المؤلفون: Tseng, Chan-Wei, Teng, Hao-Wei, Lin, Chun-Chi, Lei, Hao-Jan, Hung, Jung-Jyh, Liang, Wen-Yih, Hsia, Cheng-Yuan, Chou, Shu-Cheng, Lin, Hung-Hsin, Huang, Sheng-Chieh, Cheng, Hou-Hsuan, Lan, Yuan-Tzu, Wang, Huann-Sheng, Yang, Shung-Haur, Chen, Wei-Shone, Lin, Jen-Kou, Jiang, Jeng-Kai, Chang, Shih-Ching, Chau, Gar-Yang

المصدر: Journal of the Chinese Medical Association ; volume 86, issue 8, page 732-739 ; ISSN 1726-4901

الوصف: Background: The role of hepatectomy in a specific group of patients with synchronous colorectal cancer with liver metastases (SCRLM) and synchronous extrahepatic disease (SEHD) is still unclear. The aim of this study was to evaluate the efficacy of liver surgery and define the selection criteria for surgical candidates in patients with SCRLM + SEHD. Methods: Between July 2007 and October 2018, 475 patients with colorectal cancer with liver metastases (CRLM) who underwent liver resection were retrospectively reviewed. Sixty-five patients with SCRLM + SEHD were identified and included in the study. Clinical pathological data of these patients were analyzed to evaluate the influence on survival. Important prognostic factors were identified by univariate and multivariate analyses. The risk score system and decision tree analysis were generated according to the important prognostic factors for better patient selection. Results: The 5-year survival rate of patients with SCRLM + SEHD was 21.9%. The most important prognostic factors were SCRLM number of more than five, site of SEHD other than the lung only, inability to achieve SCRLM + SEHD R0 resection, and BRAF mutation of cancer cells. The proposed risk score system and decision tree model easily discriminated between patients with different survival rates and identified the profile of suitable surgical patients. Conclusion: Liver surgery should not be a contraindication for patients with SCRLM + SEHD. Patients with complete SCRLM + SEHD R0 resection, SCRLM number less than or equal to five, SEHD confined to the lung only, and wild-type BRAF could have favorable survival outcomes. The proposed scoring system and decision tree model may be beneficial to patient selection in clinical use.

الإتاحة: https://doi.org/10.1097/jcma.0000000000000947Test

المؤلفون: Lee, Chun-Yang, Chau, Gar-Yang, Wei, Cheng-Yi, Chao, Yee, Huang, Yi-Hsiang, Huo, Teh-Ia, Hou, Ming-Chih, Su, Yu-Hui, Wu, Jaw-Ching, Su, Chien-Wei

المساهمون: Ministry of Science and Technology, Taiwan, Taipei Veterans General Hospital

المصدر: Scientific Reports ; volume 12, issue 1 ; ISSN 2045-2322

مصطلحات موضوعية: Multidisciplinary

الوصف: We investigated the outcomes of patients with ruptured hepatocellular carcinoma (HCC) and identified the optimal treatment modality for such patients. We retrospectively enrolled 91 patients with treatment-naive HCC and tumor rupture at diagnosis, including 38 patients who underwent surgical resection (SR) alone, 28 patients who were treated with transarterial chemoembolization (TACE) only, 20 patients who had a sequential combination therapy of TACE and SR, and 5 patients who received best supportive care. After a median follow-up of 13.1 months, 54 patients died. The cumulative 5 years overall survival (OS) rates were 55.1% and 0% in the SR group and non-SR group, respectively ( p < 0.001). Non-SR therapy was associated with poorer OS according to a multivariate analysis with a hazard ratio of 6.649 (95% confidence interval 3.581–12.344, p < 0.001). Moreover, whether patients received TACE or not did not impact the OS in both the SR group and the non-SR group. In conclusion, for patients with HCC and tumor rupture at the time of diagnosis, SR could lead to better prognoses than non-surgery treatment modalities. Moreover, a sequential combination of TACE and SR had similar clinical outcomes when compared to SR alone.

