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Chiang CL, Chan MKH, Yeung CSY, Ho CHM, Lee FAS, Lee VWY, Wong FCS, Blanck O. Combined stereotactic body radiotherapy and trans-arterial chemoembolization as initial treatment in BCLC stage B-C hepatocellular carcinoma. Strahlenther Onkol 2018; 195:254-264. [PMID: 30413833 DOI: 10.1007/s00066-018-1391-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/17/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE We retrospectively evaluated the efficacy and safety of stereotactic body radiotherapy (SBRT) combined with trans-arterial chemoembolization (TACE) as initial therapy in Barcelona Clinic Liver Cancer (BCLC) system stage B-C hepatocellular carcinoma (HCC). PATIENTS AND METHODS Seventy-two patients received a single dose of TACE followed by SBRT 4 weeks later. All patients had tumor sizes ≥5 cm, at least 700 ml of disease-free liver, Child-Pugh (CP) score ≤ B7 and tumor nodules ≤5. SBRT dose, ranging from 6 × 5-8 Gy or 5-10 × 4 Gy, was individualized according to normal tissue constraints. No subsequent scheduled treatment was delivered unless disease progression was observed. Local control (LC), overall survival (OS), progression-free survival (PFS), response rate (RR), and toxicity were evaluated. RESULTS The patients' characteristics were: median age 60 years (range 28-87 years); CP score A/B (n = 68/4); BCLC stage B/C (n = 51/21); solitary/multifocal (n = 37/35); portal vein invasion (n = 18). The median tumor size and GTV were 11.2 cm (range 5.0-23.6 cm) and 751 cm3 (range 41-4009 cm3), respectively. The median equivalent dose in 2 Gy per fraction (EQD2, α/β = 10) was 37.3 Gy2 (range, 28-72 Gy2). The median follow-up time was 16.8 months (range, 3-96 months). The objective RR was 68% and the 1‑year LC rate was 93.6% (95% CI, 87.6-100%). The median OS was 19.8 months (95% CI, 11.6-30.6 months). SBRT-related grade 3 or higher adverse gastrointestinal events and treatment-related death occurred in three (2.8%) and one patient (1.4%) respectively. No patient developed classical radiation-induced liver injury. CONCLUSION Our experience suggests that combined TACE and SBRT can be a safe and effective initial therapy for BCLC stage B-C HCC with appropriate patient selection. Further prospective trials are warranted.
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Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China.,Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.,Department of Clinical Oncology, University of Hong Kong-Shenzhen Hospital, Hong Kong, China
| | - Mark K H Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China. .,Department of Radiation Oncology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany.
| | - Cynthia S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Connie H M Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Francis A S Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Venus W Y Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Frank C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Oliver Blanck
- Department of Radiation Oncology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
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202
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Carville KS, MacLachlan JH, Thursfield V, Cowie BC. Hepatocellular carcinoma over three decades in Victoria, Australia: epidemiology, diagnosis and trends, 1984-2013. Intern Med J 2018; 48:835-844. [PMID: 29604152 DOI: 10.1111/imj.13823] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Liver cancer continues to be a health priority in Australia, with the majority attributable to preventable causes, and certain populations at higher risk. AIMS Epidemiological assessment of incidence, trends and distribution to inform prevention, and reassessment of data in light of recent changes to registry case definitions. METHODS Reported cases of hepatocellular carcinoma (HCC) in Victoria, Australia, 1984-2013, were obtained from the Victorian Cancer Registry. Demographic characteristics were examined, incidence and survival assessed using Poisson and Cox regression, and geographic distribution mapped. Incidence was compared before and after inclusion of non-histologically confirmed cases in Registry data to assess impacts on incidence trends. RESULTS Diagnoses of HCC rose substantially between 1984 and 2013, increasing sixfold from 0.9 to 5.9 per 100 000. The rate of increase per year accelerated from 5.3% between 1984 and 2003 to 9.5% between 2004 and 2013. Cases were disproportionately male (80%), median age at diagnosis was 66 years and 53% were born overseas. Even during 2004-2013, 5-year survival was only 16%, although higher among younger people, metropolitan residents and people born overseas. Incidence showed strong geographic clustering. The proportion of cases diagnosed clinically increased from 1% during 1984-2004 to 43% in 2009-2013. The revised case definition added 993 cases (27.3% of total). CONCLUSION Cases of HCC are becoming increasingly common, and revised incidence estimates highlight the impact of case definitions in the context of changing diagnostic approaches. The ongoing burden, disproportionate population distribution and low survival emphasise the importance of prevention and early detection as a public health imperative.
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Affiliation(s)
- Kylie S Carville
- Epidemiology Unit, The Doherty Institute, Melbourne, Victoria, Australia
| | - Jennifer H MacLachlan
- Epidemiology Unit, The Doherty Institute, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Vicky Thursfield
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Benjamin C Cowie
- Epidemiology Unit, The Doherty Institute, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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203
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Chen Q, Shu C, Laurence AD, Chen Y, Peng BG, Zhen ZJ, Cai JQ, Ding YT, Li LQ, Zhang YB, Zheng QC, Xu GL, Li B, Zhou WP, Cai SW, Wang XY, Wen H, Peng XY, Zhang XW, Dai CL, Bie P, Xing BC, Fu ZR, Liu LX, Mu Y, Zhang L, Zhang QS, Jiang B, Qian HX, Wang YJ, Liu JF, Qin XH, Li Q, Yin P, Zhang ZW, Chen XP. Effect of Huaier granule on recurrence after curative resection of HCC: a multicentre, randomised clinical trial. Gut 2018; 67:2006-2016. [PMID: 29802174 DOI: 10.1136/gutjnl-2018-315983] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE There is little evidence that adjuvant therapy after radical surgical resection of hepatocellular carcinoma (HCC) improves recurrence-free survival (RFS) or overall survival (OS). We conducted a multicentre, randomised, controlled, phase IV trial evaluating the benefit of an aqueous extract of Trametes robinophila Murr (Huaier granule) to address this unmet need. DESIGN AND RESULTS A total of 1044 patients were randomised in 2:1 ratio to receive either Huaier or no further treatment (controls) for a maximum of 96 weeks. The primary endpoint was RFS. Secondary endpoints included OS and tumour extrahepatic recurrence rate (ERR). The Huaier (n=686) and control groups (n=316) had a mean RFS of 75.5 weeks and 68.5 weeks, respectively (HR 0.67; 95% CI 0.55 to 0.81). The difference in the RFS rate between Huaier and control groups was 62.39% and 49.05% (95% CI 6.74 to 19.94; p=0.0001); this led to an OS rate in the Huaier and control groups of 95.19% and 91.46%, respectively (95% CI 0.26 to 7.21; p=0.0207). The tumour ERR between Huaier and control groups was 8.60% and 13.61% (95% CI -12.59 to -2.50; p=0.0018), respectively. CONCLUSIONS This is the first nationwide multicentre study, involving 39 centres and 1044 patients, to prove the effectiveness of Huaier granule as adjuvant therapy for HCC after curative liver resection. It demonstrated a significant prolongation of RFS and reduced extrahepatic recurrence in Huaier group. TRIAL REGISTRATION NCT01770431; Post-results.
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Affiliation(s)
- Qian Chen
- Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Chang Shu
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, HUST, Wuhan, China.,Hepatic Surgery Centre at Tongji Hospital, Tongji Medical College, HUST, Wuhan, China.,Surgery administrator office at Tongji Hospital, Tongji Medical College, Hust, Wuhan, China
| | - Arian D Laurence
- Hematology Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust at Freeman Hospital, Newcastle, UK
| | - Yan Chen
- Hepatic Surgery Centre at Tongji Hospital, Tongji Medical College, HUST, Wuhan, China.,Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Public Health, Wuhan, China.,Hubei Province for the Clinical Medicine Research Center of Hepatic Surgery, Wuhan, China
| | - Bao-Gang Peng
- Surgery Department, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zuo-Jun Zhen
- Surgery Department, First People's Hospital, Foshan, China
| | - Jian-Qiang Cai
- Surgery Department, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China
| | - Yi-Tao Ding
- Surgery Department, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Le-Qun Li
- Surgery Department, Cancer Hospital Affiliated to Guangxi Medical University, Nanning, China
| | - Yu-Bao Zhang
- Surgery Department, Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qi-Chang Zheng
- Surgery Department, Wuhan Union Hospital of HUST, Wuhan, China
| | - Ge-Liang Xu
- Surgery Department, Shengli Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Bo Li
- Surgery Department, West China Hospital of Sichuan University, Chengdu, China
| | - Wei-Ping Zhou
- Surgery Department, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Shou-Wang Cai
- Surgery Department, Chinese PLA General Hospital of Medical School of Chinese PLA, Beijing, China
| | - Xi-Yan Wang
- Surgery Department, Cancer Hospital Affiliated to Xinjiang Medical University, Urumqi, China
| | - Hao Wen
- Surgery Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xin-Yu Peng
- Surgery Department, First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, China
| | - Xue-Wen Zhang
- Surgery Department, China and Japan Union Hospital of Jilin Hospital, Changchun, China
| | - Chao-Liu Dai
- Surgery Department, Shengjing Hospital of China Medial University, Shenyang, China
| | - Ping Bie
- Surgery Department, Southwest University Hospital, Chongqing, China
| | - Bao-Cai Xing
- Surgery Department, Beijing Cancer Hospital, Beijing, China
| | - Zhi-Ren Fu
- Surgery Department, Shanghai Changzheng Hospital, Shanghai, China
| | - Lian-Xin Liu
- Surgery Department, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yi Mu
- Surgery Department, Beijing Ditan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Ling Zhang
- Surgery Department, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Qi-Shun Zhang
- Surgery Department, Guangxi Liuzhou Worker's Hospital, Liuzhou, China
| | - Bin Jiang
- Surgery Department, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan, China
| | - Hai-Xin Qian
- Surgery Department, First Affiliated Hospital of Suzhou Medical University, Suzhou, China
| | - Yi-Jun Wang
- Surgery Department, Tianjin No.3 Hospital, Tianjin, China
| | - Jing-Feng Liu
- Surgery Branch at the Hospital of Infectious and Contagious Diseases Affiliated to Fujian Medical University, Fuzhou, China
| | - Xi-Hu Qin
- Surgery Department, Third People's Hospital of Changzhou, Changzhou, China
| | - Qiang Li
- Surgery Department, Tianjin Medical University Cancer Institute and Hospital (TMUCIH), Tianjin, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, HUST, Wuhan, China
| | - Zhi-Wei Zhang
- Hepatic Surgery Centre at Tongji Hospital, Tongji Medical College, HUST, Wuhan, China.,Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Public Health, Wuhan, China.,Hubei Province for the Clinical Medicine Research Center of Hepatic Surgery, Wuhan, China
| | - Xiao-Ping Chen
- Hepatic Surgery Centre at Tongji Hospital, Tongji Medical College, HUST, Wuhan, China.,Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Public Health, Wuhan, China.,Hubei Province for the Clinical Medicine Research Center of Hepatic Surgery, Wuhan, China
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204
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Suh JK, Lee J, Lee JH, Shin S, Tchoe HJ, Kwon JW. Risk factors for developing liver cancer in people with and without liver disease. PLoS One 2018; 13:e0206374. [PMID: 30372481 PMCID: PMC6205612 DOI: 10.1371/journal.pone.0206374] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 10/11/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The National Liver Cancer Surveillance Program (NLCSP) targets patients with liver diseases that lead to liver cancer in South Korea. This study aimed to investigate the risk of liver disease leading to liver cancer using nationally representative data to establish an efficient NLCSP. METHODS This study used data from the National Health Insurance Service National Sample Cohort (NHIS-NSC) from 2002 to 2013. A retrospective matched cohort design was applied to compare the development of liver cancer in patients with and without liver disease. Cox- proportional hazard regression for liver cancer with competing risk of death was performed for all subjects or each group stratified according to age or income level. RESULTS A total of 66,192 patients with liver disease and matched subjects without liver disease were included in the study. The incidences of liver cancer among patients with and without liver disease within a median 8-year follow-up period were 2.68% (n = 1,772) and 0.34% (n = 210), respectively. Cox- regression analysis for liver cancer incidence indicated that cirrhosis had the highest risk (hazard ratio [HR]: 18.13, 95% confidence interval [CI]: 15.24-21.58), followed by hepatitis B (HR: 9.32, 95% CI: 8.00-10.85). Subgroup analysis showed that the presence of liver disease was an important risk factor in younger as well as elderly people, and a higher risk of liver disease was also observed in the patients with Medicaid. CONCLUSIONS Attention should be paid to the development of liver cancer in young people under 50 years old and preventive efforts to decrease the incidence of liver cancer among Medicaid recipients is needed.
