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Lam YK, Yu J, Huang H, Ding X, Wong AM, Leung HH, Chan AW, Ng KK, Xu M, Wang X, Wong N. TP53 R249S mutation in hepatic organoids captures the predisposing cancer risk. Hepatology 2023; 78:727-740. [PMID: 36221953 PMCID: PMC10086078 DOI: 10.1002/hep.32802] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND AIMS Major genomic drivers of hepatocellular carcinoma (HCC) are nowadays well recognized, although models to establish their roles in human HCC initiation remain scarce. Here, we used human liver organoids in experimental systems to mimic the early stages of human liver carcinogenesis from the genetic lesions of TP53 loss and L3 loop R249S mutation. In addition, chromatin immunoprecipitation sequencing (ChIP-seq) of HCC cell lines shed important functional insights into the initiation of HCC consequential to the loss of tumor-suppressive function from TP53 deficiency and gain-of-function activities from mutant p53. APPROACH AND RESULTS Human liver organoids were generated from surgical nontumor liver tissues. CRISPR knockout of TP53 in liver organoids consistently demonstrated tumor-like morphological changes, increased in stemness and unrestricted in vitro propagation. To recapitulate TP53 status in human HCC, we overexpressed mutant R249S in TP53 knockout organoids. A spontaneous increase in tumorigenic potentials and bona fide HCC histology in xenotransplantations were observed. ChIP-seq analysis of HCC cell lines underscored gain-of-function properties from L3 loop p53 mutants in chromatin remodeling and overcoming extrinsic stress. More importantly, direct transcriptional activation of PSMF1 by mutant R249S could increase organoid resistance to endoplasmic reticulum stress, which was readily abrogated by PSMF1 knockdown in rescue experiments. In a patient cohort of primary HCC tumors and genome-edited liver organoids, quantitative polymerase chain reaction corroborated ChIP-seq findings and verified preferential genes modulated by L3 mutants, especially those enriched by R249S. CONCLUSIONS We showed differential tumorigenic effects from TP53 loss and L3 mutations, which together confer normal hepatocytes with early clonal advantages and prosurvival functions.
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Affiliation(s)
- Yin Kau Lam
- Department of Surgery, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Jianqing Yu
- Department of Surgery, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Hao Huang
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China
| | - Xiaofan Ding
- Department of Surgery, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Alissa M. Wong
- Department of Surgery, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Howard H. Leung
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Anthony W. Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin K. Ng
- Department of Surgery, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Mingjing Xu
- Department of Surgery, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Xin Wang
- Department of Surgery, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Nathalie Wong
- Department of Surgery, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
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Liu Y, Xu M, Wan HL, Wong AM, Ding X, Ng KK, Wong N. Abstract 3987: Targeting nucleotide synthesizing enzyme dUTPase (DUT) represents a metabolic weakness and therapeutic opportunity in liver cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-3987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, has an overall 5-year survival rate of around 20%, making it the third leading cause of cancer-related death worldwide. Upregulated nucleotide metabolism is frequently identified in HCC and represents a metabolic weakness of tumor cells. The enzyme dUTPase (DUT) catalyzes the synthesis of nucleotide precursor and prevents undesired uracil misincorporation into DNA, and thus plays an important role in the maintenance of DNA integrity and cell viability. Although common upregulation of DUT has been reported in cancers, its role in HCC remains largely unknown. In this study, we investigated the mechanism underlying DUT biology in HCC and tumor susceptibility to drug targeting dUTPase. Overexpression of DUT was found in 42% of HCC cases and significantly correlated with advanced stage tumors. CRISPR-Cas9 mediated knockout of DUT resulted in growth retardation, cell cycle arrest and a spontaneous induction of DNA damage in multiple HCC cell lines. A protective effect from oxidative stress was also demonstrated in both knockout and overexpression DUT assays. Metabolomics analysis showed altered DUT expression in HCC cells resulted in profound impact on pyrimidine and purine metabolism. In addition, levels of DUT protein strongly correlate with cellular level of dUTP and dTDP, which suggested its critical role in dNTP homeostasis. Interestingly, hepatic organoids overexpressing DUT showed drug resistance to tyrosine kinase inhibitor (TKI) Sorafenib. Both in vitro and in vivo assays confirmed that targeting dUTPase activity with TAS-114 synergized the effect of Sorafenib in suppressing HCC growth. In conclusion, our study showed that upregulated DUT conferred growth advantage to HCC cells by reducing uracil misincorporation and favoring nucleotide synthesis. Targeting DUT with its first-in-class inhibitor TAS-114 in combination with Sorafenib represents an effective treatment regime for HCC.
Citation Format: Yue Liu, Mingjing Xu, Ho Lee Wan, Alissa M. Wong, Xiaofan Ding, Kelvin K. Ng, Nathalie Wong. Targeting nucleotide synthesizing enzyme dUTPase (DUT) represents a metabolic weakness and therapeutic opportunity in liver cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3987.
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Affiliation(s)
- Yue Liu
- 1Sir Y.K. Pao Centre for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Mingjing Xu
- 1Sir Y.K. Pao Centre for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Ho Lee Wan
- 1Sir Y.K. Pao Centre for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Alissa M. Wong
- 1Sir Y.K. Pao Centre for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Xiaofan Ding
- 1Sir Y.K. Pao Centre for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Kelvin K. Ng
- 1Sir Y.K. Pao Centre for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Nathalie Wong
- 1Sir Y.K. Pao Centre for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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Ji R, Ng KK, Chen W, Yang W, Zhu H, Cheung TT, Chiang CL, Wong TC, Kong FM, Wu G, Lo CM. Comparison of clinical outcome between stereotactic body radiotherapy and radiofrequency ablation for unresectable hepatocellular carcinoma. Medicine (Baltimore) 2022; 101:e28545. [PMID: 35089192 PMCID: PMC8797553 DOI: 10.1097/md.0000000000028545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/21/2021] [Indexed: 01/05/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) is a novel noninvasive treatment for unresectable hepatocellular carcinoma (HCC). Whether its efficacy is comparable to radiofrequency ablation (RFA), a recommended therapy for unresectable HCC, is unknown. The present study aims to compare the clinical outcome between SBRT and RFA for patients with unresectable HCC.The clinical data of 60 patients with unresectable HCC from January 2018 to January 2021 were retrospectively reviewed. There were 22 cases treated by SBRT and 38 cases by RFA. The short-term and long-term clinical outcomes were compared.There was no significant difference in the baseline demographic characteristics between two groups. The complete remission rate at 3 months was comparable between SBRT group (81.8%) and RFA group (89.4%). Local tumor control rate was also similar between two groups (90.9% vs. 94.7%). There was no severe complication (grade IIIa or above) in both groups. The 1-year and 2-year overall survival rates were 88.2% and 85.7% in SBRT group and 100% and 75% in RFA group, respectively. There was no statistical significant difference between groups (P = .576).SBRT can achieve similar short and long-term clinical outcome as RFA for unresectable HCC. Future prospective clinical study is needed to justify its role in patients with HCC.
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Affiliation(s)
- Ren Ji
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
| | - Kelvin K. Ng
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
| | - Wenqi Chen
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, China
| | - Weihong Yang
- Division of Interventional Radiology, Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, China
| | - Hongtao Zhu
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
| | - Tan-To Cheung
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
| | - Chi-Leung Chiang
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, China
| | - Tiffany C.L. Wong
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
| | - Feng-Ming Kong
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, China
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - G. Wu
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
| | - Chung-Mau Lo
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
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Ng KK, Hui YH, Chu KS, Kung BT, Au-Yong TK. Metformin Discontinuation for 48 Hours Reduces Intestinal Fluorodeoxyglucose Uptake in 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. Hong Kong Journal of Radiology 2021. [DOI: 10.12809/hkjr2117186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- KK Ng
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Hong Kong
| | - YH Hui
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Hong Kong
| | - KS Chu
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Hong Kong
| | - BT Kung
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Hong Kong
| | - TK Au-Yong
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Hong Kong
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Katsanos AH, Lioutas VA, Charidimou A, Catanese L, Ng KK, Perera K, de Sa Boasquevisque D, Romero JR, Tsivgoulis G, Smith EE, Sharma M, Selim MH, Shoamanesh A. Abstract TP439: Statin Treatment and Prevalent Cerebral Microbleeds: A Systematic Review and Meta-Analysis. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Statins have been reported to increase the risk of intracererbral hemorrhage, however their effects on cerebral microbleeds (CMBs) formation is not well understood. We systematically reviewed previously published studies to pool adjusted and unadjusted estimates of the association between prevalent CMBs and current statin use.
Methods:
We performed a systematic search in MEDLINE and SCOPUS databases on July 28
th
, 2019 to identify all cohorts from randomized clinical trials or observational studies reporting CMB prevalence and statin use. We extracted cross-sectional data on CMBs presence, as provided by each study, in association to the history of current statin use. Associations are reported as odds ratios (ORs) with corresponding 95% confidence intervals (95%CI). Random effects model was used to calculate the pooled estimates.
Results:
We included 7 studies (n=3671 participants): unselected general population [n=1965], ischemic stroke [n=770], hemorrhagic stroke [n=252], hypertension [n=605] or neuroimaging based studies [n=72]. Statin use was not associated with CMBs presence in either unadjusted (OR=1.15, 95%CI: 0.76-1.74) or adjusted analyses (OR=1.01, 95%CI: 0.62-1.64). Statin use was more strongly related to lobar CMB presence (OR=2.01, 95%CI: 1.48-2.72) in unadjusted analysis. The effect size of this association was consistent, but no longer statistically significant in adjusted analysis that was confined to two eligible studies (OR=2.26, 95%CI: 0.86-5.91). Except for the analysis on the unadjusted probability of CMBs presence, considerable heterogeneity was present in all other analyses (I
2
>60%).
Conclusion:
Our findings suggest that statin treatment is not associated with CMBs overall, but may increase the risk of lobar CMB formation. This hypothesis deserves further investigation within magnetic resonance imaging ancillary studies of randomized trials.
