A preoperative nomogram for predicting long-term survival after resection of large hepatocellular carcinoma (>10 cm)

BACKGROUND

It has previously been demonstrated that a fraction of patients with hepatocellular carcinoma (HCC) > 10 cm can benefit from liver resection. However, there is still a lack of effective decision-making tools to inform intervention in these patients.

METHODS

We analysed a comprehensive set of clinical data from 234 patients who underwent liver resection for HCC >10 cm at the National Cancer Institute of Peru between 1990 and 2015, monitored their survival, and constructed a nomogram to predict the surgical outcome based on preoperative variables.

RESULTS

We identified cirrhosis, multifocality, macroscopic vascular invasion, and spontaneous tumour rupture as independent predictors of survival and integrated them into a nomogram model. The nomogram's ability to forecast survival at 1, 3, and 5 years was subsequently confirmed with high concordance using an internal validation. Through applying this nomogram, we stratified three groups of patients with different survival probabilities.

CONCLUSION

We constructed a preoperative nomogram to predict long-term survival in patients with HCC >10 cm. This nomogram is useful in determining whether a patient with large HCC might truly benefit from liver resection, which is paramount in low- and middle-income countries where HCC is often diagnosed at advanced stages.

Hepatocellular carcinoma surgery outcomes in the developing world: A 20-year retrospective cohort study at the National Cancer Institute of Peru

In the developing world, most patients with hepatocellular carcinoma present with advanced-stage disease, considered to be incurable based on current therapeutic algorithms. Here, we demonstrate that curative liver resection is achievable in a portion of Peruvian patients not addressed by these treatment algorithms. We conducted a retrospective cohort study of 253 hepatocellular carcinoma patients that underwent a curative hepatectomy between 1991 and 2011 at the National Cancer Institute of Peru. The median age of the cohort was 36 years, and merely 15.4% of the patients displayed cirrhosis. The average tumor size was over 14 cm in diameter, resulting in 76.3% of major hepatectomies performed. The 5- and 10-year survival probability estimates were 37.5% and 26.2%, respectively. Age (>44 vs. ≤44 years old; P = 0.005), tumor size (>10 cm vs. ≤10 cm in diameter; P = 0.009), cirrhosis (P < 0.001), satellite lesions (P < 0.001), macroscopic vascular invasion (P < 0.001), allogeneic blood transfusion (P = 0.011), and spontaneous rupture of the tumor (P = 0.006) were independent predictive factors for prognosis. Hepatocellular carcinomas in Peru are characterized by a distinct clinical presentation with notable features compared with those typically described throughout relevant literature. Despite a large number of advanced-stage hepatocellular carcinomas, the outcomes of liver resection observed in the present study were in good standing with the results previously described in other series. It thus appears that staging systems and associated therapeutic algorithms designed for use in the developed world remain inadequate in certain populations, especially in the context of Peruvian patients. Our findings suggest that clinicians in the developing world should reconsider management guidelines pertaining to hepatocellular carcinoma. Indeed, we hypothesize that, in developing countries, a strict adherence to these therapeutic algorithms might create a selection bias resulting in the dismissal of patients who could eventually be treated.

Fluorescence probes for prokaryotic and eukaryotic cells using Re(CO)3+complexes with an electron withdrawing ancillary ligand

Re(CO)₃⁺complexes with an ancillary ligand present an electron withdrawing effect suitable for cell imaging.

Effect of asymmetry on the electronic delocalization in diiron and iron-cobalt mixed valence metallocenic compounds

In this work, we report the synthesis and a study on the degree of electronic delocalization in the asymmetric mixed valence complexes [CpFe(C(8)H(6))Fe(C(8)H(7))](+), 3a(+), and [CpCo(C(8)H(6))Fe(C(8)H(7))](+), 3b(+), (Cp = C(5)Me(5), C(8)H(6) = pentalenyde, C(8)H(7) = hydropentalenyde, and = ((3,5(CF(3))(2)C(6)H(3))(4)B(-))). Electrochemical methods, (57)Fe Mössbauer spectroscopy, electronic spectroscopy, and electron paramagnetic resonance were used for this purpose. Although the anti conformation of the complexes precludes any metal-metal interaction, all the techniques employed show that 3a(+) is a electronic delocalized system, while 3b(+) behaves as two individual metallic centers with localized electron density.

[Fibrolamellar hepatocarcinoma. Case report]

We reported a case with the hystologic diagnosis of fibromellar carcinoma. A 50 year-old woman without known risk factors for hepatocellular carcinoma. She appeared at the hospital with pain in the upper right quadrant, hepatomeglia and weight loss. The automated enhanced tomography evidenced a heterogeneous tumor with a diameter of 15 cm. compromising segments 4, 5, 6, 7 and 8 of the liver. Tumor calcifications and the retraction of the hepatic capsule were identified. Alpha-fetoprotein levels were normal and a negative serology for viral hepatitis were found. The patient underwent a surgical resection (extended right hepatectomy, the partial resection of the main biliary tract and a portal lymphadenectomy). Six months later she is asymptomatic and evidences no recurrence of the disease. The clinical, pathological, radiological features, treatment options and prognoses of fibrolamellar carcinoma were discussed.

Antifungal monoterpene production in elicited cell suspension cultures of Piqueria trinervia

Cell suspension cultures of the traditional medicinal plant Piqueria trinervia Cav., which synthesizes monoterpene piquerol A, were established. A defense response was induced in the cultures when eight homogenized fungi isolated from wild populations of P. trinervia were added. Piquerol A was not produced in the elicited system, while four other substances were synthesized de novo. They were excreted into the medium and inhibited in vitro fungal growth. The most abundant substance produced in this system was a new monoterpene: 2-methylene-7,7-dimethylbicyclo (3,3,1) heptane-4,6-diol. Monoterpenes in the cell suspension culture reported here were produced via two metabolic channels: the first acted constitutively and expressed in liquid and solid cultures, the second is inducible in response to several pathogens and elicitor substances.