Junyi Shen

Prognostic nomograms for patients with resectable hepatocelluar carcinoma incorporating systemic inflammation and tumor characteristics

Background The model to predict the prognosis of resectable hepatocelluar carcinoma (HCC) has not been determined. Methods Predictors were selected using Cox model. Nomograms were generated in the training set and validated in the validation set. The predictive ability of the nomogram was determined by concordance index and calibration curve. Results Independent factors for overall survival including alpha-fetoprotein level (hazard ratio (HR):1.292), tumor size (HR:1.092), tumor number (HR:1.472), microvascular invasion (HR:1.660), neutrophil to lymphocyte count ratio (NLR) (HR:1.428), major vascular invasion (HR:2.485) and satellite lesions(HR:1.392) were selected into the nomogram for survival. The c-index in the training set and validation set were 0.767 and 0.719, respectively, which were statistically higher than those of the four conventional staging systems.(Barcelona Clinic Liver Cancer: 0.644 and 0.609; the seventh American Joint Committee on Cancer: 0.678 and 0.674; Cancer of the Liver Italian Program: 0.692 and 0.648; Hong Kong Liver Cancer: 0.689 and 0.639, p < 0.001 for all). A nomogram for predicting 3- and 5-year recurrence free survival was generated with the c-index of 0.746 for the training set and 0.718 for the validation set, respectively. Conclusions We have generated nomograms predicting prognosis for HCC treated by hepatectomy with a higher predictive power.

Liver transplantation versus surgical resection for HCC meeting the Milan criteria: A propensity score analysis.

AbstractThe optimal treatment (liver transplantation [LT] vs surgical resection [SR]) for early-stage hepatocellular carcinoma (HCC) remains controversial.A total of 209 SR patients and 129 LT patients were identified at our institution. After eliminating 27 patients with Child–Pugh C, the data from 209 SR patients and 102 LT patients were analyzed using a propensity score matching (PSM) model. Forty-six pairs were generated. A subgroup analysis was conducted based on the alpha-fetoprotein (AFP) level or platelet count (PLT). A survival analysis was performed using the Kaplan–Meier method.Gender, satellite lesions, and the treatment method were predictors of HCC recurrence. The Ishak score and treatment methods were associated with long-term survival after surgery. Before PSM, LT patients had a better prognosis than those treated by SR. Among HCC patients with childhood A/B cirrhosis, after PSM, SR achieved similar overall survival outcomes compared with LT. LT and SR resulted in comparable long-term survival for patients with or without thrombocytopenia. Patients with an AFP ≥ 400 ng/mL might achieve more survival benefits from LT.Our propensity score model provided evidence that, compared with transplantation, surgical resection could result in comparable long-term survival for resectable early-stage HCC patients, except for the AFP ≥ 400 ng/mL HCC subgroup. Surgical resection might not be a contraindication for early-stage HCC patients with thrombocytopenia due to their similar prognosis after transplantation.

Nomograms to Predict the Individual Survival of Patients with Solitary Hepatocellular Carcinoma after Hepatectomy

Background/Aims Solitary hepatocellular carcinoma (HCC) is a subgroup of HCCs. We aimed to establish nomograms for predicting the survival of solitary HCC patients after hepatectomy. Methods A total of 538 solitary HCC patients were randomly classified into training and validation sets. A Cox model was used to identify predictors of overall survival (OS) in the training set. A nomogram was generated based on these predictors and was validated using the validation set. Results Tumor size, microvascular invasion, and major vascular invasion were significantly associated with OS in the training set. Nomograms were developed based on these predictors in the multivariate analysis. The C-index was 0.75 for the OS nomogram and 0.72 for the recurrence-free survival nomogram. Compared to the index of conventional staging systems for predicting survival (0.71 for Barcelona Clinic Liver Cancer, 0.66 for the seventh American Joint Committee on Cancer, 0.68 for Cancer of the Liver Italian Program, and 0.70 for Hong Kong Liver Cancer), the index of the OS nomogram was significantly higher. Moreover, the calibration curve fitted well between the predicted and observed survival rate. Similarly, in the validation set, the nomogram discrimination was superior to those of the four staging systems (p<0.001). Conclusions The nomograms demonstrated good discrimination performance in predicting 3- and 5-year survival rates for solitary HCCs after hepatectomy.

A simple prognostic score system predicts the prognosis of solitary large hepatocellular carcinoma following hepatectomy.

