Yudong Qiu

The Clinicopathologic and Prognostic Significance of Gross Classification on Solitary Hepatocellular Carcinoma After Hepatectomy.

AbstractThe prevalence of hepatitis B virus (HBV) infection is extremely high in China. We aimed to investigate the clinicopathologic and prognostic significance of gross classification on solitary hepatocellular carcinoma (HCC) after hepatectomy.A total of 144 patients with solitary HCC who underwent hepatectomy were identified retrospectively. Based on the gross appearance, the tumors were divided into single nodular (SN), single nodular with extranodular growth (SNEG), confluent multinodular (CMN), and infiltrative types. Clinicopathologic variables and survival information were compared among patients with those 4 types.The 144 tumors composed of 25 SN, 34 SNEG, 33 CMN, and 52 infiltrative types. The serum alpha-fetoprotein (AFP) level and HBV infection rate of infiltrative type were significantly higher than other 3 types. The disease-free and overall survival times of infiltrative type were significantly shorter than other 3 types. Univariate and multivariate analysis showed that gross classification, microvascular invasion, and T stage were independent risk factors.In Chinese patients with solitary HCC, the infiltrative type accounted for a much higher proportion compared with other regions of the world. Infiltrative HCC had higher serum AFP level, HBV infection, and microvascular invasion rates with poorer prognosis compared with other 3 types.

Extracorporeal Hepatic Resection and Autotransplantation for Primary Gastrointestinal Stromal Tumor of the Liver

We report a case of primary gastrointestinal stromal tumor of the liver. A 60-year-old woman with a large mass in the liver was asymptomatic with no hepatic virus infection and negative tumor markers. Because the tumor was unresectable by conventional means, we used extracorporeal hepatic resection and autotransplantation (ECHRA) for operation. The pathology showed a gastrointestinal stromal tumor that was diagnosed based on positive immunostaining for c-kit and CD34. Mutation analysis revealed an acquired mutation in exon 11 of c-kit. As we know, this is the eighth case of a primary hepatic extragastrointestinal stromal tumor reported previously in English, and the first case of which that was treated with ECHRA.

Anatomical versus non-anatomical resection for solitary hepatocellular carcinoma without macroscopic vascular invasion: A propensity score matching analysis.

The superiority of anatomical resection (AR) in patients with hepatocellular carcinoma compared with non‐anatomical resection (NAR) remains controversial. We aimed to investigate the prognostic outcomes of AR and NAR for solitary hepatocellular carcinoma (HCC) patients without macroscopic vascular invasion, using a propensity score matching (PSM) analysis.

Clinicopathological, radiologic, and molecular study of 23 combined hepatocellular-cholangiocarcinomas with stem cell features, cholangiolocellular type☆☆☆

Cholangiolocellular carcinoma is a type of intrahepatic cholangiocarcinoma (ICC). According to the 2010 World Health Organization classification, this carcinoma is a combined hepatocellular-cholangiocarcinoma with stem cell features, cholangiolocellular type (CHC-SC-CLC). The aim of this study was to compare the clinicopathological characteristics of CHC-SC-CLC and conventional ICC. Based on the gross and histologic characteristics, we divided consecutive ICC tumors into CHC-SC-CLC (n = 23), mass-forming (MF; n = 57), and non-MF (n = 22) groups. Compared with MF and non-MF groups, the CHC-SC-CLC group featured history of hepatolithiasis or bile duct operation in significantly fewer patients (4.3% versus 14.8% and 86.4%, respectively; P < .001) and was more common in the right lobe (70% versus 47% and 27%; P = .033) but lower frequency of invasive growth or peritumoral Glisson sheath invasion (61% and 22% versus 77% and 33% and 100% and 86%, respectively; P = .002 and P < .001) and absence of mucous production (0 versus 77% and 96%; P < .001). In CHC-SC-CLCs, the mutation rate of isocitrate dehydrogenase 1 (IDH1) or IDH2 was significantly higher (35%) than in MF (4%) or non-MF (0) ICCs (P < .001). The 1-, 3-, and 5-year postresection survival rates were also significantly better with CHC-SC-CLCs (93%, 79%, and 52%, respectively) than with MF (72%, 46%, and 40%) or non-MF (61%, 18%, and 0) ICCs (P = .041). Thus, CHC-SC-CLC tumors demonstrated an indolent growth pattern, more frequent IDH1/2 gene mutations, and better prognosis than did MF or non-MF ICC tumors.

