1,073 research outputs found

    Impact of remnant vital tissue after locoregional treatment and liver transplant in hepatocellular cancer patients. A multicentre cohort study

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    The role of pathological findings after locoregional treatments as predictors of hepatocellular cancer recurrence after liver transplantation has been poorly addressed. The aim of the study was to identify the role of remnant vital tissue (RVT) of the target lesion in predicting hepatocellular cancer recurrence. Two hundred and seventy-six patients firstly undergoing locoregional treatment and then transplanted between January 2010 and December 2015 in four European Transplant Centres (i.e. Rome Tor Vergata, Birmingham, Brussels and Ancona) were enrolled in the study to investigate the role of pathological response at upfront locoregional treatment. At multivariable Cox regression analysis, RVT ≥2 cm was a strong independent risk factor for post-LT recurrence (HR = 5.6; P < 0.0001). Five-year disease-free survival rates were 60.8%, 80.9% and 95.0% in patients presenting a RVT ≥2 cm vs. 0.1-1.9 vs. no RVT, respectively. When only Milan Criteria-IN patients were analysed, similar results were reported, with 5-year disease-free survival rates of 58.1%, 79.0% and 94.0% in patients presenting a RVT ≥2 cm vs. 0.1-1.9 vs. no RVT, respectively. RVT is an important determinant of tumour recurrence after liver transplantation performed for hepatocellular cancer. Its discriminative power looks to be evident also in a Milan-IN setting, suggesting to more liberally use locoregional treatments also in these patients

    Histopathological Assessment of Microvascular Invasion in Hepatocellular Carcinoma Resection Specimens and its Correlation with Tumor Size and Grade

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    OBJECTIVES To determine the histopathological assessment of microvascular invasion in Hepatocellular Carcinoma Resection Specimens and its correlation with tumour size and grade. METHODOLOGY This retrospective cross-sectional study included the biopsy-proven Hepatocellular (HCC) case with microvascular invasion (MVI) noted in the resected specimens evaluated by two independent consultants Histopathologists. The exclusion criteria were; all patients below 18 years, unfixed autolyzed samples, and incomplete requisition-filled forms. Numerical data, i.e., patient age and tumour size, are presented as mean with standard deviation. Categorical variables, i.e., tumour size, grade, and presence or absence of MVI, were submitted as numbers with percentages. Continuous variables, i.e., tumour size and differentiation grade, were assessed using the Chi-square test. A p-value of ≤ 0.05 was considered significant. RESULTSMost patients, 34.4%, fall into the age group of 47-70. Most patients were males, 63.6%, and microvascular invasion was noted in 49.09% of cases. Most cases were of moderate to poorly differentiated tumours, 80.0%. MVI was statistically significant with the grade of the tumour. CONCLUSION Microvascular invasion is an important prognostic marker noted in a surgical resection specimen. Although the exact definition and risk stratification is unclear, survival studies have proven that MVI is associated with poor outcomes

    Texture analysis on preoperative contrast-enhanced magnetic resonance imaging identifies microvascular invasion in hepatocellular carcinoma

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    Background: Radiomic texture analysis quantifies tumor heterogeneity. The aim of this study is to determine if radiomics can predict biologic aggressiveness in HCC and identify tumors with MVI.Methods: Single-center, retrospective review of HCC patients undergoing resection/ablation with curative intent from 2009 to 2017. DICOM images from preoperative MRIs were analyzed with texture analysis software. Texture analysis parameters extracted on T1, T2, hepatic arterial phase (HAP) and portal venous phase (PVP) images. Multivariate logistic regression analysis evaluated factors associated with MVI.Results: MVI was present in 52.2% (n = 133) of HCCs. On multivariate analysis only T1 mean (OR = 0.97, 95%CI 0.95-0.99, p = 0.043) and PVP entropy (OR = 4.7, 95%CI 1.37-16.3, p = 0.014) were associated with tumor MVI. Area under ROC curve was 0.83 for this final model. Empirical optimal cutpoint for PVP tumor entropy and T1 tumor mean were 5.73 and 23.41, respectively. At these cutpoint values, sensitivity was 0.68 and 0.5, respectively and specificity was 0.64 and 0.86. When both criteria were met, the probability of MVI in the tumor was 87%.Conclusion: Tumor entropy and mean are both associated with MVI. Texture analysis on preoperative imaging correlates with microscopic features of HCC and can be used to predict patients with high-risk tumors

