• CA-125
• Hb
• hepatocellular carcinoma
• ocular metastases
• risk factors

Metastasis is crucial for the prognosis of hepatocellular carcinoma (HCC). Distinguishing the potential risk factors for distant metastasis in small HCC (diameter ≤ 5 cm) is of great significance for improving the prognosis. HCC patients in the Surveillance, Epidemiology and End Results (SEER) registry with tumors ≤ 5 cm in diameter between January 2010 and December 2015 were retrieved. Demographic and clinicopathological metrics were extracted, including age, sex, race, marital status, tumor size, histological grade, T stage, N stage, M stage, alpha-fetoprotein (AFP), and liver fibrosis score. Univariate and multivariate logistic regression analyses were used to identify independent risk factors correlated with extrahepatic metastasis in small HCC. Propensity score matching (PSM) analysis was performed to balance the confounding factors in baseline characteristics. A total of 4176 eligible patients were divided into a non-metastasis group (n = 4033) and a metastasis group (n = 143) based on metastasis status. In multivariate analysis, larger tumor size, poor histological differentiation, regional lymph node metastasis, and elevated serum AFP levels were identified as independent risk factors for distant metastasis (P < 0.05), while age, sex, race, marital status, and liver fibrosis score were not associated with extrahepatic metastasis. After propensity score analysis, the AFP level was no longer associated with metastatic risk. The present study provided no evidence for a correlation between the clinical threshold of AFP and metastasis in small hepatocellular carcinoma.

Patients with small hepatocellular carcinoma (HCC) (3 cm) still have a poor prognosis. The purpose of this study was to develop a radiomics nomogram to preoperatively predict early recurrence (ER) (2 years) of small HCC.

The study population included 111 patients with small HCC who underwent surgical resection (SR) or radiofrequency ablation (RFA) between September 2015 and September 2018 and were followed for at least 2 years. Radiomic features were extracted from the entire tumor by using the MaZda software. The least absolute shrinkage and selection operator (LASS0) method was applied for feature selection, and radiomics signature construction. A rad-score was then calculated. Multivariable logistic regression analysis was used to establish a prediction model including independent clinical risk factors, radiologic features and rad-score, which was ultimately presented as a radiomics nomogram. The predictive ability of the nomogram was evaluated using the area under the receiver operating characteristic (ROC) curve and internal validation was performed via bootstrap resampling and 5-fold cross-validation method.

A total of 53 (53/111, 47.7%) patients had confirmed ER according to the final clinical outcomes. In univariate logistic regression analysis, cirrhosis and hepatitis B infection (P=0.015 and 0.083, respectively), hepatobiliary phase hypointensity (P=0.089), Child-Pugh score (P=0.083), the preoperative platelet count (P=0.003), and rad-score (P<0.001) were correlated with ER. However, after multivariate logistic regression analysis, only the preoperative platelet count and rad-score were included as predictors in the final model. The area under ROC curve (AUC) of the radiomics nomogram to predict ER of small HCC was 0.981 (95% CI: 0.957, 1.00), while the AUC verified by bootstrap is 0.980 (95% CI: 0.962, 1.00), indicating the goodness-of-fit of the final model.

The radiomics nomogram containing the clinical risk factors and rad-score can be used as a quantitative tool to preoperatively predict individual probability of ER of small HCC.

• hepatocellular carcinoma
• magnetic resonance imaging
• nomogram
• radiomics
• recurrence

In rare instances, primary liver cancer can be associated with intraocular metastasis (IOM).

To investigate the correlation between a diverse range of clinical characteristics and IOM in diabetic patients with primary liver cancer, and to determine potential risk factors in predicting IOM.

We recruited a total of 722 diabetic patients with primary liver cancer. The differences between the IOM and non-intraocular metastasis (NIOM) groups in these patients were assessed using the chi-squared test and Student’s t-test. Binary logistic regression analysis was subsequently used to determine risk factors. Finally, the diagnostic value of IOM in this cohort with primary liver cancer was analyzed by receiver operating characteristic (ROC) curve analysis.

