Minshan Chen

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, HRu200a=u200a2.39, 95%CI 1.53–3.72) and RFS (Pu200a=u200a0.003, HRu200a=u200a1.69, 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.

High expression of high mobility group box 1 (hmgb1) predicts poor prognosis for hepatocellular carcinoma after curative hepatectomy

BackgroundHigh mobility group box 1(HMGB1) overexpression has been reported in a variety of human cancers. However, the role of HMGB1 in hepatocellular carcinoma (HCC) remains unclear. The aim of present study was to analyze HMGB1 protein expression in tumor, para-tumor and normal tissue and to assess its prognostic significance for HCC after curative hepatectomy.MethodsThe levels of HMGB1 mRNA and protein in tumor, para-tumor and normal tissue were evaluated in 11 HCC cases by Reverse Transcription-polymerase chain reaction (RT-PCR) and Western blot. Additionally, HMGB1 protein expression in 161 HCC was analyzed by immunohistochemistry and correlated with clinicopathological characteristics and survivals. Student’s t-test, spearman’s rank correlation, Kaplan-Meier plots and Cox proportional hazards regression model were used to analyze the data.ResultsBy RT-PCR and Western blot, the levels of HMGB1 mRNA and protein were significantly higher in HCC, compared to that in para-tumor (pu2009<u20090.001) and normal tissue (pu2009<u20090.001). Immunohistochemical staining revealed that high expression of HMGB1 was detected in 42.9% (69/161) HCC cases. High expression of HMGB1 was significantly associated with incomplete encapsulation (pu2009=u20090.035) and advanced TNM stage (pu2009=u20090.036). Multivariate analysis showed that high expression of HMGB1 was an independent prognostic factor for both overall (pu2009=u20090.009, HRu2009=u20091.834, 95%CI: 1.167-2.881) and disease-free survival (pu2009=u20090.018, HRu2009=u20091.622, 95%CI: 1.088-2.419), along with tumor size. Subgroup analysis revealed that high expression of HMGB1 predicted poorer overall survival only for tumor >5u2009cm (pu2009=u20090.031), but not for tumor ≤5u2009cm (pu2009=u20090.101).ConclusionsHMGB1 protein might contribute to the malignant progression of HCC, high expression of HMGB1 predicts poor prognosis for patients with HCC after curative hepatectomy, especially for patients with tumor >5u2009cm.

The inflammation-based scores to predict prognosis of patients with hepatocellular carcinoma after hepatectomy

AbstractnThe aims of this study were to compare the prognostic ability of inflammation-based prognostic scores including the Glasgow Prognostic Score (GPS), the modified Glasgow Prognostic Score (mGPS), neutrophil to lymphocyte ratio, prognostic index, and prognostic nutritional index (PNI) for patients with hepatocellular carcinoma (HCC) undergoing hepatectomy, and to propose the combination of staging systems and inflammation scores to improve the prognostic power. Data for 349 patients who underwent hepatectomy as initial treatment for HCC between 2008 and 2009 were retrieved from a prospective database. The association of inflammation scores with clinicopathological variables and overall survival (OS) was analyzed, and the concordance index (C-index) was calculated to compare the predictive ability of each inflammation scores and staging systems including Barcelona Clinic Liver Cancer (BCLC) and Cancer of the Liver Italian Program (CLIP) scores. The median follow-up period was 39xa0months, the 1, 2, and 3xa0year OS was 75.4, 67.0, and 59.0xa0%, respectively, and the median OS was 39xa0months. All inflammation scores, except PNI, were associated with tumor size, major/microvascular invasion and clinical stages, and the GPS and mGPS had a higher C-index (0.608). Multivariate analysis showed that the GPS, BCLC, and CLIP were independently associated with OS. The combined GPS and CLIP (C-indexxa0=xa00.705) were superior to CLIP alone (C-indexxa0=xa00.686) or the GPS alone in prognostic ability. The prognostic ability of the GPS is superior to other inflammation scores for patients undergoing hepatectomy as initial treatment for HCC. Combining GPS and CLIP improved the prognostic power.

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 (pu2009=u20090.015) were significantly higher in the elevated NLR group whilst local (pu2009=u20090.526) and intrahepatic (pu2009=u20090.715) 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 (pu2009=u20090.039, HRu2009=u20093.59, 95%CI 1.54–9.67) and disease-free survival (pu2009=u20090.022, HRu2009=u20093.19, 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 (pu2009=u20090.036); the corresponding disease-free survival was 64.9%, 38.7%, 26.7% and 47.6%, 14.3%, 9.5% respectively (pu2009=u20090.047). Conclusion: Elevated NLR (>5) might predict more extrahepatic metastasis and poorer survival for patients with CRLM after RFA.

