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Oh IS, Sinn DH, Kang TW, Lee MW, Kang W, Gwak GY, Paik YH, Choi MS, Lee JH, Koh KC, Paik SW. Liver Function Assessment Using Albumin-Bilirubin Grade for Patients with Very Early-Stage Hepatocellular Carcinoma Treated with Radiofrequency Ablation. Dig Dis Sci 2017; 62:3235-3242. [PMID: 28983724 DOI: 10.1007/s10620-017-4775-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/19/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND/AIM Assessment of liver function is essential for management of hepatocellular carcinoma (HCC). Recently, albumin-bilirubin (ALBI) grade has been reported as a useful tool for assessing hepatic reserve in patients with HCC. The objective of this study was to determine whether ALBI grade could be used to predict the overall survival of very early-stage HCC patients treated with radiofrequency ablation (RF ablation). METHODS A cohort of 368 patients with very early-stage HCC treated with RF ablation was retrospectively analyzed. The overall survival and recurrence-free survival were calculated in groups classified by ALBI grade and Child-Pugh score. RESULTS Overall survival of patients with ALBI grade 1 was better than that of patients with ALBI grade 2 (5-year survival rate 88.5 vs. 73.8%, P < 0.001). In multivariable-adjusted model, ALBI grade was found to be an independent factor associated with overall survival (hazard ratio 2.44; 95% confidence interval 1.43-4.15). ALBI grade was able to stratify patients with distinct overall survival among patients within the same Child-Pugh score (5-year survival rate for Child-Pugh score 5: 88.5 vs. 76.6%, P = 0.002; for Child-Pugh score 6: 88.9 vs. 70.1%, P = 0.064). In contrast, Child-Pugh score was unable to stratify patients with distinct overall survival within the same ALBI grade. CONCLUSIONS Among patients with very early-stage HCC treated with RF ablation, ALBI grade was a good stratifying biomarker. ALBI grade was better tool for assessing liver function than Child-Pugh score for very early-stage HCC treated with RF ablation.
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Affiliation(s)
- In Soo Oh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.,Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wonseok Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Geum-Youn Gwak
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Yong-Han Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Moon Seok Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Joon Hyeok Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Kwang Cheol Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Seung Woon Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
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Kumar G, Goldberg SN, Gourevitch S, Levchenko T, Torchilin V, Galun E, Ahmed M. Targeting STAT3 to Suppress Systemic Pro-Oncogenic Effects from Hepatic Radiofrequency Ablation. Radiology 2017; 286:524-536. [PMID: 28880787 DOI: 10.1148/radiol.2017162943] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose To (a) identify key expressed genes in the periablational rim after radiofrequency ablation (RFA) and their role in driving the stimulation of distant tumor growth and (b) use adjuvant drug therapies to block key identified mediator(s) to suppress off-target tumorigenic effects of hepatic RFA. Materials and Methods This institutional animal care and use committee-approved study was performed in C57BL6 mice (n = 20) and F344 rats (n = 124). First, gene expression analysis was performed in mice after hepatic RFA or sham procedure; mice were sacrificed 24 hours to 7 days after treatment. Data were analyzed for differentially expressed genes (greater than twofold change) and their functional annotations. Next, animals were allocated to hepatic RFA or sham treatment with or without STAT3 (signal transducer and activator of transcription 3) inhibitor S3I-201 for periablational phosphorylated STAT3 immunohistochemistry analysis at 24 hours. Finally, animals with subcutaneous R3230 adenocarcinoma tumors were allocated to RFA or sham treatment with or without a STAT3 inhibitor (S3I-201 or micellar curcumin, eight arms). Outcomes included distant tumor growth, proliferation (Ki-67 percentage), and microvascular density. Results At 24 hours, 217 genes had altered expression (107 upregulated and 110 downregulated), decreasing to 55 genes (27 upregulated and 28 downregulated) and 18 genes (four upregulated, 14 downregulated) at 72 hours and 7 days, respectively. At 24 hours, STAT3 occurred in four of seven activated pathways associated with pro-oncogenic genes at network analysis. Immunohistochemistry analysis confirmed elevated periablational phosphorylated STAT3 24 hours after RFA, which was suppressed with S3I-201 (percentage of positive cells per field: 31.7% ± 3.4 vs 3.8% ± 1.7; P < .001). Combined RFA plus S3I-201 reduced systemic distant tumor growth at 7 days (end diameter: 11.8 mm ± 0.5 with RFA plus S3I-201, 19.8 mm ± 0.7 with RFA alone, and 15 mm ± 0.7 with sham procedure; P < .001). STAT3 inhibition with micellar curcumin also suppressed postablation stimulation of distant tumor growth, proliferation, and microvascular density (P < .01). Conclusion Gene expression analysis identified multiple pathways upregulated in the periablational rim after hepatic RFA, of which STAT3 was active in four of seven. Postablation STAT3 activation is linked to increased distant tumor stimulation and can be suppressed with adjuvant STAT3 inhibitors. © RSNA, 2017.