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Affiliation(s)
| | | | - Andreas Charidimou
- Massachusetts General Hosp Stroke Rsch Cntr, Harvard Med Sch, Boston, MA
| | - Luciana Catanese
- McMaster Univ/Population Health Rsch Institute,, Hamilton, Canada
| | - Kelvin K Ng
- McMaster Univ/Population Health Rsch Institute,, Hamilton, Canada
| | - Kanjana Perera
- McMaster Univ/Population Health Rsch Institute,, Hamilton, Canada
| | | | | | - Georgios Tsivgoulis
- Attikon Univ Hosp, Sch of Medicine, National and Kapodistrian Univ of Athens, Athens, Greece
| | | | - Mukul Sharma
- McMaster Univ/Population Health Rsch Institute,, Hamilton, Canada
| | - Magdy H Selim
- Beth Israel Deaconess Med Cntr, Harvard Med Sch, Boston, MA
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Katsanos AH, Lioutas VA, Charidimou A, Catanese L, Ng KK, Perera K, de Sa Boasquevisque D, Tsivgoulis G, Smith EE, Sharma M, Selim MH, Shoamanesh A. Abstract TP437: Statin Treatment and Accrual of Covert Cerebral Ischemia on Neuroimaging: A Systematic Review and Meta-Analysis of Randomized Trials. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Stroke prevention is an established benefit of statin therapy, but the effects of statin treatment on the accrual of MRI markers of ischemic cerebral injury remain unknown.
Methods:
We performed a systematic review of MEDLINE and SCOPUS databases from inception to July 29
th
, 2019 to identify all studies that randomized patients to statin treatment and assessed the effect of statin treatment on incident infarcts (asymptomatic and symptomatic), covert infarcts (asymptomatic evident only in neuroimaging) and white matter hyperintensity (WMH) accrual on magnetic resonance imaging. We included only studies reporting WMH change following normal distribution. We used random effects model to calculate the pooled estimates of the crude risk ratios (RRs) and standardized mean differences (SMDs).
Results:
We included data from 3 randomized controlled trials with a total of 1399 participants evaluating the effect of rosuvastatin (10mg/d) in 637 hypertensive patients older than 60 years of age over 5 years, pravastatin (40mg/d) in 554 elderly people more than 70 years of age over 3 years and simvastatin (20mg/d) in 208 patients with asymptomatic middle cerebral artery stenosis over 2 years. Patients randomized to statin treatment had decreased accrual of new infarcts (RR=0.59; 95%CI: 0.36, 0.95), new covert infarcts (RR=0.64, 95%CI: 0.46-0.89). Only one study reported WMH decreased volume change in patients randomized to statin treatment compared to patients randomized to non-statin treatment (SMD= -1.16; -1.33, -1.00).
Conclusion:
Our findings suggest that statin treatment can reduce the accrual of covert MRI markers of ischemic cerebral injury. Dose-response effect and population disparities need to be investigated in future studies.
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Affiliation(s)
| | | | - Andreas Charidimou
- Massachusetts General Hosp Stroke Rsch Cntr, Harvard Med Sch, Boston, MA
| | - Luciana Catanese
- McMaster Univ/Population Health Rsch Institute,, Hamilton, Canada
| | - Kelvin K Ng
- McMaster Univ/Population Health Rsch Institute,, Hamilton, Canada
| | - Kanjana Perera
- McMaster Univ/Population Health Rsch Institute,, Hamilton, Canada
| | | | - Georgios Tsivgoulis
- Attikon Univ Hosp, Sch of Medicine, National and Kapodistrian Univ of Athens, Athens, Greece
| | | | - Mukul Sharma
- McMaster Univ/Population Health Rsch Institute,, Hamilton, Canada
| | - Magdy H Selim
- Beth Israel Deaconess Med Cntr, Harvard Med Sch, Boston, MA
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Wong TC, Dai J, To Cheung T, Ng KK. Outcomes after Left Lobe vs Right Lobe Living Donor Liver Transplantation: A Propensity Score Match Analysis. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ng KK. Improvement in Long-Term Survival Outcome in Adult-to-Adult Living Donor Liver Transplantation: A 20-Year Experience in Hong Kong. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Qiu S, Ng KK, Cheung T, Ji R, Liu C, Zhu H, Xu B, Lo C. Applications of surgical techniques of living donor liver transplantation in complex hepatic resection for hepatocellular carcinoma. Surg Pract 2019. [DOI: 10.1111/1744-1633.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Si‐Yuan Qiu
- Department of SurgeryThe University of Hong Kong–Shenzhen Hospital Shenzhen China
| | - Kelvin K. Ng
- Department of SurgeryThe University of Hong Kong–Shenzhen Hospital Shenzhen China
- Department of SurgeryThe University of Hong Kong Hong Kong
| | - Tan‐To Cheung
- Department of SurgeryThe University of Hong Kong–Shenzhen Hospital Shenzhen China
- Department of SurgeryThe University of Hong Kong Hong Kong
| | - Ren Ji
- Department of SurgeryThe University of Hong Kong–Shenzhen Hospital Shenzhen China
| | - Chun‐Hong Liu
- Department of SurgeryThe University of Hong Kong–Shenzhen Hospital Shenzhen China
| | - Hong‐Tao Zhu
- Department of SurgeryThe University of Hong Kong–Shenzhen Hospital Shenzhen China
| | - Bang‐Ren Xu
- Department of SurgeryThe University of Hong Kong–Shenzhen Hospital Shenzhen China
| | - Chung‐Mau Lo
- Department of SurgeryThe University of Hong Kong–Shenzhen Hospital Shenzhen China
- Department of SurgeryThe University of Hong Kong Hong Kong
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Ng KK, Cheung TT, Pang HH, Wong TC, Dai JW, Ma KW, She WH, Kotewall CN, Lo CM. A simplified prediction model for early intrahepatic recurrence after hepatectomy for patients with unilobar hepatocellular carcinoma without macroscopic vascular invasion: An implication for adjuvant therapy and postoperative surveillance. Surg Oncol 2019; 30:6-12. [PMID: 31500787 DOI: 10.1016/j.suronc.2019.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/03/2019] [Accepted: 05/18/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND An accurate prediction model of early recurrence of hepatocellular carcinoma (HCC) after hepatectomy is important to ascertain the postoperative adjuvant treatment and surveillance. METHODS This is a retrospective cohort study including 1125 patients with HCC underwent curative hepatic resection. They were randomly divided into training (n = 562) and validation (n = 563) sets. Early intrahepatic recurrence within 18 months from surgery is the primary outcome. In the training set, a prediction scoring model (Recurrent Liver Cancer Score RLCS) was developed, which was legitimised in the validation set. RESULTS RLCS was developed based on four clinicopathologic risk factors (serum alpha fetoprotein, tumor size, multiple tumors or satellite nodules, and microvascular invasion). Low-risk and high-risk groups had statistically significant differences in early recurrence rates (18% vs. 43.8%). The 5-year recurrence-free survival rates of low risk and high risk groups were 52.9% and 27.8%, respectively. This model showed good calibration and discriminatory ability in the validation set (c-index of 0.647). CONCLUSION RLCS is a user-friendly prediction scoring model which can accurately predict the occurrence of early intrahepatic recurrence of HCC. It establishes the basis of postoperative adjuvant treatment and surveillance in future studies.
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Affiliation(s)
- Kelvin K Ng
- Department of Surgery, The University of Hong Kong, Hong Kong.
| | - Tan-To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong; State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong
| | - Herbert H Pang
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Tiffany C Wong
- Department of Surgery, The University of Hong Kong, Hong Kong; State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong
| | - Jeff W Dai
- Department of Surgery, The University of Hong Kong, Hong Kong
| | - Ka-Wing Ma
- Department of Surgery, The University of Hong Kong, Hong Kong
| | - Wong-Hoi She
- Department of Surgery, The University of Hong Kong, Hong Kong
| | | | - Chung-Mau Lo
- Department of Surgery, The University of Hong Kong, Hong Kong; State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong
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Siu BW, Fistein EC, Leung HW, Chan LS, Yan CK, Lai AC, Yuen KK, Ng KK. Compulsory Admission in Hong Kong: Balance between Paternalism and Patient Liberty. East Asian Arch Psychiatry 2018; 28:122-128. [PMID: 30563948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In Hong Kong, compulsory admission is governed by the Mental Health Ordinance Section 31 (detention of a patient under observation), Section 32 (extension of period of detention for such a patient), Section 36 (detention of certified patients), and the sections in Part IV for hospital order, transfer order, and removal order. Mental health professionals adopt both legal criteria and practice criteria for compulsory admission. The present study discusses the harm principle, the patient's decision-making capacity, the multi-axial framework for compulsory admission, and the balance between paternalism and patient liberty.
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Affiliation(s)
- B Wm Siu
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - E C Fistein
- School of Clinical Medicine, University of Cambridge, United Kingdom
| | - H W Leung
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - L Sy Chan
- Department of Forensic Psychiatry and Old Age Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - C K Yan
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - A Ch Lai
- Head of the Socioanthropology Department, School of Medical Sciences, National University of Asunción (Santa Rosa Campus), Santa Rosa del Aguaray, Paraguay
| | - K K Yuen
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - K K Ng
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
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12
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Ng KK, Cheung T, Wong TC, Lo C. Prediction Model for Early Intrahepatic Recurrence after Hepatectomy for Patients with Hepatocellular Carcinoma: An Implication for Adjuvant Treatment. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Wong TC, Ng KK, Cheung TT, Chan A, Chok KS, Dai JW, Lo CM. What Can We Learn from Living Donor Evaluation? A Higher Prevalence of Metabolic Disease and Less Technical Contraindication. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kow FP, Adlina B, Sivasangari S, Punithavathi N, Ng KK, Ang AH, Ong LM. The impact of music guided deep breathing exercise on blood pressure control - A participant blinded randomised controlled study. Med J Malaysia 2018; 73:233-238. [PMID: 30121686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION As pharmacological treatment of hypertension has become a burden worldwide, the study looked into nonpharmacological ways of reducing blood pressure. The objective was to determine if music guided, slow and deep breathing will reduce the blood pressure among patients with hypertension in eight weeks. METHODS A participant blinded, multi-centre, randomised controlled trial was conducted in which the participants in the intervention group (IG) practiced deep breathing exercise guided by sound cues and those in the control group (CG) listened to the music. The primary end point was reduction in blood pressure at eight weeks. RESULTS 87 patients, 46 males and 41 females with mean age of 61.1 years were recruited and 93.1% of them successfully completed the study. There was significant reduction in systolic and diastolic Blood Pressure from baseline by 8 weeks in both groups. The reduction in Mean systolic blood pressure (SBP) in the control arm was 10.5mmHg compared to 8.3mmHg (p<0.001) in intervention group. Diastolic blood pressure (DBP) reduction in control and intervention groups were 5.2 mmHg (p<0.001) and 5.6 mmHg (p<0.001) respectively. The absolute difference in SBP reduction from baseline in IG & CG was -2.2 (95%CI: -7.8 to 3.5) and DBP was -0.4 (95%CI: -2.9 to 3.6). However, blood pressure reduction between the two groups was not significant. CONCLUSIONS Both listening to music and deep breathing exercise were associated with a clinically significant reduction in SBP and DBP. However, deep breathing exercise did not augment the benefit of music in reducing BP.
