Necessity Of Hepatic Resection Combined With Cholecystectomy In Patients With HCC

Research content:This research is divided into the following 4 parts:1.Centering on the background of medical big data,the challenges of hospital data sources,system distribution,and big data analysis were explored.2.Based on the hospitalized population,we explore the prevalence of hepatitis B virus in hospitalized patients.Further,we conduct a multidimensional analysis of the correlation between gallbladder disease and clinical factors,surgery,interventional therapy,gallbladder contraction function,and imaging misdiagnosis rate.3.A bird’s eye panoramic landscape of the clinical risk of hepatocellular carcinoma recurrence based on real-world research methods.4.Utilization cross-platform database and genome-wide exon association analysis provide preliminary insights into the mechanism of NM23 in HCC recurrence.Objective:To explore the information flow,system distribution and data advantages of the First Affiliated Hospital of Guangxi Medical University(GXMU),and summarize the difficulties and challenges of medical big data analysis.Materials and Methods:Assisted by computer management center,medical records information department and other disciplines to find out the differences in hospital information management architecture and database archiving.Collected information on inpatients’ birthplaces and residences to draw a city distribution map.The pie charts were using to describe the proportion of inpatients.Counted the total number of inpatients,annual outpatient,emergency department and medical technology departments workload of the First Affiliated Hospital of GXMU.Analyzed the difficulties and challenges of medical big data processing in the processes of digital medical.Results:The information of outpatients and inpatients of the First Affiliated Hospital of GXMU flowed to different systems,managed by the computer management center.The imaging system lacks an identification ID,and the presence of non-real-name medical records in the early electronic medical records confuses later data processing.The inpatient cases of the First Affiliated Hospital of GXMU cover the entire Guangxi region,and about half of the cases in Nanning.The number of inpatients in each year from 2013 to 2018 exceeded 100,000 after 2014.The total number of outpatient and emergency department visits exceeded 3 million in 2013,around 3.3 million from 2014 to 2016 and has increased year by year.The total is over 200,000 person-times,and the inspection items have exceeded 30 million pieces of data in 2012,and the total amount of inspections reached 40 million in 2016.Under the premise of ensuring data security,data collection,quality control and standardized processing require cross-disciplinary and multidisciplinary cooperation to meet the needs of clinical research.Conclusion:The hospital has abundant medical resources and meets the conditions for conducting medical big data analysis,but the difficulties and challenges that may be encountered during the data mining process,which need more attention.Objective:Based on inpatient data from the First Affiliated Hospital of Guangxi Medical University(GXMD),the prevalence of hepatitis and the risk factors of gallbladder stones were studied,and the incidence risk and time difference of gallbladder lesions in patients with HCC resection after gallbladder preservation were also investigated.The effect of surgery on the contractile function of the gallbladder was evaluated,and the rate of missed diagnosis of gallbladder stones in clinical imaging was analyzed.Materials and Methods:1.A statistical description of the ages,residences,results of hepatitis detection and liver function test,and history of antiviral treatment of 363,199 inpatients undergoing hepatitis B immunoassay in the First Affiliated Hospital of GXMU from 2013 to 2016.2.Collected the results of blood test items(Including liver function,blood lipid test,fasting blood glucose,etc.),imaging reports,admission records,preliminary diagnosis and previous medical history of 253,843 inpatients aged over 18 years in the first affiliated hospital of GXMU from 2013 to 2016.Parametric tests were used to analyze the differences in the test values of cases with or without gallbladder stones.Logistic regression analysis was used to evaluate the strength of the association between exposure factors and the occurrence of gallbladder stones.3.760 patients who underwent HCC resection with gallbladder preservation were included,and their imaging records,current medical history,and past history of the first liver cancer resection were retrospectively collected.Logistic regression analysis was used to evaluate the correlation between related factors and the occurrence of gallbladder lesions in patients after HCC resection with gallbladder preservation.Survival analysis was performed to compare the time difference and risk of gallbladder lesions in various subgroups after liver resection and gallbladder preservation.4.From July 2018 to December 2019,228 patients who were treated in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of GXMU were tested for gallbladder contractile function,and the gallbladder diameter line before and after the fat meal was collected.Parametric or non-parametric methods were used to assess the difference in gallbladder contraction rates before and after surgery.5.Re-assessed preoperative imaging of 1695 patients undergoing partial hepatectomy in the First Affiliated Hospital of GXMU from 2015 to 2017,and analyze the influencing factors of missed diagnosis of gallbladder stones in imaging.Results:1.The HBsAg-positive rate of inpatients in the First Affiliated Hospital of GXMU was 12.8%.The HB sAg-positive inpatients mainly came from Nanning,Guangxi,and were mainly in the age