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Liu J.-J.,Guangxi Medical University | Liu J.-J.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | Wang D.,Guangxi Medical University | Wang D.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | And 16 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2016

Objective: To compare the diagnosis accurate rate of contrast-enhanced ultrasound (CEUS) and contrast enhanced helical CT (CECT) in high echo-level small focal liver lesions (HSFLLs) (diameter ≤3 cm), and to explore the application value of CEUS in the diagnosis and differential diagnosis of the benign and malignant liver hyperechoic lesions. Methods: The institutional review board of Tumor Hospital of Guangxi Medical University approved the study protocol. The CEUS Time intensity curves (TICs) results of 75 cases (107 lesions) with HSFLLs detected by two-dimensional ultrasound (2DUS) were reviewed and analyzed. And the results were compared with CECT. Results: The area under the curve of CEUS and CECT were 0.941 and 0.936 respectively. The cut off value of CEUS diagnosis for malignant lesions was 2.5. The sensitivity, specificity and the accuracy of CEUS for diagnosing malignant hepatic tumors were respectively 90.0%, 89.4% and 89.71%, versus 90.0%, 87.2% and 88.79% in CECT. The positive predictive value of CEUS and CECT were 0.895 and 0.875. The negative predictive value of CEUS and CECT were 0.101 and 0.103. In the diagnosis and differential diagnosis of cirrhotic nodules lesions and small hepatocellular carcinoma (SHCC) lesions, the accurate rate of CEUS was 92.86%, and CECT was 90.48%. Conclusion: CEUS could effectively and dynamically evaluate the hemodynamics of liver tumors, and provide qualitative and quantitative diagnosis to HSFLLs. In the diagnosis of HSFLLs and SHCC, CEUS was equal to CECT. © 2016, E-Century Publishing Corporation. All rights reserved.


Zhong J.-H.,Guangxi Medical University | Zhong J.-H.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | You X.-M.,Guangxi Medical University | You X.-M.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | And 15 more authors.
Medicine (United States) | Year: 2015

The present study compared the efficacy of hepatic resection (HR) in patients with large hepatocellular carcinoma (HCC) and those with multinodular tumor and examined how that efficacy has changed over time in a large medical center. The intermediate stage of HCC comprises a highly heterogeneous patient population. Moreover, official guidelines have different views on the suitability of HR to treat such patients. A consecutive sample of 927 patients with preserved liver function and large and/or multinodular HCC who were treated by initial HR were divided into 3 groups: those with a single tumor ≥5cm in diameter (n=588), 2 to 3 tumors with a maximum diameter >3 cm (n=225), or >3 tumors of any diameter (n=114). Hospital mortality and overall survival (OS) in each group were compared for the years 2000 to 2007 and 2008 to 2013. Patients with >3 tumors showed the highest incidence of hospital mortality of all groups (P<0.05). Kaplan-Meier survival analysis showed that OS varied across the 3 groups as follows: single tumor > 2 to 3 tumors > 3+ tumors (all P<0.05). OS at 5 years ranged from 24% to 41% in all 3 groups for the period 2000 to 2007, and from 35% to 46% for the period 2008 to 2013. OS was significantly higher during the more recent 6-year period in the entire patient population, those with single tumor, and those with 3+ tumors (all P<0.05). However, in patients with 2 to 3 tumors, OS was only slightly higher during the more recent 6-year period (P=0.084). Prognosis can vary substantially for these 3 types of HCC. Patients with >3 tumors show the highest hospital mortality and lowest OS after HR. OS has been improving for all 3 types of HCC at our medical center as a consequence of improvements in surgical technique and perioperative management. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Xie Z.-B.,Guangxi Medical University | Xie Z.-B.,Fudan University | Wang X.-B.,Guangxi Medical University | Fu D.-L.,Fudan University | And 5 more authors.
OncoTargets and Therapy | Year: 2016

