A Scoring Model For Predicting Post-Liver Transplantation Survival In Hepatitis B Virus Cirrhosis-Related Hepatocellular Carcinoma Patients And Contrast-Enhanced Ultrasound Guided Biopsy In Hepatic Space-Occupying Lesions

Part Ⅰ A Scoring Model for Predicting Post-Liver Transplantation Survival in Hepatitis B Virus Cirrhosis-Related Hepatocellular Carcinoma PatientsBackground:The aim of this study was to assess the prognosis of HBV-related hepatocellular carcinoma (HCC) liver transplantation (LT) recipients, to analysize risk factors associated with prognosis, and to develop a quantitative assessment model for predicting post-LT patient survival.Methods:The medical information of238LT recipients at our center between2008and2013 were retrospectively analyzed in this study. Their post-LT1-year,3-year and5-year prognosis was recorded and multiple risk factors were analyzed by Cox proportional hazard model.Results:The1-,3-and5-year survival rates of HBV cirrhosis-related HCC recipients within Hangzhou criteria were87.7%,79.2%,71.5%。Cox univariate analysis showed positive HBV DNA detection time (HR0.998,95%CI0.998-0.999, P<0.001), watiting time(HR0.991,95%CI0.985-0.998, P=0.009), MELD scores(HR1.032,95%CI1.003-1.061, P=0.029), Child-Pugh classification (HR1.103,95%CI1.010-1.204, P=0.029), number of tumor nodules(HR3.360,95%CI2.286-4.938, P<0.001), max diameter of tumor nodules (HR1.160,95%CI1.113-1.208, P<0.001), total diameter of tumor nodules(HR3.880,95%CI2.623-5.739, P<0.001), vascular invasion (HR3.102,95%CI2.117-4.544, P<0.001), preoperative AFP levels (HR1.000,95%CI1.000-1.000, PO.001), tumor differentiation grades (HR1.796,95%CI1.228-2.625, P=0.003) were significant risk factors for survival. Cox multivariate analysis showed Child-Pugh score, positive HBV DNA detection time, number of tumor nodules, max diameter of tumor nodules, AFP, tumor differentiation grade were predictors for post-LT survival. The scoring model result was as follows:0.114x(Child-Pugh score)-0.002×(positive HBV DNA detection time)+0.647x(number of tumor nodules)+0.055x(max diameter of tumor nodules)+0.231×lnAFP+0.437x(tumor differentiation grade). The ROC curve analysis showed that the ROC area under the curve of the scoring model for predicting the post-LT survival was0.887. The optimal cut-off value was1.27, which was associated with a sensitivity and specificity of72.5%and90.7%, respectively. Conclusion:Child-Pugh score, positive HBV DNA detection time, number of tumor nodules, max diameter of tumor nodules, AFP and tumor differentiation grade were predictors for post-LT survival. The quantitative score model for predicting post-liver transplantation survival proved to be specific and sensitive. Part II Contrast-Enhanced Ultrasound Guided Biopsy in Hepatic Space-Occupying LesionsBackground:Use the real-time ultrasound contrast imaging and the new contrast agent SonoVue to do biopsy under the guidance of contrast-enhanced ultrasound, to assess the effectiveness of contrast-enhanced ultrasound guided biopsy in hepatic space-occupying lesions, in order to improve puncture success rate, the positive detection rate of puncture points, diagnosis coincidence rate and malignant lesion pathological diagnosis.Methods:Contrast-enhanced ultrasound guided biopsy was performed in42cases with hepatic space-occupying lesions in Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, from September2014to November2014. The diagnosis of all the patients was according to the post-operative pathology or at least three month follow-up results.Results:In42cases involved in this study, the puncture success rate was100%(42/42) with the positive detection rate of puncture points of100%(42/42). There were19cases of hepatocellular carcinoma,3cases of cholangiocarcinoma,9cases of liver metastatic cancer,3cases of nodular cirrhosis,5cases of inflammation,1case of haemangioma,1case of focal nodular hyperplasia, and1case of dysplastic nodules. The diagnosis coincidence rate was100%(42/42). The accuracy rate of diagnosis of the contrast-enhanced ultrasound was95.2%(40/42), sensitivity93.9%, specificity100%, positive predict value100%, negative predict value81.8%.33cases were under enhancement computed tomography scan, and the accuracy rate was78.8%(26/33). The difference of accuracy rates of contrast-enhanced ultrasound and enhancement computed tomography scan was statistically significant (P=0.038).Conclusion:Contrast-enhanced ultrasound is sensitive in displaying hepatic space-occupying lesions. The biopsy under the guidance of contrast-enhanced ultrasound can provide accurate locations of biopsy, improve puncture success rates, the diagnosis coincidence rates and malignant lesion pathological diagnosis rates.