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Tan Y, Zhu JY, Li J, Wu LM, Ouyang Z, Liu WY, Song H, Huang CY. Application of 3-dimensional visualization and image fusion technology in liver cancer with portal vein tumor thrombus surgery. Medicine (Baltimore) 2024; 103:e38980. [PMID: 39058856 PMCID: PMC11272227 DOI: 10.1097/md.0000000000038980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Liver cancer with portal vein tumor thrombus (PVTT) is a frequent finding and is related to poor prognosis. Surgical resection provides a more promising prognosis in selected patients. The purpose of this study was to explore the application of 3D (3-dimensional) visualization and image fusion technology in liver cancer with PVTT surgery. 12 patients were treated with surgery between March 2019 and August 2022. The preoperative standard liver volume (SLV), estimated future liver remnant (FLR), FLR/SLV, 3D visualization models, PVTT classification, operation programs, surgical results, and prognosis were collected and analyzed. Twelve patients who had complete data of 3D visualization and underwent hemihepatectomy combined with portal vein tumor thrombectomy. The operation plan was formulated by 3D visualization and was highly consistent with the actual surgery. The SLV was 1208.33 ± 63.22 mL, FLR was 734.00 mL and FLR/SLV was 61.62 ± 19.38%. The accuracy of classification of PVTT by 3D visualization was 100%, Cheng type Ⅱa (4 cases), Ⅱb (2 cases), Ⅲa (4 cases), and Ⅲb (2 cases). The 3D visualization model was a perfect fusion with the intraoperative live scene and precise guidance for hepatectomy. No patient was suffering from postoperative liver failure and without procedure‑associated death. 6 patients died of tumor recurrence, and 2 patients died of other reasons. The 12-month cumulative survival rate was 25.9%. 3D visualization and image fusion technology could be used for precise assessment of FLR, classification of PVTT, surgery navigation, and which was helpful in improving the safety of hepatectomy.
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Affiliation(s)
- Yong Tan
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Jian Yong Zhu
- Senior Department of Hepato-Pancreato-Biliary Surgery, the First Medical Center of PLA General Hospital, Beijing, P.R. China
| | - Jing Li
- Department of Pathology, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Li Ming Wu
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Zaixing Ouyang
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Wen Ying Liu
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Hao Song
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Cong Yun Huang
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
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Zeng X, Tao H, Dong Y, Zhang Y, Yang J, Xuan F, Zhou J, Jia W, Liu J, Dai C, Hu H, Xiang N, Zeng N, Zhou W, Lau W, Yang J, Fang C. Impact of three-dimensional reconstruction visualization technology on short-term and long-term outcomes after hepatectomy in patients with hepatocellular carcinoma: a propensity-score-matched and inverse probability of treatment-weighted multicenter study. Int J Surg 2024; 110:1663-1676. [PMID: 38241321 PMCID: PMC10942183 DOI: 10.1097/js9.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Three-dimensional reconstruction visualization technology (3D-RVT) is an important tool in the preoperative assessment of patients undergoing liver resection. However, it is not clear whether this technique can improve short-term and long-term outcomes in patients with hepatocellular carcinoma (HCC) compared with two-dimensional (2D) imaging. METHOD A total of 3402 patients from five centers were consecutively enrolled from January 2016 to December 2020, and grouped based on the use of 3D-RVT or 2D imaging for preoperative assessment. Baseline characteristics were balanced using propensity score matching (PSM, 1:1) and stabilized inverse probability of treatment-weighting (IPTW) to reduce potential selection bias. The perioperative outcomes, long-term overall survival (OS), and recurrence-free survival (RFS) were compared between the two groups. Cox-regression analysis was used to identify the risk factors associated with RFS. RESULTS A total of 1681 patients underwent 3D-RVT assessment before hepatectomy (3D group), while 1721 patients used 2D assessment (2D group). The PSM cohort included 892 patient pairs. In the IPTW cohort, there were 1608.3 patients in the 3D group and 1777.9 patients in the 2D group. In both cohorts, the 3D group had shorter operation times, lower morbidity and liver failure rates, as well as shorter postoperative hospital stays. The 3D group had more margins ≥10 mm and better RFS than the 2D group. The presence of tumors with a diameter ≥5 cm, intraoperative blood transfusion and multiple tumors were identified as independent risk factors for RFS, while 3D assessment and anatomical resection were independent protective factors. CONCLUSION In this multicenter study, perioperative outcomes and RFS of HCC patients following 3D-RVT assessment were significantly different from those following 2D imaging assessment. Thus, 3D-RVT may be a feasible alternative assessment method before hepatectomy for these patients.
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Affiliation(s)
- Xiaojun Zeng
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Haisu Tao
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Yanchen Dong
- School of Traditional Chinese Medicine, Southern Medical University
| | - Yuwei Zhang
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Junying Yang
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Feichao Xuan
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Jian Zhou
- Department of Liver Surgery, Zhongshan Hospital, Fudan University
| | - Weidong Jia
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei
| | - Jingfeng Liu
- Liver Department, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou
| | - Chaoliu Dai
- Department of the Second General Surgery, Shengjing Hospital of China Medical University, Shenyang
| | - Haoyu Hu
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Nan Xiang
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Ning Zeng
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Weiping Zhou
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai
| | - Wanyee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Jian Yang
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
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Wei X, Jiang Y, Feng S, Lu C, Huo L, Zhou B, Meng Y, Lau WY, Zheng Y, Cheng S. Neoadjuvant intensity modulated radiotherapy for a single and small (≤5 cm) hepatitis B virus-related hepatocellular carcinoma predicted to have high risks of microvascular invasion: a randomized clinical trial. Int J Surg 2023; 109:3052-3060. [PMID: 37352528 PMCID: PMC10583963 DOI: 10.1097/js9.0000000000000574] [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: 04/04/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND The presence of microvascular invasion (MVI) significantly impairs postoperative long-term survival of patients with hepatocellular carcinoma (HCC). The role of neoadjuvant radiotherapy (RT) in treating patients with an early-stage HCC predicted to have high risks of MVI remains to be explored. MATERIALS AND METHODS Consecutive patients with a resectable single and small (≤5 cm) hepatitis B virus-related HCC predicted to have high risks of MVI were randomized 1:1 to receive either neoadjuvant intensity modulated radiation therapy (18 Gy with fractionated doses of 3 Gy) followed by surgery 4 weeks later or upfront surgery. The primary endpoint was disease-free survival (DFS). The secondary outcomes included overall survival (OS), objective response rate, RT-related toxicity and surgical complications. RESULTS There were 30 patients randomized to each of the two groups. In the neoadjuvant RT group, three patients violated the study protocol, with two having upfront hepatectomy and one radiofrequency ablation after RT. The objective response rate after RT was 25.0% (7/28), but 2 patients suffered from grade 3 liver toxicity. The median follow-up was 68 months (interquartile range, 58-70 months) in the neoadjuvant RT group, and 68 months (interquartile range, 62-75 months) in the upfront surgery group. On intention-to-treat analysis, the median DFS and median OS were not reached in both the 2 arms. The 1-year, 2-year, 3-year and 5-year DFS rates for the neoadjuvant RT group were 86.7%, 76.7%, 60.0% and 56.3%, versus 90.0%, 66.7%, 52.8% and 45.7% in the upfront surgery group ( P =0.448), respectively. The corresponding OS rates were 96.7%, 86.7%, 83.3% and 72.7%, versus 100.0%, 93.3%, 79.6% and 60.7% ( P = 0.399). CONCLUSION AND RELEVANCE For patients with a resectable single and small hepatitis B virus-related HCC predicted to have high risks of MVI, neoadjuvant RT gave a promising response rate with a mild toxicity. Nevertheless, the neoadjuvant RT yielded similar long-term DFS and OS rates compared with patients who underwent upfront surgery.