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Affiliation(s)
- Jae Kyung Suh
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Jayoun Lee
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Jeong-Hoon Lee
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sangjin Shin
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Ha jin Tchoe
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Jin-Won Kwon
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Dae-gu, Korea
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205
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Purcell Y, Copin P, Paulatto L, Pommier R, Vilgrain V, Ronot M. Hepatocellular carcinoma surveillance: Eastern and Western perspectives. Ultrasonography 2018; 38:191-199. [PMID: 30690962 PMCID: PMC6595126 DOI: 10.14366/usg.18043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/28/2018] [Indexed: 12/21/2022] Open
Abstract
Eastern and Western guidelines for the management of hepatocellular carcinoma (HCC) are known to significantly differ on many points, because they reflect different diagnostic and therapeutic approaches to this cancer. Importantly, these guidelines are primarily consensus-driven when it comes to surveillance, both in term of the tests used and surveillance program design. The main difference between East and West lies in clinical practice, as several Eastern countries implement coordinated and systematic surveillance programs, while most Western countries rely on individual adherence to surveillance recommendations. This review article presents an overview of the evidence supporting surveillance programs for HCC, with a particular focus on the efficacy, cost-effectiveness, and consequences of this approach for patient survival. Western and Eastern guideline recommendations are discussed.
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Affiliation(s)
- Yvonne Purcell
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Clichy, France
| | - Pauline Copin
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Clichy, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Luisa Paulatto
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Clichy, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Romain Pommier
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Clichy, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Clichy, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Maxime Ronot
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Clichy, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
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206
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Hyun D, Cho SK, Shin SW, Park KB, Lee SY, Park HS, Choo SW, Do YS. Combined transarterial chemoembolization of the right inferior phrenic artery and radiofrequency ablation for small hepatocellular carcinoma near the diaphragm: its efficacy and safety. Abdom Radiol (NY) 2018; 43:2851-2858. [PMID: 29492603 DOI: 10.1007/s00261-018-1515-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of the study is to report the efficacy and safety of combined transarterial chemoembolization (TACE) of the right inferior phrenic artery (IPA) and radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC) near the diaphragm supplied by the right IPA. METHODS From July 2009 through April 2015, 11 patients with small (≤ 3 cm) HCC near the diaphragm, which was infeasible for ultrasound-guided RFA and supplied by the right IPA, received TACE of the right IPA and subsequent RFA in one session. The safety and therapeutic efficacy, including technique effectiveness and local tumor progression (LTP), were evaluated. RESULTS Technique effectiveness was achieved in all the 11 patients (100%). During average follow-up period of 39.2 months (range 13-89 months), LTP occurred in none of the 11 patients. There were twelve minor complications in eight patients, including right shoulder pain (n = 4), right pleural effusion (n = 2), diaphragmatic thickening (n = 2), transient lung change (n = 2), subsegmental intrahepatic bile duct stricture (n = 1), and subsegmental hepatic infarction (n = 1). No major complications were encountered CONCLUSION: Combined TACE of the right IPA and RFA can be a safe and effective treatment for small HCC near the diaphragm that is supplied by the right IPA.
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Affiliation(s)
- Dongho Hyun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Sung Ki Cho
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
| | - Sung Wook Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Kwang Bo Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Sang Yub Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu, 41944, Korea
| | - Hong Suk Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Sung Wook Choo
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Young Soo Do
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
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207
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Chang PY, Huang CC, Hung CH, Yu CY, Wu DK, Hwang JI, Liang PC, Wu RH, Tsai WL, Lin YJ, Liu YS, Liang HL, Lee RC, Chen CH. Multidisciplinary Taiwan Consensus Recommendations for the Use of DEBDOX-TACE in Hepatocellular Carcinoma Treatment. Liver Cancer 2018; 7:312-322. [PMID: 30488021 PMCID: PMC6249590 DOI: 10.1159/000487608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 02/11/2018] [Indexed: 02/04/2023] Open
Abstract
Transarterial chemoembolization (TACE) is the first-line treatment in patients with unresectable hepatocellular carcinoma (HCC). In recent years, there has been increasing clinical evidence that drug-eluting beads provide a combined ischemic and cytotoxic effect that may be superior to conventional TACE, with low systemic toxicity. The therapeutic value of TACE performed using the embolic microsphere DC Bead loaded with doxorubicin (drug-eluting bead doxorubicin [DEBDOX]) has been shown by several randomized controlled trials. Since Lencioni et al. [Cardiovasc Intervent Radiol 2012; 35: 980-985] published the first widely accepted technical recommendations on HCC embolization with DEBDOX-TACE in 2012, new studies have contributed to a better understanding of when and how to apply this new therapeutic modality, and they have yet to be incorporated into an updated guideline. Additionally, differences in the underlying liver pathology and practice of transcatheter embolization between Asian and Western populations have not been adequately addressed, and there remain significant variations in the TACE protocols adopted in different parts of the world. These mainly revolve around the number and type of chemotherapeutic agents used, type of embolic material, reliance on Lipiodol, and selectivity of catheter positioning. As a result of these issues, it has been difficult to interpret and compare results obtained from different centers in a systematic fashion. To address these concerns, we convened a panel of experts specializing in different aspects of HCC treatment to craft an updated set of recommendations that better reflect recent clinical experiences and are tailored to the use of DEBDOX-TACE in Taiwan. The conclusions of this expert panel are described in the following article.
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Affiliation(s)
- Pi-Yi Chang
- Department of Radiology, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Chun-Chieh Huang
- Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Chao-Hung Hung
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Chih-Yung Yu
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan
| | - Ding-Kwo Wu
- Department of Radiology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung City, Taiwan
| | - Jen-I Hwang
- Department of Radiology, Tungs' Taichung Metro Harbor Hospital, Taichung City, Taiwan
| | - Po-Chin Liang
- Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Reng-Hong Wu
- Department of Radiology, Chi Mei Hospital, Tainan City, Taiwan
| | - Wei-Lun Tsai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Yih-Jyh Lin
- Department of Surgery, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Yi-Sheng Liu
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Hung Chen
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch and National Taiwan University College of Medicine, Douliu City, Taiwan,*Chien-Hung Chen, MD, PhD, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, and National Taiwan University College of Medicine, No. 579, Sec. 2, Yunlin Road, Douliu City, Yunlin County 640 (Taiwan), E-Mail
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208
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Chernyak V, Fowler KJ, Kamaya A, Kielar AZ, Elsayes KM, Bashir MR, Kono Y, Do RK, Mitchell DG, Singal AG, Tang A, Sirlin CB. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients. Radiology 2018; 289:816-830. [PMID: 30251931 DOI: 10.1148/radiol.2018181494] [Citation(s) in RCA: 606] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) is composed of four individual algorithms intended to standardize the lexicon, as well as reporting and care, in patients with or at risk for hepatocellular carcinoma in the context of surveillance with US; diagnosis with CT, MRI, or contrast material-enhanced US; and assessment of treatment response with CT or MRI. This report provides a broad overview of LI-RADS, including its historic development, relationship to other imaging guidelines, composition, aims, and future directions. In addition, readers will understand the motivation for and key components of the 2018 update.
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Affiliation(s)
- Victoria Chernyak
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Kathryn J Fowler
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Aya Kamaya
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Ania Z Kielar
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Khaled M Elsayes
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Mustafa R Bashir
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Yuko Kono
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Richard K Do
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Donald G Mitchell
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Amit G Singal
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - An Tang
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Claude B Sirlin
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
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209
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Shui Y, Yu W, Ren X, Guo Y, Xu J, Ma T, Zhang B, Wu J, Li Q, Hu Q, Shen L, Bai X, Liang T, Wei Q. Stereotactic body radiotherapy based treatment for hepatocellular carcinoma with extensive portal vein tumor thrombosis. Radiat Oncol 2018; 13:188. [PMID: 30253783 PMCID: PMC6157064 DOI: 10.1186/s13014-018-1136-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/20/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND There is currently no worldwide consensus for the management of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). We evaluated the efficacy of stereotactic body radiotherapy (SBRT) as the initial treatment for HCC with extensive PVTT based on a relatively large number of patients. METHODS In our multidisciplinary approach for patients with hepatobiliary tumors, SBRT is recommended for unresectable HCC with PVTT or those with contraindication for transarterial chemoembolization (TACE). The aim is to shrink the tumor thrombus and preserve adequate portal venous flow, thus facilitating subsequent treatments such as TACE and tumor resection. In the present study, 70 continuous cases of HCC patients with extensive PVTT initially treated with SBRT were studied. The median follow-up period was 9.5 months (range, 1.0-21.0 months). The dynamic changes of tumor thrombosis with time after SBRT were also analyzed. RESULTS The median survival time for the whole group was 10.0 months (95% CI, 7.7-12.3 months), with a 6- and 12-month overall survival (OS) rate of 67.3%, and 40.0% respectively. Patients who received combined SBRT and TACE showed significantly longer OS than those without indication for TACE after SBRT (12.0 ± 1.6 vs. 3.0 ± 1.0 months). Patients with good response to radiation usually had better survival. SBRT was well tolerated in our patient series. CONCLUSIONS In conclusion, SBRT used as the initial treatment for HCC patients with extensive PVTT originally unsuitable for resection or TACE can achieve adequate thrombus shrinkage and portal vein flow restoration in the majority of cases. It could thus offer the patients an opportunity to undergo further treatment such as resection or TACE procedure. Such therapeutic strategy may result in survival advantage, especially for those who do receive combined modality with SBRT.
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Affiliation(s)
- Yongjie Shui
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China
| | - Wei Yu
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China.,Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University Cancer Institute, Hangzhou, 310009, People's Republic of China
| | - Xiaoqiu Ren
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China.,Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University Cancer Institute, Hangzhou, 310009, People's Republic of China
| | - Yinglu Guo
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China.,Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University Cancer Institute, Hangzhou, 310009, People's Republic of China
| | - Jing Xu
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China.,Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University Cancer Institute, Hangzhou, 310009, People's Republic of China
| | - Tao Ma
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial Key Laboratory of Pancreatic Disease, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Bicheng Zhang
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China
| | - Jianjun Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Qinghai Li
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Qiongge Hu
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China
| | - Li Shen
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China
| | - Xueli Bai
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial Key Laboratory of Pancreatic Disease, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial Key Laboratory of Pancreatic Disease, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Qichun Wei
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China. .,Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University Cancer Institute, Hangzhou, 310009, People's Republic of China.
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210
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Rastogi A. Changing role of histopathology in the diagnosis and management of hepatocellular carcinoma. World J Gastroenterol 2018; 24:4000-4013. [PMID: 30254404 PMCID: PMC6148422 DOI: 10.3748/wjg.v24.i35.4000] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common and fatal cancer in the world. HCC frequently presents with advanced disease, has a high recurrence rate and limited treatment options, which leads to very poor prognosis. This warrants urgent improvement in the diagnosis and treatment. Liver biopsy plays very important role in the diagnosis and prognosis of HCC, but with technical advancements and progression in the field of imaging, clinical guidelines have restricted the role of biopsy to very limited situations. Biopsy also has its own problems of needle tract seeding of tumor, small risk of complications, technical and sampling errors along with interpretative errors. Despite this, tissue analysis is often required because imaging is not always specific, limited expertise and lack of advanced imaging in many centers and limitations of imaging in the diagnosis of small, mixed and other variant forms of HCC. In addition, biopsy confirmation is often required for clinical trials of new drugs and targeted therapies. Tissue biomarkers along with certain morphological features, phenotypes and immune-phenotypes that serve as important prognostic and outcome predictors and as decisive factors for therapy decisions, add to the continuing role of histopathology. Advancements in cancer biology and development of molecular classification of HCC with clinic pathological correlation, lead to discovery of HCC phenotypic surrogates of prognostic and therapeutically significant molecular signatures. Thus tissue characteristics and morphology based correlates of molecular subtypes provide invaluable information for management and prognosis. This review thus focuses on the importance of histopathology and resurgence of role of biopsy in the diagnosis, management and prognostication of HCC.
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Affiliation(s)
- Archana Rastogi
- Department of Pathology, Institute of Liver & Biliary Sciences, New Delhi 110070, India
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211
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Diagnostic accuracy of contrast-enhanced dynamic CT for small hypervascular hepatocellular carcinoma and assessment of dynamic enhancement patterns: Results of two-year follow-up using cone-beam CT hepatic arteriography. PLoS One 2018; 13:e0203940. [PMID: 30231076 PMCID: PMC6145528 DOI: 10.1371/journal.pone.0203940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate the accuracy of CT for small, hypervascular hepatocellular carcinomas (HCCs) and assess the enhancement patterns on CT. Materials and methods Ninety-nine patients who underwent cone-beam CT hepatic arteriography (CBCT-HA) during initial chemoembolization for HCC suspected on CT were enrolled in this study. A total of 297 hypervascular HCCs (142 ≥ 1 cm, 155 < 1 cm) were confirmed as HCCs based on two-year follow-up CT and CBCT-HA images. During the two-year follow-up, pre-existing hypervascular foci on CBCT-HA were regarded as HCCs at the initial presentation. Two radiologists categorized HCCs according to the following enhancement patterns on CT: type I, arterial enhancement and washout; type II, arterial enhancement without washout; and type III, no arterial enhancement. Two blinded reviewers rated the possibility of HCC. Results For the 297 HCCs, the enhancement patterns according to size were as follows: type I ≥1 cm in 114 HCCs; type I <1 cm in 40 HCCs; type II ≥1 cm in 16 HCCs; type II <1 cm in 37 HCCs; type III ≥1 cm in 12 HCCs; and type III <1 cm in 10 HCCs. The remaining 68 HCCs (22.9%) were not detected on CT. The detection rates of HCCs ≥ 1 cm were 83.1%, 76.8%, and 83.1% in the formal report for reviewer 1 and reviewer 2. In comparison, the detection rates of HCCs < 1 cm were 20.6%, 17.4%, and 17.4% in the formal report for reviewer 1 and reviewer 2. Conclusion Many subcentimeter sized hypervascular HCCs were frequently missed or not evident on CT at the initial diagnostic workup. CT has limitations for diagnosing HCCs that are <1 cm in size or have atypical enhancement patterns.
