scholarly journals Effect of surgical margin in R0 hepatectomy on recurrence-free survival of patients with solitary hepatocellular carcinomas without macroscopic vascular invasion

Medicine ◽  
2016 ◽  
Vol 95 (44) ◽  
pp. e5251 ◽  
Author(s):  
Sheng Dong ◽  
Zusen Wang ◽  
Liqun Wu ◽  
Zhiqiang Qu
Keyword(s):  
Vascular Invasion ◽  
Surgical Margin ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Hepatocellular Carcinomas ◽  
Macroscopic Vascular Invasion

scholarly journals Combination Therapy after TACE for Hepatocellular Carcinoma with Macroscopic Vascular Invasion: Stereotactic Body Radiotherapy versus Sorafenib

Cancers ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 516 ◽  
Author(s):  
Lujun Shen ◽  
Mian Xi ◽  
Lei Zhao ◽  
Xuhui Zhang ◽  
Xiuchen Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Stereotactic Body Radiotherapy ◽  
Vascular Invasion ◽  
Progression Free Survival ◽  
Sorafenib Treatment ◽  
Free Survival ◽  
Sorafenib Group ◽  
Treatment Responses ◽  
Hepatic Lesions ◽  
Macroscopic Vascular Invasion

Stereotactic body radiotherapy (SBRT) has shown promising results in the control of macroscopic vascular invasion in patients with hepatocellular carcinoma (HCC); however, its efficacy in comparison to sorafenib when combined with transarterial chemoembolization (TACE) remains to be determined. Between 2009 and 2017, 77 HCC patients with macroscopic vascular invasion receiving TACE–SBRT or TACE–sorafenib combination therapies were enrolled. The best treatment responses, overall survival (OS), and progression-free survival (PFS) of the two treatment arms were compared. Of the patients enrolled, 26 patients (33.8%) received TACE–SBRT treatment, and 51 (66.2%) received TACE–sorafenib treatment. The patients in the TACE–SBRT group were more frequently classified as elder in age (p = 0.012), having recurrent disease (p = 0.026), and showing lower rates of multiple hepatic lesions (p = 0.005) than patients in TACE–sorafenib group. After propensity score matching (PSM), 26 pairs of well-matched HCC patients were selected; patients in the TACE–SBRT group showed better overall response rates in trend compared to those in the TACE–sorafenib group. The hazard ratio (HR) of OS to PFS for the TACE–SBRT approach and the TACE–sorafenib approach was 0.36 (95% CI, 0.17–0.75; p = 0.007) and 0.35 (95% CI, 0.20–0.62; p < 0.001), respectively. For HCC patients with macrovascular invasion, TACE plus SBRT could provide improved OS and PFS compared to TACE–sorafenib therapy.

Effect of transarterial chemoembolization plus external beam radiotherapy on survival of patients with hepatocellular carcinoma showing macroscopic vascular invasion compared with sorafenib: A randomized trial.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 210-210
Author(s):  
Sang MIN Yoon ◽  
So Jung Lee ◽  
Jong Hoon Kim ◽  
Ji Hoon Shin ◽  
Jihyun An ◽  
...  
Keyword(s):  
Disease Progression ◽  
Vascular Invasion ◽  
Response Rate ◽  
External Beam Radiotherapy ◽  
Progression Free Survival ◽  
External Beam ◽  
Free Survival ◽  
Advanced Hcc ◽  
Sorafenib Group ◽  
Macroscopic Vascular Invasion