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Affiliation(s)
- Gaurav Kumar
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (G.K., S.N.G., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), and Goldyne Savad Institute of Gene Therapy (S.G., E.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Department of Pharmaceutical Sciences, Northeastern University, Boston, Mass (T.L., V.T.)
| | - S Nahum Goldberg
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (G.K., S.N.G., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), and Goldyne Savad Institute of Gene Therapy (S.G., E.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Department of Pharmaceutical Sciences, Northeastern University, Boston, Mass (T.L., V.T.)
| | - Svetlana Gourevitch
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (G.K., S.N.G., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), and Goldyne Savad Institute of Gene Therapy (S.G., E.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Department of Pharmaceutical Sciences, Northeastern University, Boston, Mass (T.L., V.T.)
| | - Tatyana Levchenko
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (G.K., S.N.G., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), and Goldyne Savad Institute of Gene Therapy (S.G., E.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Department of Pharmaceutical Sciences, Northeastern University, Boston, Mass (T.L., V.T.)
| | - Vladimir Torchilin
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (G.K., S.N.G., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), and Goldyne Savad Institute of Gene Therapy (S.G., E.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Department of Pharmaceutical Sciences, Northeastern University, Boston, Mass (T.L., V.T.)
| | - Eithan Galun
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (G.K., S.N.G., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), and Goldyne Savad Institute of Gene Therapy (S.G., E.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Department of Pharmaceutical Sciences, Northeastern University, Boston, Mass (T.L., V.T.)
| | - Muneeb Ahmed
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (G.K., S.N.G., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), and Goldyne Savad Institute of Gene Therapy (S.G., E.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Department of Pharmaceutical Sciences, Northeastern University, Boston, Mass (T.L., V.T.)
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Lee HJ, Kim JW, Hur YH, Shin SS, Heo SH, Cho SB, Kang YJ, Lim HS, Seon HJ, Jeong YY. Combined Therapy of Transcatheter Arterial Chemoembolization and Radiofrequency Ablation versus Surgical Resection for Single 2–3 cm Hepatocellular Carcinoma: A Propensity-Score Matching Analysis. J Vasc Interv Radiol 2017; 28:1240-1247.e3. [DOI: 10.1016/j.jvir.2017.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 12/31/2022] Open
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Abstract
There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia–Pacific region, where HCC is one of the leading public health problems. Since the “Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines” meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia–Pacific region, which has a diversity of medical environments.
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Li W, Zhou X, Huang Z, Zhang K, Luo X, Zhong J, Chen Y. Short-term and long-term outcomes of laparoscopic hepatectomy, microwave ablation, and open hepatectomy for small hepatocellular carcinoma: a 5-year experience in a single center. Hepatol Res 2017; 47:650-657. [PMID: 27487979 DOI: 10.1111/hepr.12785] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/28/2016] [Accepted: 07/26/2016] [Indexed: 12/12/2022]
Abstract
AIM Laparoscopic hepatectomy (LH), microwave ablation (MWA), and open hepatectomy (OH) are three widely used methods to treat small hepatocellular carcinoma (HCC). However, few studies have compared the short- and long-term outcomes of these three treatments. The aim of this study was to investigate their effectiveness. METHODS The data were reviewed from 280 patients with HCCs measuring ≤3 cm (Barcelona Clinic Liver Cancer stage 0 or A) who received LH (n = 133), OH (n = 87), or MWA (n = 60) in our research center from 2005 to 2010. Short-term outcomes included intraoperative blood loss, operation time, and length of hospital stay. The disease-free survival and overall survival rates were analyzed as long-term outcomes. RESULTS The patients in the MWA and LH groups showed better short-term outcomes compared with those in the OH group. There were no significant differences in overall survival rates among the three treatments. The LH group showed significantly lower recurrence rates than the MWA group (P = 0.0146). CONCLUSIONS Laparoscopic hepatectomy may be a better option for patients with small HCC located on the liver surface and left lateral lobe. The short-term outcome of MWA is promising, although the high risk of local recurrence after the operation should be considered when planning treatment.