range of 31-70 years,which is consistent with the Chinese CDC data.22.7%of all HBsAg-positive hospitalized patients are using or have used antiviral therapy,and some patients with abnormal liver function aminotransferases have not received antiviral therapy.2.The positive rate of gallbladder stones in inpatients of the First Affiliated Hospital of GXMU from 2013 to 2016 was 3.1%.After adjusting for age,gender,ethnicity,and smoking and drinking history,multivariate regression analysis showed that hypertension,overweight,elevated bilirubin and liver function enzymes,high fasting blood glucose,and HBV infection were risk factors for gallstones(P<0.05).3.The preoperative prevalence of gallbladder lesions in HCC patients undergoing liver cancer resection with gallbladder preservation was 12.6%,and the postoperative prevalence of gallbladder lesions was 36.6%.Survival analysis showed that patients with abnormal liver function enzymes and total cholesterol before surgery had a shorter occurrence time of gallbladder lesions,which was a risk factor for gallbladder lesions(P<0.05).For patients with non-calculus gallbladder disease before surgery,the time to gallbladder stones was shortened,and the risk of gallbladder stones was significantly increased(P<0.05).4.The gallbladder sedimentary stones were detected by B-ultrasound during the hospitalization period during the period of liver resection.The detection rate of gallbladder sedimentary stones was 14.3%.The preoperative and postoperative gallbladder contraction rates of the paired HCC patients were statistically different,and the postoperative gallbladder contraction rates were weaker than before.The preoperative gallbladder contraction rate was significantly lower in patients with gallbladder lesions than in patients without gallbladder lesions.5.The results of re-assessment of cholecystolithiasis in the gallbladder before surgery in patients undergoing liver resection suggest that abdominal B ultrasound and CT/MRI have different degrees of missed diagnosis of gallbladder stones.A variety of factors affect the detection and reporting of gallstones.Conclusions:1.The prevalence of HBV in Guangxi is higher than that in the whole country and some cities.The population aged 30-60 should be listed as the key population for screening and treatment.Some HBsAg-positive patients with abnormal liver function need to strengthen antiviral treatment.2.The occurrence of gallbladder stones in hospitalized patients may be related to gender,age,BMI,ethnicity,liver function changes,blood lipids,fasting blood glucose and HBV infection.Patients with related risk factors should pay more attention.3.HCC patients who have undergone hepatic resection with gallbladder preservation have an increased proportion of gallbladder stones and gallbladder lesions and increased post-operation risk.Clinicians should inform patients of the risk of gallbladder retention before surgery.4.The comparison of gallbladder contraction rates between preoperative and postoperative patients with gallbladder after liver resection needs further study.5.Artificial intelligence methods may help enhance clinicians’ ability to improve imaging diagnosis and reduce the rate of missed diagnosis of gallbladder stones.Objective:Real-world study methods were used to depict the clinical landscape of risk factors related to the recurrence of Hepatocellular carcinoma(HCC).Materials and Methods:1814 inpatients who had undergone HCC resection in the First Affiliated Hospital of GXMU from 2013 to 2016 were screened.The preoperative,intraoperative,and postoperative indicators of the first HCC resection were collected,including preoperative inspection items,imaging examinations,surgical records,anesthesia records,and postoperative complications.Information on the location,number,and treatment of postoperative patients with the first HCC recurrence were obtained during followup.Descriptive analysis was used to calculate the proportion of indicators in the patients and the distribution of tumors in the liver.Univariate survival analysis was performed to compare the recurrence time and risk differences among the subgroups of each factor.Results:The male-to-female ratio was 6.4:1 in the HCC cases.Serum HBsAg was positive in 79.0%of cases,liver fluke infection in 19.6%of cases,and serum AFP(Alpha fetoprotein,alpha-fetoprotein)<20 ng/ml in 705(38.9%)patients.Child-Pugh liver function graded a total of 1635 patients with grade A,315 patients with huge liver cancer(≥10 cm),76.1%cases were single tumors,and 1227 patients(67.6%)with BCLC stage 0/A.A total of 936 patients(51.6%)had intraoperative bleeding of less than 500 ml.More than a quarter of liver tumor resections took less than 3 hours,76.2%were R0 resections,and 1228 patients had undergone antiviral therapy.855 patients with postoperative complications,230 with Clavien-Dindo grade III or higher,and ISGLS liver dysfunction,bile leakage,and postoperative bleeding grade B or higher were 1.8%,0.7%,and 1.9%,respectively.Other common complications are respiratory infection and postoperative pleural effusion.The median follow-up time of patients with HCC was 428 days(interquartile range was from 131 days to 1131 days,with a total average of 750 days).Intrahepatic recurrence or extrahepatic metastasis of HCC occurred in 961 cases(53.0%),and 271 cases(14.9%)had a recurrence and repeated hepatic resection.HCC patients had the highest frequency of primary lesions/invasion of S7.The highest proportion of tumors in single nodule and single liver segment(37.7%)was in S4,the highest proportion in the first of tumor recurrence liver segment was S8(21.5%),and the proportion of recurrent lesions in the gallbladder bedside(S4/5/6)is about 46%.The higher the cumulative percentage of the high AFP serum level and the incidence of MVI in each