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Yang C, Tan J, Chen Y, Wang Y, Qu Y, Chen J, Jiang H, Song B. Prediction of late recurrence after curative-intent resection using MRI-measured spleen volume in patients with hepatocellular carcinoma and cirrhosis. Insights Imaging 2024; 15:31. [PMID: 38302787 PMCID: PMC10834928 DOI: 10.1186/s13244-024-01609-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/08/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Late recurrence of hepatocellular carcinoma (HCC) after liver resection is regarded as a de novo tumor primarily related to the severity of underlying liver disease. We aimed to investigate risk factors, especially spleen volume, associated with late recurrence in patients with HCC and cirrhosis. METHODS We retrospectively analyzed 301 patients with HCC and cirrhosis who received curative resection and preoperative MRI. Patients were followed for late recurrence for at least 2 years. Spleen volume was automatically measured on MRI with artificial intelligence techniques, and qualitative MRI imaging features reflecting tumor aggressiveness were evaluated. Uni- and multivariable Cox regression analyses were performed to identify independent predictors and a risk score was developed to predict late recurrence. RESULTS Eighty-four (27.9%) patients developed late recurrence during follow-up. Preoperative spleen volume was independently associated with late recurrence, and patients with a volume > 370 cm3 had significantly higher recurrence risk (hazard ratio 2.02, 95%CI 1.31-3.12, p = 0.002). Meanwhile, no qualitative imaging features were associated with late recurrence. A risk score was developed based on the APRI score, spleen volume, and tumor number, which had time-dependent area under the curve ranging from 0.700 to 0.751. The risk score at a cutoff of 0.42 allowed for the identification of two risk categories with distinct risk of late recurrence. CONCLUSIONS Preoperative spleen volume on MRI was independently associated with late recurrence after curative-intent resection in patients with HCC and cirrhosis. A risk score was proposed for individualized risk prediction and tailoring of postoperative surveillance strategies. CRITICAL RELEVANCE STATEMENT Spleen volume measured on MRI with the aid of AI techniques was independently predictive of late HCC recurrence after liver resection. A risk score based on spleen volume, APRI score, and tumor number was developed for accurate prediction of late recurrence. KEY POINTS • Preoperative spleen volume measured on MRI was independently associated with late recurrence after curative-intent resection in patients with HCC and cirrhosis. • Qualitative MRI features reflecting tumor aggressiveness were not associated with late recurrence. • A risk score based on spleen volume was developed for accurate prediction of late recurrence and risk stratification.
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Affiliation(s)
- Chongtu Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jia Tan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yidi Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yanshu Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yali Qu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Radiology, Sanya People's Hospital, Sanya, Hainan, China.
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Fuma S, Hidaka Y, Nishinaka A, Yasuda H, Aoshima K, Nakamura S, Hara H, Shimazawa M. Timolol maleate, a β blocker eye drop, improved edema in a retinal vein occlusion model. Mol Vis 2023; 29:188-196. [PMID: 38222457 PMCID: PMC10784217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/10/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose To investigate the therapeutic effects of eye drops, namely, timolol maleate, a β-adrenergic receptor antagonist, and latanoprost, a prostaglandin F2α analog, on retinal edema in a murine retinal vein occlusion (RVO) model. Methods An RVO model was established using laser-induced RVO in mice, which were administered timolol maleate and latanoprost eye drops several times after venous occlusion. Subsequently, the thickness of the inner nuclear layer (INL) and the expression levels of such genes as Vegf and Atf4, which are stress markers of the endoplasmic reticulum, were examined. Primary human cultured retinal microvascular endothelial cells (HRMECs) were treated with timolol under hypoxic conditions, after which the gene expression pattern was investigated. Importantly, an integrated stress response inhibitor (ISRIB) was used in the RVO model, he known ISRIB, which suppresses the expression of ATF4 in retinal edema. Results Increased INL thickness was suppressed by timolol eye drops, as were the expressions of Vegf and Atf4, in the RVO model. However, latanoprost eye drops did not induce any change in INL thickness. In HRMECs, hypoxic stress and serum deprivation increased the Vegf and Atf4 expressions; in response, treatment with timolol suppressed the Vegf expression. Furthermore, the ISRIB decreased the Vegf expression pattern and edema formation, which are associated with RVO. Conclusions These results indicate that timolol eye drops may be a potential option for RVO treatment.
