Treatment strategy for intrahepatic cholangiocarcinoma: From optimal surgical management to adjuvant therapy.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 392-392
Author(s):  
Yuji Morine ◽  
Mitsuo Shimada ◽  
Satoru Imura ◽  
Tetsuya Ikemoto ◽  
Yu Saito ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Bile Duct ◽  
Adjuvant Therapy ◽  
Intrahepatic Cholangiocarcinoma ◽  
Surgical Strategy ◽  
Bile Duct Resection ◽  
Extended Surgery ◽  
Period 2 ◽  
Significant Difference ◽  
Limited Surgery

392 Background: Surgical strategy for intrahepatic cholangiocarcinoma (IHCC) including systemic lymph nodes (LN) dissection is still controversial. Also, as adjuvant chemotherapy, we adopted this GFP regimen (GEM, 5-FU, and Cisplatin). We demonstrate the adequate surgical strategy, the effect of adjuvant therapy and the tumor malignancy evaluation. Methods: Study 1: Surgical strategy) In period 1 (1994.4-2004.3, n = 20), extended surgery was basically performed. In period 2 (2004.4~, n = 34), extent of hepatectomy is conducted according to tumor conditions. Swelling LN exterpation for macroscopic curability and bile duct resection for positive surgical margin are performed. Study2: Adjuvant GFP therapy) Induction of 2 cycles of GFP for advanced IHCC with prognostic factors (LN metastasis, intrahepatic metastasis and R2 resection). Study 3: Malignancy evaluation) Significance of serum CA19-9 levels, the relationships its levels and expressions ( immunostaining ) of hypoxic inducible factor 1 (HIF-1) /Histone deacetylase 1 (HDAC1) were evaluated. Results: Study 1) In period 2, LN dissection and extrahepatic bile duct resection were significantly infrequent. Surgical outcome is rather good regardless of limited surgery in recent periods (Period 1 vs. Period 2: 5yrs survival 24.9% vs. 34.9%, p = 0.119). There was no significant difference in recurrent pattern. Study 2) There were 32 cases had some kind of prognostic factors, and of these 11 patients received adjuvant GFP. Patient’s prognosis received adjuvant GFP was significantly prolonged (GFP vs. non GFP: 1yrs survival 71.6% vs. 45.0%, p < 0.02). Study 3) CA19-9 ( > 300U/ml) high group revealed the independent prognostic factor with stepwise model, as well as LN metastasis and vessels invasion. CA19-9 levels significantly correlated to HDAC1 and HIF-1 expressions. Conclusions: Extended surgery including LN dissection might not control malignant behavior of IHCC, and adjuvant GFP should be introduced in patients with poor prognostic factors.

scholarly journals P-0144 Adjuvant Therapy and Prognostic Factors for Biliary Tract Cancer Intrahepatic Cholangiocarcinoma: Single-Center Experience

2012 ◽  
Vol 23 ◽  
pp. iv72
Author(s):  
Joaquina Martinez-Galan ◽  
Javier Garcia Garcia ◽  
Karim Muffa K-Granero ◽  
José Antonio Ortega ◽  
Beatriz Gonzalez-Astorga ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Adjuvant Therapy ◽  
Biliary Tract ◽  
Intrahepatic Cholangiocarcinoma ◽  
Biliary Tract Cancer ◽  
Single Center ◽  
Tract Cancer ◽  
Single Center Experience

Staging, prognostic factors and adjuvant therapy of intrahepatic cholangiocarcinoma after curative resection

2013 ◽  
Vol 34 (6) ◽  
pp. 953-960 ◽  
Author(s):  
Tao Li ◽  
Lun-Xiu Qin ◽  
Jian Zhou ◽  
Hui-Chuan Sun ◽  
Shuang-Jian Qiu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Adjuvant Therapy ◽  
Intrahepatic Cholangiocarcinoma ◽  
Curative Resection

Efficacy of Adjuvant Chemotherapy and Prognostic Factors for Patients with Extrahepatic Bile Duct Cancer

Chemotherapy ◽  
2016 ◽  
Vol 61 (3) ◽  
pp. 152-158 ◽  
Author(s):  
Hee Seung Lee ◽  
Sang Hoon Lee ◽  
Yun Ho Roh ◽  
Moon Jae Chung ◽  
Jeong Youp Park ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Bile Duct ◽  
Adjuvant Chemotherapy ◽  
Surgical Resection ◽  
Bile Duct Cancer ◽  
Extrahepatic Bile Duct ◽  
Extrahepatic Bile Duct Cancer ◽  
Significant Difference ◽  
Duct Cancer

Background: Surgical resection is the only curative treatment for extrahepatic bile duct cancer. Additionally, the recurrence rate after curative surgery is relatively high, requiring adjuvant therapy. However, the efficacy of adjuvant chemotherapy compared with surgery alone has not yet been clarified. This study aimed to evaluate the efficacy of adjuvant chemotherapy and identify prognostic factors influencing survival in extrahepatic bile duct cancer patients who underwent curative surgical resection. Methods: Ninety-seven patients with extrahepatic bile duct cancer who underwent curative resection between January 2005 and December 2010 were retrospectively analyzed. Results: Among the 97 patients, 31 underwent adjuvant chemotherapy and 66 did not. The 5-year overall survival rate was 34% for patients who underwent adjuvant chemotherapy. There was no significant difference for overall survival between patients who underwent adjuvant chemotherapy and those who did not (p = 0.228). On multivariate analysis, postoperative carbohydrate antigen 19-9 levels and histologic grade were independent prognostic factors related to long-term survival (p < 0.05). Conclusions: Postoperative adjuvant chemotherapy did not improve survival after surgical resection for extrahepatic bile duct cancer.

Surgical strategy for T2 and T3 gallbladder cancer: is extrahepatic bile duct resection always necessary?

2013 ◽  
Vol 398 (8) ◽  
pp. 1137-1144 ◽  
Author(s):  
Sae Byeol Choi ◽  
Hyung Joon Han ◽  
Wan Bae Kim ◽  
Tae Jin Song ◽  
Sung Ock Suh ◽  
...  
Keyword(s):  
Bile Duct ◽  
Gallbladder Cancer ◽  
Extrahepatic Bile Duct ◽  
Surgical Strategy ◽  
Bile Duct Resection ◽  
Extrahepatic Bile Duct Resection

Gamma knife radiosurgery for intracranial metastatic melanoma: a 6-year experience

2002 ◽  
Vol 97 ◽  
pp. 494-498 ◽  
Author(s):  
Jorge Gonzalez-martinez ◽  
Laura Hernandez ◽  
Lucia Zamorano ◽  
Andrew Sloan ◽  
Kenneth Levin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Brain Metastases ◽  
Metastatic Melanoma ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Content Type ◽  
Significant Difference ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was to evaluate retrospectively the effectiveness of stereotactic radiosurgery for intracranial metastatic melanoma and to identify prognostic factors related to tumor control and survival that might be helpful in determining appropriate therapy. Methods. Twenty-four patients with intracranial metastases (115 lesions) metastatic from melanoma underwent radiosurgery. In 14 patients (58.3%) whole-brain radiotherapy (WBRT) was performed, and in 12 (50%) chemotherapy was conducted before radiosurgery. The median tumor volume was 4 cm3 (range 1–15 cm3). The mean dose was 16.4 Gy (range 13–20 Gy) prescribed to the 50% isodose at the tumor margin. All cases were categorized according to the Recursive Partitioning Analysis classification for brain metastases. Univariate and multivariate analyses of survival were performed to determine significant prognostic factors affecting survival. The mean survival was 5.5 months after radiosurgery. The analyses revealed no difference in terms of survival between patients who underwent WBRT or chemotherapy and those who did not. A significant difference (p < 0.05) in mean survival was observed between patients receiving immunotherapy or those with a Karnofsky Performance Scale (KPS) score of greater than 90. Conclusions. The treatment with systemic immunotherapy and a KPS score greater than 90 were factors associated with a better prognosis. Radiosurgery for melanoma-related brain metastases appears to be an effective treatment associated with few complications.