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Affiliation(s)
| | | | | | | | - Lei Huo
- Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Navy Medical University, Shanghai
| | - Bin Zhou
- Departments of Hepatic Surgery VI
| | | | - Wan Yee Lau
- Departments of Hepatic Surgery VI
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Lu CD, Jiang YB, Feng JK, Wang L, Wei XB, Zhou B, Lin XL, Guo WX, Lau WY, Cheng SQ. Postoperative adjuvant aspirin for patients with hepatitis B virus-related hepatocellular carcinoma and portal vein tumor thrombus: An open-label, randomized controlled trial. Heliyon 2023; 9:e20015. [PMID: 37810112 PMCID: PMC10559736 DOI: 10.1016/j.heliyon.2023.e20015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose To compare the survival outcomes of postoperative adjuvant aspirin with surgery alone in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). Methods From June 2013 to July 2015, an open-label, randomized controlled study was conducted in patients with resectable HBV-related HCC and PVTT. Patients were randomly assigned to undergo surgical resection and postoperative adjuvant aspirin (n = 40) or hepatectomy alone (n = 40). The primary end point was overall survival (OS). The secondary end points were time to recurrence of primary tumor (t-TTR) and time to recurrence of PVTT (p-TTR). The expression levels of COX1 and COX2 in surgical specimens of the aspirin group were correlated with patients' survival. Results The median OS were 16.2 and 13.4 months for the adjuvant aspirin and surgery alone groups, respectively. The median t-TTR were 5.3 and 3.2 months for the adjuvant aspirin and surgery alone groups, respectively. There was no significant difference in the OS and t-TTR between the two groups of patients (P = 0.078 and 0.336, respectively). The median p-TTR were 12.0 months and 5.4 months for the adjuvant aspirin group and the surgery alone group, respectively. Patients in the adjuvant aspirin group had markedly longer p-TTR (P = 0.001). Increased expressions of COX1 or COX2 in tumor tissues denoted better prognosis for patients receiving adjuvant aspirin. Conclusion For patients with resectable HBV-related HCC and PVTT, postoperative adjuvant aspirin significantly prolonged time to recurrence of PVTT than surgery alone. Expression of COX1 or COX2 may predict survival in these patients.
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Affiliation(s)
- Chong-De Lu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Ya-Bo Jiang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Jin-Kai Feng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Lei Wang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Xu-Biao Wei
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Bin Zhou
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Xiao-Lu Lin
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Wei-Xing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region of China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China
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Hou JX, Deng Z, Liu YY, Xu SK, Li ZX, Sun JC, Zhao MY. A Bibliometric Analysis of the Role of 3D Technology in Liver Cancer Resection. World J Surg 2023; 47:1548-1561. [PMID: 36882637 DOI: 10.1007/s00268-023-06950-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Liver cancer resection is an effective but complex way to treat liver cancer, and complex anatomy is one of the reasons for the difficulty of surgery. The use of 3D technology can help surgeons cope with this dilemma. This article intends to conduct a bibliometric analysis of the role of 3D technology in liver cancer resection. METHODS (TS = (3D) OR TS = (three-dimensional)) AND (TS = (((hepatic) OR (liver)) AND ((cancer) OR (tumor) OR (neoplasm)))) AND (TS = (excision) OR TS = (resection)) was used as a search strategy for data collection in the Web of Science (WoS) Core Collection. CiteSpace, Carrot2 and Microsoft Office Excel were used for data analysis. RESULTS Three hundred and eighty-eight relevant articles were obtained. Their annual and journal distribution maps were produced. Countries/regions and institutions collaboration, author collaboration, references co-citations and their clusters and keywords co-occurrences and their clusters were constructed. Carrot2 cluster analysis was performed. CONCLUSIONS There was an overall upward trend in the number of publications. China's contribution was greater, and the USA had greater influence. Southern Med Univ was the most influential institution. However, the cooperation between institutions still needs to be further strengthened. Surgical Endoscopy and Other Interventional Techniques was the most published journal. Couinaud C and Soyer P were the authors with the highest citations and centrality, respectively. "Liver planning software accurately predicts postoperative liver volume and measures early regeneration" was the most influential article. 3D printing, 3D CT and 3D reconstruction may be the mainstream of current research, and augmented reality (AR) may be a future hot spot.
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Affiliation(s)
- Jia-Xing Hou
- Department of Hepatopancreatobiliary Surgery, Department of Pediatrics, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zhen Deng
- Department of Hepatopancreatobiliary Surgery, Department of Pediatrics, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yan-Yu Liu
- Changsha Central Hospital, University of South China, Changsha, China
| | - Shao-Kang Xu
- Department of Hepatopancreatobiliary Surgery, Department of Pediatrics, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zi-Xin Li
- Department of Hepatopancreatobiliary Surgery, Department of Pediatrics, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ji-Chun Sun
- Department of Hepatopancreatobiliary Surgery, Department of Pediatrics, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Ming-Yi Zhao
- Department of Hepatopancreatobiliary Surgery, Department of Pediatrics, The Third Xiangya Hospital of Central South University, Changsha, China.
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A meta-analysis of the three-dimensional reconstruction visualization technology for hepatectomy. Asian J Surg 2023; 46:669-676. [PMID: 35843827 DOI: 10.1016/j.asjsur.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/05/2022] [Accepted: 07/06/2022] [Indexed: 02/08/2023] Open
Abstract
This meta-analysis was conducted to systematically evaluate the short-term efficacy and safety of the three-dimensional (3D) reconstruction visualization technology (3D-RVT) technique for hepatectomy. A systematic literature search was used to gather information on the 3D reconstruction visualization technology technique for hepatectomy from retrospective cohort studies and comparative studies. The retrieval period was up to March 2022. Publications and conference papers in English were manually searched and references in bibliographies traced. After evaluating the quality of selected studies, a meta-analysis was conducted using Review Manager 5.1 software. We included 12 studies comprising 2053 patients with liver disease. Our meta-results showed that 3D-RVT significantly shortened operation times [weighted mean differences (WMD) = -29.36; 95% confidence interval (CI): -55.20 to -3.51; P = 0.03], reduced intraoperative bleeding [WMD = -93.53; 95% CI: -152.32 to -34.73; P = 0.002], reduced blood transfusion volume [WMD = -66.06; 95% CI: -109.13 to -22.99; P = 0.003], and shortened hospital stays [WMD = -1.90; 95% CI: -3.05 to -0.74; P = 0.001]. Additionally, the technique reduced the use of hepatic inflow occlusion and avoided overall postoperative complications [odds ratio (OR) = 0.60; 95% CI: 0.46 to 0.79; P < 0.001]. 3D-RVT is safe and effective for liver surgery and provides safety assessments before anatomical hepatectomy.
