Risk factors for residual tumor after resection of hepatocellular carcinoma

AIM:To identify the clinicopathological risk factors correlated with residual tumor in hepatocellular carcinoma (HCC) patients after resection. METHODS:From January 2001 to April 2007,766 HCC patients who had undergone resection were included in this research. Lipiodol angiography was performed within 2 mo after surgery and followed by post-Lipiodol computed tomography (CT) 4 wk later for all 766 patients to monitor tumor in the remnant liver. Tumor detected within the first 3-mo postoperative period was defined as residual tumor. Patients were divided into 2 groups:disease or disease-free within the first 3 mo after surgery. Risk factors for residual tumor were investigated among various clinicopathological variables. RESULTS:A total of 63 (8.22%) patients were found to have residual tumor after surgery. Three independent factors associated with residual tumor were identified by multivariate analysis:preoperative serum α-fetoprotein (AFP) level [odds ratio (OR) = 1.68 (95% confidence interval (CI):1.20-2.36)],tumor size [OR = 1.73 (95% CI:1.29-2.31)] and microvascular invasion [OR = 1.91 (95% CI:1.12-3.24)]. CONCLUSION:Residual tumor is related to AFP level,tumor size and microvascular invasion. Patients at high risk should undergo closer follow-up and could be candidates for multimodality therapy.

Over-expression of VEGF and MMP-9 in Residual Tumor Cells of Hepatocellular Carcinoma after Embolization with Lipidol

The expression and implication of vascular endothelial growth factor （VEGF） and matrix metalloproteinase-9 （MMP-9） in residual hepatic tumor cells after lipiodol embolization were investi- gated. Two weeks after transplantation of VX2 tumor cells into the livers of rabbits, a xenograft model of the human hepatic neoplasm was successfully established. Forty rabbits were randomly divided into control group （n=20） and lipiodol group （n=20）. For the control group, 1 mL normal saline was injected through the gastroduodenal artery, whereas 0.3 mL/kg lipiodol was applied for the lipiodol group. One week after embolization, the expression level of VEGF in the plasma was measured by using en- zyme-linked immunosorbent assay （ELISA）. A three-step immunohistochemieal technique （ABC） was employed to detect the protein levels of VEGF and MMP-9 and the quantitative PCR for their mRNA levels was performed in the residual tumor cells. The VEGF in the plasma was significantly higher in the lipiodol group （1.42~0.29 ng/mL） than in the control group （1.12~0.21 ng/mL） （P〈0.01）. Moreover, the positive rate of VEGF protein in the residual tumor cells was significantly higher in the lipiodol group （62.13%~7.69%） than in the control group （53.16%~9.17%） （P〈0.05）. Similarly, the MMP-9 ex- pression in the residual ~mor cells was higher in the lipiodol group. The mRNA levels of VEGF （2.9313~2.4231） and MMP-9 （3.5721~1.6107） in the lipiodol group were significantly higher than those in the control group （1.5728~0.9453 and 1.7573~1.0641, respectively, P〈0.05）. Therefore, it was rea- sonable to speculate that the increased expression of VEGF and MMP-9 in residual hepatic tumor cells and tumor angiogenesis post-embolization would be responsible for the increased metastatic potentiality and invasiveness of these cells.

Residual tumor and central lymph node metastasis after thermal ablation of papillary thyroid carcinoma: A case report and review of literature

BACKGROUND Debate exists regarding the use of thermal ablation(TA)to treat papillary thyroid carcinoma(PTC).Some studies have recommended TA as a new,ef
cient and safe technology for PTC.In this article,we report one case of a residual tumor and central lymph node metastasis(CLNM)after TA for PTC.CASE SUMMARY A 63-year-old female underwent bilateral ultrasound(US)-guided radiofrequency ablation for PTC.Three months later,she was diagnosed as thyroid cancer with suspected CLNM by US and contrast-enhanced computed tomography.The subsequent fine-needle aspiration(FNA)biopsies were negative.Due to her strong personal preference,she underwent total thyroidectomy and central lymph node dissection.Local tissue adhesion and a difficult dissection were noted during the operation.The pathology of the frozen sections during the operation was still negative.The final pathology results of paraffin-embedded sections revealed residual tumor cells at the edge of the PTC and CLNM.CONCLUSION TA may lead to a residual tumor in patients with PTC.Follow-up using US and FNA biopsy may not be adequate to evaluate the residual tumor.TA should be carefully considered in PTC treatment.

