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Carcinosarcoma of the nasal cavity and paranasal sinuses:Review of the national cancer database

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2023年第2期9卷 115-122页

作者： Jacob C.Harris Jacob G.Eide Rijul S.Kshirsagar Jason A.Brant James N.Palmer Nithin D.Adappa Department of Otorhinolaryngology-Head and NeckSurgery Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA

Background:Carcinosarcomas are rare,aggressive malignancies that can arise in the nasal cavity and paranasal sinuses.There are limited outcome data available.Accordingly,we sought to use the National Cancer Database(NCDB)to characterize patient demographics and outcomes.Method:A retrospective analysis of the NCDB from 2004 to 2016 for patients with sinonasal carcinosarcoma was conducted.Results:Thirty patients were included.The patients were predominantly male(n=20),white(n=23),and privately insured(n=15),with an average age of 62.4 years.The nasal cavity was the most common subsite(n=14),followed by the maxillary sinus(n=8).Most patient were treated with surgery followed by radiation(n=23),with the remaining undergoing surgery alone(n=4),radiation alone(n=2),or no treatment(n=1).One-third(n=10)received adjuvant chemotherapy.The 1-and 5-year overall survival(OS)in the cohort were 79.2%and 43.3%,respectively.Univariate log-rank testing showed OS varied based on intervention(P<0.029),sex(P<0.042),and age(P<0.025),while on multivariate analysis none of these factors independently predicted OS.Conclusions:We describe the demographics and presenting features of a national cohort of sinonasal carcinosarcoma patients.Future research is needed to identify predictors of overall survival,and to assess the optimal roles for radiation and systemic chemotherapy.

关键词： cancer carcinosarcoma National Cancer Database NCDB outcomes sinonasal survival

Divergent trajectories of lean vs obese non-alcoholic steatohepatitis patients from listing to post-transplant:A retrospective cohort study

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World Journal of Gastroenterology 2022年第26期28卷 3218-3231页

作者： Fakhar Ali Qazi-Arisar Raj Uchila Catherine Chen Cathy Yang Shi-Yi Chen Ravikiran Sindhuvalada Karnam Amirhossein Azhie Wei Xu Zita Galvin Nazia Selzner Leslie Lilly Mamatha Bhat Ajmera Transplant Program Toronto General HospitalUniversity Health NetworkToronto M5G 2N2OntarioCanada Division of Gastroenterology and Hepatology Department of MedicineUniversity of TorontoToronto M5G 2N2OntarioCanada National Institute of Liver and GI Diseases Dow University of Health SciencesKarachi 75330Pakistan Department of Biostatistics Princess Margaret Cancer CenterUniversity Health NetworkToronto M5G 2C1OntarioCanada Division of Biostatistics Dalla Lana School of Public HealthUniversity of TorontoToronto M5G 2C1OntarioCanada

BACKGROUND Non-alcoholic steatohepatitis(NASH)cirrhosis is the second most common indication for liver transplantation(LT).The role of body mass index(BMI)on outcomes of NASH cirrhosis has been conflicting.AIM To compare the longitudinal trajectories of patients with lean vs obese NASH cirrhosis,from listing up to post-transplant,having adjusted their BMI for ascites.METHODS We retrospectively reviewed all adult NASH patients listed for LT in our program from 2012 to 2019.Fine-Gray Competing Risk analyses and Cox Proportional-Hazard Models were performed to examine the cumulative incidence of transplant and survival outcomes respectively.RESULTS Out of 265 NASH cirrhosis listed patients,176 were included.Median age was 61.0 years;46%were females.111 patients underwent LT.Obese robust patients had better waitlist survival[hazard ratio(HR):0.12;95%CI:0.05–0.29,Poutcomes,and graft and patient survival post-LT.

关键词： outcomes Frailty Waitlist Liver transplant Survival

Clinical implications and perspectives of portal venous circulating tumor cells in pancreatic cancer

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World Journal of Gastrointestinal Oncology 2023年第4期15卷 632-643页

作者： Sung Woo Ko Seung Bae Yoon Department of Internal Medicine College of MedicineThe Catholic University of KoreaSeoul 06591South Korea Department of Internal Medicine Eunpyeong St.Mary’s HospitalSeoul 03312South Korea

