STAR), Singapore
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
- Pathology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Sarinya Kongpetch
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Apinya Jusakul
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Watcharin Loilome
- Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Patrick Tan
- Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore
- Genome Institute of Singapore, Agency for Science Technology and Research (A*STAR), Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Jing Tan
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
- State Key Laboratory of Oncology, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bin Tean Teh
- Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
- Genome Institute of Singapore, Agency for Science Technology and Research (A*STAR), Singapore
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research (A*STAR), Singapore
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Zhu Q, Li MX, Yu MC, Ma QW, Huang MJ, Lu CW, Chen CB, Chung WH, Chang CJ. Altered microbiome of serum exosomes in patients with acute and chronic cholecystitis. BMC Microbiol 2024; 24:133. [PMID: 38643067 PMCID: PMC11031981 DOI: 10.1186/s12866-024-03269-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/20/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND This study aimed to investigate the differences in the microbiota composition of serum exosomes from patients with acute and chronic cholecystitis. METHOD Exosomes were isolated from the serum of cholecystitis patients through centrifugation and identified and characterized using transmission electron microscopy and nano-flow cytometry. Microbiota analysis was performed using 16S rRNA sequencing. RESULTS Compared to patients with chronic cholecystitis, those with acute cholecystitis exhibited lower richness and diversity. Beta diversity analysis revealed significant differences in the microbiota composition between patients with acute and chronic cholecystitis. The relative abundance of Proteobacteria was significantly higher in exosomes from patients with acute cholecystitis, whereas Actinobacteria, Bacteroidetes, and Firmicutes were significantly more abundant in exosomes from patients with chronic cholecystitis. Furthermore, functional predictions of microbial communities using Tax4Fun analysis revealed significant differences in metabolic pathways such as amino acid metabolism, carbohydrate metabolism, and membrane transport between the two patient groups. CONCLUSIONS This study confirmed the differences in the microbiota composition within serum exosomes of patients with acute and chronic cholecystitis. Serum exosomes could serve as diagnostic indicators for distinguishing acute and chronic cholecystitis.
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Affiliation(s)
- Qing Zhu
- Department of Surgery, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Min-Xian Li
- Department of Surgery, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Ming-Chin Yu
- Department of Surgery, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Qi-Wen Ma
- School of Medicine and Medical Research Center, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Ming-Jie Huang
- School of Medicine and Medical Research Center, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Chun-Wei Lu
- Drug Hypersensitivity Clinical and Research Center, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Drug Hypersensitivity Clinical and Research Center, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Xiamen Chang Gung Hospital, Fujian, China
| | - Wen-Hung Chung
- School of Medicine and Medical Research Center, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
- Drug Hypersensitivity Clinical and Research Center, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Xiamen Chang Gung Hospital, Fujian, China
| | - Chih-Jung Chang
- School of Medicine and Medical Research Center, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China.
- Drug Hypersensitivity Clinical and Research Center, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Linkou, Taiwan.
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Fusai GK, Raptis DA, Hilal MA, Bassi C, Besselink M, Conlon K, Davidson B, Del Chiaro M, Dervenis C, Frigerio I, Falconi M, Hackert T, Harrison EM, Shrikhande SV, Siriwardena A, Smith M, Wolfgang C, Borakati A, Balci D, Elhadi M, Salinas CH, Machairas N, Marchegiani G, Oba A, Oberkofler C, Passas I, Ravikumar R, Velázquez PS, de Santibañes M, Schnitzbauer AA, Soggiu F, Tamburrino D, Tinguely P, Wei A, Zachiotis M, Bentabak K, Kacimi SE, Nikfarjam M, Shcherba A, Sergeant G, Coelho G, Torres O, Belev N, Tang E, Diaz C, Wei K, Hendi M, Gouvas N, Christophides T, Nikov A, Fathallah D, Saad M, Tammik O, Huhta H, Sulpice L, Lupinacci R, Demetrashvili Z, Stavrou GA, Felekouras GE, Papaziogas V, Misra S, Talib H, Al-Sader MAJ, Satoi S, Obeidat K, Fakhradiyev I, Khalife M, Elhadi M, Dulskas A, Ghani S, Padilla AE, Melchor-Ruan J, Erdene S, Benkabbou A, Nashidengo P, Koea J, Adeyeye NA, Amro S, Alnammourah WM, The C, Pędziwiatr M, Polkowski W, Barbu ST, Galun D, Goh BKP, Trotovšek B, Omoshoro-Jones J, Ielpo B, Abdelmageed A, Sandström P, Cristaudi A, Gloor B, Kuemmerli C, Tishreen AH, Chaaban MK, Wu CH, Jen PCYF, Baraket O, Taylor M, Jamieson N, Iype S, Giorgakis E, Qadan M, Ganai S, Al-Naggar H, Chihaka O, El Behi A, Kouicem AT, Chibane A, Bouzid C, Bentabak K, Bouali I, Samai N, Aya B, Drid B, Tidjane A, Tabeti B, Boudjenan-Serradj N, Larbi MH, Ouahab I, Touabti S, Ilhem O, Bouaoud S, Meriem A, Ouyahia A, Kouicem AT, Abdoun M, Mounira R, Rais M, Riffi O, Kacimi SE, McCormack L, Capitanich P, Goransky J, de Santibanes M, Mazza O, Salazar IP, Ramallo DR, Pablo F, Gondolesi GE, Schelotto PB, Rodriguez J, Apostolou C, Merrett N, Fox A, Hassen S, Joglekar S, Gananadha S, Wake R, Hagen K, Sritharan M, Hall K, Muralidharan V, Brown K, Nikfarjam M, Croagh D, Sritharan M, Berry R, Fayed A, Hodgson R, Kuany T, Loveday B, Banting S, Rowcroft A, Fox A, Knowles B, Taylor L, Chong L, Banting S, Perini M, Nikfarjam M, Lin YJ, Alsoudani A, Burnett D, Shah K, Fuge M, Bull N, Chen S, Navadgi S, Ng ZQ, Johansson M, Azaman NSBB, Pearson A, Apostolou C, Mischinger H, Schemmer P, Kornprat P, Hauer A, Hauer A, Kirbes K, Klug R, Schrittwieser R, Klaus A, Entschev A, Reichhold D, Ugrekhelidze K, Fink M, Stoyanova R, Sabateen M, Mahfoodh Z, Shenawi HA, Yaghan R, Chowdhury M, Shcherba A, Kirkovsky L, Korotkov S, Van den Bossche B, Boterbergh K, Poortmans M, Smet B, Strypstein S, Feryn T, Wahib EM, oubella S, Roeyen G, Hartman V, Bracke B, Hendrikx B, Gryspeerdt F, Berrevoet F, Poortmans N, Apers T, Appeltans B, Appeltans B, Wicherts D, Sergeant G, Garcia FOB, dos Santos IB, Garcia R, Pinto R, Leite TLS, Anghinoni M, Nobre CCG, Coelho G, Machado IFS, Carvalho N, Morais L, Barros AV, Gomes G, Buarque IL, Osvaldt AB, Militz M, Boff M, Marcelino L, Guerra E, Torelly L, Waechter FL, Rodrigues P, Teixeira UF, Osvaldt A, Marcelino L, Militz M, De Mello E, Goncalves R, Balzan S, Ramos EJB, Moraes-Junior JMA, Torres OJM, da Silva DV, Coimbra F, Coimbra FJF, Marques N, Marques N, Torres SM, Sampaio A, Canteras CA, Ferreira F, Machado MA, Kleinubing D, Lellis L, Brum SL, Gohar M, Atanasov B, Slavchev MT, Slavchev M, Belev N, Krastev P, Takorov I, Vladov N, Kostadinov R, Lukanova T, Mihaylov V, Chernopolsky PM, Madjov R, Bozhkov VM, Kostov VD, Kostov D, Nikolaev E, Muhezagiro F, Niyonkuru J, Irakoze P, Dixon E, Lo E, Ruo L, D'Souza D, Serrano PE, Skaro A, Tang E, Glinka J, Martin J, Zogopoulos G, Metrakos P, Chaudhury P, Torres-Quevedo R, Brañes A, Brañes A, Diaz C, Buckel E, Butte J, Devaud N, Paqui L, Wei K, Wang H, Cai L, Guo S, Chen Y, Hendi M, Cheung TT, Millan C, Argüello P, Pavlek G, Silovski H, Petrovic I, Romic I, Zedelj J, Amic F, Kolovrat M, Rakic M, Mikulic D, Štironja I, Bubalo T, Gouvas N, Papatheodorou P, Christophides T, Burda L, Straka M, Klos D, Tesarikova J, Loveček M, Gregorik M, Skalicky P, Stögerová C, Fichtl J, TomአS, Zaruba P, Nikov A, Tschuor C, Mohamed M, Sayed B, Shaheen A, Farid A, Attalla A, Ibrahim DF, Fathallah D, Elmzaien E, Magdy B, Salah S, Saleh A, Saker AAE, Swealem A, Sallam EI, Rozza H, Bassiony M, Elhassan M, Elmalah M, Belal M, El Gohary M, Hassanin MA, Elsayed N, Aboelfath S, El-Sayes I, Tayiawi M, Altatari A, Altatari AM, Saleh A, Qatora MS, Said M, Najjar A, Alahmed F, Zamri FMB, Ealreibi H, Alahmed H, Alyasin I, Abdelhalim K, Alfatah MA, Sharaan MA, El Moneam MA, Abdelalemm M, Mourad M, Sohaimee NB, Abosamak NE, Suhaimi NMFB, Shokralla S, Dean YE, Tanas Y, Waffa Z, Nafea A, Ramadan D, Abdelaal A, Mahmoud A, Nafea AM, Abuali ASAME, Korayem I, Fahmy M, Ibraheem M, Hamouda M, Helaly R, Khdour YF, Khdour Y, Farag M, Ibrahim A, Elareibi HE, Alboridy M, Mansour A, Ragab MG, Naguib M, Allam S, Elfarag HA, Elsakka A, Mannaa D, Elkeleny M, Suhaimi NAB, Uzir SSBM, Nasr S, El-Najjar A, Dohien M, Dohien M, Osman N, Gad N, Hassanin M, Fadel BA, Hamdan EHM, Monib F, Saad M, Abbas A, Abu-Elfatth AM, Elazeem HAA, Abdelhafez MHZ, Omar N, Hassan R, Mohamed A, Mahmoud SH, Abobakr AM, Mohamed EEE, Ahmed R, Hamza HM, Mohammed M, Marshod MA, Hussein AMM, Taha A, Ibrahim I, Nageh MA, Fouly MN, Hassan RA, Mohamed AKA, Elnabi MH, Salah M, Ali AYM, Sayed EGA, Sayad R, Saad MM, Abdelkarem M, Omar NG, Khalifa A, Faragalla H, Barakat A, Barakat ATM, Elshafey A, Eleisawy MF, Eleisawy M, Zahed MSM, Zahed M, Omer M, Allam M, Abuelnaga Y, Abdelzaher A, Alnimr A, Dabbous H, Sayed H, Elgarhy I, Elmeteini M, Bahaa M, Farag M, Eid M, Anas O, Ismail O, Nageeb O, Lasheen R, Tanyous S, Diab S, Badran Y, Fahim A, Alazab E, Elgarhy IM, Abdeljalil M, Hanna M, Gobran M, Gobran M, Abdelmawla MOMK, Nagy M, Nageeb OE, Ramadan S, Abdelmawgoud S, Zidan T, Abuelnaga Y, Tarkhan Y, Saad A, Awad AK, Elbadawy MA, Abdelmawla M, Mansy E, Moharam M, Elabd M, Eldabour A, Elwakil L, Hassanien MS, Elnashar A, Saleh HED, Michail M, Said A, El Garhy M, Ahmed MBE, Anas O, Ismail O, Abboud K, Nabil A, Elfiky M, Murad A, Azzam A, Azab MA, Awad S, Othman Z, Fahim AM, Abdelzaher AT, Zidan T, Abdelrhman R, Tolis EAN, Salem M, Ebrahim H, Abdelrazek HA, Abdelmoneim N, Salman D, Saa'd H, Ali D, Farouk A, Mandor AR, Monier A, Shehta A, Kassem A, Sanad A, Elsaadany R, Shaat MM, Elmorsi R, Awad S, Ghedan S, Menessy A, Elnabawy D, Abdou K, Abdelmaksoud M, Hassan M, Elweza O, Elboraei R, Abdallah A, Metwally IH, Elhamamsy M, Fareed AM, Zuhdy M, Elbalka SS, Alansary MN, Omar M, Elgharably AA, Hager E, El Gady A, Alsharif DS, Shaaban AM, Alsharif D, Samaan D, Samaan SSS, Oteem A, Shaaban AM, Alsharif DS, Samaan S, Zayed A, Allam A, El Gady A, Alsharif DS, Badr K, Elnoamany S, Samaan SS, Ellibady M, Ahmed EA, Elbassyiouny A, Boalot A, Badr H, Gamal M, Abuelazm M, Othman Z, Eldaly A, Eldaly AS, Essa M, Abdelrahman F, Sarhan A, Alsabbagh F, Allah MA, Bayomi A, Salama M, kivisild M, Tammik O, Podramagi T, Huhta H, Kauppila JH, Nortunen M, Jouffret L, Sommacale D, Brustia R, Cherif R, Lecolle K, El Amrani M, Beugniez C, Truant S, Piessen G, Degisors S, Dupré A, Perinel J, Adham M, Sgarbura O, Souche FR, Iannelli A, Gugenheim J, Savvala N, Scatton O, Lupinacci R, Ragot E, Manceau G, Karoui M, Goasguen N, Anyla M, Gaujoux S, Rhaiem R, Piardi T, Robin F, Sulpice L, Roussel E, Papet E, Schwarz L, Felli E, Giannone F, Pessaux P, Pipia I, Khutsishvili K, Demetrashvili Z, Krones C, Wüllenweber HP, Bartella I, Kamphues C, Loch F, Pozios I, Belyaev O, Mohan PV, Uhl W, Bulian D, Juengling N, Thomaidis P, Korn S, Welsch T, Bork U, Praetorius C, Weitz J, Distler M, Krautz C, Brunner M, Grützmann R, Mazzella E, Hecker A, Reichert M, Azizian A, Gaedcke J, Ghadimi M, Aghdassi A, Döbereiner J, Klose J, Kleeff J, Ronellenfitsch U, Oldhafer KJ, Wagner K, Reese T, Heumann A, Uzunoglu FG, Izbicki J, Goetz M, Scognamiglio P, Honselmann K, Keck T, Wellner U, Struecker B, Hackl C, Brennfleck FW, Brunner S, Kardassis D, Schütze F, Stavrou GA, Ghamarnejad O, Metzger R, Koenigsrainer A, Nadalin S, Anthoni C, Makridis G, Farkas SA, Löb S, Nikou E, Tsoukalas N, Bairamidis E, Vaia A, Prountzopoulou A, Fradelos E, Kechagias A, Kelgiorgi D, Avgerinos K, Ioannidis A, Konstantinidis KM, Konstantinidis MK, Papakonstantinou D, Papiri I, Michalopoulos N, Petropoulou Z, Christodoulou S, Margaris I, Chatzialis I, Selmani J, Papadoliopoulou M, Arkadopoulos N, Kokoropoulos P, Vassiliu P, Parasyris S, Sidiropoulos T, Stamopoulos P, Stergiou D, Sotiropoulou M, Vaslamatzis M, Roukounakis N, Kapiris SA, Kapiris SA, Vougas V, Roukounakis N, Dimitroulis D, Mantas D, Kotsifa E, Kotsifa E, Tomara N, Tomara NK, Machairas N, Dorovinis P, Kykalos S, Tsirlis T, Larentzakis A, Vrakopoulou GZ, Tzimas G, Pagkratis S, Triantafyllidis I, Papalampros A, Polydorou A, Syllaios A, Kontopoulou C, Politis D, Vouros D, Schizas D, Kyros E, Felekouras E, Karavokyros I, Griniatsos J, Bramis K, Toutouzas K, Karydakis L, Konstadoulakis M, Memos N, Kanavidis P, Massaras D, Fragulidis G, Frountzas M, Kordeni K, Vezakis A, Iliakopoulos K, Chardalias L, Kyriazanos I, Kyriazanos I, Marougkas M, Stamos N, Giannakopoulos T, Kalles V, Balalis D, Manatakis D, Korkolis D, Bourazani M, Delis S, Cyrochristos D, Baltagiannis E, Glantzounis G, Stylianidis S, Diamantis A, Valaroutsos A, Magouliotis D, Zacharoulis D, Christodoulidis G, Tepetes K, Perivoliotis K, Fergadi M, Tsiotos G, Mulita F, Maroulis I, Vailas M, Zygomalas A, Karavias D, Kontis E, Katsaros I, Kopanakis N, Tooulias A, Christou C, Raptis D, Katsanos G, Beradze N, Papaziogas V, Papadopoulos VN, Giakoustidis D, Katsourakis A, Efthymiou E, Chatzis I, Ntinas A, Hatzitheoklitos E, Tsalis K, Koustas P, Apostolos K, Petras P, Tsaramanidis S, Iakovidis C, Zacharakis E, Marjai T, Bursics A, Dede K, Tölgyes T, Vereczkei A, Kelemen D, Robert P, Vasavada B, Vaishnav D, Pawar P, Suryawanshi P, Shinde RM, Piplani C, Singh A, Sahu SK, Choudhary SR, Gupta R, Ramamurthy A, Babu E, Karuparthi S, Kumar S, Purushothaman G, Sathyanesan J, Venkatesh NR, John S, Singh AK, Gupta R, Singh SK, Sharma D, Yadav K, Leekha N, Pippari R, Pandey M, Francis NJ, Kumar T, Jain S, Poonia DR, Vishnoi JR, Sharma N, Pareek P, Byshetty R, Misra S, Varshney V, Ray R, Gulati S, Ghatak S, Das K, Khamrui S, Ray S, Sebastian GM, Chand JT, Appukuttan M, Chaturvedi A, Akhtar N, Prakash P, Gupta S, Rajan S, Kumar V, Sonkar AA, Ozair A, Suresh V, Virk S, Narasimhan M, Ardhanari R, Ramachandran S, Jain D, Velagala JR, Chattopadhyay S, Vodyala C, Velagala JR, Motwani K, Prajapati R, Tilak S, Bansal V, Kalayarasan R, Bhalerao S, S IP, Chisthi MM, A N, Latheef A, Yadev I, Sreekumar RC, Yadev I, KV V, Pandey D, Tripathi M, Fuadi AF, Prabowo E, Abbood AH, Hammoodi H, Al-juaifari MA, Al-Isawi A, Al-Tekreeti S, Al-Ogaili M, Hashim HT, Sadot E, Apel R, Sulimani O, Solomonov E, Itzhaki O, Lavy R, Shapira Z, Nicolini D, Vivarelli M, Rossi MDR, Mocchegiani F, Memeo R, Vincenti L, Fedele S, Andriola V, Gurrado A, Meo GD, Testini M, Neri V, Zironda A, Trizzino A, Pinelli D, Colledan M, Pizzini P, Cirelli R, Masetti M, Zanello M, Jovine