Zhenwei Peng

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.

A case-control study comparing percutaneous radiofrequency ablation alone or combined with transcatheter arterial chemoembolization for hepatocellular carcinoma.

AIMSnTo assess whether combining percutaneous radiofrequency ablation (PRFA) with transcatheter arterial chemoembolization (TACE) was better than PRFA alone for hepatocellular carcinoma (HCC).nnnMATERIALS AND METHODSnOne hundered twenty patients (with a solitary HCC<or=7.0 cm in diameter or multiple HCC (<or=3), each <or=3.0 cm in diameter) treated with PRFA combined with TACE were compared with 120 well-matched controls selected from a pool of 652 patients who received PRFA alone during the study period.nnnRESULTSnThe 1-, 2-, 3-, 5-year overall survival rates for the TACE-PRFA and PRFA groups were 93%, 83%, 75%, 50%, and 89%, 76%, 64%, 42%, respectively (p=.045). Subgroup analyses showed the survival for the TACE-PRFA group was better than the PRFA group for tumors >5.0 cm (p=.031) and for multiple tumors (p=.032), but not for tumors <or=5.0 cm (p=.319) and for solitary tumor (p=.128). The 1-, 2-, 3-, 5-year progression free survival (PFS) for the TACE-PRFA and PRFA groups was 90%, 76%, 63%, 42%, and 76%, 60%, 47%, 30%, respectively (p=.002). Child-pugh class, Diameter of tumor and hepatitis B surface antigen (HBsAg) were significant prognostic factors.nnnCONCLUSIONnPatients treated with TACE-PRFA had better overall survivals than PRFA alone, but only in a subgroup of patients with tumor >5 cm or multiple tumors.

Radiofrequency ablation as first-line treatment for small solitary hepatocellular carcinoma: Long-term results

AIMSnTo evaluate long-term results of patients with small solitary hepatocellular carcinoma (HCC) and well-preserved liver function who received radiofrequency ablation (RFA) as first-line treatment.nnnMATERIALS AND METHODSnBetween November 1999 and June 2007, 247 patients with solitary HCC ≤5 cm and liver status scored as Child-Pugh class A were enrolled. RFA was performed in 224 patients as first-line treatment; 23 patients excluded from RFA because of unfavorable tumor location or their unwillingness, and all of these patients converted to surgical resection.nnnRESULTSnIn the 224 patients treated with RFA, the overall 5-, 7-, 10-year survival rates were 59.8%, 55.2%, 33.9%, respectively, and the median of overall survival was 76.1 months. Complete ablation was achieved in 216 patients (96.4%). Major complications occurred in two patients (0.9%), with no treatment-related death or needle track seeding. Indocyanine green retention rate in 15 min (ICGR15) (P = 0.014) and prothrombin activity (P = 0.004) were associated with overall survival. A subgroup of patients with ICGR15 ≤ 10% and prothrombin activity >75% had 5-, 7-, 10-year survival rates of 67.1%, 64.2%, 57.1%, respectively, with a median survival of 87.7 months. The 10-year recurrence-free, tumor-free survival rates were 17.5%, 28.2%, respectively. Serum albumin was the only factor that significantly impacted recurrence-free and tumor-free survival (P = 0.008, 0.002, respectively).nnnCONCLUSIONnRFA is considered to be the treatment of first choice for patients with solitary HCC ≤5 cm and well-preserved liver function. Surgery can be used as second-line therapy for few patients if RFA is unfeasible.

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.

Hepatitis B virus reactivation after radiofrequency ablation or hepatic resection for HBV-related small hepatocellular carcinoma: A retrospective study

BACKGROUND AND PURPOSEnReactivation of hepatitis B virus (HBV) happens after systemic chemotherapy, transarterial chemoembolization (TACE) or hepatic resection for HBV-related hepatocellular carcinoma (HCC) patients. The incidence and risk factors of HBV reactivation after radiofrequency ablation (RFA) are unclear.nnnPATIENTS AND METHODSnFrom August 2006 to August 2011, 218 consecutive patients with HBV-related small HCC treated with RFA (nxa0=xa0125) or hepatic resection (nxa0=xa093) were retrospectively studied. The incidence of HBV reactivation and risk factors were analyzed.nnnRESULTSnHBV reactivation developed in 20 (9.2%) patients after treatment. The incidence of HBV reactivation was significantly lower in the RFA group (5.6%, 7/125) than the hepatic resection group (14.0%, 13/93, Pxa0=xa00.034). On univariate and multivariate analyses, no antiviral therapy (OR 11.7; 95% CI 1.52-90.8, Pxa0=xa00.018) and treatment with RFA/hepatic resection (OR3.36; 95% CI 1.26-8.97, Pxa0=xa00.016) were significant risk factors of HBV reactivation. On subgroup analysis, the incidence of HBV reactivation was lower in patients who received antiviral therapy than those who did not receive antiviral therapy in both the hepatic resection group (2.9% vs. 20.7%, Pxa0=xa00.027) and the RFA group (0% vs. 7.6%, Pxa0=xa00.188), although the difference was not significant in the latter group.nnnCONCLUSIONnThe incidence of HBV reactivation after RFA was relatively low when compared with hepatic resection. Prophylactic antiviral therapy is recommended, especially for patients who are going to receive hepatic resection for HBV-related HCC to decrease the incidence of post-treatment HBV reactivation.

