IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.05.019

Background

Cause of death (COD) is a predictor of liver transplant (LT) outcomes independent of donor age, yet has not been recently reappraised.

Methods

Analyzing UNOS database (2013-2022), the study explored COD trends and impacts on one-year post-LT graft survival (GS) and hazard ratios (HR) for graft failure.

Results

Of 80,282 brain-death donors, 55,413(69.0%) underwent initial LT. Anoxia became the predominant COD in 2015, increasing from 29.0% in 2013 to 45.1% in 2021, with notable increases in drug intoxication. Survival differences between anoxia and cerebrovascular accidents (CVA) recently became insignificant (P=0.95). Further analysis showed improved GS from intracranial hemorrhage/stroke (previously worse; P<0.01) (P=0.70). HRs for post-1-year graft failure showed reduced significance of CVA (vs.Anoxia) and intracranial hemorrhage/stroke (vs.any other COD) recently. Donors with intracranial hemorrhage/stroke, showing improved survival and HR, were allocated to recipients with lower MELD-Na, contrasting the trend for drug intoxication CODs.

Discussion

CVA, traditionally linked with poorer outcomes, shows improved GS and HRs (vs.Anoxia). This could be due to rising drug intoxication cases and the allocation of donors with drug intoxication to recipients with higher MELD-Na, and those with CVA to recipients with lower scores. While COD remains crucial in donor selection, proper matching can mitigate differences among CODs.

背景：死因（COD）是预测肝移植（LT）结果的一个独立因素，但最近尚未得到重新评估：死因（COD）是肝移植（LT）结果的预测因素，与供体年龄无关，但最近尚未得到重新评估：该研究分析了 UNOS 数据库（2013-2022 年），探讨了 COD 的趋势及其对肝移植术后一年移植存活率（GS）和移植失败危险比（HR）的影响：在80,282名脑死亡供体中，55,413人（69.0%）接受了初次LT。2015年，缺氧成为最主要的COD，从2013年的29.0%增加到2021年的45.1%，药物中毒也显著增加。缺氧和脑血管意外（CVA）之间的生存率差异最近变得不显著（P=0.95）。进一步的分析表明，颅内出血/中风的存活率有所提高（以前较差；PD 讨论）：CVA向来与较差的预后有关，但它的GS和HRs（与缺氧相比）均有所改善。这可能是由于药物中毒病例增加，以及将药物中毒的供体分配给 MELD-Na 较高的受体，而将 CVA 的供体分配给分数较低的受体。虽然COD仍然是选择供体的关键，但适当的配型可以减轻COD之间的差异。

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引用次数: 0

Safety and use of late-turndown liver allografts to increase rate of transplantation 晚期肝脏同种异体移植的安全性和使用，以提高移植率。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.06.008

Background

The demand for liver transplants (LT) in the United States far surpasses the availability of allografts. New allocation schemes have resulted in occasional difficulties with allograft placement and increased intraoperative turndowns. We aimed to evaluate the outcomes related to use of late-turndown liver allografts.

Methods

A review of prospectively collected data of LTs at a single center from July 2019 to July 2023 was performed. Late-turndown placement was defined as an open offer 6 h prior to donation, intraoperative turndown by primary center, or post-cross-clamp turndown.

Results

Of 565 LTs, 25.1% (n = 142) received a late-turndown liver allograft. There were no significant differences in recipient age, gender, BMI, or race (all p > 0.05), but MELD was lower for the late-turndown LT recipient group (median 15 vs 21, p < 0.001). No difference in 30-day, 6-month, or 1-year survival was noted on logistic regression, and no difference in patient or graft survival was noted on Cox proportional hazard regression. Late-turndown utilization increased during the study from 17.2% to 25.8%, and median waitlist time decreased from 77 days in 2019 to 18 days in 2023 (p < 0.001).

Conclusion

Use of late-turndown livers has increased and can increase transplant rates without compromising post-transplant outcomes with appropriate selection.