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Affiliation(s)
- Wenda Li
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xue Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zejian Huang
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kelin Zhang
- Department of Surgical Intensive Care Unit, The Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuan Luo
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinyi Zhong
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yajin Chen
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
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106
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Na BG, Kim JM, Oh DK, Lee KW, Kang TW, Choi GS, Lee MW, Kwon CHD, Lim HC, Joh JW. Clinical outcomes of laparoscopic radiofrequency ablation of single primary or recurrent hepatocellular carcinoma (≤3 cm). Ann Surg Treat Res 2017; 92:355-360. [PMID: 28480181 PMCID: PMC5416922 DOI: 10.4174/astr.2017.92.5.355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/20/2016] [Accepted: 11/28/2016] [Indexed: 12/12/2022] Open
Abstract
Purpose Percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) has some limitations such as poor sonic window and injury to adjacent organs. The laparoscopic approach has been suggested as an alternative option. The aim of this study was to show the safety and efficacy of laparoscopic RFA for single, small (≤3 cm), and primary or recurrent HCC that is not suitable for percutaneous RFA or surgical resection. Methods We reviewed the cases of 37 patients (32 men and 5 women, mean age 61 ± 8.1 years) who underwent laparoscopic RFA for single, small HCC (≤3 cm) that was unsuitable for percutaneous RFA or surgical resection. Results The technical success rate was 94.6% and 34 patients (95%) had no complications. There were no conversions to open RFA and no operative mortality. The primary effectiveness rate 1 month after the procedure was 100%. The overall recurrence rates at 3, 6, 12, and 24 months after the laparoscopic RFA were 8.1%, 14.4%, 25%, and 35.7%, respectively. The local tumor progression rate was 4.2% at 6 months and 8.7% at 9 months. Conclusion Laparoscopic RFA is a safe and effective treatment for HCC cases that are unsuitable for percutaneous RFA.
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Affiliation(s)
- Byung Gon Na
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Kyu Oh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyo-Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Wook Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Chul Lim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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107
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Kang TW, Lim HK, Cha DI. Aggressive tumor recurrence after radiofrequency ablation for hepatocellular carcinoma. Clin Mol Hepatol 2017; 23:95-101. [PMID: 28349677 PMCID: PMC5381839 DOI: 10.3350/cmh.2017.0006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Image-guided radiofrequency ablation (RFA) is an evolving and growing treatment option for patients with hepatocellular carcinoma (HCC) and hepatic metastasis. RFA offers significant advantages as it is less invasive than surgery and carries a low risk of major complications. However, serious complications, including aggressive tumor recurrence, may be observed during follow-up, and recently, mechanical or thermal damage during RFA has been proposed to be one of the causes of this kind of recurrence. Although the exact mechanism of this still remains unclear, physicians should be familiar with the imaging features of aggressive tumor recurrence after RFA for HCC and its risk factors. In addition, in order to prevent or minimize this newly recognized tumor recurrence, a modified RFA technique, combined RFA treatments with transarterial chemoembolization, and cryoablation can be used as alternative treatments. Ultimately, combining an understanding of this potential complication of RFA with an understanding of the possible risk factors for aggressive tumor recurrence and choosing alternative treatments are crucial to optimize clinical outcomes in each patient with HCC.
