Risk factors for intrahepatic cholangiocarcinoma:A case-control study in China

AIM: To carry out a hospital-based case-control study to investigate risk factors for intrahepatic cholangiocarcinoma (ICC) in China. METHODS: A total of 312 ICC cases and 438 matched controls were included in the study. The presence of diabetes mellitus,hypertention,hepatolithiasis,primary sclerosing cholangitis,liver fluke infection (Clonorchis sinensis ),was investigated through clinical records. Blood from all participants was tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies. Odds ratios (OR) and 95% confi dence intervals (95% CI) were estimated using conditional logistic regression. RESULTS: Compared with controls,ICC patients had a higher prevalence of HBsAg seropositivity (48.4% vs 9.6%,P < 0.000),and hepatolithiasis (5.4% vs 1.1%,P = 0.001). By multivariate analysis,the signif icant risk factors for development of ICC were HBsAg seropositivity (adjusted OR,8.876,95% CI,5.973-13.192),and hepatolithiasis (adjusted OR,5.765,95% CI,1.972-16.851). The prevalence of anti-HCV seropositivity,diabetes mellitus,hypertention,cigarette smoking,and alcohol consumption were not significantly different between cases and controls. CONCLUSION: These findings suggest that HBV infection and hepatolithiasis are strong risk factors for development of ICC in China.

Clinicopathologic characteristics of intrahepatic cholangiocarcinoma in patients with positive serum a-fetoprotein

AIM:To explore clinicopathologic characteristics of intrahepatic cholangiocarcinoma (ICC) in patients with positive serum a-fetoprotein (AFP). METHODS:One hundred and thirty one patients who underwent surgical dissection for pathologically confirmed ICC were divided into a positive AFP (> 20 ng/mL) group (n = 32) and a negative AFP group (n = 99), whose clinicopathologic features were analyzed and compared. RESULTS:The positive rate of HBsAg and liver cirrhosis of the positive AFP group was higher than that of the negative AFP group, while the positive rate of CA19-9 (> 37 U/mL) and the lymph node metastasis rate was lower. CONCLUSION:ICC patients with positive AFP share many clinicopathologic similarities with hepatocellular carcinoma.

Risk factors for combined hepatocellular-cholangiocarcinoma:A hospital-based case-control study

AIM:To identify risk factors contributing to the development of combined hepatocellular-cholangiocarcinoma(CHC) in China.METHODS:One hundred and twenty-six patients with CHC and 4:1 matched healthy controls were interviewed during the period from February 2000 to October 2012.Logistic regression analysis was used to calculate odds ratios(OR)and 95%confidence intervals(CI)for each risk factor.RESULTS:Univariate analysis showed that the significant risk factors for CHC development were hepatitis B virus(HBV)infection,heavy alcohol consumption,a family history of liver cancer,and diabetes mellitus.Multivariate stepwise logistic regression analysis showed that HBV infection(OR=19.245,95%CI:13.260-27.931)and heavy alcohol consumption(OR=2.186,95%CI:1.070-4.466)were independent factors contributing to the development of CHC.CONCLUSION:HBV infection and heavy alcohol consumption may play a role in the development of CHC in China.

A pooled analysis of treatment and prognosis of hepatic angiosarcomain adults

Background： Hepatic angiosarcoma is a rare malignant vascular tumor presenting unique treatment challenges.The aim of the present study was to determine the treatment and prognosis of this entity.Data sources： A systematic literature search was conducted using PubMed, Embase and Chinese BiomedicalLiterature database, to identify articles published from January 1980 to July 2017. Search termswere “hepatic angiosarcoma” and “liver angiosarcoma”. Additional articles were retrieved through manualsearch of bibliographies of the relevant articles. Pooled individual data concerning the prognosis followingvarious therapeutic modalities were analyzed.

Long-term outcomes of combined hepatocellular-cholangiocarcinoma after hepatectomy or liver transplantation: A systematic review and meta-analysis

Background: Combined hepatocellular-cholangiocarcinoma(cHCC-CC) is a rare primary liver malignancy. We conducted a systematic review and meta-analysis to assess the evidence available on the long-term outcomes of cHCC-CC patients after either hepatectomy or liver transplantation(LT). Data Sources: Relevant studies published between January 2000 and January 2018 were identified by searching Pub Med and Embase and reviewed systematically. Data were pooled using a random-effects model. Results: A total of 42 observational studies involving 1691 patients(1390 for partial hepatectomy and 301 for LT) were included in the analysis. The median tumor recurrence and 5-year overall survival(OS) rates were 65%(range 38%–100%) and 29%(range 0–63%) after hepatectomy versus 54%(range 14%–93%) and 41%(range 16%–73%) after LT, respectively. Meta-analysis found no significant difference in OS and tumor recurrence between LT and hepatectomy groups. Conclusion: Hepatectomy rather than LT should be considered as the prior treatment option for cHCC-CC.

Preoperative administration of bevacizumab is safe for patients with colorectal liver metastases

AIM:To assess the impact of preoperative neoadjuvant bevacizumab(Bev)on the outcome of patients undergoing resection for colorectal liver metastases(CLM). METHODS:Eligible trials were identified from Medline, Embase,Ovid,and the Cochrane database.The data were analyzed with fixed-effects or random-effects models using Review Manager version 5.0. RESULTS:Thirteen nonrandomized studies with a total of 1431 participants were suitable for meta-analysis. There was no difference in overall morbidity and severe complications between the Bev+group and Bev-group (43.3%vs 36.8%,P=0.06;17.1%vs 11.4%,P=0.07,respectively).Bev-related complications including wound and thromboembolic/bleeding events were also similar in the Bev+and Bev-groups(14.4%vs 8.1%, P=0.21;4.1%vs 3.8%,P=0.98,respectively).The incidence and severity of sinusoidal dilation were lower in patients treated with Bev than in patients treated without Bev(43.3%vs 63.7%,P<0.001;16.8%vs 46.5%,P<0.00,respectively). CONCLUSION:Bev can be safely administered before hepatic resection in patients with CLM,and has a protective effect against hepatic injury in patients treated with oxaliplatin chemotherapy.

