Objective:To explore the association between cholecystectomy and the prognostic outcomes of patients with hepatocellular carcinoma(H CC)who underwent microwave ablation(MWA).Methods:Patients with HCC(«=921)who un...Objective:To explore the association between cholecystectomy and the prognostic outcomes of patients with hepatocellular carcinoma(H CC)who underwent microwave ablation(MWA).Methods:Patients with HCC(«=921)who underwent MWA were included and divided into cholecystectomy(n=114)and non-cholecystectomy groups(n=807).After propensity score matching(PSM)at a 1:2 ratio,overall survival(OS)and disease-free survival(DFS)rates were analyzed to compare prognostic outcomes between the cholecystectomy(«=114)and non-cholecystectomy groups(n=228).Univariate and multivariate Cox analyses were performed to assess potential risk factors for OS and DFS.Major complications were also compared between the groups.Results:After matching,no significant differences between groups were observed in baseline characteristics.The 1-,3-,and 5-year OS rates were 96.5%,82.1%,and 67.1%in the cholecystectomy group,and 97.4%,85.2%,and 74.4%in the non-cholecystectomy group(P=0.396);the 1-,3-,and 5-year DFS rates were 58.4%,34.5%,and 26.6%in the cholecystectomy group,and 73.6%,44.7%,and 32.2%in the non-cholecystectomy group(P=0.026),respectively.The intrahepatic distant recurrence rate in the cholecystectomy group was significantly higher than that in the non-cholecystectomy group(P=0.026),and the local tumor recurrence and extrahepatic recurrence rates did not significantly differ between the groups(P=0.609 and P=0.879).Multivariate analysis revealed that cholecystectomy(HR=1.364,95%Cl 1.023-1.819,P=0.035),number of tumors(2 vs.1:HR=2.744,95%Cl 1.925-3.912,P<0.001;3 vs.1:HR=3.411,95%Cl 2.021-5.759,P<0.001),and y-GT levels(HR=1.003,95%Cl 1.000-1.006,P<0.024)were independent risk factors for DFS.The best y-GT level cut-off value for predicting median DFS was 39.6 U/L(area under the curve=0.600,P<0.05).A positive correlation was observed between cholecystectomy and y-GT level(r=0.108,95%Cl-0.001-0.214,P=0.047).Subgroup analysis showed that the DFS rates were significantly higher in the non-cholecystectomy group than the cholecystectomy group when Y-GT>39.6 U/L(i3=0.044).The 5-,10-,15-,20-,and 25-year recurrence rates from the time of cholecystectomy were 2.63%,21.93%,42.11%,58.77%,and 65.79%,respectively.A significant positive correlation was observed between cholecystectomy and the time from cholecystectomy to recurrence(r=0.205,95%Cl 0.016-0.379,P=0.029).There were no significant differences in complications between groups(P=0.685).Conclusions:Patients with HCC who underwent cholecystectomy were more likely to develop intrahepatic distant recurrence after MWA,an outcome probably associated with increased y-GT levels.Moreover,the recurrence rates increased with time.展开更多
Objective:Thermal ablation poses challenges in the surgical resection(SR)of small hepatocellular carcinoma(HCC),and its therapeutic outcomes for larger lesions remain debated.Methods:This retrospective study evaluated...Objective:Thermal ablation poses challenges in the surgical resection(SR)of small hepatocellular carcinoma(HCC),and its therapeutic outcomes for larger lesions remain debated.Methods:This retrospective study evaluated 729 patients with HCC meeting the Milan criteria,who were treated with curative SR or microwave ablation(MWA)between 2008 and 2014.Overall survival(OS),cancer-specific survival(CSS),disease-free survival(DFS),and local tumor progression(LTP)were compared after propensity score matching(PSM).Co-variates associated with OS,CSS,LTP,and DFS were identified.The risk of death and tumor progression were compared.Results:During the median follow-up of 78.6 months,253 patients were included in each group after PSM.For tumors≤3.0 cm and 3.1–4.0 cm,MWA achieved comparable results in terms of OS,CSS,DFS,and LTP.For tumors 4.1–5.0 cm,MWA had lower OS,CSS,and DFS rates(all P<0.05)than SR.Higher LTP rates were observed in the MWA group for tumors 4.1–5.0 cm,although the difference was not significant(P=0.18).Complication rates(P=0.41)were similar,but MWA led to less estimated blood loss(P<0.01)and shorter postoperative hospitalization times(P<0.01).Conclusions:MWA achieved comparable long-term oncologic outcomes with SR for≤4 cm HCC,with lower complication rates and faster recovery.展开更多