E, Mastrangelo L, Lombardi R, Casadei R, Malpaga A, Frena A, Patauner S, Ciola M, Andreuccetti J, Manzoni A, Hilal MA, de Graaf N, Alfano MS, Molfino S, Baiocchi GL, Pisanu A, Mellano A, Papa MV, Carlo ID, Donati M, Zanatta M, Basile PF, Antonucci A, Papis D, Pighin M, Celotti A, Sasia D, Allisiardi F, Borghi F, Maione F, Giraudo G, Migliore M, Salomone S, Giaccardi S, Testa V, Giacometti M, Zonta S, Taddei A, Risaliti M, Muiesan P, Urciuoli I, Bencini L, Moraldi L, Anastasi A, Canonico G, Nelli T, Storto GL, D'Acapito F, Ercolani G, Solaini L, Cucchetti A, Gardini A, Pacilio CA, Barberis A, Filauro M, De Cian F, Valente R, Didomenico S, Papadia FS, Di Domenico S, De Rosa R, Massobrio A, Scabini S, Carganico G, Pessia B, Sista F, Schietroma M, Spampinato MG, Garritano S, D'Ugo S, Marchese T, Saladino E, Cuticone G, Gullá N, Recordare A, Palumbo R, Giani A, Ferrari G, Mazzola M, Dondossola D, Rossi G, Caccamo L, Zerbi A, Nappo G, Montorsi M, Coppa J, Busset MDD, Mazzaferro V, Troci A, Frontali A, Crespi M, Baldi C, Benuzzi L, Ferrara F, Stella M, Capurso G, Falconi M, Tamburrino D, Benedetto FD, Magistri P, Ballarin R, Zanus G, Brizzolari M, Uggeri F, Gianotti L, Cereda M, Ferraro D, Iacomino A, Ferraro D, Pisaniello D, Vennarecci G, Pisaniello D, Rompianesi G, Troisi RI, Patrone R, Belli A, Izzo F, Palaia R, Gianpaolo M, Maida P, Pasquale T, Bassi D, Cillo U, Moletta L, Sperti C, Serafini S, Milanetto AC, Pasquali C, Tolin F, Gruppo M, De Simoni O, Buscemi S, Marino MV, Giuffrida M, Dallavalle R, Calabretto F, Cobianchi L, Pugliese L, Giardino A, Butturini G, Regi P, Kauffmann EF, Di Franco G, Morelli L, Furbetta N, Napoli N, Boggi U, Pinotti E, Montuori M, Giuliani A, Izzo ML, Zanini N, Veneroni L, Giordano M, Palini GM, Garulli G, Vaccara VL, de Rose AM, Giuliante F, Ardito F, Mingoli A, Sapienza P, Lapolla P, Petrucciani N, Cossa A, Coppola A, Belloni E, Nigri G, Tisone G, Angelico R, Manzia TM, Caputo D, Saverio SD, Porcu A, Perra T, Feo C, Deiana G, Sartarelli L, Pisconti S, Tonini V, Patrono D, Moro F, Grasso L, Brolese A, Ciarleglio F, Marcucci S, Nistri C, Massani M, Tommaso S, Galasso E, Zanus G, Brizzolari M, Romano M, Rossi S, Novello S, Ferrero A, Langella S, Armentano S, Russolillo N, Dario L, Intini S, Giovanni T, Recordare AG, Pirozzolo G, Palumbo R, Calabrese F, Querini G, Zonta S, Caneparo A, Giacometti M, De Francesco M, Balduzzi A, Guglielmi A, Ruzzenente A, Iacono C, Poletto E, Marchegiani G, Isa G, Malleo G, Alaimo L, Salvia R, Conci S, Crinò SF, Campagnaro T, Frigerio I, De Marchi F, Bonomo M, Napetti S, Frontali A, Chierici A, Cotsoglou C, Gjoni E, Paleino S, Granieri S, Hashimoto D, Satoi S, Yamamoto T, Uemura K, Matsumoto I, Kamei K, Maehira H, Tani M, Hirano S, Nakamura T, Asano T, Akahoshi K, Tanabe M, Ishii T, H Al Saffaf M, Hamoud MA, Khattab R, Alissawi S, Hassouneh A, Al-Maadani B, Alali MB, Hmdan QA, Obed A, Nijadat D, Al-Shami K, Al-shami M, Mohsen M, Al-Mallah R, Albaba S, Theab M, Massadeh N, Theab RAK, Wardeh S, Salahwardeh, Alissawi SZ, Mardini A, Arabiyat HAA, Arabiyat H, Al-Hyari A, Ababneh H, Naffa' MF, Buwaitel MM, Al-Mekhlafi A, Rababa H, Alzoubi M, Khamees A, Abuleil A, Almiani S, Obeidat K, Amarin Z, Al-Samawi A, Hammoud AAA, Hammad H, Alkhadem MA, Mahafdah MR, AlSaffaf M, Alsabah M, Hani MB, Hamoud MAAL, Alzghoul MW, Khattab RN, Shumrakh SK, Rababah A, Alghazo H, Rababah T, Khamees A, Awadi S, Sharie SA, Abdelnoor A, Shaout DM, Omarieh Q, Abu-Ghazal SY, Abu-Ghazal S, Shaout D, Abughazal SY, Fakhradiyev I, Tanabayeva S, Saliev T, Issabekov I, Spatayev Z, Han HS, Jo Y, Plaudis H, Martinsone KD, Atstupens K, Jawad M, Khalife M, Faraj WG, Alowjali F, Albaraesi MN, Aldressi W, Benamwor A, Ali SB, Saleh S, Alshatshat A, Younes E, Younes E, Ekhmaj R, Bahroun S, Bahroun SG, Ekhmaj R, Bahroun SG, Burgan D, Aalem HAA, El Hussain RK, Morgom M, Alshareea E, Ellafi AAD, Shoukrie S, Shamakhi TMO, Bareig E, Abusannuga M, Dkhakhni A, Gerwash AA, Gerwash A, Zawia A, Othman E, Binnawara M, Abdalsalam SJA, Aljamal S, Ahmeed S, Khalil WIA, Khalel W, Faraj T, Elhajdawe F, Emhemed M, Salem O, Abdulwahed E, Khalil W, Rhuma H, Alsori M, Mustafa T, Albarouni S, Albishti A, Elhadi M, Elkhuja T, Msherghi A, Hasan NSB, Hasan HB, Hasan NB, Gulbinas A, Barauskas G, Ignatavicius P, Riauka R, Vanagas T, Slepavicius A, Jurgaitis J, Dailidenas S, Eismontas V, Mikutaitis V, Šlepavičius A, Jurgaitis J, Mikutaitis V, Dulskas A, Kuliavas J, Aniukstyte L, Sileikis A, Gulla A, Šileikis A, Tumas J, Strupas K, Petrulionis M, Kvietkauskas M, Strupas K, Vito D, Rosso E, Tan JH, Zakaria AD, Mohamad IS, Meng LV, Huai TZ, Hayati F, Sellappan H, Maiyauen TK, Azman A, Chik I, Zuhdi Z, Yoong B, Soon KP, Kit KJ, Yoong BK, Koong JK, Koh PS, Ibrahim A, Abdullah NAN, Bong J, Ghani S, Zorrilla CF, Cruz MC, Valladares AM, Dominguez-Rosado I, Rosciano AEP, Sebastian GH, Melchor-Ruan J, Garcia-Herrera JS, Sandag E, Erdene S, Orgoi S, Korch M, Boutti AS, boumzebra Y, Boumzebra Y, Hourri F, Gouazar I, Belaid WA, Serji B, Tarik B, Tijani EH, Zentar A, Ghannam A, Bounaim A, Souadka A, Benkabbou A, El Ahmadi B, Amina H, Oumayma L, Amrani L, Majbar MA, Mohsine R, Elhassouni R, Echiguer S, Belkhadir Z, Nashidengo AP, Quayson F, Abebrese J, Nashidengo P, Adhikari KM, Lakhey PJ, Bhandari RS, Besselink MG, Bieze M, Augustinus S, Busch O, Pranger BK, Hoogwater FJH, Klaase JM, Meerdink M, Nijkamp MW, de Meijer VE, Koerkamp BG, van Eijck CHJ, Van Dam JL, Barbier L, Johnston P, Babor R, Chu MJJ, Oliver T, Wen D, Koea J, Koea J, Brown L, Srinivasa S, Bartlett A, Windsor J, Carr-Boyd P, Bindra V, Cross A, Connor S, Hore T, Gunawardene A, Welsh F, Mahadik M, Gordon A, Rossaak J, Adeyeye A, Enoch E, Kayode-Nissi V, Abiyere H, Alatise O, Okomayin A, Odion C, Tagar E, Sheshe AA, Muhammad AB, Garzali IU, Ajayi P, Kadri E, Jabri SA, Azri YA, Pal KMI, Siddiqui T, Waqar U, Waqar U, Chaudhry AA, Abbasy J, Khan MO, Shafqatullah S, Khokhar MI, Akbar A, Afzal A, Asghar M, Ullah S, Butt UI, Butt U, Bari H, Mohammad BN, Hameda M, Jayyab MA, Alzabadiah AHM, Adam I, Abuzaina K, Farid M, Emar MFM, Emar M, Zreqat Q, Titi R, Idkiedek SA, Amro S, Al-Qasrawi S, Almasri TA, Alnammourah WM, Kiswani G, Sinnokrot R, Harb ZA, Nafa'A H, Shtewi L, Salah AO, Joma ABA, Faraj S, Zitawi A, Dawood AJ, Saadeh I, Hmeedan A, Daraghmeh MAM, Janajreh ANA, Manassra F, Yassin LMA, Yassin R, Saleh AO, Faraj SM, Sulaiman AS, Khayyat Z, Joma ABA, Shawahni E, Salah A, khader A, Hammoudeh A, Abdulhaq A, Alawna R, Roman G, Targarona J, Grau RG, Molina R, Alegria CR, Coayla G, Enriquez JCM, Marcos JC, Hasiman AN, Teh C, Cerdeño R, David A, Sarmiento RI, Barroso RR, Alfonso C, Ang DD, Casupang A, Mamuric M, Jardinero JM, Motyka A, Flisińska M, Pierściński S, Mrowiec S, Rymarowicz J, Matyja M, Wikar T, Sierzega M, Pędziwiatr M, Richter P, Durczynski A, Kosztowny K, Ciesielski W, Wardeszkiewicz A, Szwedziak K, Wlazlak M, Grzasiak O, Szewczyk P, Hogendorf P, Wyroślak-Najs J, Rawicz-Pruszyński K, Sędłak K, Solecki M, Polkowski W, Słodkowski M, Wierzchowski M, Korcz W, Nazarewski L, Kornasiewicz O, Lopes M, Martins RM, Martins R, Vigia E, Silva DS, Davide J, Pereira A, Tenreiro N, Castro T, Eisa R, Diaconescu B, Ciubotaru C, Negoi I, Negoiţă V, Radulescu RB, Bacalbaşa N, Dima S, Dumitrascu T, Spanu A, Mardare M, Ginghina O, Catrina E, Brezean I, Misca M, Vilcu M, Aldoescu S, Petrea S, Bartos A, Liviu CC, Iancu I, Barbu ST, Bodea R, Mois E, Florin G, Hajjar NA, Matei S, Zaharie F, Scripcariu V, Musina AM, Roata CE, Dimofte GM, Velenciuc N, Lunca S, Ong WL, Ong WL, Duta C, Brebu D, Braicu V, Belyaev A, Popov A, Batova A, Katysheva A, Mizgirev D, Neledova L, Duberman B, Litvin A, Pobelenko A, Kuznetsov G, Khatkov I, Tyutyunnik P, Izrailov R, Bedzhanyan A, Petrenko K, Bredikhin M, Shatverian DG, Chardarov N, Bagmet N, Lyadov V, Mudryak D, Semenenko I, Tokarev M, Kriger A, Kaldarov A, Ivanov G, Kuchin D, Torgomyan G, Zagainov V, Davydkin V, Baranov AI, Drozdov E, Anatolievna LN, Abdullaev A, Gachabayov M, Ghunaim M, Alharthi M, Aljiffry M, Bogdanovic M, Zivanovic M, Bogdanovic A, Galun D, Dugalic V, Arbutina D, Milic L, Bezmarevic M, Antic A, Radenkovic D, Ignjatovic I, Zdujic P, Kmezic S, Karamarkovic A, Arbutina D, Juloski J, Radulovic R, Radulović R, Cuk V, Jeremic L, Radojkovic M, Stojanovic M, Golijanin D, Ignjatovic MK, Protic M, Chiow A, Seng LL, Thiruchelvam N, Poh BGK, Goh BKP, Quan DCW, Koh YX, TrotovŠek B, Petrič M, Djokić M, Tomazic A, Badovinac D, Loots E, Prodehl L, Khan MU, Marumo T, Devar JWS, Omoshoro-Jones J, Khan ZA, Jugmohan B, Valcarcel AQ, García BM, Mínguez J, Marcello M, Ramia J, Compañ A, Fernandes C, Morales M, Fernández JMV, Del Mar Rico-Morales M, Liñán MÁL, Figueras J, Soliva R, Butori E, Fondevila C, Ausania F, Martín B, Rodríguez M, Sánchez-Cabús S, Sánchez-Velázquez P, Arnau ABM, Domínguez RS, Ielpo B, Pinilla FB, Castro M, Valverde DP, Santos EPG, del Carmen Manzanares Campillo M, Ruiz P, Gutierrez EC, Falgueras L, Quer MTA, Shwely FA, Fragua RL, Gonzalez-Serna DB, Valmorisco MA, Beltran-Miranda P, Busquets J, Secanella L, Pelaez N, Plaza G, Duaigües MLG, álvarez PM, Escartín A, Loinaz C, Dziakova J, de la Serna S, Pérez-Aguirre E, Justo I, Saavedra J, Gomez JC, Boñar NL, Martín-Perez E, Di Martino M, de la Hoz Rogriguez Á, Marcacuzco A, Jiménez-Romero C, de la Rúa JFR, Hinojosa-Arco LC, Suárez-Muñoz MÁ, Martinez DF, Sanchez-Bueno F, Vazquez PG, de León AM, Saiz EC, García LS, Gonzalez-Pinto I, Rodríguez-Pino JC, Segura-Sampedro JJ, Morales R, Morales-Soriano R, Rotellar F, Zozaya G, Martí-Cruchaga P, López-Sánchez J, Muñoz-Bellvis L, Cuadrado A, ortega I, Fernández R, Gómez DD, Vera V, Padillo JP, Luque JB, Millan EI, Jorba R, García-Domingot MI, Redondo C, Cantos DM, Artigues E, Pozo CDD, Llorente CP, Martínez SN, Ibáñez CB, Ibáñez JM, Andujar RL, Dorcaratto D, Forner EM, Garces-Albir M, de Heredia JB, Montes-Manrique M, Rodriguez-Lopez M, Serrablo A, Milian D, Ruiz-Quijano P, Paterna-Lopez S, Dharmapala A, Dassanayake BK, Galketiya KB, Ibrahim AM, Hamid H, Alhaboob N, Abdelmageed A, Taha SSO, Vilhav C, Wennerblom JH, Bratlie SO, Bjornsson B, Lundgren L, Sandström P, Tingstedt B, Andersson R, Andersson B, Williamsson C, Sparrelid E, Holmberg M, Ghorbani P, Gkekas I, Kuemmerli C, Bolli M, Andreou A, Wenning AS, Gloor B, Peloso A, Toso C, Oldani G, Moeckli B, Wassmer CH, Cristaudi A, Pietro MH, Majno-Hurst PE, Roesel R, Abbassi F, Tarantino I, Steffen T, Ferrari C, Schmidt J, Meier O, Weber M, Gutknecht S, Jonas JP, Clavien PA, Al-Haj A, Aljaber A, Kayali AA, Kadoura L, Nashed E, Helaly H, Kayali H, Alhashemi M, Aloulou M, Alshaghel M, Mahli N, Al-Abed O, Azizeh O, Torab SS, Alkhaleel W, Aliwy MA, Alannaz O, Ghazal A, Masri R, Douba Z, Saad AS, Abdulmonem A, Shaban M, Alhouri AN, Alhouri A, Soliman A, Houri HNA, Houri HA, Omran S, Abbas A, Chaaban M, Kudmani MAA, Chaaban MK, Alhmaidi R, Yousef A, Youssef A, Nasri M, Alkhateb H, Almjersah A, Hassan N, Moussa A, Hamdan A, Hammed A, Alloush A, Hassan BH, Issa H, Dahhan HT, Souliman M, Hammed S, Tobba TM, Hamdan A, Ayoub S, Yu MC, Yang PC, Wu CH, Bouaziz H, Rahal K, Slim S, Karim A, Baraket O, Kchaou A, Houssem A, Said MA, Mabrouk MB, Hamida KB, Ghalleb M, Mahmoud AB, Maghrebi H, Kacem MJ, Tez M, Eminesariipek N, çetiindağ Ö, Tüzüner A, Karayalçin K, Emral AC, Dikmen K, Kerem M, Bayhan H, Türkoğlu MA, Iflazoğlu N, özet A, Aday U, öfkeli Ö, Gumusoglu A, Kabuli HA, Karabulut M, Peker K, Saglam S, Rahimi FSİ, Hanefa F, Isik A, Goksoy E, Dulundu E, Atici AE, Ozocak AB, Yegen C, Dural AC, Sahbaz NA, Ulgur HS, Aydin H, Ozkan OF, Duzgun O, çelik M, Pekmezci S, çoker A, Uguz A, Unalp OV, Sert I, Ertekin S, Ozbilgin M, Aydoğan S, Tekin E, Calik B, Yesilyurt D, Atici SD, Arıkan TB, Arıkan T, Gonullu E, Dikicier E, Capoglu R, Bayhan Z, Alfurais S, Colak E, Polat S, Çiftci AB, Milburn J, Jones C, Vass D, Taylor M, Dasari BVM, Kausar A, Sultana A, Subar D, Nunes Q, Skipworth J, Nwogwugwu O, van Laarhoven S, Kourdouli A, Awan AA, Bhatti I, Latif J, Hand F, Robertson F, Holroyd D, Holroyd D, Jamieson N, Lim W, Chang D, Frampton A, Lahiri R, Chakravartty S, Siddique H, Bashir M, Mcnally S, Young A, Smith A, Pine J, Garcea G, Haqq J, Malde D, Dunne D, Burridge I, Szatmary P, Hariharan D, Kocher H, Yip V, Khalil A, Nair AM, Liova I, O'Balogun A, Rothnie A, Chikkala B, Salinas CH, Frola C, Tsakiris C, Raptis D, Chasiotis D, Sharma D, Jessa F, Soggiu F, Fusai G, Kostakis I, Kathirvel M, Elnagar M, Dimitrokallis N, Iype S, Pericleous S, Mohamed A, Val ARD, Tinguely P, Likos-Corbett M, Afzal I, Bhogal R, Patel K, Siriwardena AK, de' Liguori Carino N, Sheen PA, Gareb F, Ammar K, Thakkar R, Pandanaboyana S, Leeds J, Gomez D, Gregory G, Ceresa C, Abbas H, Lazzereschi L, Reddy S, Gordon-Weeks A, Aroori S, Russell T, Roberts K, Chatzizacharias N, Sutcliffe R, Al-Sarireh B, Shingler G, Mortimer M, Skoryi D, Ilin I, Pisetska M, Cheverdiuk D, Kostyantyn K, Kopchak K, Kvasivka O, Valeriia S, Sumarokova V, Kryzhevskyi V, Sikachov S, Khomiak A, Malik A, Khomiak I, Bilyak A, Chooklin S, Chuklin S, Mikheiev I, Shylenko O, Klymenko A, Patel S, Cunningham S, Callery M, Kent T, Raut C, Wang J, Fairweather M, Sulciner M, Hirji S, Clancy T, Nebbia M, Qadan M, Musser A, Hogg M, Rodriquez J, Hamner J, Hennessy L, Dinerman A, Gupta A, Kimbrough C, Thompson R, Zeh HJ, Radi I, Polanco PM, Moris D, Lidsky ME, Lee D, Piper J, Gnerlich J, Tuvin D, Sticca R, Ganai S, Gusani N, Krinock D, Giorgakis E, Hardgrave H, Spencer-Cole RT, Klutts G, Hardgrave H, Nigh J, Nigh J, Andrade JCB, Mavros M, Osborn T, Ferrone C, O'Connor V, Boone B, Harris B, Schmidt C, Schrope B, Chabot J, Kluger M, Lasso ET, Nevler A, Yeo C, Ponzini F, Lavu H, Lamm R, Bowne W, Kyser N, Galanopoulos C, Abbasi A, Park J, Sham J, Dickerson L, Pillarisetty V, Sucandy I, Ross S, Winslow E, Hawksworth J, Radkani P, Fishbein T, Munoz AS, Lindberg J, Martins PN, Al-saban RAM, Al-Saban R, Al-Kubati W, Ghallab AAA, Alsanany GM, Almarashi H, Al-Samawi H, Al-Asadi MAMM, Alsayadi R, Hail S, Shream S, Bajjah HM, Al-Ameri S, Bajjah H, Al-Ameri SAAS, Al-Dowsh NA, AlDowsh NA, Al-Khawlani Q, Murshed YAA, Al-Shehari M, Jahaf AAD, Al-sharabi EAE, Aldumaini H, Alattas Z, Almassaudi A, Bajjah HMAH, Albakry R, Al-Naggar H, Shream SAA, Affary AA, Al-Markiz E, Al-Eryani F, Farhat H, Qadasi QA, Alwafy K, Abdualqader MYM, Ali RAAY, Albar A, Bleem HA, Galeb KSA, Ghushaim M, Sabbar M, Esmail M, Ali RAY, Salem RHM, Salem R, Saif W, Al-Faiq S, Alsharabi E, Hameed ATA, Almekhlafi T, Omairan A, Almarkiz E, Abduljawad H, Mansaleh O, Al-Melhani W, Abdualqader M, Al-Abdi R, Alwan HM, Mbanje C, Chihaka O. Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries. Br J Surg 2024; 111:znad330. [PMID: 38743040 DOI: 10.1093/bjs/znad330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 05/16/2024]
Abstract
BACKGROUND Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide. METHODS This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters. RESULTS A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared with 19 per cent in very high-HDI countries. CONCLUSION Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761).
