| 1 | Survival characteristics of fibrolamellar hepatocellular carcinoma:A Surveillance,Epidemiology,and End Results database study显示文摘BACKGROUND Fibrolamellar hepatocellular carcinoma(FL-HCC)is a rare and distinct type of hepatocellular carcinoma that frequently presents in an advanced stage in younger patients with no underlying liver disease.Currently,there is a limited understanding of factors that impact outcomes in FL-HCC.AIM To characterize the survival of FL-HCC by age,race,and surgical intervention.METHODS This is a retrospective study of The Surveillance,Epidemiology,and End Results database.We identified patients with FL-HCC between 2000-2018 by using an ICD-O-3 site code C22.0 and a histology code 8171/3:Hepatocellular carcinoma,fibrolamellar.In addition,demographics,tumor characteristics,types of surgical procedure,stages,and survival data were obtained.We conducted three separate survival analyses by age groups;≤19,20-59,and≥60-year-old,and race;White,Black,Hispanic,Asian and Pacific islanders(API),and surgical types;Wedge resection or segmental resection,lobectomy,extended lobectomy(lobectomy+locoregional therapy or resection of the other lobe),and transplant.The Chi-Square test analyzed categorical variables,and continuous variables were examined using the Mann-Whitney U test.The Kaplan-Meier survival curve was used to compare survival.Multivariate analysis was done with Cox regression analysis.RESULTS We identified 225 FL-HCC patients with a mean age of 36.9.Overall median survival was 34(95%CI:27-41)mo.Patients≤19-years-old had more advanced disease with positive lymph nodes status.However,they received more surgical interventions such as a wedge,segmental resection,lobectomy,extended lobectomy,and transplant.Survival for≤19 was 85(95%CI:37-137)mo,age 20-59 was 29(95%CI:18-41)mo,and age≥60 years was 12(95%CI:7-31)mo(P<0.001).There were no differences in stage,lymph node status,metastasis status,and surgical treatment among races.The median survival were;Whites had 39(95%CI:29-63),Blacks 26(95%CI:5-92),Hispanics 31(95%CI:11-54),and APIs 28(95%CI:5-39)mo(P=0.28).Of 225 patients,111 FL-HCC patients had surgical procedures.Median survivals for a wedge or segmental resection was 112(95%CI:78-NA),lobectomy was 92(95%CI:57-NA),extended lobectomy was 54(95%CI:23-NA),and a transplant was 63(95%CI:20-NA)mo(P<0.001).The median survival was better in patients who had surgical treatments regardless of lymph nodes or metastasis status(P<0.001).CONCLUSION FL-HCC occurs in a primarily younger population,but survival can be prolonged despite the aggressive disease.There were no racial differences in the survival of FL-HCC;however,Asians with FL-HCC tended to be older than in other races.Surgical treatment provided better survival even in those patients with nodal disease or metastases.Although future studies are needed to explore other therapies for FL-HCC,surgical options should be considered in all cases of FL-HCC unless contraindicated. | Tomoki Sempokuya Arnold Forlemu Muaataz Azawi Krixie Silangcruz Nathalie Khoury Jihyun Ma Linda L Wong | 2022 | World Journal of Clinical Oncology2022，13，5： | 0 |
| 2 | Relationships of hospitalization outcomes and timing to endoscopy in non-variceal upper gastrointestinal bleeding:A nationwide analysis显示文摘BACKGROUND The optimal timing of esophagogastroduodenoscopy(EGD)and the impact of clinico-demographic factors on hospitalization outcomes in non-variceal upper gastrointestinal bleeding(NVUGIB)remains an area of active research.AIM To identify independent predictors of outcomes in patients with NVUGIB,with a particular focus on EGD timing,anticoagulation(AC)status,and demographic features.METHODS A retrospective analysis of adult patients with NVUGIB from 2009 to 2014 was performed using validated ICD-9 codes from the National Inpatient Sample database.Patients were stratified by EGD timing relative to hospital admission(≤24 h,24-48 h,48-72 h,and>72 h)and then by AC status(yes/no).The primary outcome was all-cause inpatient mortality.Secondary outcomes included healthcare usage.RESULTS Of the 1082516 patients admitted for NVUGIB,553186(51.1%)underwent EGD.The mean time to EGD was 52.8 h.Early(<24 h from admission)EGD was associated with significantly decreased mortality,less frequent intensive care unit admission,shorter length of hospital stays,lower hospital costs,and an increased likelihood of discharge to home(all with P<0.001).AC status was not associated with mortality among patients who underwent early EGD(aOR 0.88,P=0.193).Male sex(OR 1.30)and Hispanic(OR 1.10)or Asian(aOR 1.38)race were also independent predictors of adverse hospitalization outcomes in NVUGIB.CONCLUSION Based on this large,nationwide study,early EGD in NVUGIB is associated with lower mortality and decreased healthcare usage,irrespective of AC status.These findings may help guide clinical management and would benefit from prospective validation. | Simcha Weissman Muhammad Aziz Ayrton I Bangolo Dean Ehrlich Arnold Forlemu Anthony Willie Manesh K Gangwani Danish Waqar Hannah Terefe Amritpal Singh Diego MC Gonzalez Jayadev Sajja Fatma L Emiroglu Nicholas Dinko Ahmed Mohamed Mark A Fallorina David Kosoy Ankita Shenoy Anvit Nanavati Joseph D Feuerstein James H Tabibian | 2023 | World Journal of Gastrointestinal Endoscopy2023，15，4： | 0 |
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