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Affiliation(s)
- Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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108
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Zhang Q, Kong J, Dong S, Xu W, Sun W. Metformin exhibits the anti-proliferation and anti-invasion effects in hepatocellular carcinoma cells after insufficient radiofrequency ablation. Cancer Cell Int 2017; 17:48. [PMID: 28450808 PMCID: PMC5404300 DOI: 10.1186/s12935-017-0418-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 04/18/2017] [Indexed: 02/06/2023] Open
Abstract
Background The mechanisms and prevention of progression of hepatocellular carcinoma (HCC) after insufficient radiofrequency ablation (RFA) has been preliminarily investigated, therefore, new strategy needs to be investigated to prevent the process. Whether metformin could be used to inhibit the growth of HCC after insufficient RFA and further prevent the progression of residual HCC remains unclearly. Methods MTT assay, colony formation assay and transwell assay were used to observe the cell viability, migration and invasion. Western blot and immunohistochemistry methods were used to observe the expression of proteins. Xenograft model was used to evaluate the growth of HCC cells in vivo. Results Metformin inhibited the enhanced proliferation, migration and invasion of HepG2 and SMMC7721 cells after insufficient RFA (named as HepG2-H and SMMC7721-H). Metformin deregulated the expression of p-Akt in HepG2 and SMMC7721 cells after insufficient RFA through AMPK/PTEN pathway. HepG2-H cells also exhibited larger tumor size in vivo. Higher expression of Ki-67 and CD31 and lower expression of E-cadherin were observed in HepG2-H tumors. Metformin blocked the enhanced growth of HepG2 cells in vivo after insufficient RFA. Metformin had no apparent toxicity on nude mice. Conclusions Metfromin inhibited the growth of HCC cells after insufficient RFA, and may be used to prevent the progression of HCC after RFA. Electronic supplementary material The online version of this article (doi:10.1186/s12935-017-0418-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qingyun Zhang
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100043 China.,Department of General Surgery, Affiliated Hospital of Chengde Medical University, Hebei, 067000 China
| | - Jian Kong
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100043 China
| | - Shuying Dong
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100043 China
| | - Wenlei Xu
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100043 China
| | - Wenbing Sun
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100043 China
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Eltorai AEM, Baird GL, Monu N, Wolf F, Seidler M, Collins S, Kim J, Dupuy DE. Optimal CT scanning parameters for commonly used tumor ablation applicators. Eur J Radiol 2017; 89:136-139. [PMID: 28267529 DOI: 10.1016/j.ejrad.2017.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/22/2016] [Accepted: 01/05/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE CT-beam hardening artifact can make tumor margin visualization and its relationship to the ablation applicator tip challenging. To determine optimal scanning parameters for commonly-used applicators. MATERIALS AND METHODS Applicators were placed in ex-vivo cow livers with implanted mock tumors, surrounded by bolus gel. Various CT scans were performed at 440mA with 5mm thickness changing kVp, scan time, ASiR, scan type, pitch, and reconstruction algorithm. Four radiologists blindly scored the images for image quality and artifact quantitatively. RESULTS A significant relationship between probe, kVp level, ASiR level, and reconstruction algorithm was observed concerning both image artifact and image quality (both p=<0.0001). Specifically, there are certain combinations of kVp, ASiR, and reconstruction algorithm that yield better images than other combinations. In particular, one probe performed equivalently or better than any competing probe considered here, regardless of kVp, ASiR, and reconstruction algorithm combination. CONCLUSION The findings illustrate the overall interaction of the effects of kVp, ASiR, and reconstruction algorithm within and between probes, so that radiologists may easily reference optimal imaging performance for a certain combinations of kVp, ASiR, reconstruction algorithm and probes at their disposal. Optimum combinations for each probe are provided.
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Affiliation(s)
| | - Grayson L Baird
- Department of Diagnostic Imaging, USA; Warren Alpert Medical School of Brown University, USA; Lifespan Biostatistics Core, USA; Rhode Island Hospital, USA
| | - Nicholas Monu
- Department of Diagnostic Imaging, USA; Warren Alpert Medical School of Brown University, USA; Rhode Island Hospital, USA
| | - Farrah Wolf
- Department of Diagnostic Imaging, USA; Warren Alpert Medical School of Brown University, USA; Rhode Island Hospital, USA
| | - Michael Seidler
- Department of Diagnostic Imaging, USA; Warren Alpert Medical School of Brown University, USA; Rhode Island Hospital, USA
| | - Scott Collins
- Department of Diagnostic Imaging, USA; Rhode Island Hospital, USA
| | - Jeomsoon Kim
- Department of Medical Physics, USA; Rhode Island Hospital, USA
| | - Damian E Dupuy
- Department of Diagnostic Imaging, USA; Warren Alpert Medical School of Brown University, USA; Rhode Island Hospital, USA.