    간세포암의 미세혈관침습 예측: 수술 전 이중에너지 전산화 단층촬영을 이용한 용적화된 요오드 정량화의 가치

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    학위논문 (석사) -- 서울대학교 대학원 : 의과대학 임상의과학과, 2020. 8. 이정민.Objective To investigate the potential value of volumetric iodine quantification using preoperative dual-energy computed tomography (DECT) for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC). Materials and Methods This retrospective study included patients with single HCC treated through surgical resection who underwent preoperative DECT. Quantitative DECT features, including normalized iodine concentration (NIC) to the aorta and mixed-energy CT attenuation value in the arterial phase, were three-dimensionally measured for peritumoral and intratumoral regions: (i) layer-by-layer analysis for peritumoral layers (outer layers 1 and 2; numbered in close order from the tumor boundary) and intratumoral layers (inner layers 1 and 2) with 2-mm layer thickness and (ii) volume of interest (VOI)-based analysis with different volume coverage (tumor itself; VOIO1, tumor plus outer layer 1; VOIO2, tumor plus outer layers 1 and 2; VOII1, tumor minus inner layer 1; VOII2, tumor minus inner layers 1 and 2). In addition, qualitative CT features, including peritumoral enhancement and tumor margin, were assessed. Qualitative and quantitative CT features were compared between HCC patients with and without MVI. Diagnostic performance of DECT parameters of layers and VOIs was assessed using receiver operating characteristic curve analysis. Results A total of 36 patients (24 men, mean age 59.9 ± 8.5 years) with MVI (n = 14) and without MVI (n = 22) were included. HCCs with MVI showed significantly higher NICs of outer layer 1, outer layer 2, VOIO1, and VOIO2 than those without MVI (P = 0.01, 0.04, 0.02, 0.02, respectively). Among the NICs of layers and VOIs, the highest area under the curve was obtained in outer layer 1 (0.747). Qualitative features, including peritumoral enhancement and tumor margin, and the mean CT attenuation of each layer and each VOI were not significantly different between HCCs with and without MVI (both P > 0.05). Conclusion Volumetric iodine quantification of peritumoral and intratumoral regions using DECT may help predict the MVI of HCC.연구 목적 본 연구는 수술 전 이중에너지 CT를 이용한 용적화된 요오드 정량화를 통해 간세포암의 미세혈관 침습을 예측하는 것을 목적으로 하였다. 연구 방법 수술 전 이중에너지 CT를 촬영하고 수술적 제거로 간세포암으로 확진된 환자들이 후향적으로 본 연구에 포함되었다. 동맥기에서 대동맥을 기준으로 표준화 된 요오드 농도 (normalized iodine concentration, NIC)와 혼합 에너지에서의 CT 감쇠 계수를 포함한 이중에너지 CT의 정량적인 특성들을 종양 주변 지역과 종양 내부 지역에서 삼차원적으로 측정하였다. 이를 통해 (i) 2 mm 층 두께로 나눈 종양 주변의 층들 (outer layers 1과 2; 종양 경계에서 가까운 순서대로 번호 매김)과 종양 내부의 층들 (inner layers 1과 2) 간의 층-대-층 (layer-by-layer) 분석과 (ii) 5개의 용적 적용 범위 (종양 자체; VOIO1, 종양과 outer layer 1을 더한 부피; VOIO2, 종양과 outer layers 1과 2을 더한 부피; VOII1, 종양에서 inner layer 1을 뺀 부피; VOII2, 종양에서 inner layers 1과 2를 뺀 부피) 를 사용한 volume of interest (VOI) 기반 분석을 시행하였다. 추가적으로 종양 주변 지역의 조영증강과 종양의 경계 모양을 포함한 정성적 분석을 시행하였다. 미세혈관 침습이 있는 간세포암과 미세혈관 침습이 없는 간세포암, 두 군에서 정량적, 정성적인 CT 특성들을 비교하였다. 층과 VOI들의 이중에너지 CT 특성들은 수신자 조작 특성 (receiver operating characteristic, ROC) 곡선 분석을 통해 진단적 가치를 평가하였다. 일변량 분석에서 유의한 결과를 얻은 변수들은 다변량 분석을 시행하였다. 연구 결과 미세혈관 침습이 있는 14명의 환자와 미세혈관 침습이 없는 22명의 환자를 포함한 총 36명의 환자 (남자 24명, 평균 나이 59.9 ± 8.5세) 가 최종적으로 포함되었다. Outer layer 1, outer layer 2, VOIO1, VOIO2의 NIC가 미세혈관 침습이 있는 환자군에서 유의하게 높게 측정되었다 (P 0.05). 다변량 분석에서 outer layer 1의 NIC는 미세혈관 침습을 예측하는 데 있어 독립적인 인자로 밝혀졌다 (위험도 7.14, P = 0.04). 결론 수술 전 이중에너지 CT를 사용한 종양 주변 지역과 종양 내부 지역의 용적화된 요오드 정량화는 간세포암의 미세혈관 침습 여부과 연관이 있었으며, 이를 예측하는 데 유용하게 쓰일 것으로 보인다.Introduction 8 Methods 10 Results 18 Discussion 30 References 34 Abstract in Korean 37Maste