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212
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Lin CC, Wu CH, Chen LY, Tsai MC, Elsarawy AM, Huang KT. Coagulation factor VII gene polymorphisms are not associated with the occurrence or the survival of hepatocellular carcinoma: a report of 37 cases. Cancer Biol Med 2018; 15:275-281. [PMID: 30197794 PMCID: PMC6121054 DOI: 10.20892/j.issn.2095-3941.2017.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective : Coagulation factor VII (FVII) triggers the extrinsic pathway of blood coagulation. In our previous study, we showed that FVII plays an important role in tumorigenesis of hepatocellular carcinoma (HCC). However, the role of FVII polymorphism in HCC is still unknown. The present study aimed to investigate the relationship between HCC carcinogenesis and single nucleotide polymorphism of FVII. Methods : Thirty-seven HCC patients and 30 healthy donors were recruited in this study. Four common FVII gene polymorphisms - a decanucleotide insertion at position -323 (-323ins10-bp), a G to T substitution at position -401 (-401G/T), a G to A substitution at position -402 (-402G/A), and a T to C substitution at position -122 (-122T/C) - were analyzed by sequencing or commercialized assays using genomic DNA isolated from blood samples. Clinicopathological parameters between control and HCC subjects were compared according to the specific genotypes. Results : The most common nucleotide variation was -402G/A. However, no statistically significant difference was observed between healthy controls and HCC subjects for all four polymorphisms in terms of genotype distribution and allele frequencies, indicating that these polymorphisms may not affect HCC tumorigenesis. Furthermore, no association was found between -402G/A polymorphisms and tumor stage, recurrence, and overall survival. Conclusions : Our results indicate that FVII polymorphisms may not be a key factor that clinically impact tumorigenesis and outcomes of HCC, although further investigations should be conducted to confirm our findings.
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Affiliation(s)
- Chih-Che Lin
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan, China
| | - Chun-Hsien Wu
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan, China.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan, China
| | - Li-Yu Chen
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan, China.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan, China
| | - Ming-Chao Tsai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan, China
| | - Ahmed M Elsarawy
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan, China
| | - Kuang-Tzu Huang
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan, China.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan, China
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213
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Chen LD, Ruan SM, Liang JY, Yang Z, Shen SL, Huang Y, Li W, Wang Z, Xie XY, Lu MD, Kuang M, Wang W. Differentiation of intrahepatic cholangiocarcinoma from hepatocellular carcinoma in high-risk patients: A predictive model using contrast-enhanced ultrasound. World J Gastroenterol 2018; 24:3786-3798. [PMID: 30197484 PMCID: PMC6127655 DOI: 10.3748/wjg.v24.i33.3786] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/30/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To develop a contrast-enhanced ultrasound (CEUS) predictive model for distinguishing intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) in high-risk patients.
METHODS This retrospective study consisted of 88 consecutive high-risk patients with ICC and 88 high-risk patients with HCC selected by propensity score matching between May 2004 and July 2016. Patients were assigned to two groups, namely, a training set and validation set, at a 1:1 ratio. A CEUS score for diagnosing ICC was generated based on significant CEUS features. Then, a nomogram based on the CEUS score was developed, integrating the clinical data. The performance of the nomogram was then validated and compared with that of the LR-M of the CEUS Liver Imaging Reporting and Data System (LI-RADS).
RESULTS The most useful CEUS features for ICC were as follows: rim enhancement (64.5%), early washout (91.9%), intratumoral vein (58.1%), obscure boundary of intratumoral non-enhanced area (64.5%), and marked washout (61.3%, all P < 0.05). In the validation set, the area under the curve (AUC) of the CEUS score (AUC = 0.953) for differentiation between ICC and HCC was improved compared to the LI-RADS (AUC = 0.742) (P < 0.001). When clinical data were added, the CEUS score nomogram was superior to the LI-RADS nomogram (AUC: 0.973 vs 0.916, P = 0.036, Net Reclassification Improvement: 0.077, Integrated Discrimination Index: 0.152). Subgroup analysis demonstrated that the CEUS score model was notably improved compared to the LI-RADS in tumors smaller than 5.0 cm (P < 0.05) but not improved in tumors smaller than 3.0 cm (P > 0.05).
CONCLUSION The CEUS predictive model for differentiation between ICC and HCC in high-risk patients had improved discrimination and clinical usefulness compared to the CEUS LI-RADS.
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Affiliation(s)
- Li-Da Chen
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Si-Min Ruan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Jin-Yu Liang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Zheng Yang
- Department of Pathology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Shun-Li Shen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Yang Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Wei Li
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Zhu Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
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Li XH, Liang Q, Chen TW, Wang J, Zhang XM. Diagnostic value of imaging examinations in patients with primary hepatocellular carcinoma. World J Clin Cases 2018; 6:242-248. [PMID: 30211204 PMCID: PMC6134275 DOI: 10.12998/wjcc.v6.i9.242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/05/2018] [Accepted: 08/01/2018] [Indexed: 02/05/2023] Open
Abstract
Primary hepatocellular carcinoma (PHC) includes hepatocellular carcinoma, intrahepatic cholangiocarcinoma and other pathological types and is characterized by rapid progression. Most of the clinical diagnoses are made at late stage or when distant metastasis occurs, increasing the difficulty of treatment and resulting in a poor prognosis. Therefore, the early diagnosis of PHC plays an important role in timely treatment and the improvement of prognosis. The gold standard for the diagnosis of primary liver cancer is liver biopsy, but it has limitations as an invasive examination. Presently, imaging has become the first choice for the diagnosis of liver cancer. We here summarize the new methods and techniques of imaging in diagnosis and evaluation of primary liver cancer in recent years, including ultrasonography, computed tomography perfusion imaging, diffusion-weighted imaging technology-voxel incoherent motion, diffusion tensor imaging, iterative decomposition of water and fat with echo asymmetry and least squares estimation-iron quantification, dynamic enhanced magnetic resonance imaging and hepatocyte-specific contrast medium imaging. Imaging diagnosis can not only evaluate the degree of differentiation, blood supply and perfusion, and invasiveness of the lesion, but also predict the prognosis, evaluate liver function, and provide references for clinical diagnosis and treatment.
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Affiliation(s)
- Xing-Hui Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Radiology, Southwest Hospital of Army Medical University, Chongqing 400038, China
| | - Qi Liang
- Department of Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Tian-Wu Chen
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital of Army Medical University, Chongqing 400038, China
| | - Xiao-Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Park JH, Kim DH, Kim SH, Kim MY, Baik SK, Hong IS. The Clinical Implications of Liver Resection Margin Size in Patients with Hepatocellular Carcinoma in Terms of Positron Emission Tomography Positivity. World J Surg 2018; 42:1514-1522. [PMID: 29026966 DOI: 10.1007/s00268-017-4275-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The positivity of positron emission tomography (PET) in hepatocellular carcinoma (HCC) correlates with aggressive tumor factors and poor survival. Adequate resection margin size is still a topic of debate. We analyzed the clinical implications of resection margin size in patients with HCC in terms of PET positivity. METHODS We retrospectively reviewed the medical records of 92 patients who underwent liver resection from March 2012 to October 2015. We investigated prognostic factors for recurrence and survival. We analyzed the correlation of resection margin size and PET positivity. Resection margins were classified as less than 1 cm and more than 1 cm. RESULTS Twenty six (31.3%) patients had PET-positive HCC. Multivariate analysis showed PET, satellite nodules, microvessel invasion, and multicentric occurrence were significant prognostic factors for HCC recurrence. Multivariate analysis also showed satellite nodules and microscopic portal vein invasion were significant prognostic factors for overall survival (OS). Resection margin size did not affect disease-free survival (DFS) (p = 0.681) or OS (p = 0.301) in patients with PET-negative HCC, but showed a difference in DFS [<1 cm at 11 months vs. ≥1 cm at 41 months (p = 0.188)] and OS [<1 cm at 28 months vs. ≥1 cm at 48 months (p < 0.001)] in patients with PET-positive HCC. CONCLUSIONS PET has low sensitivity for HCC. However, it is useful to predict treatment outcomes after liver resection or liver transplantation for HCC. Although the extent of liver resection must be decided based on liver function, a resection margin size >1 cm may improve DFS and OS in patients with PET-positive HCC.
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Affiliation(s)
- Jae Hyun Park
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju, 220-701, Kangwon-do, Korea
| | - Dong Hwi Kim
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju, 220-701, Kangwon-do, Korea
| | - Sung Hoon Kim
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju, 220-701, Kangwon-do, Korea.
| | - Moon Young Kim
- Department of Internal medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Soon Koo Baik
- Department of Internal medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - In Su Hong
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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Hyun MH, Lee YS, Kim JH, Lee CU, Jung YK, Seo YS, Yim HJ, Yeon JE, Byun KS. Hepatic resection compared to chemoembolization in intermediate- to advanced-stage hepatocellular carcinoma: A meta-analysis of high-quality studies. Hepatology 2018; 68:977-993. [PMID: 29543988 DOI: 10.1002/hep.29883] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/21/2017] [Accepted: 02/28/2018] [Indexed: 01/27/2023]
Abstract
UNLABELLED According to the American Association for the Study of Liver Diseases (AASLD) treatment guidelines for hepatocellular carcinoma (HCC), the role of surgery has been expanded beyond the Barcelona Clinic Liver Cancer (BCLC) algorithm. We compared primary hepatectomy (PH) with transarterial chemoembolization (TACE) in patients with intermediate- to advanced-stage (BCLC stage B/C) HCC to determine the current evidence. Through a database search, we included 18 high-quality studies (one randomized controlled trial [RCT], five propensity-score matching nonrandomized comparative trials [NRCTs], and 12 NRCTs) that compared survival outcomes of 5,986 patients after PH and TACE. We found significant survival benefits for PH over TACE in BCLC stage B/C patients (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.51-0.67; P < 0.00001; I2 = 84%). According to the BCLC, both stage B and stage C patients showed significantly better overall survival (OS) for PH compared to TACE (HR, 0.53; 95% CI, 0.43-0.65; P < 0.00001; I2 = 77%; HR, 0.67; 95% CI, 0.59-0.77; P < 0.00001; I2 = 79%, respectively). Five-year survival rates for PH were significantly higher than those for TACE in BCLC stage B/C, stage B, and BCLC stage C patients (odds ratio [OR], 2.71, 2.77, and 3.03, respectively; all P < 0.00001). Survival benefits persisted across subgroup, sensitivity, and metaregression analyses; interstudy heterogeneity remained constant. CONCLUSION This meta-analysis suggests that surgical resection provides survival benefits in patients with intermediate- to advanced-stage HCC. The evidence found herein may assist in the choice of treatment modality based on diverse definitions of operability. (Hepatology 2018).
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Affiliation(s)
- Myung Han Hyun
- Division of Oncology and Hematology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Young-Sun Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Ji Hoon Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Chan Uk Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Young Kul Jung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Hyung Joon Yim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jong Eun Yeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Kwan Soo Byun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
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217
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Kim JH, Shim JH, Yoon HK, Ko HK, Kim JW, Gwon DI. Chemoembolization related to good survival for selected patients with hepatocellular carcinoma invading segmental portal vein. Liver Int 2018; 38:1646-1654. [PMID: 29436101 DOI: 10.1111/liv.13719] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS We evaluated survival outcomes and prognostic factors associated with survival after TACE in a large cohort of 331 patients with HCC with segmental PVTT. METHODS From 1997 to 2015, a total of 331 patients were included in this study from among 507 patients who underwent TACE as a first-line treatment for HCC with segmental PVTT. RESULTS After TACE, the median survival of the whole cohort was 10.7 months, and the 1-year, 3-year and 5-year survival rates were 44.9%, 16% and 12% respectively. Objective tumour response after TACE was achieved in 53.8% of patients. Multivariable Cox regression analyses confirmed that up-to-11 criteria, extrahepatic metastasis, Child-Pugh class, and tumour response to TACE were independent prognostic factors for patient survival. The expected median survival times among patients with 0, 1 and 2-4 risk factors were 29.1, 15.1 and 5.3 months respectively. The 30-day mortality and major complications rates after TACE were 0.9% and 5.4% respectively. CONCLUSIONS TACE was well-tolerated and effective in selected patients with HCC with segmental PVTT. We found that four risk factors were associated with decreased length of patient survival after TACE: a major tumour burden (up-to-11 criteria out), extrahepatic spread, Child-Pugh class B liver function and nonregression to TACE. TACE may not be recommended for HCC patients with segmental PVTT with 2-4 risk factors because of poor survival outcome.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju Hyun Shim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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218
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Chen CL, Chang WC, Yi CH, Hung JS, Liu TT, Lei WY, Hsu CS. Association of coffee consumption and liver fibrosis progression in patients with HBeAg-negative chronic hepatitis B: A 5-year population-based cohort study. J Formos Med Assoc 2018; 118:628-635. [PMID: 30122312 DOI: 10.1016/j.jfma.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/11/2018] [Accepted: 08/02/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/PURPOSE Although coffee consumption has been associated with decreased risk of liver fibrosis progression, cirrhosis or hepatocellular carcinoma in patients with HCV infection or fatty liver diseases, its effect on hepatitis B patients remains unclear. We aimed to examine the effect of coffee consumption on liver fibrosis progression and cirrhosis-related complications in patients with chronic HBV infection. METHODS Coffee consumption was assessed in 2604 participants who were previously recruited from a population-based GERD survey. The primary endpoints of this study were the impact of coffee consumption on the development of cirrhosis-related complications, including liver cirrhosis, esophageal varices, or hepatocellular carcinoma at the end of 5-year follow-up. The secondary endpoints were the declines of serum predicting indices of liver fibrosis (AST/ALT, APRI, FIB-4, Hui score) or liver function tests (AST, ALT). RESULTS 328 patients with chronic HBV infection were enrolled into this study. At baseline, coffee consumption was associated with higher education level, more frequent tobacco use and normal blood pressure (p < 0.05 for all). Patients with higher coffee consumption had a significant lower serum AST, APRI and FIB-4 index value than non-coffee drinkers [adjusted HR 0.30, 95% CI(0.11-0.82) for AST; 0.30, 95% CI (0.11-0.84) for APRI; 0.30, 95% CI (0.13-0.69) for FIB-4]. However, higher coffee consumption didn't change serum AST levels, APRI, FIB-4 index values or incidences of cirrhosis-related complications at the end of 5-year follow-up. CONCLUSION Coffee consumption was not associated with fibrosis progression or HCC risk in chronic hepatitis B patients over the 5-year observation period.
