BACKGROUND： No staging systems of hepatocellular carcinoma（HCC） are tailored for assessing recurrence risk. We sought to establish a recurrence risk scoring system to predict recurrence of HCC patients receiving su...BACKGROUND： No staging systems of hepatocellular carcinoma（HCC） are tailored for assessing recurrence risk. We sought to establish a recurrence risk scoring system to predict recurrence of HCC patients receiving surgical curative treatment（liver resection or transplantation）.METHODS： We retrospectively studied 286 HCC patients with preserved liver function receiving liver resection（n=184） or transplantation（n=102）. Independent risk factors were identified to construct the recurrence risk scoring model. The recurrence free survival and discriminatory ability of the model were analyzed. RESULTS： Total tumor volume, HBs Ag status, plasma fibrinogen level were included as independent prognostic factors for recurrence-free survival and used for constructing a 3-factor recurrence risk scoring model. The scoring model was as follows： 0.758×HBs Ag status（negative： 0; positive： 1）＋0.387×plasma fibrinogen level（≤3.24 g/L： 0; 〉3.24 g/L： 1）＋0.633×total tumor volume（≤107.5 cm3： 0; 〉107.5 cm3： 1）. The cutoff value was set to 1.02, and we defined the patients with the score ≤1.02 as a low risk group and those with the score 〉1.02 as a high risk group. The 3-year recurrence-free survival rate was significantly higher in the low risk group compared with that in the high risk group（67.9% vs 41.3%, P〈0.001）. In the subgroup analysis, liver transplantation patients had a better3-year recurrence-free survival rate than the liver resection patients in the low risk group（80.0% vs 64.0%, P〈0.01）. Additionally for patients underwent liver transplantation, we compared the recurrence risk model with the Milan criteria in the prediction of recurrence, and the 3-year recurrence survival rates were similar（80.0% vs 79.3%, P=0.906）.CONCLUSION： Our recurrence risk scoring model is effective in categorizing recurrence risks and in predicting recurrencefree survival of HCC before potential surgical curative treatment.展开更多
BACKGROUND： Hepatitis B virus（HBV）-related end-stage liver disease is the leading indication for liver transplantation in China, but long-term results of liver transplantation in patients aged over 60 years are not...BACKGROUND： Hepatitis B virus（HBV）-related end-stage liver disease is the leading indication for liver transplantation in China, but long-term results of liver transplantation in patients aged over 60 years are not clear. The present study was to reveal the natural history of liver recipients with hepatitis B older than60 years.METHODS： The recipients who had received liver transplantation between December 2003 and December 2005 were divided into two groups： those equal or older than 60 years（older group,n60） and those younger than 60 years（younger group, n305）.Risk factors for poor long-term outcome in patients aged over 60 years were also analyzed.RESULTS： Except for age and preexisting chronic disease（P0.05）,no significant differences were observed in perioperative characteristics between the two groups. There was also no significant difference in HBV and hepatocellular carcinoma recurrence（P0.05）. The actuarial 1-, 3-, 5- and 8-year survival rates were 81.6%, 71.6%, 66.7% and 63.3% respectively for the older group vs 84.9%, 77.7%, 70.8% and 65.6% for the younger group（P0.05）. Multivariate analyses showed that pre-liver transplant renal insufficiency was a risk factor for poor outcome in the older group（odds ratio=3.615, P0.014）.CONCLUSIONS： Liver transplantation is safe and feasible for patients with HBV-related end-stage liver disease aged over 60years. Older patients with renal insufficiency should undergo transplantation earlier than younger patients.展开更多
There are currently more than 100 million patients with liver disease in China,and 300000 patients are estimated to be diagnosed with end-stage liver diseases each year.Since Dr.Starzl,a professor from the University ...There are currently more than 100 million patients with liver disease in China,and 300000 patients are estimated to be diagnosed with end-stage liver diseases each year.Since Dr.Starzl,a professor from the University of Pittsburgh,completed the first liver transplant in 1963,liver transplantation has been recognized as the only effective treatment for patients with end-stage liver disease.展开更多
