AIM: To investigate the long-term survival and prognostic factors in hepatocellular carcinoma(HCC) patients undergoing radiofrequency ablation(RFA) as a first-line treatment.METHODS: From 2000 to 2013, 316 consecutive...AIM: To investigate the long-term survival and prognostic factors in hepatocellular carcinoma(HCC) patients undergoing radiofrequency ablation(RFA) as a first-line treatment.METHODS: From 2000 to 2013, 316 consecutivepatients with 404 HCC(1.0-5.0 cm; mean: 3.2 ± 1.1 cm) underwent ultrasonography-guided percutaneous RFA as a first-line treatment. There were 250 males and 66 females with an average age of 60.1 ± 10.8 years(24-87 years). Patients were followed for 1 year to > 10 years after RFA(234, 181, 136, and 71 for 3, 5, 7, and 10 years, respectively). Overall local response rates and long-term survival rates were assessed. Survival results were generated using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model. RESULTS: In total, 548 RFA sessions were performed and major complications occurred in 10 sessions(1.8%). Local tumor progression and/or new tumor development were observed in 43.3%(132/305) of the patients during the follow-up period. Overall 5-and 10-year survival rates were 49.7% and 28.4%, respectively. Based on multivariate analysis, three factors were identified as independent prognostic factors for overall survival: Child-Pugh classification(HR = 4.054, P < 0.001), portal vein hypertension(HR = 2.743, P = 0.002), and tumor number(HR = 2.693, P = 0.003). The local progression-free 5- and 10-year survival rates were 42.7% and 19.5%. In addition to the Child-Pugh classification and the number of tumors, the number of RFA sessions(HR = 1.550, P = 0.002) was associated with local progression-free survival.CONCLUSION: RFA can achieve acceptable outcomes for HCC patients as a first-line treatment, especially for patients with Child-Pugh class A, patients with a single tumor and patients without portal vein hypertension.展开更多
AIM:To assess whether metformin,which has a chemopreventive effect in chronic liver disease,has any chemotherapeutic effect in hepatocellular carcinoma.METHODS:This was a retrospective study of 701 patients with newly...AIM:To assess whether metformin,which has a chemopreventive effect in chronic liver disease,has any chemotherapeutic effect in hepatocellular carcinoma.METHODS:This was a retrospective study of 701 patients with newly diagnosed hepatocellular carcinoma(HCC)seen between January 2005 and June 2011 at Mayo Clinic,Rochester,Minnesota.This patient cohort was a part of the global HCC BRIDGE study,which is a large longitudinal study of HCC determining the realworld experience of HCC characteristics,management and patient outcomes.We defined significant metformin exposure as continuation of this agent at least 90d beyond diagnosis of HCC,and compared survival of diabetic patients on metformin to diabetic patients not on metformin and non-diabetics.RESULTS:Our cohort was 72.9%male,with a mean±SD age of 62.6±12.3 years.The most common etiologies of liver disease were hepatitis C(34%),alcoholic liver disease(29%),fatty liver disease(15%)and hepatitis B(9%).By univariate analysis,using diabetics not on metformin as the reference group,diabetic patients with HCC on metformin had no survival advantage,with a HR(95%CI)of 1.0(0.8-1.3).Non-diabetic HCC patients also did not appear to have a survival advantage as compared to diabetic HCC patients not on metformin,as demonstrated by a HR(95%CI)of1.1(0.7-1.7).Diabetics on metformin beyond 90 d after HCC diagnosis had a longer median survival at 34.2 mo,as compared to 25.5 mo among diabetic patients who were not on metformin or had discontinued metformin within 90 d after HCC diagnosis.This finding was likely due to potential survival bias among those who lived long enough to receive metformin.CONCLUSION:Although the literature suggests a chemotherapeutic effect in other malignancies,our study demonstrates no survival benefit to the use of metformin in diabetic patients with HCC.展开更多