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Huber T, Huettl F, Hanke LI, Vradelis L, Heinrich S, Hansen C, Boedecker C, Lang H. Leberchirurgie 4.0 - OP-Planung, Volumetrie, Navigation und Virtuelle
Realität. Zentralbl Chir 2022; 147:361-368. [DOI: 10.1055/a-1844-0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ZusammenfassungDurch die Optimierung der konservativen Behandlung, die Verbesserung der
bildgebenden Verfahren und die Weiterentwicklung der Operationstechniken haben
sich das operative Spektrum sowie der Maßstab für die Resektabilität in Bezug
auf die Leberchirurgie in den letzten Jahrzehnten deutlich verändert.Dank zahlreicher technischer Entwicklungen, insbesondere der 3-dimensionalen
Segmentierung, kann heutzutage die präoperative Planung und die Orientierung
während der Operation selbst, vor allem bei komplexen Eingriffen, unter
Berücksichtigung der patientenspezifischen Anatomie erleichtert werden.Neue Technologien wie 3-D-Druck, virtuelle und augmentierte Realität bieten
zusätzliche Darstellungsmöglichkeiten für die individuelle Anatomie.
Verschiedene intraoperative Navigationsmöglichkeiten sollen die präoperative
Planung im Operationssaal verfügbar machen, um so die Patientensicherheit zu
erhöhen.Dieser Übersichtsartikel soll einen Überblick über den gegenwärtigen Stand der
verfügbaren Technologien sowie einen Ausblick in den Operationssaal der Zukunft
geben.
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Affiliation(s)
- Tobias Huber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Florentine Huettl
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Laura Isabel Hanke
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Lukas Vradelis
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Stefan Heinrich
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Christian Hansen
- Fakultät für Informatik, Otto von Guericke Universität
Magdeburg, Magdeburg, Deutschland
| | - Christian Boedecker
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Hauke Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
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Han H, Meng Y, Wang J. Effect of transjugular intrahepatic portosystemic shunt combined with 125I particle implantation on portal vein tumor thrombus in hepatocellular carcinoma. Am J Transl Res 2022; 14:1838-1848. [PMID: 35422930 PMCID: PMC8991118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with 125I particle implantation in the treatment of portal vein tumor thrombus (PVTT) in hepatocellular carcinoma was discussed and analyzed in this study. METHODS A total of 127 patients with primary hepatocellular carcinoma (PHC) complicated with PVTT admitted to our hospital from March 2017 to June 2018 were enrolled. The patients were classified into an observation group (n=69) and a control group (n=58) in the light of the different treatment methods. The control group patients were treated with TIPS alone, and the observation group patients received 125I particle implantation on the basis of TIPS in the control group. Subsequently, the clinical therapeutic efficacy, perioperative indicators, postoperative complications, quality of life and survival of patients before and after treatment were compared between the two groups. RESULTS The remission rate in the observation group was remarkably higher than that of the control group (P<0.05), and the difference in the overall response rate (ORR) of the two groups of patients was not statistically significant (P>0.05). The AFP, PLT, WBC and the diameter of the main portal vein in the two groups dropped substantially compared to those before treatment (P<0.05), and the AFP and the diameter of the main portal vein in the observation group were notably lower than those in the control group (P<0.05). After treatment, the ALT, AST and TBiL of the two groups were remarkably higher than those before treatment (P<0.05), and these indicators in the observation group were apparently higher than those in the control group (P<0.05). There was no significant difference in the incidence of postoperative gastrointestinal bleeding, fever, granulocytopenia and abnormal hepatic dysfunction between the observation group and the control group (P>0.05). The functional assessment of cancer therapy-hepatobiliary (FACT-Hep) scores of the two groups 6 months after operation was substantially lower than pre-op scores (P<0.05), and the observation group had apparently lower postoperative scores than the control group (P<0.05). The progression-free survival (PFS) and overall survival (OS) in the observation group were critically superior to those in the control group (P<0.05). CONCLUSION TIPS combined with 125I particle implantation in the treatment of PHC patients with PVTT can help improve patients' clinical treatment efficacy after surgery while prolonging their postoperative survival. The treatment is safe and worthy of clinical promotion.
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Affiliation(s)
- Hongbo Han
- Department of Radiation Intervention, Cangzhou Central HospitalCangzhou 061000, Hebei, China
| | - Yanli Meng
- Department of Gastroenterology, Cangzhou Central HospitalCangzhou 061000, Hebei, China
| | - Jitian Wang
- Department of Oncology, Gaomi People’s HospitalGaomi 261500, Shandong, China
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Ma KW, Chan ACY, Chok KSH, She WH, Cheung TT, Dai WC, Fung JYY, Lo CM. Liver transplantation: would it be the best and last chance of cure for hepatocellular carcinoma with major venous invasion? Hepatobiliary Surg Nutr 2021; 10:308-314. [PMID: 34159158 DOI: 10.21037/hbsn.2020.03.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) signifies advanced disease, whether LT confers any survival superiority over resection remains uncertain. Methods A propensity score matched (PSM) analysis of liver transplantation (LT) and liver resection (LR) for HCC with PVTT was performed. Results A consecutive series of 88 patients who received either LT (10 DDLTs and 3 LDLTs) or LR (n=75) respectively were recruited. Before PSM, the LT group has a higher MELD score (17.3 vs. 7.8, P<0.001), lower serum AFP levels (96 vs. 2,164 ng/mL, P=0.017) and smaller tumour size (4 vs. 10 cm, P<0.001). The 5-year overall survival for LT and LR were 55.4% and 15.9% respectively (P=0.007). After matching for serum AFP levels and tumour size, 1-, 3- and 5-year overall survival for LT were 81 ng/mL, 3.9 cm, 80%, 70% and 70% and the corresponding rates for LR were 1,417 ng/mL, 5.3 cm, 51.8%, 19,6% and 9.8% (P value =0.12, 0.27 and 0.009 respectively). Conclusions LT is associated with significantly better oncological outcomes in HCC patients with PVTT involving the lobar or segmental level. A modest expansion of selection criteria to include small HCC with segmental PVTT should be considered.
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Affiliation(s)
- Ka Wing Ma
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | | | | | - Wong Hoi She
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Tan To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Wing Chiu Dai
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | | | - Chung Mau Lo
- Department of Surgery, The University of Hong Kong, Hong Kong, China
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Zhang M, Huang S, Ye N, Wang X. Clinical characteristics and risk factors of patients with flupirtine-induced liver cirrhosis complicated with upper gastrointestinal bleeding. Am J Transl Res 2021; 13:5582-5588. [PMID: 34150161 PMCID: PMC8205751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate clinical characteristics and risk factors of patients with Flupirtine-induced liver cirrhosis complicated with upper gastrointestinal bleeding. METHODS A total of 116 patients with liver cirrhosis admitted to our hospital from July 2018 to July 2019 were selected and divided into bleeding group (liver cirrhosis complicated with upper gastrointestinal bleeding, n = 71) and non-bleeding group (liver cirrhosis, n = 45). The clinical data of patients in the two groups were collected, including general data, liver function, urinalysis, coagulation function and imaging data. Univariate analysis and multivariate logistic regression analysis were utilized to find the influencing factors of liver cirrhosis complicated with upper gastrointestinal bleeding. RESULTS Of the 116 patients, 45 patients had upper gastrointestinal bleeding, with an incidence rate of 38.79%, including 18 patients (40.00%) with rupture of esophageal varices, 9 (20.00%) with rupture of gastric varices, 9 (20.00%) of portal hypertensive gastropathy, 8 (17.78%) with peptic ulcer, 1 (2.22%) with acute erosive hemorrhagic gastritis; 14 (31.11%) experienced recurrent hemorrhage within 72 hours after treatment, but no death occurred. There were 45 cases (38.79%) in the bleeding group, and 71 (61.21%) in the non-bleeding group, and the differences in the course of liver cirrhosis, the degree of esophageal varices, peptic ulcer, portal hypertension, non-steroidal drug medication and TP between the bleeding group and non-bleeding group were significant (P < 0.05). Severe esophageal varices, liver cirrhosis, peptic ulcer, portal hypertension, non-steroidal drug medication, and TP ≥ 16 s were found to be risk factors of liver cirrhosis complicated with upper gastrointestinal bleeding by logistic regression analysis. CONCLUSION Clinically, it is necessary to take corresponding intervention measures to reduce the incidence of upper gastrointestinal bleeding in patients with liver cirrhosis and improve the prognosis of patients with liver cirrhosis.