Infiltrative Hepatocellular Carcinoma: Assessment of Factors Associated With Outcomes in Patients Undergoing Hepatectomy.

AbstractData on infiltrative hepatocellular carcinoma (iHCC) receiving hepatectomy are unclear. Our study assessed the outcomes, effects of anatomical resection, and prognostic factors in a cohort of Chinese patients with iHCC undergoing hepatectomy.Data from 47 patients with iHCC undergoing hepatectomy were analyzed in a retrospective study. Independent prognostic factors of overall survival (OS) and recurrence-free survival (RFS) were identified using univariate and multivariate analyses. Correlations between microvascular invasion (MVI) and clinicopathological features were assessed using the &khgr;2 test, Student t test, or the Mann–Whitney U test. Survival outcomes were estimated using the Kaplan-Meier method.The median OS was 27.37 months and the 1-year RFS rate were 61.7%. Alpha-fetoprotein (AFP) level was not a specific parameter in iHCC patients undergoing hepatectomy. Anatomic resection was significantly associated with increased RFS (Pu200a=u200a0.007). Patients showing MVI were observed with decreased RFS (Pu200a<u200a0.001). A high lactate dehydrogenase (LDH) level was significantly associated with decreased OS and RFS (Pu200a=u200a0.003 and Pu200a=u200a0.020, respectively). MVI was shown correlated with the levels of aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), and LDH. Subgroup analysis indicated that in mild MVI group, survival outcome was significantly more favorable in patients with high LDH level (Pu200a=u200a0.019).iHCC patients are related with higher MVI rate and patients may still derive survival benefit from anatomic resection at early and intermediate stages. MVI classification could be used to identify iHCC patients with a poorer survival, especially those with a high preoperative LDH level.

Gross classification of solitary small hepatocellular carcinoma on preoperative computed tomography: Prognostic significance after radiofrequency ablation

The prognostic significance of the gross classification of hepatocellular carcinoma (HCC) has been confirmed in both hepatectomy and living donor liver transplantation. However, the role of this type of classification in HCC treated with radiofrequency ablation (RFA) has rarely been reported. The aim of this study was to investigate the role of preoperative gross classification in cases of solitary small HCC treated with RFA.

Could temporal window for the computed tomography hepatic venography (CTHV) be extended?: A comparative study between spectral and conventional CT using porcine models.

Objective To investigate the feasibility of extending the acceptable temporal window for hepatic venography with dual-energy spectral CT imaging. Methods Five normal pigs anesthetized intramuscularly were scanned on a multislice CT (GE Discovery HD750 CT) after bolus contrast injection. Twelve CT scans with dual-energy spectral imaging mode were performed on each pig with a 10-second interval. Both conventional polychromatic and monochromatic image sets were reconstructed. The optimal energy level for hepatic vein imaging was selected from the monochromatic image sets based on the contrast-to-noise ratio (CNR) analysis. Subjective assessment of image quality was performed on volume-rendering images at 12 imaging points in time. Results The CNRs for hepatic veins in the polychromatic, default monochromatic 65 keV, and the optimal energy images were 2.24 ± 1.09, 3.48 ± 1.73, and 6.72 ± 2.56, respectively, with a significant difference among 3 groups (P < 0.001). There was no acceptable temporal window for imaging hepatic veins in the polychromatic group, but a peak plateau existed. The temporal window in the 65-keV group was 20 seconds, whereas it was 70 seconds in the optimal energy group. Conclusions Compared with conventional polychromatic CT images, monochromatic images provided superior CNR for hepatic veins and 3.5 times temporal window of hepatic venography in spectral CT.