Background: Patients with hepatocellular carcinoma have the risk of postoperative hepatitis B virus (HBV) reactivation (PHR). Antiviral therapy was given to patients with detectable HBV DNA levels but not to patients with undetectable HBV DNA levels. Methods: In this retrospective study, 258 patients were enrolled (HBV DNA levels <00 copies/mL group, n=159, and HBV DNA levels <500 copies/mL group, n=99). Results: A total of 50 patients (19.4%) had PHR. The following significant factors related to PHR were found: without antiviral therapy (hazard ratio [HR] =0.17, 95% confidence interval [CI] 0.031-0.911), hepatitis B e antigen positivity (HR =5.20, 95% CI 1.931-14.007), hepatitis B core antigen S1 positivity (HR =2.54, 95% CI 1.116-5.762), preoperative HBV DNA levels ≥500 copies/mL (HR =1.28, 95% CI 1.085-2.884), hepatic inflow occlusion (HR =3.60, 95% CI 1.402-9.277), moderate liver cirrhosis or more (HR =2.26, 95% CI 1.001-5.121), and blood transfusion (HR =2.89, 95% CI 0.836-10.041). Recurrence-free survival time was significantly shorter in patients with PHR (23.06±2.46 months) than in patients without PHR (29.30±1.27 months). Conclusion: Antiviral therapy could efficiently decrease the incidence of PHR. Patients with HBV DNA levels <500 copies/mL still have the risk of PHR. PHR remained as a prognostic risk factor for hepatocellular carcinoma recurrence and recurrence-free survival. © 2016 Xie et al.


Wang Y.-Y.,Guangxi Medical University | Zhong J.-H.,Guangxi Medical University | Zhong J.-H.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | Su Z.-Y.,Guangxi Medical University | And 11 more authors.
British Journal of Surgery | Year: 2016

Background The Child-Pugh (CP) score is used widely to assess liver function and predict postoperative outcomes in patients with hepatocellular carcinoma (HCC). Recently, the albumin-bilirubin (ALBI) score has been validated as a predictor of overall survival in these patients. This study aimed to compare the ability of the ALBI and CP scores to predict outcomes in patients with HCC after liver resection with curative intent. Methods Consecutive patients who underwent liver resection with curative intent for HCC between January 2007 and July 2013 were included in this retrospective study. The performance of the ALBI score in predicting postoperative liver failure (PHLF) and long-term survival was compared with that of the CP score. Results A total of 1242 patients were enrolled. Of these, 166 (13·4 per cent) experienced PHLF. The area under the receiver operating characteristic (ROC) curve of the ALBI score for predicting PHLF was greater than that of the CP score (0·723 versus 0·607; P < 0·001). Similar to findings for CP grade, the incidence and severity of PHLF increased with increasing ALBI grade. The ALBI grade stratified patients into at least two distinct overall survival cohorts (P < 0·001), whereas the CP grade did not. The ALBI grade also classified patients with CP grade A disease into two distinct overall survival cohorts (P < 0·001), and overall survival rates in the group with poorer survival were similar to those in the majority of patients with CP grade B disease. Both CP and ALBI scores had low power in predicting disease-free survival. Conclusion The ALBI grade predicted PHLF and overall survival in patients with HCC undergoing liver resection with curative intent more accurately than the CP grade. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.


Bai T.,Guangxi Medical University | Bai T.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | Chen J.,Guangxi Medical University | Chen J.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | And 11 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2015

Background: Surgery is the only curative therapy for patients with hilar cholangiocarcinoma (HCCA). Combined portal vein resection (PVR) could achieve negative resection margins in HCCA patients with portal vein invasion. This systematic review aimed to analysis the efficiency of combined PVR for HCCA. Methods: MEDLINE, EMBASE, the Cochrane Library, the Chinese National Knowledge Infrastructure database, and clinical trial registries were searched through April 2015. Risk ratios (RRs), and 95% confidence intervals (CIs) were calculated. Results: The analysis included 21 retrospective studies, altogether involving 2403 patients (patients with PVR, n=637, patients without PVR, n=1766). Patients with PVR were likely to have more advanced HCCA (lymphatic invasion: RR=1.14, 95% CI 1.02 to 1.28, perineural invasion: RR=1.31, 95% CI 1.05 to 1.63) and suffered less curative resections (RR=0.89, 95% CI 0.75 to 0.99). Postoperative morbidity was similar between patients with or without PVR (RR=1.06, 95% CI 0.94 to 1.02). Patients with PVR suffered higher mortality rate (RR=1.52, 95% CI 1.06 to 2.18), and worse 5-year survival rate (RR=0.67, 95% CI 0.49 to 0.91). Conclusion: Combined PVR for HCCA patients would not increase postoperative morbidity rate. However, ascribed to PVR group concluded more advanced HCCA patients, patients with PVR had increased postoperative mortality rate and worse survival rate. The results still need further high quality trails for validation. © 2015 E-Century Publishing Corporation. All rights reserved.