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Affiliation(s)
- Mengjun Zhang
- Department of Gastroenterology, Qinghai University Affiliated HospitalQinghai, China
| | - Si Huang
- The First People’s Hospital of Changde CityChangde, China
| | - Na Ye
- People’s Hospital of WuLan CountyWulan, Hainan, China
| | - Xuehong Wang
- Department of Gastroenterology, Qinghai University Affiliated HospitalQinghai, China
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11
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Zanon M, Altmayer S, Watte G, Pacini GS, Mohammed TL, Marchiori E, Pinto Filho DR, Hochhegger B. Three-dimensional virtual planning for nodule resection in solid organs: A systematic review and meta-analysis. Surg Oncol 2021; 38:101598. [PMID: 33962214 DOI: 10.1016/j.suronc.2021.101598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/08/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To systematically review the effects of 3D-imaging virtual planning for nodule resection in the following solid organs: lung, liver, and kidney. METHODS MEDLINE, EMBASE, and Cochrane Library were searched through September 31, 2020 to include randomized and non-randomized controlled studies that compared outcomes of surgical resection of lung, liver, or kidney nodule resection with and without 3D virtual planning with computed tomography. From each article, the mean operation time (OT), mean estimated blood loss (EBL), mean postoperative hospital stay (POHS), and the number of postoperative events (POE) were extracted. The effect size (ES) of 3D virtual planning vs. non-3D planning was extracted from each study to calculate the pooled measurements for continuous variables (OT, EBL, POHS). Data were pooled using a random-effects model. RESULTS The literature search yielded 2397 studies and 10 met the inclusion criteria with a total of 897 patients. There was a significant difference in OT between groups with a moderate ES favoring the 3D group (ES,-0.56; 95%CI: 0.91,-0.29; I2 = 83.1%; p < .001). Regarding EBL, there was a significant difference between 3D and non-3D with a small ES favoring IGS (ES,-0.18; 95%CI: 0.33,-0.02; I2 = 22.5%; p = .0236). There was no difference between the 3D and non-3D groups for both POHS (POHS ES,-0.15; 95%CI: 0.39,0.10; I2 = 37.0%; p = .174) and POE (POE odds ratio (OR),0.80; 95%CI:0.54,1.19; I2 = 0.0%; p = .0.973). CONCLUSIONS 3D-imaging planning for surgical resection of lung, kidney, and liver nodules could reduce OT and EBL with no effects on immediate POHS and POE. Improvements in these perioperative variables could improve medium and long-term postoperative clinical outcomes.
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Affiliation(s)
- Matheus Zanon
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre - R, Sarmento Leite, 245, Porto Alegre, 90050170, Brazil; Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil.
| | - Stephan Altmayer
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil; Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619900, Brazil.
| | - Guilherme Watte
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre - R, Sarmento Leite, 245, Porto Alegre, 90050170, Brazil; Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil; Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619900, Brazil.
| | - Gabriel Sartori Pacini
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil.
| | - Tan-Lucien Mohammed
- Department of Radiology, College of Medicine, University of Florida, 1600 SW Archer Rd m509, Gainesville, FL, 32610, United States.
| | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro - Av, Carlos Chagas Filho, 373, Rio de Janeiro, 21941902, Brazil.
| | - Darcy Ribeiro Pinto Filho
- Department of Thoracic Surgery, University of Caxias do Sul, R. Francisco Getúlio Vargas, 1130, Caxias do Sul, 95070561, Brazil.
| | - Bruno Hochhegger
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre - R, Sarmento Leite, 245, Porto Alegre, 90050170, Brazil; Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil; Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619900, Brazil.
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Akhtar Y, Dakua SP, Abdalla A, Aboumarzouk OM, Ansari MY, Abinahed J, Elakkad MSM, Al-Ansari A. Risk Assessment of Computer-aided Diagnostic Software for Hepatic Resection. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2021. [DOI: 10.1109/trpms.2021.3071148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yusuf Akhtar
- Electronics and Communication Sciences Unit, Indian Statistical Institute, Kolkata, India
| | | | | | | | | | - Julien Abinahed
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Three-dimensional versus two-dimensional video-assisted hepatectomy for liver disease: a meta-analysis of clinical data. Wideochir Inne Tech Maloinwazyjne 2020; 16:1-9. [PMID: 33786111 PMCID: PMC7991933 DOI: 10.5114/wiitm.2020.100678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/04/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction The benefit of three-dimensional (3D) visualization for liver disease is uncertain. Aim To evaluate the effectiveness and safety of 3D versus two-dimensional (2D) video-assisted hepatectomy for LD. Material and methods We searched PubMed, Embase, Cochrane Library, Medline, and Web of Science for studies addressing 3D versus 2D for 2D until 30 February 2020. Study-specific effect sizes and their 95% confidence intervals (CIs) were combined to calculate the pooled value using a fixed-effects or random-effects model. Results Nine studies with 808 patients were included. The 3D group had shorter operative time (mean difference (MD) = 34.39; 95% CI = 59.50, 9.28), experienced less intraoperative blood loss (MD = 106.55; 95% CI = 183.76, 29.34), and a smaller blood transfusion volume (MD = 88.25; 95% CI = 141.26, 35.24). The 3D group had a smaller difference between the predicted volume and the actual resected volume (MD = 103.25; 95% CI = 173.24, 33.26) and a lower rate of postoperative complications (odds ratio (OR) = 0.57; 95% CI: 0.35, 0.91). Conclusions During surgery, 3D video-assisted hepatectomy could effectively reduce operative time, intraoperative bleeding, and blood transfusion volume, and had a smaller difference between the predicted volume and the actual resected volume and a lower rate of postoperative complications. More high-quality randomized controlled trials are required to verify the reliability and validity of our conclusion.
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Tan D, Yao J, Hua X, Li J, Xu Z, Wu Y, Wu W. Application of 3D modeling and printing technology in accurate resection of complicated thoracic tumors. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1342. [PMID: 33313087 PMCID: PMC7723599 DOI: 10.21037/atm-20-1791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background To explore the application value of three-dimensional (3D) reconstruction and 3D printing in preoperative evaluation of precise resection of complicated thoracic tumors. Methods A retrospective analysis of 34 patients with complicated thoracic tumors who were treated by radical surgery from March 2016 to June 2019 was made. According to whether 3D reconstruction and 3D printing was used, the patients were divided into research group and control group. In the control group, preoperative evaluation was performed according to CT image data, and the operation plan was drawn up; in the research group, preoperative simulation and preoperative operation plan design were carried out according to 3D reconstruction and 3D printing technology. The operation time, change of operation approach, intraoperative blood loss, hospitalization time and postoperative complications were compared between the two groups. We also retrospectively reviewed additional 12 cases of unresectable complicated thoracic tumors. The above 34 patients who were treated by radical surgery were set as the resectable group. Three-dimensional reconstruction was performed for all cases. The tumor size, location, smoothness of tumor-vascular contact surface, close contact with adjacent organs were compared between these two groups. Results The 3D reconstruction and 3D printing model were successfully established. The indexes of operation time, change of incision approach and blood loss in the research group were lower than those in the control group (P<0.05). All the patients were followed up for 6 months, and there was no death, no tumor recurrence and metastasis in the two groups. In the unresectable group, the score of position and smoothness of tumor-vascular contact surface were significantly higher than that in the resectable group. Conclusions 3D reconstruction and 3D printing can effectively help surgeons carry out accurate surgical treatment, reduce the operation time and bleeding, reduce the risk of surgery, and facilitate the postoperative rehabilitation of patients, which has the value of promotion and application.
