AIM: To compare the prognoses of hepatocellular carcinoma (HCC) patients that underwent anatomic liver resection (AR) or non-anatomic liver resection (NAR) using propensity score-matched populations.
BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in...BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.展开更多
Background:The optimal regimen of infliximab salvage in acute severe ulcerative colitis(ASUC)patients remains controversial.This study aimed to compare accelerated and standard infliximab induction in Chinese ASUC pat...Background:The optimal regimen of infliximab salvage in acute severe ulcerative colitis(ASUC)patients remains controversial.This study aimed to compare accelerated and standard infliximab induction in Chinese ASUC patients,and to explore risk factors and concrete accelerated regimens for them.Methods:Data were retrospectively collected from steroid-refractory ASUC patients receiving infliximab as rescue therapy at seven tertiary centers across China.Outcomes including colectomy and clinical remission(Mayo score≤2 and every subscore≤1 at Day 14)rates were compared between patients receiving accelerated and standard infliximab induction using propensity score adjust-ment for potential confounders.The dose-response relationship was explored by plotting restricted cubic splines.Logistic regression and Cox proportional hazards regression analyses were performed to determine risk factors for adverse outcomes.A systematic re-view and meta-analysis was also performed.Results:A total of 76 patients were analysed:29 received standard and 47 received accelerated induction.The accelerated group had a higher 90-day colectomy rate(17.8%vs 0%,P=0.019)and lower clinical remission rate(27.7%vs 65.5%,P=0.001).After adjust-ing for propensity score and institution,there was no significant difference in colectomy or clinical remission rates(both P>0.05).Dose-effect curves showed decreased colectomy hazard with higher cumulative infliximab dosage within 5 days,with no improve-ment observed for increasing cumulative infliximab dosage within 28 days.Multivariate logistic regression analyses revealed C-reac-tive protein of>10 mg/L at infliximab initiation(odds ratio?5.00,95%confidence interval:1.27-24.34)as an independent risk factor for no clinical remission.Meta-analysis also revealed no significant difference in colectomy rates at 3 months(P=0.54).Conclusions:After adjusting for confounders,there were no significant differences in colectomy or clinical remission rates between accelerated and standard infliximab induction among ASUC patients.Early administration of an intensified dosage within 5 days may be beneficial.Elevated C-reactive protein at infliximab initiation indicated need for intensive treatment.展开更多
Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.T...Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.展开更多
Background: Significant portal hypertension(SPH) is a relative contraindication for patients with resectable hepatocellular carcinoma(HCC). However, increasing evidence indicates that liver resection is feasible for H...Background: Significant portal hypertension(SPH) is a relative contraindication for patients with resectable hepatocellular carcinoma(HCC). However, increasing evidence indicates that liver resection is feasible for HCC patients with SPH. Methods: HCC patients with cirrhosis who underwent laparoscopic liver resection(LLR) in two centers from January 2013 to April 2018 were included. Surgical and survival outcomes were analyzed to explore potential prognostic factors. Propensity score matching(PSM) analysis was performed to minimize bias. Results: A total of 165 patients were divided into two groups based on the presence(SPH, n = 76) or absence(non-SPH, n = 89) of SPH. Patients in the SPH group had longer operative time, more blood loss, and more advanced TNM stage than patients in the non-SPH group( P < 0.05). However, there were no significant differences in the postoperative 90-day mortality rate( n = 0), overall postoperative complications(47.4% vs. 41.6%, P = 0.455), Clavien-Dindo classification( P = 0.347), conversion to open surgery(9.2% vs. 6.7%, P = 0.557), or length of hospitalization(16 vs. 15 days, P = 0.203) between the SPH and non-SPH groups before PSM. Similar results were obtained after PSM. The 1-, 3-, and 5-year overall survival(OS) and recurrence-free survival rates in the SPH group were not significantly different from those in the non-SPH group both before and after PSM(log-rank P > 0.05). After PSM, alpha-fetoprotein(AFP) ≥ 400 μg/L [hazard ratio(HR) = 4.71, 95% confidence interval(CI): 2.69-8.25], ascites(HR = 2.18, 95% CI: 1.30-3.66), American Society of Anesthesiologists(ASA) classification(Ⅲ vs. Ⅱ)(HR = 2.13, 95% CI: 1.11-4.07) and tumor diameter > 5 cm(HR = 3.91, 95% CI: 2.02-7.56) independently predicted worse OS. Conclusions: LLR for patients with HCC complicated with SPH appears feasible at the price of increasing operative time and blood loss. AFP, ascites, ASA classification and tumor diameter may predict the prognosis of HCC complicated with SPH after LLR.展开更多
Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open l...Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open liver resection operated from year 2008 to 2018.Consecutive HCC patients aged 65 or above at the time of operation were recruited.Patients with recurrent HCC and/or alternative pathology were excluded.Short-term and long-term outcomes between the laparoscopic and the open group were compared.Propensity score matching of patients in a ratio of 1:2 was conducted before comparison.Results:A total of 911 patients underwent hepatectomy for primary HCC from 2008 to 2018.Among them,320 elderly patients aged over 65 years old were eligible for analysis.Heterogeneities between laparoscopic and open groups were identified namely pre-operative albumin level,aspartate transaminase,and magnitude of hepatectomy(major vs.minor).After propensity score matching of 1:2,46 patients in the laparoscopic group and 92 patients in the open group were included for comparison.The laparoscopic group had less blood loss(326 mL vs.735 mL;P<0.001),shorter operative time(223 min vs.324 min;P<0.001),and shorter hospital stay(6.3 days vs.10.5 days;P<0.001).No significant differences in postoperative morbidity and hospital mortality were noted between the groups.For oncological outcome,the laparoscopic group had a superior disease-free survival(59.7%vs.44.5%;P=0.041),and a trend towards better overall survival compared with the open group.(78.4%vs.64.8%;P=0.110).Conclusion:Laparoscopic liver resection is a safe approach for elderly patients with HCC with benefits from faster recovery and better oncological outcomes.展开更多
基金Supported by A Grant-in-Aid for Scientific Research from the Ministry of Education,Culture,Sports,Science,and Technology,No.23591993a Grant from the Yuasa Memorial Foundation
文摘AIM: To compare the prognoses of hepatocellular carcinoma (HCC) patients that underwent anatomic liver resection (AR) or non-anatomic liver resection (NAR) using propensity score-matched populations.
基金Supported by the Incubation Project of Zhongshan Hospital(Xiamen),Fudan University,No.2019ZSXMYS15the Clinical Research Center for Precision Medicine of Abdominal Tumor of Fujian Province+1 种基金the Key Clinical Specialty Discipline Construction Program of Fujian ProvinceXiamen Medical and Health Guidance Project,No.3502Z20244ZD1103.
文摘BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.
基金supported by National High Level Hospital Clinical Research Funding[grant number 2022-PUMCH-B-022]CAMS Innovation Fund for Medical Sciences(CIFMS)from Chinese Academy of Medical Sciences[grant number 2021-I2M-1-062].
文摘Background:The optimal regimen of infliximab salvage in acute severe ulcerative colitis(ASUC)patients remains controversial.This study aimed to compare accelerated and standard infliximab induction in Chinese ASUC patients,and to explore risk factors and concrete accelerated regimens for them.Methods:Data were retrospectively collected from steroid-refractory ASUC patients receiving infliximab as rescue therapy at seven tertiary centers across China.Outcomes including colectomy and clinical remission(Mayo score≤2 and every subscore≤1 at Day 14)rates were compared between patients receiving accelerated and standard infliximab induction using propensity score adjust-ment for potential confounders.The dose-response relationship was explored by plotting restricted cubic splines.Logistic regression and Cox proportional hazards regression analyses were performed to determine risk factors for adverse outcomes.A systematic re-view and meta-analysis was also performed.Results:A total of 76 patients were analysed:29 received standard and 47 received accelerated induction.The accelerated group had a higher 90-day colectomy rate(17.8%vs 0%,P=0.019)and lower clinical remission rate(27.7%vs 65.5%,P=0.001).After adjust-ing for propensity score and institution,there was no significant difference in colectomy or clinical remission rates(both P>0.05).Dose-effect curves showed decreased colectomy hazard with higher cumulative infliximab dosage within 5 days,with no improve-ment observed for increasing cumulative infliximab dosage within 28 days.Multivariate logistic regression analyses revealed C-reac-tive protein of>10 mg/L at infliximab initiation(odds ratio?5.00,95%confidence interval:1.27-24.34)as an independent risk factor for no clinical remission.Meta-analysis also revealed no significant difference in colectomy rates at 3 months(P=0.54).Conclusions:After adjusting for confounders,there were no significant differences in colectomy or clinical remission rates between accelerated and standard infliximab induction among ASUC patients.Early administration of an intensified dosage within 5 days may be beneficial.Elevated C-reactive protein at infliximab initiation indicated need for intensive treatment.
