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Background: Inattention has been given to the pathogenesis of adolescent and young adult (AYA) hepatocellular carcinoma (HCC). Due to the more advanced tumor progression and poorer prognosis of AYA-HCC, together with a better tolerance ability, noncirrhotic background, and a stronger willingness to treat AYA-HCC, clinical and molecular biology studies are urgent and necessary, especially for those with hepatitis B infection., Methods: For clinical aspects, the overall survival, the recurrence-free survival, and the Cox analyses were performed. Then, functional analysis, gene clustering, metabolic-related analysis, immune infiltration and competing endogenous RNA (ceRNA) construction were carried out using whole transcriptome sequencing technique., Results: Based on the clinical information of our HCC cohort, the overall survival and recurrence-free survival rates were worse in the AYA group than in the elderly group as previously described. According to our whole transcriptome sequencing results, functional analysis revealed that metabolism-related pathways as well as protein translation and endoplasmic reticulum processing were enriched. Then the hub metabolism-related genes were screened by metabolite-protein interactions (MPIs) and protein-protein interactions (PPIs). Fatty acid metabolism is a crucial component of metabolic pathways, abnormalities of which may be the reason for the worse prognosis of HBV-AYA HCC. Finally, the relationship of disrupted expression of metabolism-related genes with immune infiltration was also analyzed, and the lncRNA‒miRNA‒mRNA-related ceRNA network for HBV-AYA HCC was constructed, which may provide new cues for HBV-AHA HCC prevention., Conclusion: The worse prognosis and recurrence rate of HBV-AYA HCC may be related to abnormalities in metabolism-related pathways, especially disorders of fatty acid metabolism., (© 2023. The Author(s).)

Aim: The role of tumor differentiation in the prognosis of hepatocellular carcinoma (HCC) after hepatectomy remains controversial. The present study aimed to classify the impact of tumor differentiation on solitary hepatitis B viral (HBV)-associated HCC using propensity score matching analysis., Methods: Between January 2009 and March 2015, the data of 721 HCC patients in West China Hospital were prospectively collected and analyzed. Propensity matching analysis was applied to overcome the imbalance in baseline characteristics. Survival analysis was performed using the Kaplan-Meier method. Risk factors were identified by the Cox proportional hazards model., Results: All HCC patients were classified into the moderately well-differentiated HCCs group (group A, n = 442, 61.3%) or poorly differentiated HCCs group (group B, n = 279, 38.7%). Patients with poorly differentiated HCCs commonly had a larger tumor size, more advanced tumors, and a higher alpha-fetoprotein (AFP) level. Patients with poorly differentiated HCCs had a poorer recurrence-free survival and overall survival before and after propensity score matching analysis. Poorly differentiated tumors, positive serum hepatitis B viral e antigen, positive hepatitis B virus deoxyribonucleic acid load, tumor size, microvascular invasion, and AFP > 400 ng/ml were risk factors of a poor outcome., Conclusions: Our propensity model provided strong evidence that a poorly differentiated tumor had a negative impact on the recurrence and long-term survival of solitary HBV-associated HCCs after curative hepatectomy. Antiviral therapy might improve their prognosis.

Objective and Background: The aim of the present study was to develop and validate a prediction score for postoperative complications by severity and guide perioperative management and patient selection in hepatitis B-related hepatocellular carcinoma patients undergoing liver resection., Methods: A total of 1543 consecutive liver resections cases were included in the study. Randomly selected sample set of 70% of the study cohort was used to develop a score to predict complications III-V and the remaining 30% was used to validate the score. Based on the preoperative and predictable intraoperative parameters, logistic regression analysis was used to identify risk factors and create an integer score for the predicting of complication., Results: American Society of Anesthesiologists category, portal hypertension, major liver resection (more than 3 segments) and extrahepatic procedures were identified as independent predictors for complications III-V by logistic regression analysis. A score system integrating these 4 factors was stratified into three groups and significantly predicted the risk of complications III-V, with a rate of 1.6%, 11.9% and 65.6% for low, moderate and high risk, respectively. Using the score, the complications risk could be predicted accurately in the validation set, without significant differences between predicted (10.4%) and observed (8.4%) risks for complications III-V (P = 0.466)., Conclusions: Based on four preoperative risk factors, we have developed and validated an integer-based risk score to predict postoperative severe complications after liver resection for hepatitis B-related hepatocellular carcinoma patients in high-volume surgical center. This score may contribute to preoperative risk stratification and clinical decision-making.

Objective and Background: Although many studies on evaluating the safety of liver resection in obese patients have been conducted, the results remain contradictory. The aim of our study was to investigate the safety of overweight and obese patients undergoing liver resection for hepatitis B-related hepatocellular carcinoma in a large sample., Methods: In a retrospective cohort with 1543 hepatitis B-related hepatocellular carcinoma patients, the subjects were stratified into four groups according to their body mass index(BMI): obesity(BMI≥28), overweight(BMI:24.0-27.9), normal weight(BMI:18.5-23.9) and underweight(BMI<18.5). The Dindo-Clavien classification system was used for grading complications. Clinical characteristics and operative outcomes were compared among the four groups. Risk factors for postoperative complications were evaluated by multivariate analysis., Results: According to the category criteria of the Working Group on Obesity in China (WGOC) criteria, 73(4.7%) obese, 412(26.7%) overweight, 982(63.6%) normal weight and 76(4.9%) underweight patients were included in our cohort. Overweight and obese patients had more preoperative comorbidities such as hypertension(P<0.001). Mortality, total complications and complications classified by Clavien system were similar among the four groups except that the underweight patients had fewer total complications. However, postoperative wound complication was more common in overweight and obese patients(6.3% vs 2.5%,P<0.001,11.0% vs 2.5%,P = 0.001). Multivariate analysis revealed that BMI was not an independently significant factor for postoperative complications., Conclusions: Liver resection for obese and overweight patients is safe and BMI itself is not a risk factor for mortality and morbidity.