الإتاحة: https://doi.org/10.1038/s41598-022-12350-xTest
https://www.nature.com/articles/s41598-022-12350-x.pdfTest
https://www.nature.com/articles/s41598-022-12350-xTest

المؤلفون: Lai, Hon-Fan, Chau, Ivy Yenwen, Lei, Hao-Jan, Chou, Shu-Cheng, Hsia, Cheng-Yuan, Kao, Yi-Chu, Chau, Gar-Yang

المساهمون: Koniaris, Leonidas G, Taipei Veterans General Hospital

المصدر: PLOS ONE ; volume 17, issue 1, page e0262113 ; ISSN 1932-6203

الوصف: Purpose To evaluate the incidence and risk factors of postoperative fever (POF) after liver resection. In patients with POF, predictors of febrile infectious complications were determined. Methods A total of 797 consecutive patients undergoing liver resection from January 2015 to December 2019 were retrospectively investigated. POF was defined as body temperature ≥ 38.0°C in the postoperative period. POF was characterized by time of first fever, the highest temperature, and frequency of fever. The Institut Mutualiste Montsouris (IMM) classification was used to stratify surgical difficulty, from grade I (low), grade II (intermediate) to grade III (high). Postoperative leukocytosis was defined as a 70% increase of white blood cell count from the preoperative value. Multivariate analysis was performed to identify risk factors for POF and predictors of febrile infectious complications. Results Overall, 401 patients (50.3%) developed POF. Of these, 10.5% had the time of first fever > postoperative day (POD) 2, 25.9% had fever > 38.6°C, and 60.6% had multiple fever spikes. In multivariate analysis, risk factors for POF were: IMM grade III resection (OR 1.572, p = 0.008), Charlson Comorbidity Index score > 3 (OR 1.872, p < 0.001), and serum albumin < 3.2 g/dL (OR 3.236, p = 0.023). 14.6% patients developed infectious complication, 21.9% of febrile patients and 7.1% of afebrile patients (p < 0.001). Predictors of febrile infectious complications were: fever > 38.6°C (OR 2.242, p = 0.003), time of first fever > POD2 (OR 6.002, p < 0.001), and multiple fever spikes (OR 2.039, p = 0.019). Sensitivity, specificity, positive predictive value and negative predictive value for fever > 38.6°C were 39.8%, 78.0%, 33.7% and 82.2%, respectively. A combination of fever > 38.6°C and leukocytosis provided high specificity of 95.2%. Conclusion In this study, we found that IMM classification, CCI score, and serum albumin level related with POF development in patients undergone liver resection. Time of ...

الإتاحة: https://doi.org/10.1371/journal.pone.0262113Test

المؤلفون: Chen, Yu-Jen, Su, Chien-Wei, Wei, Cheng-Yi, Chau, Gar-Yang, Chen, Ping-Hsien, Chao, Yee, Huang, Yi-Hsiang, Wu, Jaw-Ching, Yang, Tsung-Chieh, Lee, Pei-Chang, Hou, Ming-Chih

المصدر: Journal of the Chinese Medical Association ; volume 85, issue 6, page 679-686 ; ISSN 1726-4901

الوصف: Background: Esophageal varices (EV) is common and is a poor prognostic factor for patients with hepatocellular carcinoma (HCC). However, the outcomes between cirrhotic and noncirrhotic HCC patients with EV is not well studied. The present study aimed to investigate the clinical manifestations and prognoses of HCC patients after surgical resection stratified by the cirrhosis status. Methods: A total of 111 patients with HCC and EV, who underwent surgical resection, were retrospectively enrolled between July 2003 and July 2019. The diagnosis of liver cirrhosis was established using the Ishak fibrosis score F5 or F6 in the nontumor part of liver specimens. Prognostic factors were analyzed using the Cox proportional hazards model. Results: There were 85 (76.6%) and 26 (23.4%) patients with and without cirrhosis, respectively. Compared with those without cirrhosis, there were more females, less seropositive rate of hepatitis B surface antigen (HBsAg), more seropositive rate of antibody against to hepatitis C virus (HCV), less albumin-bilirubin (ALBI) grade 1, lower platelet count, and more had tumor burden within the Milan criteria in cirrhotic patients. Cirrhotic patients had a higher risk of posthepatectomy decompensation compared to noncirrhotic patients (hazard ratio 9.577, p = 0.017). No difference was observed in overall survival and recurrence-free survival between patients with or without cirrhosis. Conclusion: Compared with patients without cirrhosis, cirrhotic patients with HCC and EV are vulnerable to posthepatectomy decompensation. However, cirrhosis is not a poor prognostic factor of overall survival and recurrence for HCC patients after surgical resection.