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Hsu HM, Tsai HI, Lee WC, Wang CC, Yu MC, Lin SM, Lin CY, Wu CH, Lee CW. The Extended Surgical Concepts for Hepatocellular Carcinoma in the Era of Immune Checkpoint Inhibitors. J Hepatocell Carcinoma 2023; 10:1873-1880. [PMID: 37901716 PMCID: PMC10612521 DOI: 10.2147/jhc.s433598] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023] Open
Abstract
Surgical resection remains one of the most effective curative therapies for HCC. However, the majority of patients have advanced unresectable diseases upon presentation. It is of paramount importance to raise the resectability of patients with HCC. The remarkable objective response rate reported by Phase III IMbrave150 trial has led to the concept of "Atezo/Bev followed by curative conversion (ABC conversion)" for initially unresectable HCC. With this revolutionary treatment strategy, the concept of surgical resection for HCC should be amended. The current opinion illustrated three extended surgical concepts, which could be integrated into clinical practice in the era of immune checkpoint inhibitors (ICI).
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Affiliation(s)
- Hsiao-Mei Hsu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-I Tsai
- Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chen Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Chi Wang
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of General Surgery, Department of Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Chin Yu
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan
| | - Shi-Ming Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Yen Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Huan Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Wei Lee
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Lee CH, Hsu CY, Yen TH, Wu TH, Yu MC, Hsieh SY. Daily Aspirin Reduced the Incidence of Hepatocellular Carcinoma and Overall Mortality in Patients with Cirrhosis. Cancers (Basel) 2023; 15:cancers15112946. [PMID: 37296908 DOI: 10.3390/cancers15112946] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Cirrhosis is the primary risk factor for hepatocellular carcinoma (HCC) and gastrointestinal bleeding (GI). We aimed to assess the efficacy and safety of daily aspirin on HCC occurrence, overall survival, and GI bleeding in cirrhotic patients. METHODS A total of 35,898 eligible cases were enrolled for analyses from an initial 40,603 cirrhotic patients without tumor history. Patients continuously treated with aspirin for at least 84 days were in the therapy group, whereas those without treatment were controls. A 1:2 propensity score matching by age, sex, comorbidities, drugs, and significant clinical laboratory tests with covariate assessment was used. RESULTS Multivariable regression analyses revealed that daily aspirin use was independently associated with a reduced risk of HCC (three-year HR 0.57; 95% CI 0.37-0.87; p = 0.0091; five-year HR 0.63, 95% CI 0.45-0.88; p = 0.0072) inversely correlated with the treatment duration [3-12 months: HR 0.88 (95% CI 0.58-1.34); 12-36 months: HR 0.56 (0.31-0.99); and ≥ 36 months: HR 0.37 (0.18-0.76)]. Overall mortality rates were significantly lower among aspirin users compared with untreated controls [three-year HR 0.43 (0.33-0.57); five-year HR 0.51 (0.42-0.63)]. Consistent results were obtained when the laboratory data were included in the propensity score for matching. CONCLUSIONS Long-term aspirin use significantly reduced the incidence of HCC and overall mortality without increasing gastrointestinal bleeding in cirrhotic patients.
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Affiliation(s)
- Chern-Horng Lee
- Division of General Medicine and Geriatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Chiu-Yi Hsu
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Tsung-Han Wu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Kou HW, Yeh CN, Tsai CY, Lee CW, Hsu JT, Wang SY, Yu MC, Chen WH, Chiu CC, Hwang TL. A novel technique of sutureless omentopexy during dual-incision laparoscopic peritoneal dialysis catheter insertion to prevent catheter dysfunction due to omental wrapping. Surg Endosc 2023; 37:148-155. [PMID: 35879570 DOI: 10.1007/s00464-022-09449-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/05/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Omental wrapping (OW) is the leading cause of obstruction of the peritoneal dialysis (PD) catheter, which interferes with dialysis treatment. Routinely or selectively performing omentopexy during laparoscopic PD catheter placement has been suggested to prevent OW. However, most of the published techniques for performing this adjunctive procedure require additional incisions and suturing. Herein, we aimed to report our experience in performing omentopexy with a sutureless technique during dual-incision PD catheter insertion. We also performed a comparative analysis to assess the benefit/risk profile of routine omentopexy in these patients. METHODS This retrospective study enrolled 469 patients who underwent laparoscopic PD catheter insertion. Their demographic characteristics and operative details were collected from the database of our institution. Omentopexy was performed by fixing the inferior edge of the omentum to the round ligament of the liver using titanium clips. For analysis, the patients were divided into the omentopexy group and the non-omentopexy group. We also reviewed the salvage management and outcomes of patients who experienced OW. RESULTS The patients were categorized into the omentopexy (n = 81) and non-omentopexy (n = 388) groups. The patients in the non-omentopexy group had a higher incidence of OW, whereas no patient in the omentopexy group experienced this complication (5.2% vs. 0.0%, p = 0.033). The median operative time was 27 min longer in patients who underwent omentopexy than in those who did not [100 (82-118) min vs. 73 (63-84) min, p < 0.001]. One patient had an intra-abdominal hematoma after omentopexy and required salvage surgery to restore catheter function. The complication rate of omentopexy was 1.2% (1/81). CONCLUSION Sutureless omentopexy during laparoscopic PD catheter insertion is a safe and reliable technique that does not require additional incisions and suturing. Routinely performing omentopexy provides clinical benefits by reducing the risk of catheter dysfunction due to OW.
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Affiliation(s)
- Hao-Wei Kou
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
- Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated By Chang Gung Medical Foundation), Tu-Cheng, New Taipei, Taiwan
| | - Wen-Hsin Chen
- Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital, Puzih, Chiayi County, Taiwan
| | - Chien-Chih Chiu
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsann-Long Hwang
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.
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Gau RY, Tsai HI, Yu MC, Chan KM, Lee WC, Wang HE, Wang SF, Cheng ML, Chiu CC, Chen HY, Lee CW. Laparoscopic liver resection is associated with less significant muscle loss than the conventional open approach. World J Surg Oncol 2022; 20:385. [PMID: 36464698 PMCID: PMC9721003 DOI: 10.1186/s12957-022-02854-1] [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: 08/27/2022] [Accepted: 11/24/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Laparoscopic liver resections (LLR) have been shown a treatment approach comparable to open liver resections (OLR) in hepatocellular carcinoma (HCC). However, the influence of procedural type on body composition has not been investigated. The aim of the current study was to compare the degree of skeletal muscle loss between LLR and OLR for HCC. METHODS By using propensity score matching (PSM) analysis, 64 pairs of patients were enrolled. The change of psoas muscle index (PMI) after the operation was compared between the matched patients in the LLR and OLR. Risk factors for significant muscle loss (defined as change in PMI > mean change minus one standard deviation) were further investigated by multivariate analysis. RESULTS Among patients enrolled, there was no significant difference in baseline characteristics between the two groups. The PMI was significantly decreased in the OLR group (P = 0.003). There were also more patients in the OLR group who developed significant muscle loss after the operations (P = 0.008). Multivariate analysis revealed OLR (P = 0.023), type 2 diabetes mellitus, indocyanine green retention rate at 15 min (ICG-15) > 10%, and cancer stage ≧ 3 were independent risk factors for significant muscle loss. In addition, significant muscle loss was associated with early HCC recurrence (P = 0.006). Metabolomic analysis demonstrated that the urea cycle may be decreased in patients with significant muscle loss. CONCLUSION LLR for HCC was associated with less significant muscle loss than OLR. Since significant muscle loss was a predictive factor for early tumor recurrence and associated with impaired liver metabolism, LLR may subsequently result in a more favorable outcome.
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Affiliation(s)
- Ruoh-Yun Gau
- grid.454211.70000 0004 1756 999XDivision of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, 33305 Taiwan
| | - Hsin-I Tsai
- grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.454211.70000 0004 1756 999XDepartment of Anesthesiology, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Ming-Chin Yu
- grid.454211.70000 0004 1756 999XDepartment of Anesthesiology, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan ,grid.413801.f0000 0001 0711 0593Division of General Surgery, Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (built and operated by Chang Gung Medical Foundation), Tu-Cheng, New Taipei City, Taiwan
| | - Kun-Ming Chan
- grid.454211.70000 0004 1756 999XDivision of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, 33305 Taiwan ,grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Wei-Chen Lee
- grid.454211.70000 0004 1756 999XDivision of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, 33305 Taiwan ,grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Haw-En Wang
- grid.454211.70000 0004 1756 999XDepartment of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Sheng-Fu Wang
- grid.454211.70000 0004 1756 999XDepartment of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Mei-Ling Cheng
- grid.145695.a0000 0004 1798 0922Metabolomics Core Laboratory, Healthy Aging Research Center, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922Department of Biomedical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.454211.70000 0004 1756 999XClinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Chien-Chih Chiu
- grid.454211.70000 0004 1756 999XDepartment of Nursing, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Hsin-Yi Chen
- grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.454211.70000 0004 1756 999XDepartment of Nursing, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan ,grid.454211.70000 0004 1756 999XDepartment of Cancer Center, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Chao-Wei Lee
- grid.454211.70000 0004 1756 999XDivision of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, 33305 Taiwan ,grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
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Sun JH, Li YR, Chang KH, Liou MJ, Lin SF, Tsai SS, Yu MC, Hsueh C, Chen ST. Evaluation of recurrence risk in patients with papillary thyroid cancer through tumor-node-metastasis staging: A single-center observational study in Taiwan. Biomed J 2022; 45:923-930. [PMID: 34808423 PMCID: PMC9795347 DOI: 10.1016/j.bj.2021.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 04/13/2020] [Revised: 08/08/2021] [Accepted: 11/12/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Many patients with papillary thyroid cancer (PTC) demonstrate satisfactory outcomes. However, 8%-28% of patients with PTC show tumor recurrence, which may affect prognosis. Therefore, identifying factors associated with tumor recurrence in patients with PTC may be helpful to refine therapeutic strategies. METHODS To identify factors associated with PTC recurrence, we retrospectively reviewed demographic features (sex and age), operation method, image character, serum thyroglobulin (Tg), accumulated radioactive iodine (I-131) therapeutic dose, I-131 uptake, and metastases at diagnosis in 829 patients with PTC. Patients were grouped into early (stage I and II; n = 698) and advanced (stage III and IV; n = 131) tumor-node-metastasis (TNM) stages. Recurrence rate, mortality rate, risk factors of recurrence, recurrent free survival and overall survival curve were compared between two groups. RESULTS Patients in the early stage demonstrated a lower recurrence rate (7.2%) than did those in the advanced stage (28.2%, p < 0.05). The mortality rate of patients with recurrence in the advanced stage was higher than that of those in the early stage (51.4% vs. 12.0%). The major impact factors on tumor recurrence in early TNM stage were distant metastasis and lymph node metastasis, while in advanced TNM stage were distant metastasis, male gender, total thyroidectomy with limited lymph node dissection, and a high serum Tg level. CONCLUSIONS Strategies to monitor tumor recurrence might be refined according to the TNM stages of PTC patients.
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Affiliation(s)
- Jui-Hung Sun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yan-Rong Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Miaw-Jene Liou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shu-Fu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Sung-Sheng Tsai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan,Corresponding author. Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, 5, Fusing St., Gueishan, Taoyuan 333, Taiwan.
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Huang CW, Lin SE, Huang SF, Yu MC, Tang JH, Tsai CN, Hsu HY. The Vessels That Encapsulate Tumor Clusters (VETC) Pattern Is a Poor Prognosis Factor in Patients with Hepatocellular Carcinoma: An Analysis of Microvessel Density. Cancers (Basel) 2022; 14:cancers14215428. [PMID: 36358846 PMCID: PMC9658947 DOI: 10.3390/cancers14215428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/08/2022] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
The outcomes of patients with hepatocellular carcinoma (HCC) are unsatisfactory because of its high recurrence rate. The Vessels that encapsulate tumor clusters (VETC) pattern is a unique vascular structure. In this study, we investigated the clinical−pathological features of HCC patients with the VETC pattern. We retrospectively reviewed patients with HCC who underwent curative hepatectomy at Chang Gung Memorial Hospital between 2007 and 2013. The form of the VETC pattern was established using an anti-CD31 stain. The results were classified into positive (VETC+) and negative (VETC−) patterns. We investigated and compared demographic data between these two groups. Overall, 174 patients were classified into either the VETC+ or VETC− groups. The median followed-up period was 80.5 months. There were significant differences in the number of hepatitis B carriers, the occurrence of vascular invasion, tumor size, TNM staging, microvessel density, and recurrence (all p < 0.05). Regarding the prediction of disease-free survival, after COX regression multivariate analysis, VETC+ remained independently associated with recurrent episodes (p = 0.003). The intra-tumoral microvessel density, demonstrated by CD-31, was the only clinical−pathological feature independently associated with VETC+. Our study demonstrated that the VETC pattern is an independent factor of poor prognosis for DFS. Higher intra-tumoral microvessel density was significantly associated with the VETC pattern. Further studies are needed to validate our findings.
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Affiliation(s)
- Chun-Wei Huang
- Department of Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 242062, Taiwan
| | - Sey-En Lin
- Department of Pathology, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
| | - Song-Fong Huang
- Department of Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 33305, Taiwan
| | - Jui-Hsiang Tang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
| | - Chi-Neu Tsai
- Department of Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan District, Taoyuan City 33302, Taiwan
| | - Heng-Yuan Hsu
- Department of Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
- Correspondence:
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Chien TP, Huang SF, Chan WH, Pan KT, Yu MC, Lee WC, Tsai HI, Lin PT, Chen HY, Chen JH, Lee CW. The combination of sarcopenia and biochemical factors can predict the survival of hepatocellular carcinoma patients receiving transarterial chemoembolization. Front Oncol 2022; 12:1005571. [PMID: 36248997 PMCID: PMC9554637 DOI: 10.3389/fonc.2022.1005571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Transarterial chemoembolization(TACE) is the suggested treatment for hepatocellular carcinoma (HCC) not amenable to curative treatments. We investigated the role of sarcopenia on overall survival in HCC patients receiving TACE and proposed a new prognostic scoring system incorporating sarcopenia. Materials and methods We retrospectively analyzed 260 HCC patients who received TACE between 2010 and 2015. Total psoas muscle was measured on a cross-sectional CT image before the first TACE session. Sarcopenia was defined by the pre-determined sex-specific cutoff value. We assessed the impact of sarcopenia and other biochemical factors on the overall survival and compared the new scoring system with other prognostic scoring systems. Results One hundred and thirty patients (50%) were classified as sarcopenia before the first TACE. They were older with a higher male tendency and a significantly lower body mass index (BMI). Cox regression multivariate analysis demonstrated that sarcopenia, multiple tumors, maximal tumor diameter≥ 5cm, major venous thrombosis, sarcopenia, AFP ≥ 200 ng/ml, and albumin<3.5mg/dL were independent poor prognostic factors for overall survival in HCC patients receiving TACE. Our scoring system comprising these factors outperformed other major scoring systems in terms of predicting survival after TACE. Conclusion The current study demonstrated that sarcopenia was an independent prognostic factor for HCC undergoing TACE therapy. Our newly developed scoring system could effectively predict patient survival after TACE. Physicians could, based on the current score model, carefully select candidate patients for TACE treatment in order to optimize their survival. Further studies are warranted to validate our findings.
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Affiliation(s)
- Tzu-Ping Chien
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Song-Fong Huang
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Hui Chan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Tse Pan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-I Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Po-Ting Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsing-Yu Chen
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jui-Hsuan Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Chao-Wei Lee,
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Lee CW, Tsai HI, Yu MC, Wang CC, Lee WC, Yeh TS, Yeh CN, Lin CY, Kuo T, Chen HY. A proposal for T1 subclassification in hepatocellular carcinoma: reappraisal of the AJCC 8th edition. Hepatol Int 2022; 16:1353-1367. [PMID: 36169915 DOI: 10.1007/s12072-022-10422-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/09/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND In the 8th edition of American Joint Committee on Cancer (AJCC) staging system for hepatocellular carcinoma (HCC), tumor size is not considered in T1 stage. The present study aimed to find out the optimal cutoff for tumor size to further stratify patients with T1 HCC. METHODS Operated HCC patients were identified from the Chang Gung Research Database (CGRD), and the patients with T1bN0M0 tumors were further divided into two groups based on the tumor size. The resulting subgroups were denoted as T1b (≤ cutoff) and T1c (> cutoff). The survivals were compared between T1a/b and T1c as well as T1c and T2. RESULTS From 2002 to 2018, a total of 2893 patients who underwent surgery for T1N0M0 HCC were identified from the CGRD. After excluding cases who died within 30 days of surgery, Kaplan-Meier survival analysis discovered that T1 tumors > 65 mm (T1c) had survivals similar to those of T2N0M0 tumors. Cox regression multivariate analysis further demonstrated that tumor size > 6.5 cm was an independent poor prognostic indicator for T1 HCC. Sensitivity tests also confirmed that tumors lager than 6.5 cm were significantly more likely to develop both tumor recurrence and liver-specific death after surgery. CONCLUSIONS Our study demonstrated that tumor size would significantly impact the survival outcome of T1 HCC after surgery. Due to significantly worse survival, we proposed a subclassification within T1 HCC, T1c: solitary tumor > 6.5 cm without vascular invasion, to further stratify those patients at risk. Further studies are mandatory to validate our findings.
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Affiliation(s)
- Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Hsin-I Tsai
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan.,Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Ming-Chin Yu
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan.,Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated By Chang Gung Medical Foundation), Tu-Cheng, New Taipei City, Taiwan
| | - Chih-Chi Wang
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Division of General Surgery, Department of Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Chen Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Cheng-Yu Lin
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Tony Kuo
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Hsing-Yu Chen
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan. .,Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Taoyuan Chang Gung Memorial Hospital, No.123, Dinghu Rd., Guishan Dist., Taoyuan, 33305, Taiwan. .,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.
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12
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Huang CW, Wu TH, Hsu HY, Pan KT, Lee CW, Chong SW, Huang SF, Lin SE, Yu MC, Chen SM. Reappraisal of the Role of Alkaline Phosphatase in Hepatocellular Carcinoma. J Pers Med 2022; 12:jpm12040518. [PMID: 35455635 PMCID: PMC9030712 DOI: 10.3390/jpm12040518] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/31/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Alkaline phosphatase (ALP) is a marker of liver function and is associated with biliary tract disease. It was reported as a prognostic factor for hepatocellular carcinoma (HCC). The genetic expression in tumor-tissue microarrays and the perioperative serologic changes in ALP have never been studied for their correlation with HCC prognosis. Methods: The genetic expression of ALP isoforms (placental (ALPP), intestinal (ALPI) and bone/kidney/liver (ALPL)) was analyzed in tumor and non-cancerous areas in 38 patients with HCC after partial hepatectomy. The perioperative change in ALP was further analyzed in a cohort containing 525 patients with HCC to correlate it with oncologic outcomes. A total of 43 HCC patients were enrolled for a volumetry study after major and minor hepatectomy. Results: The genetic expression of the bone/kidney/liver isoform was specifically and significantly higher in non-cancerous areas than in tumors. Patients with HCC with a higher ALP (>81 U/dL) had significantly more major hepatectomies, vascular invasion, and recurrence. Cox regression analysis showed that gender, major hepatectomies, the presence of satellite lesions, higher grades (III or IV) and perioperative changes in liver function tests were independent prognostic factors for recurrence-free survival, and a postoperative increase in the ALP ratio at postoperative day (POD) 7 vs. POD 0 > 1.46 should be emphasized. A liver regeneration rate more than 1.8 and correlation analysis revealed that the ALP level at POD 7 and 30 was significantly higher and correlated with remnant liver growth. Conclusions: This study demonstrated that the perioperative ALP change was an independent prognostic factor for HCC after partial hepatectomies, and the elevation of ALP represented a functional biomarker for the liver but not an HCC biomarker. The higher regeneration capacity was possibly associated with the elevation of ALP after operation.