Background: Postoperative oral antiviral treatment with nucleoside or nucleotide analogues can suppress viral replication and reduce tumour recurrence for patients with hepatitis b virus-related hepatocellular carcinoma (HBV-related HCC) after curative resection. However, the superior antiviral treatment is still unclear. We conducted this study to investigate the different effects of nucleotide and nucleoside analogues on the prognosis of HBV-related HCC after curative resection.Methods: From February 2007 to February 2016, 487 consecutive patients with newly diagnosed HCC according to the Milan criteria who underwent R0 resection were enrolled according to the inclusion and exclusion criteria. According to their postoperative antiviral treatment, they were divided into the nucleotide group (NtA, n = 111) and the nucleoside group (NsA, n = 376).Results: The baseline characteristics, serologic parameters, tumour characteristics, and operative data of the 2 groups were comparable. Nucleotide analogue use significantly decreased HCC recurrence (P = 0.028) and HCC-related death (P = 0.004), with hazard ratios (HRs) of 0.685 (95% CI, 0.484 to 0.971, P = 0.033) and 0.507 (95% CI, 0.310 to 0.830, P = 0.004), respectively, in multivariate Cox analyses. After the study patients were stratified according to three variables, we found that nucleotide analogue use was significantly associated with increased disease-free and overall survival among patients with cirrhosis, HBeAg-negative patients, and patients with positive HBV-DNA.Conclusions: In patients with HBV-related HCC, nucleotide analogues but not nucleoside analogues significantly reduced HCC recurrence and improved overall survival after R0 hepatic resection. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the safety and efficacy of adult-to-adult right-lobe living donor liver transplantation (ARL-LDLT) in HBV-related benign liver disease recipients with high model for end-stage liver disease (MELD) scores. Methods: The subjects of this study were 70 adult patients who underwent ARL-LDLT and 191 who underwent DDLT, for HBV-related end-stage liver diseases, between May 2002 and December 2009. Short-term outcomes were assessed by 30-day mortality and graft loss, parameters indicating graft dysfunction, length of hospital stay, and postoperative complications within 3 months. Long-term transplant outcomes were measured by graft- and patient survival and HBV recurrence rates at 1, 3, and 5 years. Results: There were no differences in donor outcomes or recipient short-term outcomes between the groups, although recipients with a high MELD score (Group H) had a higher incidence of pneumonia. High MELD score versus low MELD score recipients had similar 1-, 3-, and 5-year patient survival rates and post-transplant HBV recurrence rates. In the matched DDLT cases, a similar tendency was observed between group H and group L. Conclusions: ARL-LDLT can be performed safely and effectively in high-MELD score patients with HBV-related benign liver disease; thus, a high MELD score may not contraindicate ARL-LDLT. [ABSTRACT FROM AUTHOR]

Abstract: Background: The role of splenectomy on prophylaxis against hepatitis B virus (HBV) recurrence after liver transplantation (LT) for HBV-related end-stage liver diseases with severe hypersplenism and splenomegaly remains unclear today. Methods: A total of 510 consecutive patients with HBV-related end-stage liver diseases who underwent LT in Liver Transplantation Center, West China Hospital, Sichuan University (Chengdu, China) between June 1999 and October 2009 were studied retrospectively in this study. Patients were divided into three groups in this study: splenectomized group (group A, n =137), including preoperatively splenectomized subgroup (group A1, n =48) and intraoperatively splenectomized subgroup (group A2, n =89); nonsplenectomized group with severe hypersplenism (group B, n =95); and nonsplenectomized group without severe hypersplenism (group C, n =278). The incidence of posttransplant rejection, posttransplant infection, posttransplant hepatic cell carcinoma recurrence rate, and HBV recurrence rate were recorded. The end of the follow-up period was October 2010. Results: In this study, six patients with HBV recurrence were found in group A, 15 cases in group B, and 13 cases in group C during the follow-up period. (1) The incidence of posttransplant rejection in patients of group A was significantly lower than that in group B (P =0.0023) and also the HBV recurrence rates in group A markedly decreased (P =0.004). (2) The incidence of posttransplant rejection in group A was significantly lower than that in group C (P =0.0433); however, the incidence of posttransplant infection in group A largely increased compared with that in group C (P =0.0233). The HBV recurrence rates between group A and group C had no significant difference (P =0.804). (3) The HBV recurrence rates in group B were significantly higher than that in group C (P =0.001). Conclusions: The results of this study showed that splenectomy could significantly reduce the incidence of posttransplant rejection and HBV recurrence rate for the patients undergoing LT for HBV-related end-stage liver diseases with severe hypersplenism and splenomegaly. [Copyright &y& Elsevier]