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Affiliation(s)
- Chien-Lin Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wei-Chuan Chang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chih-Hsun Yi
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jui-Sheng Hung
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tso-Tsai Liu
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wei-Yi Lei
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ching-Sheng Hsu
- Liver Diseases Research Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
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Wei Y, Dai F, Yi Y, Ye W, Zhao W. Impact of local tumor lesion treatments and preoperative indicators on the survival of patients with small hepatocellular carcinomas. Oncol Lett 2018; 16:5050-5058. [PMID: 30250572 PMCID: PMC6144377 DOI: 10.3892/ol.2018.9263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 03/02/2018] [Indexed: 11/07/2022] Open
Abstract
The prognosis for small hepatocellular carcinomas (SHCC) remains uncertain. The aim of the present study was to compare three local tumor lesion treatments and identify the prognostic factors in patients with SHCC by analyzing preoperative indicators. A retrospective study was performed using data from 206 patients with SHCC from 2006–2015. All of the patients had undergone transarterial chemoembolization (TACE) alone, TACE plus percutaneous microwave coagulation therapy (PMCT) or surgical resection (SR). The Kaplan-Meier method was used to calculate the survival rates. Multivariate analysis was conducted using Cox regression analysis. The median survival time of patients with SHCC was 27 (range, 14–49) months in the TACE group, 29.5 (range, 16–52) months in the TACE-PMCT group and 36.5 (range, 26–52) months in the SR group (P=0.091). The 1, 3 and 5-year survival rates for patients with SHCC were 82.4, 64.9 and 46.8% in the TACE group; 89.0, 72.6 and 58.3% in the TACE-PMCT group and 88.8, 72.3 and 58.6% in the SR group (P=0.181), respectively. Analysis from the Cox regression model demonstrated that preoperative α-fetoprotein (AFP; <400 ng/ml vs. ≥400 ng/ml; HR=0.548; P=0.036) was an independent predictor of the survival time of patients with SHCC. Analysis of patients with preoperative AFP levels of ≥400 ng/ml revealed that the median survival time in the SR group was 36 (range, 28.25–52) months, significantly longer than the TACE (17 months; range, 12–44 months) and TACE-PMCT group (27 months; range, 14–55 months; P=0.035). The 1, 2 and 3-year survival rates for patients with SHCC with ≥400 ng/ml AFP were: 70.8, 55.5 and 49.9% in the TACE group; 83.7, 68.0 and 60.8% in the TACE-PMCT group; and 90.9, 81.8 and 61.0% in SR group, respectively (P=0.664). However, there was no significant difference among the three groups in the survival time of patients with SHCC with <400 ng/ml preoperative AFP. The observations indicated that SR is not significantly different for overall survival time in the patients with SHCC between the two groups; this method can be employed for patients with SHCC. This was based on the median survival time of patients with ≥400 ng/ml AFP in the SR group who had a longer survival time and a higher survival rate than in the TACE and TACE-PMCT group.
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Affiliation(s)
- Yanyan Wei
- Department of Liver Disease, The Second Hospital of Nanjing, Medical School of Southeast University, Nanjing, Jiangsu 210000, P.R. China
| | - Feng Dai
- Department of Liver Disease, The Second Hospital of Nanjing, Medical School of Southeast University, Nanjing, Jiangsu 210000, P.R. China
| | - Yongxiang Yi
- Department of Liver Disease, The Second Hospital of Nanjing, Medical School of Southeast University, Nanjing, Jiangsu 210000, P.R. China
| | - Wei Ye
- Department of Liver Disease, The Second Hospital of Nanjing, Medical School of Southeast University, Nanjing, Jiangsu 210000, P.R. China
| | - Wei Zhao
- Department of Liver Disease, The Second Hospital of Nanjing, Medical School of Southeast University, Nanjing, Jiangsu 210000, P.R. China
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Costentin CE, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Letouzé E, Imbeaud S, Zucman-Rossi J, Audureau E, Roudot-Thoraval F, Nahon P. Compliance With Hepatocellular Carcinoma Surveillance Guidelines Associated With Increased Lead-Time Adjusted Survival of Patients With Compensated Viral Cirrhosis: A Multi-Center Cohort Study. Gastroenterology 2018; 155:431-442.e10. [PMID: 29729258 DOI: 10.1053/j.gastro.2018.04.027] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Semi-annual surveillance for hepatocellular carcinoma (HCC) is recommended for patients with cirrhosis. We aimed to determine how compliance with HCC surveillance guidelines affects survival times of patients with hepatitis C virus- or hepatitis B virus-associated compensated cirrhosis who developed HCC. METHODS We collected data from the prospective ANRS CO12 CirVir study, from March 2006 through June 2012, on 1671 patients with biopsy-proven viral cirrhosis and no previous liver complications who were undergoing surveillance for HCC at 35 centers in France. Only 216 patients who developed HCC during the follow-up period were included in the analysis. Patients were considered to be compliant with surveillance guidelines if the time between their last surveillance image evaluation and diagnosis of HCC were fewer than 7 months and noncompliant if this time was 7 months or longer. RESULTS HCC was detected in 216 patients, at a median follow-up time of 59.7 months. Of these patients, 140 (80.5%) were Barcelona Clinic Liver Cancer stage 0/A, 135 (69.9%) received first-line curative treatment (15 underwent transplantation, 29 underwent resection, 89 received percutaneous ablation, and 2 received resection and percutaneous ablation), and 129 (60.0%) were compliant with surveillance guidelines. Seventy-nine of the patients with HCC died; 49 deaths were associated with tumor progression. After lead-time adjustment, overall survival (OS) time was longer in patients compliant with surveillance guidelines (median OS time, 53.2 months) than noncompliant patients (median OS time, 25.4 months) (P = .0107); this difference remained significant even when we changed lead time assumptions. In multivariate analysis adjusted for a propensity score, compliance with HCC surveillance guidelines was associated with low tumor burden, allocation of curative treatment, and increased OS time compared with noncompliance (hazard ratio for OS, 2.19; 95% confidence interval, 1.16-4.14; P = .0150). CONCLUSIONS In an analysis of data from the ANRS CO12 CirVir cohort, we associated compliance with HCC surveillance guidelines (fewer than 7 months between image evaluations) with early diagnosis, allocation of curative treatment, and longer adjusted OS of patients with hepatitis C virus- or hepatitis B virus-associated compensated cirrhosis and a diagnosis of HCC.
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Affiliation(s)
- Charlotte E Costentin
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France.
| | - Richard Layese
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique (Unités de Recherche Clinique Mondor), and Université Paris-Est, Ageing-Thorax- Vessels-Blood Départements Hospitalo Universitaires, Clinical Epidemiology and Aging Unit, L'Université Paris-Est Créteil, Créteil, France
| | - Valérie Bourcier
- Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, France Recherche Nord & sud Sida-HIV Hépatites, Paris, France
| | - Patrick Marcellin
- Assistance Publique-Hopitaux de Paris, Hôpital Beaujon, Service d'Hépatologie, Clichy, France
| | - Dominique Guyader
- Centre Hospitalier Universitaire Pontchaillou, Service d'Hépatologie, Rennes, France
| | - Stanislas Pol
- Assistance Publique-Hopitaux de Paris, Hôpital Cochin, Département d'Hépatologie et Institut National de la Santé et de la Recherche Médicale, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Département d'Hépatologie, Lyon, France
| | - Dominique Roulot
- Assistance Publique-Hopitaux de Paris, Hôpital Avicenne, Service d'Hépatologie, Bobigny, France
| | - Albert Tran
- Centre Hospitalier Universitaire de Nice, Service d'Hépatologie, et Institut National de la Santé et de la Recherche Médicale, Université de Nice-Sophia-Antipolis, Nice, France
| | | | | | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépato-gastroentérologie, Rouen, France
| | - Paul Calès
- Centre Hospitalier Universitaire d'Angers, Service d'Hépatologie, Angers, France
| | | | - Laurent Alric
- Centre Hospitalier Universitaire Toulouse, Service de Médecine Interne-Pôle Digestif, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | - Armand Abergel
- Centre Hospitalier Universitaire Estaing, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- Assistance Publique-Hopitaux de Paris, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France; L'Université Paris-Est Créteil et Institut National de la Santé et de la Recherche Médicale, Créteil, France
| | - Jean-Didier Grangé
- Assistance Publique-Hopitaux de Paris, Hôpital Tenon, Service d'Hépatologie, Paris, France
| | - Pierre Attali
- Assistance Publique-Hopitaux de Paris, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, Centres Hospitaliers Régionaux et Universitaires de Tours, Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Dominique Thabut
- Assistance Publique-Hopitaux de Paris, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | - Christophe Pilette
- Centre Hospitalier Universitaire Le Mans, Service d'Hépatologie, Le Mans, France
| | - Christine Silvain
- Centre Hospitalier Universitaire de Poitiers, Service d'Hépatologie, Poitiers, France
| | | | | | | | - David Zucman
- Hôpital Foch, Service d'Hépatologie, Suresnes, France
| | | | - Angela Sutton
- Liver Disease Biobank, Groupe Hospitalier Paris Seine-Saint-Denis, France; Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service de Biochimie, Bondy, France; Institut National de la Santé et de la Recherche Médicale U1148, Université Paris 13, Bobigny, France
| | - Eric Letouzé
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
| | - Sandrine Imbeaud
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
| | - Jessica Zucman-Rossi
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France; Assistance Publique-Hopitaux de Paris, Hôpital Européen Georges Pompidou, Département d'Oncologie, Paris, France
| | - Etienne Audureau
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique (Unités de Recherche Clinique Mondor), and Université Paris-Est, Ageing-Thorax- Vessels-Blood Départements Hospitalo Universitaires, Clinical Epidemiology and Aging Unit, L'Université Paris-Est Créteil, Créteil, France
| | - Françoise Roudot-Thoraval
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France; Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
| | - Pierre Nahon
- Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
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Long-term survival after partial hepatectomy for sub-stage patients with intermediate stage hepatocellular carcinoma. Int J Surg 2018; 56:256-263. [DOI: 10.1016/j.ijsu.2018.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/12/2018] [Accepted: 06/14/2018] [Indexed: 02/06/2023]
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Kotha S, Neong S, Patel K. Serum biomarkers for diagnosis and monitoring viral hepatitis and hepatocellular carcinoma. Expert Rev Mol Diagn 2018; 18:713-722. [PMID: 30019978 DOI: 10.1080/14737159.2018.1496020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Chronic liver disease due to viral hepatitis continues to be a major global health concern. Timely diagnosis and treatment will prevent cirrhosis, risk of hepatocellular carcinoma (HCC), and requirement for liver transplantation. Numerous serum biomarkers are available for viral hepatitis that are helpful in diagnosis, measuring severity, progression of disease, evaluating the best therapeutic options, and monitoring antiviral treatment response. Determining the clinical use of available diagnostic tests can be challenging for the health care provider. Areas covered: This review article attempts to summarize the established and emerging serological markers for diagnosis and managing viral hepatitis. The literature search was performed in February 2018 and included MEDLINE and Embase databases for recent relevant literature on biomarkers for viral hepatitis. Expert Commentary: Despite the discovery of several candidate biomarkers, translating these to clinical practice in viral hepatitis and HCC remains challenging. While limited availability of the new biomarkers in prevalent geographic areas and significant cost remain major obstacles, there have been exciting developments in this field. Understanding the detection limits and sensitivity of these markers and translating them into clinical use is important in management of viral hepatitis and complications of liver disease such as cirrhosis and hepatocellular cancer.
