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Treatment options for recurrence of hepatocellular carcinoma after surgical resection: review of the literature and current recommendations for management

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Hepatoma Research 2020年第5期6卷 73-81页

作者： francesco pasini Matteo Serenari Alessandro Cucchetti Giorgio Ercolani Department of Medical and Surgical Sciences University of BolognaBologna 40138Italy Department of Surgery "Morgagni-Pierantoni"HospitalForlì47121Italy

The recurrence rate after primary resection for hepatocellular carcinoma(HCC)has been reported to be up to 80%.There is no consensus or guideline about the best treatment option for such recurrent HCC(rHCC).It is therefore of paramount importance to select patients for suitable treatment due to the high risk of associated morbidity and *** this paper,we review the literature on treatment for rHCC and propose a strategy based on the best evidence *** in rHCC,it is still possible to achieve cure and good survival rates through careful patient *** hepatectomy is recognized as a feasible and safe procedure even in cirrhotic patients and should be considered as the best option with curative intent when the patient is fit *** adoption of minimally-invasive liver surgery could have the potential to increase the number of candidate patients with rHCC for repeat resection in the next few *** transplantation offers longer disease-free survival compared to repeat resection,curing the underlying cirrhosis,but is not widely available due to organ *** surgery is not feasible,locoregional treatments such as radiofrequency ablation and transarterial chemoembolization have an important role for patients who cannot tolerate repeat hepatectomy and are not suitable for *** advanced cases,systemic therapy could be considered.

关键词： Recurrence hepatocellular carcinoma hepatic resection second resection

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How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center

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Cancer Biology & Medicine 2015年第4期12卷 302-307页

作者： Giampaolo Ugolini francesco pasini Federico Ghignone Davide Zattoni Maria Letizia Bacchi Reggiani Daniele Parlanti Isacco Montroni Department of Medical and Surgical Sciences University of Bologna S.Orsola Malpighi Hospital

Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for ***: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk ***: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality ***: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.

关键词： Elderly geriatric assessment surgical oncology risk assessment screening tools colorectal cancer(CRC)

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Decreased expression of Klotho in cardiac atria biopsy samples from patients at higher risk of atherosclerotic cardiovascular disease

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Journal of Geriatric Cardiology 2016年第8期13卷 701-711页

作者： Giovanni Corsetti Evasio pasini Tiziano M Scarabelli Claudia Romano Pratik R Agrawal Carol Chen-Scarabelli Richard Knight Louis Saravolatz Jagat Narula Mario Ferrari-Vivaldi Vincenzo Flati Deodato Assanelli francesco S Dioguardi Department of Clinical & Experimental Sciences Division of Human Anatomy & Physiopathology University of Brescia Brescia Italy 'S.Maugeri Foundation ' IRCCS Cardiology Division Medical Centre of Lumezzane Brescia Italy Zena and Michael A Wiener Cardiovascular Institute Mount Sinai Medical Center New York USA Center for Heart and Vessel Preclinical Studies St. John Hospital & Medical Center Wayne State University School of Medicine Detroit USA VA Ann Arbor Health Care System University of Michigan Ann Arbor USA Department of Cardiovascular Surgery 'San Rocco' Hospital Ome Brescia Italy Department of Biotechnological and Applied Clinical Sciences University of L 'Aquila L 'Aquila Italy Division of Sport-Internal Medicine Department of Clinical & Experimental Sciences University of Brescia Brescia Italy Department of Clinical Sciences and Community Health University of Milan Milan Italy

Background Klotho proteins （α- and β） are membrane-based circulating proteins that regulate cell metabolism, as well as the lifespan modulating activity of Fibroblast Growth Factors （FGFs）. Recent data has shown that higher plasma circulating Klotho levels reduce cardio- vascular risk, suggesting Klotho has a protective role in cardiovascular diseases. However, although so far it has been identified in various organs, it is unknown whether cardiomyocytes express Klotho and FGFs, and whether high cardiovascular risk could affect cardiac expres- sion ofKlotho, FGFs and other molecules. Methods We selected 20 patients with an estimated 10-year high atherosclerotic cardiovascular disease and 10 age-matched control subjects with an estimated 10-year low risk undergone cardiac surgery for reasons other than coronary artery by-pass. In myocardial biopsies, we evaluated by immuno-histochemistry whether Klotho and FGFs were expressed in cardiomyo- cytes, and whether higher cardiovascular risk influenced the expression of other molecules involved in endoplasmic reticulum stress, oxida- tive stress, inflammation and fibrosis. Results Only cardiomyocytes of patients with a higher cardiovascular risk showed lower expression of Klotho, but higher expressions of FGFs. Furthermore, higher cardiovascular risk was associated with increased expression of oxidative and endoplasmic reticular stress, inflammation and fibrosis. Conclusions This study showed for the first time that Klotho proteins are ex- pressed in human cardiomyocytes and that cardiac expression of Klotho is down-regulated in higher cardiovascular risk patients, while expression of stress-related molecules were significantly increased.

关键词： Atherosclerotic disease Cardiomyocytes Cardiovascular risk Human heart Klotho

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