Despite being a common therapy for hepatocellular carcinoma(HCC),insufficient thermal ablation can leave behind tumor residues that can cause recurrence.This is believed to augment M2 inflammatory macrophages that usu...Despite being a common therapy for hepatocellular carcinoma(HCC),insufficient thermal ablation can leave behind tumor residues that can cause recurrence.This is believed to augment M2 inflammatory macrophages that usually play a pro-tumorigenic role.To address this problem,we designed D-mannose-chelated iron oxide nanoparticles(man-IONPs) to polarize M2-like macrophages into the antitumor Ml phenotype.In vitro and in vivo experiments demonstrated that man-IONPs specifically targeted M2-like macrophages and accumulated in peri-ablation zones after macrophage infiltration was augmented under insufficient microwave ablation(MWA).The nanoparticles simultaneously induced polarization of pro-tumorigenic M2 macrophages into antitumor M1 phenotypes,enabling the transformation of the immunosuppressive microenvironment into an immunoactivating one.Post-MWA macrophage polarization exerted robust inhibitory effects on HCC progression in a well-established orthotopic liver cancer mouse model.Thus,combining thermal ablation with man-IONPs can salvage residual tumors after insufficient MWA.These results have strong potential for clinical translation.展开更多
基金the National Key R&D Program of China(Grant No.2017 YFC0112000)the National Natural Science Foundation of China(Grant Nos.81627803 and 91859201).
文摘Objective:To explore the association between cholecystectomy and the prognostic outcomes of patients with hepatocellular carcinoma(H CC)who underwent microwave ablation(MWA).Methods:Patients with HCC(«=921)who underwent MWA were included and divided into cholecystectomy(n=114)and non-cholecystectomy groups(n=807).After propensity score matching(PSM)at a 1:2 ratio,overall survival(OS)and disease-free survival(DFS)rates were analyzed to compare prognostic outcomes between the cholecystectomy(«=114)and non-cholecystectomy groups(n=228).Univariate and multivariate Cox analyses were performed to assess potential risk factors for OS and DFS.Major complications were also compared between the groups.Results:After matching,no significant differences between groups were observed in baseline characteristics.The 1-,3-,and 5-year OS rates were 96.5%,82.1%,and 67.1%in the cholecystectomy group,and 97.4%,85.2%,and 74.4%in the non-cholecystectomy group(P=0.396);the 1-,3-,and 5-year DFS rates were 58.4%,34.5%,and 26.6%in the cholecystectomy group,and 73.6%,44.7%,and 32.2%in the non-cholecystectomy group(P=0.026),respectively.The intrahepatic distant recurrence rate in the cholecystectomy group was significantly higher than that in the non-cholecystectomy group(P=0.026),and the local tumor recurrence and extrahepatic recurrence rates did not significantly differ between the groups(P=0.609 and P=0.879).Multivariate analysis revealed that cholecystectomy(HR=1.364,95%Cl 1.023-1.819,P=0.035),number of tumors(2 vs.1:HR=2.744,95%Cl 1.925-3.912,P<0.001;3 vs.1:HR=3.411,95%Cl 2.021-5.759,P<0.001),and y-GT levels(HR=1.003,95%Cl 1.000-1.006,P<0.024)were independent risk factors for DFS.The best y-GT level cut-off value for predicting median DFS was 39.6 U/L(area under the curve=0.600,P<0.05).A positive correlation was observed between cholecystectomy and y-GT level(r=0.108,95%Cl-0.001-0.214,P=0.047).Subgroup analysis showed that the DFS rates were significantly higher in the non-cholecystectomy group than the cholecystectomy group when Y-GT>39.6 U/L(i3=0.044).The 5-,10-,15-,20-,and 25-year recurrence rates from the time of cholecystectomy were 2.63%,21.93%,42.11%,58.77%,and 65.79%,respectively.A significant positive correlation was observed between cholecystectomy and the time from cholecystectomy to recurrence(r=0.205,95%Cl 0.016-0.379,P=0.029).There were no significant differences in complications between groups(P=0.685).Conclusions:Patients with HCC who underwent cholecystectomy were more likely to develop intrahepatic distant recurrence after MWA,an outcome probably associated with increased y-GT levels.Moreover,the recurrence rates increased with time.