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Kutlu OC, Chan JA, Aloia TA, Chun YS, Kaseb AO, Passot G, Yamashita S, Vauthey JN, Conrad C. Comparative effectiveness of first-line radiofrequency ablation versus surgical resection and transplantation for patients with early hepatocellular carcinoma. Cancer 2017; 123:1817-1827. [PMID: 28085184 DOI: 10.1002/cncr.30531] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Significant controversy exists as to which treatment modality is most effective for small, solitary hepatocellular carcinomas (HCCs): radiofrequency ablation (RFA), surgical resection (RXN), or transplantation (TXP). Size cutoff values ranging from 20 to 50 mm have been proposed to achieve complete ablation. The current study compares outcomes between RFA, RXN, and TXP as first-line therapy for patients with HCC tumors measuring as large as 50 mm. METHODS The Surveillance, Epidemiology, and End Results database was queried for patients with HCC tumors measuring up to 50 mm who were treated with RFA, RXN, or TXP between 2004 and 2013. Overall survival (OS) and disease-specific survival (DSS) were examined in patients with tumors measuring ≤20 mm, 21 to 30 mm, or 31 to 50 mm. The impact of an increase in tumor size of only 5 mm beyond 30 mm was evaluated by also examining outcomes in patients with tumors measuring 31 to 35 mm. RESULTS Of 1894 cases, patients with HCC tumors measuring ≤20 mm and 21 to 30 mm demonstrated no difference in OS or DSS regardless of whether RFA and RXN was used. RFA was associated with a worse OS and DSS than TXP, whereas there was no difference in OS observed between RXN and TXP. In patients with tumors measuring 31 to 50 mm, OS and DSS were worse with RFA compared with RXN or TXP. Most important, the inferior DSS and OS noted with RFA were observed with only a 5-mm increase in tumors measuring >30 mm. CONCLUSIONS Although RFA frequently is used as first-line treatment of HCC tumors measuring as large as 50 mm, it is associated with worse results than RXN or TXP for tumors measuring >30 mm. To the best of the authors' knowledge, the results of the current study are the first to demonstrate that although RFA is an appropriate option for patients with HCC tumors measuring ≤30 mm, its use for tumors even slightly larger than 30 mm is associated with inferior outcomes. Cancer 2017;123:1817-1827. © 2017 American Cancer Society.
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Affiliation(s)
- Onur C Kutlu
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Division of Surgical Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer A Chan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yun S Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Guillaume Passot
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Suguru Yamashita
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Claudius Conrad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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112
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Radiofrequency Ablation of Hepatocellular Carcinoma with a "Nodule-in-Nodule" Appearance: Long-Term Follow-up and Clinical Implications. Cardiovasc Intervent Radiol 2016; 40:401-409. [PMID: 27933377 DOI: 10.1007/s00270-016-1525-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/01/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) with a "nodule-in-nodule" (NIN) appearance has unique histological characteristics as an early HCC. We assessed long-term therapeutic outcomes of radiofrequency ablation (RFA) in HCC patients considering this appearance. MATERIALS AND METHODS Our Institutional Review Board approved this retrospective study, and the requirement for written informed consent was waived. Between May 2006 and April 2012, a total of 572 patients underwent RFA for single HCC as a first-line treatment. Patients were divided into a NIN HCC group (n = 22) and a non-NIN HCC group (n = 550), according to the NIN feature on pretreatment imaging studies. Local tumor progression (LTP) and disease-free survival (DFS) were compared. Prognostic factors for LTP and DFS were assessed using a Cox proportional hazards model. RESULTS The cumulative LTP rates were 4.6 and 4.6% at 3 and 5 years, respectively, in the NIN HCC group, and 15.9 and 20.5% in the non-NIN HCC group, with borderline statistical significance (p = 0.085). The corresponding DFS rates were 53.8 and 37.7% in the NIN HCC group and 44.0 and 31.7% in the non-NIN HCC group, with no significant difference (p = 0.318). Although on multivariate analysis only tumor size was a significant prognostic factor for LTP, there was a trend bordering on the significance for the NIN feature [hazard ratio (HR) = 0.19; p = 0.099]. However, it was not a significant factor for DFS (HR = 0.18; p = 0.682). CONCLUSIONS The NIN appearance, a rare (4%, 22/550) but unique feature of early HCC, may be a favorable prognostic factor for RFA in terms of local tumor control.
