Ju-Dong Li

Early intrahepatic recurrence of hepatocellular carcinoma after hepatectomy treated with re-hepatectomy, ablation or chemoembolization: A prospective cohort study

AIMSnTo observe the outcomes of various treatments for patients with early intrahepatic recurrent hepatocellular carcinoma (HCC) after partial hepatectomy.nnnMETHODSnA total of 629 patients with intrahepatic recurrent HCC within Milan criteria following hepatectomy were prospectively collected between November 2004 and May 2010. Overall survival (OS) and recurrence to death survival (RTDS) were analyzed by the Kaplan-Meier method and log-rank test. Cox regression analysis was used for multivariate analyses.nnnRESULTSnThe 5-year OS and RTDS rates were 64.5%, 43.0%; 37.0%, 26.7%; 27.7% and 8.3% for patients who received re-hepatectomy (nxa0=xa0128), percutaneous radiofrequency ablation (PRFA, nxa0=xa0162) and transarterial chemoembolization (TACE, nxa0=xa0339) (re-hepatectomy vs. TACE, Pxa0<xa00.001, <0.001; vs. PRFA, Pxa0=xa00.005, 0.008; PRFA vs. TACE, Pxa0<xa00.001, <0.001). The independent predictors of OS and RTDS were tumor number (hazard ratio: 1.54, 95% confidence interval: 1.18-2.00; 1.57, 1.21-2.04), alpha fetoprotein >20xa0ng/mL (1.64, 1.24-2.17; 1.66, 1.26-2.20), presence of varices (1.69, 1.28-2.22; 1.61, 1.23-2.10) and Edmondson-Steiner grade III-IV (1.66, 1.17-2.35; 1.70, 1.20-2.40) at the initial stage; and tumor number (1.34, 1.04-1.73; 1.32, 1.03-1.70), time to recurrence (TTR) (3.46, 2.58-4.65; 1.59, 1.19-2.14) and treatment for recurrence (TACE: 3.18, 2.16-4.66; 2.95, 2.02-4.31; PRFA: 1.49, 0.97-2.29; 1.44, 0.94-2.19).nnnCONCLUSIONSnFor early intrahepatic recurrent HCC, re-hepatectomy achieved best outcome. It produced similar result as PRFA for patients with more invasive primary tumors and underlying cirrhosis/varices. TACE had worst prognosis which was only suitable for multifocal recurrence and TTR ≤1 year.

Association between neutrophil-lymphocyte ratio and prognosis after potentially curative resection for gastric cancer

Dear Editor We read with great interest the article by Dr. Szor et al. This retrospective study identified that a high eutrophil-lymphocyte ratio (NLR) was an independent risk factor for decreased survival in gastric cancer patients who underwent potentially curative resection. Herein, we would like to raise the following comments: In this study, between patients with high NLR and low NLR, nearly significant differences existed in some aspects of patient clinicopathologic characteristics, including age, gender, preoperative platelet count, and pT status (all P < 0.05), suggesting an unbalanced enrollment between the two groups. Actually, propensity score matching (PSM) analysis has been generally used in retrospective observational studies, which enables better balance between groups across all potential risk factors and evaluates the extent of balanced match in a measurable approach. As a matter of fact, a 2017 study reported by Yang et al investigated the same topic on hepatocellular carcinoma using the PSM analysis, and a same conclusion was gotten. Therefore, we suggest the study using the PSM analysis, as it is more statistically convictive. In addition, the number of variables on patient clinicopathologic characteristics investigated in this study seemed far from enough. For instance, body mass index, ASA score, chronic comorbidity, preoperative hemoglobin level, intraoperative blood loss, tumor size, postoperative Helicobacter pylori infection, and histological findings of biopsy specimen etc. were not provided, which actually are very likely to influence the postoperative survival after curative resection for gastric cancer and also have been widely included and studied in previous research. In summary, we suggested that PSM analysis be used in this study for the further confirmation of the real association between NLR and postoperative outcomes in gastric cancer patients after potentially curative resection. Meanwhile, more variables on patient clinicopathologic characteristics could be collected and included in this study. Clarification regarding the omissions mentioned above would greatly solidify the conclusions of the study by Dr Szor et al.