背景：在美国，肝移植（LT）的需求远远超过了同种异体移植物的供应。新的分配方案导致同种异体移植物置放偶有困难，术中停用情况增加。我们的目的是评估晚期肝脏同种异体移植的相关结果：方法：我们回顾了一个中心从 2019 年 7 月至 2023 年 7 月前瞻性收集的 LT 数据。晚期肝移植被定义为捐献前6小时的开放供体、主治中心术中停用或交叉钳夹后停用：结果：在565例LT患者中，25.1%（n = 142）接受了晚期转位肝脏同种异体移植。受体的年龄、性别、体重指数或种族无明显差异（均 p > 0.05），但晚期转折LT受体组的MELD较低（中位数为15 vs 21，p 结论：晚期转折LT受体组的MELD较低，但中位数为15 vs 21：晚期移植肝脏的使用有所增加，如果选择得当，可以在不影响移植后预后的情况下提高移植率。

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引用次数: 0

Towards a ‘step-up approach’ for the treatment of recurrent non-stenotic cholangitis after hepaticojejunostomy: systematic review 肝空肠吻合术后复发性非狭窄性胆管炎治疗的 "阶梯式方法"：系统综述

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.05.018

Background

Recurrent non-stenotic cholangitis (NSC) is a difficult-to-treat complication after hepaticojejunostomy (HJ) leading to multiple hospital admissions. The optimal treatment strategy is unclear as a systematic review is lacking.

Methods

A systematic review was performed including studies detailing treatment strategies and outcomes for recurrent NSC in patients with a surgical HJ in PubMed, Embase, and Cochrane Library (inception – September 2023). Primary outcome was resolution of NSC as defined by the included studies.

Results

Overall, 72 patients with recurrent NSC after HJ were included from seven retrospective studies. The rate of recurrent NSC (specified in five studies) was 4% (46/1143 HJs). Diagnosis of NSC was mostly made after excluding HJ stenosis and assessing bile reflux. Initial treatment consisted of short-course antibiotics for all patients. Second step treatment consisted of prolonged antibiotic therapy (n = 10, 13.8%). Third step treatment consisted of surgery (n = 9, n = 12.5%); mostly lengthening of the biliary loop. Together, the overall reported resolution-rate of recurrent NSC was 66.6% (n = 48).

Conclusion

A ‘step-up approach’ may be effective in two-thirds of patients with recurrent NSC after HJ, starting with short-course antibiotics, and eventually adding prolonged antibiotic therapy and, ultimately, surgery aimed at preventing intestinal content and food reflux. Prospective studies are needed.

复发性非狭窄性胆管炎（NSC）是肝空肠吻合术（HJ）后一种难以治疗的并发症，导致患者多次入院。由于缺乏系统回顾，最佳治疗策略尚不明确。我们在 PubMed、Embase 和 Cochrane 图书馆（起始时间至 2023 年 9 月）中进行了一项系统性综述，其中包括有关手术 HJ 患者复发性 NSC 治疗策略和结果的详细研究。主要结果为纳入研究中定义的 NSC 的缓解。七项回顾性研究共纳入了 72 例 HJ 术后复发 NSC 患者。NSC复发率（5项研究中明确）为4%（46/1143例HJ）。NSC 的诊断大多是在排除 HJ 狭窄并评估胆汁反流后做出的。所有患者的初始治疗均包括短期抗生素治疗。第二步治疗包括长期抗生素治疗（10 人，占 13.8%）。第三步治疗包括手术治疗（9 人，占 12.5%），主要是延长胆道襻。据报道，复发性 NSC 的总体治愈率为 66.6%（48 例）。对三分之二的 HJ 后复发性 NSC 患者来说，"阶梯式疗法 "可能有效，首先使用短程抗生素，然后延长抗生素疗程，最后进行手术，以防止肠内容物和食物反流。需要进行前瞻性研究。

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引用次数: 0

Robotic versus laparoscopic liver resection for posterosuperior segments: a systematic review and meta-analysis 机器人与腹腔镜肝后段切除术：系统回顾与元分析。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.06.003

Background

Minimally invasive hepatectomy for difficult lesions located in posterosuperior segments (segments I, IVa, VII and VIII) remains challenging. The value of robotic liver resection (RLR) compared with laparoscopic liver resection (LLR) for posterosuperior segments is controversial. Therefore, we performed this meta-analysis to validate the safety and efficacy of RLR in posterosuperior segments.

Methods

The Medline, Embase, Web of Science, and Cochrane Library electronic databases were searched to identify available research published up to October 2023. Statistical analysis was performed with RevMan software version 5.3.