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Ke S, Ding XM, Gao J, Wang SH, Kong J, Xu L, Sun WB. Feasibility of radiofrequency ablation as an alternative to surgical intervention in patients with huge multiloculated pyogenic liver abscesses: A retrospective cohort study. Medicine (Baltimore) 2016; 95:e5472. [PMID: 27930527 PMCID: PMC5265999 DOI: 10.1097/md.0000000000005472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This retrospective cohort study investigated the feasibility of radiofrequency (RF) ablation as an alternative to surgical intervention in patients with huge multiloculated pyogenic liver abscesses (PLAs).From August 2010 to April 2016, 83 patients with PLA were admitted to Beijing Chao-Yang Hospital, China. Four of these patients had huge multiloculated PLAs and underwent RF ablation plus antibiotics. The inclusion criteria for RF ablation were as follows: multiloculated PLA confirmed by computed tomography (CT) or magnetic resonance imaging (MRI), widest diameter of the PLA ≥5 cm, failure to respond to or not suitable to treatment with percutaneous drainage (PD), and patient refusal of surgery. The safety and effectiveness of RF ablation were initially assessed. All patients were commenced on antibiotics on admission to our hospital. CT-guided percutaneous catheter drainage was attempted in one patient but was unsuccessful. The main organism isolated from cultures of these patients' blood or abscess samples was Klebsiella pneumoniae (3/4). RF ablation was performed as soon as eligibility according to the above criteria was established.RF ablation was technically successful in all 4 study patients, all PLAs being completely eradicated. The median duration of fever after RF ablation was 4.5 days. No abscesses recurred; thus, this strategy for managing PLA was 100% successful (4/4). No procedure-related deaths or major complications occurred. One patient had an asymptomatic right pleural effusion that resolved with conservative treatment including albumin infusion and diuretics.Our preliminary data indicate that RF ablation is a safe, feasible, and effective treatment for huge multiloculated PLAs. It should be considered as an alternative treatment for patients who fail to respond to or not suitable for PD plus antibiotics and refuse surgical intervention.
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Takami T, Yamasaki T, Saeki I, Matsumoto T, Suehiro Y, Sakaida I. Supportive therapies for prevention of hepatocellular carcinoma recurrence and preservation of liver function. World J Gastroenterol 2016; 22:7252-7263. [PMID: 27621572 PMCID: PMC4997645 DOI: 10.3748/wjg.v22.i32.7252] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/07/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the deadliest cancers in the world and is associated with a high risk of recurrence. The development of a wide range of new therapies is therefore essential. In this study, from the perspective of supportive therapy for the prevention of HCC recurrence and preservation of liver function in HCC patients, we surveyed a variety of different therapeutic agents. We show that branched chain amino acids (BCAA) supplementation and late evening snack with BCAA, strategies that address issues of protein-energy malnutrition, are important for liver cirrhotic patients with HCC. For chemoprevention of HCC recurrence, we show that viral control after radical treatment is important. We also reviewed the therapeutic potential of antiviral drugs, sorafenib, peretinoin, iron chelators. Sorafenib is a kinase inhibitor and a standard therapy in the treatment of advanced HCC. Peretinoin is a vitamin A-like molecule that targets the retinoid nuclear receptor to induce apoptosis and inhibit tumor growth in HCC cells. Iron chelators, such as deferoxamine and deferasirox, act to prevent cancer cell growth. These chelators may have potential as combination therapies in conjunction with peretinoin. Finally, we review the potential inhibitory effect of bone marrow cells on hepatocarcinogenesis.
