Purpose Elderly patients with primary hepatocellular carcinoma (HCC) have gradually increased in recent years. Most patients also have systemic disease with poor cardiac and pulmonary function, thus can only receive non-surgical treatment. This paper is to assess the clinical efficacy of transcatheter arterial chemoembolization (TACE) and prognostic factors of HCC in elderly patients. Materials and Methods A retrospective analysis was performed in 106 patients with HCC diagnosed by US, dynamic CT or dynamic MRI [average age (74.9±3.3) years, range 71-84 years] and treated by TACE. The clinical characteristics, survival and prognosis factors were analyzed. Results Follow-up was performed at a median of 18 months (range 1–40 months). The 1-, 2-, and 3-year overall survival (OS) rates were 80.2%, 42.5% and 22.6%, respectively. Univariate analysis showed that the patient's gender and cirrhosis, HBV/HCV infection, diabetes and systemic disease were not significantly correlated with prognosis (P>0.05). Child grade, Eastern Cooperative Oncology Group (ECOG) grade, tumors size, number of tumors, serum alpha-fetoprotein level, portal vein tumor thrombus and Barcelona clinic liver cancer stage were significantly related to OS (P<0.05, P<0.001). Moreover, the Cox multivariant survival analysis revealed that portal vein tumor thrombus, tumor size, serum alpha-fetoprotein level and ECOG stage were independent prognostic indicators (P<0.05, P<0.001). Conclusion Systemic disease does not impact long-term survival in elderly patients with HCC. Portal vein tumor thrombus, tumor size, serum alpha-fetoprotein level, and ECOG grade are independent prognostic indicators.

Purpose To assess the efficacy and prognostic factors of alpha-fetoprotein (AFP) negative hepatocellular carcinoma (HCC) by transcatheter arterial chemoembolization (TACE). Materials and Methods 67 AFP negative HCC patients and 67 AFP positive HCC patients underwent TACE, the survival of two groups was compared, and the prognostic factors were also analyzed. Results All 134 HCC patients were followed up for 24 months, the one-year, two-year and five-year survival rate of AFP negative and AFP positive HCC patients were 86.6%, 58.2%, 31.3%; and 81.6%, 37.8%, 13.4%, respectively, with median survival time of 34.0 months and 19.0 months, respectively. The survival rate were statistically different between AFP negative and AFP positive HCC patients (P<0.001). In AFP positive group, the median survival time of patients with AFP>400 ng/ml and AFP ≤400 ng/ml were 18.0 months and 31.0 months, respectively with statistical difference (P<0.05). Univariate analysis showed that Child-Pugh classification, histological grade, tumor size, tumor number, portal vein tumor thrombus, BCLC staging and AFP level were independent risk factors influencing the prognosis of HCC patients. Conclusion AFP negative and AFP positive (AFP ≤400 ng/ml) HCC patients achieves good efficacy and prognosis by TACE, Child-Pugh classification, portal vein tumor thrombus, BCLC staging and AFP level were risk factors influencing the prognosis of HCC patients.

Objective To explore the utility of cone-beam CT in the evaluation of prostatic arterial embolization (PAE). Methods In a retrospective study, images of DSA and cone-beam CT for PAE in 81 patients with moderate to severe grade benign prostatic hyperplasia were evaluated. In 162 cases of internal iliac arteries (ⅡAs) in 81 patients, images of 6 ⅡAs were excluded due to the technical problems. Therefore, images of 156ⅡAs were included for evaluation. We aim to evaluate the utility of cone-beam CT versus DSA in differentiating PAs and their origins, and demonstrating anastomoses with adjacent arteries. Statistical analyses were performed with Chi-square test to compare the rate of demonstrating vessels between cone-beam CT and DSA. Results One hundred and sixty-one PAs were demonstrated in 156ⅡAs by selective DSA and Cone-beam CT. Cone-beam CT and DSA images demonstrated 158 (98.1%, 158/161) and 130 (80.8%, 130/161) PAs, respectively. The statistical difference was significant (χ2=25.78, P<0.05). PAs were demonstrated by cone-beam CT images alone in 27ⅡAs (17.3%, 27/156) and were demonstrated by DSA images alone in 3ⅡAs (1.9%, 3/161).The statistical difference was significant (χ2=22.31, P<0.05). In 137 PAs that were initially defined by DSA alone, 7 of those (5.1%, 7/137) were eventually proven not to be PAs by further selective cone-beam CT acquisitions. Origins of PAs were shown by Cone-beam CT images alone in 11 ⅡAs. In the remaining 145 ⅡAs (92.9%, 145/156), origins of PAs were shown by both
cone-beam CT and DSA images. The percentage of PA anastomoses demonstrated by cone-beam CT was 42.3%(66/156), which was higher than DSA (31.4%, 49/156). The statistical difference was significant (χ2=3.98, P<0.05). Conclusions Cone-beam CT is useful in demonstrating PAs and their origins fromⅡAs, as well as anastomoses with adjacent arteries.

OBJECTIVETo evaluate the value of angiography in clarifying the origin of the feeding arteries of primary retroperitoneal tumors and to explore the application of embolization therapy in the treating of primary retroperitoneal tumor.