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Affiliation(s)
- Sreelakshmi Kotha
- a Department of Hepatology , Toronto General Hospital , Toronto , Canada
| | - ShuetFong Neong
- a Department of Hepatology , Toronto General Hospital , Toronto , Canada
| | - Keyur Patel
- a Department of Hepatology , Toronto General Hospital , Toronto , Canada
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Seo N, Kim MS, Park MS, Choi JY, An C, Han K, Kim SU, Joo DJ, Kim MJ. Optimal criteria for hepatocellular carcinoma diagnosis using CT in patients undergoing liver transplantation. Eur Radiol 2018; 29:1022-1031. [PMID: 29974221 DOI: 10.1007/s00330-018-5557-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/27/2018] [Accepted: 05/23/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the diagnostic performance of various guidelines for hepatocellular carcinoma (HCC) diagnosis using computed tomography (CT) in patients undergoing liver transplantation (LT). METHODS In total, 216 patients who underwent preoperative CT and subsequent LT were included. Two radiologists retrospectively evaluated focal hepatic lesions independently according to various guidelines and allocated patients according to the Milan criteria. The diagnostic performance of the guidelines was compared using alternative free-response receiver-operating characteristics (AFROC) analysis with bootstrapping. Comparisons of sensitivity, specificity, and accuracy of patient allocation based on the Milan criteria between guidelines were performed using logistic regression with generalized estimating equations (GEE). RESULTS Fifty-two of 216 patients had 87 HCCs. The reader-averaged figure of merit obtained using AFROC analysis was 0.738 for the AASLD/EASL or KLCSG-NCC guidelines and 0.728 for the LI-RADS v2014 or OPTN/UNOS (bootstrapping, p = 0.005). The per-lesion sensitivity for HCCs (all and 1-2-cm lesions) was significantly higher with the AASLD/EASL (37.9-41.4% and 30.8-41.0%) than with LI-RADS (28.7% and 15.4-18.0%) (logistic regression with GEE, p = 0.008 and 0.030 for reader 1 and p = 0.005 for reader 2). The per-patient specificity (98.8-99.4%) was the same for all guidelines. The accuracy of the Milan criteria was 81.5-83.3% without significant differences among the four guidelines (logistic regression with GEE, p > 0.05). CONCLUSION AASLD/EASL showed higher diagnostic performance and sensitivity, particularly for 1-2-cm HCCs, and the same specificity with LI-RADS. All guidelines are comparable for patient allocation based on the Milan criteria for LT. KEY POINTS • The overall diagnostic performance of CT for HCC diagnosis was highest with AASLD/EASL. • AASLD/EASL showed higher sensitivity for diagnosis of 1-2-cm HCCs than LI-RADS. • The accuracy of the Milan criteria using CT was comparable among the four guidelines.
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Affiliation(s)
- Nieun Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Mi-Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Jin-Young Choi
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Chansik An
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Kyunghwa Han
- Department of Radiology, Yonsei Biomedical Research Institute, Research Institute of Radiological Science, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Myeong-Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
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Hyun D, Cho SK, Shin SW, Park KB, Lee SY, Park HS, Do YS. Combined transarterial chemoembolization and radiofrequency ablation for small treatment-naïve hepatocellular carcinoma infeasible for ultrasound-guided radiofrequency ablation: long-term outcomes. Acta Radiol 2018; 59:773-781. [PMID: 29034691 DOI: 10.1177/0284185117735349] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Ultrasound (US)-guided radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC) is often infeasible due to unfavorable location and poor conspicuity. Those small HCCs can be treated with combined transarterial chemoembolization (TACE) and RFA. Purpose To evaluate long-term outcomes of combined TACE and RFA for small treatment-naïve HCC infeasible for US-guided RFA. Material and Methods Between February 2009 and January 2014, 69 patients with small (≤3 cm) HCC infeasible for US-guided RFA received TACE and subsequent RFA in one session as a first-line treatment. Local tumor progression (LTP), overall survival (OS), and event-free survival rates were evaluated. Univariate and multivariate analyses were conducted to identify prognostic factors. Results Cumulative rates of LTP were 4.4%, 6.8%, 8.2%, 9.5%, and 9.5% at one, two, three, five, and seven years, respectively. Cumulative one-, two-, three-, five-, and seven-year OS rates were 100%, 95%, 89%, 80%, and 80%, respectively. Cumulative one-, two-, three-, five-, and seven-year event-free survival rates were 81%, 63%, 54%, 31%, and 20%, respectively. No significant prognostic factors for LTP, OS, and event-free survival were identified in univariate analysis. Conclusion Combined TACE and RFA appears to be an effective treatment for small treatment-naïve HCC infeasible for US-guided RFA in terms of LTP and OS.
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Affiliation(s)
- Dongho Hyun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Ki Cho
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Wook Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Bo Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Yub Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hong Suk Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Soo Do
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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225
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Yang JD, Mannalithara A, Piscitello AJ, Kisiel JB, Gores GJ, Roberts LR, Kim WR. Impact of surveillance for hepatocellular carcinoma on survival in patients with compensated cirrhosis. Hepatology 2018; 68:78-88. [PMID: 29023828 PMCID: PMC5897179 DOI: 10.1002/hep.29594] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/01/2017] [Accepted: 10/10/2017] [Indexed: 12/19/2022]
Abstract
UNLABELLED Surveillance for hepatocellular carcinoma (HCC) has been recommended in patients with cirrhosis. In this study, we examined the extent to which the competing risk of hepatic decompensation influences the benefit of HCC surveillance by investigating the impact of availability of liver transplantation (LTx) and the rate of progression of hepatic decompensation on survival gain from HCC surveillance. A multistate Markov model was constructed simulating a cohort of 50-year-old patients with compensated cirrhosis. The primary outcome of interest was all-cause and HCC-specific mortality. The main input data included incidence of HCC, sensitivity of screening test, and mortality from hepatic decompensation. Treatment modalities modeled included LTx, resection, and radiofrequency ablation. In the base case scenario, LTx would be available to prevent death in a certain proportion of patients. In the absence of surveillance, 68.2% of the cohort members died within 15 years; of these decedents, 25.1% died from HCC and 43.6% died from hepatic decompensation. With surveillance, the median survival improved from 10.4 years to 11.2 years. The number of subjects under surveillance needed to reduce one all-cause and one HCC-specific death over 15 years was 28 and 18, respectively. In sensitivity analyses, incidence of HCC and progression of cirrhosis had the strongest effect on the benefit of surveillance, whereas LTx availability had a negligible effect. CONCLUSION HCC surveillance decreases all-cause and tumor-specific mortality in patients with compensated cirrhosis regardless of LTx availability. In addition, incidence of HCC and sensitivity of surveillance test also had a substantial impact on the benefits of surveillance. (Hepatology 2018;68:78-88).
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Affiliation(s)
- Ju Dong Yang
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Ajitha Mannalithara
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA
| | | | - John B. Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Gregory J. Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Lewis R. Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - W. Ray Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA
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Increased cumulative doses and appearance of hand-foot skin reaction prolonged progression free survival in sorafenib-treated advanced hepatocellular carcinoma patients. Kaohsiung J Med Sci 2018; 34:391-399. [DOI: 10.1016/j.kjms.2018.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 02/06/2018] [Accepted: 03/12/2018] [Indexed: 12/14/2022] Open
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Koh YX, Tan HL, Lye WK, Kam JH, Chiow AKH, Tan SS, Choo SP, Chung AYF, Goh BKP. Systematic review of the outcomes of surgical resection for intermediate and advanced Barcelona Clinic Liver Cancer stage hepatocellular carcinoma: A critical appraisal of the evidence. World J Hepatol 2018; 10:433-447. [PMID: 29988922 PMCID: PMC6033716 DOI: 10.4254/wjh.v10.i6.433] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/10/2018] [Accepted: 03/03/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To perform a systematic review to determine the survival outcomes after curative resection of intermediate and advanced hepatocellular carcinomas (HCC).
METHODS A systematic review of the published literature was performed using the PubMed database from 1st January 1999 to 31st Dec 2014 to identify studies that reported outcomes of liver resection as the primary curative treatment for Barcelona Clinic Liver Cancer (BCLC) stage B or C HCC. The primary end point was to determine the overall survival (OS) and disease free survival (DFS) of liver resection of HCC in BCLC stage B or C in patients with adequate liver reserve (i.e., Child’s A or B status). The secondary end points were to assess the morbidity and mortality of liver resection in large HCC (defined as lesions larger than 10 cm in diameter) and to compare the OS and DFS after surgical resection of solitary vs multifocal HCC.
RESULTS We identified 74 articles which met the inclusion criteria and were analyzed in this systematic review. Analysis of the resection outcomes of the included studies were grouped according to (1) BCLC stage B or C HCC, (2) Size of HCC and (3) multifocal tumors. The median 5-year OS of BCLC stage B was 38.7% (range 10.0-57.0); while the median 5-year OS of BCLC stage C was 20.0% (range 0.0-42.0). The collective median 5-year OS of both stages was 27.9% (0.0-57.0). In examining the morbidity and mortality following liver resection in large HCC, the pooled RR for morbidity [RR (95%CI) = 1.00 (0.76-1.31)] and mortality [RR (95%CI) = 1.15 (0.73-1.80)] were not significant. Within the spectrum of BCLC B and C lesions, tumors greater than 10 cm were reported to have median 5-year OS of 33.0% and multifocal lesions 54.0%.
CONCLUSION Indication for surgical resection should be extended to BCLC stage B lesions in selected patients. Further studies are needed to stratify stage C lesions for resection.
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Affiliation(s)
- Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Weng Kit Lye
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - Juinn Huar Kam
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Adrian Kah Heng Chiow
- Department of General Surgery, Hepatopancreatobiliary Service, Changi General Hospital, Singapore 529889, Singapore
| | - Siong San Tan
- Department of General Surgery, Hepatopancreatobiliary Service, Changi General Hospital, Singapore 529889, Singapore
| | - Su Pin Choo
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Alexander Yaw Fui Chung
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Brian Kim Poh Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore
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228
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Lim HY, Merle P, Weiss KH, Yau T, Ross P, Mazzaferro V, Blanc JF, Ma YT, Yen CJ, Kocsis J, Choo SP, Sukeepaisarnjaroen W, Gérolami R, Dufour JF, Gane EJ, Ryoo BY, Peck-Radosavljevic M, Dao T, Yeo W, Lamlertthon W, Thongsawat S, Teufel M, Roth K, Reis D, Childs BH, Krissel H, Llovet JM. Phase II Studies with Refametinib or Refametinib plus Sorafenib in Patients with RAS-Mutated Hepatocellular Carcinoma. Clin Cancer Res 2018; 24:4650-4661. [PMID: 29950351 DOI: 10.1158/1078-0432.ccr-17-3588] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/09/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Refametinib, an oral MEK inhibitor, has demonstrated antitumor activity in combination with sorafenib in patients with RAS-mutated hepatocellular carcinoma (HCC). Two phase II studies evaluated the efficacy of refametinib monotherapy and refametinib plus sorafenib in patients with RAS-mutant unresectable or metastatic HCC.Patients and Methods: Eligible patients with RAS mutations of cell-free circulating tumor DNA (ctDNA) determined by beads, emulsion, amplification, and magnetics technology received twice-daily refametinib 50 mg ± sorafenib 400 mg. Potential biomarkers were assessed in ctDNA via next-generation sequencing (NGS).Results: Of 1,318 patients screened, 59 (4.4%) had a RAS mutation, of whom 16 received refametinib and 16 received refametinib plus sorafenib. With refametinib monotherapy, the objective response rate (ORR) was 0%, the disease control rate (DCR) was 56.3%, overall survival (OS) was 5.8 months, and progression-free survival (PFS) was 1.9 months. With refametinib plus sorafenib, the ORR was 6.3%, the DCR was 43.8%, OS was 12.7 months, and PFS was 1.5 months. In both studies, time to progression was 2.8 months. Treatment-emergent toxicities included fatigue, hypertension, and acneiform rash. Twenty-seven patients had ctDNA samples available for NGS. The most frequently detected mutations were in TERT (63.0%), TP53 (48.1%), and β-catenin (CTNNB1; 37.0%).Conclusions: Prospective testing for RAS family mutations using ctDNA was a feasible, noninvasive approach for large-scale mutational testing in patients with HCC. A median OS of 12.7 months with refametinib plus sorafenib in this small population of RAS-mutant patients may indicate a synergistic effect between sorafenib and refametinib-this preliminary finding should be further explored. Clin Cancer Res; 24(19); 4650-61. ©2018 AACR.
