Post-hepatectomy liver failure(PHLF)is associated with great morbidity and mortality after resection of hepatocellular carcinoma.Previous studies have underlined that advanced age could be a potential factor influenci...Post-hepatectomy liver failure(PHLF)is associated with great morbidity and mortality after resection of hepatocellular carcinoma.Previous studies have underlined that advanced age could be a potential factor influencing post-operative complications and long-term survival.In the past,candidates for resection were based on the Child-Pugh classification,the predictive value of which was rather low.The selection of patients undergoing resection in Western countries is based on the assessment of portal hypertension(PH),which is clinically assessed by measurement of the hepatic venous pressure gradient,an invasive and costly process.Thus,there have been several attempts to identify the best non-invasive test(NIT)to accurately predict PHLF.Most biochemical NITs for the prediction of PHLF are focused on evaluation of underlying liver cirrhosis and PH.Amongst them,FIB-4,which also includes the patient's age,seems to have more robust supporting results.In Europe and the USA.,the most tested and reliable NIT for predicting PHLF is the evaluation of liver stiffness measurement,which is also influenced by age.Imaging parameters are promising tools which are used only in specialized centers however,and when available.Liver volume parameters,as well as contrast-enhanced data,demonstrate good accuracy in predicting PHLF.In this scenario,the evaluation of sarcopenia and bone mineral density through contextual imaging allows the delineation of PHLF in at-risk elderly patients.Further studies focused on parameters for the evaluation of PHLF in elderly patients are needed.展开更多
Hepatocellular carcinoma(HCC)is the fifth most common neoplasm worldwide.Recurrence of HCC after resection or loco-regional therapies represents an important clinical issue as it affects up to 70%of patients.This can ...Hepatocellular carcinoma(HCC)is the fifth most common neoplasm worldwide.Recurrence of HCC after resection or loco-regional therapies represents an important clinical issue as it affects up to 70%of patients.This can be divided into early or late,if it occurs within or after 24 months after treatment,respectively.While the predictive factors for early recurrence are mainly related to tumour biology(local invasion and intrahepatic metastases),late recurrences are mainly related to de novo tumour formation.Thus,it is important to recognize these factors prior to any treatment in each patient,in order to optimize the treatment strategy and follow-up after treatment.The aim of this review is to summarize the current evidence available regarding predictive factors for the recurrence of HCC,according to the different therapeutic strategies available.In particular,we will discuss the role of new ultrasound-based techniques and biological features,such as tumor-related and circulating biomarkers,in predicting HCC recurrence.Recent advances in imaging-related parameters in computed-tomography scans and magnetic resonance imaging will also be discussed.展开更多
文摘Post-hepatectomy liver failure(PHLF)is associated with great morbidity and mortality after resection of hepatocellular carcinoma.Previous studies have underlined that advanced age could be a potential factor influencing post-operative complications and long-term survival.In the past,candidates for resection were based on the Child-Pugh classification,the predictive value of which was rather low.The selection of patients undergoing resection in Western countries is based on the assessment of portal hypertension(PH),which is clinically assessed by measurement of the hepatic venous pressure gradient,an invasive and costly process.Thus,there have been several attempts to identify the best non-invasive test(NIT)to accurately predict PHLF.Most biochemical NITs for the prediction of PHLF are focused on evaluation of underlying liver cirrhosis and PH.Amongst them,FIB-4,which also includes the patient's age,seems to have more robust supporting results.In Europe and the USA.,the most tested and reliable NIT for predicting PHLF is the evaluation of liver stiffness measurement,which is also influenced by age.Imaging parameters are promising tools which are used only in specialized centers however,and when available.Liver volume parameters,as well as contrast-enhanced data,demonstrate good accuracy in predicting PHLF.In this scenario,the evaluation of sarcopenia and bone mineral density through contextual imaging allows the delineation of PHLF in at-risk elderly patients.Further studies focused on parameters for the evaluation of PHLF in elderly patients are needed.
文摘Hepatocellular carcinoma(HCC)is the fifth most common neoplasm worldwide.Recurrence of HCC after resection or loco-regional therapies represents an important clinical issue as it affects up to 70%of patients.This can be divided into early or late,if it occurs within or after 24 months after treatment,respectively.While the predictive factors for early recurrence are mainly related to tumour biology(local invasion and intrahepatic metastases),late recurrences are mainly related to de novo tumour formation.Thus,it is important to recognize these factors prior to any treatment in each patient,in order to optimize the treatment strategy and follow-up after treatment.The aim of this review is to summarize the current evidence available regarding predictive factors for the recurrence of HCC,according to the different therapeutic strategies available.In particular,we will discuss the role of new ultrasound-based techniques and biological features,such as tumor-related and circulating biomarkers,in predicting HCC recurrence.Recent advances in imaging-related parameters in computed-tomography scans and magnetic resonance imaging will also be discussed.