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Affiliation(s)
- Chun-Wei Huang
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tucheng Hospital (by Chang Gung Medical Foundation, and Chang Gung University and Shen-Ming Chen), New Taipei 23652, Taiwan; (C.-W.H.); (H.-Y.H.); (S.-W.C.); (S.-F.H.)
| | - Tsung-Han Wu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou and Chang-Gung University, Taoyuan 33305, Taiwan; (T.-H.W.); (C.-W.L.)
| | - Heng-Yuan Hsu
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tucheng Hospital (by Chang Gung Medical Foundation, and Chang Gung University and Shen-Ming Chen), New Taipei 23652, Taiwan; (C.-W.H.); (H.-Y.H.); (S.-W.C.); (S.-F.H.)
| | - Kuang-Tse Pan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Linkou and Chang-Gung University, Taoyuan 33305, Taiwan; (T.-H.W.); (C.-W.L.)
| | - Sio-Wai Chong
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tucheng Hospital (by Chang Gung Medical Foundation, and Chang Gung University and Shen-Ming Chen), New Taipei 23652, Taiwan; (C.-W.H.); (H.-Y.H.); (S.-W.C.); (S.-F.H.)
| | - Song-Fong Huang
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tucheng Hospital (by Chang Gung Medical Foundation, and Chang Gung University and Shen-Ming Chen), New Taipei 23652, Taiwan; (C.-W.H.); (H.-Y.H.); (S.-W.C.); (S.-F.H.)
| | - Sey-En Lin
- Department of Pathology, New Taipei Municipal Tucheng Hospital, New Taipei 23652, Taiwan;
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tucheng Hospital (by Chang Gung Medical Foundation, and Chang Gung University and Shen-Ming Chen), New Taipei 23652, Taiwan; (C.-W.H.); (H.-Y.H.); (S.-W.C.); (S.-F.H.)
- Correspondence: (M.-C.Y.); (S.-M.C.)
| | - Shen-Ming Chen
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei 106, Taiwan
- Correspondence: (M.-C.Y.); (S.-M.C.)
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Hsieh HL, Yu MC, Cheng LC, Chu MY, Huang TH, Yeh TS, Tsai MM. Quercetin exerts anti-inflammatory effects via inhibiting tumor necrosis factor-α-induced matrix metalloproteinase-9 expression in normal human gastric epithelial cells. World J Gastroenterol 2022; 28:1139-1158. [PMID: 35431500 PMCID: PMC8985486 DOI: 10.3748/wjg.v28.i11.1139] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/23/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric injury is the most common digestive system disease worldwide and involves inflammation, which can lead to gastric ulcer or gastric cancer (GC). Matrix metallopeptidase-9 [MMP-9 (gelatinase-B)] plays an important role in inflammation and GC progression. Quercetin and quercetin-rich diets represent potential food supplements and a source of medications for treating gastric injury given their anti-inflammatory activities. However, the effects and mechanisms of action of quercetin on human chronic gastritis and whether quercetin can relieve symptoms remain unclear.
AIM To assess whether tumor necrosis factor-α (TNF-α)-induced MMP-9 expression mediates the anti-inflammatory effects of quercetin in normal human gastric mucosal epithelial cells.
METHODS The normal human gastric mucosa epithelial cell line GES-1 was used to establish a normal human gastric epithelial cell model of TNF-α-induced MMP-9 protein overexpression to evaluate the anti-inflammatory effects of quercetin. The cell counting Kit-8 assay was used to evaluate the effects of varying quercetin doses on cell viability in the normal GES-1 cell line. Cell migration was measured using Transwell assay. The expression of proto-oncogene tyrosine-protein kinase Src (c-Src), phospho (p)-c-Src, extracellular-signal-regulated kinase 2 (ERK2), p-ERK1/2, c-Fos, p-c-Fos, nuclear factor kappa B (NF-κB/p65), and p-p65 and the effects of their inhibitors were examined using Western blot analysis and measurement of luciferase activity. p65 expression was detected by immunofluorescence. MMP-9 mRNA and protein levels were measured by quantitative reverse transcription polymerase chain reaction (qRT–PCR) and gelatin zymography, respectively.
RESULTS qRT-PCR and gelatin zymography showed that TNF-α induced MMP-9 mRNA and protein expression in a dose- and time-dependent manner. These effects were reduced by the pretreatment of GES-1 cells with quercetin or a TNF-α antagonist (TNFR inhibitor) in a dose- and time-dependent manner. Quercetin and TNF-α antagonists decreased the TNF-α-induced phosphorylation of c-Src, ERK1/2, c-Fos, and p65 in a dose- and time-dependent manner. Quercetin, TNF-α antagonist, PP1, U0126, and tanshinone IIA (TSIIA) reduced TNF-α-induced c-Fos phosphorylation and AP-1–Luciferase (Luc) activity in a dose- and time-dependent manner. Pretreatment with quercetin, TNF-α antagonist, PP1, U0126, or Bay 11-7082 reduced TNF-α-induced p65 phosphorylation and translocation and p65–Luc activity in a dose- and time-dependent manner. TNF-α significantly increased GES-1 cell migration, and these results were reduced by pretreatment with quercetin or a TNF-α antagonist.
CONCLUSION Quercetin significantly downregulates TNF-α-induced MMP-9 expression in GES-1 cells via the TNFR-c-Src–ERK1/2 and c-Fos or NF-κB pathways.
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Affiliation(s)
- Hsi-Lung Hsieh
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan 333, Taiwan
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, New Taipei Municipal TuCheng Hospital, New Taipei 236, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Li-Ching Cheng
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Mei-Yi Chu
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
| | - Tzu-Hao Huang
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan 333, Taiwan
| | - Ta-Sen Yeh
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ming-Ming Tsai
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan 333, Taiwan
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of General Surgery, New Taipei Municipal TuCheng Hospital, New Taipei 236, Taiwan
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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14
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Hsieh HL, Yu MC, Cheng LC, Yeh TS, Tsai MM. Molecular mechanism of therapeutic approaches for human gastric cancer stem cells. World J Stem Cells 2022; 14:76-91. [PMID: 35126829 PMCID: PMC8788185 DOI: 10.4252/wjsc.v14.i1.76] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/15/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer (GC) is a primary cause of cancer-related mortality worldwide, and even after therapeutic gastrectomy, survival rates remain poor. The presence of gastric cancer stem cells (GCSCs) is thought to be the major reason for resistance to anticancer treatment (chemotherapy or radiotherapy), and for the development of tumor recurrence, epithelial–mesenchymal transition, and metastases. Additionally, GCSCs have the capacity for self-renewal, differentiation, and tumor initiation. They also synthesize antiapoptotic factors, demonstrate higher performance of drug efflux pumps, and display cell plasticity abilities. Moreover, the tumor microenvironment (TME; tumor niche) that surrounds GCSCs contains secreted growth factors and supports angiogenesis and is thus responsible for the maintenance of the growing tumor. However, the genesis of GCSCs is unclear and exploration of the source of GCSCs is essential. In this review, we provide up-to-date information about GCSC-surface/intracellular markers and GCSC-mediated pathways and their role in tumor development. This information will support improved diagnosis, novel therapeutic approaches, and better prognosis using GCSC-targeting agents as a potentially effective treatment choice following surgical resection or in combination with chemotherapy and radiotherapy. To date, most anti-GCSC blockers when used alone have been reported as unsatisfactory anticancer agents. However, when used in combination with adjuvant therapy, treatment can improve. By providing insights into the molecular mechanisms of GCSCs associated with tumors in GC, the aim is to optimize anti-GCSCs molecular approaches for GC therapy in combination with chemotherapy, radiotherapy, or other adjuvant treatment.
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Affiliation(s)
- Hsi-Lung Hsieh
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan 333, Taiwan
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of General Surgery, New Taipei Municipal TuCheng Hospital, New Taipei 236, Taiwan
| | - Li-Ching Cheng
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan 333, Taiwan
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ming-Ming Tsai
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan 333, Taiwan
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of General Surgery, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
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Lim AH, Chan JY, Yu MC, Wu TH, Hong JH, Ng CCY, Low ZJ, Liu W, Vikneswari R, Sung PC, Fan WL, Teh BT, Hsieh SY. Rare Occurrence of Aristolochic Acid Mutational Signatures in Oro-Gastrointestinal Tract Cancers. Cancers (Basel) 2022; 14:cancers14030576. [PMID: 35158844 PMCID: PMC8833562 DOI: 10.3390/cancers14030576] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/06/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Aristolochic acids (AAs) are potent mutagens commonly found in herbal plant-based remedies widely used throughout Asian countries. PATIENTS AND METHODS To understand whether AA is involved in the tumorigenesis of the oro-gastrointestinal tract, we used whole-exome sequencing to profile 54 cases of four distinct types of oro-gastrointestinal tract cancer (OGITC) from Taiwan. RESULTS A diverse landscape of mutational signatures including those from DNA mismatch repair and reactive oxygen species was observed. APOBEC mutational signatures were observed in 60% of oral squamous cell carcinomas. Only one sample harbored AA mutational signatures, contradictory to prior reports of cancers from Taiwan. The metabolism of AA in the liver and urinary tract, transient exposure time, and high cell turnover rates at OGITC sites may explain our findings. CONCLUSION AA signatures in OGITCs are rare and unlikely to be a major contributing factor in oro-gastrointestinal tract tumorigenesis.
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Affiliation(s)
- Abner Herbert Lim
- Cheng Kin Ku Herbal Biodiversity & Medicine Program, SingHealth Duke-NUS Institute of Biodiversity Medicine, Singapore 169610, Singapore; (A.H.L.); (J.H.H.); (C.C.Y.N.); (Z.J.L.); (W.L.)
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore 169610, Singapore; (J.Y.C.); (R.V.)
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Jason Yongsheng Chan
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore 169610, Singapore; (J.Y.C.); (R.V.)
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan; (M.-C.Y.); (T.-H.W.)
- Department of Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tsung-Han Wu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan; (M.-C.Y.); (T.-H.W.)
| | - Jing Han Hong
- Cheng Kin Ku Herbal Biodiversity & Medicine Program, SingHealth Duke-NUS Institute of Biodiversity Medicine, Singapore 169610, Singapore; (A.H.L.); (J.H.H.); (C.C.Y.N.); (Z.J.L.); (W.L.)
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Cedric Chuan Young Ng
- Cheng Kin Ku Herbal Biodiversity & Medicine Program, SingHealth Duke-NUS Institute of Biodiversity Medicine, Singapore 169610, Singapore; (A.H.L.); (J.H.H.); (C.C.Y.N.); (Z.J.L.); (W.L.)
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore 169610, Singapore; (J.Y.C.); (R.V.)
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Zhen Jie Low
- Cheng Kin Ku Herbal Biodiversity & Medicine Program, SingHealth Duke-NUS Institute of Biodiversity Medicine, Singapore 169610, Singapore; (A.H.L.); (J.H.H.); (C.C.Y.N.); (Z.J.L.); (W.L.)
| | - Wei Liu
- Cheng Kin Ku Herbal Biodiversity & Medicine Program, SingHealth Duke-NUS Institute of Biodiversity Medicine, Singapore 169610, Singapore; (A.H.L.); (J.H.H.); (C.C.Y.N.); (Z.J.L.); (W.L.)
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore 169610, Singapore; (J.Y.C.); (R.V.)
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Rajasegaran Vikneswari
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore 169610, Singapore; (J.Y.C.); (R.V.)
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Pin-Cheng Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
| | - Wen-Lang Fan
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
| | - Bin Tean Teh
- Cheng Kin Ku Herbal Biodiversity & Medicine Program, SingHealth Duke-NUS Institute of Biodiversity Medicine, Singapore 169610, Singapore; (A.H.L.); (J.H.H.); (C.C.Y.N.); (Z.J.L.); (W.L.)
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore 169610, Singapore; (J.Y.C.); (R.V.)
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore 169610, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Correspondence: (B.T.T.); or (S.-Y.H.); Tel.: +65-6436-8000 (B.T.T.); +886-975368031 (S.-Y.H.)
| | - Sen-Yung Hsieh
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Correspondence: (B.T.T.); or (S.-Y.H.); Tel.: +65-6436-8000 (B.T.T.); +886-975368031 (S.-Y.H.)
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Hung HC, Hsu PJ, Chang TC, Chou HH, Huang KG, Lai CH, Lee CW, Yu MC, You JF, Hsu YJ, Hsu JT, Wu TJ. The Impact of Multidisciplinary Team Approach on Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis. J Pers Med 2021; 11:jpm11121313. [PMID: 34945785 PMCID: PMC8705741 DOI: 10.3390/jpm11121313] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/26/2021] [Accepted: 12/05/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a therapeutic approach used to achieve curative treatment in intra-abdominal malignancy with peritoneal carcinomatosis (PC). However, it is a complicated procedure with high post-operative complication rates. Thus, we analyzed our preliminary data to establish whether multidisciplinary teamwork (MDT) implementation is beneficial for CRS-HIPEC outcomes. METHOD A series of 132 consecutive patients with synchronous or recurrent PC secondary to gastrointestinal or gynecologic cancer who received CRS-HIPEC operation between May 2015 and September 2017 were included. Ninety-nine patients were categorized into the MDT group, with the 33 other patients into the non-MDT group. RESULTS The mean PCI score was 16.3 ± 8.8. Patients in the MDT group more often presented a higher PCI score (p value = 0.038). Regarding CRS completeness (CCR 0-1), it was distributed 81.8% and 57.6% in the MDT and the non-MDT group, respectively (p value = 0.005). Although post-operative complications were common (n = 62, 47.0%), post-operative complication rates did not differ between the two groups. The cumulative OS survival rate at the first year was 75.5%. Older age (p = 0.030, HR = 4.58, 95% CI = 1.16-18.10), ECOG 2 (p = 0.030, HR = 6.41, 95% CI = 1.20-34.14), and incomplete cytoreduction (p = 0.048, HR = 2.79, 95% CI = 1.04-8.27) were independent prognostic factors for survival. CONCLUSIONS Our experience suggests that the CRS-HIPEC performed under MDT cooperation may result in higher complete cytoreduction rates without increasing post-operative complications and hospital mortalities.
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Affiliation(s)
- Hao-Chien Hung
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
| | - Po-Jung Hsu
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (T.-C.C.); (H.-H.C.); (K.-G.H.); (C.-H.L.)
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (T.-C.C.); (H.-H.C.); (K.-G.H.); (C.-H.L.)
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (T.-C.C.); (H.-H.C.); (K.-G.H.); (C.-H.L.)
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (T.-C.C.); (H.-H.C.); (K.-G.H.); (C.-H.L.)
| | - Chao-Wei Lee
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
| | - Ming-Chin Yu
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
| | - Jeng-Fu You
- Department of Colon and Rectal Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (J.-F.Y.); (Y.-J.H.)
| | - Yu-Jen Hsu
- Department of Colon and Rectal Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (J.-F.Y.); (Y.-J.H.)
| | - Jun-Te Hsu
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
| | - Ting-Jung Wu
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
- Correspondence: or ; Tel.: +886-3-3281200 (ext. 3366); Fax: +886-3-3285818
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Tsai MM, Lin HC, Yu MC, Lin WJ, Chu MY, Tsai CC, Cheng CY. Anticancer Effects of Helminthostachys zeylanica Ethyl acetate Extracts on Human Gastric Cancer Cells through Downregulation of the TNF-α-activated COX-2-cPLA2-PGE 2 Pathway. J Cancer 2021; 12:7052-7068. [PMID: 34729107 PMCID: PMC8558661 DOI: 10.7150/jca.64638] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Gastric cancer (GC) is the second most prevalent cancer worldwide and the eighth most common cause of tumor-related death in Taiwan. Helminthostachys zeylanica, a flavonoid compound, has anti-inflammatory, immunomodulatory, and anticancer effects. We examined whether an extract of H. zeylanica (E1 and E2) has potential as a treatment for GC. Methods: We investigated the effects (pro-apoptosis, pro-autophagy, and antiproliferation ability) of H. zeylanica-E2 on cell viability in healthy gastric epithelial (GES-1) and GC cells (AGS and BGC823). H. zeylanica-E2 was toxic to GC cells but had little or no toxicity to normal cells. Results: In this study, H. zeylanica-E2 induced apoptosis through caspase 3/7, Bcl-2, Bax, cyclooxygenase-2 (COX-2), and cleaved poly (ADP-ribose) polymerase pathways in GC cells. In addition, it increased autophagy by stimulating autophagy-related protein (ATG)5, ATG7, LC3-I/LC3-II, and inhibiting COX-2 activity in GC cells. We also found that H. zeylanica-E2 exhibited antiproliferation ability through cell cycle arrest in G0/G1 and G2/M and suppressed the migration of GC cells. The anticancer effects of H. zeylanica-E2 in GC cells might be mediated partly through inhibition of tumor necrosis factor-α (TNF-α)-activated proinflammatory cytosolic phospholipase A2 (cPLA2)-COX-2-prostaglandin E2 (PGE2) pathway. Conclusions: Our results suggest that H. zeylanica-E2 has potential as a novel adjunctive agent for the treatment of GC.
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Affiliation(s)
- Ming-Ming Tsai
- Department of Nursing, Division of Basic Medical Sciences, Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan and Department of General Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Jung Lin
- Graduate Institute of Health Industry Technology, Research Center for Chinese Herbal Medicine and Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Mei-Yi Chu
- Graduate Institute of Health Industry Technology, Research Center for Chinese Herbal Medicine and Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Ching-Ching Tsai
- Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, and Department of Cardiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ching-Yi Cheng
- Graduate Institute of Health Industry Technology, Research Center for Chinese Herbal Medicine and Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Pulmonary Infection and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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18
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Song WY, Wang XR, Yu MC, Cui YX, Qi Y, Sun SM. [Progress of researches on serine protease inhibitors for zoonotic cestode family Taeniidae]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2021; 33:650-654. [PMID: 35128901 DOI: 10.16250/j.32.1374.2021024] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Serine protease inhibitor, a protein superfamily that inhibits the serine protease activity, protects hosts from parasitic infections. This review describes the spatial structure and classification of serine protease inhibitor, mechanisms underlying the interplay between serine protease inhibitor and host immune responses and current advances in serine protease inhibitor of zoonotic cestode family Taeniidae, so as to provide insights into the diagnosis of zoonotic tapeworm infections, discovery of therapeutic targets and screening of vaccine candidates.
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Affiliation(s)
- W Y Song
- College of Animal Science and Technology, Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia 028000, China
| | - X R Wang
- College of Animal Science and Technology, Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia 028000, China
| | - M C Yu
- College of Animal Science and Technology, Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia 028000, China
| | - Y X Cui
- College of Animal Science and Technology, Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia 028000, China
| | - Y Qi
- College of Animal Science and Technology, Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia 028000, China
| | - S M Sun
- College of Animal Science and Technology, Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia 028000, China
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19
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Lee CW, Yu MC, Wang CC, Lee WC, Tsai HI, Kuan FC, Chen CW, Hsieh YC, Chen HY. Liver resection for hepatocellular carcinoma larger than 10 cm: A multi-institution long-term observational study. World J Gastrointest Surg 2021; 13:476-492. [PMID: 34122737 PMCID: PMC8167847 DOI: 10.4240/wjgs.v13.i5.476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/13/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The treatment of hepatocellular carcinoma (HCC) ≥ 10 cm remains a challenge.
AIM To consolidate the role of surgical resection for HCC larger than 10 cm.
