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O'Neill AF, Church AJ, Feraco A, Spidle J, Wall CB, Kim HB, Elisofon S, Vakili K, Pimkin M, Dharia NV, Shelman NR, Perez-Atayde AR, Rodriguez-Galindo C. Clinical and immunophenotype correlating with response to immunotherapy in paediatric patients with primary liver carcinoma. A case series. EBioMedicine 2024; 104:105147. [PMID: 38749302 PMCID: PMC11108818 DOI: 10.1016/j.ebiom.2024.105147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Paediatric hepatocellular carcinomas (HCC) traditionally arise in the context of a normal structural and functional liver and carry a dismal prognosis. While chemotherapy is the frontline standard, there is emerging interest in the study of immunotherapies for paediatric patients with relapsed/refractory disease. There is limited data to support whether immunotherapies will be of utility in this patient population. METHODS Six paediatric patients (median age:16 years, range: 12-17 at the time of treatment) with advanced hepatocellular neosplams, either conventional hepatocellular or fibrolamellar carcinoma, were treated with immunotherapy. Patients were consented to institutional genomic profiling and biobanking protocols. Baseline samples and serial tissue samples, when available, were evaluated for somatic mutation rate, actionable gene mutations, and pan-immune bulk RNA expression profiling. Results were correlated with clinical course. FINDINGS Three patients responded to checkpoint inhibition: one achieved a complete, durable response and the other two, prolonged stable disease. Three additional patients progressed. Diagnostic tissue from the complete responder demonstrated a higher relative mutational burden and robust immune infiltrate. Pre-treatment samples from the three responders demonstrated decreased expression of genes associated with T-cell dysfunction. INTERPRETATION A subset of patients with primary paediatric hepatocellular tumours will respond to immunotherapy. Immunotherapies are currently under prospective study for relapsed/refractory liver tumours in paediatric patients. Results from this report support the prospective collection of serial serum and tissue samples which may further identify genomic and immunophenotypic patterns predictive of response. FUNDING This work was supported by Philanthropic funds (Pan Mass Challenge, Team Angus and Team Perspective).
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Affiliation(s)
- Allison F O'Neill
- Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Department of Pediatric Oncology, Boston, MA, USA.
| | - Alanna J Church
- Boston Children's Hospital and Harvard Medical School, Department of Pathology, Boston, MA, USA
| | - Angela Feraco
- Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Department of Pediatric Oncology, Boston, MA, USA
| | - Jennifer Spidle
- Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Department of Pediatric Oncology, Boston, MA, USA
| | - Catherine B Wall
- Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Department of Pediatric Oncology, Boston, MA, USA
| | - Heung Bae Kim
- Boston Children's Hospital and Harvard Medical School, Department of Surgery, Boston, MA, USA
| | - Scott Elisofon
- Boston Children's Hospital and Harvard Medical School, Department of Hepatology, Boston, MA, USA
| | - Khashayar Vakili
- Boston Children's Hospital and Harvard Medical School, Department of Surgery, Boston, MA, USA
| | - Max Pimkin
- Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Department of Pediatric Oncology, Boston, MA, USA
| | | | - Nathan R Shelman
- University of Kentucky, Department of Pathology, Lexington, KY, USA
| | - Antonio R Perez-Atayde
- Boston Children's Hospital and Harvard Medical School, Department of Pathology, Boston, MA, USA
| | - Carlos Rodriguez-Galindo
- St. Jude Children's Research Hospital, Departments of Global Pediatric Medicine and Oncology, Memphis, TN, USA
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Lahidheb D, Komarov R, Alikhanov R, Tlisov B, Ismailbaev A, Dhif I. Uncommon using of the pulmonary homograft in oncological case - three years follow up. J Cardiothorac Surg 2024; 19:204. [PMID: 38615010 PMCID: PMC11015555 DOI: 10.1186/s13019-024-02684-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 03/24/2024] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION There are enough cases of colorectal cancer with liver metastasis, but inferior vena cava infiltraion with dissemination to the right atrium is an infrequent event. PRESENTATION OF CASE This is the first case of surgical treatment of recurrent liver metastasis with the infiltration to the inferior vena cava and to the right atrium of the heart, using a cryopreserved pulmonary homograft. DISCUSSION The choice of a cryopreserved pulmonary homograft was preferred by the need for a radical and wide resection of tissues involved in the metastasis, as well as to potentially reduce the risk of thrombosis in the short- and long-term postoperative period. CONCLUSION The use of a cryopreserved homograft in operation undergoing cardiopulmonary bypass allowed us to perform the required volume of radical resection and to replace an extended section of the inferior vena cava.
