Factors affecting postoperative prognosis in the solitary-nodule type of hepatocellular carcinoma: experience of 132 cases in our institute.
T AsaharaK DohiK KatayamaToshiyuki ItamotoYuzo OkamotoHideki NakaharaEiji OnoK SuginoSeiji MarubayashiH YahataM. KitamotoToshiyuki NakanishiK AzumaK. ItoFumio Shimamoto
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Abstract:
A retrospective analysis of clinical and pathological factors was performed on 132 surgical cases with solitary-nodule type HCC in our hospital. The overall cancer-free survival rates after 1, 3 and 5 years were 82.2%, 42.3% and 26.5%, respectively. With univariate analysis, the significant prognostic factors for survival were tumor size, cancer cell infiltration of the fibrous capsule of the tumor (fc-inf), invasion into portal vein (vp), and intrahepatic metastasis (im), while significant prognostic factors for non-recurrence were tumor size, fc-inf, vp, im, Edmondson-Steiner's classification and perioperative blood transfusion. With multivariate analysis for recurrence, significant factors were vp, clinical stage (CS), and perioperative blood transfusion. Therefore, prognostic factors for long-term survival in surgical cases of HCC are thought to be good hepatic function, absence of portal invasion, and avoidance of perioperative blood transfusion if possible.Keywords:
Univariate analysis
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Objective:To explore the feasibility and safety of hip arthroplasty in treatment of femoral neck fracture and propose the perioperative approach and the methods of arthroplasty.Methods:Retrospective analysis of the efficacy and complications of artificial joint replacement in 26 patients aged more than 70 years old with fractures of the femoral neck from March 2000 to September 2006 were performed.The average duration of hospitalization,the surgical time,the intraoperative and postoperative bleeding,the blood transfusion,Harris score,the time to get out of bed were compared between the hemiarthroplasty group of 20 patients and total hip replacement group of 6 patients.Results:No patients in the two groups died intraoperatively and postoperatively.Harris score improved by an average of 38.2 and the excellent rate was 88.46%.The complications occurred in 5 patients with the incidence of 19.23%.The operative time,the intraoperative and postoperative bleeding,blood transfusion,the incidence of complications in hemiarthroplasty group were significantly lower than those in the total hip replacement group(P0.01-P0.001).There were no significant differences in Harris and the score,time to get out of bed,the average length of stay between the two groups(P0.001-P0.01).Conclusions:Elderly patients with femoral neck fracture,artificial joint replacement for effective treatment,can significantly improve the patient's quality of life.The correct perioperative management can help such patients pass through the perioperative period and achieve good results.For the two surgical approaches,hemiarthroplasty is more suitable for 80 older patients with femoral neck fracture.
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AIM:To discuss strategies and prognosis for the emergency treatment of ruptured bleeding in primary hepatocellular carcinoma.METHODS:The retrospective analysis was performed by examining the emergency treatment experiences of60 cases of ruptured bleeding in primary hepatocellular carcinoma.The treatment methods included surgical tumour resection,transcatheter arterial embolization(TAE)and non-surgical treatment.Univariate and multivariate analyses were performed to identify the risk factors that impacted 30-d mortality in the research groups.RESULTS:The 30-d mortality of all patients was 28.3%(n=17).The univariate analysis showed that ChildPugh C level liver function,shock,massive blood transfusion and large tumour volume were risk factors thatinfluenced 30-d mortality.The multivariate analysis showed that shock and massive blood transfusion were independent risk factors that impacted the 30-d mortality of surgical resection.As for the TAE patients,larger tumour volume was a risk factor towards prognosis.CONCLUSION:Radical resection and TAE therapy would achieve better results in carefully selected ruptured hepatocellular tumours.