scholarly journals Reduction of body-weight gain enhances in vitro embryo production in overfed superovulated dairy heifers

Reproduction ◽  
2006 ◽  
Vol 131 (4) ◽  
pp. 783-794 ◽  
Author(s):  
S Freret ◽  
B Grimard ◽  
A A Ponter ◽  
C Joly ◽  
C Ponsart ◽  
...  
Keyword(s):  
Weight Gain ◽  
Dietary Intake ◽  
Live Weight ◽  
Reproductive Hormones ◽  
Embryo Production ◽  
Live Weight Gain ◽  
Dairy Heifers ◽  
Period 2 ◽  
Significant Difference

The aim of our study was to test whether a reduction in dietary intake could improve in vitro embryo production in superovulated overfed dairy heifers. Cumulus–oocyte complexes of 16 Prim’ Holstein heifers (14 ± 1 months old) were collected by ovum pick-up (OPU), every 2 weeks following superovulation treatment with 250 μg FSH, before being matured and fertilized in vitro. Embryos were cultured in Synthetic Oviduct Fluid medium for 7 days. Heifers were fed with hay, soybean meal, barley, minerals and vitamins. From OPU 1 to 4 (period 1), all heifers received individually for 8 weeks a diet formulated for a 1000 g/day live-weight gain. From OPU 5 to 8 (period 2), the heifers were allocated to one of two diets (1000 or 600 g/day) for 8 weeks. Heifers’ growth rates were monitored and plasma concentrations of metabolites, metabolic and reproductive hormones were measured each week. Mean live-weight gain observed during period 1 was 950 ± 80 g/day (n = 16). In period 2 it was 730 ± 70 (n = 8) and 1300 ± 70 g/day (n = 8) for restricted and overfed groups respectively. When comparing period 1 and period 2 within groups, significant differences were found. In the restricted group, a higher blastocyst rate, greater proportions of grade 1–3 and grade 1 embryos, associated with higher estradiol at OPU and lower glucose and β-hydroxybutyrate, were observed in period 2 compared with period 1. Moreover, after 6 weeks of dietary restriction (OPU 7), numbers of day 7 total embryos, blastocysts and grade 1–3 embryos had significantly increased. On the contrary, in the overfed group, we observed more <8 mm follicles 2 days before superovulation treatment, higher insulin and IGF-I and lower nonesterified fatty acids in period 2 compared with period 1 (no significant difference between periods for embryo production). After 6 weeks of 1300 g/day live-weight gain (OPU 7), embryo production began to decrease. Whatever the group, oocyte collection did not differ between period 1 and 2. These data suggest that following a period of overfeeding, a short-term dietary intake restriction (6 weeks in our study) may improve blastocyst production and embryo quality when they are low. However, nutritional recommendations aiming to optimize both follicular growth and embryonic development may be different.

scholarly journals Clinical Characteristics and Prognostic Factors of Early-Onset Pancreatic Neuroendocrine Tumors

2021 ◽  
Vol 28 ◽  
pp. 107327482098682
Author(s):  
Min Shi ◽  
Biao Zhou
Keyword(s):  
Prognostic Factors ◽  
Neuroendocrine Tumors ◽  
Early Onset ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Clinicopathological Characteristics ◽  
Pancreatic Neuroendocrine Tumors ◽  
Chi Square ◽  
Younger Patients ◽  
Significant Difference

Background: The incidence of pancreatic neuroendocrine tumors (PNETs) has increased significantly. The purpose of this study was to analyze the clinical characteristics and prognosis of patients under 50 years old. Methods: Patients with PNETs recorded in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 were analyzed. The clinical characteristics were analyzed by Chi-square test. The Kaplan-Meier method was used to estimate overall survival (OS). Multivariate Cox proportional risk regression analysis was used to determine independent prognostic factors. Results: 2,303 patients included, of which 547 (23.8%) patients were younger than 50 years old. The number of younger patients has increased steadily, while the proportion in total PNETs decreased recently. Compared with older group, the proportion of the Black, grade I/II, and surgery were higher in early-onset PNETs. Liver was the most frequent metastatic site. There was no significant difference in the incidence of different metastatic sites between younger and older PNETs patients, while younger patients had better OS (P < 0.05). Grade, N stage, M stage, and surgery were independent prognostic factors for OS in early-onset PNETs. Conclusions: Younger patients have unique clinicopathological characteristics compared with older patients in PNETs. Better OS was observed in younger patients which might due to the higher proportion of well-differentiated tumor and surgery than older patients.