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Affiliation(s)
- Dhaker Lahidheb
- Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Roman Komarov
- Department of Cardiac surgery, The First Clinical Hospital, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Ruslan Alikhanov
- Department of Cardiac surgery, The First Clinical Hospital, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Boris Tlisov
- Department of Cardiac surgery, The First Clinical Hospital, Sechenov First Moscow State Medical University, Moscow, Russian Federation.
| | - Alisher Ismailbaev
- Department of Cardiac surgery, The First Clinical Hospital, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Ines Dhif
- Department of Cardiac surgery, The First Clinical Hospital, Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Chao WS, Shen CH, Luo SC, Wu FH, Wei HJ, Yu CL, Wu CC, Yen Y, P’eng FK. Concomitant Hepatectomy and Atrial Thrombectomy under Cardiopulmonary Bypass versus Staged Hepatectomy in the Treatment for Hepatocellular Carcinoma with Large Right Atrial Tumor Thrombi. J Clin Med 2022; 11:jcm11082140. [PMID: 35456235 PMCID: PMC9025558 DOI: 10.3390/jcm11082140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/03/2022] [Accepted: 04/09/2022] [Indexed: 11/20/2022] Open
Abstract
(1) Background: Hepatocellular carcinoma (HCC) with a large right atrium tumor thrombus (RATT) is a rare and critical presentation. Emergency hepatectomy and thrombectomy under cardiopulmonary bypass (CPB) is life-saving and potentially curative. The aim of this study is to propose an appropriate approach for this condition. (2) Methods: In period A (1998 to 2010, n = 7), hepatectomy and thrombectomy were concomitantly performed, and staged hepatectomy was performed in period B (2011 to 2018, n = 17). (3) Results: The median overall survival time (MOST) in the published studies was 14 months. Moreover, the blood loss, blood transfusion rate, length of ICU stays, and hospital costs were significantly reduced in period B. The MOSTs of patients in period A (n = 6) and period B (n = 17) were 14 vs. 18 months (p = 0.099). The median disease-free survival times (MDFTs) in period A (n = 6) and period B (n = 15) were 8 vs. 14 months (p = 0.073), while the MOSTs in period A and period B were 14 vs. 24 months (p = 0.040). (4) Conclusions: Emergency thrombectomy under CPB and staged hepatectomy 4–6 weeks later may be an appropriate approach for HCC with large RATT. However, the optimal waiting interval requires further investigation.
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Affiliation(s)
- Wen-Shan Chao
- Department of Surgery, Ministry of Health and Welfare Feng Yuan Hospital, Taichung City 42055, Taiwan;
| | - Ching-Hui Shen
- Departments of Anesthesiology, Taichung Veterans General Hospital, Taichung City 40705, Taiwan;
- Department of Anesthesiology, Faculty of Medicine, National Yang-Ming University, Taipei City 112304, Taiwan
| | - Shao-Ciao Luo
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
| | - Feng-Hsu Wu
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
- Department of Nursing, Hung Kuang University, Taichung City 433304, Taiwan
- Correspondence: ; Tel.: +886-4-23592525; Fax: +886-4-23595046
| | - Hao-Ji Wei
- Departments of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (H.-J.W.); (C.-L.Y.)
| | - Chu-Leng Yu
- Departments of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (H.-J.W.); (C.-L.Y.)
| | - Cheng-Chung Wu
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
- Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei City 112304, Taiwan
| | - Yun Yen
- Cancer Translation Research Center, Taipei Medical University, Taipei City 106, Taiwan;
| | - Fang-Ku P’eng
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
- Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei City 112304, Taiwan
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Shimizu S, Sakamoto S, Fukuda A, Yanagi Y, Uchida H, Baba C, Suzuki Y, Kondo R, Kaneko Y, Nakano N, Haga C, Yoshioka T, Matsumoto K, Kasahara M. The extracorporeal circulation with transdiaphragmatic approach in living-donor liver transplantation for HB with atrial extension of tumor thrombus: A case report. Pediatr Transplant 2021; 25:e13948. [PMID: 33326681 DOI: 10.1111/petr.13948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/30/2020] [Accepted: 11/23/2020] [Indexed: 12/17/2022]
Abstract
Surgical intervention for HB with tumor thrombi extending into the IVC and the RA might requires careful planning of the surgical procedures, including vascular reconstruction and extracorporeal circulation. We herein report a successful case of LDLT for HB with atrial extension of a tumor thrombus by extracorporeal circulation with a transdiaphragmatic approach. The patient was a 5-year-old boy with PRETEXT IV HB with a tumor thrombus that extended into the IVC and the RA. After 4 cycles of chemotherapy and resection of bilateral lung metastases, the size of the primary HB tumor decreased. As the tumor extension from the LHV to the RA had decreased but was still present, we performed LDLT with tumor thrombectomy. The central part of the diaphragm was sagittally incised to expose the suprahepatic IVC and the RA. Venovenous bypass was achieved from the right femoral vein and IMV to the RA En bloc resection of the native liver with the tumor thrombus was then performed. HV anastomosis was made between the newly created orifice on the IVC and the graft LHV. The duration of LDLT was 10 hours and 44 minutes (extracorporeal circulation time: 78 minutes). Pediatric LT for HB with the extension of tumor thrombi into the RA under extracorporeal circulation is a feasible option and allows for the expansion of the indications for transplantation for children with unresectable liver tumors.