基金supported by grants from the Guang dong Natural Science Foundation(S2013010016023)National Natural Science Foundation of China(81572368)+2 种基金Science and Technology Planning Project of Guangdong Province,China(2014A020212084)the Fundamental Research Funds for the Central Universities(12ykpy47 and 12ykpy43)National 12th Five-Year Science and Technology Plan Major Projects of China(2012ZX10002017-005)
文摘BACKGROUND： No staging systems of hepatocellular carcinoma（HCC） are tailored for assessing recurrence risk. We sought to establish a recurrence risk scoring system to predict recurrence of HCC patients receiving surgical curative treatment（liver resection or transplantation）.METHODS： We retrospectively studied 286 HCC patients with preserved liver function receiving liver resection（n=184） or transplantation（n=102）. Independent risk factors were identified to construct the recurrence risk scoring model. The recurrence free survival and discriminatory ability of the model were analyzed. RESULTS： Total tumor volume, HBs Ag status, plasma fibrinogen level were included as independent prognostic factors for recurrence-free survival and used for constructing a 3-factor recurrence risk scoring model. The scoring model was as follows： 0.758×HBs Ag status（negative： 0; positive： 1）＋0.387×plasma fibrinogen level（≤3.24 g/L： 0; 〉3.24 g/L： 1）＋0.633×total tumor volume（≤107.5 cm3： 0; 〉107.5 cm3： 1）. The cutoff value was set to 1.02, and we defined the patients with the score ≤1.02 as a low risk group and those with the score 〉1.02 as a high risk group. The 3-year recurrence-free survival rate was significantly higher in the low risk group compared with that in the high risk group（67.9% vs 41.3%, P〈0.001）. In the subgroup analysis, liver transplantation patients had a better3-year recurrence-free survival rate than the liver resection patients in the low risk group（80.0% vs 64.0%, P〈0.01）. Additionally for patients underwent liver transplantation, we compared the recurrence risk model with the Milan criteria in the prediction of recurrence, and the 3-year recurrence survival rates were similar（80.0% vs 79.3%, P=0.906）.CONCLUSION： Our recurrence risk scoring model is effective in categorizing recurrence risks and in predicting recurrencefree survival of HCC before potential surgical curative treatment.
基金supported by grants from the Major State Basic Research Development Program of China(973 Program)(2009CB522404)Science Technology Research Development Program of Guangdong Province(2011B031800060)Science Technology Research Development Program of Guangzhou(2011Y1000332)
文摘BACKGROUND： Hepatitis B virus（HBV）-related end-stage liver disease is the leading indication for liver transplantation in China, but long-term results of liver transplantation in patients aged over 60 years are not clear. The present study was to reveal the natural history of liver recipients with hepatitis B older than60 years.METHODS： The recipients who had received liver transplantation between December 2003 and December 2005 were divided into two groups： those equal or older than 60 years（older group,n60） and those younger than 60 years（younger group, n305）.Risk factors for poor long-term outcome in patients aged over 60 years were also analyzed.RESULTS： Except for age and preexisting chronic disease（P0.05）,no significant differences were observed in perioperative characteristics between the two groups. There was also no significant difference in HBV and hepatocellular carcinoma recurrence（P0.05）. The actuarial 1-, 3-, 5- and 8-year survival rates were 81.6%, 71.6%, 66.7% and 63.3% respectively for the older group vs 84.9%, 77.7%, 70.8% and 65.6% for the younger group（P0.05）. Multivariate analyses showed that pre-liver transplant renal insufficiency was a risk factor for poor outcome in the older group（odds ratio=3.615, P0.014）.CONCLUSIONS： Liver transplantation is safe and feasible for patients with HBV-related end-stage liver disease aged over 60years. Older patients with renal insufficiency should undergo transplantation earlier than younger patients.
基金supported by grants from the Science and Tech-nology Program of Guangdong Province(2019B020236003)Science and Technology Program of Guangzhou City(201803040005)Natural Science Foundation of Guangdong Province(2019A1515011698 and 2022A1515011919)。
文摘There are currently more than 100 million patients with liver disease in China,and 300000 patients are estimated to be diagnosed with end-stage liver diseases each year.Since Dr.Starzl,a professor from the University of Pittsburgh,completed the first liver transplant in 1963,liver transplantation has been recognized as the only effective treatment for patients with end-stage liver disease.
