AIM： To investigate preoperative factors associated with poor shore-term outcome after resection for multi- nodular hepatocellular carcinoma （HCC） and to assess the contraindication of patients for surgery, METHODS...AIM： To investigate preoperative factors associated with poor shore-term outcome after resection for multi- nodular hepatocellular carcinoma （HCC） and to assess the contraindication of patients for surgery, METHODS： We retrospectively analyzed 162 multi- nodular HCC patients with Child-Pugh A liver function who underwent surgical resection. The prognostic significance of preoperative factors was investigated by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards model. Each independent risk factor was then assigned points to construct a scoring model to evaluate the in- dication for surgical intervention. A receiver operating characteristics （ROC） curve was constructed to assess the predictive ability of this system.RESULTS： The median overall survival was 38.3 mo （range： 3-80 too）, while the median disease-free sur- vival was 18.6 mo （range： 1-79 too）. The 1-year mor- tality was 14%. Independent prognostic risk factors of 1-year death included prealburnin 〈 170 rng/L [hazard ratio （HR）： 5.531, P 〈 0.001], alkaline phosphatase 〉 129 U/L （HR： 3.252, P = 0.005）, α fetoprotein 〉 20 μg/L （HR： 7.477, P = 0.011）, total tumor size 〉 8 cm （HR： 10.543; P 〈 0.001）, platelet count 〈 100×109/L （HR： 9.937, P 〈 0.001）, and y-glutamyl transpeptidase 〉 64 U/L （HR： 3.791, P 〈 0.001）. The scoring model had a strong ability to predict 1-year survival （area under ROC： 0.925, P 〈 0.001）. Patients with a score ≥5 had significantly poorer short-term outcome than those with a score 〈 5 （1-year mortality： 62% vs 5%, P 〈 0.001; 1-year recurrence rate： 86% vs 33%, P 〈 0.001）. Patients with score ≥5 had greater possibility of microvascular invasion （P 〈 0.001）, poor tumor dif- ferentiation （P = 0.003）, liver cirrhosis with small nod- ules （P 〈 0.001）, and intraoperative blood transfusion （P = 0.010）. CONCLUSION： A composite preoperative scoring model can be used as an indication of prognosis of HCC patients after surgical resection. Resection should be considered with caution in patients with a score ≥5, which indicates a contraindication for surgery.展开更多
Purpose: The incidence of hyperplastic thyroid nodular disease has been consistently rising over the last decades. In addition, unsuspected papillary thyroid carcinoma (PTC) can be found in up to 34% of patients opera...Purpose: The incidence of hyperplastic thyroid nodular disease has been consistently rising over the last decades. In addition, unsuspected papillary thyroid carcinoma (PTC) can be found in up to 34% of patients operated for benign thyroid lesions. PTC tends to occur multi-focally and is commonly of polyclonal origin. We set out to test the hypothesis that in benign thyroid disease, a unique genetic signature can already be identified in the benign pathology, which is associated with a susceptibility of the thyroid tissue to neoplastic transformation in the context of additional growth promoting stimuli. Patients and Methods: We obtained a set of 23 samples from patients with multinodular goiter (MNG), 12 of whom also harbored an unsuspected PTC. We used global gene expression analysis to evaluate for dissimilarities in the gene expression patterns between these two groups. We also compared these patterns to the profiles of 3 normal thyroid and 7 PTC samples. Results: We were able to accurately distinguish between hyperplastic nodules of patients with multinodular goiter and those that were associated with a PTC. One of the strongest differentially expressed genes, CDC42, has been implicated to respond to environmental factors such as UVB radiation and might point to novel factors contributing to PTC genesis in the setting of pre-existing benign proliferative disease. Conclusion: While the comparison between histologically identical samples cannot distinguish the two groups of goiters, unsupervised or supervised approaches allowed us to identify a molecular signature associated with PTC susceptibility in multinodular goiter.展开更多
目的总结多结节和空泡状神经元肿瘤(multinodular and vacuolating neuronal tumor,MVNT)的临床、病理及影像学特点,提高对该病的认识。材料与方法分析文献,总结大脑MVNT的临床、病理及影像学特点。检索北京协和医院放射科数据库,回顾...目的总结多结节和空泡状神经元肿瘤(multinodular and vacuolating neuronal tumor,MVNT)的临床、病理及影像学特点,提高对该病的认识。材料与方法分析文献,总结大脑MVNT的临床、病理及影像学特点。检索北京协和医院放射科数据库,回顾性分析具有MVNT典型影像特征的病例特点。结果截至2018年1月,英文文献共报道87例MVNT患者,其中31例为病理证实,56例具有典型影像表现诊断为MVNT。发病年龄平均41岁(6～71岁),女性略多见。临床上以癫痫/发作性疾病、头痛或其他非特异性症状就诊。病理上表现为皮层下白质内多发的结节状病灶,伴有空泡状结构,符合未成熟神经元细胞的表型特征。影像表现可分为典型特征和非典型特征两大类,前者很好地反映了大体病理特点,表现为大脑半球灰白质交界区多发簇状分布的小结节,或表现为斑片状病变伴周围多发簇状结节,T2WI及FLAIR上病变为高信号,无占位效应,一般无强化。回顾分析我院近3年约10万例头颅磁共振图像,发现12例具有MVNT的典型影像特征。结论 MVNT是一组具有典型病理和影像特征的良性病变,提高对该病的影像学表现的认识,大部分MVNT无需病理即可根据其典型影像特征加以诊断。展开更多