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Affiliation(s)
- Seiichi Shimizu
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yusuke Yanagi
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Chiaki Baba
- Department of Anesthesia and Intensive care, National Center for Child Health and Development, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Anesthesia and Intensive care, National Center for Child Health and Development, Tokyo, Japan
| | - Ryoichi Kondo
- Division of Cardiovascular Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Kaneko
- Division of Cardiovascular Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Noriyuki Nakano
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Chizuko Haga
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Kimikazu Matsumoto
- Children Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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Zawistowski M, Nowaczyk J, Jakubczyk M, Domagała P. Outcomes of ex vivo liver resection and autotransplantation: A systematic review and meta-analysis. Surgery 2020; 168:631-642. [PMID: 32727659 DOI: 10.1016/j.surg.2020.05.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many patients with hepatic tumors cannot benefit from resection owing to the difficult anatomic sites of their lesions. Some of these patients might be eligible for ex vivo liver resection and autotransplantation. This procedure consists of complete hepatectomy, extracorporeal liver resection, and autotransplantation of the remnant liver. METHODS Four databases were searched for studies reporting cases of ex vivo liver resection and autotransplantation. Outcomes of this procedure were evaluated by meta-analysis of proportions with random effects model and individual participant data analysis. RESULTS Fifty-three studies were assessed. Meta-analysis revealed an R0 resection rate of 93.4% (95% confidence interval: 81.0-97.9%, I2 = 0%), a frequency of major surgical complications of 24.5% (95% confidence interval, 16.9-34.3%, I2 = 26%), a 30-day mortality of 9.5% (95% confidence interval: 5.9-14.9%, I2 = 0%), and a 1-year survival of 78.4% (95% confidence interval: 62.2-88.8%, I2 = 64%). We were able to obtain the individual participant data in 244 patients; R0 resection was achieved in 98.6%, with no obvious difference between analyzed subgroups. The 30-day mortality and 1-year survivals were 7.9% and 82.1%, respectively. For groups with malignant and nonmalignant tumors, the 30-day mortalities were 11.3% vs. 6.3% (P = .181), and 1-year survivals were 65.0% vs. 89.7% (P < .001). When comparing those with malignant versus those with nonmalignant lesions, major surgical complications occurred in 50.0% vs. 21.0%; P < .001). Regression analysis revealed that outcomes of patients with benign tumors were better compared with those with malignant tumors (1-year survival, odds ratio: 4.629; 95% confidence interval: 2.181-10.097, P < .001). CONCLUSION Ex vivo liver resection and autotransplantation facilitates radical treatment in selected patients with conventionally unresectable hepatic tumors and normal liver function. The outcomes of treatment of malignant lesions appear to be less satisfactory.
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Affiliation(s)
| | | | - Michał Jakubczyk
- Decision Analysis and Support Unit, SGH Warsaw School of Economics, Warsaw, Poland
| | - Piotr Domagała
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
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Shah SB, Pandey S, Kumar A, Dutta A, Sood J. Anesthesia Considerations in Combined Open Heart Cardiac Myofibroblastic Tumor Excision and Living Donor Liver Transplantation. J Cardiothorac Vasc Anesth 2019; 34:1010-1014. [PMID: 31791855 DOI: 10.1053/j.jvca.2019.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/18/2019] [Accepted: 10/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
| | - Shashank Pandey
- Department of Anaesthesiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Akhil Kumar
- Department of Anaesthesiology, Sir Ganga Ram Hospital, New Delhi, India.
| | - Amitabh Dutta
- Department of Anaesthesiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayashree Sood
- Department of Anaesthesiology, Sir Ganga Ram Hospital, New Delhi, India
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