Results

Six studies with a total of 2289 patients (RLR: n = 749; LLR: n = 1540) were included in this meta-analysis. The RLR group had less intraoperative blood loss (WMD = −119.54 ml, 95% CI: −178.89 to −60.19, P < 0.0001), fewer blood transfusions (OR = 0.56, 95% CI: 0.39 to 0.80, P = 0.001), a lower conversion rate (OR = 0.37, 95% CI: 0.23 to 0.61, P < 0.0001), and a shorter operative time (WMD = −27.16 min, 95% CI: −35.95 to −18.36, P < 0.00001).

Discussion

Compared with LLR, RLR for lesions in the posterosuperior segments could be safe and effective, and it has superior surgical outcomes.

背景对位于后上段（I、IVa、VII 和 VIII 段）的疑难病变进行微创肝切除术仍具有挑战性。与腹腔镜肝切除术（LLR）相比，机器人肝切除术（RLR）对后上段肝脏切除的价值仍存在争议。因此，我们进行了这项荟萃分析，以验证RLR在后上段的安全性和有效性。方法检索Medline、Embase、Web of Science和Cochrane Library电子数据库，以确定截至2023年10月发表的现有研究。结果本荟萃分析纳入了六项研究，共 2289 名患者（RLR：n = 749；LLR：n = 1540）。RLR 组术中失血较少（WMD = -119.54 ml，95% CI：-178.89 至 -60.19，P <；0.0001），输血较少（OR = 0.56，95% CI：0.39 至 0.80，P = 0.001），转换率较低（OR = 0.37，95% CI：0.23 至 0.61，P <；0.0001），手术时间更短（WMD = -27.16 min，95% CI：-35.95 to -18.36，P < 0.00001）。讨论与LLR相比，RLR治疗后上段病变安全有效，手术效果更优。

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引用次数: 0

Meta-analysis of survival after pulmonary resection for isolated metachronous pancreatic cancer metastasis: a promising, albeit infrequent, approach 孤立的胰腺癌转移灶肺切除术后存活率的荟萃分析：一种前景广阔但并不常见的方法

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.05.015

Background

To evaluate survival outcomes of pulmonary resection for isolated metachronous pancreatic cancer metastasis.

Methods

A systematic search of electronic data sources and reference lists were conducted. Proportion meta-analysis model was constructed to quantify 1- to 5-year survival after pulmonary resection for isolated metachronous pancreatic cancer metastasis. Random-effects modelling was applied to calculate pooled outcome data.

Results

Twenty-four retrospective studies were included reporting a total of 168 patients who underwent pulmonary resection for isolated pancreatic cancer metastasis. The nature of the index pancreatic surgery included 65% pancreaticoduodenectomies, 17.5% distal pancreatectomies, 0.5% total pancreatectomy, and 17% unspecified. Adjuvant chemotherapy was given to 88% of the patients. The median disease-free interval was 35 (8–96) months. The type of pulmonary resection included 54% wedge resections, 26% lobectomies, 4% segmentectomies, 1% pneumonectomies, and 15% unspecified. Pulmonary resection was associated with 1-year survival of 91.1% (95% CI 86.6%–95.5%), 2-year survival of 77.5% (95% CI 68.9%–86.0%), 3-year survival of 65.0% (95% CI 50.7%–79.3%), 4-year survival of 52.0% (95% CI 37.2%–66.9%), and 5-year survival of 37.0% (95% CI 25.0%–49.1%).

Conclusion

Pulmonary resection for isolated pancreatic cancer metastasis is associated with acceptable overall patient survival. We recommend selective pulmonary resection for isolated pulmonary metastasis from pancreatic cancer. Our findings may encourage conduction of better-quality studies in this context to help establishment of definitive treatment strategies.