BACKGROUND The selection criteria for Barcelona Clinic Liver Cancer(BCLC)intermediate-stage hepatocellular carcinoma(HCC)patients who would truly benefit from liver resection(LR)remain undefined.AIM To identify BCLC-B...BACKGROUND The selection criteria for Barcelona Clinic Liver Cancer(BCLC)intermediate-stage hepatocellular carcinoma(HCC)patients who would truly benefit from liver resection(LR)remain undefined.AIM To identify BCLC-B HCC patients more suitable for LR.METHODS We included patients undergoing curative LR for BCLC stage A or B multinodular HCC(MNHCC)and stratified BCLC-B patients by the sum of tumor size and number(N+S).Overall survival(OS),recurrence-free survival(RFS),recurrence-to-death survival(RTDS),recurrence patterns,and treatments after recurrence in BCLC-B patients in each subgroup were compared with those in BCLC-A patients.RESULTS In total,143 patients who underwent curative LR for MNHCC with BCLC-A(n=25)or BCLC-B(n=118)were retrospectively analyzed.According to the N+S,patients with BCLC-B HCC were divided into two subgroups:BCLC-B1(N+S≤10,n=83)and BCLC-B2(N+S>10,n=35).Compared with BCLC-B2 patients,those with BCLC-B1 had a better OS(5-year OS rate:67.4%vs 33.6%;P<0.001),which was comparable to that in BCLC-A patients(5-year OS rate:67.4%vs 74.1%;P=0.250),and a better RFS(median RFS:19 mo vs 7 mo;P<0.001),which was worse than that in BCLC-A patients(median RFS:19 mo vs 48 mo;P=0.022).Further analysis of patients who developed recurrence showed that both BCLC-B1 and BCLC-A patients had better RTDS(median RTDS:Not reached vs 49 mo;P=0.599),while the RTDS in BCLC-B2 patients was worse(median RTDS:16 mo vs not reached,P<0.001;16 mo vs 49 mo,P=0.042).The recurrence patterns were similar between BCLC-B1 and BCLC-A patients,but BCLC-B2 patients had a shorter recurrence time and a higher proportion of patients had recurrence with macrovascular invasion and/or extrahepatic metastasis,both of which were independent risk factors for RTDS.CONCLUSION BCLC-B HCC patients undergoing hepatectomy with N+S≤10 had mild recurrence patterns and excellent OS similar to those in BCLC-A MNHCC patients,and LR should be considered in these patients.展开更多
文摘AIM： To investigate preoperative factors associated with poor shore-term outcome after resection for multi- nodular hepatocellular carcinoma （HCC） and to assess the contraindication of patients for surgery, METHODS： We retrospectively analyzed 162 multi- nodular HCC patients with Child-Pugh A liver function who underwent surgical resection. The prognostic significance of preoperative factors was investigated by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards model. Each independent risk factor was then assigned points to construct a scoring model to evaluate the in- dication for surgical intervention. A receiver operating characteristics （ROC） curve was constructed to assess the predictive ability of this system.RESULTS： The median overall survival was 38.3 mo （range： 3-80 too）, while the median disease-free sur- vival was 18.6 mo （range： 1-79 too）. The 1-year mor- tality was 14%. Independent prognostic risk factors of 1-year death included prealburnin 〈 170 rng/L [hazard ratio （HR）： 5.531, P 〈 0.001], alkaline phosphatase 〉 129 U/L （HR： 3.252, P = 0.005）, α fetoprotein 〉 20 μg/L （HR： 7.477, P = 0.011）, total tumor size 〉 8 cm （HR： 10.543; P 〈 0.001）, platelet count 〈 100×109/L （HR： 9.937, P 〈 0.001）, and y-glutamyl transpeptidase 〉 64 U/L （HR： 3.791, P 〈 0.001）. The scoring model had a strong ability to predict 1-year survival （area under ROC： 0.925, P 〈 0.001）. Patients with a score ≥5 had significantly poorer short-term outcome than those with a score 〈 5 （1-year mortality： 62% vs 5%, P 〈 0.001; 1-year recurrence rate： 86% vs 33%, P 〈 0.001）. Patients with score ≥5 had greater possibility of microvascular invasion （P 〈 0.001）, poor tumor dif- ferentiation （P = 0.003）, liver cirrhosis with small nod- ules （P 〈 0.001）, and intraoperative blood transfusion （P = 0.010）. CONCLUSION： A composite preoperative scoring model can be used as an indication of prognosis of HCC patients after surgical resection. Resection should be considered with caution in patients with a score ≥5, which indicates a contraindication for surgery.