METHODS Eligible HCC patients were identified from the Chang Gung Research Database, the largest multi-institution database, which collected medical records of all patients from Chang Gung Memorial Foundation. The surgical outcome of HCC ≥ 10 cm (L-HCC) was compared to that of HCC < 10 cm (S-HCC) (model 1). The survival of L-HCC after either liver resection or transarterial chemoembolization (TACE) was also analyzed (model 2). The long-term risks of all-cause mortality and recurrence were assessed to consolidate the role of surgery for L-HCC.
RESULTS From January 2004 to July 2015, a total of 32403 HCC patients were identified from the Chang Gung Research Database. Among 3985 patients who received liver resection, 3559 (89.3%) had S-HCC, and 426 had L-HCC. The L-HCC patients had a worse disease-free survival (0.27 for L-HCC vs 0.40 for S-HCC) and overall survival (0.18 for L-HCC vs 0.45 for S-HCC) than the S-HCC after liver resection (both P < 0.001). However, the surgical and long-term outcome of resected L-HCC had improved dramatically in the recent decades. After adjusting for covariates, surgery could provide a better outcome for L-HCC than TACE (adjusted hazard ratio of all-cause mortality: 0.46, 95% confidence interval: 0.38-0.56 for surgery). Subgroup analysis stratified by different stages showed similar trend of survival benefit among L-HCC patients receiving surgery.
CONCLUSION Our study demonstrated an improving surgical outcome for HCC larger than 10 cm. Under selected conditions, surgery is better than TACE in terms of disease control and survival and should be performed. Due to inferior survival, a subclassification within T1 stage should be considered. Future studies are mandatory to confirm our findings.
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Affiliation(s)
- Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan 333, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), Tu-Cheng 236017, New Taipei City, Taiwan
| | - Chih-Chi Wang
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Division of General Surgery, Department of Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Wei-Chen Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
| | - Hsin-I Tsai
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
| | - Feng-Che Kuan
- Department of Hematology and Oncology, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Chun-Wei Chen
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
| | - Yi-Chung Hsieh
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
| | - Hsing-Yu Chen
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Taoyuan Chang Gung Memorial Hospital, Guishan 33378, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
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20
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Wu SJ, Huang WC, Yu MC, Chen YL, Shen SC, Yeh KW, Liou CJ. Tomatidine ameliorates obesity-induced nonalcoholic fatty liver disease in mice. J Nutr Biochem 2021; 91:108602. [PMID: 33548473 DOI: 10.1016/j.jnutbio.2021.108602] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 12/01/2020] [Accepted: 12/31/2020] [Indexed: 02/06/2023]
Abstract
Tomatidine is isolated from the leaves and green fruits of some plants in the Solanaceae family, and has been reported to have anti-inflammatory and antitumor effects. Previous studies have found that tomatidine decreases hepatic lipid accumulation via regulation of vitamin D receptor and activation of AMP-activated protein kinase (AMPK) phosphorylation. However, whether tomatidine reduces weight gain and improves nonalcoholic fatty liver disease (NAFLD) remains unclear. In this study, we investigated how tomatidine ameliorates NAFLD in obese mice and evaluated the regulatory mechanism of lipogenesis in hepatocytes. Male C57BL/6 mice were fed a high-fat diet (HFD) to induce obesity and NAFLD, and treated with tomatidine via intraperitoneal injection. In vitro, FL83B hepatocytes were incubated with oleic acid and treated with tomatidine to evaluate lipid metabolism. Our results demonstrate that tomatidine significantly decreases body weight and fat weight compared to HFD-fed mice. In addition, tomatidine decreased hepatic lipid accumulation and improved hepatocyte steatosis in HFD-induced obese mice. We also found that tomatidine significantly regulated serum total cholesterol, fasting blood glucose, low-density lipoprotein, and triglyceride levels, but the serum high-density lipoprotein and adiponectin concentrations were higher than in the HFD-fed obese mice. In vivo and in vitro, tomatidine significantly suppressed the expression of fatty acid synthase and transcription factors involved in lipogenesis, and increased the expression of adipose triglyceride lipase. Tomatidine promoted the sirtuin 1 (sirt1)/AMPK signaling pathway to increase lipolysis and β-oxidation in fatty liver cells. These findings suggest that tomatidine potentially ameliorates obesity and acts against hepatic steatosis by regulating lipogenesis and the sirt1/AMPK pathway.
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Affiliation(s)
- Shu-Ju Wu
- Department of Nutrition and Health Sciences, Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Taoyuan City, Taiwan; Aesthetic Medical Center, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Chung Huang
- Graduate Institute of Health Industry Technology, Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan City, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
| | - Ya-Ling Chen
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei City, Taiwan
| | - Szu-Chuan Shen
- Graduate Program of Nutrition Science, National Taiwan Normal University, Taipei City, Taiwan
| | - Kuo-Wei Yeh
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
| | - Chian-Jiun Liou
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; Department of Nursing, Division of Basic Medical Sciences, Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.
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21
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Tsai HI, Chou TC, Yu MC, Yeh CN, Peng MT, Hsieh CH, Su PJ, Wu CE, Kuo YC, Chiu CC, Lee CW. Purely laparoscopic feeding jejunostomy: a procedure which deserves more attention. BMC Surg 2021; 21:37. [PMID: 33441134 PMCID: PMC7805100 DOI: 10.1186/s12893-021-01050-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023] Open
Abstract
Background Laparoscopic procedure has inherent merits of smaller incisions, better cosmesis, less postoperative pain, and earlier recovery. In the current study, we presented our method of purely laparoscopic feeding jejunostomy and compared its results with that of conventional open approach. Methods We retrospectively reviewed our patients from 2012 to 2019 who had received either laparoscopic jejunostomy (LJ, n = 29) or open ones (OJ, n = 94) in Chang Gung Memorial Hospital, Linkou. Peri-operative data and postoperative outcomes were analyzed. Results In the current study, we employed 3-0 Vicryl, instead of V-loc barbed sutures, for laparoscopic jejunostomy. The mean operative duration of LJ group was about 30 min longer than the OJ group (159 ± 57.2 mins vs 128 ± 34.6 mins; P = 0.001). There were no intraoperative complications reported in both groups. The patients in the LJ group suffered significantly less postoperative pain than in the OJ group (mean NRS 2.03 ± 0.9 vs. 2.79 ± 1.2; P = 0.002). The majority of patients in both groups received early enteral nutrition (< 48 h) after the operation (86.2% vs. 74.5%; P = 0.143). Conclusions Our study demonstrated that purely laparoscopic feeding jejunostomy is a safe and feasible procedure with less postoperative pain and excellent postoperative outcome. It also provides surgeons opportunities to enhance intracorporeal suture techniques.
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Affiliation(s)
- Hsin-I Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Ta-Chun Chou
- Department of Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Ming-Chin Yu
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan, Republic of China.,Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated By Chang Gung Medical Foundation), Tu-Cheng, New Taipei City, Taiwan, Republic of China
| | - Chun-Nan Yeh
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Meng-Ting Peng
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chia-Hsun Hsieh
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China.,Division of Hematology and Oncology, Department of Internal Medicine, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), Tu-Cheng, New Taipei City, Taiwan, Republic of China
| | - Po-Jung Su
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Chiao-En Wu
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Yung-Chia Kuo
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chien-Chih Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chao-Wei Lee
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China. .,Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan, Republic of China.
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22
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Peng JM, Lin SH, Yu MC, Hsieh SY. CLIC1 recruits PIP5K1A/C to induce cell-matrix adhesions for tumor metastasis. J Clin Invest 2021; 131:133525. [PMID: 33079727 DOI: 10.1172/jci133525] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 10/07/2019] [Accepted: 10/14/2020] [Indexed: 12/27/2022] Open
Abstract
Membrane protrusion and adhesion to the extracellular matrix, which involves the extension of actin filaments and formation of adhesion complexes, are the fundamental processes for cell migration, tumor invasion, and metastasis. How cancer cells efficiently coordinate these processes remains unclear. Here, we showed that membrane-targeted chloride intracellular channel 1 (CLIC1) spatiotemporally regulates the formation of cell-matrix adhesions and membrane protrusions through the recruitment of PIP5Ks to the plasma membrane. Comparative proteomics identified CLIC1 upregulated in human hepatocellular carcinoma (HCC) and associated with tumor invasiveness, metastasis, and poor prognosis. In response to migration-related stimuli, CLIC1 recruited PIP5K1A and PIP5K1C from the cytoplasm to the leading edge of the plasma membrane, where PIP5Ks generate a phosphatidylinositol 4,5-bisphosphate-rich (PIP2-rich) microdomain to induce the formation of integrin-mediated cell-matrix adhesions and the signaling for cytoskeleon extension. CLIC1 silencing inhibited the attachment of tumor cells to culture plates and the adherence and extravasation in the lung alveoli, resulting in suppressed lung metastasis in mice. This study reveals what we believe is an unrecognized mechanism that spatiotemporally coordinates the formation of both lamellipodium/invadopodia and nascent cell-matrix adhesions for directional migration and tumor invasion/metastasis. The unique traits of upregulation and membrane targeting of CLIC1 in cancer cells make it an excellent therapeutic target for tumor metastasis.
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Affiliation(s)
- Jei-Ming Peng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Sheng-Hsuan Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
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23
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Yu MC, Wu TH, Lee CW, Lee YS, Lian JH, Tsai CL, Hsieh SY, Tsai CN. Percentage genome change and chromosome 7q amplification predict sorafenib response in advanced hepatocellular carcinoma. Biomed J 2020; 44:S73-S83. [PMID: 35747997 PMCID: PMC9038951 DOI: 10.1016/j.bj.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 07/05/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) may arise from genomic instability and has dismal outcome. Sorafenib is the first-line treatment for advanced stage HCC, but its therapeutic efficacy is less than 50%. Biomarkers for predicting the therapeutic efficacy of sorafenib administration to patients with advanced HCC are required. Here, we evaluated the role of chromosomal copy number aberrations (CNAs) in patients with advanced HCC who were treated with sorafenib along with their drug response. Methods The response to sorafenib treatment of twenty-three HCC patients who developed advanced recurrence after partial hepatectomy was analyzed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Formalin fixed paraffin embedded (FFPE) tissue specimens obtained after tumor resection were analyzed using the Affymetrix OncoScan® FFPE assay. Results From the 23 patients analyzed in this study, 7 (30.4%) had complete/partial response to sorafenib (CR/PR), 7 (30.4%) had stable disease (SD), and 9 (39.1%) had progressive disease (PD). The mean genome-wide percentage of genome change acquisition via the OncoScan platform was 19.8% for patients with CR/PR/SD and 50.02% in the PD group (p = 0.055). Percentage of genome change above 33% was associated with adverse outcomes for sorafenib treatment in the time-to-progression analysis (p = 0.007) and overall survival (p = 0.096). Among these CNAs, amplification of chromosome 7q, containing the multidrug resistance gene ATP Binding Cassette Subfamily B Member 1 (ACBC1), significantly associated with poor overall survival (p = 0.004) and time-to-progression (p < 0.001). Conclusions Higher percentage genome change and amplification of chromosome 7q in advanced HCC is associated with sorafenib resistance.
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Lee CW, Yu MC, Lin G, Chiu JC, Chiang MH, Sung CM, Hsieh YC, Kuo T, Lin CY, Tsai HI. Serum metabolites may be useful markers to assess vascular invasion and identify normal alpha-fetoprotein in hepatocellular carcinoma undergoing liver resection: a pilot study. World J Surg Oncol 2020; 18:121. [PMID: 32493393 PMCID: PMC7271504 DOI: 10.1186/s12957-020-01885-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/10/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver with a dismal prognosis. Vascular invasion, among others, is the most robust indicator of postoperative recurrence and overall survival after liver resection for HCC. Few studies to date have attempted to search for effective markers to predict vascular invasion before the operation. The current study would examine the plasma metabolic profiling via 1H-NMR of HCC patients undergoing liver resection and aim to search for potential biomarkers in the early detection of HCC with normal alpha-fetoprotein (AFP) and the diagnosis of vascular invasion preoperatively. Materials and methods HCC patients scheduled to receive liver resections for their HCC were recruited and divided into two separate groups, investigation cohort and validation cohort. Their preoperative blood samples were collected and subjected to a comprehensive metabolomic profiling using 1H-nuclear magnetic resonance spectroscopy (NMR). Results There were 35 HCC patients in the investigation group and 22 patients in the validation group. Chronic hepatitis B remained the most common etiology of HCC, followed by chronic HCV infection. The two study cohorts were essentially comparable in terms of major clinicopathological variables. After 1H-nuclear NMR analysis, we found in the investigation cohort that HCC with normal alpha-fetoprotein (AFP < 15 ng/mL) had significantly higher serum level of O-acetylcarnitine than those with higher AFP (AFP ≥ 15 ng/mL, P = 0.025). In addition, HCC with microscopic vascular invasion (VI) had significantly higher preoperative serum level of formate than HCC without microscopic VI (P = 0.023). These findings were similar in the validation cohort. Conclusion A comprehensive metabolomic profiling of HCC demonstrated that serum metabolites may be utilized to assist the early diagnosis of AFP-negative HCC patients and recognition of microvascular invasion in order to facilitate preoperative surgical planning and postoperative follow-up. Further, larger scale prospective studies are warranted to consolidate our findings.
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Affiliation(s)
- Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Gigin Lin
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Imaging Core Laboratory, Institute for Radiological Research, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Jo-Chu Chiu
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Han Chiang
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Mu Sung
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Chung Hsieh
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tony Kuo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Yu Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-I Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Lee CW, Chan KM, Tsai HI, Hsieh YC, Lin CY, Kuo YC, Hsu HY, Yu MC. Hepatic resection for hepatocellular carcinoma in the octogenarian: is it justified? Aging (Albany NY) 2020; 11:1537-1550. [PMID: 30867335 PMCID: PMC6428089 DOI: 10.18632/aging.101854] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/06/2019] [Indexed: 12/12/2022]
Abstract
Liver resection is a standard treatment for hepatocellular carcinoma (HCC). The purpose of this study was to investigate the clinicopathological characteristics and long-term outcomes of octogenarians with HCC treated with liver resection. Records of patients who underwent liver resection for HCC were reviewed, and patients older and younger than 80 years were compared. There were 77 patients 80 years of age or older and 3,309 younger than 80 years. Hepatitis C virus infection was the most common etiology among the octogenarians (43.1%), followed by non-viral causes (37.5%). The older group had more co-morbidity but less hepatitis B virus infection and cirrhosis. More than 70% of the non-viral older group had diabetes mellitus, as compared to only 21.6% in the viral older group. The older group had rates of perioperative morbidity, mortality, disease-free survival, and overall survival comparable to the younger group (all p>0.1). Multivariate analysis revealed that α-fetoprotein ≥400 ng/mL, tumor size ≥10 cm, and vascular invasion were independent prognostic factors for overall survival in the older patients. These findings demonstrate that liver resection is a justified treatment for HCC in octogenarians, and it can achieve surgical outcomes comparable to those in younger populations.
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Affiliation(s)
- Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Kun-Ming Chan
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan
| | - Hsin-I Tsai
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan.,Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan
| | - Yi-Chung Hsieh
- Division of Hepatology, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan
| | - Cheng-Yu Lin
- Division of Gastroenterology, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan
| | - Yung-Chia Kuo
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan
| | - Heng-Yuan Hsu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan
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26
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Yu CC, Kuo WL, Shen SC, Chou HH, Lo YF, Yu MC, Chen SC. Prognostic study for isolated local recurrence operated with salvage excision in hormone-receptor-positive patients with invasive breast cancer after primary breast surgery. Biomed J 2020; 43:83-93. [PMID: 32200960 PMCID: PMC7090316 DOI: 10.1016/j.bj.2019.07.002] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 07/10/2019] [Accepted: 07/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background This study aimed to identify the factors that predict distant recurrence and survival outcome after patients with primary positive hormone receptor-positive (HR+) invasive breast cancer undergo complete excision for isolated local recurrence (ILR). Methods From January 2000 to December 2009, we performed a retrospective review of our database and identified 51 patients with HR + invasive breast cancer who underwent complete excision for ILR as a component of salvage therapy. The distant metastasis-free survival (DMFS) and overall survival (OS) from the time of ILR were calculated using the Kaplan–Meier method, and a Cox regression model was used for multivariate analysis. Results Of the 51 cases of ILR, 28 were of ipsilateral breast tumor recurrence and 23 were of chest wall recurrence. By receiver operating characteristic curve analyses, the cut-off time point for time to ILR was determined to be 29 months. According to time to ILR (≤29 vs. >29 months) and primary tumor size (≤2 vs. >2 cm), patients were divided into four risk groups as variables for analysis. On multivariate analysis, two independent prognostic factors for DMFS and OS after ILR were identified: risk groups (ILR≤29 months with primary tumor size >2 cm vs. ILR>29 months with primary tumor size ≤ 2 cm, HR = 8.53 for DMFS and HR = 11.18 for OS) and primary tumor grade (2/3 vs. 1, HR = 6.10 for DMFS and 4.27 for OS). Conclusion We demonstrated that poor DMFS and OS are associated with high risk group defined as short time to ILR (≤29 months) with primary tumor size (>2 cm) and higher primary tumor grade (2/3) among patients with HR + invasive breast cancer treated with complete excision for ILR. Therapeutic strategies for ILR based on hormone therapy with new agents should be explored in future prospective studies, especially for patients with poor outcome.
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Affiliation(s)
- Chi-Chang Yu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Wen-Lin Kuo
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Che Shen
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsu-Huan Chou
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Feng Lo
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shin-Cheh Chen
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Tsai CL, Chang JS, Yu MC, Lee CH, Chen TC, Chuang WY, Kuo WL, Lin CC, Lin SM, Hsieh SY. Functional Genomics Identifies Hepatitis-Induced STAT3-TYRO3-STAT3 Signaling as a Potential Therapeutic Target of Hepatoma. Clin Cancer Res 2019; 26:1185-1197. [PMID: 31831556 DOI: 10.1158/1078-0432.ccr-18-3531] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/27/2019] [Accepted: 12/09/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Hepatitis promotes the development and recurrence of hepatocellular carcinoma (HCC). Receptor tyrosine kinases (RTK) play critical roles in the development of many cancers. We explored the potential roles of RTKs in hepatitis-related liver cancers. EXPERIMENTAL DESIGN We conducted loss-of-function screening to elucidate the roles of RTKs in the development of HCC in vitro and in vivo. RESULTS Many RTKs were coexpressed in HCC and were involved in tumor development and growth. Of these, TYRO3 promoted tumor growth and was clinically associated with hepatitis activity and poor prognosis. In mice, chemical-induced hepatitis transcriptionally activated Tyro3 expression via IL-6/IL6R-STAT3 signaling. Moreover, hepatitis-associated apoptotic cells facilitated the presentation of GAS6, a TYRO3 ligand, to further activate TYRO3-mediated signaling. Furthermore, TYRO3 activation elicited intracellular SRC- and STAT3 signaling. In mice, hepatitis and Tyro3 synergistically promoted HCC development. Silencing TYRO3 expression or inhibiting its kinase activity suppressed xenograft HCC growth in nude mice. CONCLUSIONS Many RTKs are simultaneously involved in HCC development. Hepatitis exerts dual effects on the activation of TYRO3-mediated signaling in HCC cells, which further elicits the "TYRO3-STAT3-TYRO3" signaling loop to facilitate tumor growth. Our findings unveil a previously unrecognized link between RTKs and hepatitis-associated HCC and suggest TYRO3 as a marker and therapeutic target for the HCCs with higher hepatitis activity.
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Affiliation(s)
- Chia-Liang Tsai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jeng-Shou Chang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chern-Horng Lee
- Department of General Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tse-Ching Chen
- Department of Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Yu Chuang
- Department of Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Liang Kuo
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chan WH, Huang SF, Lee CW, Wu TH, Pan KT, Lin SM, Yu MC, Hung CF. Incorporation of biochemical factors for survival analysis of transarterial chemoembolization in patients with hepatocellular carcinoma: A retrospective cohort study. J Int Med Res 2019; 47:4862-4871. [PMID: 31446817 PMCID: PMC6833392 DOI: 10.1177/0300060519866941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 12/20/2022] Open
Abstract
Introduction Hepatocellular carcinoma (HCC) is a common gastrointestinal cancer that occurs worldwide, and conventional transarterial chemoembolization (cTACE) is one of the first treatment choices for advanced HCC. However, biochemical factors and comorbidity have seldom been reported in the long-term outcomes. Methods This retrospective cohort study included 444 HCC patients who underwent cTACE-based therapy in 2010 to 2012. Survival outcomes were analyzed using a Kaplan–Meier curve and Cox regression analysis. Results The mean age was 62.1 ± 12.5 years, and 74.3% were men. Analysis of the mean biochemical values indicated that the presence of portal vein thrombosis, α-fetoprotein (AFP) >200 ng/mL, AJCC 7th stage III, diabetes, albumin <3 g/dL, and hemoglobin were significantly and independently associated with poorer long-term outcomes. Discussion The presence of venous thrombus and elevation of AFP levels are the most important factors in cTACE treatment. The host factors, including metabolic status and liver damage, should be evaluated in these patients.
