Background
Eastern data highlight the oncological benefits of the anterior approach (AA) during right hepatectomy (RH) for hepatocellular carcinoma (HCC). However, to our knowledge, previous western ...data on this topic are scarce.
In this study, the oncological outcomes of AA and classical approach (CA) during RH for HCC were compared.
Methods
A retrospective inverse propensity score-weighted fashion (IPTW) case–control study was performed in two French hepatobiliary surgery departments. Overall survival (OS), disease-free survival (DFS), and early recurrence rate (within 2 years after surgery) were analyzed.
Results
Survival analysis was performed for 114 patients (CA group,60 patients; AA group, 54 patients). Before IPTW adjustment, the 3-year DFS rates were 29.4% (AA group) and 44% (CA group), respectively. No significant differences were found in DFS (HR = 1.1, 95%CI:0.62–1.9,
p
= 0.77) and OS (HR = 1.2, 95%CI:0.54–2.6,
p
= 0.66).
After IPTW, DFS and OS analyses showed no differences between the two groups (
p
= 0.77 and
p
= 0.46, respectively). Early recurrence rates were similar before and after IPTW. Satellite nodules were the only significant independent risk factor for recurrence.
Conclusion
AA and CA did not result in significant differences in DFS, OS, or early recurrence after right hepatectomy for HCC before and after IPTW.
Eighty percent of hepatocellular carcinoma (HCC) cases occur after cirrhosis from various etiologies. The association between diet and cancer is well accepted, but the links with cirrhosis ...progression and HCC risk have been poorly investigated. However, we hypothesized that diet could be a modifiable preventive factor for HCC. Thus, the aim of our study was to explore the relationships between dietary factors and the risk of HCC in a population of cirrhotic patients. A total of 582 cirrhotic patients were studied: 401 without HCC (controls) and 181 with HCC (cases). These patients were recruited between 2008 and 2012 for the “CiRCE” case-control study conducted in six French university hospitals. Information about the consumption of 208 food items and 23 nutrients were collected through a diet history questionnaire. Unconditional multivariate logistic regressions were performed for each residual food group and nutrients in tertiles. HCC patients were more often men, diabetic and older than controls. After adjustment, a significant positive association was found between HCC risk and carbonated beverages (ORTertile3vsTertile1 = 2.44 1.17–5.09 p-trend = 0.021), total cereals (ORT3vsT1 = 1.87 1.09–3.22 p-trend = 0.035), processed meat (ORT3vsT1 = 1.97 1.14–3.41 p-trend = 0.028) and sodium (ORT3vsT1 = 2.00 1.14–3.53 p-trend = 0.043). Conversely, the consumption of fiber (ORT3vsT1 = 0.49 0.28–0.86 p-trend = 0.012), vitamin E (ORT3vsT1 = 0.52 0.30–0.89 p-trend = 0.017), vitamin B9 (folate and folic acid) (ORT3vsT1 = 0.56 0.33–0.95 p-trend = 0.036), manganese (ORT3vsT1 = 0.56 0.32–0.97 p-trend = 0.038) and potassium (ORT3vsT1 = 0.44 0.25–0.76 p-trend = 0.004) were significantly lower in HCC patients compared with cirrhotic controls. Although these findings must be confirmed in prospective studies, using dietary patterns or biological parameters, they suggest that certain dietary components may modulate HCC risk in cirrhotic patients.
Aim
We aimed to evaluate the accuracy of the dosage of calprotectin in ascitic fluid (AF) using the Quantum Blue assay, for the prompt diagnosis of spontaneous bacterial peritonitis (SBP).
Methods
We ...prospectively collected 236 AF samples from 119 cirrhotic patients hospitalized in two French centers between May 2016 and May 2017. Bloody and chylous/cloudy AF, and secondary peritonitis were excluded. SBP was diagnosed if neutrophils in AF were >250/mm3 using standard cytology. The Quantum Blue Reader selectively measured the calprotectin antigen (MRP8/14) in 12 min within the measurable range from 0.18 to 1.80 μg/mL; values outside this range were registered as 0.17 and 1.81 μg/mL.