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Affiliation(s)
- F P Kow
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia.
| | - B Adlina
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
| | - S Sivasangari
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
| | - N Punithavathi
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
| | - K K Ng
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
| | - A H Ang
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
| | - L M Ong
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
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Siu BWM, Au-Yeung CCY, Chan AWL, Chan LSY, Yuen KK, Leung HW, Yan CK, Ng KK, Lai ACH, Davies S, Collins M. Validation of the "Security Needs Assessment Profile" for measuring the profiles of security needs of Chinese forensic psychiatric inpatients. Int J Law Psychiatry 2017; 54:61-66. [PMID: 28528124 DOI: 10.1016/j.ijlp.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/13/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
Mapping forensic psychiatric services with the security needs of patients is a salient step in service planning, audit and review. A valid and reliable instrument for measuring the security needs of Chinese forensic psychiatric inpatients was not yet available. This study aimed to develop and validate the Chinese version of the Security Needs Assessment Profile for measuring the profiles of security needs of Chinese forensic psychiatric inpatients. The Security Needs Assessment Profile by Davis was translated into Chinese. Its face validity, content validity, construct validity and internal consistency reliability were assessed by measuring the security needs of 98 Chinese forensic psychiatric inpatients. Principal factor analysis for construct validity provided a six-factor security needs model explaining 68.7% of the variance. Based on the Cronbach's alpha coefficient, the internal consistency reliability was rated as acceptable for procedural security (0.73), and fair for both physical security (0.62) and relational security (0.58). A significant sex difference (p=0.002) in total security score was found. The Chinese version of the Security Needs Assessment Profile is a valid and reliable instrument for assessing the security needs of Chinese forensic psychiatric inpatients.
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Affiliation(s)
- B W M Siu
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - C C Y Au-Yeung
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - A W L Chan
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - L S Y Chan
- Department of Forensic Psychiatry & Old Age Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - K K Yuen
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - H W Leung
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - C K Yan
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - K K Ng
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - A C H Lai
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - S Davies
- Nottinghamshire Healthcare NHS Trust, UK.
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Fury MG, Sherman EJ, Rao SS, Wolden S, Smith-Marrone S, Mueller B, Ng KK, Dutta PR, Gelblum DY, Lee JL, Shen R, Kurz S, Katabi N, Haque S, Lee NY, Pfister DG. Phase I study of weekly nab-paclitaxel + weekly cetuximab + intensity-modulated radiation therapy (IMRT) in patients with stage III-IVB head and neck squamous cell carcinoma (HNSCC). Ann Oncol 2014; 25:689-694. [PMID: 24496920 PMCID: PMC4433511 DOI: 10.1093/annonc/mdt579] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/27/2013] [Accepted: 12/10/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is a clinical need to improve the efficacy of standard cetuximab + concurrent intensity-modulated radiation therapy (IMRT) for patients with locally and/or regionally advanced HNSCC. Taxanes have radiosensitizing activity against HNSCC, and nab-paclitaxel may offer therapeutic advantage in comparison with other taxanes. PATIENTS AND METHODS This was a single-institution phase I study with a modified 3 + 3 design. Four dose levels (DLs) of weekly nab-paclitaxel were explored (30, 45, 60, and 80 mg/m(2)), given with standard weekly cetuximab (450 mg/m(2) loading dose followed by 250 mg/m(2) weekly) and concurrent IMRT (total dose, 70 Gy). RESULTS Twenty-five eligible patients (20 M, 5 F) enrolled, with median age 58 years (range, 46-84 years). Primary tumor sites were oropharynx, 19 (10 human papillomavirus [HPV] pos, 8 HPV neg, 1 not done); neck node with unknown primary, 2; larynx 2; and oral cavity and maxillary sinus, 1 each. Seven patients had received prior induction chemotherapy. Maximum tolerated dose (MTD) was exceeded at DL4 (nab-paclitaxel, 80 mg/m(2)) with three dose-limiting toxicities (DLTs) (grade 3 neuropathy, grade 3 dehydration, with grade 3 mucositis grade 3 anemia) among five assessable patients. There was only one DLT (grade 3 supraventricular tachycardia) among six patients at DL3 (nab-paclitaxel, 60 mg/m(2)), and this was deemed the MTD. Among 23 assessable patients, the most common ≥ g3 AEs were lymphopenia 100%, functional mucositis 65%, and pain in throat/oral cavity 52%. At a median follow-up of 33 months, 2-year failure-free survival (FFS) is 65% [95% confidence interval (CI) 42% to 81%] and 2-year overall survival (OS) is 91% (95% CI 69-97). CONCLUSION The recommended phase II dose for nab-paclitaxel is 60 mg/m(2) weekly when given standard weekly cetuximab and concurrent IMRT. This regimen merits further study as a nonplatinum alternative to IMRT + cetuximab alone. CLINICALTRIALSGOV ID NCT00736619.
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MESH Headings
- Aged
- Aged, 80 and over
- Albumins/adverse effects
- Albumins/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Phytogenic/adverse effects
- Antineoplastic Agents, Phytogenic/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/radiotherapy
- Cetuximab
- Chemoradiotherapy
- Combined Modality Therapy/adverse effects
- ErbB Receptors/antagonists & inhibitors
- Female
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/radiotherapy
- Humans
- Male
- Maximum Tolerated Dose
- Middle Aged
- Neoplasm Staging
- Paclitaxel/adverse effects
- Paclitaxel/therapeutic use
- Radiotherapy, Intensity-Modulated
- Squamous Cell Carcinoma of Head and Neck
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Affiliation(s)
| | | | | | | | | | - B Mueller
- Radiation Oncology, MSKCC Regional Network Affiliate, Sleepy Hollow
| | | | - P R Dutta
- Radiation Oncology, MSKCC Regional Network Affiliate, Rockville Center
| | | | - J L Lee
- Radiation Oncology, MSKCC Regional Network Affiliate, Commack, USA
| | - R Shen
- Epidemiology and Biostatistics
| | | | | | - S Haque
- Radiology, Memorial Sloan-Kettering Cancer Center (MSKCC), New York
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17
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Low WHH, Seet W, A S R, Ng KK, H J, Dan SP, Teng CL, Lee VKM, Chua SS, M Y FA, T K, Chee WSS, Goh PP, M Z, Lim TO. Community-based cardiovascular Risk Factors Intervention Strategies (CORFIS) in managing hypertension: A pragmatic non-randomised controlled trial. Med J Malaysia 2013; 68:129-135. [PMID: 23629558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Hypertension is the number one cardiovascular risk factor in Malaysia. This study aimed to evaluate the effectiveness of a Community-Based Cardiovascular Risk Factors Intervention Strategies (CORFIS) in the management of hypertension in primary care. METHODS This is a pragmatic, non-randomized controlled trial. Seventy general practitioners (GPs) were selected to provide either CORFIS (44 GPs) or conventional care (26 GPs) for 6 months. A total of 486 hypertensive patients were recruited; 309 were in the intervention and 177 in the control groups. Primary outcome was the proportion of hypertensive patients who achieved target blood pressure (BP) of <140/90mmHg (for those without diabetes mellitus) and <130/80mmHg (with diabetes mellitus). Secondary outcomes include change in the mean/median BP at 6-month as compared to baseline. RESULTS The proportion of hypertensive patients who achieved target BP at 6-month was significantly higher in the CORFIS arm (69.6%) as compared to the control arm (57.6%), P=0.008. Amongst those who had uncontrolled BP at baseline, the proportion who achieved target BP at 6-month was also significantly higher in the CORFIS arm (56.6%) as compared to the control arm (34.1%), p<0.001. There was no difference in the patients who had already achieved BP control at baseline. There were significant reductions in SBP in the CORFIS arm (median -9.0mmHg; -60 to 50) versus control (median -2mmHg; -50 to 48), p=0.003; as well as in DBP (CORFIS arm: median -6.0mmHg; ranged from -53 to 30 versus control arm: median 0.0mmHg; ranged from -42 to 30), p<0.001. CONCLUSIONS Patients who received CORFIS care demonstrated significant improvements in achieving target BP.
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Affiliation(s)
- W H H Low
- Clinical Research Center, Clinical Epidemiology Unit, 1st Floor MMA House, 124, Jalan Pahang, Kuala Lumpur 53000 Malaysia.
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18
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Chen CY, Chang HP, Ng KK, Wang CC, Lai CH, Chao A. Long-term disease-free survival in three ovarian cancer patients with a single relapse. EUR J GYNAECOL ONCOL 2012; 33:321-3. [PMID: 22873111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Recurrent ovarian cancer with long-term survival is uncommon and often associated with poor prognosis. We report three cases of patients with advanced ovarian cancer who have achieved long-term disease-free survival following a single prior relapse. Case 1 relapsed with a localized bulky tumor and received a complete surgical resection and chemotherapy. Case 2 had a persistent central pelvic tumor after debulking surgery and second-line chemotherapy, and yet achieved excellent control with concurrent chemoradiation to the true pelvis. Case 3 relapsed with paraaortic lymph node metastasis and probable lung metastasis (subsequently negated by positron emission tomography) and received chemotherapy alone. These three patients have since remained disease-free for 13, 12, and seven years, respectively, since their first relapse. We conclude that select patients can obtain long-term disease-free survival after the first relapse by accurate restaging and aggressive multimodality treatment.