Despite recent improvements in the diagnosis and treatment of pancreatic cancer(PC),clinical outcomes remain dismal.Moreover,there are no effective prognostic or predictive biomarkers or options beyond carbohydrate antigen 19-9 for personalized and precise treatment.Circulating tumor cells(CTCs),as a member of the liquid biopsy family,could be a promising biomarker;however,the rarity of CTCs in peripheral venous blood limits their clinical use.Because the first venous drainage of PC is portal circulation,the portal vein can be a more suitable location for the detection of CTCs.Endoscopic ultrasound-guided portal venous sampling of CTCs is both feasible and safe.Several studies have suggested that the detection rate and number of CTCs may be higher in the portal blood than in the peripheral blood.CTC counts in the portal blood are highly associated with hepatic metastasis,recurrence after surgery,and survival.The phenotypic and genotypic properties measured in the captured portal CTCs can help us to understand tumor heterogeneity and predict the prognosis of PC.Small sample sizes and heterogeneous CTC detection methods limit the studies to date.Therefore,a large number of prospective studies are needed to corroborate portal CTCs as a valid biomarker in PC.

关键词： Circulating tumor cell Pancreatic cancer Portal vein outcomes Prognosis Survival

Sarcopenia in hepatocellular carcinoma:Current knowledge and future directions

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World Journal of Gastroenterology 2022年第4期28卷 432-448页

作者： Abhilash Perisetti Hemant Goyal Rachana Yendala Saurabh Chandan Benjamin Tharian Ragesh BabuThandassery Department of Internal Medicine Gastroenterology and Hepatology DivisionUniversity of Arkansas for Medical SciencesLittle RockAR 72205United States Department of Interventional Oncology and Surgical Endoscopy Parkview HealthFort WayneIN 46825United States Department of Internal Medicine The Wright Center for Graduate Medical EducationThe Wright Center for Graduate Medical EducationScrantonPA 18501United States Department of Hematology and Oncology Conway Regional Medical CenterConwayAR 72034United States Department of Internal Medicine Gastroenterology and Hepatology DivisionCHI Creighton University Medical CenterOmahaNE 68107United States Department of Medicine Central Arkansas Veterans Healthcare SystemLittle RockAR 72205United States

Liver cancer is the second most occurring cancer worldwide and is one of the leading causes of cancer-related deaths.Hepatocellular carcinoma(HCC)is the most common(80%-90%)type among malignant liver cancers.Sarcopenia occurs very early in HCC and can predict and provide an opportunity to improve muscle health before engaging in the treatment options such as loco-regional,systemic,and transplant management.Multiple prognostic stating systems have been developed in HCC,such as Barcelona Clinic Liver Cancer,Child-Pugh score and Albumin-Bilirubin grade.However,the evaluation of patients’performance status is a major limitation of these scoring systems.In this review,we aim to summarize the current knowledge and recent advances about the role of sarcopenia in cirrhosis in general,while focusing specifically on HCC.Additionally,the role of sarcopenia in predicting clinical outcomes and prognostication in HCC patients undergoing loco-regional therapies,liver resection,liver transplantation and systematic therapy has been discussed.A literature review was performed using databases PubMed/MEDLINE,EMBASE,Cochrane,Web of Science,and CINAHL on April 1,2021,to identify published reports on sarcopenia in HCC.Sarcopenia can independently predict HCC-related mortality especially in patients undergoing treatments such as loco-regional,surgical liver transplantation and systemic therapies.Basic research is focused on evaluating a balance of anabolic and catabolic pathways responsible for muscle health.Early clinical studies have shown promising results in methods to improve sarcopenia in HCC which can potentially increase prognosis in these patients.As sarcopenia occurs very early in HCC,it can predict and provide an opportunity to improve muscle health before engaging in the treatment options such as loco-regional,systemic,and transplant management.Further,sarcopenia measurement can obviate the confounding caused by the abdominal ascites in these patients.The use of sarcopenia can add to the existing scoring systems to better pr

关键词： Sarcopenia Skeletal muscle Hepatocellular carcinoma Cirrhosis outcomes Liver cancer

Significance of age and sex in botulinum neurotoxin dosing for adductor spasmodic dysphonia

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2023年第2期9卷 168-173页

作者： Richard Heyes Charles H.Adler Nan Zhang David G.Lott Stephen F.Bansberg Department of Otorhinolaryngology-Head and Neck Surgery Mayo Clinic ArizonaPhoenixArizonaUSA Department of Neurology Mayo Clinic ArizonaPhoenixArizonaUSA Department of Biostatistics and Bioinformatics Mayo Clinic ArizonaPhoenixArizonaUSA