AIM:To determine the optimal type of surgery for latestage gastric cancer with hepatic metastases.METHODS:We retrospectively analyzed 49 gastrectomies for late-stage gastric cancer conducted in the FirstHospital Affil...AIM:To determine the optimal type of surgery for latestage gastric cancer with hepatic metastases.METHODS:We retrospectively analyzed 49 gastrectomies for late-stage gastric cancer conducted in the FirstHospital Affiliated to Henan University of Science and Technology between September 2003 and September 2010.All gastrectomy operations were divided into two groups:radical resection(gastrectomy and simultaneous resection of hepatic metastases,n =31),and palliative resection(gastrectomy without hepatic resection,n =18).All 49 patients had chemotherapy catheter implantation in the hepatic artery via the gastroduodenal artery.Postoperative complications and cumulative survival rates of the two groups were compared and analyzed.RESULTS:There was no significant difference in the number of perioperative complications between the radical and palliative resection groups(6 and 3 cases,respectively,P > 0.05).The incidence of long-term complications including ileus(3 in the radical resection and 2 in the palliative resection groups) and anastomosis(2 cases in each group) was not significantly different(P > 0.05).The cumulative survival rate was significantly lower in the palliative resection group(P < 0.05).CONCLUSION:Radical gastrectomy with resection of hepatic metastases and hepatoarterial catheter implantation is the recommended surgery for late-stage gastric cancer patients with hepatic metastases.展开更多
Gastric cancer is the fourth most common cancer and second most common cause of cancer death worldwide.Globally,gastric cancer poses a significant public health burden-both economically and socially.In 2008,the econom...Gastric cancer is the fourth most common cancer and second most common cause of cancer death worldwide.Globally,gastric cancer poses a significant public health burden-both economically and socially.In 2008,the economic burden from premature cancer deaths and disability was$895 billion and gastric cancer was the second highest cancer responsible for healthy life lost.With the expected increase in cancer deaths and non-communicable diseases,these costs are expected to rise and impact patient care.World Health Organization,estimates a 15%increase in non-communicable disease worldwide,with more than 20%increase occurring in Africa between 2010 and 2020.Mali,West Africa,is ranked 15th highest incidence of gastric cancer worldwide at a rate of 20.3/100000,yet very scarce published data evaluating etiology,prevention or management exist.It is understood that risk factors of gastric cancer are multifactorial and include infectious agents(Helicobacter pylori,Epstein-Barr virus),genetic,dietary,and environmental factors(alcohol,smoking).Interestingly,African patients with gastric cancer are younger,in their 3rd-4th decade,and present at a late stage of the disease.There is sparse data regarding gastric cancer in Africa due to lack of data collection and under-reporting,which impacts incidence and mortality rates.Currently,GLOBOCAN,an International Agency for Research on Cancer resource,is the most comprehensive available resource allowing comparison between nations.In resource limited settings,with already restricted healthcare funding,data is needed to establish programs in Africa that increase gastric cancer awareness,curtail the economic burden,and improve patient management and survival outcomes.展开更多
AIM:To assess the prognostic significance of cathepsin L,a cysteine protease that degrades the peri-tumoral tissue,in patients with pancreatic cancer.METHODS:Plasma samples from 127 pancreatic cancer patients were ana...AIM:To assess the prognostic significance of cathepsin L,a cysteine protease that degrades the peri-tumoral tissue,in patients with pancreatic cancer.METHODS:Plasma samples from 127 pancreatic cancer patients were analyzed for cathepsin L levels by ELISA.Out of these patients,25 underwent surgeryand their paraffin-embedded tissue was analyzed for cathepsin L expression by immunohistochemistry.Survival of patients and clinicopathological parameters was correlated with cathepsin L expression in plasma and tissue using appropriate statistical analysis.RESULTS:The mean(±SD)cathepsin L in plasma samples of pancreatic cancer patients was 5.98±2.5ng/m L that was significantly higher compared to the levels in healthy controls(3.83±0.45)or chronic pancreatitis patients(3.97±1.06).Using ROC curve,a cut-off level of 5.0 ng/m L was decided for survival analysis.Elevated plasma levels of cathepsin L were found to be associated with poor prognosis(P=0.01)in multivariate analysis.The plasma levels of the protease decreased after surgery.Though no significant correlation was seen between plasma and tissue expression of this protease,a trend did emerge that high cathepsin L expression in tissue correlated with its high levels in plasma.CONCLUSION:Cathepsin L levels in plasma of pancreatic cancer patients may be used as a potential prognostic marker for the disease.展开更多