基金supported by The National Key R&D Program of Ministry of Science and Technology of China(Grant No.2018ZX10723-204)The National Scientific Foundation Committee of China(Grant Nos.81801722,81971625,82030047,81627803,and 91859201)and The National Scientific Foundation Committee of Beijing(Grant No.JQ18021).
文摘Objective:Thermal ablation poses challenges in the surgical resection(SR)of small hepatocellular carcinoma(HCC),and its therapeutic outcomes for larger lesions remain debated.Methods:This retrospective study evaluated 729 patients with HCC meeting the Milan criteria,who were treated with curative SR or microwave ablation(MWA)between 2008 and 2014.Overall survival(OS),cancer-specific survival(CSS),disease-free survival(DFS),and local tumor progression(LTP)were compared after propensity score matching(PSM).Co-variates associated with OS,CSS,LTP,and DFS were identified.The risk of death and tumor progression were compared.Results:During the median follow-up of 78.6 months,253 patients were included in each group after PSM.For tumors≤3.0 cm and 3.1–4.0 cm,MWA achieved comparable results in terms of OS,CSS,DFS,and LTP.For tumors 4.1–5.0 cm,MWA had lower OS,CSS,and DFS rates(all P<0.05)than SR.Higher LTP rates were observed in the MWA group for tumors 4.1–5.0 cm,although the difference was not significant(P=0.18).Complication rates(P=0.41)were similar,but MWA led to less estimated blood loss(P<0.01)and shorter postoperative hospitalization times(P<0.01).Conclusions:MWA achieved comparable long-term oncologic outcomes with SR for≤4 cm HCC,with lower complication rates and faster recovery.
基金supported by the National Natural Science Foundation of China (Grant Nos. 91859201, 92159305, 81971625, and 82030047)
文摘Despite being a common therapy for hepatocellular carcinoma(HCC),insufficient thermal ablation can leave behind tumor residues that can cause recurrence.This is believed to augment M2 inflammatory macrophages that usually play a pro-tumorigenic role.To address this problem,we designed D-mannose-chelated iron oxide nanoparticles(man-IONPs) to polarize M2-like macrophages into the antitumor Ml phenotype.In vitro and in vivo experiments demonstrated that man-IONPs specifically targeted M2-like macrophages and accumulated in peri-ablation zones after macrophage infiltration was augmented under insufficient microwave ablation(MWA).The nanoparticles simultaneously induced polarization of pro-tumorigenic M2 macrophages into antitumor M1 phenotypes,enabling the transformation of the immunosuppressive microenvironment into an immunoactivating one.Post-MWA macrophage polarization exerted robust inhibitory effects on HCC progression in a well-established orthotopic liver cancer mouse model.Thus,combining thermal ablation with man-IONPs can salvage residual tumors after insufficient MWA.These results have strong potential for clinical translation.