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Affiliation(s)
- Deli Tan
- Institute of Digital Medicine, Biomedical Engineering College, Army Medical University (Third Military Medical University), Chongqing, China.,Thoracic Surgery Department, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Yao
- Institute of Digital Medicine, Biomedical Engineering College, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xing Hua
- Ultrasound Department, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jingyao Li
- Thoracic Surgery Department, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhou Xu
- Institute of Digital Medicine, Biomedical Engineering College, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yi Wu
- Institute of Digital Medicine, Biomedical Engineering College, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wei Wu
- Thoracic Surgery Department, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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15
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Chen J, Zhu J, Zhang C, Song Y, Huang P. Contrast-enhanced ultrasound for the characterization of portal vein thrombosis vs tumor-in-vein in HCC patients: a systematic review and meta-analysis. Eur Radiol 2020; 30:2871-2880. [PMID: 32020403 PMCID: PMC7160216 DOI: 10.1007/s00330-019-06649-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/09/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. However, differentiation of thrombosis and tumor-in-vein (TIV) may be challenging. Contrast-enhanced ultrasound (CEUS) is an excellent method for detection of vascularization and could help in the distinction. We performed a systematic review and meta-analysis for evaluating the diagnostic value of CEUS in differentiating between PVT and TIV in hepatocellular carcinoma (HCC) patients. METHODS PubMed, Embase, Cochrane Library, and Web of Science were searched up to the 5th of May 2019. The study quality was assessed by QUADAS-2 tool. Pooled sensitivity and specificity were calculated by the bivariate random effect model and hierarchical summary receiver-operating characteristic (SROC) curve was plotted. RESULTS Seven studies including 425 participants were analyzed after screening 986 articles searched from databases. The pooled sensitivity and specificity of CEUS in diagnosing TIV were 0.94 (95%CI, 0.89-0.97) and 0.99 (95%CI, 0.80-1.00), respectively. The area under the curve (AUC) of SROC curve was 0.97 (95%CI, 0.95-0.98). The pooled sensitivity and AUC were consistent across all the subgroups of different subject numbers, country, study design, CEUS contrast agents, and diagnostic criteria. CONCLUSIONS CEUS is highly efficient in differentiating TIV from PVT and is an alternative or a substitute for CT and/or MRI. TRIAL REGISTRATION PROSPERO registration number: CRD42019138847 KEY POINTS: • Characterization of portal vein thrombosis (PVT) vs tumor-in-vein (TIV) is critical for HCC staging. • CEUS has an excellent safety profile, provides a real-time analysis without any loss in accuracy compared with CT and MRI. • This meta-analysis demonstrates that contrast-enhanced ultrasound (CEUS) is a suitable method for the detection of PVT and distinction with TIV.
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Affiliation(s)
- Jifan Chen
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianing Zhu
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chao Zhang
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yue Song
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Pintong Huang
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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16
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Li P, Wang M, Yang Y, Liu H, Pan Z, Jiang B, Lau WY, Huang G, Zhou W. Preoperative three-dimensional versus two-dimensional evaluation in assessment of patients undergoing major liver resection for hepatocellular carcinoma: a propensity score matching study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:182. [PMID: 32309329 PMCID: PMC7154448 DOI: 10.21037/atm.2020.01.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Compared with 2D evaluation, 3D evaluation possesses the virtues of displaying spatial anatomy of intrahepatic blood vessels and its relations to tumors, and enabling calculation of liver volumes, thus facilitating preoperative surgery planning. Methods The objective of this study is to study whether preoperative 3D (three-dimensional) evaluation produced better long-term overall survival (OS) outcomes compared to the traditional 2D (two-dimensional) evaluation in patients who underwent major hepatectomy for hepatocellular carcinoma (HCC). This retrospective study matched patients who underwent preoperative 2D evaluation with those who underwent preoperative 3D evaluation in a 1:1 ratio using propensity score matching. The primary endpoints were long-term survival outcomes in the two groups after major hepatectomy for HCC. Results Of the 248 patients in each of the 2 matched groups, the baseline characteristics were comparable. The median follow-up for all patients was 36 months (range, 0-40 months). The 3-year OS of patients in the PSM cohort was 38.5%. Compared with the 2D Group, patients in the 3D Group had a better OS rate (HR 0.722, 95% CI: 0.556-0.938, P=0.015) and disease-free survival (DFS) rate (HR 0.741, 95% CI: 0.590-0.929, P=0.009). The 3-year OS and DFS rate for the 3D Group versus the 2D group were 58.9% and 44.0% versus 47.4% and 33.1%, respectively. Conclusions 3D preoperative evaluation resulted in significantly better intermediate-term (3-year) overall survival rate than the traditional 2D evaluation.
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Affiliation(s)
- Pengpeng Li
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Mengchao Wang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Yuan Yang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Hui Liu
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Zeya Pan
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Beige Jiang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Gang Huang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Weiping Zhou
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
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17
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Gao Y, Wang PX, Cheng JW, Sun YF, Hu B, Guo W, Zhou KQ, Yin Y, Li YC, Wang J, Huang JF, Qiu SJ, Zhou J, Fan J, Yang XR. Chemotherapeutic perfusion of portal vein after tumor thrombectomy and hepatectomy benefits patients with advanced hepatocellular carcinoma: A propensity score-matched survival analysis. Cancer Med 2019; 8:6933-6944. [PMID: 31566899 PMCID: PMC6853833 DOI: 10.1002/cam4.2556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/08/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Portal vein tumor thrombus (PVTT) is a common complication in hepatocellular carcinoma (HCC), signaling dismal outcomes. This study was conducted to evaluate the survival benefit of postoperative portal vein perfusion chemotherapy (PVC) in patients with HCC and PVTT. METHODS A retrospective review was conducted in 401 consecutive patients with HCC and PVTT who underwent hepatic resection between January 2009 and December 2015 and 67 patients received adjuvant postoperative PVC. A propensity score matching (PSM) was used to match patients with and without PVC at a ratio of 1:1. RESULTS After PSM, the median time to recurrence (TTR) and overall survival (OS) were significantly longer in PVC group compared with control group (12.3 vs 5.8 months, P = .001; 19.0 vs 13.4 months, P = .037; respectively). At 1, 2, 3, and 5 years, the cumulative recurrence rates in PVC group were 48.1%, 86.5%, 92.3% ,96.2%, respectively, with OS rates of 63.8%, 37.9%, 24.4%, 18.3%, respectively; whereas cumulative recurrence rates of 76.6%, 91.5%, 94.3%, and 97.2%, respectively and OS rates of 55.4%, 23.0%, 12.4%, and 12.4%, respectively were recorded for the control group. In multivariate analysis, postoperative PVC emerged as a significant predictor for TTR (hazard ratio [HR], 0.523; P = .001) and OS (HR, 0.591; P = .010). PVC could reduce early recurrence (≤1 year) rate after surgical resection (40.3% vs 64.2%, P = .006) and clinical outcomes were further enhanced by adding sorafenib to postoperative PVC. CONCLUSIONS Compared with surgical resection alone, postoperative adjuvant PVC treatment boosts survival and reduces early tumor recurrences in patients surgically treated for HCC and PVTT.