الإتاحة: https://doi.org/10.1097/jcma.0000000000000739Test

المؤلفون: Cheng, Han-Fang, Tsai, Yi-Fang, Huang, Chi-Cheng, Lien, Pei-Ju, Wang, Yu-Ling, Hsu, Chih-Yi, Chen, Yen-Jen, Liu, Chun-Yu, Chao, Ta-Chung, Lin, Yen-Shu, Feng, Chin-Jung, Chiu, Jen-Hwey, Chau, Gar-Yang, Tseng, Ling-Ming

المصدر: Journal of the Chinese Medical Association ; volume 85, issue 1, page 88-94 ; ISSN 1726-4901

الوصف: Background: To assess the clinical outcomes and metastatic behavior between de novo versus recurrent human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) based on a single-institution database in Taiwan. Methods: We retrospectively identified patients diagnosed between January 2000 and December 2017 with de novo stage IV or recurrent HER2-positive MBC. Several variables were recorded in patients with recurrent disease: age at diagnosis, metastatic site, hormone receptor (HR) status, HER2 status, and disease-free interval (DFI). Treatments and metastatic patterns were compared between de novo stage IV and recurrent MBC cohorts. Post-metastasis survival (PMS) was estimated using the Kaplan-Meier method with log-rank tests. Hazard ratios and 95% CIs were estimated using Cox regression analysis. Results: In total, 1360 patients were diagnosed with breast cancer with HER2 overexpression. At baseline, de novo stage IV patients were older than recurrent MBC patients (median age 58 vs 53). The majority of the de novo stage IV patients were diagnosed after 2010, while most of the recurrent MBC patients were diagnosed during 2000-2009. An increased number of de novo stage IV patients underwent targeted therapy than recurrent MBC patients was also noted. PMS in patients with de novo stage IV and recurrent MBC was 79.2 months and 61.8 months, respectively, which indicated significant better survival in de novo stage IV than those with recurrent MBC disease. Longer survival was also noted in de novo stage IV and recurrent MBC with DFI >24 months than in those with recurrent MBC with DFI <24 months and in patients receiving HER2-targeted therapy after MBC diagnosis than in those not receiving the therapy. However, median PMS showed no significant difference between patients with the luminal B2 (HR-positive, HER2-negative) and HER2-enriched (HR-negative, HER2-positive) subtypes. After adjustment in multivariate analysis, a low risk of BC-specific death was observed in patients aged ...

الإتاحة: https://doi.org/10.1097/jcma.0000000000000622Test

المؤلفون: Chen, Bo-Fang, Tsai, Yi-Fang, Huang, Chi-Cheng, Hsu, Chih-Yi, Lien, Pei-Ju, Wang, Yu-Ling, Lin, Yen-Shu, Feng, Chin-Jung, King, Kuang-Liang, Chiu, Jen-Hwey, Chau, Gar-Yang, Tseng, Ling-Ming

المصدر: Journal of the Chinese Medical Association ; volume 85, issue 2, page 190-197 ; ISSN 1726-4901

الوصف: Background: Hormone receptor-positive, human epidermal growth factor receptor II (HER2)-negative luminal B1 breast cancer is associated with a higher risk of disease relapse than luminal A breast cancer. Therefore, we assessed and compared the distant metastasis pattern and clinical outcomes associated with luminal B1 and luminal A breast cancer in an Asian population. Methods: In this observational study, we assessed patients with estrogen receptor-positive, HER2-negative breast cancer who underwent surgery from 2009 to 2016. Patients were classified into luminal A or luminal B1 subsets via immunohistochemical analysis. Disease-free survival, post-metastasis survival, and overall survival were estimated; time to disease relapse and patterns of distant metastasis were compared. Risk of relapse and mortality were assessed using Cox proportional hazards model. Results: Patients with luminal B1 breast cancer (n = 677) were significantly younger and had larger tumors and a higher degree of affected axillary lymph nodes, lymphovascular invasion, and tumor necrosis than those with luminal A breast cancer (n = 630). Higher rates of local recurrence and distant metastasis were observed for luminal B1 (both p < 0.05); however, no difference was observed in the specific distant metastatic sites. We observed a significant increase in disease relapse risk in luminal B1 patients compared with that in luminal A (hazard ratio: 2.157, 95% CI: 1.340-3.473, p < 0.05). Patient age, tumor size, stage, lymphovascular invasion, and receiving chemotherapy and hormone therapy were independent risk factors for metastasis and recurrence. Only the luminal B1 subtype (hazard ratio: 5.653, 95% CI: 1.166-27.409, p < 0.05) and stage (hazard ratio: 3.400, 95% CI: 1.512-7.649, p < 0.05) were identified as independent risk factors for post metastatic mortality. Conclusion: Luminal B1 breast cancer has aggressive tumor biology compared with luminal A breast cancer in the follow-up period. However, there was no significant difference ...

