Junting Huang

Postoperative Neutrophil-to-Lymphocyte Ratio Change Predicts Survival of Patients with Small Hepatocellular Carcinoma Undergoing Radiofrequency Ablation

Background An elevated preoperative neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic factor for hepatocellular carcinoma (HCC) patients after treatment. However, the clinical implication of postoperative NLR change remains unclear. Materials and Methods From May 2005 to Aug 2008, a cohort of consecutive 178 small HCC patients treated with radiofrequency ablation (RFA) was retrospectively reviewed. The NLR was recorded within 3 days before and 1 month after RFA. Baseline characteristics, overall survival (OS) and recurrence free survival (RFS) were compared according to preoperative NLR and/or postoperative NLR change. Prognostic factors were assessed by multivariate analysis. Results Compared with preoperative NLR level, postoperative NLR decreased in 87 patients and increased in 91 patients after RFA. No significant differences were identified between two groups in commonly used clinic-pathologic features. The 1, 3, 5 years OS was 98.8%, 78.6%, 67.1% for NLR decreased group, and 92.2%, 55.5%, 35.4% for NLR increased group respectively (P<0.001); the corresponding RFS was 94.2%, 65.2%, 33.8% and 81.7%, 46.1%, 12.4% respectively (P<0.001). In subgroup analysis, the survival of patients with lower or higher preoperative NLR can be distinguished more accurate by postoperative NLR change. Multivariate analysis showed that postoperative NLR change, but not preoperative NLR, was an independent prognostic factor for both OS (P<0.001, HR = 2.39, 95%CI 1.53–3.72) and RFS (P = 0.003, HR = 1.69, 95%CI 1.87–8.24). Conclusion The postoperative NLR change was an independent prognostic factor for small HCC patient undergoing RFA, and patients with decreased NLR indicated better survival than those with increased NLR.

Elevated neutrophil to lymphocyte ratio might predict poor prognosis for colorectal liver metastasis after percutaneous radiofrequency ablation.

Purpose: Elevated neutrophil to lymphocyte ratio (NLR) has been shown to be a predictor of poor survival in certain malignancies. We hypothesised NLR might predict prognosis for patients with colorectal liver metastasis (CRLM) undergoing percutaneous radiofrequency ablation (RFA). Patients and methods: A cohort of 92 consecutive patients with metachronous CRLM treated with RFA was retrospectively reviewed. Baseline clinico-pathological characteristics, recurrence, overall and disease-free survival were compared according to preoperative NLR level. Prognostic factors were assessed by multivariate analysis. Results: Elevated NLR (>5) was recorded in 21 patients (22.8%). No correlations between NLR and clinico-pathological characteristics were identified. Complete ablation was achieved in 90 patients (97.8%). After RFA, extrahepatic metastases (p = 0.015) were significantly higher in the elevated NLR group whilst local (p = 0.526) and intrahepatic (p = 0.715) recurrence. The 1, 3 and 5 years overall survival rates of 92 patients were 86.5%, 74.1%, 36.3%, and disease-free survival was 64.3%, 32.8%, 22.4% respectively. Multivariate analysis showed that NLR was an independent prognostic factor for both overall (p = 0.039, HR = 3.59, 95%CI 1.54–9.67) and disease-free survival (p = 0.022, HR = 3.19, 95%CI 1.87–8.24). The 1, 3, 5 years overall survival rates were 86.9%, 61.1%, 41.7% for the normal NLR group, and 85.2%, 53.2%, 18.4% for the elevated NLR group respectively (p = 0.036); the corresponding disease-free survival was 64.9%, 38.7%, 26.7% and 47.6%, 14.3%, 9.5% respectively (p = 0.047). Conclusion: Elevated NLR (>5) might predict more extrahepatic metastasis and poorer survival for patients with CRLM after RFA.

Microwave tumour coagulation plus in situ treatment with cytokine-microparticles : Induction of potent anti-residual tumour immunity

After local microwave coagulation and subsequent intra-tumoural injection of microparticles encapsulating interleukin-2 and granulocyte-macrophage colony-stimulating factor, the anti-tumour efficacy against subcutaneous Lewis lung carcinoma in syngeneic mice was evaluated. This treatment elicited a potent systemic anti-tumour immunity that protected treated mice from re-challenge with the same tumour cells and caused the distal tumours in a bilateral tumour model to be rejected. Cytotoxicity assay indicated that both T- and natural killer cells acted as the effector cells in the anti-tumour immunity. These data highlight the feasibility of microwave-pre-treated in situ cancer vaccination for clinical use.