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Affiliation(s)
- Yang Gao
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
| | - Peng-Xiang Wang
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
| | - Jian-Wen Cheng
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
| | - Yun-Fan Sun
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
| | - Bo Hu
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
| | - Wei Guo
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Kai-Qian Zhou
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
| | - Yue Yin
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
| | - Yuan-Cheng Li
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Jian Wang
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
| | - Jun-Feng Huang
- Department of Intensive Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuang-Jian Qiu
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
| | - Jian Zhou
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
| | - Jia Fan
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
| | - Xin-Rong Yang
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, P. R. China
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Zhao D, Lau WY, Zhou W, Yang J, Xiang N, Zeng N, Liu J, Zhu W, Fang C. Impact of three-dimensional visualization technology on surgical strategies in complex hepatic cancer. Biosci Trends 2019; 12:476-483. [PMID: 30473555 DOI: 10.5582/bst.2018.01194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Surgical resection is still the mainstay of treatment for primary liver cancer (PLC). It is unclear whether three-dimensional visualization (3DV) preoperative evaluation and simulated liver resection would affect the surgical strategies and improve the R0 resection rates of patients with complex PLC when compared with the 2D evaluation using computed tomography or magnetic resonance imaging. In the study, patients with complex PLC who were subjected to laparotomy underwent both 2D and 3DV evaluation before operation. A comparison between the 2D and 3DV evaluation was compared with the gold standard of laparotomy findings. In this study, of 335 patients with complex PLC, 71 were assessed to have resectable tumors. 2D and 3DV assessments determined 63 and 71 patients to have resectable PLC, respectively. At laparotomy 69 of the 71 patients were found to have resectable PLC, but 2 patients were found to be unresectable because of detection of metastatic lesions on laparotomy, which were not detected either by 2D or 3DV preoperative evaluation. The accuracy, false positive and false negative rates of the 2D and the 3DV preoperative assessments in determining tumor resectability were 85.9%, 2.8%, 11.3%, and 97.2% (p < 0.05), 2.8%, 0%, respectively. The 3DV and 2D preoperative evaluation revealed 17 and 13 patients with vascular anomalies, respectively. There were 4 patients with major vascular anomalies not detected by 2D evaluation, whose surgical strategies were modified by 3DV evaluation. These results suggested 3DV preoperative assessment could lead to better in evaluating tumor resectability, with potential benefit in the modification of surgical strategy for patients with complex PLC.
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Affiliation(s)
- Dong Zhao
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University.,Guangdong Provincial Clinical and Engineering Center of Digital Medicine
| | - Wan Yee Lau
- Faculty of Medicine, the Chinese University of Hong Kong, Shatin, New Territories
| | - Weiping Zhou
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
| | - Jian Yang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University.,Guangdong Provincial Clinical and Engineering Center of Digital Medicine
| | - Nan Xiang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University.,Guangdong Provincial Clinical and Engineering Center of Digital Medicine
| | - Ning Zeng
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University.,Guangdong Provincial Clinical and Engineering Center of Digital Medicine
| | - Jun Liu
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University.,Guangdong Provincial Clinical and Engineering Center of Digital Medicine
| | - Wen Zhu
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University.,Guangdong Provincial Clinical and Engineering Center of Digital Medicine
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University.,Guangdong Provincial Clinical and Engineering Center of Digital Medicine
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Wang Y, Ma L, Yuan Z, Zheng J, Li W. Percutaneous thermal ablation combined with TACE versus TACE monotherapy in the treatment for liver cancer with hepatic vein tumor thrombus: A retrospective study. PLoS One 2018; 13:e0201525. [PMID: 30063737 PMCID: PMC6067729 DOI: 10.1371/journal.pone.0201525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/17/2018] [Indexed: 01/17/2023] Open
Abstract
Purpose To investigate the efficacy of percutaneous thermal ablation combined with transarterial chemoembolization (TACE) versus TACE monotherapy in treating primary liver cancer with hepatic vein tumor thrombus (HVTT), and to identify potential factors of overall survival after combination therapy. Materials and methods Patients with primary liver cancer and HVTT from 2011 to 2016 at our institute were retrospectively identified. They were divided into two groups (group A and group B). Patients in group A underwent TACE with subsequent percutaneous thermal ablation, while patients in group B who were unsuitable for ablation received TACE monotherapy. Characteristics and survival data of the two groups were analyzed and compared. Relevant factors for overall survival (OS) of group A were explored by univariate analysis. Results Twenty-six patients were included and analyzed. The median OS for group A (n = 13) was 18 months, while the 1-, 2- and 3-year survival rates were 58.6%, 46.9% and 46.9%, respectively. The median OS for group B (n = 13) was 6.5 months and the 1-year survival rate was 10.9%. The survival of group A was significantly better than group B (P = 0.02). The following factors were related with overall survival of group A: ablation technique, complete response of tumor and HVTT, Child-pugh grade, pre-operative extrahepatic metastases and lymph node metastases. In group A, patients who achieved complete response had the longest average survival time (42.1 months). Conclusion For patients with primary liver cancer and HVTT, percutaneous thermal ablation and TACE present better efficacy than TACE monotherapy. Long-term survival could be achieved in selected patients.
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Affiliation(s)
- Yang Wang
- Center of Interventional Oncology and Liver Diseases, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Liang Ma
- Center of Interventional Oncology and Liver Diseases, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Zhuhui Yuan
- Center of Interventional Oncology and Liver Diseases, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Jiasheng Zheng
- Center of Interventional Oncology and Liver Diseases, Beijing You’an Hospital, Capital Medical University, Beijing, China
- * E-mail: (WL); (JZ)
| | - Wei Li
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- * E-mail: (WL); (JZ)
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20
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Pasquier H, Gardavaud F, Chiaradia M, Zanca F, Hérin E, Mulé S, Rahmouni A, Luciani A. Iterative reconstructions in multiphasic CT imaging of the liver: qualitative and task-based analyses of image quality. Clin Radiol 2018; 73:834.e9-834.e16. [PMID: 29929903 DOI: 10.1016/j.crad.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/04/2018] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the clinical benefits on image quality (IQ) of adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR) in multiphasic liver CT compared to filtered back-projection (FBP), in patients and on phantoms using a novel task-based metric. MATERIALS AND METHODS Image data of 65 patients who underwent a routine multiphasic liver CT during a 1-month period were reconstructed with FBP, ASIR50, ASIR80, and MBIR. IQ was assessed qualitatively by ranking the most distal hepatic artery (HA) and portal vein (PV) visible; and quantitatively by measuring contrast-to-noise ratio (CNR) of the liver parenchyma, HA and PV. IQ was compared between each reconstruction and correlated to CNR and detectability index (d') measurements computed on phantoms scanned with the same CT protocol as for patients. RESULTS HA and PV were seen more distally on MBIR and ASIR80 compared to FBP (p≤0.001). The CNR correlated weakly between patient and phantom (r=0.76 and 0.80 for HA and PV, respectively), whereas d' correlated strongly with the division order of HA and PV (r=0.96 and 0.95, respectively). CONCLUSION MBIR and ASIR significantly improve the IQ of multiphasic liver CT, especially through better distal detection of HA and PV, in agreement with the adapted task-based metric d' estimated on phantoms.