scholarly journals Limited predictive value of illness perceptions for short-term poor recovery in musculoskeletal pain. A multi-center longitudinal study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
E. J. de Raaij ◽  
H. Wittink ◽  
J. F. Maissan ◽  
P. Westers ◽  
R. W. J. G. Ostelo
Keyword(s):  
Prognostic Factors ◽  
Pain Intensity ◽  
Musculoskeletal Pain ◽  
Physical Functioning ◽  
Predictive Value ◽  
Illness Perceptions ◽  
Illness Perception ◽  
Added Value ◽  
Poor Recovery ◽  
Significant Difference

Abstract Background Musculoskeletal pain (MSP) is recognized worldwide as a major cause of increased years lived with disability. In addition to known generic prognostic factors, illness perceptions (IPs) may have predictive value for poor recovery in MSP. We were interested in the added predictive value of baseline IPs, over and above the known generic prognostic factors, on clinical recovery from MSP. Also, it is hypothesized there may be overlap between IPs and domains covered by the Four-Dimensional Symptom Questionnaire (4DSQ), measuring distress, depression, anxiety and somatization. The aim of this study is twofold; 1) to assess the added predictive value of IPs for poor recovery and 2) to assess differences in predictive value for poor recovery between the Brief Illness Perception Questionnaire - Dutch Language Version (Brief IPQ-DLV) and the 4DSQ. Methods An eligible sample of 251 patients with musculoskeletal pain attending outpatient physical therapy were included in a multi-center longitudinal cohort study. Pain intensity, physical functioning and Global Perceived Effect were the primary outcomes. Hierarchical logistic regression models were used to assess the added value of baseline IPs for predicting poor recovery. To investigate the performance of the models, the levels of calibration (Hosmer-Lemeshov test) and discrimination (Area under the Curve (AUC)) were assessed. Results Baseline ‘Treatment Control’ added little predictive value for poor recovery in pain intensity [Odds Ratio (OR) 0.80 (Confidence Interval (CI) 0.66–0.97), increase in AUC 2%] and global perceived effect [OR 0.78 (CI 0.65–0.93), increase in AUC 3%]. Baseline ‘Timeline’ added little predictive value for poor recovery in physical functioning [OR 1.16 (CI 1.03–1.30), increase in AUC 2%]. There was a non-significant difference between AUCs in predictive value for poor recovery between the Brief IPQ-DLV and the 4DSQ. Conclusions Based on the findings of this explorative study, assessing baseline IPs, over and above the known generic prognostic factors, does not result in a substantial improvement in the prediction of poor recovery. Also, no recommendations can be given for preferring either the 4DSQ or the Brief IPQ-DLV to assess psychological factors.

scholarly journals Comprehensive analysis of genomic mutation signature and tumor mutation burden for prognosis of intrahepatic cholangiocarcinoma

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rui Zhang ◽  
Qi Li ◽  
Jialu Fu ◽  
Zhechuan Jin ◽  
Jingbo Su ◽  
...  
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Cox Regression ◽  
Tnm Stage ◽  
Gene Set Enrichment Analysis ◽  
Functional Enrichment ◽  
Tumor Mutation Burden ◽  
Kaplan Meier ◽  
Mutation Burden ◽  
Significant Difference ◽  
Genomic Mutation