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Arterial Embolization
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INTRODUCTION: Lung ressection is the treatment of choice in Non-Small Cell Lung Cancer (NSCLC). Besides TNM staging, other features have been reported as significant prognostic factors. AIM: To analyze factors affecting relapse and survival in NSCLC after complete ressection. METHODS: A retrospective study was conducted, including patients with NSCLC completely ressected in the last 12 years. Clinical and histological factors were assessed and its influence on survival free of relapse and overall survival was determined. RESULTS: 160 patients were included, 77.5% male and 22.5% female, with a median age of 65years. Relapse occurred in 69 patients (median survival free of relapse - 56 months). At univariate analysis, an association was found between reduced survival free of relapse and age≤62 years, clinical tumor size≥4cm, clinical TNM stage>IB, clinical T>1, clinical N>0, pathological TNM stage>IB, pathological T>2, pathological N>0 and vascular invasion. At multivariate analysis, tumor size≥4cm (p=0.004), pathological TNM stage>IB (p=0.023) and vascular invasion (p=0.024) were associated to a reduced survival free of relapse. 64 patients died (median overall survival – 112 months). At univariate analysis, an association was found between reduced overall survival and age≤62 years, clinical tumor size≥4cm, clinical TNM stage>IB, clinical N>0, pathological TNM stage>IB, pathological T>2, pathological N>0, vascular invasion and poor differentiation of tumor. At multivariate analysis, only pathological TNM stage>IB (p=0.029) remained associated a poorer overall survival. CONCLUSION: Besides TNM staging, other features are important on relapse and survival and should be considered for adjuvant therapy.
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TNM staging system
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<b><i>Background:</i></b><i></i> Pulmonary complications remain relatively high in morbidities that arise after liver surgery and are associated with increased length of hospital stay and higher cost. Identification of possible risk factors in this retrospective analysis may help reduce operative morbidity and achieve better outcomes. <b><i>Methods:</i></b><i></i> In all, 363 consecutive patients underwent elective hepatectomies between July 2008 and November 2013 and these were identified and analyzed retrospectively. Patient demographics and perioperative variables were collected. The main outcome was an analysis of risk factors associated with postoperative pleural effusion (PPE). <b><i>Results:</i></b> Of 363 patients receiving hepatectomies, 80 patients (22.0%) developed pulmonary complications. The predominant pulmonary complication in this series is pleural effusion (76 patients, 95%). Univariate analysis found that older age, higher body mass index (BMI), chronic obstructive lung disease, asthma, heart disease, hepatitis C infection, heavy smoking, American Society of Anesthesiology class III and IV, hepatectomy site, combined surgeries, perioperative blood transfusion, and cirrhosis of liver were associated with PPE. Only older age, higher BMI, asthma, heavy smoker, combined gastrointestinal surgeries, and perioperative blood transfusion were identified as independent risk factors in multivariate analysis. <b><i>Conclusion:</i></b> This study identifies 6 risk factors for PPE. Identification and management of some of these factors could possibly reduce morbidity and improve short-term surgical outcomes.
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Liver disease
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To discuss strategies and prognosis for the emergency treatment of ruptured bleeding in primary hepatocellular carcinoma.The retrospective analysis was performed by examining the emergency treatment experiences of 60 cases of ruptured bleeding in primary hepatocellular carcinoma. The treatment methods included surgical tumour resection, transcatheter arterial embolization (TAE) and non-surgical treatment. Univariate and multivariate analyses were performed to identify the risk factors that impacted 30-d mortality in the research groups.The 30-d mortality of all patients was 28.3% (n = 17). The univariate analysis showed that Child-Pugh C level liver function, shock, massive blood transfusion and large tumour volume were risk factors that influenced 30-d mortality. The multivariate analysis showed that shock and massive blood transfusion were independent risk factors that impacted the 30-d mortality of surgical resection. As for the TAE patients, larger tumour volume was a risk factor towards prognosis.Radical resection and TAE therapy would achieve better results in carefully selected ruptured hepatocellular tumours.
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Liver function
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To compare the postoperative survival difference between stage IA and IB non-small cell lung cancer ( NSCLC) and analyze the prognostic factors affecting the long-term survival of resected stage I NSCLC.Ninety-six patients with stage I NSCLC surgically treated in our department from 1974 to 1995 were studied retrospectively. Nine possible prognostic factors including gender, age, T grade, primary tumor size, visceral pleural involvement , type of resection, pathological type, tumor differentiation, and location were analyzed by univariate analysis and multivariate analysis subsequently.There was a significant difference in postoperative 5-year survival between stage IA and IB ( P < 0. 05) . The significant prognostic factors ( P < 0. 05) demonstrated by univariate analysis included T grade, primary tumor size, visceral pleural involvement and tumor differentiation, while visceral pleural involvement and tumor differentiation served as the independent prognostic factors ( P < 0. 05) with multivariate analysis.Stage I NSCLC should be subdivided into IA and IB whose five-year survival was proved to be significantly different. Visceral pleural involvement as well as tumor differentiation played as the independent prognostic factors in resected stage I NSCLC.