الإتاحة: https://doi.org/10.1097/jcma.0000000000000632Test

المؤلفون: Yeh, Chia-Yi, Chang, Wen-Kuei, Wu, Hsiang-Ling, Chau, Gar-Yang, Tai, Ying-Hsuan, Chang, Kuang-Yi

المصدر: Frontiers in Medicine ; volume 8 ; ISSN 2296-858X

مصطلحات موضوعية: General Medicine

الوصف: Background This study aimed to investigate the influential factors of postoperative pain trajectories and morphine consumption after hepatic cancer surgery with a particular interest in multimodal analgesia. Methods Patients receiving hepatic cancer surgery at a tertiary medical center were enrolled between 2011 and 2016. Postoperative pain scores and potentially influential factors like patient characteristics and the analgesic used were collected. Latent curve analysis was conducted to investigate predictors of postoperative pain trajectories and a linear regression model was used to explore factors associated with postoperative morphine consumption. Results 450 patients were collected, the daily pain scores during the first postoperative week ranged from 2.0 to 3.0 on average. Male and higher body weight were associated with more morphine consumption (both P < 0.001) but reduced morphine demand was noted in the elderly ( P < 0.001) and standing acetaminophen users ( P = 0.003). Longer anesthesia time was associated with higher baseline pain levels ( P < 0.001). In contrast, male gender ( P < 0.001) and standing non-steroidal anti-inflammatory drugs (NSAIDs) use ( P = 0.012) were associated with faster pain resolution over time. Conclusions Multimodal analgesia with standing acetaminophen and NSAIDs had benefits of opioid-sparing and faster pain resolution, respectively, to patients receiving hepatic cancer surgery.

الإتاحة: https://doi.org/10.3389/fmed.2021.777369Test

المؤلفون: Lee, I-Cheng, Huang, Jo-Yu, Chen, Ting-Chun, Yen, Chia-Heng, Chiu, Nai-Chi, Hwang, Hsuen-En, Huang, Jia-Guan, Liu, Chien-An, Chau, Gar-Yang, Lee, Rheun-Chuan, Hung, Yi-Ping, Chao, Yee, Ho, Shinn-Ying, Huang, Yi-Hsiang

المصدر: Liver Cancer ; volume 10, issue 6, page 572-582 ; ISSN 2235-1795 1664-5553

الوصف: Background and Aims: Current prediction models for early recurrence of hepatocellular carcinoma (HCC) after surgical resection remain unsatisfactory. The aim of this study was to develop evolutionary learning-derived prediction models with interpretability using both clinical and radiomic features to predict early recurrence of HCC after surgical resection. Methods: Consecutive 517 HCC patients receiving surgical resection with available contrast-enhanced computed tomography (CECT) images before resection were retrospectively enrolled. Patients were randomly assigned to a training set (n = 362) and a test set (n = 155) in a ratio of 7:3. Tumor segmentation of all CECT images including noncontrast phase, arterial phase, and portal venous phase was manually performed for radiomic feature extraction. A novel evolutionary learning-derived method called genetic algorithm for predicting recurrence after surgery of liver cancer (GARSL) was proposed to design prediction models for early recurrence of HCC within 2 years after surgery. Results: A total of 143 features, including 26 preoperative clinical features, 5 postoperative pathological features, and 112 radiomic features were used to develop GARSL preoperative and postoperative models. The area under the receiver operating characteristic curves (AUCs) for early recurrence of HCC within 2 years were 0.781 and 0.767, respectively, in the training set, and 0.739 and 0.741, respectively, in the test set. The accuracy of GARSL models derived from the evolutionary learning method was significantly better than models derived from other well-known machine learning methods or the early recurrence after surgery for liver tumor (ERASL) preoperative (AUC = 0.687, p < 0.001 vs. GARSL preoperative) and ERASL postoperative (AUC = 0.688, p < 0.001 vs. GARSL postoperative) models using clinical features only. Conclusion: The GARSL models using both clinical and radiomic features significantly improved the accuracy to predict early recurrence of HCC after surgical ...

