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Xu L, Xu Y, Li G, Yang B. Perioperative factors related to the prognosis of elderly patients with hepatocellular carcinoma. Eur J Med Res 2022; 27:280. [PMID: 36494837 PMCID: PMC9733384 DOI: 10.1186/s40001-022-00896-5] [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: 01/23/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatic resection is a potentially curative treatment for patients with hepatocellular carcinoma (HCC). The treatment of elderly patients with HCC has always been difficult. With the development of geriatrics and geriatric surgery, the number of elderly patients with HCC undergoing hepatectomy has gradually increased. To further improve the long-term prognosis of elderly patients with hepatocellular carcinoma undergoing surgery, it is necessary to study the related perioperative factors. Our aim was to study the impact of preoperative and intraoperative factors on the long-term survival of elderly patients with HCC who underwent hepatectomy. METHODS A total of 151 elderly patients with HCC who underwent hepatectomy were retrospectively studied. Univariate and multivariate Cox regression analyses were performed for preoperative- and intraoperative-related prognostic factors. RESULTS The 1-, 3-, 5- and 10-year overall survival rates of elderly patients with HCC who underwent resection were 79.5%, 60.8%, 46.6%, and 25.4%, respectively. Multivariate analyses identified four independent predictors of long-term prognosis: Child-Pugh grade (B/C versus A: HR[hazard ratio] = 2.318, P = 0.019), alpha-fetoprotein value (> 20 ng/ml versus ≤ 20 ng/ml: HR = 1.972, P = 0.005), resection style (anatomical versus no anatomical: HR = 1.976, P = 0.006), and intraoperative blood loss (> 400 ml versus ≤ 400 ml: HR = 2.008, P = 0.003). CONCLUSIONS Poor survival of elderly patients with HCC who underwent hepatectomy was correlated with the preoperative and intraoperative factors of Child-Pugh grade, Alpha-fetoprotein value, resection style, and intraoperative blood loss.
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Affiliation(s)
- Lining Xu
- grid.414252.40000 0004 1761 8894Department of General Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853 China
| | - Yingying Xu
- grid.414008.90000 0004 1799 4638Department of Internal Medicine, Henan Cancer Hospital, Zhengzhou, 450003 China
| | - Guiping Li
- Department of Radiology, Hubei Province Integrated Hospital of Chinese and Western Medicine, Wuhan, 430015 China
| | - Bo Yang
- grid.33199.310000 0004 0368 7223Department of Radiology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
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Kwee SA, Tiirikainen M, Sato MM, Acoba JD, Wei R, Jia W, Le Marchand L, Wong LL. Transcriptomics Associates Molecular Features with 18F-Fluorocholine PET/CT Imaging Phenotype and Its Potential Relationship to Survival in Hepatocellular Carcinoma. Cancer Res 2019; 79:1696-1704. [PMID: 30760520 DOI: 10.1158/0008-5472.can-18-3837] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/22/2019] [Accepted: 02/05/2019] [Indexed: 12/15/2022]
Abstract
Studies involving transcriptomics have revealed multiple molecular subtypes of hepatocellular carcinoma (HCC). Positron emission tomography/computed tomography (PET/CT) has also identified distinct molecular imaging subtypes, including those with increased and decreased choline metabolism as measured by the tissue uptake of the radiopharmaceutical 18F-fluorocholine. Gene signatures reflecting the molecular heterogeneity of HCC may identify the biological and clinical significance of these imaging subtypes. In this study, 41 patients underwent 18F-fluorocholine PET/CT, followed by tumor resection and gene expression profiling. Over- and underexpressed components of previously published gene signatures were evaluated for enrichment between tumors with high and low 18F-fluorocholine uptake using gene set analysis. Significant gene sets were enumerated by FDR based on phenotype permutation. Associations with overall survival were analyzed by univariate and multivariate proportional hazards regression. Ten gene sets related to HCC were significantly associated with high tumor 18F-fluorocholine uptake at FDR q < 0.05, including those from three different clinical molecular classification systems and two prognostic signatures for HCC that showed predictive value in the study cohort. Tumor avidity for 18F-fluorocholine was associated with favorable characteristics based on these signatures with lower mortality based on survival analysis (HR 0.36; 95% confidence interval, 0.14-0.95). Tumors demonstrating high 18F-fluorocholine uptake were also enriched for genes involved in oxidative phosphorylation, fatty acid metabolism, peroxisome, bile acid metabolism, xenobiotic metabolism, and adipogenesis. These results provide a pathobiological framework to further evaluate 18F-fluorocholine PET/CT as a molecular and prognostic classifier in HCC. SIGNIFICANCE: A pathobiological framework for HCC brings together multiple prognostically relevant gene signatures via convergence with 18F-fluorocholine PET/CT imaging phenotype.