210 Background: Sorafenib is the sole treatment option for advanced stage hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI) with unsatisfactory response rate and survival benefit. Combined transarterial chemoembolization (TACE) plus external beam radiotherapy (RT) has shown promising results in these patients by observational studies. Here, we report the efficacy and safety of TACE plus RT compared to sorafenib in patients with advanced HCC and MVI. Methods: This study was a randomized, open-label trial at an academic tertiary care center. Between 2013 and 2016, 90 treatment-naive patients with liver-confined HCC showing MVI were randomly assigned to receive sorafenib (400 mg twice-daily; n = 45; sorafenib group) or TACE (every 6 weeks) plus RT (within 3 weeks after the first TACE; n = 45; TACE+RT group). Primary endpoint was 12-week the progression-free survival (PFS) rate by intention-to-treat analysis. Radiologic response was assessed by independent review according to Response Evaluation Criteria in Solid Tumors (version 1.1). Crossover of treatment was permitted after confirming disease progression. Results: All patients had portal vein invasion of HCC and Child-Pugh class A liver function. The median maximal tumor diameter was 9.7 cm. At week 12, the PFS rate was significantly higher in the TACE+RT group than the sorafenib group (77.8% vs. 26.7%; P< 0.001). The TACE+RT group showed significantly higher radiologic response rate (33.3% vs. 2.2% at 24 weeks; P< 0.001), significantly longer median time to disease progression (30 weeks vs. 8 weeks; P< 0.001), and significantly longer overall survival (55 weeks vs. 43 weeks; P= 0.04), compared with the sorafenib group. No patients in the TACE+RT group discontinued treatment due to hepatic decompensation. Conclusions: In patients with advanced HCC showing MVI, first-line treatment with TACE+RT was well-tolerated and provided improved progression-free survival, objective response rate, time to disease progression, and overall survival, compared with sorafenib treatment. Clinical trial information: NCT01901692.

scholarly journals Locally recurrent chondrosarcoma of the pelvis and limbs can only be controlled by wide local excision

2019 ◽  
Vol 101-B (3) ◽  
pp. 266-271 ◽  
Author(s):  
M. K. Laitinen ◽  
M. C. Parry ◽  
L-R. Le Nail ◽  
C. H. Wigley ◽  
J. D. Stevenson ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Primary Tumour ◽  
Surgical Margin ◽  
Recurrence Free Survival ◽  
Disease Specific Survival ◽  
Univariable Analysis ◽  
Free Survival ◽  
Local Recurrence Free Survival ◽  
Disease Specific ◽  
Significant Factors

Aims The purpose of this study was to investigate the potential for achieving local and systemic control after local recurrence of a chondrosarcoma of bone Patients and Methods A total of 126 patients with local recurrence (LR) of chondrosarcoma (CS) of the pelvis or a limb bone were identified from a prospectively maintained database, between 1990 and 2015 at the Royal Orthopaedic Hospital, Birmingham, United Kingdom. There were 44 female patients (35%) and 82 male patients (65%) with a mean age at the time of LR of 56 years (13 to 96). The 126 patients represented 24.3% of the total number of patients with a primary CS (519) who had been treated during this period. Clinical data collected at the time of primary tumour and LR included the site (appendicular, extremity, or pelvis); primary and LR tumour size (in centimetres); type of operation at the time of primary or LR (limb-salvage or amputation); surgical margin achieved at resection of the primary tumour and the LR; grade of the primary tumour and the LR; gender; age; and oncological outcomes, including local recurrence-free survival and disease-specific survival. A minimum two years’ follow-up and complete histopathology records were available for all patients included in the study. Results For patients without metastases prior to or at the time of local recurrence, the disease-specific survival after local recurrence was 62.5% and 45.5% at one and five years, respectively. After univariable analysis, significant factors predicting disease-specific survival were grade (p < 0.001) and surgical margin (p = 0.044). After multivariable analysis, grade, increasing age at the time of diagnosis of local recurrence, and a greater time interval from primary surgery to local recurrence were significant factors for disease-specific survival. A secondary local recurrence was seen in 26% of patients. Wide margins were a good predictor of local recurrence-free survival for subsequent recurrences after univariable analysis when compared with intralesional margins (p = 0.002) but marginal margins did not reach statistical significance when compared with intralesional margins (p = 0.084) Conclusion In cases of local recurrence of a chondrosarcoma of bone, we have shown that if the tumour is non-metastatic at re-staging, an increase in disease-specific survival and in local recurrence-free survival is achievable, but only by resection of the local recurrence with a wide margin. Cite this article: Bone Joint J 2019;101-B:266–271.