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Affiliation(s)
- Shinichiro Fuma
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Yae Hidaka
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Anri Nishinaka
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Hiroto Yasuda
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Kota Aoshima
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Shinsuke Nakamura
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Hideaki Hara
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
- Laboratory of Collaborative research for Innovative Drug Discovery, Gifu Pharmaceutical University, Gifu, Japan
| | - Masamitsu Shimazawa
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
- Laboratory of Collaborative research for Innovative Drug Discovery, Gifu Pharmaceutical University, Gifu, Japan
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Zhang Q, Fang G, Huang T, Wei G, Li H, Liu J. Development of preoperative and postoperative machine learning models to predict the recurrence of huge hepatocellular carcinoma following surgical resection. Oncol Lett 2023; 26:275. [PMID: 37274474 PMCID: PMC10236130 DOI: 10.3892/ol.2023.13861] [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: 01/03/2023] [Accepted: 04/05/2023] [Indexed: 06/06/2023] Open
Abstract
Resection has been commonly utilized for treating huge hepatocellular carcinoma (HCC) with a diameter of ≥10 cm; however, a high rate of mortality is reported due to recurrence. The present study was designed to predict the recurrence following resection based on preoperative and postoperative machine learning models. In total, 1,082 patients with HCC who underwent liver resection in the Eastern Hepatobiliary Surgery Hospital cohort between January 2008 and December 2016 were divided into a training cohort and an internal validation cohort. In addition, 164 patients from Mengchao Hepatobiliary Hospital cohort between January 2014 and December 2016 served as an external validation cohort. The demographic information, and serological, MRI, and pathological data were obtained from each patient prior to and following surgery, followed by evaluating the model performance using the concordance index, time-dependent receiver operating characteristic curves, prediction error cures, and a calibration curve. A preoperative random survival forest (RSF) model and a postoperative RSF model were constructed based on the training set, which outperformed the conventional models, such as the Barcelona Clinic Liver Cancer (BCLC), the 8th edition of the American Joint Committee on Cancer (AJCC 8th) staging systems, and the Chinese stage systems. In addition, the preoperative and postoperative RSF models could also re-stratify patients with BCLC stage A/B/C or AJCC 8th stage IB/II/IIIA/IIIB or Chinese stage IB/IIA/IIB/IIIA into low-risk, intermediate-risk, and high-risk groups in the training and the two validation cohorts. The preoperative and postoperative RSF models were effective for predicting recurrence in patients with huge HCC following hepatectomy.
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Affiliation(s)
- Qinghua Zhang
- Department of Hepatobiliary Pancreatic Cancer Surgery, College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
| | - Guoxu Fang
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian 350025, P.R. China
- The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian 350025, P.R. China
| | - Tiancong Huang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Guangya Wei
- Department of Hepatobiliary Pancreatic Cancer Surgery, College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
| | - Haitao Li
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian 350025, P.R. China
| | - Jingfeng Liu
- The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian 350025, P.R. China
- Department of Hepatopancreatobiliary Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian 350014, P.R. China
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Wee JJ, Tee CL, Junnarkar SP, Low JK, Tan YP, Huey CW, Shelat VG. Outcomes of surgical resection of super-giant (≥15 cm) hepatocellular carcinoma: Volume does matter, if not the size. J Clin Transl Res 2022; 8:209-217. [PMID: 35813892 PMCID: PMC9260342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND AIM Resection for giant hepatocellular carcinoma (HCC) (≥10 cm) is deemed safe and feasible. However, a super-giant HCC (≥15 cm) poses unique technical complexity for hepatectomy with limited data suggesting feasibility and oncologic efficiency. This study aims to evaluate the short-term and long-term outcomes of hepatectomy in patients with super-giant HCC. METHODS A retrospective review was conducted on patients with super-giant HCC who underwent hepatectomy from 2011 to 2021. We report perioperative and oncologic outcomes such as length of stay (LOS), 30-day readmission, 90-day mortality, and cumulative survival rate. RESULTS Of the 18 patients, the median tumor diameter was 172.5 mm (range 150-250). The most common risk factor was chronic hepatitis B virus (HBV) infection (n=7, 38.9%). Most of the patients were Barcelona Clinic Liver Cancer (BCLC) Stage B (n=14, 77.8%) and Hong Kong Liver Cancer (HKLC) Stage IIb (n=15, 83.3%). Extended right hepatectomy was the most common procedure. The median LOS was 11 days (range 3-90). The most common post-operative complication was pneumonia (n=4, 22.2%). Fourteen patients were discharged well without any need for invasive therapy (n=7, 38.9% no complications, n=1, 5.6% Clavien Grade I, n=6, 33.3% Clavien Grade II). Thirty-day readmission rate was 5.6% (n=1) and 90-day mortality rate was 5.6% (n=1). There were 12 patients (66.7%) with microvascular invasion and three patients (16.7%) with macrovascular invasion. Most patients had Grade III (poorly differentiated) HCC (n=9, 50%). At a median follow-up of 11 months (range 2-95), 12 (66.7%) patients had local recurrence, and 9 (50%) developed distant metastasis. The 1-, 2-, and 3-year cumulative disease-free survival (DFS) was 36%, 18%, and 18%, respectively. The 1-, 2-, and 3-year cumulative overall survival was 49% and 39%, and 29%, respectively. CONCLUSION Primary hepatic resection is safe in patients with super-giant HCC. However, long-term outcomes are poor, and high tumor volume may be associated with inferior oncological outcomes in HCC. RELEVANCE FOR PATIENTS The presentation of super-giant HCCs may be asymptomatic and some patients are diagnosed late with limited treatment options. In some centers, this group of patients are denied surgical resection and recommended for only locoregional therapies like TACE. This paper demonstrates that hepatic resection is safe and may be an option in patients who present at an advanced stage with a high tumor burden.