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Affiliation(s)
- Sandi A Kwee
- Hamamatsu/Queen's PET Imaging Center, The Queen's Medical Center, Honolulu, Hawaii. .,Cancer Biology Program, Clinical Sciences Program, and Epidemiology Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Maarit Tiirikainen
- Cancer Biology Program, Clinical Sciences Program, and Epidemiology Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Miles M Sato
- The Queen's Medical Center, Queen's Cancer Center, Honolulu, Hawaii
| | - Jared D Acoba
- Cancer Biology Program, Clinical Sciences Program, and Epidemiology Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii.,The Queen's Medical Center, Queen's Cancer Center, Honolulu, Hawaii
| | - Runmin Wei
- Cancer Biology Program, Clinical Sciences Program, and Epidemiology Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Wei Jia
- Cancer Biology Program, Clinical Sciences Program, and Epidemiology Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Loic Le Marchand
- Cancer Biology Program, Clinical Sciences Program, and Epidemiology Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Linda L Wong
- Cancer Biology Program, Clinical Sciences Program, and Epidemiology Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii.,Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
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Nishioka ST, Sato MM, Wong LL, Tiirikainen M, Kwee SA. Clinical and molecular sub-classification of hepatocellular carcinoma relative to alpha-fetoprotein level in an Asia-Pacific island cohort. ACTA ACUST UNITED AC 2018; 4. [PMID: 29376136 PMCID: PMC5786161 DOI: 10.20517/2394-5079.2017.46] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aim Increased serum alpha-fetoprotein (AFP) levels are associated with
specific molecular sub-classes of hepatocellular carcinoma (HCC), supporting
AFP as a predictive or therapeutic biomarker for precision treatment of this
disease. Considering recent efforts to validate HCC molecular classification
systems across different populations, we applied existing signature-based
classification templates to Hawaii cohorts and examined whether associations
between HCC molecular sub-class, AFP levels, and clinical features found
elsewhere can also be found in Hawaii, a region with a unique demographic
and risk factor profile for HCC. Methods Whole-genome expression profiling was performed on HCC tumors
collected from 40 patients following partial hepatectomy. Tumors underwent
transcriptome-based categorization into 3 molecular sub-classes (S1, S2, and
S3). Patient groups based on molecular sub-class and AFP level were then
compared with regards to clinical features and survival. Differences
associated with AFP level and other clinical parameters were also examined
at the gene signature level by gene set enrichment analysis. Results Statistically confident (false discovery rate < 0.05)
sub-classifications were made in 98% (39/40) of tumors. Patient
sub-groups differed significantly with regards to serum AFP level, with
significantly lower levels in the S3 sub-group as compared to S1
(P = 0.048) and S2 (P = 0.010). Serum
AFP > 400 ng/mL predicted significant tumor enrichment for genes
corresponding to MYC target activation, high cell
proliferation, poor clinical prognosis, and the S2 sub-class. AFP >
400 ng/mL and non-S3 tumor classification were found to be significant
predictors of overall survival. Conclusion Distinct sub-classes of HCC associated with different molecular
features and survival outcomes can be detected with statistical confidence
in a Pacific Island cohort. Molecular classification signatures and other
predictive markers for HCC that are valid for all patient populations are
needed to support multi-center efforts to develop targeted therapies for
HCC.
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Affiliation(s)
| | - Miles M Sato
- The Queen's Medical Center, Honolulu, HI 96813, USA
| | - Linda L Wong
- Cancer Biology Program and Genomics Shared Resource, University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI 96822, USA
| | - Maarit Tiirikainen
- Cancer Biology Program and Genomics Shared Resource, University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI 96822, USA
| | - Sandi A Kwee
- The Queen's Medical Center, Honolulu, HI 96813, USA.,Cancer Biology Program and Genomics Shared Resource, University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI 96822, USA.,Hamamatsu/Queen's PET Imaging Center, The Queen's Medical Center, Honolulu, HI 96813, USA
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Gwiasda J, Schulte A, Kaltenborn A, Ramackers W, Kleine M, Beetz O, Klempnauer J, Emmanouilidis N, Schrem H. Identification of the resection severity index as a significant independent prognostic factor for early mortality and observed survival >5 and >10 years after liver resection for hepatocellular carcinoma. Surg Oncol 2017; 26:178-187. [PMID: 28577724 DOI: 10.1016/j.suronc.2017.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/31/2017] [Accepted: 03/12/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVES This study evaluates predictive factors for observed long-term survival of more than 5 and 10 years for patients after liver resection for hepatocellular carcinoma and compares their life expectancy to the normal national population matched for sex, year of birth and age at resection. METHODS 230 patients after primary liver resection for HCC (01.01.1995-31.12.2004) were analyzed. Multivariable logistic regression models were determined based on Cox regression results and their prognostic capability evaluated with areas under the receiver operating characteristic curve (AUROCs). RESULTS Life years after surgery in deceased patients compared to the normal national population matched for sex, year of birth and age at resection was reduced by median 21.7 years. Independent predictive factors for 10-year survival were age at resection (p < 0.001; OR = 0.898; 95%-CI: 0.846-0.954), UICC 7 tumor staging (p = 0.003; OR = 0.344; 95%-CI: 0.126-0.941) and ASAT (GOT) in U/l divided by Quick in percent multiplied by the extent of liver resection graded in points labelled as the resection severity index (p < 0.001; OR = 0.136; 95%-CI: 0.022-0.843) enabling prediction of 10-year survival with an AUROC of 0.884. The same factors plus revision surgery (yes/no) predict 5-year survival (AUROC 0.736). CONCLUSIONS Liver resection enables predictable long-term survival >5 and > 10 years. The proposed resection severity index quantifies the prognostic relevance of liver cellular damage, synthesis and loss of parenchyma for long-term survival.
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Affiliation(s)
- Jill Gwiasda
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Aron Schulte
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Alexander Kaltenborn
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Wolf Ramackers
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Moritz Kleine
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Oliver Beetz
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jürgen Klempnauer
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Nikos Emmanouilidis
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Harald Schrem
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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