Objectives: This study aims to analyze the impact of age and sex on botulinum neurotoxin (BoNT-A) dosing and outcomes in adductor spasmodic dysphonia (AdSD).Methods: A database review of all spasmodic dysphonia patients treated with BoNT from 1989 to 2018 at the Mayo Clinic in Arizona was performed. Only patients who had received ≥4 injections of BoNT-A for AdSD were included. Patients were divided into two cohorts to analyze age, with an age of first treatment cutoff of 60 years. Patients were divided into male and female cohorts to analyze sex.Results: The final analysis included 398 patients. The mean dose of BoNT-A per treatment was significantly higher in the younger cohort (4.4 vs. 3.9 units,p = 0.048). The mean maximal benefit was similar (72% vs. 70%,p = 0.48);however, the mean length of benefit was significantly shorter in younger patients (3.0 vs. 3.6 months,p outcomes in AdSD.

关键词： adductor age gender outcomes sex spasmodic dysphonia

MELD or MELD-Na as a Predictive Model for Mortality Following Transjugular Intrahepatic Portosystemic Shunt Placement

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Journal of Clinical and Translational Hepatology 2023年第1期11卷 38-44页

作者： Arunkumar Krishnan Tinsay A.Woreta Dhananjay Vaidya Yisi Liu James P.Hamilton Kelvin Hong Alia Dadabhai Michelle Ma Division of Gastroenterology and Hepatology Johns Hopkins University School of MedicineBaltimoreMDUSA Department of General Internal Medicine Johns Hopkins University School of MedicineBaltimoreMDUSA Department of Pediatrics Johns Hopkins University School of MedicineBaltimoreMDUSA Division of Interventional Radiology Johns Hopkins University School of MedicineBaltimoreMDUSA

Background and Aim:The model for end-stage liver disease(MELD)was originally developed to predict survival after transjugular intrahepatic portosystemic shunt(TIPS).The MELD-sodium(MELD-Na)score has replaced MELD for organ allocation for liver transplantation.However,there are limited studies to compare the MELD with MELD-Na to predict mortality after TIPS.Methods:We performed a retrospective chart review of patients who underwent TIPS placement between 2006 and 2016 at our institution.The primary outcome was mortality,and the secondary outcomes sought to assess which variables could provide prognostic information for mortality after TIPS placement.We performed receiver operating characteristic(ROC)curve analysis to assess the performance of MELD and MELD-Na.Results:There were 186 eligible patients in the analysis.The mean pre-TIPS MELD and MELD-Na were 13 and 15,respectively.Overall,mortality after TIPS was 15%at 30 days and 16.7%at 90 days.In a comparison of the areas under the ROCs for MELD and MELD-Na,MELD was superior to MELD-Na for 30-day(0.762 vs.0.709)and 90-day(0.780 vs.0.730)mortality after TIPS.The optimal cutoff score for 30-day mortality was 15(0.676–0.848)for MELD and 17(0.610–0.808)for MELD-Na,whereas the optimal cutoff score for 90-day mortality was 16(95%CI:0.705–0.855)for MELD and 17(95%CI:0.643–0.817)for MELDNa.There were 24 patients with high MELD-Na≥17,but with low MELD<15,and 90-day mortality in this group was 8.3%.Conclusions:Although MELD-Na is a superior prognostic tool to MELD for predicting overall mortality in cirrhotic patients,MELD tended to outperform MELD-Na to predict mortality after TIPS.

关键词： Cirrhosis Portal hypertension Model for end-stage liver disease Sodium Transjugular intrahepatic portosystemic shunt outcomes Mortality

Current perspectives on the role of liver transplantation for Langerhans cell histiocytosis:A narrative review

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World Journal of Gastroenterology 2022年第30期28卷 4044-4052页

作者： Jagadeesh Menon Ashwin Rammohan Mukul Vij Naresh Shanmugam Mohamed Rela Institute of Liver Disease&Transplantation Dr.Rela Institute&Medical CentreBharath Institute of Higher Education&ResearchChennai 600044India

Langerhans cell histiocytosis(LCH)is a malignant disease of the histiocytes involving various organ systems.The spectrum of liver involvement in LCH ranges from mild transaminitis to end-stage liver disease.The hallmark of hepatic LCH is secondary sclerosing cholangitis,which manifests due to a progressive destruction of the biliary tree by malignant histiocytes.Chemotherapy remains the mainstay of treatment for active LCH.Early recognition,diagnosis and a systematic approach to the management of LCH can ameliorate the disease process.Nonetheless,the liver involvement in these patients may progress despite the LCH being in remission.Liver transplantation(LT)remains central in the management of such patients.Various facets of the management of LCH,especially those with liver involvement remain unclear.Furthermore,aspects of LT in LCH with regards to the indication,timing and post-LT management,including immunosuppression and adjuvant therapy,remain undefined.This review summarises the current evidence and discusses the practical aspects of the role of LT in the management of LCH.