worse HCC stage.Cox survival analysis showed that preoperative abnormal test indicators,poor clinical staging and pathological examination of HCC,and postoperative complications were risk factors that affected the recurrence of HCC after surgery.The intraoperative hepatic hilar occlusion time and total operation time did not affect postoperative relapse.Using multivariate and stratified survival analysis,the results suggest that cholecystectomy is not an independent risk factor for tumor recurrence in HCC patients after hepatectomy.Conclusion:The clinical panoramic analysis of HCC patients undergoing the first hepatic resection by integrating multiple clinical evidences shows that various preoperative,intraoperative,and postoperative risk factors that may have a bad effect on postoperative recurrence of HCC patients,providing a perspective for prognosis evaluation and subsequent treatment of HCC patients.Objective:To investigate the expression level of NM23 and related hereditary factors affecting NM23 expression in HCC tissues based on public databases and genome-wide exon association analysis.Materials and Methods:The expression differences of NM23 in HCC tissues and adjacent non-tumor tissues were evaluated by multi-platform expression profile sets,and the tissue distinguished ability and prognostic value of NM23 were evaluated.GSEA analysis of NM23 expression was performed using genome-wide expression data to explore the genes and pathways involved in the occurrence and development in HCC.A total of 424 HBV-related HCC patients who underwent NM23 immunohistochemical examination at the First Affiliated Hospital of GXMU from 2005 to 2013 were enrolled.Single nucleotide polymorphisms(SNPs)data was obtained by scanning tissue samples with genome-wide exon chips.After association analysis and quality control by bioinformatics processing,candidate SNPs and parent genes that affected NM23 expression were obtained.Logistic regression models were used to analyze candidate SNPs and haplotypes to explore their association with NM23 expression levels.Survival analysis was performed to evaluate the prognostic value of candidate SNPs,haplotypes,and parent genes in HBV-related HCC patients.The GTEx database was allocated to locate and quantify the expression quantitative trait loci in candidate SNPs tissues.Results:In 28 HCC datasets,the expression level of NM23 in HCC cancer tissues in 26 datasets was higher than that in adjacent tissues.ROC curve analysis showed that the expression level of NM23 in 25 datasets was highly discriminative and statistically significant in the diagnosis of HCC(P<0.05).GSEA showed that NM23 inhibits HCC metastasis by controlling RNA transcription and protein translation.Genome-wide exon association analysis was performed on samples and SNPs screened after quality control,and 6 loci of PSORS1C1 gene and 2 loci of STARD3 gene were identified as candidate SNPs.The results of ordered logistic regression analysis showed that different SNPs and haplotypes had a cumulative effect on the expression level of NM23.Candidate gene PSORS1C1 was negatively correlated with NM23 expression level,while STARD3 was positively correlated with NM23 expression level(P<0.05).Survival analysis showed that the SNPs rs541820233,rs556285588,rs560052000,and rs3095301 on the candidate gene PSORS1C1 were correlated with the prognosis of HBV-related HCC patients.There were differences in prognosis between different genotypes and haplotypes in overall survival and recurrencefree survival(P<0.05).According to the GTEx database screening,candidate genotypes of candidate SNPs rs1877031,rs3095302,rs3131003,and rs11869286 have quantitative loci in normal liver tissues.Conclusion:The SNPs in the candidate genes PSORS1C1 and STARD3 are related to NM23 expression levels and clinical outcomes in HBV-related HCC patients,which may be potential biomarkers and therapeutic targets for HCC patients.This doctoral dissertation started with the clinical question of whether it is necessary to simultaneously remove the gallbladder in HCC patients undergoing liver tumor resection,mining actual results from multiple perspectives based on the implementation of real-world research norms in the context of big data: 1.HBs Ag-positive people with HBV infection are at higher risk for gallstones.2.The positive rate of HBs Ag in HCC patients is higher than that in hospitalized patients.In addition,with the presence of liver cirrhosis and other adverse conditions,the risk of gallstones is increased.3.Prevalence of postoperative gallbladder lesions is elevated in HCC patients who have undergone liver tumor resection but preserved the gallbladder.4.Gallbladder contraction is weakened in patients with gallbladder lesions,and gallbladder silt-like stones occur during perioperative period in patients with retained gallbladder.5.Patients with noncalculus gallbladder lesions before surgery have a significantly shorter time to develop gallbladder stones during the postoperative period.6.Patients undergoing TACE after surgery are at risk for lipiodol ectopic embolism in the gallbladder.7.Missed diagnosis of patients with gallbladder stones may occur on imaging examinations.8.Gallbladder bedside(S4/S5/S6)recurrence accounted for a high proportion of postoperative lesions,and the preservation of the gallbladder may affect the choice of subsequent local treatment methods.9.Cholecystectomy is not an independent risk factor for recurrence in HCC patients after hepatectomy.Therefore,based on the above-mentioned big data from the real world,we strongly recommend that patients with HCC undergo conventional HCC resection for simultaneous gallbladder resection.In addition,in order to improve the postoperative MRT of patients,the clinical and genetic factors of HCC patients should be fully evaluated.