ObjectiveTo find out the risk factors affecting the prognoses and microvascular invasion (MVI) of patients with China Liver Cancer Staging-stageⅠ a (CNLC Ⅰ a) hepatocellular carcinoma (HCC). MethodsBased on the established inclusion and exclusion criteria, the clinicopathologic information and follow-up data of patients with CNLC Ⅰ a HCC were retrospectively collected, who underwent radical resection in the West China Hospital of Sichuan University from Jan. 2012 to Dec. 2016. The Cox proportional hazards regression was utilized to analyze the risk factors affecting the prognosis of patients with CNLC Ⅰ a HCC, and the non-conditional logistic regression was utilized to analyze the preoperative clinical indicators associating with MVI. ResultsA total of 300 patients with CNLC Ⅰ a HCC were included in this study, among which 51 (17.0%) cases accompanied with MVI. The follow-up period ranged from 2 to 104 months (median 39 months), with a recurrence time ranging from 2 to 104 months (median 52 months), and an overall survival time ranging from 3 to 104 months (median 98 months). During the follow-up period, postoperative recurrence occurred in 145 (48.3%) cases. The Cox proportional hazards regression analysis revealed that: tumor diameter >3 cm, presences of MVI and satellite nodules increased the risk of shortened recurrence time for the patients with CNLC Ⅰ a HCC (P<0.05); Factors including gamma-glutamyltranspeptidase level >60 U/L, tumor low differentiation, presences of MVI and satellite nodules were associated with shortened overall survival time for the patients with CNLC Ⅰ a HCC (P<0.05). The preoperative alpha-fetoprotein level ≥400 μg/L and tumor diameter >3 cm increased the risk of presence of MVI for the patients with CNLC Ⅰ a HCC [χ2=3.059, OR(95%CI)=2.357(1.047, 5.306), P=0.038; χ2=3.002, OR(95%CI)=2.301(1.026, 5.162), P=0.043]. ConclusionThe results of this study suggest that adopting corresponding strategies to address the risk factors affecting prognosis of patients with CNLC Ⅰ a HCC and the risk factors associated with MVI can have a significant clinical impact on improving surgical treatment outcomes for these patients.
Objective To summarize the research progress of magnetic resonance imaging (MRI) in evaluating microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in order to provide information and evidence for therapy of HCC. Methods Papers published from May 1950 to May 2017, were retrieved in PubMed, OVID, CNKI database using the keywords on hepatocellular carcinoma, microvascular invasion, and magnetic resonance imaging. Sixty-seven papers were retrieved in English literatures and 13 in Chinese literatures. Criteria of paper adoption: ① the imaging method was MRI; ② the assessment content was MVI of HCC; ③ the golden standard was postoperative pathologic diagnosis. fifty-four papers were finally analyzed and reviewed. Results Currently there were various ways to evaluating the MVI of HCC using MRI, including morphology, texture analysis, diffusion-weighted imaging, dynamic-enhanced MRI, fat assessment, hepatocellular function and comprehensive evaluation. Conclusions Various methods perform differently in evaluating MVI. The use of multiparametric MRI techniques offers the potential for comprehensive assessment of MVI of HCC.
ObjectiveTo assess the feasibility of intravoxel incoherent motion diffusion-weighted imaging (IVIM) in evaluating microvessel density (MVD) and microvascular invasion (MVI) of hepatocellular carcinoma (HCC).MethodsRat models were established to be scanned by IVIM. HCC lesions corresponding to IVIM image were examined pathologically to get data of MVD and MVI. Spearman correlation analysis was used to compare the apparent diffusion coefficient (ADC), D, D*, and f with MVD, independent samples t test was used to compare ADC, D, D*, and f between MVI (+) and MVI (–) groups.ResultsFifty HCC lesions were included finally. ADC and D values both showed a negative correlation with MVD (r=–0.406, P=0.003; r=–0.468, P=0.001), D* and f showed no statistical correlation with MVD (P=0.172, 0.074, respectively). The differences in ADC and all the IVIM parameters (D, D*, and f) between MVI (+) and MVI (–) HCCs were not statistically significant (P=0.393, 0.395, 0.221, 0.550).ConclusionADC and D can be used to evaluate MVD of HCC, but ADC and IVIM parameters were limited in evaluating MVI.
