Background
Several important changes were made to the 8th edition of the American Joint Committee on Cancer (AJCC) tumor staging system for intrahepatic cholangiocarcinoma (ICC). We assessed the ...prognostic impact of this new tumor staging system compared to the 7th edition.
Methods
A retrospective single‐institution study was performed with 626 patients who underwent R0 resection for ICC over 20‐year period.
Results
Anatomical resection and concurrent bile duct resection were performed in 571 (91.2%) and 62 (9.9%) patients, respectively. Cumulative tumor recurrence and patient survival rates were 40.6% and 73.3% at 1 year; 66.7% and 43.8% at 3 years; 73.6% and 30.4% at 5 years; and 74.4% and 20.3% at 10 years, respectively. Independent prognostic factors for tumor recurrence and patient survival were multiple tumors, carbohydrate antigen 19‐9 >200 U/ml, tumor size >5 cm, direct invasion to extrahepatic structure, and lymph node metastasis. For tumor‐node‐metastasis stages in the 7th versus the 8th editions, concordance index was 0.615 and 0.625 for tumor recurrence and 0.626 and 0.628 for patient survival, respectively.
Conclusions
The 8th edition of the AJCC staging system appears to provide high prognostic contrast for T stage categories, except for T3. However, overall prognostic performance of the 8th edition was not markedly improved over the 7th edition.
Highlight
In this high‐volume single‐center study, Kang and colleagues compared the prognostic impact of the 7th and 8th editions of the AJCC tumor staging system for intrahepatic cholangiocarcinoma. The 8th edition appears to provide high prognostic contrast for most tumor stage categories, but no marked improvement in overall prognostic performance.
Interaction forces are traditionally predicted by a contact type haptic sensor. In this paper, we propose a novel and practical method for inferring the interaction forces between two objects based ...only on video data-one of the non-contact type camera sensors-without the use of common haptic sensors. In detail, we could predict the interaction force by observing the texture changes of the target object by an external force. For this purpose, our hypothesis is that a three-dimensional (3D) convolutional neural network (CNN) can be made to predict the physical interaction forces from video images. In this paper, we proposed a bottleneck-based 3D depthwise separable CNN architecture where the video is disentangled into spatial and temporal information. By applying the basic depthwise convolution concept to each video frame, spatial information can be efficiently learned; for temporal information, the 3D pointwise convolution can be used to learn the linear combination among sequential frames. To validate and train the proposed model, we collected large quantities of datasets, which are video clips of the physical interactions between two objects under different conditions (illumination and angle variations) and the corresponding interaction forces measured by the haptic sensor (as the ground truth). Our experimental results confirmed our hypothesis; when compared with previous models, the proposed model was more accurate and efficient, and although its model size was 10 times smaller, the 3D convolutional neural network architecture exhibited better accuracy. The experiments demonstrate that the proposed model remains robust under different conditions and can successfully estimate the interaction force between objects.
When timely access to deceased‐donor livers is not feasible, living‐donor liver transplantation (LDLT) is an attractive option for patients with hepatorenal syndrome (HRS). This study's primary ...objective was to describe outcomes after LDLT among HRS recipients, and the secondary objective was to determine predictors of poor renal recovery after LDLT. This single‐center, retrospective study included 2185 LDLT recipients divided into HRS (n = 126, 5.8%) and non‐HRS (n = 2059, 94.2%) groups. The study outcomes were survival and post‐LT renal recovery. The HRS group had a higher death rate than the non‐HRS group (17.5% vs. 8.6%, p < 0.001). In the HRS group, post‐LT renal recovery occurred in 69.0%, and the death rate was significantly lower in association with HRS recovery compared with non‐recovery (5.7% vs. 43.6%, p < 0.001). Multivariable analysis indicated that post‐LT sepsis (p < 0.001) and non‐recovery of HRS (p < 0.001) were independent negative prognostic factors for survival. Diabetes mellitus (p = 0.01), pre‐LT peak serum creatinine ≥3.2 mg/dl (p = 0.002), time interval from HRS diagnosis to LDLT ≥38 days (p = 0.01), and post‐LT sepsis (p = 0.03) were important negative prognostic factors for renal recovery after LDLT. In conclusion, post‐LT renal recovery was important for survival, and the interval from HRS to LDLT was significantly associated with post‐LT renal recovery.
When timely access to deceased‐donor livers is not available for candidates with hepatorenal syndrome, expeditious living‐donor liver transplantation can reduce the risk of death or permanent renal failure. Selzner and Wong comment on page 2291
Background
Salvage liver transplantation is a definite treatment for recurrent hepatocellular carcinoma (HCC) after hepatectomy. ADV score is calculated by multiplying α‐fetoprotein and ...des‐γ‐carboxyprothrombin concentrations and tumor volume. Prognostic accuracy of ADV score was assessed in patients undergoing salvage living donor liver transplantation (LDLT) and their outcomes were compared with patients undergoing primary LDLT.
Methods
This study was a retrospective, single‐center, case‐controlled study. Outcomes were compared in 125 patients undergoing salvage LDLT from 2007 to 2018 and in 500 propensity score‐matched patients undergoing primary LDLT.