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Affiliation(s)
- Ho Yeong Lim
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea.
| | - Philippe Merle
- Service of Hepato-Gastroenterology, Hepatology Unit, Croix-Rousse Hospital, Lyon, France
| | - Karl Heinz Weiss
- Section of Transplant Hepatology, Liver Cancer Center Heidelberg, Heidelberg, Germany
| | - Thomas Yau
- Department of Medicine, Queen Mary Hospital, Hong Kong
| | - Paul Ross
- Cancer Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vincenzo Mazzaferro
- Gastrointestinal Surgery and Liver Transplant Unit, The Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute) and University of Milan, Milan, Italy
| | - Jean-Frédéric Blanc
- Service of Hepato-Gastroenterology and Digestive Oncology, Hôpital Haut-Lévêque, Bordeaux, France
| | - Yuk Ting Ma
- Department of Medical Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Chia Jui Yen
- Division of Hematology and Oncology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Judit Kocsis
- Oncology Department, Debrecen University Clinical Center, Debrecen, Hungary
| | - Su Pin Choo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - René Gérolami
- Service of Hepato-Gastroenterology, Aix-Marseille University, Marseille, France
| | - Jean-François Dufour
- Department of Hepatology, University Clinic for Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland
| | - Edward J Gane
- New Zealand Liver & Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, Seoul, Korea
| | - Markus Peck-Radosavljevic
- Department of Gastroenterology and Hepatology, Endocrinology, Rheumatology and Nephrology, Medical University of Vienna, Vienna, Austria
| | - Thong Dao
- Service of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France
| | - Winnie Yeo
- Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong
| | | | - Satawat Thongsawat
- Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
| | - Michael Teufel
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, New Jersey
| | | | - Diego Reis
- Medical and Data Management, Bayer S.A., São Paulo, Brazil
| | | | | | - Josep M Llovet
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York. .,Liver Cancer Translational Research Laboratory, Barcelona Clinic Liver Cancer Group (BCLC), IDIBAPS-Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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Song KD, Lee MW, Rhim H, Kang TW, Cha DI, Sinn DH, Lim HK. Percutaneous US/MRI Fusion-guided Radiofrequency Ablation for Recurrent Subcentimeter Hepatocellular Carcinoma: Technical Feasibility and Therapeutic Outcomes. Radiology 2018; 288:878-886. [PMID: 29916771 DOI: 10.1148/radiol.2018172743] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose To evaluate the technical feasibility and therapeutic outcomes of percutaneous US/MRI fusion-guided radiofrequency ablation (RFA) of recurrent subcentimeter-sized hepatocellular carcinomas (HCCs). Materials and Methods For this retrospective study, between January 2012 and December 2014 a total of 194 planning US examinations were performed in 186 patients (159 men and 27 women; mean age, 61.1 years ± 10.0 [standard deviation]) for newly developed subcentimeter recurrent HCCs. These recurrent HCCs were defined as hypervascular nodules (>5.5 mm and <10 mm) with typical MRI findings of HCC. The study assessed how often US/MRI fusion-guided percutaneous RFA was deemed technically feasible at planning US examination (the feasibility rate) and the therapeutic outcomes after RFA, including the rates of technical success, technique efficacy, local tumor progression (LTP), and major complications. Cumulative LTP rates were estimated with the Kaplan-Meier method. Results The feasibility rate of percutaneous RFA at planning US examination was 65.7% (138 of 210 HCCs). The most common reason for RFA infeasibility was that an index tumor was inconspicuous at US. Among 138 subcentimeter HCCs feasible for RFA, 125 lesions underwent percutaneous RFA. The rates of both technical success and technique efficacy were 98.4% (123 of 125). The cumulative LTP rates at 1, 2, and 3 years were 3.6%, 5.4%, and 7.4%, respectively. The major complication rate was 2.5% (three of 119). Conclusion Percutaneous US/MRI fusion-guided radiofrequency ablation (RFA) was feasible in approximately two-thirds of subcentimeter recurrent hepatocellular carcinomas (HCCs). Percutaneous US/MRI fusion-guided RFA is a safe and effective treatment modality for patients with subcentimeter recurrent HCCs.
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Affiliation(s)
- Kyoung Doo Song
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Min Woo Lee
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Hyunchul Rhim
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Tae Wook Kang
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Dong Ik Cha
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Dong Hyun Sinn
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Hyo Keun Lim
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
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Lim CH, Tseng CW, Lin CT, Huang WN, Chen YH, Chen YM, Chen DY. The clinical application of tumor markers in the screening of malignancies and interstitial lung disease of dermatomyositis/polymyositis patients: A retrospective study. SAGE Open Med 2018; 6:2050312118781895. [PMID: 29977547 PMCID: PMC6024348 DOI: 10.1177/2050312118781895] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 05/14/2018] [Indexed: 01/21/2023] Open
Abstract
Objective: To examine the clinical utility of tumor markers in dermatomyositis/polymyositis patients in Taiwan. Method: Data were collected retrospectively from the database of Taichung Veterans General Hospital in Taiwan from 1998 to 2014. Patients who fulfilled Bohan and Peter criteria of dermatomyositis/polymyositis were recruited. Serum level of tumor markers including carcinoembryonic antigen, alpha-fetoprotein, carbohydrate antigen 125, carbohydrate antigen 19-9 and carbohydrate antigen 15-3 were measured. The occurrence of malignancies and interstitial lung disease was identified. The association of tumor markers with malignancies and interstitial lung disease was examined using Chi-square test or Fisher’s exact test. Results: Among the enrolled 151 patients, 98 (64.9%) dermatomyositis and 53 (35.1%) polymyositis, a total of 15 malignancies were detected: breast ductal carcinoma (n = 4), bladder transitional cell carcinoma (n = 2), lung adenocarcinoma (n = 2), cervical intraepithelial neoplasia 3 and papillary squamous cell carcinoma (n = 2), colorectal (colon and rectal adenocarcinoma) (n = 2), uterine adenocarcinoma (n = 1), nasopharyngeal carcinoma (n = 1) and hematological malignancy (myelodysplastic with excess blast cells) (n = 1). Among the patients with malignancies, 13 (86.7%) had dermatomyositis, 2 (13.3%) polymyositis and 3 (20%) interstitial lung disease. The mean duration from dermatomyositis/polymyositis diagnosis to the occurrence of malignancies was 6.05 ± 5.69 years. There was no significant association of raised tumor markers with the occurrence of malignancies (p > 0.085), while a significant association was observed between the elevated levels of carbohydrate antigen 15-3 and the presence of interstitial lung disease (p = 0.006). Conclusion: Tumor markers were not useful in malignancy screening or dermatomyositis/polymyositis patients in this tertiary center. The evaluation of the occurrence of malignancy in dermatomyositis/polymyositis patient should include a multidimensional approach. A raised level of carbohydrate antigen 15-3 may be a potential indicator of the presence of interstitial lung disease in dermatomyositis/polymyositis patients.
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Affiliation(s)
- Chong Hong Lim
- Rheumatology Unit, Department of Internal Medicine, Hospital Sultanah Bahiyah, Alor Setar, Malaysia.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Wei Tseng
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Tsai Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Nan Huang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Biomedical Sciences and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.,Translational Medicine Laboratory, Rheumatic Diseases Research Center, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
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231
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Han S, Choi JI, Park MY, Choi MH, Rha SE, Lee YJ. The Diagnostic Performance of Liver MRI without Intravenous Contrast for Detecting Hepatocellular Carcinoma: A Case-Controlled Feasibility Study. Korean J Radiol 2018; 19:568-577. [PMID: 29962863 PMCID: PMC6005954 DOI: 10.3348/kjr.2018.19.4.568] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To preliminarily evaluate the diagnostic performance of an unenhanced MRI for detecting hepatocellular carcinoma (HCC) with a case-control study design. Materials and Methods The case group consisted of 175 patients with initially-diagnosed HCC, who underwent a 3T liver MRI. A total of 237 HCCs were identified. The number of HCCs that were smaller than 1 cm, 1 cm ≤ and < 2 cm, and ≥ 2 cm were 19, 105, and 113, respectively. For the control group, 72 patients with chronic liver disease, who did not have HCC, were enrolled. Two radiologists independently reviewed the T2 half-Fourier acquisition single-shot turbo spin echo, T2 fast spin echos with fat saturation, T1 gradient in- and out-of-phase images, and diffusion-weighted images/apparent diffusion coefficient maps to detect HCC. Per-patient analyses were performed to evaluate the sensitivity and specificity of the non-contrast MRI for diagnosing HCC. Furthermore, the per-lesion sensitivity was also calculated according to tumor size. Results In the per-patient analyses, the sensitivity and specificity of reader 1 were 86.3% (151/175) and 87.5% (63/72), respectively; while those of reader 2 were 82.9% (145/175) and 76.4% (55/72), respectively. When excluding HCCs smaller than 1 cm, the sensitivity of reader 1 and 2 were 88.0% (147/167) and 86.2% (144/167), respectively. In the per-lesion analyses, the sensitivities of reader 1 and reader 2 were 75.9% (180/237) and 70.5% (167/237), respectively. Conclusion The per-patient sensitivity and specificity of non-contrast MRIs were within a reasonable range for the initial diagnosis of HCC. Non-contrast MRIs may have a potential for surveillance of HCC. Further confirmatory diagnostic test accuracy studies are needed.
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Affiliation(s)
- Seunghee Han
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.,Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Michael Yong Park
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.,Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.,Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Young Joon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
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Microwave ablation provides better survival than liver resection for hepatocellular carcinoma in patients with borderline liver function: application of ALBI score to patient selection. HPB (Oxford) 2018; 20:546-554. [PMID: 29352659 DOI: 10.1016/j.hpb.2017.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/23/2017] [Accepted: 12/19/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Studies comparing microwave ablation (MWA) and liver resection are lacking. This study evaluates the survival of patients with hepatocellular carcinoma (HCC) treated with liver resection or MWA and the role of Albumin-Bilirubin (ALBI) score in patient selection for treatments. METHODS This is a retrospective analysis of patients who received curative liver resection or MWA for HCC. Propensity score matching was used at a 1:1 ratio. The value of ALBI grade for patient selection was evaluated. Overall and disease-free survival were compared between two groups. RESULTS Of the 442 patients underwent MWA or liver resection for HCC during the study period, 63 patients received MWA and 379 patients received liver resection. Propensity scoring matching analysis resulted in 63 matched pairs for further analysis. Subgroup analysis according to the ALBI grade was performed. Liver resection offered better overall and disease-free survivals in patients with ALBI grade 1. MWA provided a significantly better overall survival (p = 0.025) and a trend towards better disease-free survival (p = 0.39) in patients with ALBI grade 2 or 3. CONCLUSIONS Liver resection offered superior disease-free survival to MWA in patients with HCC. The ALBI grade could identify patients with worse liver function who might gain survival advantage from MWA.
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Role of liver resection in treating intermediate and advanced stage adolescent and young adult hepatocellular carcinoma patients: A propensity-matching cohort study. Int J Surg 2018; 54:259-264. [DOI: 10.1016/j.ijsu.2018.03.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/22/2018] [Accepted: 03/21/2018] [Indexed: 01/27/2023]
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234
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Kim HY, Nam JY, Lee JH, Lee HA, Chang Y, Lee HY, Cho H, Lee DH, Cho YY, Cho EJ, Yu SJ, Lee JM, Kim YJ, Yoon JH. Intensity of surveillance for hepatocellular carcinoma determines survival in patients at risk in a hepatitis B-endemic area. Aliment Pharmacol Ther 2018; 47:1490-1501. [PMID: 29611209 DOI: 10.1111/apt.14623] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/01/2018] [Accepted: 03/01/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Data are insufficient regarding the survival benefit of surveillance for hepatocellular carcinoma (HCC). AIM To investigate the effectiveness of HCC surveillance in a hepatitis B-endemic population. METHODS This retrospective cohort study included 1402 consecutive patients who were newly diagnosed with HCC between 2005 and 2012 at a single tertiary hospital in Korea. The primary endpoint was overall survival. Lead-time and length-time biases were adjusted (sojourn time = 140 days) and sensitivity analyses were performed. RESULTS The most common aetiology was hepatitis B (80.4%). Cirrhosis was present in 78.2%. HCC was diagnosed during regular surveillance (defined as mean interval of ultrasonography <8 months, n = 834), irregular surveillance (n = 104) or nonsurveillance (n = 464). Patients in the regular surveillance group were diagnosed at earlier stages ([very] early stage, 64.4%) than the irregular surveillance (40.4%) or nonsurveillance (26.9%) groups and had more chance for curative treatments (52.4%) than the irregular surveillance (39.4%) or nonsurveillance (23.3%) groups (all P < 0.001). Mortality risk was significantly lower in the regular surveillance group (adjusted hazard ratio [aHR], 0.69; 95% [CI], 0.57-0.83) but not in the irregular surveillance group (aHR, 0.94; 95% CI, 0.69-1.28) compared with the nonsurveillance group after adjusting for confounding factors and lead-time. When the subjects were restricted to cirrhotic patients or Child-Pugh class A/B patients, similar results were obtained for mortality risk reduction between groups. CONCLUSIONS HCC surveillance was associated with longer survival owing to earlier diagnosis and curative treatment. Survival advantage was significant with regular surveillance but not with irregular surveillance.
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Affiliation(s)
- H Y Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - J Y Nam
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - J-H Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - H A Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Y Chang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - H Y Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - H Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - D H Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Y Y Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - E J Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - S J Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - J M Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Y J Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - J-H Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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235
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Kis B, El-Haddad G, Sheth RA, Parikh NS, Ganguli S, Shyn PB, Choi J, Brown KT. Liver-Directed Therapies for Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma. Cancer Control 2018; 24:1073274817729244. [PMID: 28975829 PMCID: PMC5937250 DOI: 10.1177/1073274817729244] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC) are primary liver cancers where all or most of the tumor burden is usually confined to the liver. Therefore, locoregional liver-directed therapies can provide an opportunity to control intrahepatic disease with minimal systemic side effects. The English medical literature and clinical trials were reviewed to provide a synopsis on the available liver-directed percutaneous therapies for HCC and IHC. Locoregional liver-directed therapies provide survival benefit for patients with HCC and IHC compared to best medical treatment and have lower comorbid risks compared to surgical resection. These treatment options should be considered, especially in patients with unresectable disease.