Liu J.-J.,Guangxi Medical University | Liu J.-J.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | Li H.-X.,Guangxi Medical University | Li H.-X.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | And 14 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2015

To compare the consistency of contrast-enhanced ultrasound (CEUS) and contrast-enhance CT (CECT) in diagnosis of 1~2 cm and 2.1~3 cm small hepatocellular carcinoma (HCC) and evaluate the value of CEUS in diagnosis of HCC. Methods: A total of 74 patients (89 lesions) with small HCC and cirrhosis background were retrospectively analyzed. All of the eighty-nine lesions were confirmed by histopathological examination of surgical samples or needle biopsy. All the cases were divided into 1~2 cm group and 2.1~3 cm group. The CEUS and CECT enhanced pattern and diagnosis results of the two groups were compared and the consistency between the two imaging methods were statistically analyzed. Results: In the diagnosis of 1.0-2.0 cm HCC, CEUS and CECT had a moderate consistency in arterial phase, CEUS showed a tolerable consistency with CECT in portal venous and delayphase. The two imaging methods have a better consistency for the diagnosis in 2.1-3.0 cm HCC. Conclusion: CEUS can be used as a supplement to provide important diagnostic information in clinical practice when positive results or definite diagnoses cannot obtain. © 2015 E-Century Publishing Corporation. All rights reserved.


Chen J.,Guangxi Medical University | Chen J.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | Bai T.,Guangxi Medical University | Bai T.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | And 10 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2015

Background: Compared with open hepatectomy (OH), laparoscopic hepatectomy (LH) had better shortterm outcomes in normal hepatocellular carcinoma (HCC) patients. Since liver cirrhosis is the major risk of HCC, serve postoperative complications can be observed after LH in HCC patients with cirrhosis. We conducted this systematic review to analysis the safety and the efficiency of LH in HCC patients with liver cirrhosis. Methods: MEDLINE, EMBASE, the Cochrane Library, the Chinese National Knowledge Infrastructure database, and clinical trial registries were searched through March 2015. Risk ratios (RRs), weigh mean difference (WMD) and 95% confidence intervals (CIs) were calculated. Results: The analysis included 7 retrospective trials, altogether involving 828 patients. Patients in LH group had wider tumor margin (WMD = 0.12, 95% CI 0.04 to 0.21, P = 0.003), less blood loss (WMD = -157.25, 95% CI -295.05 to -19.45, P = 0.03), less blood transfusion (RR = 0.41, 95% CI 0.22 to 0.74, P = 0.004), less postoperative mobility (RR = 0.48, 95% CI 0.35 to 0.66, P<0.001) and less hospital stay (WMD = -4.11, 95% CI -6.23 to -1.98, P<0.001). Overall survival (OS) and disease free survival (DFS) were similar between 2 groups, except LH had a better 5-year survival rate (RR = 1.28, 95% CI 1.01 to 1.62, P = 0.04). Conclusion: In HCC patients with liver cirrhosis, LH have short-term outcomes advantages of tumor margin, blood loss, blood transfusion, postoperative mobility, and hospital stay. OS and DFS were similar between LH and OH. LH is safe in HCC patients with liver cirrhosis. © 2015 E-Century Publishing Corporation. All rights reserved.


Pang Y.-B.,Guangxi Medical University | Zhong J.-H.,Guangxi Medical University | Zhong J.-H.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | Luo X.-L.,Guangxi Medical University | And 8 more authors.
Tumor Biology | Year: 2015

