Treatment of patients with advanced gastrointestinal stromal tumor of small bowel: Implications of imatinib mesylate

瞄准：检验 imatinib 的影响耐心的幸存和反应和它的安全上的 mesylate (Glivec ) ，和反应的关联与工具包基因变化地位评价。方法：74 中的 33 个(44.6%) 在药品切除术以后并且不开发了复发的胃肠的基质肿瘤(大意) 病人与 Glivec 对待的小肠是被分类组 A 病人。与 Glivec 对待的 22 个先进的小肠大意病人作为组 B 病人被分类。Clinicopathological 特征，复发以后、全面的幸存率被比较。在组 B 病人的每个肿瘤为工具包或导出血小板的生长因素高山的变化被调查哈(PDGFRA ) 。变化类型与临床的结果被相关。在组 B 病人的 Glivec 的反肿瘤效果和安全也被估计。结果：与 Glivec 对待的先进的小肠大意病人比没与 Glivec 对待的那些有 substatntially 更长的复发以后的幸存和更高全面的幸存率。15 个病人的一个总数有部分回答(PR )(67.8%) 。c 工具包的激活的变化在 19 个测试病人中的 16 个被发现，没有 PDGFRA 异种被识别。在有在 11 个工具包变化上怀有前的大意的 13 个病人，部分反应率(PR ) 是 69.3% ，而有在 9 工具包变化上包含前的肿瘤的三个病人中的二个有 66.7% 的全面反应率(ORR )( 不重要) 。结论：Glivec 显著地与先进大意延长亚洲病人的复发以后、全面的幸存。Glivec 导致持续客观回答在多于有先进的小肠大意的亚洲病人的一半。11 上的工具包前的激活的变化在绝大多数大意是可检测的。在 11 个变化上处于为其大意在 9 上有工具包前的病人和前的 PR 率没有差别。

Efficacy of surgical resection in management of isolated extrahepatic metastases of hepatocellular carcinoma

AIM:To clarify the benefit of surgical excision for patients with extrahepatic metastases of hepatocellular carcinoma(HCC). METHODS:We retrospectively reviewed the medical records of 140 patients with pathologically proven extrahepatic metastases of HCC and evaluated the outcomes of those who had undergone surgical resection(SR)for extrahepatic metastatic lesions.Prognoses made on the basis of extrahepatic metastatic sites were also examined. RESULTS:The survival rates of patients who underwent SR of extrahepatic metastases were significantly better than those of patients who did not receive SR. For the SR group,1-and 3-year survival rates were 24%and 7%,respectively,while for the non-resection group,the survival rates were 8%and 0%,respec- tively(P<0.0001).Survival rates related to metastatic sites were also significantly superior after SR of extrahepatic metastases:median survivals were 32 mo with lung metastasis,10 mo with bone metastasis,6.1 mo with brain metastasis. CONCLUSION:SR can provide survival benefits forpatients with 1 or 2 isolated extrahepatic metastases and who concurrently exhibit good hepatic functional reserve and general performance status as well as successful treatment of intrahepatic HCC.

Outcomes associated with the intention of loco-regional therapy prior to living donor liver transplantation for hepatocellular carcinoma

transplantation(LT)appears to be a logical approach to reduce the risk of tumor progression and dropout in the waitlist.Living donor LT(LDLT)offers a flexible timing for transplantation providing timeframe for well preparation of transplantation.AIM To investigate outcomes in relation to the intention of pre-transplantation locoregional therapy in LDLT for HCC patients.METHODS A total of 308 consecutive patients undergoing LDLTs for HCC between August 2004 and December 2018 were retrospectively analyzed.Patients were grouped according to the intention of loco-regional therapy prior to LT,and outcomes of patients were analyzed and compared between groups.RESULTS Overall,38 patients(12.3%)were detected with HCC recurrence during the follow-up period after LDLT.Patients who were radiologically beyond the University of California at San Francisco criteria and received loco-regional therapy as down-staging therapy had significant inferior outcomes to other groups for both recurrence-free survival(RFS,P<0.0005)and overall survival(P=0.046).Moreover,patients with defined profound tumor necrosis(TN)by locoregional therapy had a superior RFS(5-year of 93.8%)as compared with others(P=0.010).CONCLUSION LDLT features a flexible timely transplantation for patient with HCC.However,the loco-regional therapy prior to LDLT does not seem to provide benefit unless a certain effect in terms of profound TN is noted.

Modified preoperative score to predict disease-free survival for hepatocellular carcinoma patients with surgical resections

BACKGROUND No prognostic models specific to hepatocellular carcinoma patients receiving surgical resection have been considered strong and convincing enough for survival prediction thus far,and there are no models including only preoperative predictors.We derived a nomogram to predict disease-free survival in a previous study.AIM To simplify our score and compare research outcomes among other scoring systems.METHODS We retrospectively reviewed data from 1106 patients with hepatocellular carcinoma who underwent liver resection at the Linkou Chang Gung Memorial Hospital between April 2003 and December 2012.Multivariate analyses were conducted to identify the significant survival predictors.Homogeneity,Harrell’s C-index,and Akaike information criterion were compared between our score,AJCC 8^(th)edition,Tokyo score,and Taipei Integrated Scoring System(TTV-CTPAFP model).RESULTS Among the 1106 patients,731(66.1%)had tumor recurrence at a median followup of 83.9 mo.Five risk factors were identified:platelet count,albumin level,indocyanine green retention rate,multiplicity,and radiologic total tumor volume.Patients were divided into three risk groups,and the 5-year survival rates were 61.7%,39%,and 25.7%,respectively.The C-index was 0.617,which was higher than the Tokyo score(0.613)and the Taipei Integrated Scoring System(0.562)and equal to the value of the AJCC 8th edition(0.617).CONCLUSION The modified score provides an easier method to predict survival.Appropriate treatment can be planned preoperatively by dividing patients into risk groups.