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Objective
To retrospectively study the relationship between several risk factors such as cirrhosis, Child-Pugh classification, tumor size, portal vein tumor thrombus, intraoperative transfusion, hepatic portal occlusion time and the prognosis of hepatic cellular cancer (HCC) patients after hepatic resection.
Methods
The clinical data of 123 patients who received hepatic resection for HCC at Tongji Hospital between 2007 and 2009 were retrospectively analyzed. Log-Rank test and Cox proportional hazard model were used in the univariate and multivariate analyses of risk factors.
Results
1, 2, 3, 5 year recurrence and survival rates were 54.17%, 66.67%, 81.40%, 87.50% and 93.50%, 73.17%, 58.54%, 27.64%, respectively. The mean recurrence time and survival time were 19.5 months and 42.9 months. In univariate analysis, presence of cirrhosis (χ2=11.159, P=0.005), Child-Pugh classification (χ2=7.715, P=0.028), tumor size (≥5cm) (χ2=11.483, P=0.004), presence of portal vein invasion (χ2=22.271, P=0.001) were risk factors affecting HCC recurrence. In multivariate analysis, presence of cirrhosis (χ2=8.993, P=0.003), tumor size (≥5cm) (χ2=4.022, P=0.039), presence of portal vein invasion (χ2=5.023, P=0.027) were independent risk factors affecting HCC recurrence. In univariate analysis, presence of cirrhosis (χ2=7.339, P=0.025), AFP>400 ng/ml (χ2=5.431, P=0.042), Child-Pugh classification (χ2=13.389, P=0.002), tumor size(≥5cm) (χ2=11.342, P=0.003), presence of portal vein invasion (χ2=52.167, P<0.001), hepatic portal occlusion (χ2=5.801, P=0.037), intraoperative blood transfusion (χ2=14.959, P=0.001) were risk factors affecting a shorter overall survival. In multivariate analysis, presence of cirrhosis (χ2=9.133, P=0.003), Child-Pugh classification (χ2=4.799, P=0.028), tumor size (≥5 cm) (χ2=9.101, P=0.004), presence of portal vein invasion (χ2=11.126, P=0.001), hepatic portal occlusion (χ2=3.985, P=0.046) were independent prognostic factors affecting shorter overall survival.
Conclusion
Cirrhosis, Child-Pugh classification, tumor size (≥5 cm), presence of portal vein invasion, and hepatic portal occlusion were independent prognostic factors for HCC patients after hepatic resection.
Key words:
Liver neoplasms; Prognosis; Risk factors
Univariate analysis
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Objective To compare the postoperative survival difference between stage ⅠA and ⅠB non small cell lung cancer (NSCLC) and analyze the prognostic factors affecting the long term survival of resected stage Ⅰ NSCLC. Methods Ninety six patients with stage Ⅰ NSCLC surgically treated in our department from 1974 to 1995 were studied retrospectively. Nine possible prognostic factors including gender, age, T grade, primary tumor size, visceral pleural involvement, type of resection, pathological type, tumor differentiation, and location were analyzed by univariate analysis and multivariate analysis subsequently. Results There was a significant difference in postoperative 5 year survival between stage ⅠA and ⅠB (P0.05). The significant prognostic factors (P0.05) demonstrated by univariate analysis included T grade, primary tumor size, visceral pleural involvement and tumor differentiation, while visceral pleural involvement and tumor differentiation served as the independent prognostic factors (P0.05) with multivariate analysis. Conclusion Stage Ⅰ NSCLC should be subdivided into ⅠA and ⅠB whose five year survival was proved to be significantly different. Visceral pleural involvement as well as tumor differentiation played as the independent prognostic factors in resected stage Ⅰ NSCLC.
Univariate analysis
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