Results
In patients undergoing salvage LDLT, median intervals between hepatectomy and tumor recurrence, between first HCC diagnosis and salvage LDLT, and between hepatectomy and salvage LDLT were 12.0, 37.2, and 29.3 months, respectively. Disease‐free survival (DFS, P = .98) and overall survival (OS, P = .44) rates did not differ significantly in patients undergoing salvage and primary LDLT. Pretransplant and explant ADV scores were significantly predictive of DFS and OS in patients undergoing salvage and primary LDLT (P < .001). DFS after prior hepatectomy (P = .52) and interval between hepatectomy and LDLT (P = .82) did not affect DFS after salvage LDLT. Milan criteria and ADV score were independently prognostic of DFS and OS following salvage LDLT, and prognosis of patients within and beyond Milan criteria could be further stratified by ADV score.
Conclusions
Risk factors and posttransplant outcomes were similar in patients undergoing salvage and primary LDLT. ADV score is surrogate biomarker for posttransplant prognosis in salvage and primary LDLT recipients. Prognostic model incorporating ADV scores can help determine whether to perform salvage LDLT.
Highlight
Hwang and colleagues developed a prognostic model for hepatocellular carcinoma based on α‐fetoprotein and des‐γ‐carboxyprothrombin concentrations and tumor volume (ADV). The ADV score is a surrogate biomarker for post‐transplant prognosis in salvage and primary liver transplant recipients. Prognostic models incorporating ADV scores can help determine whether to perform salvage liver transplantation.
Living donor liver transplantation (LDLT) is a significant advancement for the treatment of children with end‐stage liver disease given the shortage of deceased donors. The ultimate goal of pediatric ...LDLT is to achieve complete donor safety and zero recipient mortality. We conducted a retrospective, single‐center assessment of the outcomes as well as the clinical factors that may influence graft and patient survival after primary LDLTs performed between 1994 and 2020. A Cox proportional hazards model was used for multivariate analyses. The trends for independent prognostic factors were analyzed according to the following treatment eras: 1, 1994 to 2002; 2, 2003 to 2011; and 3, 2012 to 2020. Primary LDLTs were performed on 287 children during the study period. Biliary atresia (BA; 52%), acute liver failure (ALF; 26%), and monogenic liver disease (11%) were the leading indications. There were 45 graft losses (16%) and 27 patient deaths (7%) in this population during the study period. During era 1 (n = 81), the cumulative survival rates at 1 and 5 years after LDLT were 90.1% and 81.5% for patients and 86.4% and 77.8% for grafts, respectively. During era 2 (n = 113), the corresponding rates were 92.9% and 92% for patients and 89.4% and 86.7% for grafts, respectively. During era 3 (n = 93), the corresponding rates were 100% and 98.6% for patients and 98.9% and 95.4% for grafts, respectively. In the multivariate analyses, primary diagnosis ALF, bloodstream infection, posttransplant lymphoproliferative disease, and chronic rejection were found to be negative prognostic indicators for patient survival. Based on generalized care guidelines and center‐oriented experiences, comprehensive advances in appropriate donor selection, refinement of surgical techniques, and meticulous medical management may eventually realize a zero‐mortality rate in pediatric LDLT.
Combined hepatocellular carcinoma–cholangiocarcinoma (cHCC‐CC) is a rare disease. We investigated the clinicopathological features of cHCC‐CC and compared the longterm outcomes following liver ...transplantation (LT) and hepatic resection (HR). We identified 32 LT patients with cHCC‐CC through an institutional database search. The HR control group (n = 100) was selected through propensity score‐matching. The incidence of cHCC‐CC among all adult LT patients was 1.0%. Mean patient age was 53.4 ± 6.7 years, and 26 patients were male. Thirty patients had hepatitis B virus infection. All patients of cHCC‐CC were diagnosed incidentally in the explanted livers. Mean tumor diameter was 2.5 ± 1.3 cm, and 28 patients had single tumors. Tumor stage was stage I in 23 and II in 9. Concurrent hepatocellular carcinoma (HCC) was detected in 12 patients with stage I in 5 and II in 7. Mean tumor diameter was 1.9 ± 1.2 cm, and 5 had single tumors. Tumor recurrence and survival rates were 15.6% and 84.4% at 1 year and 32.2% and 65.8% at 5 years, respectively. Patients with very early stage cHCC‐CC (1 or 2 tumors ≤ 2.0 cm) showed 13.3% tumor recurrence and 93.3% patient survival rates at 5 years, which were significantly improved than those with advanced tumors (P = 0.002). Tumor recurrence and survival rates did not differ significantly between the LT and HR control groups (P = 0.22 and P = 0.91, respectively); however, postrecurrence patient survival did (P = 0.016). In conclusion, cHCC‐CC is rarely diagnosed following LT, and one‐third of such patients have concurrent HCC. The longterm posttransplant prognosis was similar following LT and HR. Very early cHCC‐CC resulted in favorable posttransplant prognosis, thus this selection condition can be prudently considered for LT indication. Liver Transplantation 23 330–341 2017 AASLD.