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Affiliation(s)
- C Y Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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19
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Tam TKW, Ng KK, Lau CM, Lai TC, Lai WY, Tsang LCY. Faecal occult blood screening: knowledge, attitudes, and practice in four Hong Kong primary care clinics. Hong Kong Med J 2011; 17:350-357. [PMID: 21979470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES. To assess primary care patients for their awareness, knowledge, and attitude towards colorectal cancer and screening, to report on the uptake of faecal occult blood test screening and the results of screening, and explore predictors of screening uptake. DESIGN. Cross-sectional study. SETTING. Four primary care clinics in Hong Kong. PATIENTS. A total of 1664 patients aged 50 to 74 years attending the clinics in the period July 2006 to July 2007. MAIN OUTCOME MEASURES. Percentage of subjects who were aware that colorectal cancer is common and curable at an early stage, and who knew that faecal occult blood test or colonoscopy is useful for screening; relevant knowledge score; uptake rate of faecal occult blood testing; rate of testing positive; and factors predicting uptake. RESULTS. A total of 1645 questionnaires were collected. In all, 89% (95% confidence interval, 88-91%) were aware that colorectal cancer is common, 95% (94-96%) believed faecal occult blood test and colonoscopy are useful for screening, and 58% (56-61%) achieved a knowledge score of 50% or above. The uptake rate of the faecal occult blood test was 35%. Uptake was higher among those with a positive family history (odds ratio=1.57; 95% confidence interval, 1.08-2.27; P=0.02), those who were more aware that colorectal cancer is common (1.86; 1.29-2.69; P=0.001), and that colorectal cancer is potentially curable at an early stage (1.76; 1.32-2.36; P=0.0001). Rate of testing positive was 2.1% (95% confidence interval, 0.9-3.3%); no colorectal cancer was detected and the neoplasia detection rate (for cancers and adenomas) was 5.1 per 1000 subjects screened. CONCLUSIONS. Patients were aware that colorectal cancer is common in our community, and faecal occult blood test or colonoscopy is useful for screening. The uptake of screening was low, though relatively higher for those with a positive family history and greater awareness of the high frequency and potential for cure of colorectal cancer. Faecal occult blood test positivity rate was 2.1%, and neoplasia detection rate 5.1 per 1000 screened.
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Affiliation(s)
- Tammy K W Tam
- Primary Care Research Team, Professional Development and Quality Assurance, Department of Health, Hong Kong.
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20
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Poh BK, Mancer K, Goh D, Lim T, Ng V, Ng KK, Ng FC. PlasmaKinetic™ (bipolar) transurethral resection of prostate: a prospective trial to study pathological artefacts, surgical parameters and clinical outcomes. Singapore Med J 2011; 52:336-339. [PMID: 21633766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The aims of the study were to compare the degree of cautery artefacts in prostatic chips between monopolar and PlasmaKinetic™ transurethral resection of prostate (TURP), and to determine if there is any difference in the intraoperative and post surgical parameters between them. METHODS After institutional review board approval, patients were prospectively enrolled to undergo PlasmaKinetic™ TURP. Their parameters were compared with those of the historical monopolar TURP controls. All histological specimens were reviewed by a single senior pathologist. RESULTS 46 patients were recruited to undergo PlasmaKinetic™ TURP. The resection time was significantly longer for the bipolar group compared to the monopolar group (50.2 versus 36.7 min, p-value is 0.001). The speed of resection (resection weight/time) was lower for the bipolar group (0.45 versus 0.56 g/min, p-value is 0.017). More irrigant was used for the bipolar group (21.2 versus 15.6 litres, p-value is 0.001) intraoperatively. There was no statistically significant difference in terms of intraoperative drop in haemoglobin and serum sodium change between the two groups. There seems to be a lesser degree of cautery artefacts in the PlasmaKinetic™ group than the monopolar group (42.17 versus 45.07 microns); however, this was not statistically significant (p-value is 0.452). CONCLUSION Bipolar TURP seems to result in a lesser degree of cautery artefacts when compared to conventional monopolar TURP, albeit statistically insignificant, compared to monopolar TURP. TURP also resulted in a longer resection time and increased irrigant use, but no difference in blood loss and serum sodium levels.
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Affiliation(s)
- B K Poh
- Department of Urology, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
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21
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Chan CYZ, Lam CH, Lam DY, Lee LY, Ng KK, Wong ML. A qualitative study on HPV vaccination from a nursing perspective in Hong Kong. Asian Pac J Cancer Prev 2011; 12:2539-2545. [PMID: 22320952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To identify the perception on human papillomavirus (HPV) vaccination among female nursing students in Hong Kong. DATA SOURCES Data were collected through focus group discussions and semi-structured in-depth interviews. All participants (n=28) were female nursing students of a university in Hong Kong. Tape recordings of individual interviews and focus group discussions were transcribed verbatim in Chinese, translated into English, and analyzed according to Colaizzi's phenomenological analysis. STUDY DESIGN Four major themes emerged from the data: nursing students' understanding about HPV vaccine, nursing students' attitude on HPV vaccine, nursing students' perspective on HPV vaccination promotion, and nursing role on HPV vaccination. CONCLUSIONS Government should take initiative in promotion with vaccine suppliers. The awareness and knowledge of HPV and HPV vaccination among women should be increased in order to raise the positive attitude of women towards HPV vaccination and prevention of cervical cancer. Health professionals should work together on HPV promotion among women and increase the HPV vaccination rates. Moreover, further studies regarding attitude and awareness of HPV vaccination among women in different age groups are needed in order to identify more associated factors affecting their perceptions towards HPV vaccination.
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Affiliation(s)
- C Y Z Chan
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
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22
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Ng KK. Is laparoscopy-assisted distal gastrectomy a superior alternative to the open approach? J Surg Res 2010; 165:46-8. [PMID: 20934712 DOI: 10.1016/j.jss.2010.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 08/23/2010] [Accepted: 08/18/2010] [Indexed: 12/01/2022]
Affiliation(s)
- Kelvin K Ng
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
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23
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Cheung TT, Ng KK, Chok KS, Chan SC, Poon RT, Lo CM, Fan ST. Combined resection and radiofrequency ablation for multifocal hepatocellular carcinoma: Prognosis and outcomes. World J Gastroenterol 2010; 16:3056-62. [PMID: 20572310 PMCID: PMC2890947 DOI: 10.3748/wjg.v16.i24.3056] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the combined treatment of resection and intraoperative radiofrequency ablation (RFA) for multifocal hepatocellular carcinoma in terms of prognosis and surgical outcomes.
METHODS: This study was a retrospective case comparison study using prospectively collected data. The study covered the period from April 2001 to December 2006. The data of 200 patients with histologically confirmed hepatocellular carcinoma were reviewed. Nineteen patients (17 men and 2 women) having received resection in combination with RFA were chosen as subjects of the study (the combination group). Fifty-four patients (43 men and 11 women) having received resection alone were selected for comparison (the resection group). The two groups matched tumor number and tumor size, and all the patients in the two groups displayed no tumor rupture, major vascular involvement and distant metastasis. Their demographics, preoperative assessment, disease recurrence patterns, overall survival and disease-free survival were compared.
RESULTS: In the combination group, the median age was 65 years (range, 34-77 years), the median tumor number was 3 (range, 2-9), and the median tumor size was 6 cm (range, 1.2-14 cm). In the resection group, the median age was 51.5 years (range, 27-80 years, P = 0.003), the median tumor number was 3 (range, 2-9, P = 0.574), and the median tumor size was 6 cm (range, 1-14 cm, P = 0.782). The two groups were similar in characteristics of tumors and comorbidities, and had comparable results in preoperative liver function tests. All patients had Child-Pugh class A status. Bilobar involvement occurred in 14 patients (73.6%) in the combination group and 3 patients (5.5%) in the resection group (P = 0.04). Six patients (32%) in the combination group and 35 patients (65%) in the resection group underwent major hepatectomy. Thirteen patients (68%) in the combination group and 19 patients (35%) in the resection group underwent minor hepatectomy (P = 0.012). The combination group had fewer major resections (32% vs 65%, P = 0.012), less blood loss (400 vs 657 mL, P = 0.007), shorter operation time (270 vs 400 min, P = 0.001), and shorter hospital stay (7 vs 8.5 d, P = 0.042). The two groups displayed no major differences in surgical complications (15.8% vs 31.5%, P = 0.24), disease recurrence (63.2% vs 50%, P = 0.673), hospital mortality (5.3% vs 5.6%, P = 1), and overall survival (53 vs 44.5 mo, P = 0.496).
CONCLUSION: Safe and effective for selected patients with multifocal hepatocellular carcinoma, the combination of resection and intraoperative RFA widens the applicability of surgical intervention for the disease.
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Yau T, Yao TJ, Chan P, Epstein RJ, Ng KK, Chok SH, Cheung TT, Fan ST, Poon RTP. The outcomes of elderly patients with hepatocellular carcinoma treated with transarterial chemoembolization. Cancer 2010; 115:5507-15. [PMID: 19701904 DOI: 10.1002/cncr.24636] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The authors evaluated and compared the treatment outcomes of transarterial chemoembolization (TACE) between young (<or=70 years) and elderly (>70 years) patients at their institute over an 18-year period. METHODS Advanced hepatocellular carcinoma (HCC) patients who received TACE at the authors' center were analyzed retrospectively. The demographic data, TACE-related morbidities, and survival outcome were compared between these 2 age groups. RESULTS Between 1989 and 2006, 843 patients who were <or=70 years old and 197 patients who were >70 years old received TACE treatment for advanced HCC. There were significantly more comorbid illnesses associated with the elderly patients than the young patients (64 % vs 33%, P < .01). Moreover, elderly patients who received TACE treatment for HCC were at earlier stages of disease (P < .01). Both the overall median survival (14.0 months vs 8.1 months, P < .003) and disease-specific survival (15.2 months vs 8.7 months, P < .001) were significantly higher in elderly than young patients. The most commonly encountered TACE-related morbidity in both age groups was liver function derangement. Young patients had a significantly higher rate of developing liver derangement after TACE than elderly patients (21% vs 11%, P < .01). Conversely, the elderly patients had a significantly higher rate of developing peptic ulcer disease with TACE treatment than young patients (2.5% vs 0.5%, P = .01). Overall, there was no significant difference in TACE-related mortality between the young and elderly patients (3% vs 4%, P = .49). CONCLUSIONS This study has confirmed the comparable efficacy and tolerability in using TACE for the treatment of advanced HCC in young and elderly patient populations.
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Affiliation(s)
- Thomas Yau
- Department of Medicine, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
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Abstract
The native liver of a familial amyloidotic polyneuropathy recipient who undergoes living donor liver transplantation used as a graft for sequential liver transplantation does not include the inferior vena cava. Implantation of this whole liver graft to a second recipient could be simplified by borrowing the experience from right liver living donor liver transplantation. With careful release of the hepatic vein from its surrounding adventitia mainly by sharp dissections, adequate lengths of these veins could be attained without compromising the native inferior vena cava. Following venoplasty of the right and middle/left hepatic vein stumps, the single cuff of the hepatic veins is anastomosed to the inferior vena cava without interpositional venous graft or patch. Satisfactory venous outflow is reliably achieved because this is the most direct outflow tract.