评估肺切除术治疗孤立的胰腺癌转移的生存效果。对电子数据源和参考文献列表进行了系统性检索。构建比例荟萃分析模型，以量化孤立的间变性胰腺癌转移肺切除术后的 1-5 年生存率。随机效应模型用于计算汇总结果数据。共纳入24项回顾性研究，报告了168名因孤立性胰腺癌转移而接受肺切除术的患者。指标胰腺手术的性质包括65%的胰十二指肠切除术、17.5%的远端胰腺切除术、0.5%的全胰腺切除术和17%的未指定手术。88%的患者接受了辅助化疗。无病间隔中位数为35（8-96）个月。肺切除术的类型包括54%的楔形切除术、26%的肺叶切除术、4%的肺段切除术、1%的肺切除术和15%的不明原因切除术。肺切除术后的 1 年生存率为 91.1%（95% CI 86.6%-95.5%），2 年生存率为 77.5%（95% CI 68.9%-86.0%），3 年生存率为 65.0%（95% CI 50.7%-79.3%），4 年生存率为 52.0%（95% CI 37.2%-66.9%），5 年生存率为 37.0%（95% CI 25.0%-49.1%）。针对孤立性胰腺癌转移的肺切除术与可接受的患者总生存率相关。我们建议对孤立性胰腺癌肺转移进行选择性肺切除。我们的研究结果可能会鼓励在这方面开展更高质量的研究，以帮助制定明确的治疗策略。

{"title":"Meta-analysis of survival after pulmonary resection for isolated metachronous pancreatic cancer metastasis: a promising, albeit infrequent, approach","authors":"","doi":"10.1016/j.hpb.2024.05.015","DOIUrl":"10.1016/j.hpb.2024.05.015","url":null,"abstract":"<div><h3>Background</h3><p><span>To evaluate survival outcomes of pulmonary resection for isolated metachronous pancreatic </span>cancer metastasis.</p></div><div><h3>Methods</h3><p>A systematic search of electronic data sources and reference lists were conducted. Proportion meta-analysis model was constructed to quantify 1- to 5-year survival after pulmonary resection for isolated metachronous pancreatic cancer metastasis. Random-effects modelling was applied to calculate pooled outcome data.</p></div><div><h3>Results</h3><p><span><span><span>Twenty-four retrospective studies were included reporting a total of 168 patients who underwent pulmonary resection for isolated pancreatic cancer metastasis. The nature of the index pancreatic surgery included 65% </span>pancreaticoduodenectomies<span><span>, 17.5% distal pancreatectomies, 0.5% </span>total pancreatectomy<span>, and 17% unspecified. Adjuvant chemotherapy was given to 88% of the patients. The median disease-free interval was 35 (8–96) months. The type of pulmonary resection included 54% </span></span></span>wedge resections, 26% </span>lobectomies<span>, 4% segmentectomies, 1% pneumonectomies, and 15% unspecified. Pulmonary resection was associated with 1-year survival of 91.1% (95% CI 86.6%–95.5%), 2-year survival of 77.5% (95% CI 68.9%–86.0%), 3-year survival of 65.0% (95% CI 50.7%–79.3%), 4-year survival of 52.0% (95% CI 37.2%–66.9%), and 5-year survival of 37.0% (95% CI 25.0%–49.1%).</span></p></div><div><h3>Conclusion</h3><p>Pulmonary resection for isolated pancreatic cancer metastasis is associated with acceptable overall patient survival. We recommend selective pulmonary resection for isolated pulmonary metastasis from pancreatic cancer. Our findings may encourage conduction of better-quality studies in this context to help establishment of definitive treatment strategies.</p></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 9","pages":"Pages 1103-1113"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141254439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessment by a multidisciplinary team conference affects treatment strategy and overall survival in patients with synchronous colorectal liver metastases 多学科小组会议的评估影响同步结直肠肝转移患者的治疗策略和总生存率

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.05.008

Background

The aim of this retrospective observational study was to investigate the geographical or sex differences in patients with synchronous colorectal liver metastases (sCRLM) in terms of assessment by a multidisciplinary team conference (MDT), curative treatment, and overall survival.

Method

All sCRLM patients in the South-East Health Care Region of Sweden from 2009 to 2015 were included (n = 615). Data were derived from the Swedish Colorectal Cancer Registry, Swedish Registry of Liver and Bile Surgery and medical records.

Results

Patients who had a hepatobiliary unit (HBU) at the nearest hospital were more likely to undergo liver surgery (HBU+, 37% (n = 106), compared to HBU−, 22% (n = 60); p = 0.001) and had a better median survival (p < 0.001). No sex differences were observed. In multivariate Cox regression analyses of overall survival, assessment by an MDT that included a liver surgeon was independently linked to better survival (HR 0.574, 0.433–0.760).

Conclusion

There were no sex differences in access to liver surgery or overall survival, however, there were geographical inequalities, where residency near a hospital with HBU was associated with increased overall survival and the possibility to receive liver surgery. Assessment at MDT with liver surgeon present was associated with greater survival, indicating its important role for treatment.

