Successful initial ablation therapy contributes to survival in patients with hepatocellular carcinoma

AIM： To evaluate the outcome predictors of percutaneous ablation therapy in patients with unresectable hepatocellular carcinoma （HCC）, especially to identify whether the initial treatment response contributes to the survival of the patients. METHODS： The study cohort included 153 patients with single （102） and two or three （51） HCC nodules 5 cm or less in maximum diameter. As an initial treatment, 110 patients received radiofrequency ablation and 43 patients received percutaneous ethanol injection. RESULTS： The Kaplan-Meier estimates of overall 3- and S-year survival rates were 75% and 59%, respectively. The log-rank test revealed statistically significant differences in the overall survivals according to ChildPugh class （P = 0.0275）, tumor size （P = 0.0130）, serum albumin level （P = 0.0060）, serum protein induced by vitamin K absence or antagonist Ⅱ level （P = 0.0486）, and initial treatment response （P = 0.0130）. The independent predictors of survival were serum albumin level （dsk ratio, 3.216; 950 CI, 1.407-7.353; P = 0.0056） and initial treatment response （risk ratio, 2.474; 95% CI, 1.076-5.692; P = 0.0330） based on the Cox proportional hazards regression models. The patients had a serum albumin level 3.5 g/dL and the 3- and 5-year survival rates of 86% and 82%. CONCLUSION： In HCC patients treated with percutaneous ablation therapy, serum albumin level and initial treatment response are the independent outcome predictors.

Survival nomograms for simultaneous resection of primary and hepatic lesions without neoadjuvant chemotherapy in patients with resectable colorectal liver metastasis

Background No well-performing nomogram has been developed specifically to predict individual-patient cancer-specific survival(CSS)and overall survival(OS)among patients with resectable colorectal liver metastasis(CRLM)who undergo simultaneous resection of primary and hepatic lesions without neoadjuvant chemotherapy(NAC).We aim to investigate the prognosis of patients with resectable CRLM undergoing simultaneous resection of primary and hepatic lesions without NAC.Methods Data of patients with CRLM in the Surveillance,Epidemiology and End Results Program(cohort,n=225)were collected as the training set,and data of patients with CRLM treated at the National Cancer Center(cohort,n=180)were collected as the validation set.The prognostic value of the clinicopathological parameters in the training cohort was assessed using Kaplan‒Meier curves and univariate and multivariate Cox proportional hazards models,and OS and CSS nomograms integrated with the prognostic variables were constructed.Calibration analyses,receiver operating characteristic(ROC)curves,and decision curve analyses(DCAs)were then performed to evaluate the performance of the nomograms.Results There was no collinearity among the collected variables.Three factors were associated with OS and CSS:the pretreatment carcinoembryonic antigen(CEA)concentration,pathologic N(pN)stage,and adjuvant chemotherapy(each p<0.05).OS and CSS nomograms were constructed using these three parameters.The calibration plots revealed favorable agreement between the predicted and observed outcomes.The areas under the ROC curves were approximately 0.7.The DCA plots revealed that both nomograms had satisfactory clinical benefits.The ROC curves and DCAs also confirmed that the nomogram surpassed the tumor,node,and metastasis staging system.Conclusion The herein-described nomograms containing the pretreatment CEA concentration,pN stage,and adjuvant chemotherapy may be effective models for predicting postoperative survival in patients with CRLM.