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.

Percutaneous microwave ablation of 5-6 cm unresectable hepatocellular carcinoma: local efficacy and long-term outcomes

Abstract Objective: This study aims to evaluate the local efficacy and long-term outcomes of microwave ablation (MWA) for treating large unresectable hepatocellular carcinomas (HCCs). Methods: A total of 82 patients with 5-6u2009cm unresectable HCCs, who underwent a single MWA procedure during the period of January 2007 to July 2011, were retrospectively enrolled into this study. Percentages of technical success and complications of MWA and HCC local recurrence (LR) after MWA were determined. In addition, prognostic factors were screened and overall survival (OS) and recurrence-free survival (RFS) rates were estimated. Results: One-, three- and five-year OS rates in this MWA-treated cohort were 92.7, 63.4 and 41.1%, respectively; and the corresponding RFS rates were 65.9, 31.7 and 23.0%, respectively. Primary technical efficacy was 89.0% after the first round of ablation, three (3.7%) patients developed major complications, and LR rate was 20.7%. Child-Pugh classification (pu2009<u2009.001), tumour location (pu2009=u2009.049) and LR (pu2009=u2009.002) were independent factors associated with OS, as determined by multivariate analysis. Conclusions: MWA is safe and effective for the treatment of selected large HCCs, and provides an alternative treatment option for patients with unresectable HCCs. Furthermore, the favourable local efficacy of MWA could potentially improve long-term survival.

Advanced Recurrent Hepatocellular Carcinoma: Treatment with Sorafenib Alone or in Combination with Transarterial Chemoembolization and Radiofrequency Ablation

Purpose To retrospectively investigate the safety and efficacy of sorafenib combined with transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) (hereafter, TACE-RFA) in the treatment of recurrent hepatocellular carcinoma (rHCC) with portal vein tumor thrombosis, extrahepatic metastases (advanced hepatocellular carcinoma), or both after initial hepatectomy. Materials and Methods The study was centrally approved by the ethics committee of three tertiary medical centers in China. From January 2010 to January 2015, 207 consecutive patients with advanced rHCC after initial hepatectomy received sorafenib combined with TACE-RFA (combination group, n = 106) or sorafenib alone (sorafenib group, n = 101) at the three medical centers. Overall survival (OS) and time to progression (TTP) were compared between the two groups. Complications were assessed. Survival curves were constructed with the Kaplan-Meier method and were compared with the log-rank test. Results Baseline characteristics were balanced between the two groups. No treatment-related death occurred in either group. The toxicity profile in the combination group was similar to that in the sorafenib group. After treatment, median OS (14.0 vs 9.0 months, respectively; P < .001) and TTP (7.0 vs 4.0 months, respectively; P < .001) were significantly longer in the combination group than in the sorafenib group. Multivariate analysis showed that treatment allocation was a significant predictor of OS and TTP, while the number of intrahepatic tumors was another prognostic factor of OS. Conclusion Sorafenib combined with TACE-RFA was well tolerated and safe and was superior to sorafenib alone in improving survival outcomes in patients with advanced rHCC after initial hepatectomy.

Association of Sustained Response Duration With Survival After Conventional Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma

Key Points Question Is there an early reliable surrogate end point for overall survival (OS) in patients with hepatocellular carcinoma after conventional transarterial chemoembolization? Findings In this cohort study of 2734 patients in China, sustained response duration of 6 months or more was found to have the strongest association with 5-year OS after chemoembolization. Sustained response duration of 6 months or more was found to be the independent prognostic factor for OS. Meaning Sustained response duration of 6 months or more was associated with OS and may serve as an early surrogate end point after conventional transarterial chemoembolization for intermediate hepatocellular carcinoma.