背景这项回顾性观察研究旨在调查同步性结直肠肝转移（sCRLM）患者在多学科小组会议（MDT）评估、根治性治疗和总生存率方面的地域或性别差异。方法纳入2009年至2015年期间瑞典东南医疗保健区的所有sCRLM患者（n = 615）。数据来源于瑞典结直肠癌登记处、瑞典肝胆外科登记处和医疗记录。结果最近的医院设有肝胆科（HBU）的患者更有可能接受肝脏手术（HBU+，37%（n = 106），HBU-，22%（n = 60）；p = 0.001），中位生存率更高（p <0.001）。没有观察到性别差异。在总生存率的多变量 Cox 回归分析中，由包括肝脏外科医生在内的 MDT 进行评估与较好的生存率有独立联系（HR 0.574，0.433-0.760）。有肝脏外科医生在场的MDT评估与更高的生存率相关，这表明MDT在治疗中发挥着重要作用。

{"title":"Assessment by a multidisciplinary team conference affects treatment strategy and overall survival in patients with synchronous colorectal liver metastases","authors":"","doi":"10.1016/j.hpb.2024.05.008","DOIUrl":"10.1016/j.hpb.2024.05.008","url":null,"abstract":"<div><h3>Background</h3><p>The aim of this retrospective observational study was to investigate the geographical or sex differences in patients with synchronous colorectal liver metastases (sCRLM) in terms of assessment by a multidisciplinary team conference (MDT), curative treatment, and overall survival.</p></div><div><h3>Method</h3><p>All sCRLM patients in the South-East Health Care Region of Sweden from 2009 to 2015 were included (n = 615). Data were derived from the Swedish Colorectal Cancer Registry, Swedish Registry of Liver and Bile Surgery and medical records.</p></div><div><h3>Results</h3><p>Patients who had a hepatobiliary unit (HBU) at the nearest hospital were more likely to undergo liver surgery (HBU+, 37% (n = 106), compared to HBU−, 22% (n = 60); <em>p</em> = 0.001) and had a better median survival (<em>p</em> < 0.001). No sex differences were observed. In multivariate Cox regression analyses of overall survival, assessment by an MDT that included a liver surgeon was independently linked to better survival (HR 0.574, 0.433–0.760).</p></div><div><h3>Conclusion</h3><p>There were no sex differences in access to liver surgery or overall survival, however, there were geographical inequalities, where residency near a hospital with HBU was associated with increased overall survival and the possibility to receive liver surgery. Assessment at MDT with liver surgeon present was associated with greater survival, indicating its important role for treatment.</p></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 9","pages":"Pages 1131-1140"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1365182X24017349/pdfft?md5=48ed769a80facf8b934320460ed6e234&pid=1-s2.0-S1365182X24017349-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141134938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of age-stratified survival outcomes of gallbladder cancers in an Indian population 印度人群胆囊癌的年龄分层生存结果比较。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.05.011

Background

Gallbladder cancers (GBCs) occur a decade earlier in India in comparison to the global occurrence, limiting the applicability of existing literature on age adjusted outcomes.

Methods

Patients who underwent surgery between 01.01.2010 and 31.12.2020 for GBC were analyzed. Patients were divided into three age groups: group 1(≤40 years), group 2(41–60 years), group 3(>60 years) and their outcomes were compared.

Results

Total of 6190 patients were treated for suspected or diagnosed GBC with a median age of 57 years. Curative resection was performed in 749 (67.9%) patients, of whom 114 (16.2%), 471 (62.9%), and 164 (21.9%) patients were in groups 1, 2, and 3, respectively. 5-year disease-free survival (DFS) [46.8% vs. 58.5%, p = 0.031] and overall survival (OS)[53.5% vs. 66.6%, p = 0.05] of group 3 were significantly lower than group 1. Patient age (HR 1.021), AJCC stage (HR 6.413), pathologic residual disease in the gallbladder fossa (HR 2.44), and extranodal tumor deposits (HR 1.762) were identified as independent predictors of poor OS.

Conclusions

Gallbladder cancers in the Indian population show poorer outcomes with advancing age. Higher proportion of males in the elderly group with a more advanced stage at presentation are plausible reasons for poorer outcomes.