文摘Purpose: The incidence of hyperplastic thyroid nodular disease has been consistently rising over the last decades. In addition, unsuspected papillary thyroid carcinoma (PTC) can be found in up to 34% of patients operated for benign thyroid lesions. PTC tends to occur multi-focally and is commonly of polyclonal origin. We set out to test the hypothesis that in benign thyroid disease, a unique genetic signature can already be identified in the benign pathology, which is associated with a susceptibility of the thyroid tissue to neoplastic transformation in the context of additional growth promoting stimuli. Patients and Methods: We obtained a set of 23 samples from patients with multinodular goiter (MNG), 12 of whom also harbored an unsuspected PTC. We used global gene expression analysis to evaluate for dissimilarities in the gene expression patterns between these two groups. We also compared these patterns to the profiles of 3 normal thyroid and 7 PTC samples. Results: We were able to accurately distinguish between hyperplastic nodules of patients with multinodular goiter and those that were associated with a PTC. One of the strongest differentially expressed genes, CDC42, has been implicated to respond to environmental factors such as UVB radiation and might point to novel factors contributing to PTC genesis in the setting of pre-existing benign proliferative disease. Conclusion: While the comparison between histologically identical samples cannot distinguish the two groups of goiters, unsupervised or supervised approaches allowed us to identify a molecular signature associated with PTC susceptibility in multinodular goiter.
基金approved by the Ethics Committee of the Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology(Approval No.TJIRB20210918).
文摘BACKGROUND The selection criteria for Barcelona Clinic Liver Cancer(BCLC)intermediate-stage hepatocellular carcinoma(HCC)patients who would truly benefit from liver resection(LR)remain undefined.AIM To identify BCLC-B HCC patients more suitable for LR.METHODS We included patients undergoing curative LR for BCLC stage A or B multinodular HCC(MNHCC)and stratified BCLC-B patients by the sum of tumor size and number(N+S).Overall survival(OS),recurrence-free survival(RFS),recurrence-to-death survival(RTDS),recurrence patterns,and treatments after recurrence in BCLC-B patients in each subgroup were compared with those in BCLC-A patients.RESULTS In total,143 patients who underwent curative LR for MNHCC with BCLC-A(n=25)or BCLC-B(n=118)were retrospectively analyzed.According to the N+S,patients with BCLC-B HCC were divided into two subgroups:BCLC-B1(N+S≤10,n=83)and BCLC-B2(N+S>10,n=35).Compared with BCLC-B2 patients,those with BCLC-B1 had a better OS(5-year OS rate:67.4%vs 33.6%;P<0.001),which was comparable to that in BCLC-A patients(5-year OS rate:67.4%vs 74.1%;P=0.250),and a better RFS(median RFS:19 mo vs 7 mo;P<0.001),which was worse than that in BCLC-A patients(median RFS:19 mo vs 48 mo;P=0.022).Further analysis of patients who developed recurrence showed that both BCLC-B1 and BCLC-A patients had better RTDS(median RTDS:Not reached vs 49 mo;P=0.599),while the RTDS in BCLC-B2 patients was worse(median RTDS:16 mo vs not reached,P<0.001;16 mo vs 49 mo,P=0.042).The recurrence patterns were similar between BCLC-B1 and BCLC-A patients,but BCLC-B2 patients had a shorter recurrence time and a higher proportion of patients had recurrence with macrovascular invasion and/or extrahepatic metastasis,both of which were independent risk factors for RTDS.CONCLUSION BCLC-B HCC patients undergoing hepatectomy with N+S≤10 had mild recurrence patterns and excellent OS similar to those in BCLC-A MNHCC patients,and LR should be considered in these patients.