    Invasão microvascular no carcinoma hepatocelular : é possível predizer pelos parâmetros quantitativos da tomografia computadorizada?

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    To investigate whether quantitative computed tomography (CT) measurements can predict microvascular invasion (MVI) in hepatocellular carcinoma (HCC). This was a retrospective analysis of 200 cases of surgically proven HCCs in 125 consecutive patients evaluated between March 2010 and November 2017. We quantitatively measured regions of interest in lesions and adjacent areas of the liver on unenhanced CT scans, as well as in the arterial, portal venous, and equilibrium phases on contrast-enhanced CT scans. Enhancement profiles were analyzed and compared with histopathological references of MVI. Univariate and multivariate logistic regression analyses were used in order to evaluate CT parameters as potential predictors of MVI. Of the 200 HCCs, 77 (38.5%) showed evidence of MVI on histopathological analysis. There was no statistical difference between HCCs with MVI and those without, in terms of the percentage attenuation ratio in the portal venous phase (114.7 vs. 115.8) and equilibrium phase (126.7 vs. 128.2), as well as in terms of the relative washout ratio, also in the portal venous and equilibrium phases (15.0 vs. 8.2 and 31.4 vs. 26.3, respectively). Quantitative dynamic CT parameters measured in the preoperative period do not appear to correlate with MVI in HCC525287292O objetivo deste estudo foi investigar se parâmetros quantitativos da tomografia computadorizada (TC) podem predizer invasão microvascular (IMV) no carcinoma hepatocelular (CHC). Foram analisados, retrospectivamente, 200 CHCs comprovados de 125 pacientes submetidos consecutivamente a transplante ou ressecção hepática entre março/2010 e novembro/2017. Foram realizadas medidas quantitativas da densidade das lesões e do parênquima hepático adjacente pré-contraste e nas fases arterial, portal e de equilíbrio das TCs. Parâmetros de impregnação foram comparados com a presença de IMV nos laudos anatomopatológicos. Regressões logísticas univariadas e multivariadas foram utilizadas para avaliar os parâmetros da TC como potenciais preditores de IMV. Dos 200 CHCs, 77 (38,5%) tinham IMV no anatomopatológico. Não houve diferença estatística na razão de atenuação entre CHCs com IMV e os sem IMV na fase portal (114,7 para IMV positiva e 115,8 para IMV negativa) ou de equilíbrio (126,7 para IMV positiva e 128,2 para IMV negativa), nem na razão de washout relativa nas fases portal e de equilíbrio (15,0 para IMV positiva e 8,2 para IMV negativa na fase portal, e 31,4 para IMV positiva e 26,3 para IMV negativa na fase de equilíbrio

    Role of transarterial chemoembolization as neoadjuvant treatment in T2 stage patients waiting for liver transplantation