A monocyte/granulocyte to lymphocyte ratio predicts survival in patients with hepatocellular carcinoma

Conflict that the derived neutrophil lymphocyte (dNLR) has prognostic value in patients with a variety of cancers exists. The aim of the present study was to devise a monocyte/granulocyte to lymphocyte ratio (M/GLR) which counts as (white cell count - lymphocyte count) to lymphocyte count, and verify its prognostic value in patients with hepatocellular carcinoma (HCC). 1061 HCC patients were retrieved and the associations between M/GLR/NLR/dNLR and clinicopathological variables and survivals (OS and RFS) were analyzed. The area under the curve (AUC) was calculated to evaluate the discriminatory ability of M/GLR/NLR/dNLR. The median follow-up period was 947 days, the 1, 3, 5 year OS was 64%, 51%, and 46% respectively, and the median OS was 842 days. The cut-off values were determined by ROC as 2.8, 1.6, and 3.2 for NLR, dNLR, M/GLR respectively. Elevated M/GLR/NLR/dNLR was associated with poor prognosis (P = 0.001, P = 0.009 and P = 0.022 respectively). By time-dependent ROC, the AUC of M/GLR was higher than that of NLR or dNLR, either in whole group or in subgroups according to TNM stages or different treatments. We concluded that elevated M/GLR predicted poor prognosis for patients with HCC and the M/GLR can be used as an alternative to NLR and dNLR.

Antiviral therapy in the improvement of survival of patients with hepatitis B virus-related hepatocellular carcinoma treated with sorafenib

To evaluate the role of antiviral therapy with nucleoside analogs (NAs) in sorafenib‐treated patients with hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC).

Preparation of carbon-coated iron nanofluid and its application in radiofrequency ablation

Carbon-coated iron nanoparticles (Fe@C CCINs) were synthesized by carbon arc discharge method and were studied via X-ray diffraction (XRD) and transmission electron microscopy (TEM). The results showed that CCINs have good core-shell structure and are in size of 40-50 nm. Also, carbon-coated iron nanofluid (CCINs-nanofluid) was prepared via two-step method by dispersing as-prepared CCINs and polyvinylpyrrolidone (PVP) into physiological saline. Its dispersion stability and thermal conductivity were detected by gravity sedimentation method and Hotdisk thermal constant analyzer respectively. The results indicated that CCINs-nanofluid possesses good dispersity and stability. Moreover, CCINs-nanofluid showed enhanced thermal conductivity compared with its base fluid physiological saline. The enhancement of thermal conductivity even reaches 41%. Additionally, CCINs-nanofluid injection aided radiofrequency ablation (RFA) was carried out. The relation between tissue temperature and ablation time revealed that by injecting CCINs-nanofluid into pork livers during RFA, target tissue temperatures were less than 100°C. Dissected pork livers showed that there was little or no tissue charring around the ablation probe. Results of ablation area calculation showed that the ablation area of CCINs-nanofluid injection aided RFA was 67% larger than that of saline injection aided RFA, indicating that a larger-volume tumor tissue necrosis at a single session can be achieved by CCINs-nanofluid injection aided RFA.

[Hepatitis B reactivation after treatment for HBV-related hepatocellular carcinoma: comparative analysis of radiofrequency ablation versus hepatic resection].

OBJECTIVE To perform a comparative analysis of the reactivation rate of hepatitis B virus (HBV) infection and related risk factors after treatment of HBV-related hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA) or hepatic resection. METHODS We retrospectively analyzed the HBV reactivation rate and related risk factors of a cohort of 218 patients treated for HBV-related HCC between August 2008 and August 2011; the study population consisted of 125 patients who received RFA and 93 patients who received hepatic resection. Comparisons were made using the unpaired Students t-test for continuous variables and the x2-test and Fishers exact test for categorical variables. Univariate and multivariate logistic regression analysis was used to assess risk factors. RESULTS Twenty patients showed HBV reactivation following treatment, but the incidence was significantly lower in the RFA group than in the hepatic resection group (5.6% vs. 14.0%, 7/125 vs. 13/93, x2 = 4.492, P = 0.034). The univariate and multivariate analysis indicated that no antiviral therapy (OR = 11.7; 95% CI: 1.52-90.8, P = 0.018) and the treatment type (i.e. RFA or hepatic resection) (OR = 3.36; 95% CI: 1.26-8.97, P = 0.016) were significant risk factors of HBV reactivation. Subgroup analysis showed that the incidence of HBV reactivation was lower in patients who received antiviral therapy than in those who did not for both the RFA group and the hepatic resection group but the difference was not significant in the former group (1/68 vs. 19/150, x2=7.039, P = 0.008 and 0/33 vs. 7/92, x2 = 2.660, P = 0.188, respectively). However, the incidence of HBV reactivation in patients who did not receive antiviral therapy was higher than in those who did receive antiviral therapy in the hepatic resection group (12/58 vs. 1/35, x2 = 5.773, P = 0.027). CONCLUSION The incidence of HBV reactivation was lower in patients who received RFA than in those who received hepatic resection to treat HBV-related HCC. Antiviral therapy prior to the hepatic resection treatment may be beneficial for reducing the incidence of HBV reactivation.