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Affiliation(s)
- See Ching Chan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
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26
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Ng KK, Lo CM, Chan SC, Chok KS, Cheung TT, Fan ST. Liver transplantation for hepatocellular carcinoma: the Hong Kong experience. J Hepatobiliary Pancreat Sci 2009; 17:548-54. [PMID: 19760139 DOI: 10.1007/s00534-009-0165-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/13/2009] [Indexed: 12/12/2022]
Abstract
Orthotopic liver transplantation (OLT) is the best treatment option for selected patients with hepatocellular carcinoma (HCC) with the background of cirrhosis since this treatment modality can cure both diseases at once. Over the years, the applicability of OLT for HCC has evolved. In Asia, including Hong Kong, a shortage of deceased donor liver grafts is a universal problem having to be faced in all transplant centers. Living-donor liver transplant (LDLT) has therefore been developed to counteract organ shortage and the high prevalence of HCC. The application of LDLT for HCC is a complex process involving donor voluntarism, selection criteria for the recipient and justification with respect to long-term survival in comparison to the result of deceased donor liver transplant. This article reviews the authors' experience with OLT for HCC patients in Hong Kong, with emphasis on the applicability and outcome of LDLT for HCC. Donor voluntarism has a significant impact on the application of LDLT. "Fast-track" LDLT in the setting of recurrence following curative treatment carries a high risk of recurrence even though the tumor stage fulfills the standard criteria. Although the survival outcome may be worse following LDLT than DDLT for HCC, LDLT is still the main treatment option for patients with transplantable HCC in Hong Kong, and a reasonable survival outcome can be achieved in selected patients with extended indications. It is particularly true that LDLT provides the only hope for patients with advanced HCC under the constricting problem of organ shortage.
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Affiliation(s)
- Kelvin K Ng
- Department of Surgery, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
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Chan AC, Fan ST, Lo CM, Liu CL, Chan SC, Ng KK, Yong BH, Chiu A, Lam BK. Liver transplantation for acute-on-chronic liver failure. Hepatol Int 2009; 3:571-81. [PMID: 19680733 PMCID: PMC2790588 DOI: 10.1007/s12072-009-9148-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 07/23/2009] [Accepted: 08/03/2009] [Indexed: 12/13/2022]
Abstract
Purpose To evaluate the outcome of liver transplantation for acute-on-chronic liver failure. Patients and methods From November 1991 to December 2007, 517 patients underwent liver transplantation at Queen Mary Hospital, Hong Kong. Among them, 149 had acute-on-chronic liver failure as defined in the recent Asian Pacific Association for the Study of Liver Consensus Meeting. Their clinical data were reviewed and their survival outcomes were compared with those of patients who underwent liver transplantation for fulminant hepatic failure and for cirrhosis only in the same period. Results The patients with acute-on-chronic liver failure included 50 patients having acute exacerbation of chronic hepatitis B and 99 cirrhotic patients with acute deterioration. Their median model for end-stage liver disease scores were 35 and 37, respectively. Preoperative infection (35%), hepatorenal syndrome (38%), and respiratory failure (28.8%) were common. One hundred and three patients received living donor liver grafts and 46 patients received deceased donor liver grafts. The hospital mortality rate was 4.7%. The 5-year survival rates were 93.2% for patients with acute exacerbation of chronic hepatitis B and 90.5% for cirrhotic patients with acute deterioration. The results were similar to those of the patients with fulminant hepatic failure (n = 37) and the patients having cirrhosis only (n = 301). Conclusions Liver transplantation for acute-on-chronic liver failure is life-saving, and the survival rates it attains are similar to those attained by transplantation for other liver conditions.
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Affiliation(s)
- Albert C Chan
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
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Cheung TT, Ng KK, Poon RT, Fan ST. Tolerance of radiofrequency ablation by patients of hepatocellular carcinoma. ACTA ACUST UNITED AC 2009; 16:655-60. [PMID: 19370304 DOI: 10.1007/s00534-009-0103-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 01/27/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is currently an effective method for ablation of hepatocellular carcinoma (HCC). Early reports have indicated that RFA is safe and virtually free from major complications. Unlike partial hepatectomy for HCC on patients with cirrhosis, there are no data on the safety limit of RFA. However, information is vital for selection of appropriate patients for the procedure. In this study, we analyzed results from use of RFA on HCC patients and determined the lower limit of liver function with which HCC patients can tolerate RFA. METHOD Preoperative variables of 310 patients who underwent RFA for HCC were analyzed to identify the risk factors in RFA intolerance in terms of morbidity associated with stress-induced complications. RESULTS Thirty-nine (12.6%) patients developed intolerance of RFA. Postoperative morbidity was mainly because of intractable ascites (n = 13), hyperbilirubinemia (n = 10), massive pleural effusion (n = 7), and other complications (n = 14). Multivariate analysis revealed that serum albumin level (P = 0.001), serum bilirubin level (P = 0.000), tumor number (P = 0.002), and RFA duration (P = 0.017) all played a role in this issue. CONCLUSIONS Simple data such as serum bilirubin, serum albumin level, and tumor number can be used to predict HCC patients' tolerance of RFA. Avoidance of excessive RFA time and careful monitoring of patients at risk are important means of reducing the postoperative morbidity rate.
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Affiliation(s)
- Tan To Cheung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
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Ng KK, Lo CM. Liver Transplantation in Asia: Past, Present and Future. Ann Acad Med Singap 2009. [DOI: 10.47102/annals-acadmedsg.v38n4p322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
With the technical advances and improvements in perioperative management and immunosuppressants, liver transplantation is the standard treatment for patients with end-stage liver diseases. In Asia, a shortage of deceased donor liver grafts is the universal problem to be faced with in all transplant centres. Many surgical innovations are then driven to counteract this problem. This review focuses on 3 issues that denote the development of liver transplantation in Asian countries. These include living donor liver transplantation (LDLT), split liver transplantation (SLT) and liver transplantation for hepatocellular carcinoma (HCC). Minimal graft weight, types of liver graft to donate and the inclusion of the middle hepatic vein with the graft are the main issues to be established in LDLT. The rapid growth and wide dissemination of LDLT has certainly alleviated the supply-and-demand problem of liver grafts in Asia. SLT is another attractive approach. Technical expertise, donor selection and graft allocation are the main determinants for its success. Liver transplantation plays a key role in the management of HCC in Asia. LDLT would be the main strategy in this aspect. The issue of extending the selection criteria for HCC patients for LDLT is still controversial. On the whole, future developments to increase the donor pool for the expanding recipient need in Asia would involve transplantation from non-heart beating donor and ABO incompatible transplantation.
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Ng KK, Lo CM. Liver transplantation in Asia: past, present and future. Ann Acad Med Singap 2009; 38:322-10. [PMID: 19434335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
With the technical advances and improvements in perioperative management and immunosuppressants, liver transplantation is the standard treatment for patients with end-stage liver diseases. In Asia, a shortage of deceased donor liver grafts is the universal problem to be faced with in all transplant centres. Many surgical innovations are then driven to counteract this problem. This review focuses on 3 issues that denote the development of liver transplantation in Asian countries. These include living donor liver transplantation (LDLT), split liver transplantation (SLT) and liver transplantation for hepatocellular carcinoma (HCC). Minimal graft weight, types of liver graft to donate and the inclusion of the middle hepatic vein with the graft are the main issues to be established in LDLT. The rapid growth and wide dissemination of LDLT has certainly alleviated the supply-and-demand problem of liver grafts in Asia. SLT is another attractive approach. Technical expertise, donor selection and graft allocation are the main determinants for its success. Liver transplantation plays a key role in the management of HCC in Asia. LDLT would be the main strategy in this aspect. The issue of extending the selection criteria for HCC patients for LDLT is still controversial. On the whole, future developments to increase the donor pool for the expanding recipient need in Asia would involve transplantation from non-heart beating donor and ABO incompatible transplantation.
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Affiliation(s)
- Kelvin K Ng
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Yau T, Chan P, Ng KK, Chok SH, Cheung TT, Fan ST, Poon RT. Phase 2 open-label study of single-agent sorafenib in treating advanced hepatocellular carcinoma in a hepatitis B-endemic Asian population: presence of lung metastasis predicts poor response. Cancer 2009; 115:428-36. [PMID: 19107763 DOI: 10.1002/cncr.24029] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The current study was a phase 2 open-label study to evaluate the efficacy and tolerability of single-agent sorafenib in the treatment of advanced HCC patients in a hepatitis B-endemic Asian population. METHODS Patients with advanced hepatocellular carcinoma (HCC) received sorafenib at a dose of 400 mg twice daily in 4-week cycles. Tumor response was assessed every 3 cycles using Response Evaluation Criteria in Solid Tumors criteria. RESULTS Fifty-one patients were enrolled in the study and were treated with sorafenib for at least 12 weeks. The median age was 56 years (range, 28-79 years). Approximately 90% had hepatitis B virus-related HCC. Thirty-six (71%) patients had underlying Child-Pugh A cirrhosis, 13 (26%) Child-Pugh B, and 2 (3%) Child-Pugh C. Four (8%) patients achieved partial responses, and 9 (18%) patients had stable disease for at least 12 weeks. The median overall survival was 5 months (range, 4-17 months). Patients without extrahepatic spread, particularly without lung metastasis (P<.01), are more likely to benefit from sorafenib treatment. The most common toxicities were diarrhea (67%), malaise (55%), and hand-foot-skin reaction (54%). The majority of patients had transient liver function derangement. Patients with and without underlying portal vein thrombosis had similar therapeutic benefits and likewise shared a similar treatment-related toxicity profile with sorafenib treatment. CONCLUSIONS Single-agent sorafenib demonstrates good efficacy and acceptable tolerability in treating an advanced HCC patient population in a hepatitis B-endemic area. The presence of lung metastasis predicts poor response to sorafenib in advanced HCC patients.