Why is endosonography insufficient for residual diagnosis after neoadjuvant therapy for esophageal cancer?Solutions using muscle layer evaluation

BACKGROUND The diagnosis of residual tumors using endoscopic ultrasound(EUS)after neoadjuvant therapy for esophageal cancer is considered challenging.However,the reasons for this difficulty are not well understood.AIM To investigate the ultrasound imaging features of residual tumors and identify the limitations and potential of EUS.METHODS This exploratory prospective observational study enrolled 23 esophageal squamous cell carcinoma patients receiving esophagectomy after neoadjuvant therapy[15 patients after neoadjuvant chemotherapy(NAC)and 8 patients after chemoradiotherapy(CRT)]at the Department of Surgery,Chiba University Hospital,between May 2020 and October 2021.We diagnosed the T stage for specimens using ultrasound just after surgery and compared ultrasound images with the cut surface of the fixed specimens of the same level of residual tumor.The ratio of esophageal muscle layer defect measured by ultrasound was compared with clinicopathological factors.Furthermore,the rate of reduction for the muscle layer defect was evaluated using EUS images obtained before and after neoadjuvant therapy.RESULTS The accuracy of T stage rate was 61%(n=14/23),which worsened after CRT(38%,n=3/8)than after NAC(73%,n=11/15)because of overstaging.Moreover,pT0 could not be diagnosed in all cases.The detection rate of residual tumor for specimens using ultrasound retrospectively was 75%(n=15/20).There was no correlation between after-NAC(79%,n=11/14)and after-CRT(67%,n=4/6)detection rate.The detection of superficial and submucosal types was poor.The pathologic tumor size and pathological response were correlated.Tumor borders were irregular and echogenicity was mixed type after CRT.There was a correlation between the pT stage(pT0/1 vs pT2/3)and the length of muscle layer circumference(P=0.025),the length of muscle layer defect(P<0.001),and the ratio of muscle layer defect(P<0.001).There was also a correlation between the pT stage and the rate of muscle layer defect reduction measured by EUS(P=0.001).CONCLUSION Compared to pathological images,some tumors are undetectable by ultrasound.Focusing on the esophageal muscle layer might help diagnose the depth of the residual tumor.

Prospective study of transsphenoidal pituitary surgery： is tumor volume a predictor for the residual tumor？

Background The presence of residual tumor after surgery for pituitary adenoma may necessitate further treatment. The suprasellar and parasellar extension of the tumor have been widely considered as the predictors for residual tumor. However there is scarcity of studies regarding the preoperative tumor volume and residual tumor. This study was conducted to evaluate if tumor volume could predict the outcome of transsphenoidal pituitary surgery. Methods A prospective study was designed and 48 patients who underwent transsphenoidal pituitary surgery within 1 year in the First Affiliated Hospital of Xi＇an Jiaotong University were included in this study. The preoperative tumor volume and immediate postoperative tumor volume （within 4-7 days） were calculated in the contrast magnetic resonance imaging by using the formula of ellipsoid. All these volumes were divided into three subgroups, i.e. group 1, group 2 and group 3 with preoperative volume of less than 4 cm3, 4-8 cm3, and more than 8 cm3 respectively. The parasellar and suprasellar extension of the tumor were also classified by Knosp and modified Hardy＇s classifications. Results Baseline characteristics were comparable. The preoperative tumor volume of more than 8 cm3 （group 3, （12.1±1.1） cm3） had increased risk on postoperative tumor residue （P 〈0.01） than the other two groups （（2.1±0.3） cm3 and （6.1±0.3） cm3 in groups 1 and 2）. The mean postoperative volume in group 3 patients （（2.2±0.1） cm3） was significantly higher than the other two groups （P 〈0.01）. Conclusion Preoperative volume of more than 8 cm3 can be considered as a predictor for postoperative residual volume.