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Affiliation(s)
- H Pasquier
- Université Paris Est, Ecole Doctorale Sciences de la Vie et de la Santé - ED402, Créteil, F-94010, France; AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Médicale, Créteil, F-94010, France.
| | - F Gardavaud
- AP-HP, Hôpital Tenon, Imagerie Médicale, Paris, F-75020, France
| | - M Chiaradia
- AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Médicale, Créteil, F-94010, France
| | - F Zanca
- DoseWatch, GE Healthcare, Buc, F-78530, France
| | - E Hérin
- AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Médicale, Créteil, F-94010, France; Université Paris Est Créteil, Créteil, Faculté de Médecine, F-94010, France
| | - S Mulé
- AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Médicale, Créteil, F-94010, France
| | - A Rahmouni
- AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Médicale, Créteil, F-94010, France; Université Paris Est Créteil, Créteil, Faculté de Médecine, F-94010, France
| | - A Luciani
- AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Médicale, Créteil, F-94010, France; Université Paris Est Créteil, Créteil, Faculté de Médecine, F-94010, France; INSERM Unité U955 IMRB, Equipe 18, Créteil, F-94010, France
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Yin J, Bo WT, Sun J, Xiang X, Lang JY, Zhong JH, Li LQ. New Evidence and Perspectives on the Management of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus. J Clin Transl Hepatol 2017; 5:169-176. [PMID: 28660155 PMCID: PMC5472938 DOI: 10.14218/jcth.2016.00071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/02/2017] [Accepted: 03/04/2017] [Indexed: 02/06/2023] Open
Abstract
Portal vein tumor thrombosis (PVTT) is an intractable condition but common phenomenon in hepatocellular carcinoma (HCC). HCC patients with PVTT may have worse liver function, a higher chance of comorbidity related to portal hypertension, lower tolerance to treatment and poorer prognoses. In Western guidelines, patients are offered palliative treatment with sorafenib or other systemic agents because HCC with PVTT is grouped together with metastatic HCC during the planning of its management. In recent years, various treatment options have become available for patients with HCC and PVTT. Therapy has also shifted toward evidence-based treatment. However, policies for the management of HCC with PVTT have not been established. This comprehensive literature review aims to present current and available management options for patients with HCC and PVTT. Evidence is mainly based on studies published after 2010.
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Affiliation(s)
- Jun Yin
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wen-Tao Bo
- Department of Hepatobiliary Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jian Sun
- Department of Medical Affairs, ZiBo Hospital of Integrated Traditional Chinese and Western Medicine, Zibo, China
| | - Xiao Xiang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Jin-Yi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jian-Hong Zhong
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
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22
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Ye JZ, Wang YY, Bai T, Chen J, Xiang BD, Wu FX, Li LQ. Surgical resection for hepatocellular carcinoma with portal vein tumor thrombus in the Asia-Pacific region beyond the Barcelona Clinic Liver Cancer treatment algorithms: a review and update. Oncotarget 2017; 8:93258-93278. [PMID: 29190996 PMCID: PMC5696262 DOI: 10.18632/oncotarget.18735] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/25/2017] [Indexed: 01/27/2023] Open
Abstract
Portal vein tumor thrombus (PVTT) usually worsens prognosis of hepatocellular carcinoma (HCC), as characterized by aggressive disease progression, impaired liver function and tolerance to treatment. Conventionally, the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) accepted the Barcelona Clinical Liver Cancer (BCLC) treatment algorithms, identifying PVTT as an absolute contra-indication of surgical resection for HCC. HCC-PVTT patients are offered sorafenib as the standard treatment. Evidently, SHARP and Asia-Pacific trials demonstrated that sorafenib only improves overall survival by approximately 3 months in patients with advanced HCC. Besides, BCLC treatment algorithm does not provide different therapeutic recommendations for different degree of PVTT, and only supports single treatment option for each stage of HCC rather than a combination of comprehensive treatments, which limited individual and best care for every HCC-PVTT patients. In the past few years, many surgeons do not restrict surgical resection to HCC with PVTT. There have been new reports demonstrated that surgical treatment is feasible for selected HCC-PVTT patients with resectable tumor and moderate liver function to prolong survival period and elevate life quality as long as PVTT limited to the first-order branch, whereas non-surgical treatments fail to provide comparable therapeutic effects. At present, guidelines on HCC management from mainland China, Japan, and Hong Kong have been updated and a consensus of Asia-Pacific experts has established that portal venous invasion is not an absolute contradiction of surgical resection for HCC. This review summarized the emerging data on surgical resection for HCC-PVTT patients beyond the BCLC treatment algorithms and discussed recent therapeutic conceptualchanges in the Asia-Pacific region.
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Affiliation(s)
- Jia-Zhou Ye
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, PR China
| | - Yan-Yan Wang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, PR China
| | - Tao Bai
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, PR China
| | - Jie Chen
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, PR China
| | - Bang-De Xiang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, PR China
| | - Fei-Xiang Wu
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, PR China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, PR China
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23
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Jia GS, Feng GL, Li JP, Xu HL, Wang H, Cheng YP, Yan LL, Jiang HJ. Using receiver operating characteristic curves to evaluate the diagnostic value of the combination of multislice spiral CT and alpha-fetoprotein levels for small hepatocellular carcinoma in cirrhotic patients. Hepatobiliary Pancreat Dis Int 2017; 16:303-309. [PMID: 28603099 DOI: 10.1016/s1499-3872(17)60018-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The various combination of multiphase enhancement multislice spiral CT (MSCT) makes the diagnosis of a small hepatocellular carcinoma (sHCC) on the background of liver cirrhosis possible. This study was to explore whether the combination of MSCT enhancement scan and alpha-fetoprotein (AFP) level could increase the diagnostic efficiency for sHCC. METHODS This study included 35 sHCC patients and 52 cirrhotic patients without image evidence of HCC as a control group. The diagnoses were made by three radiologists employing a 5-point rating scale, with postoperative pathologic results as the gold standard. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of the three MSCT combination modes (arterial phase+portal-venous phase, arterial phase+delayed phase, arterial phase+portal-venous phase+delayed phase) and AFP levels for sHCC on the background of liver cirrhosis. RESULTS The area under ROC curve (AUC), sensitivity, and specificity of the combination of arterial phase+portal-venous phase+delayed phase were 0.93, 93%, and 82%, respectively. The average AUC of the arterial phase+portal-venous phase+delayed phase combination was significantly greater than that of the arterial phase+portal-venous phase (AUC=0.84, P=0.01) and arterial phase+delayed phase (AUC=0.85, P=0.03). Arterial phase+portal-venous phase had a smaller AUC (0.84) than arterial phase+delayed phase (0.85), but the difference was insignificant (P=0.15). After combining MSCT enhancement scan with AFP, the AUC, sensitivity, and specificity were 0.95, 94%, and 83%, respectively, indicating a greatly increased diagnostic efficiency for sHCC. CONCLUSIONS The combination of AFP and 3 phases MSCT enhancement scan could increase the diagnostic efficiency for sHCC on the background of liver cirrhosis. The application of ROC curve analysis has provided a new method and reference in HCC diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | - Hui-Jie Jiang
- Department of Radiology, Second Affiliated Hospital, Harbin Medical University, Harbin 150086, China.