ObjectiveTo assess value of preoperative clinical data and enhanced CT imaging features in predic-tion of microvascular invasion (MVI) and early recurrence (recurrence in one year) after curative resection for hepatoce-llular carcinoma (HCC). MethodsA retrospective analysis was conducted for 150 patients with HCC who underwent curative tumor resection in West China Hospital of Sichuan University from April 2014 to May 2015. The roles of preoperative CT characteristics and clinical data on MVI and early recurrence after curative tumor resection were evaluated by univariate and multivariate analyses. Resultscompared with HCC with no MVI and no early recurrence after curative resection, univariate analysis results showed that HCC with MVI and early recurrence had larger tumor size (P=0.002, P=0.005), a higher proportion of non-smooth tumor margin (P<0.001, P<0.001), and tumor multifocality (P=0.005, P=0.038), HCC with MVI had a higher proportion of incomplete tumor capsule (P=0.032), HCC with early recurrence had a higher proportion of incomplete and absence tumor capsules (P=0.038) and a faster washout on portal venous phase-the percentage attenuation ratio on the portal venous phase (P=0.049) and relative washout ratio on the portal venous phase (P=0.020) were higher. A multivariate logistic regression analysis results showed that non-smooth tumor margin (OR=7.075, P<0.001; OR=4.125, P<0.001) and tumor multifocality (OR=3.290, P=0.008; OR=2.354, P=0.047) were the independent predictors for MVI and early recurrence after curative tumor resection, HCC with early recurrence also had a faster washout on the portal venous phase (OR=1.023, P=0.017). ConclusionNon-smooth tumor margin and tumor multifocality are independent risk factors for MVI and early recurrence after curative tumor resection, and HCC with early recurrence has a faster washout on portal venous phase. Preoperative enhanced CT imaging could predict MVI and early recurrence after curative tumor resection and CT imaging findings are helpful to choose reasonable treatment and predict prognosis.
ObjectiveTo evaluate therapeutical effects of Huaier granule combined with transcatheter arterial chemoembolization (TACE) following radical resection of primary hepatocellular carcinoma with microvascular invasion. MethodsThe clinical data of 45 cases of primary hepatocellular carcinoma with microvascular invasion underwent Huaier granule combined with transcatheter arterial chemoembolization (TACE) following radical resection from June 2010 to June 2013 in Liaoning Cancer Hospital were retrospectively analyzed. These patients were divided into Huaier granule plus TACE treatment group (20 cases) and simple TACE treatment group (25 cases) according to the postoperative treatment of the patients. The immune function (CD4+/CD8+ ratio and IL-2 level), 1and 3-year tumor recurrence rates and 3-year cumulative survival rate were compared between two groups after operation. Result① The CD4+/CD8+ ratio and IL-2 level had no significant differences between the 2 groups before operation (P > 0.05), which in the Huaier granule plus TACE treatment group were significantly higher than those in the simple TACE treatment group (P < 0.05) on month 3, 6, and 12 after operation.② 1and 3-year tumor recurrence rates in the Huaier granule plus TACE treatment group were significantly lower than those in the simple TACE treatment group[15% (3/20) versus 48% (12/25), P < 0.05; 45% (9/20) versus 80% (20/25), P < 0.05]. ③ The 3-year cumulative survival rate was 75% and 68% in the Huaier granule plus TACE treatment group and the simple TACE treatment group, respectively. The survival curve analysis showed that the 3-year survival rate had a decreased trend, which in the Huaier granule plus TACE treatment group was slightly higher than that in the simple TACE treatment group, but the difference had no statistical significance between the 2 groups (P > 0.05). ConclusionsAlthough the results of this study fails to confirm that Huaier granule plus TACE treatment for primary hepatocellular carcinoma with microvascular invasion following radical resection could significantly improve the 3-year cumulative survival rate, it could effectively decrease the recurrence rate. It is needed larger sample size to further explore in future research.
Objective To probe CT grading criteria of vascular invasion in pancreatic cancer. Methods Retrieved articles in CNKI and PubMed about value of CT in preoperative assessment of vascular invasion in pancreatic cancer last ten years. Results Multislice helical CT is considered the best imaging method to assess the invaded peripancreatic vessels in pancreatic cancer. There are different CT criteria of vascular invasion in pancreatic cancer based on extension of hypodense tumor and its relation to blood vessels, on the degree of circumferential contiguity of tumor to vessel, on the degree of lumen stenosis, and on the degree of contiguity between tumor and vessels combined vascular caliber. Conclusion CT grading criteria are not uniform, each one has defects.
目的：探讨胆囊癌肝侵犯的CT诊断及临床价值。方法：回顾性分析经手术、病理证实的17例胆囊癌肝侵犯CT资料。结果：肿块型11例，腔内型2例，厚壁型4例。侵犯肝左内叶5例，肝右叶前段3例，同时侵犯肝左内叶及右叶前段9例。5例侵犯深度＜2 cm，12例侵犯深度＞2 cm。CT表现为胆囊窝脂肪间隙消失，邻近胆囊窝的肝脏组织内出现不规则形低密度影，边界模糊，胆囊癌肿与肝脏组织分界不清，增强后肝内病灶不规则强化。结论：CT对胆囊癌肝侵犯的诊断及临床分期、治疗方案的选择具有重要价值。
Objective To summarize the research progress of MRI in the assessment of rectal cancer before surgery. Methods Literatures about the recent studies on the research progress of MRI in the assessment of rectal cancer before surgery were reviewed according to the results searched from Pubmed, CNKI, and WanFang database. Results Preoperative staging, circumferential resection margin, and extramural vascular invasion were closely related to the prognosis of rectal cancer patients, MRI could provide a good assessment of preoperative staging, circumferential resection margin, and extramural vascular invasion for rectal cancer patients, but it still had some deficiencies which needed further studies. Conclusion Application of MRI in the assessment of preoperative staging, circumferential resection margin, and extramural vascular invasion before surgery, is conducive to the development of the most appropriate treatment options for patients with rectal cancer.