scholarly journals Influence of Lymphangio (L), Vascular (V), and Perineural (Pn) Invasion on Recurrence and Survival of Resected Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (11) ◽  
pp. 2426
Author(s):  
Fabian Bartsch ◽  
Lisa-Katharina Heuft ◽  
Janine Baumgart ◽  
Maria Hoppe-Lotichius ◽  
Rabea Margies ◽  
...  
Keyword(s):  
Overall Survival ◽  
Intrahepatic Cholangiocarcinoma ◽  
Vascular Invasion ◽  
Tumor Recurrence ◽  
Perineural Invasion ◽  
Tnm Classification ◽  
Recurrence Free Survival ◽  
Extrahepatic Recurrence ◽  
Free Survival ◽  
Rare Malignancy

(1) Background: Intrahepatic cholangiocarcinoma (ICC) is a rare malignancy. Besides tumor, nodal, and metastatic status, the UICC TNM classification describes further parameters such as lymphangio- (L0/L1), vascular (V0/V1/V2), and perineural invasion (Pn0/Pn1). The aim of this study was to analyze the influence of these parameters on recurrence and survival. (2) Methods: All surgical explorations for patients with ICC between January 2008 and June 2018 were collected and further analyzed in our institutional database. Statistical analyses focused on perineural, lymphangio-, and vascular invasion examined histologically and their influence on tumor recurrence and survival. (3) Results: Of 210 patients who underwent surgical exploration, 150 underwent curative-intended resection. Perineural invasion was present in 41, lymphangioinvasion in 21, and vascular invasion in 37 patients (V1 n = 34, V2 n = 3). Presence of P1, V+ and L1 was significantly associated with positivity of each other of these factors (p < 0.001, each). None of the three parameters showed direct influence on tumor recurrence in general, but perineural invasion influenced extrahepatic recurrence significantly (p = 0.019). Whereas lymphangio and vascular invasion was neither associated with overall nor recurrence-free survival, perineural invasion was significantly associated with a poor 1-, 3- and 5-year overall survival (OS) of 80%, 35%, and 23% for Pn0 versus 75%, 23%, and 0% for Pn1 (p = 0.027). Concerning recurrence-free survival (RFS), Pn0 showed a 1-, 3- and 5-year RFS of 42%, 18%, and 16% versus 28%, 11%, and 0% for Pn1, but no significance was reached (p = 0.091). (4) Conclusions: Whereas lymphangio- and vascular invasion showed no significant influence in several analyses, the presence of perineural invasion was associated with a significantly higher risk of extrahepatic tumor recurrence and worse overall survival.

scholarly journals Cribriform glands are associated with worse outcome than other pattern 4 subtypes: A study of prognostic and clinicopathologic characteristics of prostate adenocarcinoma with an emphasis on grade groups

2021 ◽  
Author(s):  
Eylul Gun ◽  
Irfan Ocal
Keyword(s):  
Tumor Volume ◽  
Histopathological Examination ◽  
Management Strategies ◽  
Surgical Margin ◽  
Prostate Adenocarcinoma ◽  
Recurrence Free Survival ◽  
Clinicopathologic Characteristics ◽  
Free Survival ◽  
Prognostic Effect ◽  
The Mean