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Affiliation(s)
- Thomas Yau
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Chok KS, Ng KK, Poon RT, Lo CM, Fan ST. Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br J Surg 2009; 96:81-7. [PMID: 19065644 DOI: 10.1002/bjs.6358] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this retrospective study was to determine the impact of postoperative complications on the long-term outcome of curative liver resection for hepatocellular carcinoma (HCC). METHODS A total of 863 patients who had curative resection of HCC from December 1989 to December 2004 were included in the analysis. Median follow-up was 35.6 months. RESULTS Some 288 patients (33.4 per cent) developed postoperative complications. The hospital mortality rate was 5.3 per cent (46 patients). Multiple logistic regression analysis showed that older age and massive intraoperative blood loss were related to a significantly higher complication rate. Demographics of patients with and without postoperative complications were comparable. The former had significantly more blood loss (median 1.1 versus 0.7 litres; P < 0.001) and required more transfused blood (P < 0.001). The overall survival rates of patients without complications at 1, 3, 5 and 10 years were 83.6, 62.8, 51.5 and 32.1 per cent respectively. Corresponding rates for those with complications were 67.8, 52.4, 41.5 and 26.6 per cent (P = 0.004). Cox proportional hazard model analysis revealed that the presence of postoperative complications was independently associated with poor overall survival. CONCLUSION Postoperative complications can affect overall long-term survival after resection of HCC.
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Affiliation(s)
- K S Chok
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
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Abstract
BACKGROUND Radical surgery is the only curative treatment for carcinoma of gallbladder. This study aimed to evaluate the outcome of patients with carcinoma of gallbladder managed in a single institution over 16 years. METHODS From April 1988 to November 2003, 86 patients (29 males, 57 females) were diagnosed to have carcinoma of gallbladder. Tumor staging, treatment modalities and clinical outcome of these patients were evaluated. Thirty-two patients (37%) had early stage (TNM stage I or II) disease whereas 54 patients (63%) had advanced stage (TNM stage III or IV) disease. Curative treatment by surgical resection was performed in 23 patients (27%). RESULTS Overall survival was significantly better in patients with curative treatment (1-year: 85%; 2-year: 63%; 3-year: 55%) than those with palliative treatment (1-year: 11%; 2-year: 3%; 3-year: 0%; P < 0.01). Using Cox regression model, curative treatment was the only independent prognostic factor affecting overall survival of patients with carcinoma of gallbladder. A significantly better survival was associated with curative treatment compared with palliative treatment in patients with incidental gallbladder cancer. The median survival was 33.9 months for the curative treatment group versus 3 months for the palliative treatment group (P = 0.0001). CONCLUSION Favorable survival outcome can be achieved in patients with carcinoma of gallbladder after curative resection.
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Affiliation(s)
- Siu Yin Chan
- Centre for the Study of Liver Disease, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
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Ng KK, Lo CM, Liu CL, Poon RTP, Chan SC, Fan ST. Survival analysis of patients with transplantable recurrent hepatocellular carcinoma: implications for salvage liver transplant. ACTA ACUST UNITED AC 2008; 143:68-74; discussion 74. [PMID: 18209155 DOI: 10.1001/archsurg.2007.15] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS There is no difference in the survival benefit between salvage liver transplant and nontransplant therapies for recurrent hepatocellular carcinoma (HCC). DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS Sixty patients developed transplantable intrahepatic recurrent HCC after curative resection. Twelve patients received salvage liver transplant, whereas 48 received nontransplant therapies, including a second surgical resection, radiofrequency ablation, transarterial chemoembolization, and percutaneous ethanol injection. MAIN OUTCOME MEASURES The overall survival rates were compared between the 2 groups. Clinicopathologic variables were evaluated by univariate and multivariate analyses for their influence on overall survival. RESULTS There was no significant difference in overall survival rates between the salvage transplant and nontransplant groups. In the nontransplant group, pTNM (pathologic TNM) staging at primary resection and the time from primary resection to tumor recurrence were identified as independent prognostic factors affecting overall survival. These 2 factors carried no prognostic value in the salvage transplant group. Patients in the salvage transplant group with stage II tumors before the primary resection or intrahepatic recurrence within 12 months of the primary resection had significantly better overall survival than did the nontransplant group with corresponding poor prognostic factors. CONCLUSIONS Patients with transplantable intrahepatic recurrence can be treated effectively by salvage transplant or nontransplant therapies. Salvage transplant may be more beneficial to patients with stage II tumors before the primary resection and those with early intrahepatic recurrence.
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Affiliation(s)
- Kelvin K Ng
- FRCS(Glasg), FRCS(Edin), FACS, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong
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Ribero D, Curley SA, Imamura H, Madoff DC, Nagorney DM, Ng KK, Donadon M, Vilgrain V, Torzilli G, Roh M, Vauthey JN. Selection for Resection of Hepatocellular Carcinoma and Surgical Strategy: Indications for Resection, Evaluation of Liver Function, Portal Vein Embolization, and Resection. Ann Surg Oncol 2008; 15:986-92. [DOI: 10.1245/s10434-007-9731-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 07/13/2007] [Accepted: 07/17/2007] [Indexed: 12/15/2022]
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Ng KK, Poon RT, Lo CM, Yuen J, Tso WK, Fan ST. Analysis of recurrence pattern and its influence on survival outcome after radiofrequency ablation of hepatocellular carcinoma. J Gastrointest Surg 2008; 12:183-91. [PMID: 17874276 DOI: 10.1007/s11605-007-0276-y] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 07/19/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is an effective local ablation therapy for hepatocellular carcinoma (HCC) with favorable long-term outcome. There is no data on the analysis of recurrence pattern and its influence on long-term survival outcome after RFA in HCC patients. AIM OF STUDY To evaluate the tumor recurrence pattern and its influence on long-term survival in patients with HCC treated with RFA. PATIENTS AND METHODS From April 2001 to January 2005, 209 patients received RFA using internally cooled electrode as the sole treatment modality for HCC. Among them, 117 patients (56%) had unresectable HCC because of bilobar disease, poor liver function, and/or high medical risk for resection; whereas 92 patients (44%) underwent RFA as the primary treatment for small resectable HCC. The ablation procedure was performed through percutaneous (n=101), laparoscopic (n=17), or open approaches (n=91). The tumor recurrence pattern and long-term survival were analyzed. Multivariate analysis was carried out to identify independent prognostic factors affecting the overall survival of patients. RESULTS The mortality and morbidity rates were 0.9 and 15.7%, respectively. Complete tumor ablation was achieved in 192 patients (92.7%). With a median follow-up period of 26 months, local recurrence occurred in 28 patients (14.5%). Same segment and different segment intrahepatic recurrence occurred in 30 patients (15.6%) and 78 patients (40.6%), respectively. Twenty patients (10.4%) developed distant extrahepatic metastases. The overall 1-, 3-, and 5-year survival rates were 87.2, 66.6, and 42%, respectively. Different segment intrahepatic recurrence and distant recurrence after RFA carried significant poor prognostic influence on overall survival outcome. Using multivariate analysis, Child-Pugh grade (risk ratio [RR]=2.918, 95% confident interval [CI] 1.704-4.998, p=0.000), tumor size (RR=1.231, 95% CI 1.031-1.469, p=0.021), and pattern of recurrence (risk ratio [RR]=1.464, 95% CI 1.156-1.987, P=0.020) were identified as independent prognostic factors for overall survival. CONCLUSION The tumor recurrence pattern after RFA carries significant prognostic value in relation to overall survival. Long-term regular surveillance and aggressive treatment strategy are required for patients with different segment intrahepatic recurrence to optimize the benefits of RFA.
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Affiliation(s)
- Kelvin K Ng
- Department of Surgery, The University of Hong Kong Medical Center, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
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Khan MR, Poon RTP, Ng KK, Chan AC, Yuen J, Tung H, Tsang J, Fan ST. Comparison of percutaneous and surgical approaches for radiofrequency ablation of small and medium hepatocellular carcinoma. ACTA ACUST UNITED AC 2007; 142:1136-43; discussion 1143. [PMID: 18086979 DOI: 10.1001/archsurg.142.12.1136] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
HYPOTHESIS Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) can be performed by percutaneous or surgical approach. Tumor size is an important consideration while deciding the treatment approach. DESIGN Case series with prospective data collection. SETTING A tertiary referral center. PATIENTS A total of 228 patients who underwent RFA of small (</= 3 cm; n = 155) and medium (3.1-5 cm; n = 73) HCC by percutaneous or surgical approach. MAIN OUTCOME MEASURES Complete ablation rate, post-RFA complications, treatment-related mortality, and overall and disease-free survival. RESULTS In patients with small HCC, the complete ablation rate was 95% with both approaches (P > .99). Complication rate (P < .001) and hospital stay (P < .001) were higher with the surgical approach. One-year and 3-year survival rates were 91% and 71%, respectively, in the percutaneous group, and 89% and 57%, respectively, in the surgical group (P = .30). In patients with medium HCC, the complete ablation rate was similar between the surgical and the percutaneous groups (92% vs 95%; P = .48), and the complication rate was also comparable (P = .17). The 1-year and 3-year survival rates were 92% and 68%, respectively, in the surgical group, significantly superior to the corresponding rates of 81% and 42% in the percutaneous group (P = .03). CONCLUSIONS In patients with small HCC, the percutaneous approach achieved similar tumor control with lower morbidity compared with the surgical approach and should be the preferred approach provided that tumor location is suitable. For medium HCC, the surgical approach seems to achieve better overall survival and may be a preferred option.
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Affiliation(s)
- Muhammad Rizwan Khan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, China
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Lam VWT, Ng KK, Chok KSH, Cheung TT, Yuen J, Tung H, Tso WK, Fan ST, Poon RTP. Incomplete ablation after radiofrequency ablation of hepatocellular carcinoma: analysis of risk factors and prognostic factors. Ann Surg Oncol 2007; 15:782-90. [PMID: 18095030 DOI: 10.1245/s10434-007-9733-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 10/16/2007] [Accepted: 10/16/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Complete ablation rates after a single session of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) vary from 48% to 97%. Limited data are available regarding risk factors and prognostic significance of incomplete ablation. METHODS Between April 2001 and March 2006, 298 patients underwent RFA of 393 HCC nodules with an intent of complete ablation after a single session. Risk factors for incomplete ablation and its effect on overall survival were analyzed. RESULTS Two hundred seventy-three (91.6%) underwent complete tumor ablation, whereas the other 25 (8.4%) underwent incomplete tumor ablation after a single session of RFA. By multivariate analysis, tumor size > 3 cm (P = .049) was found to be the only independent risk factor for incomplete ablation. There was no statistically significant difference in overall survival between patients with complete and incomplete ablation. By univariate analysis, no previous transarterial chemoembolization (TACE), preoperative serum alfa-fetoprotein < or = 100 microg/mL, and complete response after further treatment of incomplete ablation were associated with better overall survival in patients with incomplete ablation. CONCLUSIONS This study demonstrated that incomplete ablation after RFA of HCC was associated with tumor size > 3 cm. Our data also suggest that aggressive further treatment of tumors with incomplete ablation aiming at complete tumor response improves overall survival.