Results
A total of 36 AF were considered as SBP (15.2%). SBP had higher median levels of calprotectin than non‐SBP (1.81 vs. 0.25 μg/mL, P < 0.001). Calprotectin levels were positively correlated with neutrophils in AF (r = 0.57, P < 0.001) and C‐reactive protein (r = 0.43, P < 0.001), but not with the Child–Pugh and Model for End‐Stage Liver Disease scores. The optimal threshold of calprotectin to diagnose SBP was set at 1.51 μg/mL (80th percentile of calprotectin), yielding sensitivity, specificity, and positive and negative predictive values of 86.1%, 92.0%, 65.9%, and 97.3%, respectively. Only one asymptomatic patient with SBP had a low calprotectin level, but a high serum C‐reactive protein level that strongly suggested an ongoing infection. We also showed that intraclass correlation coefficients for inter‐ and intra‐observer agreement were excellent, with 0.95 and 0.89, respectively.
Conclusions
The dosage of calprotectin in AF using the Quantum Blue assay is a rapid and reliable method of ruling out SBP in hospitalized cirrhotic patients.
Summary
Background
Disturbances in fatty acid (FA) metabolism have been reported in cirrhosis, but the role of FAs in the development of hepatocellular carcinoma (HCC) is still unclear. Biomarkers ...are a promising means to explore the associations between exogenous intake or endogenous production of FAs and cancer risk.
Aim
To estimate the relationship between fatty acid content in erythrocyte membranes and HCC risk in cirrhotic patients
Methods
The “CiRCE” case‐control study recruited cirrhotic patients from six French hospitals between 2008 and 2012. Cases were cirrhotic patients with HCC (n = 349); controls were cirrhotic patients without HCC at inclusion (n = 550). FA composition of phospholipids in erythrocyte membranes was determined by high performance gas chromatography. Odds ratios for HCC risk according to FA concentrations were estimated with multivariable logistic regression.
Results
HCC patients were older and more often men (P < 0.001). In both groups, saturated FAs represented more than 39% of all FAs in erythrocyte membranes, mono‐unsaturated FAs around 14%, and polyunsaturated FAs around 46%. High levels of C15:0 + C17:0, C20:1 n‐9, C18:2 n‐6 and C20:2 n‐6 were associated with higher risk of HCC. The levels of C18:0 and C20:4 n‐6 were lower in HCC cases than in controls.
Conclusions
The FA composition of erythrocyte membranes differed according to the presence of HCC with higher levels of saturated FAs, linoleic and eicosadienoic acids, and lower levels of stearic and arachidonic acids. These alterations may reflect particular dietary patterns and/or altered FA metabolism. Further investigations are warranted.
Abstract
Background and study aims
White bile is defined as a colorless fluid occasionally found in the biliary tract of patients with bile duct obstruction. Its significance is not clearly ...established. Our objective was to analyze the prognostic value of white bile in a series of patients with biliary obstruction due to biliary or pancreatic cancer.
Patients and methods
The study was conducted on a series of consecutive patients with malignant obstructive jaundice. They all underwent endoscopic retrograde cholangiopancreatography with collection of bile and biliary stent insertion. White bile was defined as bile duct fluid with bilirubin level < 20 µmol/L. Univariate and multivariate analyses were performed to identify variables associated with overall survival (OS).
Results
Seventy-three patients were included (32 pancreatic cancers, 41 bile duct cancers). Thirty-nine (53.4 %) had white bile. The mean bile duct bilirubin level in this group was 4.2 ± 5.9 µmol/L vs 991 ± 1039 µmol/L in patients with colored bile (P < 0.0001). In the group of 54 patients not eligible for surgery, the multivariate analysis demonstrated an association between the presence of white bile and reduced OS (HR 2.3, 95 %CI 1.1–4.7; P = 0.02). Other factors independently associated with OS were metastatic extension (HR 2.8, 95 %CI 1.4–5.7) and serum total bilirubin (HR 1.003, 95 %CI 1.001–1.006). There was a significant inverse correlation between serum and bile duct bilirubin levels (r = –0.43, P = 0.0001).
Conclusion
White bile in patients with inoperable malignant biliary obstruction is an independent factor of poor survival.
Vibrational spectroscopy can provide rapid, label-free, and objective analysis for the clinical domain. Spectroscopic analysis of biofluids such as blood components (e.g. serum and plasma) and others ...in the proximity of the diseased tissue or cell (e.g. bile, urine, and sputum) offers non-invasive diagnostic/monitoring possibilities for future healthcare that are capable of rapid diagnosis of diseases via specific spectral markers or signatures. Biofluids offer an ideal diagnostic medium due to their ease and low cost of collection and daily use in clinical biology. Due to the low risk and invasiveness of their collection they are widely welcomed by patients as a diagnostic medium. This review underscores recent research within the field of biofluid spectroscopy and its use in myriad pathologies such as cancer and infectious diseases. It highlights current progresses, advents, and pitfalls within the field and discusses future spectroscopic clinical potentials for diagnostics. The requirements and issues surrounding clinical translation are also considered.