Aim: Although prostate adenocarcinoma is the most common cancer in men, survival is quite high and with the help of histopathological examination using the updated classification, patient management strategies are developing. We aimed to evaluate the correlation between the histopathological features and biochemical recurrence (BCR) in patients who underwent radical prostatectomy (RP) using the new classification. Methods: A total of 285 prostate adenocarcinoma cases that underwent RP between January 2009 and December 2017 and followed up for at least 3 months were included in the study. The cases were re-evaluated according to WHO-ISUP 2016 classification and the findings were recorded. Results: The mean age was 63,4 years. Gleason scores of the cases were as follows: 3+3 144 cases (50.5%), 3+4 81 cases (28.4%), 4+3 28 cases (9.8%), 4+4 7 cases (2.5%) , 3+5 6 cases (2.1%), 5+3 2 cases (0.7%), 4+5 17 cases (6%). There were 198 (69,5%) pT2, 54 (18,9%) pT3a and 33 (11,6%) pT3b cases. The mean follow-up time was 44,1 months and BCR was detected in 97 cases (34%). The relationship between the Group Grades and BCR was statistically significant. BCR rate increased as the tumor volume and the percentage of pattern 4 increased (p<0.001).There was a significant correlation between preoperative PSA value, extraprostatic extension, seminal vesicle invasion, surgical margin positivity, tumor volume, pattern 4 percentage, presence of cribriform glands and BCR and recurrence-free survival in both univariate and multivariate analysis and recurrence-free survival was also affected by these parameters. Among the morphological subtypes of Pattern 4, recurrence-free survival decreased as the incidence of cribriform glands increased (p <0.001). Conclusion: Histopathological evaluation is important in predicting BCR in prostate adenocarcinoma, the Group Grade system seems to be helpful in this regard. More studies are needed to prove the relatively worse prognostic effect of cribriform glands.

scholarly journals SURGICAL MANAGEMENT OF LARGE HEPATOCELLULAR CARCINOMA: THE FIRST SINGLE-CENTER STUDY FROM WESTERN INDIA

2020 ◽  
Vol 33 (2) ◽  
Author(s):  
Prasad WAGLE ◽  
Rajvilas NARKHEDE ◽  
Gunjan DESAI ◽  
Prasad PANDE ◽  
D R KULKARNI ◽  
...  
Keyword(s):  
Vascular Invasion ◽  
Bile Leak ◽  
Postoperative Liver Failure ◽  
Western India ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Large Hepatocellular Carcinoma ◽  
Cirrhotic Patients ◽  
The Difference

ABSTRACT Background: Majority of patients with large size HCC (>10 cm) are not offered surgery as per Barcelona Clinic Liver Cancer (BCLC) criteria and hence, their outcomes are not well studied, especially from India, owing to a lower incidence. Aim: To analyze outcomes of surgery for large HCCs. Methods: This retrospective observational study included all patients who underwent surgery for large HCC from January 2007 to December 2017. The entire perioperative and follow up data was collected and analyzed. Results: Nineteen patients were included. Ten were non-cirrhotic; 16 were BCLC grade A; one BCLC grade B; and two were BCLC C. Two cirrhotic and three non-cirrhotic underwent preoperative sequential trans-arterial chemoembolization and portal vein embolization. Right hepatectomy was the most commonly done procedure. The postoperative 30-day mortality rate was 5% (1/19). Wound infection and postoperative ascites was seen in seven patients each. Postoperative liver failure was seen in five. Two cirrhotic and two non-cirrhotic patients had postoperative bile leak. The hospital stay was 11.9±5.4 days (median 12 days). Vascular invasion was present in four cirrhotic and five non-cirrhotic patients. The median follow-up was 32 months. Five patients died in the follow-up period. Seven had recurrence and median recurrence free survival was 18 months. The cumulative recurrence free survival was 88% and 54%, whereas the cumulative overall survival was 94% and 73% at one and three years respectively. Both were better in non-cirrhotic; however, the difference was not statistically significant. The recurrence free survival was better in patients without vascular invasion and the difference was statistically significant (p=0.011). Conclusion: Large HCC is not a contraindication for surgery. Vascular invasion if present, adversely affects survival. Proper case selection can provide the most favorable survival with minimal morbidity.