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Affiliation(s)
- Jia Jia Wee
- 1Division of Hepatopancreatobilliary Surgery, General Surgery, Tan Tock Seng Hospital, Singapore,Corresponding author: Jia Jia Wee Division of Hepatopancreatobilliary Surgery, General Surgery, Tan Tock Seng Hospital, Singapore. Tel: +65-96255092 E-mail:
| | - Chin Li Tee
- 1Division of Hepatopancreatobilliary Surgery, General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sameer P. Junnarkar
- 1Division of Hepatopancreatobilliary Surgery, General Surgery, Tan Tock Seng Hospital, Singapore
| | - Jee Keem Low
- 1Division of Hepatopancreatobilliary Surgery, General Surgery, Tan Tock Seng Hospital, Singapore
| | - Yen Pin Tan
- 1Division of Hepatopancreatobilliary Surgery, General Surgery, Tan Tock Seng Hospital, Singapore
| | - Cheong Wei Huey
- 1Division of Hepatopancreatobilliary Surgery, General Surgery, Tan Tock Seng Hospital, Singapore
| | - Vishal G. Shelat
- 1Division of Hepatopancreatobilliary Surgery, General Surgery, Tan Tock Seng Hospital, Singapore
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Liu D, Liu W, Chen X, Yin J, Ma L, Liu M, Zhou X, Xian L, Li P, Tan X, Zhao J, Liao Y, Cao G. circKCNN2 suppresses the recurrence of hepatocellular carcinoma at least partially via regulating miR-520c-3p/methyl-DNA-binding domain protein 2 axis. Clin Transl Med 2022; 12:e662. [PMID: 35051313 PMCID: PMC8775140 DOI: 10.1002/ctm2.662] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Recurrence is the major cause of hepatocellular carcinoma (HCC) death. We aimed to identify circular RNA (circRNA) with predictive and therapeutic value for recurrent HCC. METHODS Tissue samples from recurrent and non-recurrent HCC patients were subjected to circRNA sequencing and transcriptome sequencing. circKCNN2 was identified through multi-omics analyses. The effects of circKCNN2 on HCC were evaluated in cells, animals, database of The Cancer Genome Atlas, and a cohort with 130 HCC patients. circRNA precipitation, chromatin immunoprecipitation assay, RNA pull-down, luciferase assay, and cell experiments were applied to evaluate the interaction of circKCNN2 with miRNAs and proteins. The association between circKCNN2 and the therapeutic effect of lenvatinib was investigated in HCC cell lines and HCC tissue-derived organoids. RESULTS The expression of circKCNN2 was downregulated in HCC tissues and predicted a favorable overall survival and recurrence-free survival. The expression of circKCNN2 was positively correlated with the parental gene, potassium calcium-activated channel subfamily N member (KCNN2). Nuclear transcription factor Y subunit alpha (NFYA) was proven to inhibit the promoter activity of KCNN2, downregulate the expression of KCNN2 and circKCNN2, and predict an unfavorable recurrence-free survival. Ectopic expression of circKCNN2 inhibited HCC cell proliferation, colony formation, migration, and tumor formation in a mouse model. miR-520c-3p sponged by circKCNN2 could reverse the inhibitory effect of circKCNN2 on HCC cells and down-regulate the expression of methyl-DNA-binding domain protein 2 (MBD2). The intratumoral expression of MBD2 predicted a favorable recurrence-free survival. circKCNN2 down-regulated the expression of fibroblast growth factor receptor 4 (FGFR4), which can be reversed by miR-520c-3p and knockdown of MBD2. Lenvatinib inhibited the expression of FGFR4 and upregulated the expression of circKCNN2 and MBD2. Ectopic expression of circKCNN2 in HCC cells enhanced the therapeutic effect of lenvatinib. However, the high inherent level of circKCNN2 in HCC cells was associated with lenvatinib resistance. CONCLUSIONS circKCNN2, transcriptionally repressed by NFYA, suppresses HCC recurrence via the miR-520c-3p/MBD2 axis. Inherent level of circKCNN2 in HCC cells predisposes anti-tumor effect of lenvatinib possibly because both circKCNN2 and lenvatinib repress the expression of FGFR4. circKCNN2 may be a promising predictive biomarker and therapeutic agent for HCC recurrence.