Survival after repeat hepatectomy for recurrent colorectal liver metastasis: A review and meta-analysis of prognostic factors

Background:Frequent recurrent hepatic metastasis after hepatic metastasectomy is a major obstacle in the treatment of colorectal liver metastasis(CRLM).We performed the present systematic review to evaluate the short-and long-term outcomes after repeat hepatectomy for recurrent CRLM and determine factors associated with survival in these patients.Data sources:An electronic search of PubMed database was undertaken to identify all relevant peerreviewed papers published in English between January 20 0 0 and July 2018.Hazard ratios(HR)with 95%confidence interval(95%CI)were calculated for prognostic factors of overall survival(OS).Results:The search yielded 34 studies comprising 3039 patients,with a median overall morbidity of 23%(range 8%–71%),mortality of 0(range 0–6%),and 5-year OS of 42%(range 17%–73%).Pooled analysis showed that primary T3/T4 stage tumor(HR=1.94;95%CI:1.04–3.63),multiple tumors(HR=1.49;95%CI:1.10–2.01),largest liver lesion≥5 cm(HR=1.89;95%CI:1.11–3.23)and positive surgical margin(HR=1.80;95%CI:1.09–2.97)at initial hepatectomy,and high serum level of carcinoembryonic antigen(HR=1.87;95%CI:1.27–2.74),disease-free interval≤12 months(HR=1.34;95%CI:1.10–1.62),multiple tumors(HR=1.64;95%CI:1.32–2.02),largest liver lesion≥5 cm(HR=1.85;95%CI:1.34–2.56),positive surgical margin(HR=2.25;95%CI:1.39–3.65),presence of bilobar disease(HR=1.62;95%CI:1.19–2.20),and extrahepatic metastases(HR=1.60;95%CI:1.23–2.09)at repeat hepatectomy were significantly associated with poor OS.

Pancreatic fistula after central pancreatectomy: case series and review of the literature

BACKGROUND: Postoperative pancreatic fistula is one of the most common complications after pancreatectomy. This study aimed to assess the occurrence and severity of pancreatic fistula after central pancreatectomy.METHODS: The medical records of 13 patients who had undergone central pancreatectomy were retrospectively studied together with a literature review of studies including at least five cases of central pancreatectomy. Pancreatic fistula was defined and graded according to the recommendations of the International Study Group on Pancreatic Fistula (ISGPF).RESULTS: No death was observed in the 13 patients. Pancreatic fistula developed in 7 patients and was successfully treated nonoperatively. None of these patients required re-operation. A total of 40 studies involving 867 patients who underwent central pancreatectomy were reviewed. The overall pancreatic fistula rate of the patients was 33.4% (0-100%). Of 279 patients, 250(89.6%) had grade A or B fistulae of ISGPF and were treated nonoperatively, and the remaining 29 (10.4%) had grade C fistulae of ISGPF. In 194 patients, 15 (7.7%) were re-operated upon. Only one patient with grade C fistula of ISGPF died from multiple organ failure after re-operation.CONCLUSION: Despite the relatively high occurrence, most pancreatic fistulae after central pancreatectomy are recognized a grade A or B fistula of ISGPF, which can be treated conservatively or by mini-invasive approaches.

Proposal of a new T-stage classification system for ampullary carcinoma based on Surveillance,Epidemiology and End Result(SEER)database

Background:Tumor size is still considered a useful prognostic factor in currently available tumor-nodemetastasis(TNM)classification staging systems for most solid tumors,but the significance of tumor size on the prognosis of ampullary carcinoma remains controversial.The aim of the current study was to propose a new T-stage classification system for ampullary carcinoma to address the impact of tumor size on the prognostic outcome.Methods:Using the Surveillance,Epidemiology,and End Results(SEER)database,we identified 1080 patients with ampullary carcinoma who underwent radical surgical resection between 2004 and 2015.Based on the results obtained from analysis of various clinicopathologic factors,a new T-stage classification system was proposed.Results:Among the 1080 patients,618 were men and 462 were women,with a median tumor size of 2.3(range 0.1–12)cm.Using the 7 th edition of the American Joint Committee on Cancer(AJCC)staging manual,we noticed significant differences in overall survival(OS)between T2 vs.T3 tumors(P<0.001)and T3 vs.T4 tumors(P=0.002),but failed to observe significant differences between T1 vs.T2 tumors(P=0.498)in our pair-wise comparison.Using the newly developed T-stage classification system,we were able to differentiate significant differences in OS between T1 vs.T2 tumors(P=0.032),T2 vs.T3 tumors(P<0.001)and T3 vs.T4 tumor(P=0.003)in all pair-wise comparisons.The c-index of the new staging system was 0.653(95%CI:0.629–0.677),showing a better discriminatory power than the 0.636 of the 7 th AJCC staging system(95%CI:0.612–0.660).Conclusions:The new T-stage classification system described herein can better differentiate prognostic outcomes after radical resection in patients with ampullary carcinoma by incorporating tumor size and depth of tumor infiltration.