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Affiliation(s)
- Vincent Wai-To Lam
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Yau T, Chan P, Wong H, Ng KK, Chok SH, Cheung TT, Lam V, Epstein RJ, Fan ST, Poon RTP. Efficacy and tolerability of low-dose thalidomide as first-line systemic treatment of patients with advanced hepatocellular carcinoma. Oncology 2007; 72 Suppl 1:67-71. [PMID: 18087184 DOI: 10.1159/000111709] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
OBJECTIVE The systemic treatment of advanced hepatocellular carcinoma (HCC) has produced disappointing results thus far. HCC is a hypervascular tumor with over-expression of angiogenic factors such as vascular endothelial growth factor. Thalidomide is an anti-neoplastic agent with anti-angiogenic and other mechanisms of action. We aim to evaluate the efficacy and toxicity of low-dose (100 mg) thalidomide as the first-line treatment of advanced HCC. METHODS Between August 2003 and March 2007, 45 patients who had received thalidomide 100 mg daily as first-line treatment of advanced HCC were reviewed retrospectively. Advanced HCC was defined as either metastatic or not amenable to surgical or locoregional therapies. Diagnosis of HCC was based on clinical, biochemical and radiological grounds. Survival was analyzed by the Kaplan-Meier method. RESULTS Thirty-eight patients were evaluable for response and toxicity. Two (5%) patients had partial response and 8 (21%) had stable disease. The overall median survival of patients in this cohort was 3.2 months (95% CI: 2.8-3.7 months). The common toxicities were somnolence (13%), peripheral neuropathy (11%) and ankle edema (8%), with no grade 3 or 4 toxicities and treatment-related deaths. CONCLUSION Our study shows that a single agent, low-dose thalidomide has a modest clinical activity with good tolerability in treating advanced HCC patients.
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Affiliation(s)
- Thomas Yau
- Department of Medicine, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Poon RTP, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, Wong J. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 2007; 246:425-33; discussion 433-5. [PMID: 17717446 PMCID: PMC1959348 DOI: 10.1097/sla.0b013e3181492c28] [Citation(s) in RCA: 297] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy. External drainage of pancreatic duct with a stent has been shown to reduce pancreatic fistula rate of pancreaticojejunostomy in a few retrospective or prospective nonrandomized studies, but no randomized controlled trial has been reported thus far. This single-center prospective randomized trial compared the results of pancreaticoduodenectomy with external drainage stent versus no stent for pancreaticojejunal anastomosis. METHODS A total of 120 patients undergoing pancreaticoduodenectomy with end-to-side pancreaticojejunal anastomosis were randomized to have either an external stent inserted across the anastomosis to drain the pancreatic duct (n = 60) or no stent (n = 60). Duct-to-mucosa anastomosis was performed in all cases. RESULTS The 2 groups were comparable in demographic data, underlying pathologies, pancreatic consistency, and duct diameter. Stented group had a significantly lower pancreatic fistula rate compared with nonstented group (6.7% vs. 20%, P = 0.032). Radiologic or surgical intervention for pancreatic fistula was required in 1 patient in the stented group and 4 patients in the nonstented group. There were no significant differences in overall morbidity (31.7% vs. 38.3%, P = 0.444) and hospital mortality (1.7% vs. 5%, P = 0.309). Two patients in the nonstented group and none in the stented group died of pancreatic fistula. Hospital stay was significantly shorter in the stented group (mean 17 vs. 23 days, P = 0.039). On multivariate analysis, no stenting and pancreatic duct diameter <3 mm were significant risk factors of pancreatic fistula. CONCLUSION External drainage of pancreatic duct with a stent reduced leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy.
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Affiliation(s)
- Ronnie T P Poon
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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Chan FS, Ng KK, Poon RT, Yuen J, Tso WK, Fan ST. Duodenopleural Fistula Formation After Percutaneous Radiofrequency Ablation for Recurrent Hepatocellular Carcinoma. Asian J Surg 2007; 30:278-82. [DOI: 10.1016/s1015-9584(08)60039-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Ng KK, Poon RT. Current treatment strategy for hepatocellular carcinoma. Saudi Med J 2007; 28:1330-8. [PMID: 17768455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
With the current practice of surveillance programs in high-risk patients, early stage hepatocellular carcinoma HCC is commonly diagnosed. This poses great challenge to clinicians, in terms of prognostic estimation, patient stratification to various treatment modalities and patient management during long-term follow-up. This review focuses on the current trends in the management of HCC, with special attention to tumor staging, treatment algorithm, and outcome of various treatment modalities. According to the American Association for the Study of Liver Diseases AASLD practice guideline, Barcelona Clinic Liver Cancer BCLC staging system has fulfilled the criteria that HCC patients can be stratified into different prognostic subgroups, to which optimal treatments can be offered. Under this management scheme, curative treatments hepatic resection, liver transplantation, and percutaneous ablation would be reserved to the subgroup of patients with relatively good prognosis. For patients with advanced malignancy localized to the liver, local ablation or transarterial chemoembolization TACE may offer effective symptomatic palliation, and prolongation of patients' survival. For patients with distant metastases, no effective therapy can be offered, and symptomatic palliative care is the best option. Until now, favorable survival outcomes have been reported following hepatic resection, liver transplantation, and local ablation for HCC. Although the therapeutic effect of TACE is less pronounced than curative treatments, randomized controlled studies have proven its survival benefit for HCC patients. A comprehensive treatment algorithm involving these treatment modalities is mandatory to ensure optimal care of patients with HCC.
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Affiliation(s)
- Kelvin K Ng
- Department of Surgery, Centre for the Study of Liver Disease, The University of Hong Kong, Pokfulam, Hong Kong, China
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Poon RTP, Lau C, Pang R, Ng KK, Yuen J, Fan ST. High serum vascular endothelial growth factor levels predict poor prognosis after radiofrequency ablation of hepatocellular carcinoma: importance of tumor biomarker in ablative therapies. Ann Surg Oncol 2007; 14:1835-45. [PMID: 17406950 DOI: 10.1245/s10434-007-9366-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 01/09/2007] [Indexed: 12/23/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is a recently developed treatment for hepatocellular carcinoma (HCC). Thus far, the prognostic impact of tumor biomarkers has not been evaluated in this treatment. High serum level of vascular endothelial growth factor (VEGF) has been shown to predict microscopic vascular invasion and metastasis in HCC. This study investigated the prognostic significance of pre-treatment serum VEGF level in patients with HCC undergoing RFA treatment. METHODS Serum VEGF levels were measured using enzyme-linked immunosorbent assay in 120 patients with HCC undergoing RFA, and in 15 healthy controls. Serum VEGF levels were correlated with clinicopathological features of the HCC patients. The prognostic significance of serum VEGF levels was assessed by univariate and multivariate analyses. RESULTS The median serum VEGF level in the HCC patients was 240 pg/mL (range 17-1162), significantly higher than that of healthy controls (p = .024). The serum VEGF levels were significantly correlated with platelet counts (r = .487, p < .001) but not other clinicopathological features. Patients with serum VEGF level > 240 pg/mL had worse overall and recurrence-free survival compared with those with serum VEGF level > 240 pg/mL (p = .005 and .002, respectively). By multivariate analysis, serum VEGF level was a significant prognostic factor of both overall and recurrence-free survival. CONCLUSIONS High pre-treatment serum VEGF levels predict poor prognosis after RFA of HCC. This study highlights the importance of tumor biomarker as a prognostic predictor in ablative therapy for HCC, which has an intrinsic problem of unavailability of histopathological prognostic features.
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Affiliation(s)
- Ronnie T P Poon
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
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Chok KS, Ng KK, Poon RTP, Lam CM, Yuen J, Tso WK, Fan ST. Comparable survival in patients with unresectable hepatocellular carcinoma treated by radiofrequency ablation or transarterial chemoembolization. ACTA ACUST UNITED AC 2007; 141:1231-6. [PMID: 17178966 DOI: 10.1001/archsurg.141.12.1231] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS The survival benefits of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) are similar for patients with unresectable hepatocellular carcinoma amenable to either treatment. DESIGN Retrospective comparative study. SETTING Tertiary care institution. PATIENTS From February 22, 2001, to March 10, 2004, 91 patients with unresectable hepatocellular carcinoma (tumor diameter <5 cm and <4 tumor nodules) treated by either TACE or RFA were analyzed from a prospective database. MAIN OUTCOME MEASURES The treatment-related morbidity, mortality, overall survival, and time to disease progression. RESULTS Forty patients received TACE and 51 patients received RFA during the study period. Demographic data were comparable in both groups of patients. The treatment-related morbidities of TACE and RFA were 10% and 28%, respectively (P = .04). There was no treatment-related mortality in either group. There was 1 patient (2%) with complete tumor remission in the TACE group, and the complete ablation rate in the RFA group was 96%. The time to disease progression was similar in both groups (P = .95). The overall survival rates at 1 and 2 years were 80% and 58%, respectively, in the TACE group and 82% and 72%, respectively, in the RFA group (P = .21). CONCLUSIONS The overall survival and time for disease progression were similar in both groups of patients. In terms of the survival result, the efficacies of RFA and TACE were comparable for patients with unresectable hepatocellular carcinoma.