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    RIASSUNTO Scopo: Valutare retrospettivamente i risultati clinici a lungo termine di pazienti cirrotici con HCC allo stadio T2 sottoposti a trapianto ortotopico di fegato (TOF) dopo chemioembolizzazione intraarteriosa (TACE), rispetto ai risultati ottenuti in un’analoga serie di pazienti non sottoposti ad alcun trattamento loco-regionale pre-TOF. Materiali e Metodi: Lo studio ha incluso 168 pazienti cirrotici (147 maschi, età media 55,8 anni) trapiantati per HCC allo stadio T2 dal 1996 al 2010. In pazienti sottoposti a TACE pre-TOF, lo studio TC eseguito prima del trapianto è stato revisionato per stimare la risposta tumorale al trattamento secondo i criteri RECIST modificati. I pazienti sono stati suddivisi in 3 gruppi: A) nessun trattamento pre-TOF; B) risposta completa (CR) dopo TACE; C) risposta parziale, stabilità o progressione di malattia dopo TACE. Le sopravvivenze cumulativa (OS), libera da recidiva (RFS) e libera da malattia (DFS) sono state calcolate secondo l’analisi di Kaplan-Meyer e comparate mediante test log-rank. Risultati: Il gruppo A era costituito da 56 pazienti, il gruppo B da 60 e il gruppo C da 52; i dati clinici dei tre gruppi erano sovrapponibili. A 5 anni, OS, RFS e DFS sono state 75,2%, 92,7% e 73,2%, rispettivamente. Le sopravvivenze sono state significativamente maggiori nel gruppo B rispetto al gruppo C e sovrapponibili fra gruppo A e B. In pazienti con diametro tumorale totale >3cm, RFS e DFS censurata per morti periprocedurali (n=7) sono state significativamente superiori nel gruppo B rispetto al gruppo A. Conclusioni: In pazienti con HCC allo stadio T2 sottoposti a TOF, la CR dopo TACE pre-operatoria è un fattore prognostico favorevole di sopravvivenza e recidiva tumorale. La TACE pre-TOF può apportare un beneficio clinico in pazienti T2 con HCC >3cm. SUMMARY Aim: To provide a retrospective assessment of long-term results in cirrhotic patients with stage T2 hepatocellular carcinoma (HCC) treated by orthotopic liver transplantation (LT). Materials e Methods: The study included 168 cirrhotic patients (147 males, mean age 55.8 years) transplanted for stage T2 HCC from 1996 to 2010. In patients submitted to pre-LT transarterial chemoembolization (TACE), the CT study carried out prior to LT was reviewed to estimate tumour response to treatment in accordance with the modified RECIST criteria. The patients were subdivided into 3 groups: A) no pre-LT treatment; B) complete response (CR) after TACE; C) partial response, stable or progressive disease after TACE. Overall survival (OS) and recurrence-free (RFS) and disease-free (DFS) survival were calculated according to the Kaplan-Meyer analysis and compared using log-rank tests. Results: Group A was made up of 56 patients, group B of 60 and Group C of 52. The clinical data were comparable for the three groups. At 5 years, OS, RFS and DFS were 75.2%, 92.7% and 73.2%, respectively. Survival rates were significantly higher in Group B than in Group C, and comparable in Groups A and B. In patients with total tumour diameter of >3cm, RFS and DFS censored in peri-procedural deaths (n=7) were significantly higher in Group B than in Group A. Conclusions: In patients with T2-stage HCC submitted to LT, CR after pre-operative TACE is a favourable prognostic factor for survival and absence of tumour recurrence. Pre-OLT TACE may be clinically beneficial for T2-stage HCC patients with tumour size >3cm

    Vascular invasion and survival after liver transplantation for hepatocellular carcinoma: a study from the European Liver Transplant Registry

