Pre-operative Predicting Model of Early Tumor Recurrence Outside the Milan Criteria for Hepatocellular Carcinoma

Background. Liver resection is a primary curative treatment for early stage hepatocellular carcinoma (HCC), but the outcomes are impeded by early tumor recurrence. This study aimed to establish a prediction model which could predict tumor recurrence outside the Milan criteria prior to liver resection.Methods. A cohort of 891 HCC patients who had curative liver resections were reviewed. HCC recurrence was divided into 4 groups: early recurrence inside the Milan criteria (ER-MI), early recurrence outside the Milan criteria (ER-MO), late recurrence inside the Milan criteria (LR-MI), and late recurrence outside the Milan criteria (LR-MO). The risk factors of ER-MO were analyzed to establish a prediction model.Results: During a median follow-up of 83.4 months, 589 (66.1%) patients developed recurrent HCC. Among 589 patients, 276 (31.0%), 86 (9.6%), 46 (5.2%) and 181(23.3%) patients were in ER-MO, ER-MI, LR-MO and LR-MI groups, respectively. In multivariate analysis of pre-operative factors, large tumors, non-single tumors, high α-fetoprotein level, high neutrophil-to-lymphocyte ratio and high indocyanine green retention were the independent predictors of ER-MO. By adjusting the weight of independent risk factors into scores and stratifying patients into class I, II, III and IV according to score 0, 2-6, 7-10 and ≥11, ER-MO events at 24 months were 12.5%, 22.5%, 45.4% and 66.3% for class I, II, III and IV, respectively (P< 0.05).Conclusions. A risk scoring model was built and could predict ER-MO based on pre-operative factors. This scoring model would be helpful for sharing the decision marking of treatments with patients.

Seizure burden pre- and postresection of low-grade gliomas as a predictor of tumor progression in low-grade gliomas

Background Low-grade gliomas (LGGs) are slow-growing, infiltrative tumors frequently associated with seizures. Predicting which patients will develop early tumor recurrence based on clinical indicators following initial surgical intervention remains a challenge. Seizure recurrence following surgery may be an early indicator of tumor recurrence, especially in patients presenting with increase in seizure frequency. Methods This study analyzed 148 patients meeting inclusion criteria (age >18 years, LGG diagnosis, at least 1 seizure event recorded before and after initial surgical intervention). All patients were treated at the Brain and Spine Center at The University of Texas MD Anderson Cancer Center from January 2000 to March 2013. Seizure frequency in a 6-month period before and after tumor resection was categorized as none, 1, few (2 to 3 seizures) or several (>3 seizures). Immediately postoperative seizures (up to 48 hours from surgery) were not included in the analysis. Results A total of 116 (78.4%) patients had seizures at initial presentation and most (95%) were started on antiepileptic drugs (AEDs). We found 2 clinical variables with a significant impact on progression-free survival (PFS): Higher seizure frequency during the 6-month postoperative period and seizure frequency increase between the 6-month pre- and the 6-month postoperative periods were both correlated to higher risk of early tumor recurrence (P = .007 and P = .004, respectively). Conclusion Seizure frequency following surgical resection of LGGs and the seizure frequency change between the 6-month preoperative and postoperative periods may serve as clinical predictors of early tumor recurrence in patients with LGGs who are also afflicted by seizures.