scholarly journals The Positive Correlations between the Expression of Histopathological Ubiquitin-Conjugating Enzyme 2O Staining and Prostate Cancer Advancement

2021 ◽  
Vol 14 (8) ◽  
pp. 778
Author(s):  
Jae-Heon Kim ◽  
Hee-Jo Yang ◽  
Chang-Ho Lee ◽  
Youn-Soo Jeon ◽  
Jae-Joon Park ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Recurrence Free Survival ◽  
Clinical Recurrence ◽  
Free Survival ◽  
Ubiquitin Conjugating Enzyme ◽  
Positive Correlations ◽  
Conjugating Enzyme

Background: The mTOR signaling pathway is inactivated by AMPK’s tumor-suppressing function. It is recognized that ubiquitin conjugating enzyme 2O (UBE2O), which directly targets AMPK for ubiquitination and degradation, is intensified in human cancers. Methods: This study investigated the clinical data about prostate cancer. Examination was also carried out into tissue microarrays (TMA) of human prostate cancer (n = 382) and adjacent non-neoplastic tissues around prostate cancer (n = 61). The TMA slides were incubated with antibodies against UBE2O, and the cores were scored by the pathologist blind to cancer results. Results: Very strong positive correlations were identified between the expression of UBE2O staining and high PSA and pathological stage of prostate cancer. Cox’s proportional hazard analysis established correlations between the following: (1) positive surgical margin and biochemical recurrence free survival, (2) PSA grade and clinical recurrence free survival, (3) regional lymph node positive and clinical recurrence free survival, (4) adjuvant treatment and overall survival, and (5) pathological T stage and overall survival. Conclusion: There is a positive correlation between the expression of UBE2O staining and prognosis for prostate cancer. Thus, a prostate cancer prognosis can be assessed with the expression of UBE2O staining.

scholarly journals Efficacy of upfront hepatectomy without neoadjuvant chemotherapy for resectable colorectal liver metastasis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Kosuke Ono ◽  
Tomoyuki Abe ◽  
Akihiko Oshita ◽  
Yusuke Sumi ◽  
Takuya Yano ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Liver Metastasis ◽  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Primary Tumor ◽  
Vascular Invasion ◽  
Propensity Score Analysis ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Score Analysis

Abstract Background Hepatectomy for resectable colorectal liver metastasis (CRLM) is recommended. However, the efficacy of upfront hepatectomy without neoadjuvant chemotherapy (NAC) is unclear due to the uncertainty of perioperative systemic chemotherapy. Moreover, it is crucial to predict the prognosis when considering perioperative chemotherapy. This study evaluated the impact of neoadjuvant chemotherapy on the prognosis of patients with resectable CRLM and assessed the usefulness of Beppu’s nomogram for predicting prognosis. Methods This retrospective study identified 88 consecutive inpatients who underwent primary hepatic resection for CRLM; 58 received neoadjuvant chemotherapy and 30 underwent upfront surgery. Factors associated with recurrence-free survival were identified via univariate and multivariate analysis. Furthermore, propensity score analysis using inverse probability of treatment weighting (IPTW) was performed. Results On univariate analysis, poor recurrence-free survival was associated with multiple tumors, advanced primary tumor stage, vascular invasion by the primary tumor, a Beppu’s nomogram score ≥ 6, and neoadjuvant chemotherapy. On multivariate analysis, a Beppu’s nomogram score ≥ 6 and neoadjuvant chemotherapy were independent risk factors for recurrence. Neoadjuvant chemotherapy recipients had a higher incidence of lymph node metastasis and vascular invasion than non-recipients. Propensity score analysis revealed no significant difference in the recurrence-free survival rate between these groups. Conclusions Our results show that upfront hepatectomy without neoadjuvant chemotherapy can be considered for resectable CRLM treatment. Beppu’s nomogram score can be a tool for predicting the prognosis of patients with CRLM.

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