Abstract Solitary large hepatocellular carcinomas (SLHCC) form a heterogeneous group of patients with different survival probabilities. The aim of our study was to develop a simple prognostic index for identifying prognostic subgroups of SLHCC patients. A retrospective analysis of clinical data from 268 patients with operable SLHCC was conducted to investigate prognostic factors and to construct a score system based on risk factors. A Cox proportional hazard regression analysis was used to evaluate the variables associated with prognosis. Survival analyses were performed using Kaplan–Meier survival curves. Three variables remained in the final multivariate model: platelet to lymphocyte ratio (PLR), microvascular invasion (MVI), and tumor size with hazard ratios equal to 1.004 (95% confidence interval: 1.001–1.006), 1.092 (1.044–1.142), and 2.233 (1.125–2.233), respectively. A score of 1 was assigned to each risk factor. Patient scores were determined based on these risk factors; thus, the scores ranged between 0 and 3. Ultimately, three categories (0, 1–2, 3) were defined. Patients with scores of 3 had a 5-year survival rate of 25.4%, whereas patients with a score of 0 had a 5-year survival rate of 52.1%. The prognosis significantly worsened as the score increased. Similar results were found among cirrhotic and noncirrhotic patients. Our simple prognostic index successfully predicts SLHCC survival.

IQGAP1 expression in hepatocellular carcinoma predicts poor prognosis by inducing epithelial-mesenchymal transition

Background: The prognostic value of expression of the IQ motif containing GTPase activating protein 1 (IQGAP1) in hepatocellular carcinoma (HCC) following liver resection and its potential mechanism were unclear. In this study, we attempted to clarify them. Methods: The expression of IQGAP1 in HCC and adjacent samples was assessed by immunohistochemistry staining, and its correlations with postoperative recurrence and mortality were also analyzed. Epithelial and mesenchymal markers and the invasive and migration ability of HCC cells were examined in HCC cell lines by overexpression or silencing expression of IQGAP1 using IQGAP1 plasmids or SiRNA. Results: IQGAP1 expression was significantly increased in HCC tissues in comparison with adjacent tissues (57.78% versus 8.15%; P Conclusions: The positive expression of IQGAP1 in HCC was related to poor prognosis following liver resection, which may occur through induction of the epithelial-mesenchymal transition (EMT).

The prognostic significance of serum HBeAg on the recurrence and long-term survival after hepatectomy for hepatocellular carcinoma: A propensity score matching analysis

The effects of serum hepatitis B e antigen (HBeAg) on the prognosis of hepatocellular carcinoma (HCC) patients after hepatectomy remain controversial. Our aim was to explore the prognostic significance of serum HBeAg on the prognosis of patients with HCC using a propensity matching model. Between January 2009 and March 2015, 953 patients with HCC who underwent hepatectomy in West China Hospital were analysed. Propensity matching analysis was applied, and survival analysis was performed using the Kaplan‐Meier method. Risk factors were identified by the Cox proportional hazards model. All patients with HCC were classified into an HBeAg(−) group (n = 775, 81.3%) or an HBeAg(+) group (n = 178, 18.7%). Patients with positive serum HBeAg had poorer recurrence‐free survival and overall survival before and after propensity matching. Similar results were found in patients within the Milan criteria. For patients beyond the Milan criteria, the HBeAg(+) group had poor overall survival before and after propensity matching. In term of recurrence‐free survival, there was no statistically significant impact after propensity matching (P = .055), although there was a trend for HBeAg(+) patient to have reduced recurrence‐free survival. Positive serum HBeAg, positive HBV‐DNA load, largest tumour size, multiple tumours, microvascular invasion and a high serum level of preoperative alpha‐fetoprotein were risk factors for recurrence. Our propensity model confirmed that positive serum HBeAg had a negative impact on the recurrence and long‐term survival irrespective of tumour stages. HBeAg seroconversion might be beneficial for reducing the rate of recurrence.

The Prognostic Prediction Role of Preoperative Serum Albumin Level in Patients with Intahepatic Cholangiocarcinoma Following Hepatectomy.