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    Background: Studies suggest that vascular invasion may be a superior prognostic marker compared with traditional selection criteria, e.g. Milan criteria. This study aimed to investigate the prognostic value of micro and macrovascular invasion in a large database material. Methods: Patients liver transplanted for HCC and cirrhosis registered in the European Liver Transplant Registry (ELTR) database were included. The association between the Milan criteria, Up-to-seven criteria and vascular invasion with overall survival and HCC specific survival was investigated with univariate and multivariate Cox regression analyses. Results: Of 23,124 patients transplanted for HCC, 9324 had cirrhosis and data on explant pathology. Patients without microvascular invasion, regardless of number and size of HCC nodules, had a five-year overall survival of 73.2%, which was comparable with patients inside both Milan and Up-to-seven criteria. Patients without macrovascular invasion had an only marginally reduced survival of 70.7% after five years. Patients outside both Milan and Up-to-seven criteria without micro or macrovascular invasion still had a five-year overall survival of 65.8%. Conclusion: Vascular invasion as a prognostic indicator remains superior to criteria based on size and number of nodules. With continuously improving imaging studies, microvascular invasion may be used for selecting patients for transplantation in the future

    Prognostic Factors for Tumor Recurrence after a 12-Year, Single-Center Experience of Liver Transplantations in Patients with Hepatocellular Carcinoma

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    Background. Factors affecting outcomes after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) have been extensively studied, but some of them have only recently been discovered or reassessed. Methods. We analyzed classical and more recently emerging variables with a hypothetical impact on recurrence-free survival (RFS) in a single-center series of 283 patients transplanted for HCC between 1997 and 2009. Results. Five-year patient survival and RFS were 75% and 86%, respectively. Thirty-four (12%) patients had HCC recurrence. Elevated preoperative alpha-fetoprotein (AFP) levels, preoperative treatments of HCC, unfulfilled Milan and up-to-seven criteria at final histology, poor tumor differentiation, and tumor microvascular invasion negatively affected RFS by univariate analysis. Milan and up-to-seven criteria applied preoperatively, and the use of m-TOR inhibitors did not reach statistical significance. Cox's proportional hazard model showed that only elevated AFP levels (Odds Ratio = 2.88; 95% C.I. = 1.43–5.80; P = .003), preoperative tumor treatments (Odds Ratio = 4.84; 95% C.I. = 1.42–16.42; P = .01), and microvascular invasion (Odds Ratio = 4.82; 95% C.I. = 1.87–12.41; P = .001) were predictors of lower RFS. Conclusions. Biological aggressiveness and preoperative tumor treatment, rather than traditional and expanded dimensional criteria, conditioned the outcomes in patients transplanted for HCC

    Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion

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    PURPOSE: Microvascular invasion of hepatocellular carcinoma (HCC) is considered a poor prognostic factor of liver resection (LR) and liver transplantation (LT), but its significance for lesions within the up-to-7 criteria is unclear. This study investigated the survival benefit of primary LT against LR for HCC with microvascular invasion and within the up-to-7 criteria. METHODS: Adult patients who underwent LR or LT as the primary treatment for HCC were included for study. Patients with prior local ablation, neoadjuvant systemic chemotherapy, targeted therapy, positive resection margin, or metastatic spread were excluded. RESULTS: There were 471 LR patients and 95 LT recipients (70 with living donor, 25 with deceased donor). Seventy-seven (81.1%) LT recipients had HCC within the up-to-7 criteria. Twenty-five (26.3%) LT recipients had HCC with either macrovascular (n = 4) or microvascular (n = 21) invasion. The 5-year survival rate was 85.7% for LT recipients with HCC within the up-to-7 criteria, unaffected by the presence or absence of vascular invasion (88.2 vs. 85.1%). The rate was comparable with that of LR patients with HCC without vascular invasion (81.2%, p 0.227), but far superior to that of LR patients with lesions with vascular invasion (50.0%, p < 0.0001). Overall survivals were compromised by multiple tumors [odds ratio (OR) 1.902, confidence interval (CI) 1.374-2.633, p = 0.0001], vascular invasion (OR 2.678, CI 1.952-3.674, p < 0.0001), blood transfusion (OR 2.046, CI 1.337-3.131, p = 0.001), and being beyond the up-to-7 criteria (OR 1.457, CI 1.041-2.037, p = 0.028). LT was a favorable factor for survival (OR 0.243, CI 0.130-0.454, p < 0.0001). CONCLUSION: Primary LT for HCC with microvascular invasion and within the up-to-7 criteria doubled the chance of cure as compared with LR.published_or_final_versio
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