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24
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Kong XQ, Dong YP, Wu JX, He JY, Le YY, Du KX, Peng QQ, Li JL. High-biologically effective dose palliative radiotherapy for a tumor thrombus might improve the long-term prognosis of hepatocellular carcinoma: a retrospective study. Radiat Oncol 2017; 12:92. [PMID: 28569169 PMCID: PMC5452386 DOI: 10.1186/s13014-017-0831-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/25/2017] [Indexed: 02/06/2023] Open
Abstract
Background This study aimed to highlight the type of tumor thrombus and identify the prognostic factors influencing the long-term survival outcomes in patients with hepatocellular carcinoma (HCC) having a tumor thrombus. A tumor thrombus in HCC is associated with poor prognosis. Methods Eighty patients diagnosed with HCC having a tumor thrombus between May 2006 and April 2014 were enrolled in this study. Age, gender, clinical characteristics, laboratory findings, Child-Pugh classification, performance status (ECOG), types of tumor thrombi, radiotherapy method, biologically effective dose (BED), and primary treatment method were analyzed to identify the prognostic factors associated with the overall survival (OS) rates. Statistical analyses were performed using SPSS version 19.0. Results The median follow-up duration was 24 months (range 6–90). The 1-, 3-, and 5-year OS rates of the patients were 77.6%, 37.6%, and 18.8%, respectively. On univariate analysis, gender, radiotherapy method, BED, types of tumor thrombi, Child-Pugh classification, ECOG, and total bilirubin were associated with OS (P < 0.001, P = 0.001, P = 0.016, P = 0.003, P < 0.001, P < 0.001, P = 0.039, respectively). The prognostic factors for OS in multi-variate analyses were gender (P < 0.001), BED (P = 0.044), Child Pugh classification (P = 0.020), performance status (ECOG) (P = 0.004), and types of tumor thrombi (P = 0.001). The median OS for the high-BED group was better than that for the low-BED groups (42 months vs. 19 months, P = 0.016). Conclusions Gender, BED, performance status (ECOG), Child-Pugh classification, and types of tumor thrombi seemed to affect OS, and a stepwise decrease in survival was observed with the types of tumor thrombi ranging from I to IV. High-BED palliative radiotherapy might improve the long-term outcomes for patients with HCC having a tumor thrombus.
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Affiliation(s)
- Xiang-Quan Kong
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, 420 Fuma Rd, Jinan District, Fuzhou, 350014, China
| | - Ya-Ping Dong
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, 420 Fuma Rd, Jinan District, Fuzhou, 350014, China
| | - Jun-Xin Wu
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, 420 Fuma Rd, Jinan District, Fuzhou, 350014, China
| | - Jun-Yan He
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, 420 Fuma Rd, Jinan District, Fuzhou, 350014, China
| | - Yu-Yin Le
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, 420 Fuma Rd, Jinan District, Fuzhou, 350014, China
| | - Kai-Xin Du
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, 420 Fuma Rd, Jinan District, Fuzhou, 350014, China
| | - Qing-Qin Peng
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, 420 Fuma Rd, Jinan District, Fuzhou, 350014, China
| | - Jin-Luan Li
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, 420 Fuma Rd, Jinan District, Fuzhou, 350014, China.
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25
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Jiang JF, Lao YC, Yuan BH, Yin J, Liu X, Chen L, Zhong JH. Treatment of hepatocellular carcinoma with portal vein tumor thrombus: advances and challenges. Oncotarget 2017; 8:33911-33921. [PMID: 28430610 PMCID: PMC5464922 DOI: 10.18632/oncotarget.15411] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/02/2017] [Indexed: 02/06/2023] Open
Abstract
Portal vein tumor thrombus is a frequent, challenging complication in hepatocellular carcinoma. Hepatocellular carcinoma patients with portal vein tumor thrombus may show worse liver function, less treatment tolerance and worse prognosis than patients without portal vein tumor thrombus, and they may be at higher risk of comorbidity related to portal hypertension. Western and some Asian guidelines stratify hepatocellular carcinoma with portal vein tumor thrombus together with metastatic hepatocellular carcinoma and therefore recommend only palliative treatment with sorafenib or other systemic agents. In recent years, more treatment options have become available for hepatocellular carcinoma patients with portal vein tumor thrombus, and an evidence-based approach to optimizing disease management and treatment has become more widespread. Nevertheless, consensus policies for managing hepatocellular carcinoma with portal vein tumor thrombus have not been established. This comprehensive literature review, drawing primarily on studies published after 2010, examines currently available management options for patients with hepatocellular carcinoma and portal vein tumor thrombus.
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Affiliation(s)
- Jin-Fang Jiang
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Yong-Cong Lao
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Bao-Hong Yuan
- Department of General Surgery, Yan’An Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Jun Yin
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xin Liu
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Long Chen
- Department of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Jian-Hong Zhong
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
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Cheng S, Yang J, Shen F, Zhou W, Wang Y, Cong W, Yang GS, Cheng H, Hu H, Gao C, Guo J, Li A, Meng Y, Jiang X, Yang Y, Qian G, Luo M, Hu B, Man X, Zhang B, Su C, Zhou F, Li N, Shi J, Wang M, Zheng Y, Guo W, Sun J, Wang H, Lau WY, Wu MC. Multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus - Eastern Hepatobiliary Surgical Hospital consensus statement. Oncotarget 2016; 7:40816-40829. [PMID: 27027235 PMCID: PMC5130047 DOI: 10.18632/oncotarget.8386] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/18/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombus (PVTT) is associated with poor prognosis, early recurrence of HCC, and limited treatment options. Current guidelines do not have standardized diagnostic and treatment modalities, thus creating a need for a multidisciplinary treatment model for standardization of the treatment. Eastern Hepatobiliary Surgical Hospital (China) convened two working parties of experts from all the departments, to consolidate the current evidence, prevailing vision for the future, and experience of the practicing clinicians engaged in HCC management, so as to develop a consensus for PVTT diagnosis and treatment according to the GRADE system. Based on the quality of the existing evidence and the strength of recommendations, the consensus statements were categorized into 3 evidence levels (A/B/C) and 5 classes (I/II/IIa/IIb/III).The panel discussed and provided clarity on the management and research options in the field of HCC with PVTT. In addition, the panel also assessed the quality of the cited studies and assigned grades to the recommendation statements. Among the group of experts, there was excellent agreement with regard to effective diagnosis and treatment of HCC with PVTT. The recommendations of this consensus will provide guidance to physicians and clinical researchers on the effective management of HCC with PVTT.
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Affiliation(s)
- Shuqun Cheng
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Jiamei Yang
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Feng Shen
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Weiping Zhou
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Yi Wang
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Wenming Cong
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Guang shun Yang
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Hongyan Cheng
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Heping Hu
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Chunfang Gao
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Jia Guo
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Aijun Li
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Yan Meng
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Xiaoqing Jiang
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Yefa Yang
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Guojun Qian
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Ming Luo
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Bing Hu
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Xiaobo Man
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Baohua Zhang
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Changqing Su
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Feiguo Zhou
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Nan Li
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Jie Shi
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Meng Wang
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Yaxin Zheng
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Weixing Guo
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Juxian Sun
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Hongyang Wang
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Wan-yee Lau
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Meng-chao Wu
- Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
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