Mutation Detection of Fibroblast Growth Factor Receptor 3 for Infiltrative Hepatocellular Carcinoma by Whole-Exome Sequencing

AbstractBackgroundnGene data on infiltrative hepatocellular carcinoma (iHCC) are still unknown.AimsThis study aims to identify the gene expression signature of iHCC compared with single nodular (SN)-type HCC according to the gross classification.MethodsThe whole-exome sequencing was performed in six matched HCC tumor/normal pairs (three infiltrative type and three single nodular type) from six patients who received curative hepatectomy. Subsequent validation using Sanger sequencing and real-time PCR was performed in 30 HCC tumor samples (15 infiltrative type and 15 single nodular type).ResultsFollowing whole-exome sequencing, Sanger sequencing, and bioinformatics analysis, it revealed significant difference of iHCC from SN-type HCC in gene patterns. Particularly, a typical growth factor receptor tyrosine kinase FGFR3 was predominantly mutated in iHCC. One nonsynonymous variant c.G285T (p.Q95H) and five additional mutations (c.G938A:p.G313D, c.G1291A:p.A431T, c.C1355G:p.T452R, c.C1377T:p.L459L, and c.A1445T:p.E482V) were investigated by whole-exome and Sanger sequencing, respectively. Immunohistochemical studies confirmed the specific expression of FGFR3 in iHCC samples.ConclusionOur studies indicated that FGFR3 may be a candidate oncogene in tumor progression and a promising therapeutic target in iHCC patients who had early recurrence.

Low-level clonal FGFR2 amplification defines a unique molecular subtype of intrahepatic cholangiocarcinoma in a Chinese population

Intrahepatic cholangiocarcinoma (ICC) is a subtype of primary liver cancer rarely curable by surgery that is increasing rapidly in incidence. Chromosomal translocations and amplifications of the fibroblast growth factor receptor 2 (FGFR2) locus are present in several kinds of tumors including ICC, but their incidence has not been assessed in Chinese patients. Using break-apart probes and by determining the ratios of FGFR2/chromosome enumeration probe (CEP) 10 double-color probes, we evaluated 122 ICCs for the presence of FGFR2 translocations and amplifications, respectively, by fluorescence in situ hybridization. We further determined FGFR2 protein expression by immunohistochemistry and analyzed the clinicopathologic records of the patients. Eight tumors (6.6%) had FGFR2 translocations, whereas 15 (12.3%) had low-level FGFR2 amplification. Interestingly, the tumors that showed both translocation and low-level amplification frequently were of the mass-forming type. Compared with the ICCs with normal FGFR2s, tumors with amplifications secreted less mucus (P = .017) and typically were accompanied by hepatitis B virus infection (P = .004). Tumors with low-level amplification generally were of lower stage (P = .013) and associated with better overall survival (P = .017). As tumors with FGFR2 amplification exhibit different biology from lesions with a normal gene, low-level amplification of FGFR2 may play an important role in tumor progression and may be a marker for targeted therapy.

Modification and establishment of CT criteria in preoperative assessment of portal venous invasion by hilar cholangiocarcinoma

BACKGROUNDnTo compare the diagnostic performance of CT criteria and to establish a new model in evaluating portal venous invasion by hilar cholangiocarcinoma.nnnMETHODSnCT images of 67 patients with hilar cholangiocarcinoma were retrospectively reviewed. Modified Loyers, Lus and Lis standard introduced from pancreatic cancer were used to evaluate portal venous invasion with the reference of intraoperative findings and/or postoperative pathological diagnosis. A new model was constructed with modified Lus standard and contact length between portal vein and tumor.nnnRESULTSnThe modified Loyers standard, modified Lus standard and Lis standard showed a sensitivity of 86.7%, 83.3%, 70.0%, a specificity of 89.4%, 95.7%, 95.7% and an accuracy of 88.6%, 92.0%, 88.1%, respectively. CT criteria performed better in evaluating left branch. The new model performed significantly better than any CT criterion or contact length, with a sensitivity of 95.0%, a specificity of 96.5% and an accuracy of 96.0%.nnnCONCLUSIONSnModified Lus standard performed best in evaluating portal venous invasion by hilar cholangiocarcinoma among three CT criteria. The left branch invasion could be evaluated by CT criteria better than the right branch and the trunk of portal vein. The new mode significantly improved the diagnostic performance of portal venous invasion by hilar cholangiocarcinoma.