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115
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Bo XW, Li XL, Xu HX, Guo LH, Li DD, Liu BJ, Wang D, He YP, Xu XH. 2D shear-wave ultrasound elastography (SWE) evaluation of ablation zone following radiofrequency ablation of liver lesions: is it more accurate? Br J Radiol 2016; 89:20150852. [PMID: 26933911 DOI: 10.1259/bjr.20150852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the usefulness of two-dimensional quantitative ultrasound shear-wave elastography (2D-SWE) [i.e. virtual touch imaging quantification (VTIQ)] in assessing the ablation zone after radiofrequency ablation (RFA) for ex vivo swine livers. METHODS RFA was performed in 10 pieces of fresh ex vivo swine livers with a T20 electrode needle and 20-W output power. Conventional ultrasound, conventional strain elastography (SE) and VTIQ were performed to depict the ablation zone 0 min, 10 min, 30 min and 60 min after ablation. On VTIQ, the ablation zones were evaluated qualitatively by evaluating the shear-wave velocity (SWV) map and quantitatively by measuring the SWV. The ultrasound, SE and VTIQ results were compared against gross pathological and histopathological specimens. RESULTS VTIQ SWV maps gave more details about the ablation zone, the central necrotic zone appeared as red, lateral necrotic zone as green and transitional zone as light green, from inner to exterior, while the peripheral unablated liver appeared as blue. Conventional ultrasound and SE, however, only marginally depicted the whole ablation zone. The volumes of the whole ablation zone (central necrotic zone + lateral necrotic zone + transitional zone) and necrotic zone (central necrotic zone + lateral necrotic zone) measured by VTIQ showed excellent correlation (r = 0.915, p < 0.001, and 0.856, p = 0.002, respectively) with those by gross pathological specimen, whereas both conventional ultrasound and SE underestimated the volume of the whole ablation zone. The SWV values of the central necrotic zone, lateral necrotic zone, transitional zone and unablated liver parenchyma were 7.54-8.03 m s(-1), 5.13-5.28 m s(-1), 3.31-3.53 m s(-1) and 2.11-2.21 m s(-1), respectively (p < 0.001 for all the comparisons). The SWV value for each ablation zone did not change significantly at different observation times within an hour after RFA (all p > 0.05). CONCLUSION The quantitative 2D-SWE of VTIQ is useful for the depiction of the ablation zone after RFA and it facilitates discrimination of different areas in the ablation zone qualitatively and quantitatively. This elastography technique might be useful for the therapeutic response evaluation instantly after RFA. ADVANCES IN KNOWLEDGE A new quantitative 2D-SWE (i.e. VTIQ) for evaluation treatment response after RFA is demonstrated. It facilitates discrimination of the different areas in the ablation zone qualitatively and quantitatively and may be useful for the therapeutic response evaluation instantly after RFA in the future.
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Affiliation(s)
- Xiao W Bo
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao L Li
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui X Xu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,3 Department of Ultrasound, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
| | - Le H Guo
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Dan D Li
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Bo J Liu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Dan Wang
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Ya P He
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao H Xu
- 3 Department of Ultrasound, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
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He ZX, Xiang P, Gong JP, Cheng NS, Zhang W. Radiofrequency ablation versus resection for Barcelona clinic liver cancer very early/early stage hepatocellular carcinoma: a systematic review. Ther Clin Risk Manag 2016; 12:295-303. [PMID: 26966370 PMCID: PMC4770065 DOI: 10.2147/tcrm.s96760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim To compare the long-term survival outcomes of radiofrequency ablation and liver resection for single very early/early stage hepatocellular carcinoma (HCC). Methods The Cochrane Library (Issue 3, 2015), Embase (1974 to March 15, 2015), PubMed (1950 to March 15, 2015), Web of Science (1900 to March 15, 2015), and Chinese Biomedical Literature Database (1978 to March 15, 2015) were searched to identify relevant trials. Only trials that compared radiofrequency ablation and liver resection for single very early stage (≤2 cm) or early stage (≤3 cm) HCC according to the Barcelona clinic liver cancer (BCLC) staging system were considered for inclusion in this review. The primary outcomes that we analyzed were the 3-year and 5-year overall survival (OS) rates, and the secondary outcomes that we analyzed were the 3-year and 5-year disease-free survival (DFS) rates. Review Manager 5.3 was used to perform a cumulative meta-analysis. Possible publication bias was examined using a funnel