Background:The Barcelona Clinic Liver Cancer(BCLC)system has been endorsed by international guidelines as a staging algorithm of hepatocellular carcinoma.This analysis was performed to assess the outcome of liver tran...Background:The Barcelona Clinic Liver Cancer(BCLC)system has been endorsed by international guidelines as a staging algorithm of hepatocellular carcinoma.This analysis was performed to assess the outcome of liver transplantation in patients treated against the BCLC recommendations.Methods:The data of 198 patients who underwent liver transplantation for hepatocellular carcinoma were extracted from a prospectively maintained database to classify the patients according to the BCLC system.Results:BCLC staging was as follows:0,n=5;A,n=77;B,n=41;C,n=53;and D,n=22.Accordingly,liver transplantation was performed in the majority of patients against BCLC recommendations.Surgery(n=16),radiofrequency ablation(n=15)and transarterial chemoembolization(n=151)preceded liver transplantation in 182 patients.Sixteen patients were transplanted without pretreatment.The 1-,5-and 10-year survival rates were 83.8%,62.4%and 45.9%,and 1-,5-,and 10-year recurrence rates were 7.7%,22.7%and 26.7%.The BCLC classification did neither impact survival(P=0.796)nor recurrence(P=0.693).In the Cox analysis,RECIST tumor progression and initial alpha fetoprotein were independent predictors of outcome.Conclusions:Neither the oncological nor the functional stratification imposed by the BCLC system was of importance for outcome.Lack of flexibility and disregard of biological parameters hamper its clinical applicability in liver transplantation.展开更多
Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of e...Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of effectiveness and safety, as reported in recent research articles, systematic reviews and meta-analyses. In this report, we summarized for the first time the results of proton therapy treatment for HCC according with respect to the Barcelona Clinic Liver Cancer Staging System, the most adopted classification system for HCC which provides information on both prognostic prediction and treatment allocation.展开更多
Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hyperten...Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.展开更多
文摘Background:The Barcelona Clinic Liver Cancer(BCLC)system has been endorsed by international guidelines as a staging algorithm of hepatocellular carcinoma.This analysis was performed to assess the outcome of liver transplantation in patients treated against the BCLC recommendations.Methods:The data of 198 patients who underwent liver transplantation for hepatocellular carcinoma were extracted from a prospectively maintained database to classify the patients according to the BCLC system.Results:BCLC staging was as follows:0,n=5;A,n=77;B,n=41;C,n=53;and D,n=22.Accordingly,liver transplantation was performed in the majority of patients against BCLC recommendations.Surgery(n=16),radiofrequency ablation(n=15)and transarterial chemoembolization(n=151)preceded liver transplantation in 182 patients.Sixteen patients were transplanted without pretreatment.The 1-,5-and 10-year survival rates were 83.8%,62.4%and 45.9%,and 1-,5-,and 10-year recurrence rates were 7.7%,22.7%and 26.7%.The BCLC classification did neither impact survival(P=0.796)nor recurrence(P=0.693).In the Cox analysis,RECIST tumor progression and initial alpha fetoprotein were independent predictors of outcome.Conclusions:Neither the oncological nor the functional stratification imposed by the BCLC system was of importance for outcome.Lack of flexibility and disregard of biological parameters hamper its clinical applicability in liver transplantation.
文摘Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of effectiveness and safety, as reported in recent research articles, systematic reviews and meta-analyses. In this report, we summarized for the first time the results of proton therapy treatment for HCC according with respect to the Barcelona Clinic Liver Cancer Staging System, the most adopted classification system for HCC which provides information on both prognostic prediction and treatment allocation.
基金supported by grants from the Sichuan Science and Technology Program(2023YFQ0094)the 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(25HXJS028).
文摘Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.