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Affiliation(s)
- Donghong Liu
- Key Laboratory of Molecular Biology for Infectious DiseasesMinistry of EducationChongqing Medical UniversityChongqingChina
- Institute for Viral HepatitisChongqing Medical UniversityChongqingChina
- Department of Infectious Diseasesthe Second Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Wenbin Liu
- Department of EpidemiologySecond Military Medical UniversityShanghaiChina
| | - Xi Chen
- Department of EpidemiologySecond Military Medical UniversityShanghaiChina
| | - Jianhua Yin
- Department of EpidemiologySecond Military Medical UniversityShanghaiChina
| | - Longteng Ma
- Department of EpidemiologySecond Military Medical UniversityShanghaiChina
| | - Mei Liu
- Department of EpidemiologySecond Military Medical UniversityShanghaiChina
| | - Xinyu Zhou
- Department of EpidemiologySecond Military Medical UniversityShanghaiChina
| | - Linfeng Xian
- Department of EpidemiologySecond Military Medical UniversityShanghaiChina
| | - Peng Li
- Department of EpidemiologySecond Military Medical UniversityShanghaiChina
| | - Xiaojie Tan
- Department of EpidemiologySecond Military Medical UniversityShanghaiChina
| | - Jun Zhao
- Department of Hepatic SurgeryEastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityShanghaiChina
| | - Yong Liao
- Key Laboratory of Molecular Biology for Infectious DiseasesMinistry of EducationChongqing Medical UniversityChongqingChina
- Institute for Viral HepatitisChongqing Medical UniversityChongqingChina
- Department of Infectious Diseasesthe Second Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Guangwen Cao
- Department of EpidemiologySecond Military Medical UniversityShanghaiChina
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Liang XJ, Huang ZS. Predictive value of preoperative C-reactive protein/serum albumin ratio and gamma-glutamyl transpeptidase for early recurrence in patients with hepatocellular carcinoma after resection. Shijie Huaren Xiaohua Zazhi 2021; 29:999-1005. [DOI: 10.11569/wcjd.v29.i17.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, some studies have reported that increased C-reactive protein/serum albumin ratio (CRP/Alb) and gamma-glutamyl transpeptidase (GGT) predict a poor prognosis in hepatocellular carcinoma (HCC) after treatment; however, there are few studies on their predictive value for the prognosis after HCC resection.
AIM To evaluate the predictive value of preoperative CRP/Alb and GGT for early recurrence in patients with HCC after resection.
METHODS A retrospective analysis was performed on the clinical data of 80 initially treated patients who were pathologically confirmed as having hepatocellular carcinoma after radical resection at our hospital from January 1, 2016 to January 20, 2019 and then followed for the prognosis. The patients were divided into either an early recurrence group or a non-early recurrence group based on the presence of recurrence in 2 years or not. The χ2 test was used for univariate analysis, and Cox proportional hazards model was used for multivariate analysis. The tumor-free survival curves of independent risk factors were plotted using the Kaplan-Meier method, and log-rank method was used to compare their difference.
RESULTS The best cut-off values of CRP/Alb and GGT were 0.041 and 75.5 U/L, respectively, according to the results of ROC curve analysis. The recurrence-free survival rates within 1 and 2 years were 70% and 56.25%, respectively, in this group of patients. Univariate analysis showed that microvascular invasion (MVI), CRP/Alb, and GGT were risk factors for early recurrence in patients with hepatocellular carcinoma after resection. Multivariate analysis showed that MVI and GGT were independent risk factors for early recurrence in patients with hepatocellular carcinoma after resection. The tumor-free survival time of HCC patients with MVI was significantly shorter than that of patients without (P < 0.001). The tumor-free survival time in the GGT > 75.5 U/L group was significantly shorter than that of the GGT ≤ 75.5 U/L group (P = 0.001).
CONCLUSION CRP/Alb, GGT, and MVI have potential predictive value for early tumor recurrence in patients with hepatocellular carcinoma after resection.
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Affiliation(s)
- Xun-Jie Liang
- Graduate College, Youjiang Medical College for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Zan-Song Huang
- Graduate College, Youjiang Medical College for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China,Department of Gastroenterology, The Affiliated Hospital of Youjiang Medical College for Nationalities, Guangxi Clinical Medical Research Center for Hepatobiliary Diseases, Baise 533000, Guangxi Zhuang Autonomous Region, China
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