Abstract Background Intrahepatic cholangiocarcinoma (iCCA) is a highly lethal malignancy of the biliary tract. Analysis of somatic mutational profiling can reveal new prognostic markers and actionable treatment targets. In this study, we explored the utility of genomic mutation signature and tumor mutation burden (TMB) in predicting prognosis in iCCA patients. Methods Whole-exome sequencing and corresponding clinical data were collected from the ICGC portal and cBioPortal database to detect the prognostic mutated genes and determine TMB values. To identify the hub prognostic mutant signature, we used Cox regression and Lasso feature selection. Mutation-related signature (MRS) was constructed using multivariate Cox regression. The predictive performances of MRS and TMB were assessed using Kaplan–Meier (KM) analysis and receiver operating characteristic (ROC). We performed a functional enrichment pathway analysis using gene set enrichment analysis (GSEA) for mutated genes. Based on the MRS, TMB, and the TNM stage, a nomogram was constructed to visualize prognosis in iCCA patients. Results The mutation landscape illustrated distributions of mutation frequencies and types in iCCA, and generated a list of most frequently mutated genes (such as Tp53, KRAS, ARID1A, and IDH1). Thirty-two mutated genes associated with overall survival (OS) were identified in iCCA patients. We obtained a six-gene signature using the Lasso and Cox method. AUCs for the MRS in the prediction of 1-, 3-, and 5-year OS were 0.759, 0.732, and 0.728, respectively. Kaplan–Meier analysis showed a significant difference in prognosis for patients with iCCA having a high and low MRS score (P < 0.001). GSEA was used to show that several signaling pathways, including MAPK, PI3K-AKT, and proteoglycan, were involved in cancer. Conversely, survival analysis indicated that TMB was significantly associated with prognosis. GSEA indicated that samples with high MRS or TMB also showed an upregulated expression of pathways involved in tumor signaling and the immune response. Finally, the predictive nomogram (that included MRS, TMB, and the TNM stage) demonstrated satisfactory performance in predicting survival in patients with iCCA. Conclusions Mutation-related signature and TMB were associated with prognosis in patients with iCCA. Our study provides a valuable prognostic predictor for determining outcomes in patients with iCCA.

scholarly journals Efficacy of lenvatinib for unresectable hepatocellular carcinoma based on background liver disease etiology: multi-center retrospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Atsushi Hiraoka ◽  
Takashi Kumada ◽  
Toshifumi Tada ◽  
Joji Tani ◽  
Kazuya Kariyama ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prognostic Factors ◽  
Liver Disease ◽  
Hazard Analysis ◽  
Progression Free Survival ◽  
Significant Prognostic Factor ◽  
Disease Etiology ◽  
Alcoholic Fatty Liver ◽  
Free Survival ◽  
Significant Difference

AbstractIt was recently reported that hepatocellular carcinoma (HCC) patients with non-alcoholic steatohepatitis (NASH) are not responsive to immune-checkpoint inhibitor (ICI) treatment. The present study aimed to evaluate the therapeutic efficacy of lenvatinib in patients with non-alcoholic fatty liver disease (NAFLD)/NASH-related unresectable-HCC (u-HCC). Five hundred thirty u-HCC patients with Child–Pugh A were enrolled, and divided into the NAFLD/NASH (n = 103) and Viral/Alcohol (n = 427) groups. Clinical features were compared in a retrospective manner. Progression-free survival (PFS) was better in the NAFLD/NASH than the Viral/Alcohol group (median 9.3 vs. 7.5 months, P = 0.012), while there was no significant difference in overall survival (OS) (20.5 vs. 16.9 months, P = 0.057). In Cox-hazard analysis of prognostic factors for PFS, elevated ALT (≥ 30 U/L) (HR 1.247, P = 0.029), modified ALBI grade 2b (HR 1.236, P = 0.047), elevated AFP (≥ 400 ng/mL) (HR 1.294, P = 0.014), and NAFLD/NASH etiology (HR 0.763, P = 0.036) were significant prognostic factors. NAFLD/NASH etiology was not a significant prognostic factor in Cox-hazard analysis for OS (HR0.758, P = 0.092), whereas AFP (≥ 400 ng/mL) (HR 1.402, P = 0.009), BCLC C stage (HR 1.297, P = 0.035), later line use (HR 0.737, P = 0.014), and modified ALBI grade 2b (HR 1.875, P < 0.001) were significant. Lenvatinib can improve the prognosis of patients affected by u-HCC irrespective of HCC etiology or its line of treatment.

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