The aim of this study was to analyze the clinicopathological characteristics and expression of liver stem cell markers of hepatocellular carcinoma (HCC) involving bile duct tumor thrombi (BDTT). A total of 35 patients with HCC and BDTT in a consecutive series of HCC patients who underwent surgical treatment were studied retrospectively and compared with 916 patients without BDTT from the same series. Clinicopathological characteristics, overall survival (OS), and tumor expression of liver stem cell markers CD133, CD90, EpCAM, CK19, VEGF, and C-kit were compared between the two patient groups. Analysis was performed for the entire patient groups as well as for 35 pairs of patients with or without BDTT matched by propensity score. HCC patients with BDTT tended to have smaller tumors than those without BDTT, as well as a higher probability of having poorly differentiated tumor, Child-Pugh class B, liver cirrhosis, and microvascular invasion. Tumor tissue in patients with BDTT showed significantly higher expression rates of all liver stem cell markers examined. OS was significantly lower for patients with BDTT at 1 year (69 vs 84 %), 3 years (37 vs 64 %), and 5 years (20 vs 55 %) (P < 0.001). Patients with HCC and BDTT show lower OS than patients without BDTT. The higher frequency of liver stem cell marker expression in the presence of BDTT suggests that such stem cells may play a role in the pathogenesis of this form of HCC. © 2015 International Society of Oncology and BioMarkers (ISOBM)


Liu L.,Guangxi Medical University | Zhang Q.-S.,Guangxi Medical University | Pan L.-H.,Guangxi Medical University | Zhong J.-H.,Guangxi Medical University | And 12 more authors.
Tumor Biology | Year: 2015

Official guidelines group together all cases of solitary hepatocellular carcinoma (HCC) without macroscopic vascular invasion, regardless of tumor size. Here, we examined whether this is justified based on overall survival (OS) after hepatic resection (HR). Patients with newly diagnosed solitary HCC treated by initial HR from January 2004 to October 2013 were classified into six groups based on tumor size (in 2-cm increments). Combining adjacent categories with similar OS led to three groups: ≤5 cm (n = 426), >5 and ≤8 cm (n = 229), and >8 cm (n = 202). Among all patients, median survival time was 62 months, and OS was 95 % at 1 year, 73 % at 3 years, and 54 % at 5 years. Patients in the ≤5 cm group showed significantly higher OS (P < 0.001) and lower tumor recurrence (P = 0.004) than those in the >5 and ≤8 cm group, who in turn showed significantly higher OS (P = 0.003) and lower tumor recurrence (P = 0.021) than those in the >8 cm group. Our results suggest that patients with solitary HCC should be subclassified based on tumor size for more accurate prognosis. We propose defining solitary HCC tumors >5 and ≤8 cm as “large” and tumors >8 cm as “huge”. © 2015 International Society of Oncology and BioMarkers (ISOBM)


Lu S.D.,Guangxi Medical University | Wang Y.Y.,Guangxi Medical University | Peng N.F.,Guangxi Medical University | Peng N.F.,Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center | And 12 more authors.
Medicine (United States) | Year: 2016

This study aims to clarify the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) for patients with hepatocellular carcinoma (HCC) after potentially curative hepatic resection (HR). The prognostic value of the NLR for HCC patients has not been definitely reviewed by large studies, especially for those with different Barcelona Clinic Liver Cancer (BCLC) stages. A consecutive sample of 963 HCC patients who underwent potentially curative HR was classified as having low or high NLR using a cutoff value of 2.81. Overall survival (OS) and tumor recurrence were compared for patients with low or high NLR across the total population, as well as in subgroups of patients in BCLC stages 0/A, B, or C. Clinicopathological parameters, including NLR, were evaluated to identify risk factors of OS and tumor recurrence after potentially curative hepatic resection. Multivariate analyses were performed using the Cox proportional hazards model or subdistribution hazard regression model. Multivariate analyses showed that NLR (>2.81), tumor number (>3), incomplete capsule, serum albumin (35 g/L), alanine transaminase activity (>40 U/L), and macrovascular invasion were risk factors for low OS, whereas NLR (>2.81), tumor size (>5 cm), alpha fetal protein concentration (>400 ng/L), and macrovascular invasion were risk factors for low tumor recurrence. NLR > 2.81 was significantly associated with poor OS and tumor recurrence in the total patient population (both P<0.001), as well as in the subgroups of patients in BCLC stages 0/A or B (all P<0.05). Moreover, those with high NLR were associated with low OS (P1/40.027), and also with slightly higher tumor recurrence than those with low NLR for the subgroups in BCLC stage B (P1/40.058). Neither association, however, was observed among patients with BCLC stage C disease. NLR may be an independent predictor of low OS and tumor recurrence after potentially curative HR in HCC patients in BCLC stages 0/A or B. © 2016 Wolters Kluwer Health, Inc.

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