基金Supported by the National Natural Science Foundation of ChinaNo.81471768+3 种基金the Natural Science Foundation of Beijing MunicipalityNo.7152031the Beijing Municipal Health System Special Funds of High-Level Medical Personnel ConstructionNo.2013-3-086
文摘AIM: To investigate the long-term survival and prognostic factors in hepatocellular carcinoma(HCC) patients undergoing radiofrequency ablation(RFA) as a first-line treatment.METHODS: From 2000 to 2013, 316 consecutivepatients with 404 HCC(1.0-5.0 cm; mean: 3.2 ± 1.1 cm) underwent ultrasonography-guided percutaneous RFA as a first-line treatment. There were 250 males and 66 females with an average age of 60.1 ± 10.8 years(24-87 years). Patients were followed for 1 year to > 10 years after RFA(234, 181, 136, and 71 for 3, 5, 7, and 10 years, respectively). Overall local response rates and long-term survival rates were assessed. Survival results were generated using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model. RESULTS: In total, 548 RFA sessions were performed and major complications occurred in 10 sessions(1.8%). Local tumor progression and/or new tumor development were observed in 43.3%(132/305) of the patients during the follow-up period. Overall 5-and 10-year survival rates were 49.7% and 28.4%, respectively. Based on multivariate analysis, three factors were identified as independent prognostic factors for overall survival: Child-Pugh classification(HR = 4.054, P < 0.001), portal vein hypertension(HR = 2.743, P = 0.002), and tumor number(HR = 2.693, P = 0.003). The local progression-free 5- and 10-year survival rates were 42.7% and 19.5%. In addition to the Child-Pugh classification and the number of tumors, the number of RFA sessions(HR = 1.550, P = 0.002) was associated with local progression-free survival.CONCLUSION: RFA can achieve acceptable outcomes for HCC patients as a first-line treatment, especially for patients with Child-Pugh class A, patients with a single tumor and patients without portal vein hypertension.
基金Supported by National Institutes of Health,No.NCI CA165076Mayo Clinic Center for Cell Signaling in Gastroenterology,No.NIDDK P30DK084567+1 种基金Mayo Clinic Cancer Center,No.NCI CA15083Mayo Clinic Center for Clinical and Translational Science,No.NCATS UL1 TR000135
文摘AIM:To assess whether metformin,which has a chemopreventive effect in chronic liver disease,has any chemotherapeutic effect in hepatocellular carcinoma.METHODS:This was a retrospective study of 701 patients with newly diagnosed hepatocellular carcinoma(HCC)seen between January 2005 and June 2011 at Mayo Clinic,Rochester,Minnesota.This patient cohort was a part of the global HCC BRIDGE study,which is a large longitudinal study of HCC determining the realworld experience of HCC characteristics,management and patient outcomes.We defined significant metformin exposure as continuation of this agent at least 90d beyond diagnosis of HCC,and compared survival of diabetic patients on metformin to diabetic patients not on metformin and non-diabetics.RESULTS:Our cohort was 72.9%male,with a mean±SD age of 62.6±12.3 years.The most common etiologies of liver disease were hepatitis C(34%),alcoholic liver disease(29%),fatty liver disease(15%)and hepatitis B(9%).By univariate analysis,using diabetics not on metformin as the reference group,diabetic patients with HCC on metformin had no survival advantage,with a HR(95%CI)of 1.0(0.8-1.3).Non-diabetic HCC patients also did not appear to have a survival advantage as compared to diabetic HCC patients not on metformin,as demonstrated by a HR(95%CI)of1.1(0.7-1.7).Diabetics on metformin beyond 90 d after HCC diagnosis had a longer median survival at 34.2 mo,as compared to 25.5 mo among diabetic patients who were not on metformin or had discontinued metformin within 90 d after HCC diagnosis.This finding was likely due to potential survival bias among those who lived long enough to receive metformin.CONCLUSION:Although the literature suggests a chemotherapeutic effect in other malignancies,our study demonstrates no survival benefit to the use of metformin in diabetic patients with HCC.