الإتاحة: https://doi.org/10.1159/000518728Test
https://www.karger.com/Article/Pdf/518728Test

المؤلفون: Lei, Hoa-Jan, Wang, Sheng-Yu, Chau, Ivy Yenwen, Li, Anna Fen-Yau, Chau, Yat-Pang, Hsia, Cheng-Yuan, Chou, Shu-Cheng, Kao, Yi-Chu, Chau, Gar-Yang

المصدر: Journal of the Chinese Medical Association ; volume 84, issue 6, page 623-632 ; ISSN 1726-4901

الوصف: Background: Hepatoma upregulated protein (HURP) and Ki-67 have been identified as cancer-related genes involved in cell growth and proliferation. Previous experimental studies have suggested an essential role for HURP expression in liver carcinogenesis. However, data regarding HURP expression in hepatocellular carcinoma (HCC) and its correlation with patient outcomes are limited. In this study, we examined the clinicopathologic features associated with HURP expression in HCC, and compared them to the results of the Ki-67 study. Methods: Eighty-seven resected HCC at tumor, node, metastasis (TNM) stages I (n = 28), II (n = 29), and III (n = 30) were evaluated. HURP and Ki-67 expression were assessed by immunohistochemistry. Multivariate analysis was used to examine the prognostic significance of HURP and Ki-67 expression. Results: HURP expression in HCC tissue was observed in 59% of patients and associated with female sex, low white blood cell count, and low platelet count. Ki-67 expression was observed in 67% of patients and associated with younger age, higher serum α-fetoprotein (AFP) levels, and frequent microvascular invasion. Univariate analysis showed that factors related to overall survival were: age >55 years, AFP >20 ng/mL, indocyanine green retention rate at 15 minutes (ICG-15) >15%, tumor size >5 cm, multiple tumors, macrovascular invasion, microvascular invasion, Ki-67 expression, and serum vascular endothelial growth factor >170 pg/mL. HURP expression was not associated with postresection survival. Multivariate analysis indicated that macrovascular invasion, multiple tumors, ICG-15 >15%, and Ki-67 expression were independent factors for overall survival. Multiple tumors and Ki-67 expression were independent factors related to recurrence-free survival. Conclusion: In our study, HURP expression in HCC tissue was not associated with post-resection survival. Ki-67 expression was an independent prognostic factor for survival. Our results suggest that the effect of HURP activity on growth, ...

الإتاحة: https://doi.org/10.1097/jcma.0000000000000540Test

المؤلفون: Chang, Chung-Yu, Wei, Cheng-Yi, Chen, Ping-Hsien, Hou, Ming-Chih, Chao, Yee, Chau, Gar-Yang, Lee, Rheun-Chuan, Huang, Yi-Hsiang, Su, Yu-Hui, Wu, Jaw-Ching, Su, Chien-Wei

المصدر: Journal of the Chinese Medical Association ; volume 84, issue 2, page 136-143 ; ISSN 1726-4901

الوصف: Background: Patients with hepatocellular carcinoma (HCC) and with a single tumor <2 cm in size are classified as having Barcelona Clinic Liver Cancer (BCLC) stage 0 HCC. We aimed to investigate the role of the albumin–bilirubin (ALBI) grade in predicting outcomes in patients with BCLC stage 0 HCC. Methods: We retrospectively enrolled patients with BCLC stage 0 HCC in Taipei Veterans General Hospital from 2007 to 2015. Prognostic factors were analyzed using a Cox proportional hazards model and propensity score matching (PSM) analysis. Results: There were 420 patients enrolled, including 207 with ALBI grade 1, and 213 with ALBI grade 2 or 3. After a median follow-up of 60.0 months (interquartile range, 37.2–84.6 months), 179 patients died. The cumulative 5-year overall survival (OS) rates were 80.6% in patients with ALBI grade 1 and 53.7% in those with ALBI grade 2 or 3, respectively ( p < 0.001). Multivariate analysis showed that age >65 years, negative hepatitis B surface in serum, creatinine >1.0 mg/dL, platelet count ≤10 5 /mm 3 , tumor size >1.5 cm, nonsurgical resection (SR) therapy, and higher ALBI grade were independent risk factors related to poor OS. Patients who underwent SR had a better OS and recurrence-free survival than those who received radiofrequency ablation, which was confirmed by a multivariate analysis and PSM analysis. Conclusion: The ALBI grade can determine OS for patients with BCLC stage 0 HCC. SR can also provide a better outcome than nonsurgical treatment.

الإتاحة: https://doi.org/10.1097/jcma.0000000000000482Test