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Affiliation(s)
- Kenneth S Chok
- Departments of Surgery and Radiology, Centre for the Study of Liver Disease, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong
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Mulier S, Ni Y, Frich L, Burdio F, Denys AL, De Wispelaere JF, Dupas B, Habib N, Hoey M, Jansen MC, Lacrosse M, Leveillee R, Miao Y, Mulier P, Mutter D, Ng KK, Santambrogio R, Stippel D, Tamaki K, van Gulik TM, Marchal G, Michel L. Experimental and Clinical Radiofrequency Ablation: Proposal for Standardized Description of Coagulation Size and Geometry. Ann Surg Oncol 2007; 14:1381-96. [PMID: 17242989 DOI: 10.1245/s10434-006-9033-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 04/03/2006] [Indexed: 12/22/2022]
Abstract
BACKGROUND Radiofrequency (RF) ablation is used to obtain local control of unresectable tumors in liver, kidney, prostate, and other organs. Accurate data on expected size and geometry of coagulation zones are essential for physicians to prevent collateral damage and local tumor recurrence. The aim of this study was to develop a standardized terminology to describe the size and geometry of these zones for experimental and clinical RF. METHODS In a first step, the essential geometric parameters to accurately describe the coagulation zones and the spatial relationship between the coagulation zones and the electrodes were defined. In a second step, standard terms were assigned to each parameter. RESULTS The proposed terms for single-electrode RF ablation include axial diameter, front margin, coagulation center, maximal and minimal radius, maximal and minimal transverse diameter, ellipticity index, and regularity index. In addition a subjective description of the general shape and regularity is recommended. CONCLUSIONS Adoption of the proposed standardized description method may help to fill in the many gaps in our current knowledge of the size and geometry of RF coagulation zones.
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Affiliation(s)
- Stefaan Mulier
- Department of Radiology, Gasthuisberg University Hospital, Herestraat 49, 3000 Leuven, Belgium
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Chow DHF, Sinn LHY, Ng KK, Lam CM, Yuen J, Fan ST, Poon RTP. Radiofrequency ablation for hepatocellular carcinoma and metastatic liver tumors: a comparative study. J Surg Oncol 2006; 94:565-71. [PMID: 17048238 DOI: 10.1002/jso.20674] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study compared the effectiveness of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and liver metastases. METHODS We compared the outcomes of 240 patients with HCC and 44 patients with liver metastases treated with RFA. Data were prospectively collected and retrospectively analyzed. Effects of different variables on recurrences were studied. RESULTS A total of 406 tumor nodules were treated. The median size of the largest ablated tumor was 2.5 cm, and the median tumor number was 1. Complete tumor ablation was achieved in 91.2%. Local recurrence rate was 15.4% after a median follow-up of 24.5 months. There was no significant impact of tumor pathology on local recurrence. However, patients with liver metastasis had higher extrahepatic recurrence rate (P = 0.019) and shorter disease-free survival (P = 0.007). Patients with multiple tumors had higher local (P = 0.047) and extrahepatic (P = 0.019) recurrence rates than those with a solitary tumor. Tumor size had an impact on local recurrence rate only in patients with liver metastasis with a higher rate in those with tumor > 2.5 cm in diameter (P = 0.028). CONCLUSIONS Tumor pathology does not appear to have a significant impact on local recurrence rates. RFA is effective in local tumor control for both HCC and liver metastasis.
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Affiliation(s)
- Danny H F Chow
- Department of Surgery, Centre for the Study of Liver Disease, The University of Hong Kong, Pokfulam, Hong Kong, China
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Ng KK, Poon RT, Lam CM, Yuen J, Tso WK, Fan ST. Efficacy and safety of radiofrequency ablation for perivascular hepatocellular carcinoma without hepatic inflow occlusion. Br J Surg 2006; 93:440-7. [PMID: 16470712 DOI: 10.1002/bjs.5267] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of radiofrequency ablation (RFA) for perivascular (up to 5 mm from the major intrahepatic portal vein or hepatic vein branches) hepatocellular carcinoma (HCC) is unclear because of possible incomplete tumour ablation and potential vascular damage. This study aimed to evaluate the safety and efficacy of RFA for perivascular HCC without hepatic inflow occlusion. METHODS Between May 2001 and November 2003, RFA using an internally cooled electrode was performed on 52 patients with perivascular HCC (group 1) through open (n = 39), percutaneous (n = 9), laparoscopic (n = 2) and thoracoscopic (n = 2) approaches. Hepatic inflow occlusion was not applied during the ablation procedure. The perioperative and postoperative outcomes were compared with those of 90 patients with non-perivascular HCC (group 2) treated by RFA during the same period. RESULTS The morbidity rate was similar between groups 1 and 2 (25 versus 28 per cent; P = 0.844). One patient in group 1 (2 per cent) and two in group 2 (2 per cent) had developed thrombosis of major intrahepatic blood vessels on follow-up computed tomography scan. There were no significant differences between groups 1 and 2 in mortality rate (2 versus 0 per cent; P = 0.366), complete ablation rate for small HCC (92 versus 98 per cent; P = 0.197), local recurrence rate (11 versus 9 per cent; P = 0.762) and overall survival (1-year: 86 versus 87 per cent; 2-year: 75 versus 75 per cent; P = 0.741). CONCLUSION RFA without hepatic inflow occlusion is a safe and effective treatment for perivascular HCC.
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Affiliation(s)
- K K Ng
- Centre for the Study of Liver Disease, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China.
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Abstract
BACKGROUND Large-volume hepatic radiofrequency ablation (RFA) has been used to treat large liver tumors, but its safety limit is unknown. This study aimed to investigate the possible systemic responses of large-volume hepatic RFA and to estimate its safety limit in normal and cirrhotic rats. HYPOTHESIS Large-volume hepatic RFA causes a significant systemic inflammatory reaction. DESIGN Experimental study. SETTING University teaching hospital. INTERVENTION Using the Cool-tip RF System (Radionics, Burlington, Mass), RFA was performed for different percentages of the liver volume by weight in normal and cirrhotic Sprague-Dawley rats. MAIN OUTCOME MEASURES Changes in concentrations of serum inflammatory markers (tumor necrosis factor alpha [TNF-alpha] and interleukin [IL] 6), functions of various end organs, and survival rates were assessed. RESULTS In the normal liver groups, the concentrations of TNF-alpha and IL-6 were significantly elevated in the early postoperative period when 50% (mean +/- SD TNF-alpha concentration, 130.3 +/- 15.6 pg/mL; mean +/- SD IL-6 concentration, 163.2 +/- 12.2 pg/mL) and 60% (mean +/- SD TNF-alpha concentration, 145.7 +/- 13.0 pg/mL; mean +/- SD IL-6 concentration, 180.8 +/- 11.0 pg/mL) of the liver volume were ablated compared with the control group (mean +/- SD TNF-alpha concentration, 30.4 +/- 9.9 pg/mL, P<.001; mean +/- SD IL-6 concentration, 28.4 +/- 6.7 pg/mL, P<.001). The concentrations of TNF-alpha and IL-6 in other groups remained similar to those in the control group. Thrombocytopenia, prolonged clotting time, and interstitial pneumonitis occurred when 50% and 60% of the liver volume were ablated. The 4-week survival rates were 100%, 60%, and 0% when 40%, 50%, and 60%, respectively, of the liver volume were ablated. Similar systemic inflammatory responses and poor survival rates were observed among the cirrhotic liver groups when 30% and 40% of the liver volume were ablated. CONCLUSIONS The normal rats can tolerate RFA of 40% of the liver volume with minimal morbidity and no mortality whereas the cirrhotic rats can only tolerate 20% of the ablated liver volume. Beyond that limit, RFA would cause significant systemic inflammatory responses and poor survival.
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Affiliation(s)
- Kelvin K Ng
- Centre for the Study of Liver Disease and Departments of Surgery and Pathology, University of Hong Kong, Pokfulam, Hong Kong.
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Tam TKW, Lau CM, Tsang LCY, Ng KK, Ho KS, Lai TC. Epidemiological study of diabetic retinopathy in a primary care setting in Hong Kong. Hong Kong Med J 2005; 11:438-44. [PMID: 16340019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVES To estimate the prevalence and risk factors of diabetic retinopathy in type 2 diabetic patients, and to investigate the difference in retinopathy progression in patients with normal fundi or established retinopathy at baseline and the risk factors implicated in the progression. DESIGN Retrospective community-based study. SETTING Ten primary care clinics in Hong Kong. PATIENTS Type 2 diabetic patients; subsidiary analysis included subjects with more than one screening event. MAIN OUTCOME MEASURES Patient demographics, baseline prevalence, and risk factors of diabetic retinopathy; progression of retinopathy in patients with normal fundi and established retinopathy at baseline, and the associated risk factors. RESULTS A total of 6165 patients were recruited from January 1998 to May 2004. Primary analysis included 4423 patients with good-quality retinal photographs. The mean age of the patients was 60.36 years (standard deviation, 10.80 years; range, 28-94 years), the mean duration of diabetes was 4.71 years (standard deviation, 4.67 years; range, 0.1-40.6 years), and the mean level of glycated haemoglobin was 7.47% (standard deviation, 1.44%). The prevalence of retinopathy at baseline was 28.4%. Subsidiary analysis showed progression to sight-threatening retinopathy was more common in the group with baseline retinopathy than that without (7.9% vs 0.7%), and occurred at a faster rate (mean, 1.5 [range, 0.5-3.0] vs 2.0 [1.0-4.2] years). Logistic regression revealed that the level of glycated haemoglobin was positively associated with both the onset (P<0.001) and progression of retinopathy (P=0.03). CONCLUSION Optimal glycaemic control is important for reducing sight-threatening retinopathy. Close observation is required for patients with established retinopathy as progression occurs more rapidly.
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Affiliation(s)
- T K W Tam
- Professional Development and Quality Assurance, Department of Health, 2/F Ngautaukok Jockey Club Clinic, 60 Ting On Street, Hong Kong.
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Abstract
Radiofrequency ablation (RFA) has been widely practiced to treat unresectable malignant liver tumors. It has the merits of localized tumor ablation and preservation of maximal normal liver parenchyma. In recent years, there has been a tremendous expansion in the application of RFA for patients with malignant liver tumors. However, the therapeutic effect of this local ablation treatment needs to be balanced against its risks and possible local failure. This review focuses on the current status of RFA for malignant liver tumors, with special attention to the indication, approaches, complications, survival benefits, combination therapies, and comparison with other treatment modalities. Although the results of most clinical studies of RFA seem favorable, the associated risks and tumor recurrence should not be underestimated. Careful patient selection, meticulous RFA techniques, and prompt treatment of residual and recurrent tumors are necessary to ensure a better outcome after RFA. Until recently, there has been no strong evidence showing that RFA can replace any other treatment modalities in the management of liver tumors. Nonetheless, more convincing evidence by randomized trials is required for the establishment of a treatment protocol of RFA for patients with malignant liver tumors.
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Affiliation(s)
- Kelvin K Ng
- Department of Surgery, Centre for the Study of Liver Disease, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
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