Objective To determine the most appropriate T-stage and surgical resection range of non-small cell lung cancer(NSCLC) with adjacent lobe invasion (ALI). Methods Fifty one NSCLC patients who were confirmed as direct ALI were divided into an ALI-T2 and an ALI-T3 group according to the eighth edition of TNM classification. Cases were matched by propensity score matching method at a ratio of 2∶1. The overall survival (OS), progression free survival (PFS), postoperative hospitalization, and postoperative complications among the groups were compared. Results Patients' characteristics were comparable among the groups. Three-year or 5-year survival rate in the ALI-T2 group, the single-lobe invasion T2 (SLI-T2) group, and the T3 (SLI-T3) group was 73.90% and 61.60%, 89.60% and 89.60%, 68.90% and 61.20%, respectively. The OS of SLI-T2 group was significantly higher than that of the ALI-T2 ( P=0.042) group and with similar survival in the SLI-T3 group( P=0.955). In the survival analysis of the ALI-T3 group, the 3-year or 5-year OS of the SLI-T3 group was 70.80% and 65.70%, respectively, while in the poorest prognosis ALI-T3 group was only 31.60% and 21.00% ( P=0.009), respectively. However, no statistical difference was detected between the ALI-T3 and SLI-T4 groups ( P=0.343). The PFS of the patients in the ALI-T3 group was closer to the SLI-T4 group level while lower than that of the SLI-T3 group, but the trend had not been confirmed by statistical analysis ( P 1=0.071, P 2=0.648). The OS and PFS did not differ between the patients undergoing a lobectomy plus wedge resection (LWR) and those undergoing a bilobectomy or pneumonectomy. Compared with a bilobectomy or pneumonectomy, LWR had distinct advantages in the postoperative hospital stay (6.90±3.11days vs. 9.23± 4.43 days, P=0.030), the postoperative duration of drainage (4.41±2.98 days vs. 6.50±4.11 days, P=0.041) and complication rates (4.00% vs. 31.58%, P=0.032). Conclusions We believe that T1-2 stage tumor invading adjacent lobe should be classified as T3 and ALI-T3 tumor should be revised as T4. Beside that, LWR could be considered as a reasonable surgical option for patients with lesser invasive depth (less than 2 cm) in the adjacent lobes.
ObjectiveTo explore the influence of 5 mm surgical margin (SM) width on the prognosis of patients with solitary hepatocellular carcinoma (HCC) and the influence of tumor size and microvascular invasion (MVI) on strategic decision of SM width.MethodsThe clinicopathologic data of patients with solitary HCC underwent the surgical resection in the West China Hospital of Sichuan University from January 2014 to September 2015 were collected. According to the inclusion and exclusion criteria of this study, the prognostic differences of the patients with SM≤5 mm and SM>5 mm were compared after the propensity score matching (PSM), and the influences of the 5 mm SM on the recurrence-free survival rate of large HCC (>5 cm) or small HCC (≤5 cm) and MVI positive or negative patients were analyzed.ResultsA total of 266 eligible patients were included, with a median overall survival of 40.01 months and a median recurrence-free survival of 37.01 months. During the follow-up period, 137 patients recurred and 75 patients died. After PSM, the basic indexes had no significant differences between the patients with SM>5 mm (n=78) and SM≤5 mm (n=78). The results of the multivariate Cox regression analysis showed that the tumor size and MVI were the important factors of the recurrence-free survival (P<0.05) and the tumor size, MVI, HBeAg, and alpha-fetoprotein (AFP) were the important factors of the overall survival (P<0.05) before the PSM; while the MVI and SM were the important factors of the recurrence-free survival (P<0.05), the gender, AFP, and MVI were the important factors of the overall survival (P<0.05) after the PSM. The recurrence-free survival rate of the patients with SM >5 mm had better than that with SM≤5 mm after the PSM, but the overall survival had no difference. In the MVI negative and large HCC subgroups, the patients with SM>5 mm showed the better recurrence-free survival rate. However, in the MVI positive and small HCC subgroups did not show any differences in the recurrence-free survival rate for the different SM widths.ConclusionsAccording to the results of this study, a wider SM (>5 mm) could improve recurrence-free survival in patients with a single tumor within BCLC stage 0/A. For patients without MVI or large HCC, SM>5 mm might be adequate. However, for patients with MVI or small HCC, the determination of an appropriate SM width needs further to be investigated.