文摘AIM:To determine the optimal type of surgery for latestage gastric cancer with hepatic metastases.METHODS:We retrospectively analyzed 49 gastrectomies for late-stage gastric cancer conducted in the FirstHospital Affiliated to Henan University of Science and Technology between September 2003 and September 2010.All gastrectomy operations were divided into two groups:radical resection(gastrectomy and simultaneous resection of hepatic metastases,n =31),and palliative resection(gastrectomy without hepatic resection,n =18).All 49 patients had chemotherapy catheter implantation in the hepatic artery via the gastroduodenal artery.Postoperative complications and cumulative survival rates of the two groups were compared and analyzed.RESULTS:There was no significant difference in the number of perioperative complications between the radical and palliative resection groups(6 and 3 cases,respectively,P > 0.05).The incidence of long-term complications including ileus(3 in the radical resection and 2 in the palliative resection groups) and anastomosis(2 cases in each group) was not significantly different(P > 0.05).The cumulative survival rate was significantly lower in the palliative resection group(P < 0.05).CONCLUSION:Radical gastrectomy with resection of hepatic metastases and hepatoarterial catheter implantation is the recommended surgery for late-stage gastric cancer patients with hepatic metastases.
文摘Gastric cancer is the fourth most common cancer and second most common cause of cancer death worldwide.Globally,gastric cancer poses a significant public health burden-both economically and socially.In 2008,the economic burden from premature cancer deaths and disability was$895 billion and gastric cancer was the second highest cancer responsible for healthy life lost.With the expected increase in cancer deaths and non-communicable diseases,these costs are expected to rise and impact patient care.World Health Organization,estimates a 15%increase in non-communicable disease worldwide,with more than 20%increase occurring in Africa between 2010 and 2020.Mali,West Africa,is ranked 15th highest incidence of gastric cancer worldwide at a rate of 20.3/100000,yet very scarce published data evaluating etiology,prevention or management exist.It is understood that risk factors of gastric cancer are multifactorial and include infectious agents(Helicobacter pylori,Epstein-Barr virus),genetic,dietary,and environmental factors(alcohol,smoking).Interestingly,African patients with gastric cancer are younger,in their 3rd-4th decade,and present at a late stage of the disease.There is sparse data regarding gastric cancer in Africa due to lack of data collection and under-reporting,which impacts incidence and mortality rates.Currently,GLOBOCAN,an International Agency for Research on Cancer resource,is the most comprehensive available resource allowing comparison between nations.In resource limited settings,with already restricted healthcare funding,data is needed to establish programs in Africa that increase gastric cancer awareness,curtail the economic burden,and improve patient management and survival outcomes.
基金Supported by Grants from Indian Council of Medical Research,New Delhi and Council of Scientific and Industrial Research,New Delhi
文摘AIM:To assess the prognostic significance of cathepsin L,a cysteine protease that degrades the peri-tumoral tissue,in patients with pancreatic cancer.METHODS:Plasma samples from 127 pancreatic cancer patients were analyzed for cathepsin L levels by ELISA.Out of these patients,25 underwent surgeryand their paraffin-embedded tissue was analyzed for cathepsin L expression by immunohistochemistry.Survival of patients and clinicopathological parameters was correlated with cathepsin L expression in plasma and tissue using appropriate statistical analysis.RESULTS:The mean(±SD)cathepsin L in plasma samples of pancreatic cancer patients was 5.98±2.5ng/m L that was significantly higher compared to the levels in healthy controls(3.83±0.45)or chronic pancreatitis patients(3.97±1.06).Using ROC curve,a cut-off level of 5.0 ng/m L was decided for survival analysis.Elevated plasma levels of cathepsin L were found to be associated with poor prognosis(P=0.01)in multivariate analysis.The plasma levels of the protease decreased after surgery.Though no significant correlation was seen between plasma and tissue expression of this protease,a trend did emerge that high cathepsin L expression in tissue correlated with its high levels in plasma.CONCLUSION:Cathepsin L levels in plasma of pancreatic cancer patients may be used as a potential prognostic marker for the disease.