A modified TNM-7 staging system to better predict the survival in patients with hepatocellular carcinoma after hepatectomy

ObjectiveTo evaluate the accuracy of the 7th edition of the American Joint Committee on Cancer staging system (TNM-7) for patients undergoing hepatectomy for hepatocellular carcinoma (HCC) and to propose a modified TNM system for better prediction of survival.MethodsClinico-pathological data for 1,313 patients who underwent hepatectomy as initial treatment for HCC between 2000 and 2008 were retrieved from a prospective database. Overall survival (OS) and disease-free survival (DFS) were analyzed to evaluate the predictive value.ResultsThe 1-, 3-, 5-year OS and DFS of 1,313 patients were 79.2, 55.4, 45.5xa0%, and 52.6, 36.1, 31.8xa0%, respectively. Multivariate analysis revealed that major vascular invasion was the most important prognostic factor for both OS and DFS, along with tumour number and size. Patients with pT1 and pT2 disease had significantly better OS and DFS than those with pT3 disease (Pxa0<xa00.001). There was no significant difference between pT3a and pT4 (Pxa0=xa00.552) but patients with pT3b disease had a worse OS and DFS than those with pT4 disease (Pxa0=xa00.006 and Pxa0<xa00.001, respectively). A modified TNM system within the existing framework was proposed to combine the current pT3a and pT4 together as the new pT3 and to change pT3b to the new pT4. Analysis showed that this modified system had a better prognostic power than either TNM-6 or TNM-7.ConclusionTNM-7 would seem to be inaccurate for staging advanced HCC. The modified system can improve both the prognostic accuracy and the hazard discrimination of disease to be consistent among subgroups of HCC.

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 (Pu2009=u20090.001, Pu2009=u20090.009 and Pu2009=u20090.022 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.

Derived neutrophil to lymphocyte ratio predicts prognosis for patients with HBV-associated hepatocellular carcinoma following transarterial chemoembolization

The derived neutrophil to lymphocyte ratio (dNLR) has been proposed as an easily determinable prognostic factor for cancer patients, but the prognostic significance of the dNLR in hepatocellular carcinoma (HCC) has not been investigated. The present study aimed to validate the prognostic power of the NLR and dNLR in HCC patients undergoing transarterial chemoembolization (TACE). The data of 279 consecutive patients who underwent TACE for unresectable HBV-associated HCC between September 2009 and November 2011 at the Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center (Guangzhou, China) were retrieved from a prospective database. The cut-off values for the NLR and dNLR were determined by receiver operating characteristic (ROC) analysis. The association between the NLR and dNLR and the clinicopathological characteristics and overall survival (OS) rates and times of patients was analyzed. The area under the curve (AUC) was calculated to evaluate the discriminatory ability of the NLR and dNLR. The median follow-up period was 446 days, the 1, 2 and 3-year OS rates were 38.8, 18.5 and 11.1% respectively, and the median OS time was 264 days. The cut-off values were determined as 2.6 and 1.8 for the NLR and dNLR, respectively. The NLR and dNLR were each associated with patient age, presence of vascular invasion, tumor size, AST level and ALP level. Multivariate analysis showed that the NLR, dNLR, ALT level and AFP level were independent prognostic factors for OS. An elevated NLR or dNLR was associated with a poor prognosis (P=0.001 and P=0.002, respectively). The prognostic power of NLR [AUC=0.539; 95% confidence interval (CI), 0.423–0.656] and dNLR (AUC=0.522; 95% CI, 0.406–0.638) was similar. Elevated dNLR predicted poor prognosis for patients with HBV-associated HCC undergoing TACE, with similar prognostic power to NLR. The dNLR may be used as an alternative to the NLR, as it is easily available and inexpensive.

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).

Novel Percutaneous Radiofrequency Ablation of Portal Vein Tumor Thrombus: Safety and Feasibility

PurposeWe report our experience of the safety of partial recanalization of the portal vein using a novel endovascular radiofrequency (RF) catheter for portal vein tumor thrombosis.MethodsSix patients with liver cancer and tumor thrombus in the portal vein underwent percutaneous intravascular radiofrequency ablation (RFA) using an endovascular bipolar RF device. A 0.035-inch guidewire was introduced into a tributary of the portal vein and through which a 5G guide catheter was introduced into the main portal vein. After manipulation of the guide catheter over the thrombus under digital subtraction angiography, the endovascular RF device was inserted and activated around the thrombus.ResultsThere were no observed technique specific complications, such as hemorrhage, vessel perforation, or infection. Post-RFA portography showed partial recanalization of portal vein.ConclusionsRFA of portal vein tumor thrombus in patients with hepatocellular carcinoma is technically feasible and warrants further investigation to assess efficacy compared with current recanalization techniques.

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.