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Affiliation(s)
- Wen-Hui Chan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Medical Center, Taoyuan
| | - Song-Fong Huang
- Department of General surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Medical Center, Taoyuan
| | - Chao-Wei Lee
- Department of General surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Medical Center, Taoyuan
| | - Tsung-Han Wu
- Department of General surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Medical Center, Taoyuan
| | - Kuan-Tse Pan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Medical Center, Taoyuan
| | - Shi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan
| | - Ming-Chin Yu
- Department of General surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Medical Center, Taoyuan.,Department of Surgery, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Chien-Fu Hung
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Medical Center, Taoyuan.,Department of Radiology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
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Kou HW, Yeh CH, Tsai HI, Hsu CC, Hsieh YC, Chen WT, Cheng HT, Yu MC, Lee CW. Sarcopenia is an effective predictor of difficult-to-wean and mortality among critically ill surgical patients. PLoS One 2019; 14:e0220699. [PMID: 31393937 PMCID: PMC6687130 DOI: 10.1371/journal.pone.0220699] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/22/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Critically-ill surgical patients are at higher risk for sarcopenia, which is associated with worse survival. Sarcopenia may impair the respiratory musculature, which can subsequently influence the outcome of ventilator weaning. Although there are a variety of weaning parameters predictive of weaning outcomes, none have tried to incorporate "muscle strength" or "sarcopenia". The aim of the current study was to explore the association between sarcopenia and difficult-to-wean (DtW) in critically-ill surgical patients. The influence of sarcopenia on ICU mortality was also analyzed. METHODS Ninety-six patients undergoing mechanical ventilation in the surgical intensive care unit (ICU) were enrolled. Demographic data and weaning parameters were recorded from the prospectively collected database, and the total psoas muscle area (TPA) was determined at the level of the 3rd lumbar vertebra by computed tomography. Sarcopenia was defined by previously established cut-off points and its influence on clinical outcomes was examined. Receiver operating characteristic (ROC) curve analysis was conducted to investigate the predictive capability of TPA and weaning parameters for predicting weaning outcomes. RESULTS The median age of the studied patients was 73 years. Thirty patients (31.3%) were sarcopenic and 30 (31.3%) were defined as DtW. Eighteen patients (18.8%) had ICU mortality. Multivariate logistic regression analyses revealed that sarcopenia was an independent risk factor for DtW and ICU mortality. The area under the ROC curve (AUC) of TPA for predicting successful weaning was 0.727 and 0.720 in female and male patients, respectively. After combining TPA and conventional weaning parameters, the AUC for DtW increased from 0.836 to 0.911 and from 0.835 to 0.922 in female and male patients, respectively. CONCLUSION Sarcopenia is an independent risk factor for DtW and ICU mortality. TPA has predictive value when assessing weaning outcomes and can be used as an effective adjunct predictor along with conventional weaning parameters.
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Affiliation(s)
- Hao-Wei Kou
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Hsin-I Tsai
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chih-Chieh Hsu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Yi-Chung Hsieh
- Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Wei-Ting Chen
- Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Hao-Tsai Cheng
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Department of Surgery, Xiamen Chang Gung Hospital, Xiamen, China
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- * E-mail:
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Chou HH, Kuo WL, Yu CC, Tsai HP, Shen SC, Chu CH, Yu MC, Lo YF, Dabora MA, Chang HK, Lin YC, Ueng SH, Chen SC. Impact of age on pathological complete response and locoregional recurrence in locally advanced breast cancer after neoadjuvant chemotherapy. Biomed J 2019; 42:66-74. [PMID: 30987708 PMCID: PMC6468039 DOI: 10.1016/j.bj.2018.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 04/01/2018] [Revised: 10/05/2018] [Accepted: 10/23/2018] [Indexed: 12/31/2022] Open
Abstract
Background Neoadjuvant chemotherapy (NAC) is the standard approach for downstaging of locally advanced breast cancer and can improve breast conservation rates. A pathological complete response (pCR) after NAC associated with favorable long-term outcomes has been described. There is still a high locoregional recurrence (LRR) rate after NAC and the influence of age on LRR after NAC is unclear. This study analyzed the relationship between age and LRR after NAC. Methods Two hundred and sixty-three patients with invasive breast cancer who received NAC followed by mastectomy or breast conserving surgery (BCS) were enrolled. Concurrent weekly epirubicin and docetaxel was the NAC regimen. Results Twenty-nine patients (11%) achieved a pCR after NAC. In univariate analysis, age <50 years, luminal B (HER2 positive) subtype, HER2 overexpression subtype, and triple-negative subtype were factors to predict a pCR. In multivariate analysis, age <50 years, luminal B (HER2 positive) type, HER2 overexpression, and triple-negative subtype were the independent factors to predict a pCR. No patients in the pCR group developed LRR compared with 31 patients in the non-pCR group. Eleven patients (6.9%) in the younger group (age <50 years) developed LRR compared with 20 patients (19.4%) in the older group (age ≥50 years). In multivariate analysis, younger age (<50 years) was the only independent prognostic factor for a LRR-free survival. Conclusion Younger age can predict a pCR and is an independent prognostic factor for LRR in locally advanced breast cancer patients after NAC as concurrent epirubicin and docetaxel.
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Affiliation(s)
- Hsu-Huan Chou
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wen-Ling Kuo
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chi-Chang Yu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hsiu-Pei Tsai
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shih-Cheh Shen
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chia-Hui Chu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yung-Feng Lo
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | | | - Hsien-Kun Chang
- Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yung-Chang Lin
- Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shin-Cheh Chen
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Lee CW, Tsai HI, Cheng HT, Chen WT, Hsu HY, Chiu CC, Liu YP, Wu TH, Yu MC, Lee WC, Chen MF. Stapleless laparoscopic left lateral sectionectomy for hepatocellular carcinoma: reappraisal of the Louisville statement by a young liver surgeon. BMC Gastroenterol 2018; 18:178. [PMID: 30486797 PMCID: PMC6264597 DOI: 10.1186/s12876-018-0903-y] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Laparoscopic liver resection has been regarded as the standard treatment for liver tumors located at the left lateral liver sector. However, few studies have reported the results of laparoscopic left lateral sectionectomy (LLS) for HCC, not to mention the feasibility of this emerging technique for the less experienced liver surgeons. The current study would reappraise the Louisville statement by examining the outcome of LLS performed by a young liver surgeon. METHODS We retrospectively reviewed two separate groups of patients who underwent open or laparoscopic left lateral sectionectomies at Chung Gung Memorial Hospital, Linkou. All laparoscopic hepatectomies were performed by the index young surgeon following a stepwise stapleless LLS. The surgical results and oncological outcomes of laparoscopic vs. open hepatectomies (LH and OH, respectively) with the surgical indication of HCC at left lateral liver sector were further compared and analyzed. RESULTS 18 of 29 patients in the laparoscopic group and 75 patients in the conventional open group had primary HCC. The demographic data was essentially the same for the two groups. Statistical analysis revealed that the LH group had smaller tumor size, higher blood transfusion requirement, longer duration of inflow control and parenchymal transection, and longer operation time. However, no significant difference was observed in terms of complication rate, mortality rate, and hospital stay between the two groups. After adjusting for tumor size, LH and OH showed no statistical difference in the amount of blood transfusion, operation time and patient survival. CONCLUSIONS This study demonstrated that stapleless LLS is a safe and feasible procedure for less experienced liver surgeons to resect HCC located at the left lateral liver sector. This stepwise stapleless LSS can not only achieve surgical results comparable to OH but also can provide a platform for liver surgeons to apply laparoscopic technique before conducting more complicated liver resections.
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Affiliation(s)
- Chao-Wei Lee
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Hsin-I Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Hao-Tsai Cheng
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Wei-Ting Chen
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Heng-Yuan Hsu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Chien-Chih Chiu
- Department of Nursing, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Yi-Ping Liu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Tsung-Han Wu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Ming-Chin Yu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China. .,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China. .,Department of Surgery, Xiamen Chang Gung Hospital, Xiamen, China.
| | - Wei-Chen Lee
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Miin-Fu Chen
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
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Lee CW, Kou HW, Chou HS, Chou HH, Huang SF, Chang CH, Wu CH, Yu MC, Tsai HI. A combination of SOFA score and biomarkers gives a better prediction of septic AKI and in-hospital mortality in critically ill surgical patients: a pilot study. World J Emerg Surg 2018; 13:41. [PMID: 30214469 PMCID: PMC6131912 DOI: 10.1186/s13017-018-0202-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 04/26/2018] [Accepted: 08/27/2018] [Indexed: 12/17/2022] Open
Abstract
Background Sepsis is a syndrome characterized by a constellation of clinical manifestations and a significantly high mortality rate in the surgical intensive care unit (ICU). It is frequently complicated by acute kidney injury (AKI), which, in turn, increases the risk of mortality. Therefore, it is of paramount importance to identify those septic patients at risk for the development of AKI and mortality. The objective of this pilot study was to evaluate several different biomarkers, including NGAL, calprotectin, KIM-1, cystatin C, and GDF-15, along with SOFA scores, in predicting the development of septic AKI and associated in-hospital mortality in critically ill surgical patients. Methods Patients admitted to the surgical ICU were prospectively enrolled, having given signed informed consent. Their blood and urine samples were obtained and subjected to enzyme-linked immunosorbent assay (ELISA) to determine the levels of various novel biomarkers. The clinical data and survival outcome were recorded and analyzed. Results A total of 33 patients were enrolled in the study. Most patients received surgery prior to ICU admission, with abdominal surgery being the most common type of procedure (27 patients (81.8%)). In the study, 22 patients had a diagnosis of sepsis with varying degrees of AKI, while the remaining 11 were free of sepsis. Statistical analysis demonstrated that in patients with septic AKI versus those without, the following were significantly higher: serum NGAL (447.5 ± 35.7 ng/mL vs. 256.5 ± 31.8 ng/mL, P value 0.001), calprotectin (1030.3 ± 298.6 pg/mL vs. 248.1 ± 210.7 pg/mL, P value 0.049), urinary NGAL (434.2 ± 31.5 ng/mL vs. 208.3 ± 39.5 ng/mL, P value < 0.001), and SOFA score (11.5 ± 1.2 vs. 4.4 ± 0.5, P value < 0.001). On the other hand, serum NGAL (428.2 ± 32.3 ng/mL vs. 300.4 ± 44.3 ng/mL, P value 0.029) and urinary NGAL (422.3 ± 33.7 ng/mL vs. 230.8 ± 42.2 ng/mL, P value 0.001), together with SOFA scores (10.6 ± 1.4 vs. 5.6 ± 0.8, P value 0.003), were statistically higher in cases of in-hospital mortality. A combination of serum NGAL, urinary NGAL, and SOFA scores could predict in-hospital mortality with an AUROC of 0.911. Conclusions This pilot study demonstrated a promising panel that allows an early diagnosis, high sensitivity, and specificity and a prognostic value for septic AKI and in-hospital mortality in surgical ICU. Further study is warranted to validate our findings. Electronic supplementary material The online version of this article (10.1186/s13017-018-0202-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China.,2College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,3Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Hao-Wei Kou
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
| | - Hong-Shiue Chou
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
| | - Hsu-Huan Chou
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
| | - Song-Fong Huang
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
| | - Chih-Hsiang Chang
- Division of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
| | - Chun-Hsing Wu
- 3Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China.,2College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Hsin-I Tsai
- 3Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
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Ng AWT, Poon SL, Huang MN, Lim JQ, Boot A, Yu W, Suzuki Y, Thangaraju S, Ng CCY, Tan P, Pang ST, Huang HY, Yu MC, Lee PH, Hsieh SY, Chang AY, Teh BT, Rozen SG. Aristolochic acids and their derivatives are widely implicated in liver cancers in Taiwan and throughout Asia. Sci Transl Med 2018; 9:9/412/eaan6446. [PMID: 29046434 DOI: 10.1126/scitranslmed.aan6446] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/31/2017] [Accepted: 09/25/2017] [Indexed: 12/21/2022]
Abstract
Many traditional pharmacopeias include Aristolochia and related plants, which contain nephrotoxins and mutagens in the form of aristolochic acids and similar compounds (collectively, AA). AA is implicated in multiple cancer types, sometimes with very high mutational burdens, especially in upper tract urothelial cancers (UTUCs). AA-associated kidney failure and UTUCs are prevalent in Taiwan, but AA's role in hepatocellular carcinomas (HCCs) there remains unexplored. Therefore, we sequenced the whole exomes of 98 HCCs from two hospitals in Taiwan and found that 78% showed the distinctive mutational signature of AA exposure, accounting for most of the nonsilent mutations in known cancer driver genes. We then searched for the AA signature in 1400 HCCs from diverse geographic regions. Consistent with exposure through known herbal medicines, 47% of Chinese HCCs showed the signature, albeit with lower mutation loads than in Taiwan. In addition, 29% of HCCs from Southeast Asia showed the signature. The AA signature was also detected in 13 and 2.7% of HCCs from Korea and Japan as well as in 4.8 and 1.7% of HCCs from North America and Europe, respectively, excluding one U.S. hospital where 22% of 87 "Asian" HCCs had the signature. Thus, AA exposure is geographically widespread. Asia, especially Taiwan, appears to be much more extensively affected, which is consistent with other evidence of patterns of AA exposure. We propose that additional measures aimed at primary prevention through avoidance of AA exposure and investigation of possible approaches to secondary prevention are warranted.
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Affiliation(s)
- Alvin W T Ng
- Centre for Computational Biology, Duke-NUS Medical School, Singapore 169857, Singapore.,Programme in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore.,NUS Graduate School for Integrative Sciences and Engineering, Singapore 117456, Singapore
| | - Song Ling Poon
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Mi Ni Huang
- Centre for Computational Biology, Duke-NUS Medical School, Singapore 169857, Singapore.,Programme in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Jing Quan Lim
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore 169610, Singapore.,Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Arnoud Boot
- Centre for Computational Biology, Duke-NUS Medical School, Singapore 169857, Singapore.,Programme in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Willie Yu
- Centre for Computational Biology, Duke-NUS Medical School, Singapore 169857, Singapore.,Programme in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Yuka Suzuki
- Centre for Computational Biology, Duke-NUS Medical School, Singapore 169857, Singapore.,Programme in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Saranya Thangaraju
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Cedric C Y Ng
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Patrick Tan
- Programme in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore.,SingHealth/Duke-NUS Precision Medicine Institute, Singapore 169609, Singapore.,Genome Institute of Singapore, Singapore 138672, Singapore
| | - See-Tong Pang
- Division of Urooncology, Department of Urology, Chang Gung University and Memorial Hospital, Linkou, Taoyuan 33305, Taiwan
| | - Hao-Yi Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University, Taipei 10051, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan.
| | - Alex Y Chang
- Johns Hopkins Singapore, Singapore 308433, Singapore.
| | - Bin T Teh
- Programme in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore. .,Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore 169610, Singapore.,SingHealth/Duke-NUS Precision Medicine Institute, Singapore 169609, Singapore.,Institute of Molecular and Cell Biology, Singapore 138673, Singapore
| | - Steven G Rozen
- Centre for Computational Biology, Duke-NUS Medical School, Singapore 169857, Singapore. .,Programme in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore.,NUS Graduate School for Integrative Sciences and Engineering, Singapore 117456, Singapore.,SingHealth/Duke-NUS Precision Medicine Institute, Singapore 169609, Singapore
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Hong YW, Lin JD, Yu MC, Hsu CC, Lin YS. Outcomes and prognostic factors in thyroid cancer patients with cranial metastases: A retrospective cohort study of 4,683 patients. Int J Surg 2018; 55:182-187. [PMID: 29883619 DOI: 10.1016/j.ijsu.2018.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 04/19/2018] [Revised: 05/20/2018] [Accepted: 06/01/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cranial metastasis of thyroid cancer is rare. The aim of this study was to analyse the clinical characteristics, treatments and outcomes of thyroid cancer patients with cranial metastasis and to identify the associated prognostic factors. MATERIALS AND METHODS Between January 1977 and August 2017, a total of 4683 patients were histologically confirmed to have thyroid cancer. Among them, 25 patients (0.53%) were identified as having cranial metastases, and their medical records were reviewed. The Kaplan-Meier method with a log-rank test was performed with cancer-specific survival as the main outcome. Cox regression analysis was used to examine the potential prognostic factors influencing patient survival. RESULTS Of the 25 patients, 21 were female, and 4 were male. The median age at the time of diagnosis of cranial metastasis was 63 years. Sixteen patients had metastases to the brain, and nine patients had metastases involving the skull only. Papillary carcinoma and follicular carcinoma accounted for 84.0% of cases. Twenty-four cases (96.0%) had extracranial metastases at the time of diagnosis of cranial metastases. Twenty patients received surgery, and 4 patients received palliative radiotherapy. One patient received supportive care only. The median cancer-specific survival after the diagnosis of cranial metastases was 27 months. According to the Kaplan-Meier test, 3 factors had a significant impact on survival, the metastatic site, histological types and surgical resection. According to the Cox regression analysis, skull metastases (HR: 0.274, 95% CI: 0.083-0.904, p = 0.033) and surgical resection (HR: 0.134, 95% CI: 0.019-0.929, p = 0.042) were identified as independent prognostic factors for a better outcome. CONCLUSIONS Surgical resection is the mainstay therapy for thyroid cancer patients with cranial metastasis. Cranial metastases involving the skull only are associated with a better outcome.
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Affiliation(s)
- Yi-Wen Hong
- Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, No. 5, Fuxing St, Guishan Dist, Taoyuan City 333, Taiwan
| | - Jen-Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, No. 5, Fuxing St, Guishan Dist, Taoyuan City 333, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, No. 5, Fuxing St, Guishan Dist, Taoyuan City 333, Taiwan
| | - Chih-Chieh Hsu
- Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, No. 5, Fuxing St, Guishan Dist, Taoyuan City 333, Taiwan
| | - Yann-Sheng Lin
- Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, No. 5, Fuxing St, Guishan Dist, Taoyuan City 333, Taiwan.
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Peng JM, Bera R, Chiou CY, Yu MC, Chen TC, Chen CW, Wang TR, Chiang WL, Chai SP, Wei Y, Wang H, Hung MC, Hsieh SY. Actin cytoskeleton remodeling drives epithelial-mesenchymal transition for hepatoma invasion and metastasis in mice. Hepatology 2018; 67:2226-2243. [PMID: 29171033 DOI: 10.1002/hep.29678] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [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: 06/04/2017] [Revised: 11/10/2017] [Accepted: 11/19/2017] [Indexed: 01/11/2023]
Abstract
UNLABELLED High invasiveness is a hallmark of human hepatocellular carcinoma (HCC). Large tumors predict invasion and metastasis. Epithelial-mesenchymal transition (EMT) is crucial for cancer invasion and metastasis. However, the mechanisms whereby large tumors tend to undergo EMT remain unclear. We conducted a subgenome-wide screen and identified KLHL23 as an HCC invasion suppressor by inhibiting EMT. KLHL23 binds to actin and suppresses actin polymerization. KLHL23 silencing induced filopodium and lamellipodium formation. Moreover, EMT was suppressed by KLHL23 through its action on actin dynamics. Traditionally, actin cytoskeleton remodeling is downstream of EMT reprogramming. It is therefore intriguing to ask why and how KLHL23 inversely regulates EMT. Activation of actin cytoskeleton remodeling by either KLHL23 silencing or treatment with actin cytoskeleton modulators augmented cellular hypoxic responses in a cell-density-dependent manner, resulting in hypoxia-inducible factor (HIF) and Notch signals and subsequent EMT. Environmental hypoxia did not induce EMT unless actin cytoskeleton remodeling was simultaneously activated and only when cells were at high density. The resulting EMT was reversed by either adenosine 5'-triphosphate supplementation or actin polymerization inhibitors. Down-regulation of KLHL23 was associated with invasion, metastasis, and poor prognosis of HCC and pancreatic cancer. Correlations of tumor size with EMT and inverse association of expression of KLHL23 with HIF/Notch signals were further validated in patient-derived xenograft HCCs in mice. CONCLUSION Simultaneously activation of actin cytoskeleton remodeling by intrinsic (such as KLHL23 down-regulation) or microenvironment cues is crucial for cell-density-dependent and hypoxia-mediated EMT, providing a mechanistic link between large tumor size and invasion/metastasis. Our findings provide a means of developing the prevention and treatment strategies for tumor invasion and metastasis. (Hepatology 2018;67:2226-2243).
