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3. Surgical Strategy for Hepatocellular Carcinoma Patients with Portal/Hepatic Vein Tumor Thrombosis

Author

Shi Ming, Wang Qiaoxuan, Wei Wei, Li Qing, Li Shaohua, Yang Zhongyuan, Guo Rongping, and Sun Peng

Subjects
Male, medicine.medical_specialty, Carcinoma, Hepatocellular, medicine.medical_treatment, lcsh:Medicine, Hepatic Veins, Postoperative Complications, Surgical oncology, medicine, Carcinoma, Hepatectomy, Humans, lcsh:Science, Vein, Survival rate, Neoplasm Staging, Retrospective Studies, Thrombectomy, Venous Thrombosis, Multidisciplinary, Portal Vein, business.industry, Liver Neoplasms, lcsh:R, Middle Aged, Prognosis, medicine.disease, Thrombosis, digestive system diseases, Survival Rate, Venous thrombosis, medicine.anatomical_structure, Hepatocellular carcinoma, Female, lcsh:Q, Radiology, Neoplasm Recurrence, Local, business, Research Article, Follow-Up Studies
Abstract

Background Portal/hepatic vein tumor thrombosis (PVTT/HVTT) in hepatocellular carcinoma (HCC) is a sign of advanced stage disease and is associated with poor prognosis. This study investigated the surgical outcomes of patients with HCC and PVTT/HVTT to determine the most appropriate surgical treatment strategy for these patients. Materials and Methods The study population included 77 HCC patients from January 2004 to June 2009 who underwent hepatectomy in our department and were diagnosed with PVTT/HVTT based on pathological examination. The patients were divided into two groups: in group 1, PVTT/HVTT was located in the hepatic resection area and removed with the tumor en bloc (38 cases); in group 2, PVTT/HVTT was beyond the resection line and removed by suction or thrombectomy (39 cases). Concerning the factor of surgical margins, the patients were further divided into four subgroups: group 1A: patients in group 1 with surgical margins ≤1 cm (28 cases); group 1B: patients in group 1 with surgical margins >1 cm (9 cases); group 2A: patients in group 2 with surgical margins ≤1 cm (28 cases); and group 2B: patients in group 2 with surgical margins >1 cm (9 cases). Results Most of the characteristics of groups 1 and 2 were similar. Patients in group 2 had significantly higher median blood loss (p=0.002) and higher blood transfusion rate (p=0.002) during the operation, which were not considered prognostic factors (p=0.323 and 0.571, respectively). The median overall survival (OS) duration in group 1 was significantly longer than that in group 2 (14.3 vs. 10.4 months, p=0.047). The median OS durations in groups 1A, 1B, 2A, and 2B were 14.3, 42.7, 7.5, and 18.0 months, respectively, which were significantly different(p=0.018). Conclusions When PVTT/HVTT is located in the hepatic resection area and removed with the tumor en bloc, the median OS duration is longer. Based on this finding, widening the surgical margins when technically possible may increase OS.

Published
2015
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4. Clinical analysis of second primary gingival squamous cell carcinoma after radiotherapy.

Author

Fu, Xiaoyan, Chen, Shuwei, Chen, Weichao, Yang, Zhongyuan, Song, Ming, Li, Hao, Zhang, Huayong, Yao, Fan, Su, Xuan, Yang, An-Kui, and Liu, Tianrun

Subjects
*ORAL cancer, *RADIOTHERAPY, *CARCINOMA, *PATIENTS, *PROGNOSIS
Abstract

Introduction: Clinically, we have observed that some oral cancer patients have a history of radiotherapy for head and neck cancer; we have named this condition radiotherapy-associated cancer (RAC). Gingival cancer, which is usually juxtaposed with other oral cancer subtypes, is seldom reported individually, and there are few reports on the association between the incidence of oral cancer and history of radiation therapy. Therefore, this study aimed to elucidate the clinicopathological features and prognosis of second primary gingival squamous cell carcinoma after head and neck radiotherapy.Materials and Methods: The data collected included 450 patients diagnosed with gingival squamous cell carcinoma from 1964 to 2012 at Sun Yat-sen University Cancer, among whom 52 patients had a history of radiotherapy for head and neck cancer. We retrospectively analysed the differences in the clinicopathological characteristics and prognosis between sporadic gingival squamous cell carcinoma and radiation-associated gingival carcinoma, with an emphasis on gingival carcinoma.Results: Sporadic gingival squamous cell carcinoma is less likely to have more advanced T stage, and the second primary tumour is more likely to be located in the molar area of the maxillary gingiva than in the mandibular gingiva (75.6% vs 24.4%, P < 0.05). The 5-year overall survival of patients with second primary gingival carcinoma was influenced by age distribution, T classification, N classification, clinical TNM stage, histological grade and radiation history in head and neck. Mandibular gingival carcinoma was more likely to have an increased neck lymph node metastasis than maxillary gingival carcinoma (P = 0.001), but there was no significant difference in 5-year overall survival between these two groups (P = 0.828). The main therapy for gingiva carcinoma is surgery or comprehensive treatment based on surgery.Conclusions: Second primary gingival squamous cell carcinoma after radiotherapy demonstrated particular clinicopathologic features, such as prominent sites and TNM stage; and there was statistically significant difference in 5-year overall survival and prognosis between second primary gingival carcinoma after radiotherapy and sporadic gingival carcinoma. [ABSTRACT FROM AUTHOR]

Published
2018
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