背景印度的胆囊癌（GBC）发病时间比全球早十年，这限制了现有文献对年龄调整后结果的适用性。结果共有6190名疑似或确诊为GBC的患者接受了治疗，中位年龄为57岁。749例（67.9%）患者接受了根治性切除术，其中1、2、3组患者分别为114例（16.2%）、471例（62.9%）和164例（21.9%）。第 3 组患者的 5 年无病生存期（DFS）[46.8% vs. 58.5%，P = 0.031]和总生存期（OS）[53.5% vs. 66.6%，P = 0.05]明显低于第 1 组。413）、胆囊窝病理残留（HR 2.44）和结节外肿瘤沉积（HR 1.762）被认为是不良OS的独立预测因素。结论印度人口中的膀胱癌患者随着年龄的增长预后较差，老年组中男性比例较高，发病时处于晚期，这些都是预后较差的可能原因。

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引用次数: 0

The incidence of gallbladder carcinoma is increasing in the younger U.S. population: a SEER-based study 胆囊癌发病率在美国年轻人群中呈上升趋势：一项基于 SEER 的研究

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.05.020

引用次数: 0

Corrigendum to “Donor-recipient race-ethnicity concordance and patient survival after liver transplantation” [HPB 26 (2024) 772–781] 肝移植后捐献者与接受者种族-民族一致性与患者存活率"[HPB 26 (2024) 772-781]的更正。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.06.007

引用次数: 0

Tumor burden score as a prognostic factor in patients with intermediate and locally advanced hepatocellular carcinoma undergoing liver resection: an attempt to extend resectability criteria 肿瘤负荷评分作为接受肝切除术的中晚期和局部晚期肝细胞癌患者的预后因素：扩展可切除性标准的尝试。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.05.021

Background

Surgery is currently recommended as a curative treatment option for hepatocellular carcinomas (HCC) belonging to Barcelona Clinic Liver Cancer (BCLC) stage A only. This study aims to classify various BCLC groups as per Tumor Burden Score (TBS) in an attempt to identify patients who could benefit from resection.

Materials and methods

A retrospective analysis of a prospectively maintained database of all patients operated for HCC between January 2010 and July 2022 was performed. TBS was defined as, TBS² = (maximum tumor diameter)² + (number of tumors)².

Results

Two hundred and ninety-one patients who underwent resection were staged as per the latest BCLC (A = 219, B = 45, C = 27) staging. Patients were segregated into low (<7.3) and high (>7.3) TBS. With a median follow-up of 36.2 months, the median OS for stages, A and B in the low TBS group was 107.4 and 42.7 months respectively. Median OS was not reached for patients in the BCLC C stage. In patients with high TBS, the median OS for BCLC A, B and C was 42.3, 25.72, and 16.9 months respectively.

Conclusion

TBS is a significant factor influencing survival in patients of HCC. TBS can be used to stratify patients in BCLC B and C stages and help select patients who would benefit from surgical resection to achieve good long-term survival with acceptable morbidity.

背景：目前，对于仅属于巴塞罗那临床肝癌（BCLC）A期的肝细胞癌（HCC），建议将手术作为治愈性治疗方案。本研究旨在根据肿瘤负担评分（TBS）对不同的 BCLC 组别进行分类，以确定哪些患者可以从切除术中获益：该研究对 2010 年 1 月至 2022 年 7 月期间所有接受 HCC 手术的患者的前瞻性数据库进行了回顾性分析。TBS定义为：TBS2 =（肿瘤最大直径）2 +（肿瘤数量）2：根据最新的 BCLC 分期（A = 219、B = 45、C = 27），对接受切除手术的 291 名患者进行了分期。患者被分为低（7.3）TBS。中位随访时间为 36.2 个月，低 TBS 组 A 期和 B 期患者的中位 OS 分别为 107.4 个月和 42.7 个月。BCLC C期患者的中位生存期没有达到。在高TBS患者中，BCLC A、B和C期的中位OS分别为42.3个月、25.72个月和16.9个月：结论：TBS是影响HCC患者生存的重要因素。结论：TBS 是影响 HCC 患者生存期的重要因素。TBS 可用于对 BCLC B 期和 C 期患者进行分层，帮助选择可从手术切除中获益的患者，从而在发病率可接受的情况下获得良好的长期生存。

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引用次数: 0