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Affiliation(s)
- Jei-Ming Peng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Rabindranath Bera
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chih-Yung Chiou
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Tse-Chin Chen
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chia-Wei Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Tsung-Rui Wang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Wan-Ling Chiang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Shin-Pei Chai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yongkun Wei
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Huamin Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mien-Chie Hung
- Center for Molecular Medicine and Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
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36
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Wu HY, Huang SF, Pan KT, Yu MC. Preoperative radiologic patent blue localization for intracorporeal laparoscopic resection of a terminal ileal submucosal lipoma: A case report. Int J Surg Case Rep 2018; 45:91-95. [PMID: 29604532 PMCID: PMC6000738 DOI: 10.1016/j.ijscr.2018.03.011] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/20/2018] [Accepted: 03/05/2018] [Indexed: 01/06/2023] Open
Abstract
Small submucosal ileal lesion is difficulty to localize when laparoscopic surgery. Localization by radiologic intervention is effective and harmless. laparoscopic submucosal lipoma resection could be performed intracorporeally.
Background Ileal submucosal lipomas are rare cases and surgical intervention was necessary in case of abdominal pain and intussusception. Laparoscopic resection may be difficult for the intraluminal submucosal lesion. Herein, we report a case of terminal ileal submucosal lipoma resected by radiologic-assisted laparoscopic surgery. Case presentation The 31-year-old female was admitted for intermittent abdominal pain. The colonoscopy showed a 1.5 cm diameter subepithelial lesion in terminal ileum and computed tomography showed a hypodense lesion in distal ileum. The diagnosis of terminal ileal submucosal lipoma without obstruction was impressed and surgical strategy of minimal invasive surgery was taken. Preoperative CT-guided patent blue dye injection near the terminal ileal submucosal lipoma for localization was performed by Radiologist. Then laparoscopic resection with intracorporeal suture was done smoothly without complications. The pathology proved lipoma and she had good recovery within one week. Conclusions There are many kinds of intervention methods to treat the small bowel lipoma. Our experience supports that laparoscopic surgery with radiologic localization assistance is feasible for terminal ileal nonintussusceptive submucosal lipoma resection.
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Affiliation(s)
- Hsin-Yi Wu
- Department of General Surgery, No. 5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan.
| | - Song-Fong Huang
- Department of General Surgery, No. 5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan.
| | - Kuang-Tse Pan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan.
| | - Ming-Chin Yu
- Department of General Surgery, No. 5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan; Department of Surgery, Xiamen Chang Gung Hospital, Xiamen, Fujian, China.
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Kuo WL, Ueng SH, Wu CH, Lee LY, Lee YS, Yu MC, Chen SC, Yu CC, Tsai CN. Establishment of two basal-like breast cancer cell lines with extremely low tumorigenicity from Taiwanese premenopausal women. Hum Cell 2018; 31:154-166. [PMID: 29484537 PMCID: PMC5852199 DOI: 10.1007/s13577-017-0197-3] [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: 06/04/2017] [Accepted: 12/24/2017] [Indexed: 11/19/2022]
Abstract
The research of carcinogenetic mechanisms of breast cancer in different ethnic backgrounds is an interesting field, as clinical features of breast cancers vary among races. High premenopausal incidence is distinctive in East-Asian breast cancer. However, human cell lines derived from Asian primary breast tumor are rare. To provide alternative cell line models with a relevant genetic background, we aimed to establish breast cancer cell lines from Taiwanese patients of Han-Chinese ethnicity. Fresh tissue from mammary tumors were digested into organoids, plated and grown in basal serum-free medium of human mammary epithelial cells (HuMEC) with supplements. Cells were further enriched by positive selection with CD326 (epithelial cell adhesion molecule; EpCAM)-coated micro-magnetic beads. Two breast cancer cell lines derived from premenopausal women were successfully established by this method, and named Chang-Gung Breast Cancer 01 (CGBC 01) and 02 (CGBC 02). These two cell lines had a similar phenotype with weak expression of estrogen receptor (ER), progesterone receptor (PR), and without amplification of receptor tyrosine protein kinase erbB-2 (HER2/neu). Genome-wide Single Nucleotide Polymorphism (SNP) array showed multiple copy number alterations in both cell lines. Based on gene expression profiles, CGBC 01 and 02 were clustered into basal-like subtype with reference to the breast cancer cell line gene expression database. The tumorigenicity of both cell lines was extremely low in both anchorage-independence assay and transplantation into the mammary fat pads of nude mice. CGBC 01 and CGBC 02 are low tumorigenic breast cancer cell lines, established from Han-Chinese premenopausal breast cancer patients, which serve as in vitro models in studying the biological features of Asian breast cancer.
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Affiliation(s)
- Wen-Ling Kuo
- Division of Breast Surgery and General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Guishan Dist., Taoyuan, 33305, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, 33302, Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Guishan Dist., Taoyuan, 33305, Taiwan
| | - Chun-Hsing Wu
- Division of Breast Surgery and General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Guishan Dist., Taoyuan, 33305, Taiwan
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Guishan Dist., Taoyuan, 33305, Taiwan
| | - Yun-Shien Lee
- Department of Biotechnology, Ming Chuan University, Guishan Dist., Taoyuan, 33348, Taiwan.,Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Linkou, Guishan Dist., Taoyuan, 33305, Taiwan
| | - Ming-Chin Yu
- Division of Breast Surgery and General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Guishan Dist., Taoyuan, 33305, Taiwan
| | - Shin-Cheh Chen
- Division of Breast Surgery and General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Guishan Dist., Taoyuan, 33305, Taiwan
| | - Chi-Chang Yu
- Division of Breast Surgery and General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Guishan Dist., Taoyuan, 33305, Taiwan
| | - Chi-Neu Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, 33302, Taiwan. .,Department of Pediatric, Chang-Gung Memorial Hospital, LinKou, Guishan Dist., Taoyuan, 33305, Taiwan.
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Abstract
Acute severe pancreatitis caused high mortality, and several scoring systems for predicting mortality are available. We evaluated the effectiveness of serial measurement of several scoring systems in patients with acute severe pancreatitis.We retrospectively obtained serial measurements of Ranson, Acute Physiology and Chronic Health Assessment (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores of 159 patients with acute severe pancreatitis.The overall mortality rate was 20%, and early mortality (in the first 2 weeks) occurred in 10 (7.4%) patients, while late mortality occurred in 17 (12.6%).All scoring systems were reliable for predicting overall and intensive care unit mortality, while the SOFA score on day 7 presented the largest area under the receiver operator characteristic (ROC) curve (0.858, SE 0.055). Changes in scores over time were evaluated for predicting the progression of organ failure, and the change in SOFA score on hospital day 7 or no interval change in SOFA score was associated with higher mortality rates.APACHE II and SOFA scores are both sensitive for predicting mortality in acute pancreatitis. The serial SOFA scores showed reliable for predicting mortality. Hospital day 7 is a reasonable time for SOFA score reassessment to predict late mortality in acute severe pancreatitis.
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Affiliation(s)
- Yu-San Tee
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
| | - Hsin-Yueh Fang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
| | - I.-Ming Kuo
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
| | - Yann-Sheng Lin
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
| | - Song-Fong Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
- Department of Surgery, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
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Yu MC, Lee CW, Lee YS, Lian JH, Tsai CL, Liu YP, Wu CH, Tsai CN. Prediction of early-stage hepatocellular carcinoma using OncoScan chromosomal copy number aberration data. World J Gastroenterol 2017; 23:7818-7829. [PMID: 29209123 PMCID: PMC5703911 DOI: 10.3748/wjg.v23.i44.7818] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To identify chromosomal copy number aberrations (CNAs) in early-stage hepatocellular carcinoma (HCC) and analyze whether they are correlated with patient prognosis.
METHODS One hundred and twenty patients with early-stage HCC were enrolled in our study, with the collection of formalin fixed, paraffin-embedded (FFPE) specimens and clinicopathological data. Tumor areas were marked by certified pathologists on a hematoxylin and eosin-stained slide, and cancer and adjacent non-cancerous tissues underwent extraction of DNA, which was analyzed with the Affymetrix OncoScan platform to assess CNAs and loss of heterozygosity (LOH). Ten individuals with nonmalignant disease were used as the control group. Another cohort consisting of 40 patients with stage I/II HCC were enrolled to analyze gene expression and to correlate findings with the OncoScan data.
RESULTS Copy number amplifications occurred at chromosomes 1q21.1-q44 and 8q12.3-24.3 and deletions were found at 4q13.1-q35.2, 8p 23.2-21.1, 16q23.3-24.3, and 17p13.3-12, while LOH commonly occurred at 1p32.3, 3p21.31, 8p23.2-21.1, 16q22.1-24.3, and 17p 13.3-11 in early-stage HCC. Using Cox regression analysis, we also found that a higher percentage of genome change (≥ 60%) was an independent factor for worse prognosis in early-stage HCC (P = 0.031). Among the 875 genes in the OncoScan GeneChip, six were independent predictors of worse disease-free survival, of which three were amplified (MYC, ELAC2, and SYK) and three were deleted (GAK, MECOM, and WRN). Further, patients with HCC who exhibited ≥ 3 CNAs involving these six genes have worse outcomes compared to those who had < 3 CNAs (P < 0.001). Similarly, Asian patients with stage I HCC from The Cancer Genome Atlas harboring CNAs with these genes were also predicted to have poorer outcomes.
CONCLUSION Patients with early-stage HCC and increased genome change or CNAs involving MYC, ELAC2, SYK, GAK, MECOM, or WRN are at risk for poorer outcome after resection.
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Affiliation(s)
- Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Surgery, Xiamen Chang Gung Hospital, Xiamen 361028, China
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yun-Shien Lee
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Biotechnology, Ming-Chuan University, Taoyuan 33348, Taiwan
| | - Jang-Hau Lian
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chia-Lung Tsai
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Yi-Ping Liu
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chun-Hsing Wu
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chi-Neu Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
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Hsu HY, Yu MC, Lee CW, Tsai HI, Sung CM, Chen CW, Huang SW, Lin CY, Jeng WJ, Lee WC, Chen MF. RAM score is an effective predictor for early mortality and recurrence after hepatectomy for hepatocellular carcinoma. BMC Cancer 2017; 17:742. [PMID: 29121890 PMCID: PMC5680811 DOI: 10.1186/s12885-017-3748-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 02/23/2017] [Accepted: 11/01/2017] [Indexed: 02/08/2023] Open
Abstract
Background Liver resection had been regarded as a standard treatment for primary hepatocellular carcinoma (HCC). However, early mortality and recurrence after surgery were still of major concern. RAM (Risk Assessment for early Mortality) scoring system is a newly developed tool for assessing early mortality after hepatectomy for HCC. In this study, we compared RAM scoring system with ALBI and MELD scores for their capability of predicting short-term outcome. Methods We retrospectively reviewed patients with hepatocellular carcinoma who were treated with hepatectomy at Chang Gung Memorial Hospital between 1986 and 2015. Their clinical characteristics and perioperative variables were collected. We applied RAM, albumin-bilirubin (ALBI), and model for end-stage liver disease (MELD) scoring systems to predict early mortality and early recurrence in HCC patients after surgery. We investigated the discriminative power of each scoring system by receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). Results A total of 1935 patients (78% male) who underwent liver resection for HCC were included in this study. The median follow-up period was 41.9 months. One hundred and forty-nine patients (7.7%) died within 6 months after hepatectomy (early mortality). All the three scoring systems were effective predictor for early mortality, with higher score indicating higher risk of early mortality (AUC of RAM = 0.723, p < 0.001; AUC of ALBI = 0.682, p < 0.001; AUC of MELD = 0.590, p = 0.002). Cox regression multivariate analysis demonstrated that the RAM class was the most significant independent predictor of early mortality after surgery, while MELD grade failed to discriminatively predict early mortality. In addition to early mortality, the RAM score was also predictive of early recurrence in HCC after surgery. Conclusions This study demonstrated that RAM score is an effective and user-friendly bedside scoring system to predict early mortality and early recurrence after hepatectomy for HCC. In addition, the predictive capability of RAM score is superior to ALBI and MELD scores. Further study is warranted to validate our findings.
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Affiliation(s)
- Heng-Yuan Hsu
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China.
| | - Hsin-I Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China.,Department of Anesthesiology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Chang-Mu Sung
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China.,Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Chun-Wei Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Shu-Wei Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Cheng-Yu Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Wei-Chen Lee
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Miin-Fu Chen
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
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Lee CW, Lin SE, Tsai HI, Su PJ, Hsieh CH, Kuo YC, Sung CM, Lin CY, Tsai CN, Yu MC. Cadherin 17 is related to recurrence and poor prognosis of cytokeratin 19-positive hepatocellular carcinoma. Oncol Lett 2017; 15:559-567. [PMID: 29387234 DOI: 10.3892/ol.2017.7320] [Citation(s) in RCA: 7] [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] [Received: 03/22/2017] [Accepted: 10/20/2017] [Indexed: 12/15/2022] Open
Abstract
A previous study demonstrated that cytokeratin 19 (CK19) expression in hepatocellular carcinoma (HCC) is an indicator of HCC invasiveness, including lymph node metastasis (LNM), tumor infiltration/non-encapsulation and poor prognosis. The exact mechanism by which CK19 expression results in poor prognosis remains unclear. Through the use of an Affymetrix U133A oligonucleotide microarray [20 patients with hepatitis B virus (HBV)-HCC], it was demonstrated that cadherin 17 (CDH17) significantly correlated with CK19 expression (R2, 0.867; P<0.001) in HBV-HCC. Immunohistochemical analysis (114 patients with HBV-HCC) also demonstrated a significant correlation between CK19 and CDH17 expressions in primary tumor tissue (R2, 0.414; P<0.001). In addition, CK19 and CDH17 expressions levels revealed a significant association with LNM (P<0.001). Cox regression multivariate analysis demonstrated that indocyanine green retention at 15 min >10% and CDH17 expression were independent prognostic factors for disease free survival (P=0.010 and 0.002, respectively). In vitro studies showed that epidermal growth factor can induce the expression of both CK19 and CDH17, and CDH17 in turn can enhance the expression of CK19 in HCC. In summary, this study demonstrated that the early recurrence and poor prognosis of CK19(+) HCC may be due to the expression of CDH17, a gene known to be associated with vascular invasion, tumor metastasis, and advanced tumor stage of HCC. Thus, novel therapeutics by targeting CDH17 may be beneficial for CK19(+) HCC.
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Affiliation(s)
- Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C
| | - Sey-En Lin
- Department of Pathology, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan, R.O.C
| | - Hsin-I Tsai
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C
| | - Po-Jung Su
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C.,Graduate Institute of Data Science, Taipei Medical University, Taipei 11031, Taiwan, R.O.C
| | - Chia-Hsun Hsieh
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C
| | - Yung-Chia Kuo
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C
| | - Chang-Mu Sung
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C
| | - Cheng-Yu Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C
| | - Chi-Neu Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C
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Lin YS, Lin JD, Hsu CC, Yu MC. The long-term outcomes of thyroid function after subtotal thyroidectomy for Graves' hyperthyroidism. J Surg Res 2017; 220:112-118. [PMID: 29180171 DOI: 10.1016/j.jss.2017.06.091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 04/14/2017] [Revised: 06/22/2017] [Accepted: 06/29/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Surgical management of Graves' disease (GD) is changing from subtotal to total thyroidectomy because the latter eliminates the risk of recurrence. However, to preserve thyroid function in a euthyroid state, subtotal thyroidectomy is still performed for GD in non-Western countries. Therefore, we designed a study to investigate the long-term outcomes in GD patients after subtotal thyroidectomy and the correlation between remnant weight and postoperative thyroid function. MATERIALS AND METHODS This was a retrospective cohort observation study. Between January 2005 and December 2011, 415 consecutive GD patients treated by subtotal thyroidectomy were enrolled. All data were collected from 385 patients who underwent bilateral subtotal thyroidectomy and 57 patients who underwent the Hartley-Dunhill operation. The median postoperative follow-up time was 72 months (range 12-144 months). RESULTS The mean weight of the preserved thyroid remnant was 5.1 g. Persistent or recurrent hyperthyroidism was observed in 119 (28.7%) patients. The median time of recurrence was 36 months (range 12-120 months). Hypothyroidism developed in over 50% of patients. A euthyroid state was achieved in only 19.3% of patients, and the rate did not increase significantly as remnant weight increased. Based on a Cox regression analysis, the remnant weight is an independent risk factor for persistent or recurrent hyperthyroidism (hazard ratio: 1.323, 95% confidence interval: 1.198-1.461, P < 0.001). CONCLUSIONS Subtotal thyroidectomy with the intent to maintain a euthyroid state is not an optimal surgical strategy for the definitive treatment of GD because the persistence or recurrence rate is high and the euthyroid rate is lower than expected.
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Affiliation(s)
- Yann-Sheng Lin
- Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, Taoyuan City, Taiwan (R.O.C.)
| | - Jen-Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, Taoyuan City, Taiwan (R.O.C.)
| | - Chih-Chieh Hsu
- Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, Taoyuan City, Taiwan (R.O.C.)
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, Taoyuan City, Taiwan (R.O.C.).
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Jusakul A, Cutcutache I, Yong CH, Lim JQ, Huang MN, Padmanabhan N, Nellore V, Kongpetch S, Ng AWT, Ng LM, Choo SP, Myint SS, Thanan R, Nagarajan S, Lim WK, Ng CCY, Boot A, Liu M, Ong CK, Rajasegaran V, Lie S, Lim AST, Lim TH, Tan J, Loh JL, McPherson JR, Khuntikeo N, Bhudhisawasdi V, Yongvanit P, Wongkham S, Totoki Y, Nakamura H, Arai Y, Yamasaki S, Chow PKH, Chung AYF, Ooi LLPJ, Lim KH, Dima S, Duda DG, Popescu I, Broet P, Hsieh SY, Yu MC, Scarpa A, Lai J, Luo DX, Carvalho AL, Vettore AL, Rhee H, Park YN, Alexandrov LB, Gordân R, Rozen SG, Shibata T, Pairojkul C, Teh BT, Tan P. Whole-Genome and Epigenomic Landscapes of Etiologically Distinct Subtypes of Cholangiocarcinoma. Cancer Discov 2017; 7:1116-1135. [PMID: 28667006 DOI: 10.1158/2159-8290.cd-17-0368] [Citation(s) in RCA: 556] [Impact Index Per Article: 79.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/07/2017] [Accepted: 06/28/2017] [Indexed: 02/07/2023]
Abstract
Cholangiocarcinoma (CCA) is a hepatobiliary malignancy exhibiting high incidence in countries with endemic liver-fluke infection. We analyzed 489 CCAs from 10 countries, combining whole-genome (71 cases), targeted/exome, copy-number, gene expression, and DNA methylation information. Integrative clustering defined 4 CCA clusters-fluke-positive CCAs (clusters 1/2) are enriched in ERBB2 amplifications and TP53 mutations; conversely, fluke-negative CCAs (clusters 3/4) exhibit high copy-number alterations and PD-1/PD-L2 expression, or epigenetic mutations (IDH1/2, BAP1) and FGFR/PRKA-related gene rearrangements. Whole-genome analysis highlighted FGFR2 3' untranslated region deletion as a mechanism of FGFR2 upregulation. Integration of noncoding promoter mutations with protein-DNA binding profiles demonstrates pervasive modulation of H3K27me3-associated sites in CCA. Clusters 1 and 4 exhibit distinct DNA hypermethylation patterns targeting either CpG islands or shores-mutation signature and subclonality analysis suggests that these reflect different mutational pathways. Our results exemplify how genetics, epigenetics, and environmental carcinogens can interplay across different geographies to generate distinct molecular subtypes of cancer.Significance: Integrated whole-genome and epigenomic analysis of CCA on an international scale identifies new CCA driver genes, noncoding promoter mutations, and structural variants. CCA molecular landscapes differ radically by etiology, underscoring how distinct cancer subtypes in the same organ may arise through different extrinsic and intrinsic carcinogenic processes. Cancer Discov; 7(10); 1116-35. ©2017 AACR.This article is highlighted in the In This Issue feature, p. 1047.