The mutation of hepatitis B virus and the prognosis of hepatocellular carcinoma after surgery: A pilot study

Background Although hepatitis B virus (HBV) is still one of the most common etiological factors for hepatocellular carcinoma (HCC), the association between the HBV mutations and the clinical characteristics and prognosis of HBV-related HCC patients (HBV-HCC) after surgical resection remains largely unknown. Materials and methods A cohort of 131 consecutive patients who received hepatectomy for HBV-HCC were retrospectively enrolled. The HBV genotype and 14 genomic mutations, which have been reported to relate to HCC in liver samples, were sequenced. The associations between the genomic mutations and clinical characteristics and outcomes were analyzed. Results Both A1762T/G1764A mutation and Pre S deletion related to worse overall survival (OS, p=0.040 and p<0.001, respectively) and disease-free survival (DFS, p=0.040 and p<0.001, respectively), G1899A mutation related to worse OS (p=0.030), A1762T/G1764A mutation correlated with tumor size (r=0.204, p=0.019), G1899A mutation correlated with vascular invasion (r=0.332, p<0.001), and Pre S deletion correlated with alpha-fetoprotein (AFP; r=0.254, p=0.003) positively. Multivariate analysis with Cox proportional hazards model revealed that both A1762T/G1764A mutation and Pre S deletion were independent prognostic factors for OS (hazard ratio [HR]=3.701, 95% CI=1.390–9.855, p=0.009, and HR=4.816, 95% CI=2.311–10.032, p<0.001, respectively) and DFS (HR=3.245, 95% CI=1.400–7.521, p=0.006, and HR=2.437, 95% CI=1.311–4.530, p<0.001, respectively), and patients with dual mutations were found to have the worst OS and DFS (p<0.001 and p<0.001, respectively). Patients with A1762T/G1764A mutation or Pre S deletion were more likely to have early recurrence (p=0.042 and p=0.019, respectively). Conclusion HBV DNA genomic mutations in A1762T/G1764A and Pre S deletion were associated with worse prognoses and early recurrence for HBV-HCC patients after surgery.

Role of post-chemotherapy radiation in the management of children and adolescents with primary advanced malignant mediastinal germ cell tumors

Objective Primary malignant mediastinal germ cell tumors (MMGCTs) are rare in children and adolescents and have a poorer prognosis than their gonadal counterparts. We report a single institutional experience of a 10-year period of primary advanced MMGCTs treated with chemotherapy, followed by radiotherapy in those who had residual mass. Methods Children and adolescents with primary advanced MMGCTs between 2005 and 2014 were identified from the Cancer Center, Sun Yat-Sen University. Medical records were reviewed for clinicopathological characteristics, treatments, and outcomes. Results Twenty-four children and adolescents with either stage III or IV primary advanced MMGCTs met the inclusion criteria. There were 23 males and one female with a median age of 16 (range 10–18). Seven cases were seminomas (29.2%); four (16.7%) yolk sac tumors (YST); three (12.5%) choriocarcinomas; and ten (41.6%) nonteratomatous combined germ cell tumors (CGCTs). All patients were treated with first-line cisplatin-based chemotherapy regimens (PEB: 19, VIP: 5). Thirteen (54.2%) and Twelve (50%) patients received surgery and radiotherapy, respectively. With a median follow-up of 46.2 months (range 9.6–124.8 months), a total of five (20%) patients died of disease progression; the five-year overall survival (OS) and disease-free survival (DFS) rates were 82.3% and 64.9%, respectively.—Seven patients with seminoma GCTs received post-chemotherapy irradiation were alive with sustained CR (5-year OS and DFS, 100%, respectively). Five patients with NSGCTs were administered irradiation and one relapsed 35 months later and died of metastasis (5-year OS, 100%; 5-year DFS 66.7%). Univariate analysis identified histology and stage were prognostic factors. Conclusion Multimodality treatment approach of chemotherapy followed by radiation consolidation ensured long-term survival in primary advanced MMGCTs. Further research is warranted to improve the prognosis of children with primary advanced MMGCTs.

Family history of hepatocellulcar carcinoma is not associated with its patients' prognosis after hepatectomy.

BackgroundFamily history of liver cancer is a major risk factor for hepatocellular carcinoma (HCC). In this study, we investigated the prognosis of patients with HCC with or without family history.MethodsData for 1,313 patients who underwent hepatectomy as initial treatment for HCC between 2000 and 2008 at a tertiary cancer center hospital were retrieved from a prospective database. A positive family history was defined as a self-reported history of HCC in first-degree relatives. Clinicopathologic characteristics were compared by family history. Kaplan-Meier method and Cox proportional hazards regressions were applied for overall survival (OS) and disease-free survival (DFS).ResultsOf 1,313 patients, 169 patients (12.9%) had first-degree relatives with a history of HCC. There were no significant differences between patients with or without family history in basic clinicopathologic characteristics. In either whole group or each stage according to the TNM staging system, first-degree family history was not associated with survival in all patients, hepatitis B virus-positive patients, as well as male patients. Multivariate analysis revealed that first-degree family history was not a prognostic factor, either for OS or DFS.ConclusionA first-degree family history of HCC is not associated with its patients’ prognosis after hepatectomy.