Preoperative prealbumin level as an independent predictor of long-term prognosis after liver resection for hepatocellular carcinoma: a multi-institutional study

BACKGROUNDnSerum prealbumin is a sensitive and stable marker for nutritional status and liver function. Whether preoperative prealbumin level is associated with long-term prognosis in patients undergoing liver resection for hepatocellular carcinoma (HCC) is unclear.nnnMETHODSnPatients who underwent liver resection for HCC between 2001 and 2014xa0at six institutions were enrolled. These patients were divided into the low and normal prealbumin groups using a cut-off value of 170xa0mg/L for preoperative prealbumin level. The overall survival (OS) and recurrence-free survival (RFS) were compared between them.nnnRESULTSnIn 1483 patients, 437 (29%) had a low prealbumin level. The 3- and 5-year OS and RFS rates of patients in the low-prealbumin group were 57 and 31%, and 40 and 20%, respectively, which were significantly poorer than those in the normal-prealbumin group (76 and 43%, and 56 and 28%, respectively, both pxa0<xa00.001). Multivariable Cox-regression analyses revealed that preoperative prealbumin level was an independent predictor of OS (HR, 1.45, 95% CI: 1.24-1.70, pxa0<0.001) and RFS (HR, 1.28, 95% CI: 1.10-1.48, pxa0<0.001).nnnCONCLUSIONSnPreoperative prealbumin level could be used in predicting long-term prognosis for patients undergoing liver resection for HCC.

Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy

We read with great interest the article by Dr. De Pastena M, etxa0al. 1 This retrospective study identified that preoperative biliary drain does not increase major complications and mortality rates after pancreatoduodenectomy, but it is associated with higher surgical site infection rates. Herein, we would like to raise the following comments. This article is protected by copyright. All rights reserved.

Association between Concomitant Mediastinoscopy and Postoperative Pneumonia After Pulmonary Lobectomy

We read with great interest the article by Yendamuri et al. This retrospective study identified that mediastinoscopy may be associated with an increased risk of postoperative pneumonia after pulmonary lobectomy for patients with lung cancer. Herein, we would like to raise the following comments. As shown in Tables 1 and 4 of the study by Yendamuri et al., significant differences exist between patients with and without mediastinoscopy in some aspects of patient demographics and characteristics, both in the Roswell Cancer Institute (RPCI) cohort and the National Surgical Quality Improvement Program (NSQIP) cohort, including age, sex, American Society of Anesthesiologists class, history of chronic obstructive pulmonary disease, smoking status, forced expiratory volume in 1 s, and operating room time (all p 0.05), suggesting an imbalanced enrollment between the two groups due to these confounding variables. As a matter of fact, propensity score matching (PSM) analysis has generally been used in retrospective observational studies, which enables better balance between groups across all putative risk factors, and evaluates the extent of a balanced match in a measurable approach. Therefore, we suggest that PSM analysis be used here. In fact, a study published by Agostini et al. in 2017 investigated a similar topic on postoperative pulmonary complications using this method, with an opposite conclusion being drawn. We prefer the study using PSM analysis as it is more statistically convictive. In addition, the number of variables on patient demographics and characteristics investigated in the NSQIP cohort seemed far from enough. For instance, lung function, smoking status, etc., were not provided, which are in fact very likely to influence the incidence of postoperative pneumonia after pulmonary lobectomy for patients with lung cancer. In short, we suggest that PSM analysis be used in the present study for further confirmation of the real relationship between mediastinoscopy and postoperative pneumonia after pulmonary lobectomy for patients with lung cancer. Meanwhile, more details of variables on patient demographics and characteristics should be included in this study. Clarification regarding the abovementioned omissions would greatly solidify the conclusions of the study by Yendamuri et al.