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Affiliation(s)
- Apinya Jusakul
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore.,Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore.,The Centre for Research and Development of Medical Diagnostic Laboratories and Department of Clinical Immunology and Transfusion Sciences, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Ioana Cutcutache
- Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Chern Han Yong
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore.,Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Jing Quan Lim
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore.,Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Division of Medical Oncology, Singapore
| | - Mi Ni Huang
- Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Nisha Padmanabhan
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore
| | - Vishwa Nellore
- Department of Biostatistics and Bioinformatics, Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
| | - Sarinya Kongpetch
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore.,Cholangiocarcinoma Screening and Care Program and Liver Fluke and Cholangiocarcinoma Research Centre, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Alvin Wei Tian Ng
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore
| | - Ley Moy Ng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Su Pin Choo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Swe Swe Myint
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Raynoo Thanan
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sanjanaa Nagarajan
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Weng Khong Lim
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore.,Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Cedric Chuan Young Ng
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Arnoud Boot
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore.,Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Mo Liu
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore.,Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Choon Kiat Ong
- Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Division of Medical Oncology, Singapore
| | - Vikneswari Rajasegaran
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Stefanus Lie
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore.,Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Alvin Soon Tiong Lim
- Cytogenetics Laboratory, Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - Tse Hui Lim
- Cytogenetics Laboratory, Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - Jing Tan
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - Jia Liang Loh
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore
| | - John R McPherson
- Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Narong Khuntikeo
- Cholangiocarcinoma Screening and Care Program and Liver Fluke and Cholangiocarcinoma Research Centre, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Puangrat Yongvanit
- Cholangiocarcinoma Screening and Care Program and Liver Fluke and Cholangiocarcinoma Research Centre, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sopit Wongkham
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yasushi Totoki
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Hiromi Nakamura
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Yasuhito Arai
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Satoshi Yamasaki
- Laboratory of Molecular Medicine, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Japan
| | - Pierce Kah-Hoe Chow
- Division of Surgical Oncology, National Cancer Center Singapore and Office of Clinical Sciences, Duke-NUS Medical School, Singapore
| | - Alexander Yaw Fui Chung
- Department of Hepatopancreatobiliary/Transplant Surgery, Singapore General Hospital, Singapore
| | | | - Kiat Hon Lim
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Simona Dima
- Center of Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Dan G Duda
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irinel Popescu
- Center of Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Philippe Broet
- DHU Hepatinov, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Aldo Scarpa
- Applied Research on Cancer Centre (ARC-Net), University and Hospital Trust of Verona, Verona, Italy
| | - Jiaming Lai
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P. R. China
| | - Di-Xian Luo
- National and Local Joint Engineering Laboratory of High-through Molecular Diagnostic Technology, the First People's Hospital of Chenzhou, Southern Medical University, Chenzhou, P. R. China
| | | | - André Luiz Vettore
- Laboratory of Cancer Molecular Biology, Department of Biological Sciences, Federal University of São Paulo, Rua Pedro de Toledo, São Paulo, Brazil
| | - Hyungjin Rhee
- Department of Pathology, Brain Korea 21 PLUS Project for Medical Science, Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Korea
| | - Young Nyun Park
- Department of Pathology, Brain Korea 21 PLUS Project for Medical Science, Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Korea
| | - Ludmil B Alexandrov
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, and Center for Nonlinear Studies, Los Alamos National Laboratory, Los Alamos, New Mexico
| | - Raluca Gordân
- Department of Biostatistics and Bioinformatics, Center for Genomic and Computational Biology, Duke University, Durham, North Carolina. .,Department of Computer Science, Duke University, Durham, North Carolina
| | - Steven G Rozen
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore. .,Centre for Computational Biology, Duke-NUS Medical School, Singapore.,SingHealth/Duke-NUS Institute of Precision Medicine, National Heart Centre, Singapore
| | - Tatsuhiro Shibata
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan. .,Laboratory of Molecular Medicine, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Japan
| | - Chawalit Pairojkul
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Bin Tean Teh
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore. .,Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Centre Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore.,SingHealth/Duke-NUS Institute of Precision Medicine, National Heart Centre, Singapore.,Institute of Molecular and Cell Biology, Singapore
| | - Patrick Tan
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore.,SingHealth/Duke-NUS Institute of Precision Medicine, National Heart Centre, Singapore.,Genome Institute of Singapore, Singapore
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Yeh CT, Lee WC, Lin SM, Lin CL, Hsu CW, Wu TJ, Yu MC, Hung CF, Tseng JH, Lin CC, Chen WT, Teng W, Chen YC, Chang ML. GALNT14 genotype-guided, sorafenib in combination with transarterial chemoembolization in hepatocellular carcinoma: An interim report of a prospective randomized controlled trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15657] [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] [Indexed: 11/20/2022] Open
Abstract
e15657 Background: Sorafenib is the only approved targeted agent for treatment of unresectable hepatocellular carcinoma (HCC). Transarterial chemoembolization (TACE) is the mainstay of treatment for advanced HCC patients in Barcelona Clinical Liver Cancer (BCLC) stage B. Previous randomized controlled trials did not show definite beneficial effect for TACE + sorafenib combination therapy in Asian HCC patients. Recently, an SNP marker on GALNT14gene, rs9679162, was found associated with therapeutic outcomes in HCC patients receiving chemotherapy or chemoembolization, wherein rs9679162-TT genotype was associated with a favorable therapeutic response. In this study, we examined whether this marker could be used as a guide for TACE + sorafenib therapy. Methods: From 2015-Aug, HCC patients in BCLC stage B were genotyped for GALNT14-rs9679162. Patients with genotype TT were treated with TACE alone. Patients with non-TT (CT or CC) were randomized 1:1 to receive TACE + sorafenib treatment or TACE treatment alone (NCT02504983). Results: Interim analysis was performed on 2017-Jan. Totally 40 patients were enrolled. Of them, 16 and 24 patients had GALNT14-TT and non-TT genotypes, respectively. Of the non-TT patients, 11 and 13 patients were randomized into TACE alone (TACEA) and TACE + sorafenib (TACE+S) group. TACEA patients had significant shorter time-to-tumor progression compared with TACE+S (P = 0.019) and GALNT14-TT patients (P < 0.001). No significant difference was found for time-to-therapeutic response (CR + PR) between the three groups. However, when evaluating the time-to-therapeutic response occurring > 3 m of the first TACE (excluding early response), it was found that TACEA patients had significant longer time-to-therapeutic response compared with TACE+S (P = 0.046) and GALNT14-TT patients (P = 0.034). Conclusions: The interim analysis confirmed that patients with GALNT14-TT genotype had a favorable TACE response compared with the non-TT genotype. In addition, in patients with non-TT genotype, TACE + sorafenib combination therapy had a significantly better therapeutic response compared with TACE alone. Clinical trial information: NCT02504983.
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Affiliation(s)
- Chau-Ting Yeh
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Shi-Ming Lin
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Lang Lin
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Wei Hsu
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Jung Wu
- Department of Liver Transplantation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Fu Hung
- Department of Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jeng-Hwei Tseng
- Department of Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Chun Lin
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Ting Chen
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei Teng
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Cheng Chen
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Ling Chang
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Tsai SC, Lin CC, Shih TC, Tseng RJ, Yu MC, Lin YJ, Hsieh SY. The miR-200b-ZEB1 circuit regulates diverse stemness of human hepatocellular carcinoma. Mol Carcinog 2017; 56:2035-2047. [PMID: 28383782 DOI: 10.1002/mc.22657] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 03/12/2017] [Accepted: 04/04/2017] [Indexed: 12/21/2022]
Abstract
Accumulating evidence suggests that human hepatocellular carcinoma (HCC) can be derived from cancer stem cells (CSCs), which contribute to tumor initiation, metastasis, chemoresistance, and recurrence. A great variety of HCC CSCs resulting in diverse clinical manifestations have been reported. However, how CSC diversity is regulated and generated remains unclear. Here we report that the miR-200b-ZEB1 circuit is closely involved with the induction and maintenance of a diverse group of CSCs. We found that miR-200b downregulation occurred in early HCC and associated with poor prognosis. The downregulation was attributable to genome deletion and promoter methylation of the miR-200a/b/429 gene. Ectopic expression of miR-200b or silencing of ZEB1 led to a decrease in CD13+ and CD24+ HCC CSCs and an increase in EpCAM+ HCC CSCs. Mechanistically, miR-200b directly suppressed BMI1 and ZEB1 expressions. ZEB1 recognized promoters of CD13, CD24, and EpCAM genes resulting in CD13 and CD24 upregulation and EpCAM downregulation. Neither miR-200b nor ZEB1 had obvious effects on CD133 or CD90 expression. Silencing CD13 or CD24 expression suppressed tumorigenicity of HCC cells. Ectopic expression of CD24 reversed the suppression of tumorigenicity by ectopic expression of miR-200b. Clinically, miR-200b downregulation was coupled with ZEB1 upregulation in approximately two-thirds of HCC patients. ZEB1 expression was positively correlated with CD13 and CD24 expressions in HCCs, while miR-200b expression was positively correlated with EpCAM. Our findings suggest that the miR-200b-ZEB1 circuit is a master regulator of diverse stemness of HCC, which differentiates HCCs into those containing CD13+ /CD24+ CSCs from those containing EpCAM+ CSCs.
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Affiliation(s)
- Shu-Chun Tsai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Tsung-Chieh Shih
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, California
| | - Rong-Jeng Tseng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yu-Jr Lin
- Medical Statistics and Clinical Informatics Lab, Chang Gung University, Taoyuan, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Lin YS, Hsueh C, Wu HY, Yu MC, Chao TC. Incidental parathyroidectomy during thyroidectomy increases the risk of postoperative hypocalcemia. Laryngoscope 2017; 127:2194-2200. [PMID: 28121013 DOI: 10.1002/lary.26448] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 05/14/2016] [Revised: 09/17/2016] [Accepted: 11/10/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The correlation between incidental parathyroidectomy (IP) during thyroidectomy and postoperative hypocalcemia remains controversial. Our aim was to investigate the incidence of IP, risk factors, and impact on patient outcomes. STUDY DESIGN Retrospective cohort study. METHODS This was a retrospective observational study including 3,186 consecutive patients who underwent thyroidectomy between January 2007 and December 2014. The patients were divided into two groups: the IP group and the non-IP. Numerous clinical parameters were collected and analyzed. RESULTS The overall incidence of incidentally excised parathyroid glands during thyroidectomy was 6.4%. Patients with IP had significantly higher incidences of postoperative hypocalcemia and hypoparathyroidism than those without IP (P < 0.001). Intrathyroidal parathyroid glands presented only 2.2% of all removed parathyroid glands. Total thyroidectomy, central compartment lymph node dissection, and reoperation were independent risk factors for IP. CONCLUSION Incidental parathyroidectomy during thyroidectomy is associated with the increased likelihood of postoperative hypocalcemia. All independent risk factors examined in the study for IP are surgery-related. Surgeons should perform meticulous dissection with the intention of avoiding IP and resultant hypocalcemia. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2194-2200, 2017.
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Affiliation(s)
- Yann-Sheng Lin
- Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yi Wu
- Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chieh Chao
- Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, Taoyuan, Taiwan
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Karthik R, Govindasamy M, Chen SM, Chen TW, Vinoth kumar J, Elangovan A, Muthuraj V, Yu MC. A facile graphene oxide based sensor for electrochemical detection of prostate anti-cancer (anti-testosterone) drug flutamide in biological samples. RSC Adv 2017. [DOI: 10.1039/c6ra28792a] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An electrochemical sensor based on graphene oxide modified glassy carbon electrode for the determination of anti-cancer drug flutamide.
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Affiliation(s)
- R. Karthik
- Electroanalysis and Bioelectrochemistry Lab
- Department of Chemical Engineering and Biotechnology
- National Taipei University of Technology
- Taipei
- Republic of China
| | - Mani Govindasamy
- Electroanalysis and Bioelectrochemistry Lab
- Department of Chemical Engineering and Biotechnology
- National Taipei University of Technology
- Taipei
- Republic of China
| | - Shen-Ming Chen
- Electroanalysis and Bioelectrochemistry Lab
- Department of Chemical Engineering and Biotechnology
- National Taipei University of Technology
- Taipei
- Republic of China
| | - Tse-Wei Chen
- Electroanalysis and Bioelectrochemistry Lab
- Department of Chemical Engineering and Biotechnology
- National Taipei University of Technology
- Taipei
- Republic of China
| | - J. Vinoth kumar
- Department of Chemistry
- VHNSN College
- Virudhunagar – 626001
- India
| | - A. Elangovan
- Department of Chemistry
- Thiagarajar College
- Madurai – 625009
- India
| | - V. Muthuraj
- Department of Chemistry
- VHNSN College
- Virudhunagar – 626001
- India
| | - Ming-Chin Yu
- Department of Surgery
- Chang Gung Memorial Hospital at Linkou
- Taoyuan
- Taiwan
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Lee CW, Tsai HI, Sung CM, Chen CW, Huang SW, Jeng WJ, Wu TH, Chan KM, Yu MC, Lee WC, Chen MF. Risk factors for early mortality after hepatectomy for hepatocellular carcinoma. Medicine (Baltimore) 2016; 95:e5028. [PMID: 27684875 PMCID: PMC5265968 DOI: 10.1097/md.0000000000005028] [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: 12/16/2022] Open
Abstract
Despite advances in surgical technique and medical care, liver resection for hepatocellular carcinoma (HCC) remains a high-risk major operation. The present study evaluated the risk factors for early mortality after hepatectomy.We retrospectively reviewed records of patients undergoing liver resection for HCC between 1983 and 2015. A point score (Risk Assessment for early Mortality (RAM) score) for hepatectomy was developed based on multivariate analyses.Three hundred eighty-three patients (11.3%) expired within 6 months after the operation. Logistic regression analyses identified that operative duration >270 minutes and blood loss >800 cc were significant predictors of major surgical complications (P = 0.013 and 0.002, respectively). On the other hand, diabetes mellitus, albumin ≤3.5 g/dL, α-fetoprotein (AFP) >200 ng/mL, major surgical procedure, blood loss >800 cc, and major surgical complications were independent risk factors for early mortality after hepatectomy (P = 0.019, <0.001, <0.001, 0.006, 0.018, and <0.001, respectively). Risk Assessment for early Mortality score (RAM score) identified 3 subgroups of patients with distinct 6-month mortality rate, with Class III (score 10) having highest risk of early mortality.Our study demonstrated that meticulous surgical techniques to minimize blood loss and avoid prolonged operative time may help decrease the occurrence of major surgical complications. In addition to major surgical complications, diabetes mellitus, hypoalbuminemia, high AFP, massive blood loss, and major surgical procedure are also associated with early mortality after liver resection. Further study is warranted to validate the utility of RAM score as a bedside scoring system to predict postoperative outcome.
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Affiliation(s)
- Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Guishan, Taoyuan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan
| | - Hsin-I Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan
- Department of Anesthesiology,Chang Gung Memorial Hospital, Linkou
| | - Chang-Mu Sung
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
| | - Chun-Wei Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
| | - Shu-Wei Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
| | - Tsung-Han Wu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
| | - Kun-Ming Chan
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Guishan, Taoyuan
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Guishan, Taoyuan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan
- Correspondence: Ming-Chin Yu, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan (R.O.C.) (e-mail: )
| | - Wei-Chen Lee
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Guishan, Taoyuan
| | - Miin-Fu Chen
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Guishan, Taoyuan
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49
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Abstract
BACKGROUND the difference in the risk of thyroid malignancy for patients with multinodular goiter (MNG) and solitary nodular goiter (SNG) remains controversial. Although total thyroidectomy (TT) is the current preferred surgical option for MNG, permanent hypothyroidism in these patients may be a concern. Therefore, we discuss whether nontotal thyroidectomy is a reasonable alternative surgical option. METHODS A retrospective cohort study was performed for 1598 consecutive patients who underwent thyroid surgery for nodular goiter between January 2007 and December 2012. Numerous clinical parameters were collected and analyzed. RESULTS We reviewed 795 patients with MNG and 803 patients with SNG. The prevalence of malignancy on final pathology was significantly higher in the patients with MNG than in the patients with SNG (15.6% vs 10.1%, P = 0.001). However, a multivariate analysis revealed that this difference was insignificant (P = 0.50). Papillary carcinoma was the predominant type in both groups, but papillary microcarcinoma was more frequently found (41.1%) in the patients with MNG. The only multifocal cancers were of the papillary carcinoma histologic type, and the incidence of multifocal papillary carcinoma was significantly higher in the patients with MNG (23.4% vs 7.4%, P = 0.005). Reoperation was not required for the patients who underwent TT for goiter recurrence or incidental carcinoma. The overall rate of recurrence following nontotal thyroidectomy was 12.2%. Among the patients who underwent reoperation for goiter recurrence, 2 (20.0%) were complicated with permanent hypoparathyroidism. Among the patients who underwent a nontotal bilateral thyroidectomy, an average of 56.5% had permanent hypothyroidism. CONCLUSIONS Multinodularity does not increase the risk of thyroid malignancy. However, patients with MNG who develop papillary carcinoma are at an increased risk of cancer multifocality. If a patient can tolerate lifelong thyroid hormone replacement, TT is the preferred surgical option because it helps avoid reoperation and the associated complications. Nontotal bilateral thyroidectomy does not ensure the preservation of thyroid hormone function.
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Affiliation(s)
- Yann-Sheng Lin
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Hsin-Yi Wu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Chih-Chieh Hsu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Tzu-Chieh Chao
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
- Correspondence: Tzu-Chieh Chao, Chang Gung Memorial Hospital, Linkou, Taiwan (e-mail: )
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50
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Chan KM, Wu TH, Wu TJ, Chou HS, Yu MC, Lee WC. Bioinformatics microarray analysis and identification of gene expression profiles associated with cirrhotic liver. Kaohsiung J Med Sci 2016; 32:165-76. [PMID: 27185598 DOI: 10.1016/j.kjms.2016.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/22/2016] [Accepted: 02/25/2016] [Indexed: 01/15/2023] Open
Abstract
Cirrhosis is the endpoint of liver fibrosis that is accompanied by limited regeneration capacity and complications and is the ultimate cause of death in many patients. Despite this, few studies have thoroughly looked at the gene expression profiles in the cirrhotic liver. Hence, this study aims to identify the genes that were differentially expressed in the cirrhotic liver and to explore the putative related signaling pathway and interaction networks. The gene expression profiles of cirrhotic livers and noncirrhotic livers were examined and compared using microarray gene analysis. Proteins encoded by the differentially expressed genes were analyzed for functional clustering and signaling pathway involvement using MetaCore bioinformatics analyses. The Gene Ontology analysis as well as the Kyoto encyclopedia of Genes and Genomes pathway analysis were also performed. A total of 213 significant genes were differentially expressed at more than a two-fold change in cirrhotic livers as compared to noncirrhotic livers. Of these, 105 upregulated genes and 63 downregulated genes were validated through MetaCore bioinformatics analyses. The signaling pathways and major functions of proteins encoded by these differentially expressed genes were further analyzed; results showed that the cirrhotic liver has a unique gene expression pattern related to inflammatory reaction, immune response, and cell growth, and is potentially cancer related. Our findings suggest that the microarray analysis may provide clues to the molecular mechanisms of liver cirrhosis for future experimental studies. However, further exploration of areas regarding therapeutic strategy might be possible to support metabolic activity, decrease inflammation, or enhance regeneration for liver cirrhosis.
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Affiliation(s)
- Kun-Ming Chan
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Tsung-Han Wu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Jung Wu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hong-Shiue Chou
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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