In all, 13 patients had IOM. There were no remarkable intergroup differences with respect to age, sex, histopathological sub-types, or blood biochemical parameters. However, the IOM group had significantly higher alpha-fetoprotein (AFP) and cancer antigen 125 (CA125) values than the NIOM group. Binary logistic regression identified AFP and CA125 to be significant risk factors for IOM in diabetic patients with primary liver cancer. ROC curve analysis showed that the area under the curve values for AFP and CA125 were 0.727 and 0.796, with the cut-off values of 994.20 ng/mL and 120.23 U/mL, respectively. The sensitivity and specificity for AFP were 92.3% and 59.9%, while those for CA125 were 84.6% and 70.1%, respectively.

Elevated AFP and CA125 represent significant risk factors for IOM in diabetic patients with primary liver cancer.

• Primary liver cancer
• Intraocular metastasis
• Diabetes
• Alpha-fetoprotein
• Cancer antigen 125
• Risk factors

• CLEC4M
• HCC
• metastasis
• prognostic factor
• recurrence

To observe the effect of targeted therapy with 64-slice spiral computed tomography (CT) combined with cryoablation for liver cancer.

A total of 124 patients (142 tumors) were enrolled into this study. According to the use of dual-slice spiral CT or 64-slice spiral CT as a guide technology, patients were divided into two groups: dual-slice group (n = 56, 65 tumors) and 64-slice group (n = 8, 77 tumors). All patients were accepted and received targeted therapy by an argon-helium superconducting surgery system. The guided scan times of the two groups was recorded and compared. In the two groups, the lesion ice coverage in diameter of ≥ 3 cm and < 3 cm were recorded, and freezing effective rate was compared. Hepatic perfusion values [hepatic artery perfusion (HAP), portal vein perfusion (PVP), and the hepatic arterial perfusion index (HAPI)] of tumor tissues, adjacent tissues and normal liver tissues at preoperative and postoperative four weeks in the two groups were compared. Local tumor changes were recorded and efficiency was compared at four weeks post-operation. Adverse events were recorded and compared between the two groups, including fever, pain, frostbite, nausea, vomiting, pleural effusion and abdominal bleeding.

Guided scan times in the dual-slice group was longer than that in the 64-slice group (t = 11.445, P = 0.000). The freezing effective rate for tumors < 3 cm in diameter in the dual-slice group (81.58%) was lower than that in the 64-slice group (92.86%) (χ² = 5.707, P = 0.017). The HAP and HAPI of tumor tissues were lower at four weeks post-treatment than at pre-treatment in both groups (all P < 0.05), and those in the 64-slice group were lower than that in the dual-slice group (all P < 0.05). HAP and PVP were lower and HAPI was higher in tumor adjacent tissues at post-treatment than at pre-treatment (all P < 0.05). Furthermore, the treatment effect and therapeutic efficacy in the dual-slice group were lower than the 64-slice group at four weeks post-treatment (all P < 0.05). Moreover, pleural effusion and intraperitoneal hemorrhage occurred in patients in the dual-slice group, while no complications occurred in the 64-slice group (all P < 0.05).

64-slice spiral CT applied with cryoablation in targeted therapy for liver cancer can achieve a safe and effective freezing treatment, so it is worth being used.

• 64-slice spiral computed tomography
• Cryoablation
• Liver cancer

• Adult
• Aged
• Cryosurgery/adverse effects
• Female
• Humans
• Liver Circulation
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Multidetector Computed Tomography
• Perfusion Imaging/methods
• Postoperative Complications/etiology
• Predictive Value of Tests
• Treatment Outcome
• Tumor Burden

• Cryoablation
• Image-guided ablation
• Percutaneous

• Cryosurgery/adverse effects
• Cryosurgery/methods
• Humans
• Magnetic Resonance Imaging/methods
• Neoplasms/diagnostic imaging
• Neoplasms/surgery
• Tomography, X-Ray Computed/methods