plot. A random-effects model was applied to summarize the various outcomes. Results Six studies involving 947 patients were identified that compared radiofrequency ablation (n=528) to liver resection (n=419) for single BCLC very early HCC. In these six studies, the rates of 3-year OS, 5-year OS, 3-year DFS, and 5-year DFS were significantly lower in the radiofrequency ablation group than in the liver resection group (risk ratio [RR] =0.90, 95% confidence interval [CI]: 0.83–0.98, P=0.01; RR =0.84, 95% CI: 0.75–0.95, P=0.004; RR =0.77, 95% CI: 0.60–0.98, P=0.04; and RR =0.70, 95% CI: 0.52–0.94, P=0.02, respectively). Ten studies involving 2,501 patients were identified that compared radiofrequency ablation (n=1,476) to liver resection (n=1,025) for single BCLC early HCC. In these ten studies, the rates of 3-year OS, 5-year OS, 3-year DFS, and 5-year DFS were also significantly lower in the radiofrequency ablation group than in the liver resection group (RR =0.93, 95% CI: 0.88–0.98, P=0.003; RR =0.84, 95% CI: 0.75–0.94, P=0.002; RR =0.72, 95% CI: 0.58–0.89, P=0.002; and RR =0.47, 95% CI: 0.33–0.67, P<0.0001, respectively). Conclusion The long-term survival outcomes for patients with single BCLC very early/early stage HCC appear to be superior after liver resection compared to radiofrequency ablation.
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Affiliation(s)
- Zhen-Xin He
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Pu Xiang
- State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, People's Republic of China
| | - Jian-Ping Gong
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Nan-Sheng Cheng
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wei Zhang
- Department of Hepatobiliary Surgery, Yue Bei People's Hospital, Shaoguan, Guangdong, People's Republic of China
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Mazzanti R, Arena U, Tassi R. Hepatocellular carcinoma: Where are we? World J Exp Med 2016; 6:21-36. [PMID: 26929917 PMCID: PMC4759352 DOI: 10.5493/wjem.v6.i1.21] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/14/2015] [Accepted: 01/05/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the second cause of death due to malignancy in the world, following lung cancer. The geographic distribution of this disease accompanies its principal risk factors: Chronic hepatitis B virus and hepatitis C virus infection, alcoholism, aflatoxin B1 intoxication, liver cirrhosis, and some genetic attributes. Recently, type II diabetes has been shown to be a risk factor for HCC together with obesity and metabolic syndrome. Although the risk factors are quite well known and it is possible to diagnose HCC when the tumor is less than 1 cm diameter, it remains elusive at the beginning and treatment is often unsuccessful. Liver transplantation is thus far considered the best treatment for HCC as it cures HCC and the underlying liver disease. Using the Milan criteria, overall survival after liver transplantation for HCC is about 70% after 5 years. Many attempts have been made to go beyond the Milan Criteria and according to recent works reasonably good results have been achieved by using a histochemical marker such as cytokeratine 19 and the so-called "up to seven criteria" to divide patients into categories according to their risk of relapse. In addition to liver transplantation other therapies have been proposed such as resection, tumor ablation by different means, embolization and chemotherapy. An important step in the treatment of advanced HCC has been the introduction of sorafenib, the first oral, systemic drug that has provided significant improvement in survival. Treatment of HCC patients must be multidisciplinary and by using the different approaches discussed in this review it is possible to offer prolonged survival and quite good and sometimes even excellent quality of life to many patients.
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Pompili M, Francica G. Role of ablation: should it be used as primary therapy for early-stage hepatocellular carcinoma? Hepat Oncol 2015; 2:339-342. [PMID: 30191015 DOI: 10.2217/hep.15.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Maurizio Pompili
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampiero Francica
- Diagnostic & Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy.,Diagnostic & Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy
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Hocquelet A, Balageas P, Laurent C, Blanc JF, Frulio N, Salut C, Cassinotto C, Saric J, Possenti L, Bernard PH, Montaudon M, Trillaud H. Radiofrequency ablation versus surgical resection for hepatocellular carcinoma within the Milan criteria: A study of 281 Western patients. Int J Hyperthermia 2015; 31:749-57. [DOI: 10.3109/02656736.2015.1068382] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Tumor size is a major determinant of prognosis of resected stage I hepatocellular carcinoma. Langenbecks Arch Surg 2015; 400:725-34. [DOI: 10.1007/s00423-015-1329-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023]
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