Background & Aims With the introduction of rituximab prophylaxis, the survival of ABO-incompatible (ABOi) adult living donor liver transplant (ALDLT) has been strikingly improved due to the decreased ...incidence of antibody-mediated rejection. However, biliary stricture (BS) related to ABO incompatibility remains an unresolved concern. Methods Excluding 105 dual graft ALDLTs, 1102 ALDLT cases including 142 ABOi recipients were included in this study. The desensitization protocol for overcoming the ABO blood group barrier comprised pretransplant plasma exchange, and rituximab (300–375 mg/m2 BSA). Results The mean follow-up period was 34.2 ± 15.4 months. The cumulative graft and patient survival rates were comparable in the two groups. The 1- and 3-year BS-free survival rates of ABOi ALDLT were 81.5 and 79.0%, respectively, lower than those of ABOc ALDLT (87.6 and 85.7%, respectively, p = 0.022). In the risk factor analysis, diameter of graft bile duct opening <5 mm, antecedent acute cellular rejection, and ABO incompatibility were independent risk factors for BS. Diffuse intrahepatic biliary stricture (DIHBS) exclusively occurred in 12 patients (8.5%) receiving ABOi ALDLT. The deaths of 3 patients and 4 cases of re-transplantation were related to DIHBS. Graft and patient survival rates were significantly reduced in ABOi ALDLT recipients with DIHBS. However, we failed to identify any significant risk factors for DIHBS. Conclusions The incidence of BS in ABOi ALDLT is higher than in ABOc, mainly due to the fact of DIHBS which significantly affected survival outcomes. To predict and prevent DIHBS, we need further studies to identify significant risk factors.
Introduction
Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is rare. This study investigated the clinicopathological features of cHCC-CC and compared the postresection survival ...outcomes of cHCC-CC, hepatocellular carcinoma (HCC), and intrahepatic cholangiocarcinoma (IHC).
Methods
Between January 2000 and September 2012, 53 patients with cHCC-CC underwent tumor resection, accounting for 1.1 % of surgeries for primary liver malignancies. Control groups included patients with HCC (
n
= 1452) and IHC (
n
= 149) who underwent R0 resection of stage I/II tumors ≤5 cm.
Results
Mean tumor diameter of cHCC-CC group was 5.5 ± 2.9 cm, and single tumor was identified in 50. Pathological classification included combined (
n
= 41), mixed (
n
= 11), and double (
n
= 1) tumors. The 1-, 3-, 5-, and 10-year tumor recurrence rates were 60.8, 71.8, 80.7, and 80.7 %, respectively. The 1-, 3-, 5-, and 10-year overall survival rates were 73.3, 35.6, 30.5, and 11.1 %, respectively. Tumor recurrence and patient survival did not differ significantly according to AJCC tumor staging and histological type (all
p
≥ 0.2). Tumor recurrence rates did not differ significantly between the cHCC-CC, HCC, and IHC groups (
p
= 0.43), whereas differences in survival rates were significant (
p
= 0.000), with a median survival after tumor recurrence of 8, 51, and 6 months, respectively (
p
= 0.000).
Conclusions
Patients with cHCC-CC showed similar recurrence rates to those of control patients with HCC and IHC, whereas their survival outcomes were worse than those of control HCC patients because of poor responses to recurrence treatment. Further evaluation of differences in tumor characteristics and tumor biology is necessary to accurately predict the prognosis of patients with cHCC-CC.
Objective
Because noticeable changes were made to the 7th American Joint Committee on Cancer (AJCC) tumor–node–metastasis (TNM) staging for intrahepatic cholangiocarcinoma (IHCC), we validated the ...prognostic impact of tumor staging after macroscopic curative resection of IHCC.
Methods
A cohort of 659 IHCC patients who underwent R0 (
n
= 539) or R1 (
n
= 120) resection were selected with exclusion of R2 resection (
n
= 111). Study patients were followed up for ≥24 months or until death with no patient lost during survival analysis.
Results
Anatomical resection was performed in 599 (90.9 %) and concurrent bile duct resection was conducted in 97 (14.7 %). Median survival periods following R0, R1, and R2 resections were 28, 12, and 3 months, respectively (
p
= 0.000). In the R0 resection group, the 1-, 3-, 5-, and 10-year tumor recurrence rates were 36.4 %, 57.9 %, 64.7 %, and 65.0 %, respectively, and the 1-, 3-, 5-, and 10-year patient survival rates were 73.1 %, 44.2 %, 33.0 %, and 23.1 %, respectively. Independent risk factors for tumor recurrence and patient survival were tumor growth type, tumor size > 5 cm, perineural invasion, and lymph node metastasis. According to the 7th AJCC staging system, the prognostic contrast was marginal in stage T2–4 tumors without lymph node metastasis (
p
> 0.8). With our redefined staging system with tumor growth types and risk factors including tumor number and perineural/lymphovascular invasion, clear prognostic contrast was achieved among T1–3 stages (
p
= 0.000).
Conclusion
Growth type of IHCC seems to be essential for determining tumor stage. Although the stratification of the 7th AJCC IHCC staging system seems reasonably established, refinements and further validation could improve prognostic predictability.
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