关键词： Langerhans cell histiocytosis Liver transplantation outcomes Management Chemotherapy Ethics

Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A national survey and case-vignette study

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World Journal of Gastroenterology 2023年第21期29卷 3328-3340页

作者： Noor J Sissingh Jesse V Groen Hester C Timmerhuis Marc G Besselink Bas Boekestijn Thomas L Bollen Bert A Bonsing Frederikus A Klok Hjalmar C van Santvoort Robert C Verdonk Casper H J van Eijck Jeanin E van Hooft Jan Sven D Mieog Department of Gastroenterology and Hepatology Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Research and Development St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Surgery Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Surgery St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Surgery Amsterdam UMCLocation University of AmsterdamAmsterdam 1081 HZNetherlands Amsterdam Gastroenterology Endocrinology Metabolism Amsterdam 1105 AZNetherlands Department of Radiology Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Radiology St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Medicine-Thrombosis and Hemostasis Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Surgery University Medical Centre UtrechtUtrechtUtrecht 3584 CXNetherlands Department of Gastroenterology and Hepatology St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Surgery Erasmus Medical CentreRotterdam 3015 GDNetherlands

BACKGROUND Splanchnic vein thrombosis(SVT)is a major complication of moderate and severe acute pancreatitis.There is no consensus on whether therapeutic anticoagulation should be started in patients with acute pancreatitis and SVT.AIM To gain insight into current opinions and clinical decision making of pancreatologists regarding SVT in acute pancreatitis.METHODS A total of 139 pancreatologists of the Dutch Pancreatitis Study Group and Dutch Pancreatic Cancer Group were approached to complete an online survey and case vignette survey.The threshold to assume group agreement was set at 75%.RESULTS The response rate was 67%(n=93).Seventy-one pancreatologists(77%)regularly prescribed therapeutic anticoagulation in case of SVT,and 12 pancreatologists(13%)for narrowing of splanchnic vein lumen.The most common reason to treat SVT was to avoid complications(87%).Acute thrombosis was the most important factor to prescribe therapeutic anticoagulation(90%).Portal vein thrombosis was chosen as the most preferred location to initiate therapeutic anticoagulation(76%)and splenic vein thrombosis as the least preferred location(86%).The preferred initial agent was low molecular weight heparin(LMWH;87%).In the case vignettes,therapeutic anticoagulation was prescribed for acute portal vein thrombosis,with or without suspected infected necrosis(82%and 90%),and thrombus progression(88%).Agreement was lacking regarding the selection and duration of long-term anticoagulation,the indication for thrombophilia testing and upper endoscopy,and about whether risk of bleeding is a major barrier for therapeutic anticoagulation.CONCLUSION In this national survey,the pancreatologists seemed to agree on the use of therapeutic anticoagulation,using LMWH in the acute phase,for acute portal thrombosis and in the case of thrombus progression,irrespective of the presence of infected necrosis.

关键词： Acute pancreatitis Splanchnic vein thrombosis Therapeutic anticoagulation Bleeding Recanalization outcomes

COVID-19 in patients with pre-existing chronic liver disease–predictors of outcomes

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World Journal of Virology 2023年第1期12卷 30-43页

作者： Dinesh Walia Anoop Saraya Deepak Gunjan Gastroenterology and Human Nutrition Unit All India Institute of Medical SciencesNew Delhi 110029New DelhiIndia

Coronavirus disease 2019(COVID-19)has affected patients with pre-existing chronic liver disease(CLD)in various ways.The maximum impact was seen on patients with underlying cirrhosis who have shown to have poor clinical outcomes in the form of increased risk of hepatic decompensation,acute-onchronic liver failure,and even mortality.It is of paramount importance to identify various factors which are associated with unfavorable outcomes for prognostication and making informed management strategy.Many factors have been evaluated in different studies in patients with underlying CLD.Some of these factors include the severity of underlying chronic liver disease,comorbid conditions,age,and severity of COVID-19.Overall,the outcomes are not favorable in patients with cirrhosis as evidenced by data from various studies.The main purpose of this review is to identify the predictors of adverse clinical outcomes including mortality in patients with CLD for risk stratification,prognostication,and appropriate clinical management.

关键词： Severe acute respiratory syndrome coronavirus 2 Cirrhosis Predictors outcomes