Inoperable hepatocellular carcinoma treated with transcatheter arterial chemoembolisation (TACE): an analysis of prognostic factors in five years survivors

Aim: To evaluate the long-term survival benefit of TACE in patients with inoperable hepatocellular carcinoma and determine prognostic factors by analysis of actual 5-year survivors. Methods: Pretreatment variables were analysed from a prospective database of 335 consecutive patients from January 1989 to December 1996. Univariate and multivariate analyses were performed to identify factors predictive of 5-year survival. Results: Complete 5-year follow-up (median 91 months) was obtained on 320 patients (275 males) who underwent a mean of 3 TACEs (range 1–41) for inoperable HCC. Median age was 59 years (range 19–83). The majority were Child-Pugh grade A (81 per cent). Median tumour size was 9 cm (1–28 cm). There were 98 (30.6 per cent) 1-year and 36 (11.3 per cent) 3-year survivors. Among the 25 (7.8 per cent) 5-year survivors, survival ranged from 60.7 to 138.8 months (median 72.3 months) and tumour size from 1 to 21 cm (median 5.3 cm), with eight tumours greater than 10 cm. On univariate analysis, female gender (P = 0.037), absence of ascites (P = 0.028), platelet count 35 g L−1 (P = 0.04), α-fetoprotein 35 g L−1 (P = 0.014), unilobar distribution (P = 0.011) and α-fetoprotein <1000 ng mL−1 (0.014) were independent predictors of 5-year survival on multivariate regressional analysis. Conclusion: Five-year survival is possible in patients with inoperable hepatocellular carcinoma. Poor prognosis is associated with a bilobar distribution, an α-fetoprotein level of >1000 ng L−1 on presentation and poor underlying liver function

Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study

Background: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer.Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III-V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%).Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p &lt; 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC.Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved