Assessment of preoperative exercise capacity in hepatocellular carcinoma patients with chronic liver injury undergoing hepatectomy

BACKGROUND: Cardiopulmonary exercise testing measures oxygen uptake at increasing levels of work and predicts cardiopulmonary performance under conditions of stress, such as after abdominal surgery. Dynamic assessment of preoperative exercise capacity may be a useful predictor of postoperative prognosis. This study examined the relationship between preoperative exercise capacity and event-free survival in hepatocellular carcinoma (HCC) patients with chronic liver injury who underwent hepatectomy. METHODS: Sixty-one HCC patients underwent preoperative cardiopulmonary exercise testing to determine their anaerobic threshold (AT). The AT was defined as the break point between carbon dioxide production and oxygen consumption per unit of time (VO(2)). Postoperative events including recurrence of HCC, death, liver failure, and complications of cirrhosis were recorded. Univariate and multivariate analyses were performed to evaluate associations between 35 clinical factors and outcomes, and identify independent prognostic indicators of event-free survival and maintenance of Child-Pugh class. RESULTS: Multivariate analyses identified preoperative branched-chain amino acid/tyrosine ratio (BTR) <5, alanine aminotransferase level ≥42 IU/l, and AT VO(2) <11.5 ml/min/kg as independent prognostic indicators of event-free survival. AT VO(2) <11.5 ml/min/kg and BTR <5 were identified as independent prognostic indicators of maintenance of Child-Pugh class. CONCLUSIONS: This study identified preoperative exercise capacity as an independent prognostic indicator of event-free survival and maintenance of Child-Pugh class in HCC patients with chronic liver injury undergoing hepatectomy

Perioperative exercise capacity in chronic liver injury patients with hepatocellular carcinoma undergoing hepatectomy.

Dynamic assessment of preoperative exercise capacity may be a useful predictor of postoperative prognosis. We aimed to clarify whether perioperative exercise capacity was related to long-term survival in hepatocellular carcinoma patients with chronic liver injury undergoing hepatectomy. One hundred-six patients with hepatocellular carcinoma underwent pre- and postoperative cardiopulmonary exercise testing to determine their anaerobic threshold, defined as the point between carbon dioxide production and oxygen consumption per unit of time. Testing involved 35 items including blood biochemistry analysis, in-vivo component analysis, dual-energy X-ray absorptiometry, and cardiopulmonary exercise testing preoperatively and 6 months postoperatively. We classified patients with anaerobic threshold ≥ 90% 6 months postoperatively compared with the preoperative level as the maintenance group (n = 78) and patients with anaerobic threshold < 90% as the decrease group (n = 28). Five-year recurrence-free survival rates were 39.9% vs. 9.9% (maintenance vs. decrease group) (hazard ratio: 1.87 [95% confidence interval: 1.12-3.13]; P = 0.018). Five-year overall survival rates were maintenance: 81.9%, and decrease: 61.7% (hazard ratio: 2.95 [95% confidence interval: 1.37-6.33]; P = 0.006). Multivariable Cox proportional hazards models showed that perioperative maintenance of anaerobic threshold was an independent prognostic indicator for both recurrence-free- and overall survival. Although the mean anaerobic threshold from preoperative to postoperative month 6 decreased in the exercise-not-implemented group, the exercise-implemented group experienced increased anaerobic threshold, on average, at postoperative month 6. The significant prognostic factor affecting postoperative survival for chronic liver injury patients with HCC undergoing hepatectomy was maintenance of anaerobic threshold up to 6 months postoperatively

乳癌術後に高カルシウム血症を契機に発見された悪性リンパ腫の１例

症例は52歳の女性で, 3年前に左乳癌で乳腺部分切除,腋窩リンパ節郭清を受けた.病理組織診断は乳頭腺管癌で, リンパ節転移はなかった. 最近, 倦怠感, 食欲低下, 腰痛が出現し, 他院で高カルシウム血症と大動脈周囲リンパ節の腫大を指摘され, 当科に紹介となった. CT で大動脈周囲のリンパ節は著明に腫大し, 血清の可溶性インターロイキン-2レセプターは8980U/mlと高値を示したことから悪性リンパ腫を強く疑った. ゾレドロン酸とエルカトニンを投与し,高カルシウム血症が改善した後,他院血液内科に転院となった.転院後,頚部のリンパ節生検で, CD5陽性びまん性大細胞型B細胞性リンパ腫と診断された. 化学療法が行われたが,7か月後に永眠された.（Kitakanto Med J 2014；64：159～163）A 52-year-old woman underwent partial mastectomy and axillary lymph-node dissection three years ago. The pathological diagnosis was papillotubular carcinoma and no metastases were found in axillary lymph nodes. Recently, the patient complained of general fatigue, appetite loss and lumbago, and consulted another hospital. Laboratory tests revealed hypercalcemia. CT showed para-aortic lymphadenopathy. The patient was transferred to our hospital. Because of para-aortic lymphadenopathy and the high level of soluble interleukin-2 receptor in serum,we suspected malignant lymphoma. After hypercalcemia was improved following administration of zoledronic acid hydrate and elcatonin, the patient was transferred to the department of hematology in another hospital. By cervical lymph node biopsy, the diagnosis was a CD5-positive diffuse large B-cell lymphoma. The patient was treated with chemotherapy, but died seven months later.（Kitakanto Med J 2014；64：159～163