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Affiliation(s)
- Bela Kis
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ghassan El-Haddad
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Rahul A Sheth
- 2 Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Nainesh S Parikh
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Suvranu Ganguli
- 3 Center for Image Guided Cancer Therapy, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul B Shyn
- 4 Department of Radiology, Abdominal Imaging and Intervention, Brigham and Women's, Boston, MA, USA
| | - Junsung Choi
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Karen T Brown
- 5 Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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236
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Song P, Cai Y, Tang H, Li C, Huang J. The clinical management of hepatocellular carcinoma worldwide: A concise review and comparison of current guidelines from 2001 to 2017. Biosci Trends 2018; 11:389-398. [PMID: 28904327 DOI: 10.5582/bst.2017.01202] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the second leading cause of cancer-related mortality worldwide. In this review, we made a review on current guidelines published from January 2001 to June 2017 worldwide with a focus on the clinical management of HCC. The electronic databases MEDLINE, the Chinese SinoMed, and the Japanese CiNii were systematically searched. A total of 18 characteristic guidelines for HCC management were finally included, including 8 guidelines from Asia, 5 from Europe, and 5 from the United States of America (USA). If guidelines were published in multiple versions, the most recent update was included, and surveillance, diagnosis, and treatment were compared. The composition of and recommendations in current guidelines on HCC varied, so these guidelines were regrouped and diagnostic and treatment algorithms were summarized graphically to provide the latest information to clinicians. The diagnostic criteria were grouped into 2 categories of a "Size-based pathway" and a "Non-size-based pathway." The treatment criteria were divided into 4 categories: i) Criteria based on the Barcelona Clinic Liver Cancer staging system; ii) Criteria based on the modified Union of International Cancer Control staging system; iii) Criteria based on the Child-Pugh class of liver function; and iv) Criteria based on tumor resectability. Findings from comparison of current guidelines might help target and concentrate efforts to improve the clinical management of HCC. However, further studies are needed to improve the management and outcomes of HCC. More straightforward or refined guidelines would help guide doctors to make better decisions in the treatment of HCC in the future.
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Affiliation(s)
- Peipei Song
- Graduate School of Frontier Sciences, The University of Tokyo
| | - Yulong Cai
- Department of Bile Duct Surgery, West China Hospital, Sichuan University
| | - Haowen Tang
- Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital
| | - Chuan Li
- Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University
| | - Jiwei Huang
- Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University
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237
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Yin Z, Jin H, Ma T, Zhou Y, Yu M, Jian Z. A meta-analysis of long-term survival outcomes between surgical resection and radiofrequency ablation in patients with single hepatocellular carcinoma ≤ 2 cm (BCLC very early stage). Int J Surg 2018; 56:61-67. [PMID: 29723677 DOI: 10.1016/j.ijsu.2018.04.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/15/2018] [Accepted: 04/26/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The optimal management choice in consideration of long-term overall survival (OS) and disease-free survival (DFS) for patients with BLCL very early stage is a matter of debate. AIM A systematic review and meta-analysis was conducted to evaluate the efficacy of liver resection (RES) and radiofrequency ablation (RFA) for single HCC 2 cm or less. MATERIAL AND METHOD The primary sources of the reviewed studies through December 2017, without restriction on the languages or regions, were Pubmed and Embase. The hazard ratio (HR) was used as a summary statistic for long-term outcomes. RESULTS A total of 5 studies qualified for inclusion in this quantified meta-analysis with a total of 729 HCC patients of BCLC very early stage. Only postoperative 1-year OS was comparable in both RES and RFA groups. As for long-term outcomes of 3-year and 5-year OSs, RES was significantly better than RFA, the HRs were 0.64 (95%CI: 0.41, 1.00; P = 0.05) and 0.63 (95%CI: 0.42, 0.95; P = 0.03) respectively. In terms of postoperative DFS, reduced tumor recurrence was observed in RES, and all the short- and long-terms outcomes were favored RES. DISCUSSION RES offers better long-term oncologic outcomes compared with RFA in current clinical evidences.
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Affiliation(s)
- Zi Yin
- General Surgery Department of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Haosheng Jin
- General Surgery Department of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Tingting Ma
- Gynaecology and Obstetrics Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Yu Zhou
- General Surgery Department of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Min Yu
- General Surgery Department of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Zhixiang Jian
- General Surgery Department of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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238
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Yong CC, Elsarawy AM, Wang SH, Lin TS, Wang CC, Li WF, Lin TL, Kuo FY, Cheng YF, Chen CL, Lin CC. The surgical challenges of salvage living donor liver transplantation for Hepatocellular carcinoma; The cumulative experience of 100 cases - A retrospective cohort study and a propensity score analysis. Int J Surg 2018; 54:187-192. [PMID: 29723674 DOI: 10.1016/j.ijsu.2018.04.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/10/2018] [Accepted: 04/26/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is increasingly managed by liver resection first then salvage liver transplantation in case of recurrence within accepted criteria. Many reports compared the safety of the salvage against the primary surgery in the setting of deceased donation but the difference in case of living donation is not sufficiently defined. Salvage living donor liver transplantation (SLDLT) is believed to be a more challenging surgery than primary living donor liver transplantation (PLDLT) due to operative field adhesions, in addition to the inherent difficulties particularly short vasculobiliary stumps. In this report, we compared both pathways from a surgical perspective in a homogenous LDLT-only cohort. MATERIALS AND METHODS Over 15 years, 448 LDLTs for HCC were performed in a single liver transplant institution in Taiwan, including PLDLT (n = 348) and SLDLT (n = 100). A retrospective comparative review of the surgical outcomes of both pathways using a propensity score matching model (1-1, 100 pairs) was performed with adjustment for age, Child score and MELD score. The surgical outcome and survival were compared across 2 time eras. RESULTS The operative data showed that SLDLT surgery encountered more extensive adhesions (57% vs. 0%, p < 0.001), longer operative duration (650 vs. 618 min, p=0.04), and was followed by more incidence of re-exploration (16% vs. 5%, p=0.01), than the PLDLT surgery. There was no significant difference regarding the incidence of in-hospital mortality, vascular and biliary complications, or overall survival (OS). The 1-year OS of SLDLT was inferior to PLDLT in the first 50 cases (90% vs. 98%, p=0.03), then the same OS was found in the 2nd 50 cases (96% vs. 96%, p=0.9). CONCLUSIONS The SLDLT surgery is a demanding lengthy procedure with extensive adhesions and possibility of frequent re-explorations. Significant case load and high centre volume are important factors for safe practice of SLDLT and better cumulative OS.
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Affiliation(s)
- Chee-Chien Yong
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Ahmed M Elsarawy
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Shih-Ho Wang
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Tsan-Shiun Lin
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Chih-Chi Wang
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Wei-Feng Li
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Ting-Lung Lin
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Fang-Ying Kuo
- Liver Transplantation Center, Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Yu-Fan Cheng
- Liver Transplantation Center, Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Chao-Long Chen
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Chih-Che Lin
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
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Transarterial chemoembolization combined with computed tomography-guided 125iodine implantation enhances survival in hepatocellular carcinoma patients with portal vein tumor thrombus. Oncotarget 2018; 8:29258-29268. [PMID: 28418927 PMCID: PMC5438728 DOI: 10.18632/oncotarget.16491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/14/2017] [Indexed: 12/16/2022] Open
Abstract
We conducted a retrospective study to evaluate the safety and efficacy of transarterial chemoembolization (TACE) combined with computed tomography-guided 125iodine implantation (TACE-125iodine) in hepatocellular carcinoma (HCC) patients with type B portal vein tumor thrombus (PVTT). From medical records, we determined that 50 patients who received 125iodine implantation 4-7 days after the first TACE session showed better survival than 50 patients who received only TACE (median survival, 13.1 vs. 6.0 months; P<0.01). Moreover, the PVTT control rate was higher in the TACE-125iodine than TACE alone group (78% vs. 18%; P<0.01). Multivariate analysis demonstrated that the TACE-125iodine procedure was an independent prognostic factor for overall survival. We also observed that bilirubin levels were increased at 4 weeks, indicating that 125iodine seeding in the PVTT beneficially impacted the small bile duct, which is proximal to the portal vein. No severe adverse events were observed in patients that received 125iodine seed implantation, and the mild adverse events were successfully treated. This study shows that TACE-125iodine therapy enhances patient survival with minimal adverse events. It is also more affordable than sorafenib, which is currently the recommended therapy for advanced HCC patients with PVTT.
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240
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Significance of Glypican-3 in Early Detection of Hepatocellular Carcinoma in Cirrhotic Patients. J Gastrointest Cancer 2018; 50:434-441. [DOI: 10.1007/s12029-018-0095-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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241
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Li D, Cheng Z, Chen G, Liu F, Wu W, Yu J, Gu Y, Liu F, Ren C, Liang P. A multimodality imaging-compatible insertion robot with a respiratory motion calibration module designed for ablation of liver tumors: a preclinical study. Int J Hyperthermia 2018; 34:1194-1201. [PMID: 29566561 DOI: 10.1080/02656736.2018.1456680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Dongrui Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Gang Chen
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Wenbo Wu
- Beijing Baihui Weikang Medical Robot Technology Co., Ltd, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ying Gu
- Department of Laser Medicine, Chinese PLA General Hospital, Beijing, China
| | - Fengyong Liu
- Department of Intervention Therapy, Chinese PLA General Hospital, Beijing, China
| | - Chao Ren
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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242
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Ronot M, Fouque O, Esvan M, Lebigot J, Aubé C, Vilgrain V. Comparison of the accuracy of AASLD and LI-RADS criteria for the non-invasive diagnosis of HCC smaller than 3 cm. J Hepatol 2018; 68:715-723. [PMID: 29274407 DOI: 10.1016/j.jhep.2017.12.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Non-invasive imaging is crucial for the early diagnosis and successful treatment of hepatocellular carcinoma (HCC). Terminology and criteria for interpreting and reporting imaging results must be standardized to optimize diagnosis. The aim of this study was to prospectively compare the diagnostic accuracy of the American Association for the Study of Liver Diseases (AASLD) and the 2014 version of Liver Imaging Reporting and Data System (LI-RADS®) criteria for the non-invasive diagnosis of small HCC, and to evaluate the diagnostic value of ancillary features used in the LI-RADS criteria. METHODS Between April 2009 and April 2012, patients with cirrhosis and one to three 10-30 mm nodules were enrolled and underwent computed tomography (CT) and magnetic resonance (MR) imaging. The diagnostic accuracy of both the AASLD and the LI-RADS criteria were determined based on their sensitivity, specificity, positive (PPV) and negative predictive values (NPV). RESULTS A total of 595 nodules were included (559 [341 HCC, 61%] with MR imaging and 529 [332 HCC, 63%] with CT). Overall, no (0%) LR-1 and LR-2, 44 (33%) and 47 (41%) LR-3, 50 (53%) and 54 (55%) LR-4, 244 (94%) and 222 (91%) LR-5 and 4 (67%) and 9 (82%) LR-5V were HCC on MR imaging and CT, respectively. The sensitivity, specificity, PPV/NPV of the AASLD score was 72.5%, 87.6%, 90.2%, and 66.9% for MR imaging, and 71.4%, 77.7%, 84.3%, 61.7% for CT, respectively. For the combination of LR-5V and LR-5 nodules these measures were 72.5%, 89.9%, 91.9% and 67.5% on MRI and 66.9%, 88.3%, 90.9% and 63.3% on CT, respectively. For the combination of LR-5V, LR-5 and LR-4 nodules they were 87.1%, 69.1%, 81.6% and 77.3% on MRI and 85.8%, 66%, 81% on 73.5% on CT, respectively. CONCLUSION The 2014 version of the LI-RADS is no more accurate than the AASLD score for the non-invasive diagnosis of small HCC in high-risk patients, but it provides important and complementary information on the probability of having HCC in high-risk patients, allowing for possible changes in the management of these patients. LAY SUMMARY The 2014 version of Liver Imaging Reporting and Data System criteria does not outperform the American Association for the Study of Liver Diseases criteria for the non-invasive diagnosis of hepatocellular carcinoma (HCC) smaller than 3 cm. Liver Imaging Reporting and Data System offers a nodule-based evaluation of the risk of HCC, allowing possible changes in management in these patients. The added value of ancillary features appears limited for the non-invasive diagnosis of small HCC.