Background: There is little information regarding the role of preoperative serum albumin (ALB) in intrahepatic cholangiocarcinoma (ICC) patients who underwent liver resection. Methods: Clinicopathological characteristics and survival rate of 91 ICC patients who underwent surgery between 2009 and 2013 were included in this study. The optimal cut-off for ALB were determined by plotting the receiver operating characteristics curves of ALB in predicting overall survival (OS) and utilizing the Youden index. Long-term outcome was calculated by Kaplan-meire method. Results: The pathological characteristics were similar in both groups. The 1- and 3-year disease-free survival (DFS) rates between the high ALB group and the lower ALB group were 62.7 vs. 25.5% and 27.0 vs. 11.1% respectively (p < 0.001). The 1- and 3-year OS rates between the high ALB group and the lower ALB group were 78.4 vs. 57.5% and 42.6 vs. 6.7% respectively (p < 0.001). The ALB level as continuous variable in multivariate analysis remained a favorable factor for DFS and OS (p < 0.05). Furthermore, ALB could distinguish the prognoses in non-cirrhotic patients. Multivariate analysis showed other pathological risk factors like lymph node involvement, positive surgical margin, satellite lesions, and carbohydrate antigen 19-9 were associated with DFS and OS (p < 0.05 for all). Conclusions: A higher preoperative serum ALB level is associated with better long-term survival in ICC patients.

The prognostic value of microvascular invasion in early-intermediate stage hepatocelluar carcinoma: a propensity score matching analysis

BackgroundMicrovascular invasion (MVI) is well established as a negative prognostic factor for hepatocelluar carcinoma (HCC). However, its prognostic value in different subgroups of Barcelona Clinical Liver Cancer (BCLC) stages remains to be elucidated.MethodsFour hundred fifty-eight MVI-negative and 204 MVI-positive patients who underwent hepatectomy were retrospectively analyzed. After propensity score matching (PSM) analysis, 187 pairs of matched patients were generated. Long-term survival was compared by the Kaplan–Meier method.ResultsPatients with MVI commonly had more advanced tumors. All the patients with MVI had significantly worse survival rate compared to the patients without MVI before and after PSM(p < 0.001). In the subgroup analysis, BCLC stage A HCC patients without MVI had better prognosis than those with MVI before and after PSM (p < 0.001 and p = 0.024). For BCLC stage B HCCs, long-term survival was significantly better for patients without MVI before PSM(p = 0.001). However, the overall survival (OS) rate was comparable between both groups after PSM (p = 0.682), although MVI-positive group had a higher rate of recurrence (p = 0.011).. Surgery type, satellite lesions, tumor size, and serum ALT level were statistically significant factors associated with survival in MVI-positive group. Tumor number, tumor size and neutrophil to lymphocyte ratio (NLR) were predictors of survival in MVI-negative group.ConclusionsIts prognostic value in different subgroups of BCLC stages differed. MVI is an independent predictor of prognosis in patients with BCLC stage A. For BCLC stage B HCCs, MVI-positive group had poor prognosis through more advanced HCCs.

Model predicting the microvascular invasion and satellite lesions of hepatocelluar carcinoma after hepatectomy: Model for prediction of MS in HCCs

Microvascluar invasion and satellite lesion (MS), important unfavourable pathological factors, significantly contribute to tumour recurrence and impair the prognosis in hepatocellular carcinoma. We aimed to construct a model for the prediction of MS in order to plan treatment better.

High-grade myofibroblastic sarcoma in the liver: A case report

Only two cases of myofibroblastic sarcoma in the liver have been reported in the literature. Here, we report the case of a male patient with high-grade myofibroblastic sarcoma mimicking echinococcosis in the liver. The 25-year-old male patient complained of right upper quadrant swelling pain for one week and was initially diagnosed with echinococcosis. He was then scheduled for an exploratory laparotomy. During the operation, a huge mass exceeding 16 cm in diameter was found to occupy nearly the entire right trisegment of the liver, with a clear boundary and a round shape, and the mass was resected by right hepatic trisegmentectomy. Immunohistochemical staining revealed that the tumor tissue was positive for desmin, α-smooth muscle actin, CD56, and vimentin and negative for ALK-1, myogenin, calponin, β-catenin, S100, and glypican-3, with a Ki-67 (MIB-1) index of approximately 20%. Based on the histological manifestations and immunohistochemical staining, a diagnosis of myofibroblastic sarcoma was established. The postoperative recovery was uneventful. There was no evidence of recurrence or metastasis through the last follow-up, 6 mo after surgery, despite a lack of postoperative chemotherapy or radiotherapy. To the best of our knowledge, the present case is the first reported case of high-grade myofibroblastic sarcoma in the liver, and it is also the first reported case in a male patient.