METHODS68 patients with primary retroperitoneal tumor were randomized into conventional tumor resection group (n = 35) and the preoperative embolization group (n = 33). Some clinical data were compared between the preoperative embolization group and the routine operation group, including blood loss, blood transfusion, operation time and adverse reactions after embolization. All the diagnoses were pathologically confirmed. The origins of the tumor-feeding arteries were analyzed. The clinical value of embolization in assisting the surgery as well as in making prognosis was assessed.

RESULTSAccording to their location and size, primary retroperitoneal tumors had feeding arteries from different origins. In this series of cases the tumor blood supply originated from the lumbar artery (81.8%), internal iliac artery (45.5%) and adrenal artery (27.3%). In the preoperative embolization group and conventional surgery group, the blood loss was 912 ml vs. 2 500 ml (P < 0.001), the blood transfusion was 1 000 ml vs. 2 600 ml (P < 0.001), the operation time was 4.1 h vs. 5.9 h (P < 0.001), and the length of hospital stay was 12.5 d vs. 19.8 d (P < 0.001).

CONCLUSIONSThe origins of the feeding arteries in primary retroperitoneal tumors are very complex. Preoperative embolization therapy may effectively reduce the intraoperative blood loss, postoperative adverse events, length of hospital stay, and facilitate the patients' recovery.

Adolescent ; Adult ; Angiography ; Blood Loss, Surgical ; Blood Transfusion ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Preoperative Care ; Retroperitoneal Neoplasms ; diagnostic imaging ; surgery ; therapy ; Young Adult

OBJECTIVETo evaluate the prognostic significance of (18)F-FDG PET-CT SUVmax value in 85 patients with hepatocellular carcinoma (HCC) before transarterial chemoembolization (TACE).

METHODSA retrospective analysis was conducted on 85 patients with HCC before TACE to evaluate the prognostic significance of SUVmax of (18)F-FDG PET-CT. The survival rates were calculated using Kaplan-Meier method. Log-rank method was used for univariate analysis, and Cox regression model was used for multivariate analysis.

RESULTSThe patients were divided into two groups before TACE: The high metabolic group (63 patients, with SUVmax value 7.71 ± 2.78) and low metabolic group (22 patients, with SUVmax value 3.89 ± 0.80). The SUVmax levels were statistically different (P < 0.001). The 1-, 2- and 3-year survival rates of the 63 patients of high metabolic group were 66.6%, 26.9% and 12.6%, respectively. The 1-, 2- and 3-year survival rates of the 22 patients of low metabolic group were 81.8%, 72.7% and 63.6%, respectively. The median survival time of the high metabolic group was 16.0 months and that of the low metabolic group was 48.0 months (P = 0.001). Univariate analysis indicated that SUVmax value of the intrahepatic primary tumor, hepatic cirrhosis, Child-Pugh score, ECOG score, intrahepatic tumor size, number of tumors(solitary or multiple), portal vein tumor thrombus, BCLC stage, and serum AFP level were significantly correlated with prognosis of the patients (P < 0.05 for all). Multivariate analysis indicated that SUVmax value, tumor size >8 cm, number of tumors (solitary or multiple) and AFP level were independent prognostic factors (P < 0.05 for all).

CONCLUSIONThe SUVmax value of the primary intrahepatic tumor can be used as an important prognostic factor to predict the effect of TACE in patients with hepatocellular carcinoma.

Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; therapy ; Chemoembolization, Therapeutic ; Female ; Fluorodeoxyglucose F18 ; Glucose ; metabolism ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; therapy ; Male ; Middle Aged ; Neoplasm Staging ; Positron-Emission Tomography ; Retrospective Studies ; Survival Rate

OBJECTIVEThe aim of this study was to evaluate the efficacy, survival and prognosis of transarterial chemoembolization (TACE) alone and TACE in combination with multimodality therapy for huge hepatocellular carcinoma.

METHODSA retrospective analysis was conducted in 115 patients with huge hepatocellular carcinoma treated in our hospital from August 2008 to January 2012. Among them, 72 patients were treated by TACE alone (TACE group) and 43 patients by TACE plus multimodality therapy (TACE-combined treatment group). Their clinicopathological data and survival were analyzed.

RESULTSThe median follow-up of the 115 cases was 24 months (range 1-40 months). The 1-, 2-, and 3-year overall survival (OS) rates for the TACE group were 60.4,% 23.3% and 9.8%, respectively, and 39 months, 78.1%, 43.3% and 36.8%, respectively, for the combined treatment group (P < 0.001). The univariate analysis showed that the patient gender and age, HIV infection and AFP level were not significantly correlated with prognosis of the patients (P > 0.05 for all), while multimodality therapy, Child's grading, ECOG scores, distant metastasis, and portal vein tumor thrombus were significantly related to the overall survival. Moreover, the Cox multivariate survival analysis revealed that therapy and ECOG scores were independent prognostic indicators (P < 0.05 for all).

CONCLUSIONSMultimodality therapy is a safe and effective treatment for huge hepatocellular carcinoma. Multimodality therapy and ECOG scores are independent prognostic indicators for the patients.

Carcinoma, Hepatocellular ; therapy ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Humans ; Liver Neoplasms ; therapy ; Retrospective Studies ; Survival Rate ; Treatment Outcome