基金supported by grants from the Science&Technology Key Program of Zhejiang China(2017C03051)the National Science&Technology Major Project of China(2017ZX10203201)。
文摘Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.
基金supported by grants from the National Natu-ral Science Foundation of China(81701950 and 82172135)Medi-cal Research Projects of Chongqing for staffagainst the epidemic(2020FYYX248)the Kuanren Talents Program of the Second Affiliated Hospital,Chongqing Medical University(KY2019Y002).
文摘Background: Significant portal hypertension(SPH) is a relative contraindication for patients with resectable hepatocellular carcinoma(HCC). However, increasing evidence indicates that liver resection is feasible for HCC patients with SPH. Methods: HCC patients with cirrhosis who underwent laparoscopic liver resection(LLR) in two centers from January 2013 to April 2018 were included. Surgical and survival outcomes were analyzed to explore potential prognostic factors. Propensity score matching(PSM) analysis was performed to minimize bias. Results: A total of 165 patients were divided into two groups based on the presence(SPH, n = 76) or absence(non-SPH, n = 89) of SPH. Patients in the SPH group had longer operative time, more blood loss, and more advanced TNM stage than patients in the non-SPH group( P < 0.05). However, there were no significant differences in the postoperative 90-day mortality rate( n = 0), overall postoperative complications(47.4% vs. 41.6%, P = 0.455), Clavien-Dindo classification( P = 0.347), conversion to open surgery(9.2% vs. 6.7%, P = 0.557), or length of hospitalization(16 vs. 15 days, P = 0.203) between the SPH and non-SPH groups before PSM. Similar results were obtained after PSM. The 1-, 3-, and 5-year overall survival(OS) and recurrence-free survival rates in the SPH group were not significantly different from those in the non-SPH group both before and after PSM(log-rank P > 0.05). After PSM, alpha-fetoprotein(AFP) ≥ 400 μg/L [hazard ratio(HR) = 4.71, 95% confidence interval(CI): 2.69-8.25], ascites(HR = 2.18, 95% CI: 1.30-3.66), American Society of Anesthesiologists(ASA) classification(Ⅲ vs. Ⅱ)(HR = 2.13, 95% CI: 1.11-4.07) and tumor diameter > 5 cm(HR = 3.91, 95% CI: 2.02-7.56) independently predicted worse OS. Conclusions: LLR for patients with HCC complicated with SPH appears feasible at the price of increasing operative time and blood loss. AFP, ascites, ASA classification and tumor diameter may predict the prognosis of HCC complicated with SPH after LLR.
文摘Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open liver resection operated from year 2008 to 2018.Consecutive HCC patients aged 65 or above at the time of operation were recruited.Patients with recurrent HCC and/or alternative pathology were excluded.Short-term and long-term outcomes between the laparoscopic and the open group were compared.Propensity score matching of patients in a ratio of 1:2 was conducted before comparison.Results:A total of 911 patients underwent hepatectomy for primary HCC from 2008 to 2018.Among them,320 elderly patients aged over 65 years old were eligible for analysis.Heterogeneities between laparoscopic and open groups were identified namely pre-operative albumin level,aspartate transaminase,and magnitude of hepatectomy(major vs.minor).After propensity score matching of 1:2,46 patients in the laparoscopic group and 92 patients in the open group were included for comparison.The laparoscopic group had less blood loss(326 mL vs.735 mL;P<0.001),shorter operative time(223 min vs.324 min;P<0.001),and shorter hospital stay(6.3 days vs.10.5 days;P<0.001).No significant differences in postoperative morbidity and hospital mortality were noted between the groups.For oncological outcome,the laparoscopic group had a superior disease-free survival(59.7%vs.44.5%;P=0.041),and a trend towards better overall survival compared with the open group.(78.4%vs.64.8%;P=0.110).Conclusion:Laparoscopic liver resection is a safe approach for elderly patients with HCC with benefits from faster recovery and better oncological outcomes.