Objectives
To determine whether image texture parameters analysed on pre-operative contrast-enhanced computed tomography (CT) can predict overall survival and recurrence-free survival in patients ...with hepatocellular carcinoma (HCC) treated by surgical resection.
Methods
We retrospectively included all patients operated for HCC who had liver contrast-enhanced CT within 3 months prior to treatment in our centre between 2010 and 2015. The following texture parameters were evaluated on late-arterial and portal-venous phases: mean grey-level, standard deviation, kurtosis, skewness and entropy. Measurements were made before and after spatial filtration at different anatomical scales (SSF) ranging from 2 (fine texture) to 6 (coarse texture). Lasso penalised Cox regression analyses were performed to identify independent predictors of overall survival and recurrence-free survival.
Results
Forty-seven patients were included. Median follow-up time was 345 days (interquartile range IQR, 176–569). Nineteen patients had a recurrence at a median time of 190 days (IQR, 141–274) and 13 died at a median time of 274 days (IQR, 96–411). At arterial CT phase, kurtosis at SSF = 4 (hazard ratio 95% confidence interval = 3.23 1.35–7.71
p
= 0.0084) was independent predictor of overall survival. At portal-venous phase, skewness without filtration (HR CI 95% = 353.44 1.31–95102.23,
p
= 0.039), at SSF2 scale (HR CI 95% = 438.73 2.44–78968.25,
p
= 0.022) and SSF3 (HR CI 95% = 14.43 1.38–150.51,
p
= 0.026) were independently associated with overall survival. No textural feature was identified as predictor of recurrence-free survival.
Conclusions
In patients with resectable HCC, portal venous phase–derived CT skewness is significantly associated with overall survival and may potentially become a useful tool to select the best candidates for resection.
Key Points
• HCC heterogeneity as evaluated by texture analysis of contrast-enhanced CT images may predict overall survival in patients treated by surgical resection.
• Among texture parameters, skewness assessed at different anatomical scales at portal-venous phase CT is an independent predictor of overall survival after resection.
• In patients with HCC, CT texture analysis may have the potential to become a useful tool to select the best candidates for resection.
Management of patients with cirrhosis includes endoscopic screening and surveillance to detect esophageal varices (EV) and prevent bleeding. However, the Baveno VI guidelines recommend avoiding ...endoscopies for patients with liver stiffness measurements below 20 kPa and platelet counts above 150,000 (favorable Baveno VI status) and endoscopic assessment of patients with higher levels of liver stiffness and platelet counts (unfavorable Baveno VI status). We aimed to validate the Baveno VI guidelines, evaluating outcomes of patients in the ANRS-CO12 CirVir cohort with compensated cirrhosis associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, with or without a sustained response to antiviral therapy.
We performed an ancillary study using data from 891 patients in the ANRS CO12 CirVir cohort, treated at 35 centers in France, with HCV or HBV infection and biopsy-proven cirrhosis, Child-Pugh A scores, no previous complications, and no hepatocellular carcinoma who underwent an endoscopic procedure and had interpretable liver stiffness measurements and platelet counts. Progression of portal hypertension (PHT) was defined as the onset of varices needing treatment (VNT) or PHT-related bleeding. An sustained response to antiviral therapy was defined as undetectable level of HCV RNA by polymerase chain reaction assay (<50 IU/mL) 12 weeks after the end of treatment (SVR) or an undetectable level of HBV DNA. The primary aims were to validate the Baveno VI guidelines for screening and surveillance of EV in patients with compensated cirrhosis and to study the effects of an SVR on the progression of PHT.
A total of 200 patients achieved an SVR (22.4%) (94 patients with HCV infection, 98 patients with HBV infection, and 8 patients with both); 80 of these patients had favorable Baveno VI status and none had VNT. Progression of PHT was studied in 548 patients; during a follow-up period of 61.2 months (interquartile range, 39.5–80.6 months), 105 of these patients (19.1%) had progression of PHT. Lack of an SVR and grade 1 EV were independently associated with progression of PHT. At the time of PHT progression, all patients had unfavorable Baveno VI status. Achieving favorable Baveno VI status after an SVR was associated with the absence of PHT progression. Favorable Baveno VI status and SVR were independently associated with survival.
In an analysis of data from a large cohort of patients with HBV- or HCV-associated cirrhosis in France, we validated the Baveno VI guidelines on screening and surveillance of PHT, even for patients who achieved a sustained response to antiviral therapy.
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