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Affiliation(s)
- Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Olivia Fouque
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Maxime Esvan
- URC HEGP CIC-EC, Hôpitaux universitaires Paris Ouest (AP-HP), Paris, France
| | - Jérome Lebigot
- Department of radiology, University Hospital Angers, University Bretagne Loire, Angers, France; HIFIH Laboratory, University Bretagne Loire, University of Angers, Angers, France
| | - Christophe Aubé
- Department of radiology, University Hospital Angers, University Bretagne Loire, Angers, France; HIFIH Laboratory, University Bretagne Loire, University of Angers, Angers, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
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243
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Guss D, Sherigar J, Rosen P, Mohanty SR. Diagnosis and Management of Hepatitis C Infection in Primary Care Settings. J Gen Intern Med 2018; 33:551-557. [PMID: 29352420 PMCID: PMC5880771 DOI: 10.1007/s11606-017-4280-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/09/2017] [Accepted: 12/14/2017] [Indexed: 12/18/2022]
Abstract
Hepatitis C virus (HCV) infection is a significant health problem worldwide, and is the leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation in the United States. The management of HCV has changed significantly over the last 5 years, as treatments have become simpler and more efficacious. Medication efficacy is now greater than 90%, with a high barrier to resistance and few side effects. This review is a collaboration between primary care and hepatology providers to explore all aspects of HCV management: acute versus chronic HCV infection, transmission and testing, and diagnosis and treatment. Specific medications for the treatment of HCV infection are considered, and patient and medication factors including genotype, liver disease status, and comorbidities affecting medication choice are discussed. This is a new era for the management of HCV infection, and interested primary care physicians, family doctors, and general internists can be at the forefront of diagnosis, management, and treatment of HCV.
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Affiliation(s)
- Debra Guss
- Division of Gastroenterology and Hepatobiliary Diseases, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA.
| | - Jagannath Sherigar
- Division of Gastroenterology and Hepatobiliary Diseases, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Paul Rosen
- Department of Family Medicine, Brooklyn Hospital, Brooklyn, USA
| | - Smruti R Mohanty
- Division of Gastroenterology and Hepatobiliary Diseases, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
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244
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Nault JC, Sutter O, Nahon P, Ganne-Carrié N, Séror O. Percutaneous treatment of hepatocellular carcinoma: State of the art and innovations. J Hepatol 2018; 68:783-797. [PMID: 29031662 DOI: 10.1016/j.jhep.2017.10.004] [Citation(s) in RCA: 241] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/01/2017] [Accepted: 10/06/2017] [Indexed: 02/06/2023]
Abstract
Percutaneous treatment of hepatocellular carcinoma (HCC) encompasses a vast range of techniques, including monopolar radiofrequency ablation (RFA), multibipolar RFA, microwave ablation, cryoablation and irreversible electroporation. RFA is considered one of the main curative treatments for HCC of less than 5 cm developing on cirrhotic liver, together with surgical resection and liver transplantation. However, controversies exist concerning the respective roles of ablation and liver resection for HCC of less than 3 to 5 cm on cirrhotic liver. In line with the therapeutic algorithm of early HCC, percutaneous ablation could also be used as a bridge to liver transplantation or in a sequence of upfront percutaneous treatment, followed by transplantation if the patient relapses. Moreover, several innovations in ablation methods may help to efficiently treat early HCC, initially considered as "non-ablatable", and might, in some cases, extend ablation criteria beyond early HCC, enabling treatment of more patients with a curative approach.
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Affiliation(s)
- Jean-Charles Nault
- Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France.
| | - Olivier Sutter
- Department of Radiology, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
| | - Pierre Nahon
- Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Nathalie Ganne-Carrié
- Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Olivier Séror
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France; Department of Radiology, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France.
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245
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Galia M, Agnello F, Sparacia G, Matranga D, Albano D, Midiri M, Lagalla R. Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients. Radiol Med 2018; 123:489-497. [PMID: 29546493 DOI: 10.1007/s11547-018-0873-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To retrospectively analyze the evolution of indeterminate hepatocellular nodules in cirrhotic patients on serial Gd-EOB-DPTA-enhanced MRI, and to identify predictors of HCC development. MATERIALS AND METHODS This IRB approved study included 33 cirrhotic patients with 69 indeterminate hepatocellular nodules (mean diameter 1.1 cm) at baseline Gd-EOB-DPTA-enhanced MRI and a Gd-EOB-DPTA-enhanced-MRI follow-up of at least 2 years. Two radiologists evaluated size and signal intensity of each nodule at baseline and follow-up. Age, cirrhosis etiology, and HCC history were recorded. Data were compared between nodules that became HCCs at follow-up (HCC) and those that did not (no-HCC). RESULTS On follow-up, 5/69 nodules became HCCs and 64/69 showed indeterminate characteristics. HCC history was more frequently found in HCCs than in no-HCCs. Age, sex, and cirrhosis etiology were not significantly different between HCCs and no-HCCs. HCCs had a significantly greater baseline diameter and increase in size than no-HCCs. Hepatobiliary phase hypointensity was significantly more common in HCCs than in no-HCCs. Multivariate regression analysis showed that increase in size (OR 10.48; sensitivity, 100%; specificity, 81.2%; p < 0.001) and hepatobiliary phase hypointensity (OR 1.02; sensitivity, 100%; specificity, 78.1%; p < 0.001) was associated with HCC development. CONCLUSION Indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients rarely became HCCs. Hepatobiliary phase hypointensity had a weak association with HCC development.
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Affiliation(s)
- Massimo Galia
- Department of Radiology, University of Palermo, Via XII Gennaio 1/g, 90141, Palermo, Italy
| | - Francesco Agnello
- Department of Radiology, University of Palermo, Via XII Gennaio 1/g, 90141, Palermo, Italy.
| | - Gianvincenzo Sparacia
- Department of Radiology, University of Palermo, Via XII Gennaio 1/g, 90141, Palermo, Italy
| | - Domenica Matranga
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Domenico Albano
- Department of Radiology, University of Palermo, Via XII Gennaio 1/g, 90141, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, University of Palermo, Via XII Gennaio 1/g, 90141, Palermo, Italy
| | - Roberto Lagalla
- Department of Radiology, University of Palermo, Via XII Gennaio 1/g, 90141, Palermo, Italy
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246
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Sheng J, Qin H, Zhang K, Li B, Zhang X. Targeting autophagy in chemotherapy-resistant of hepatocellular carcinoma. Am J Cancer Res 2018; 8:354-365. [PMID: 29636994 PMCID: PMC5883089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/04/2018] [Indexed: 06/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a malignant tumor with poor prognosis. Surgical resection is recommended for very early-stage and early-stage HCC, but HCC is still prone to recurrence and metastasis after surgery. Furthermore, treatment options for intermediate- and advanced-stage HCC are relatively limited. Systemic therapy is the preferred method to kill residual cancer cells after surgery and prolong survival time of inoperable patients, but most cases are insensitive to chemotherapeutic agents, restricting widespread clinical application of systemic therapy. Many studies have found that various chemotherapeutic drugs for HCC treatment can increase autophagic flux of HCC cells, and it may be related with enhancing drug resistance and promoting cell survival. However, enhancement of autophagic flux may also induce tumor cell death in some cases, leading to marked inconsistency across studies. Here we reviewed the mechanisms underlying the increase in autophagic flux in HCC cells induced by chemotherapeutic drugs and examined the contributions of autophagy and related pathways to chemotherapy drug resistance. Our aim was to identify potential autophagy-related targets for improving the sensitivity of HCC to chemotherapeutic drugs.
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Affiliation(s)
- Jiyao Sheng
- Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Jilin UniversityChangchun 130041, Jilin, China
| | - Hanjiao Qin
- Department of Radiotherapy, The Second Hospital of Jilin UniversityChangchun 130041, Jilin, China
| | - Kun Zhang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin UniversityChangchun 130041, Jilin, China
| | - Bingjin Li
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin UniversityChangchun 130041, Jilin, China
| | - Xuewen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Jilin UniversityChangchun 130041, Jilin, China
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247
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Zhao C, Jin M, Le RH, Le MH, Chen VL, Jin M, Wong GLH, Wong VWS, Lim YS, Chuang WL, Yu ML, Nguyen MH. Poor adherence to hepatocellular carcinoma surveillance: A systematic review and meta-analysis of a complex issue. Liver Int 2018; 38:503-514. [PMID: 28834146 DOI: 10.1111/liv.13555] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/15/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) surveillance is associated with improved outcomes and long-term survival. Our goal is to evaluate adherence rates to HCC surveillance. METHODS We performed a systematic search of the PubMed and Scopus databases and abstract search of relevant studies from recent major liver meetings. All searches and data extraction were performed independently by two authors. Analysis was via random-effects models and multivariate meta-regression. RESULTS A total of 22 studies (n = 19 511) met inclusion criteria (original non-interventional studies with defined cirrhosis or chronic hepatitis B or chronic hepatitis C with advanced fibrosis populations, and surveillance tests and intervals). Overall adherence rate was 52% (95% CI 38%-66%). Adherence was significantly higher in cirrhotic patients compared to chronic hepatitis B and other high-risk patients, in European compared to North American studies, in less than 12-month compared to yearly surveillance intervals, and in prospective compared to retrospective studies (71%, 95% CI 64%-78% vs 39%, 95% CI 26%-51%, P < .001). The between-study heterogeneity of all above analyses was significant (P < .001). Only the study design (retrospective vs prospective cohort) had statistical significance in a multivariate meta-regression model (P < .05) and could account for some of the differences above. CONCLUSIONS Overall adherence rate to HCC surveillance was suboptimal at 52% with no significant differences by liver disease aetiology or study location in multivariate meta-regression analysis. Further research and educational efforts are needed to improve the current rate of HCC surveillance.
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Affiliation(s)
- Changqing Zhao
- Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T. C. M., Shanghai, China.,Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Mingjuan Jin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Richard Hieu Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | | | - Vincent Lingzhi Chen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Michelle Jin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
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248
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Terzi E, Iavarone M, Pompili M, Veronese L, Cabibbo G, Fraquelli M, Riccardi L, De Bonis L, Sangiovanni A, Leoni S, Zocco MA, Rossi S, Alessi N, Wilson SR, Piscaglia F. Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1,006 nodules. J Hepatol 2018; 68:485-492. [PMID: 29133247 DOI: 10.1016/j.jhep.2017.11.007] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/28/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The use of contrast enhanced ultrasound (CEUS) for the diagnosis of hepatocellular carcinoma (HCC) in cirrhosis was questioned because of the risk of a false positive diagnosis in cases of cholangiocarcinoma. The American College of Radiology has recently released a scheme (CEUS Liver Imaging Reporting and Data System [LI-RADS®]) to classify lesions at risk of HCC investigated by CEUS. The aim of the present study was to validate this LI-RADS scheme for the diagnosis of HCC. METHODS A total of 1,006 nodules from 848 patients with chronic liver disease at risk of HCC were collected in five Italian centers and retrospectively analyzed. Nodules were classified as LR-5, (HCC) if ≥1 cm with arterial phase hyperenhancement, and late washout (onset ≥60 s after contrast injection) of mild degree. Rim enhancement and/or early and/or marked washout qualified lesions as LR-M (malignant, but not specific for HCC). Other combinations qualified lesions at intermediate risk for HCC (LR-3) or probable HCC (LR-4). Diagnostic reference standard was CT/MRI diagnosis of HCC (n = 506) or histology (n = 500). RESULTS The median nodule size was 2 cm. Of 1,006 nodules, 820 (81%) were HCC, 40 (4%) were cholangiocarcinoma, 116 (11%) regenerative nodules (±dysplastic). The LR-5 category (52% of all nodules) was 98.5% predictive of HCC, with no risk of misdiagnosis for pure cholangiocarcinoma. Sensitivity for HCC was 62%. All LR-M nodules were malignant and the majority of non-hepatocellular origin. Over 75% of cholangiocarcinomas were LR-M. The LR-3 category included 203 lesions (HCC 96 [47%]) and the LR-4 202 (HCC 173 [87%]). CONCLUSIONS The CEUS LI-RADS class LR-5 is highly specific for HCC, enabling its use for a confident non-invasive diagnosis. LAY SUMMARY This is a retrospective study of approximately 1,000 focal lesions at risk for hepatocellular carcinoma (HCC). Herein, we demonstrate that the refined definition of the typical contrast enhanced ultrasound pattern of HCC introduced by the Liver Imaging Reporting and Data System (LI-RADS®) practically abolishes the risk of misdiagnosis of other malignant entities (e.g. cholangiocarcinoma) for HCC with negligible reduction in sensitivity. These data support the use of contrast enhanced ultrasound to diagnose HCC in cirrhosis.
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Affiliation(s)
- Eleonora Terzi
- Department of Medical and Surgical Sciences, Division of Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Massimo Iavarone
- A.M. & A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy
| | - Maurizio Pompili
- Internal Medicine, Gastroenterology and Hepatology, Gemelli Hospital, University of Rome, Rome, Italy
| | - Letizia Veronese
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Giuseppe Cabibbo
- Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy
| | - Mirella Fraquelli
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy
| | - Laura Riccardi
- Internal Medicine, Gastroenterology and Hepatology, Gemelli Hospital, University of Rome, Rome, Italy
| | - Ludovico De Bonis
- Department of Medical and Surgical Sciences, Division of Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Angelo Sangiovanni
- A.M. & A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy
| | - Simona Leoni
- Department of Medical and Surgical Sciences, Division of Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Assunta Zocco
- Internal Medicine, Gastroenterology and Hepatology, Gemelli Hospital, University of Rome, Rome, Italy
| | - Sandro Rossi
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Nicola Alessi
- Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy
| | - Stephanie R Wilson
- Radiology and Medicine, Division of Gastroenterology, University of Calgary, Canada
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, Division of Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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Ban D, Ogura T, Akahoshi K, Tanabe M. Current topics in the surgical treatments for hepatocellular carcinoma. Ann Gastroenterol Surg 2018; 2:137-146. [PMID: 29863117 PMCID: PMC5881293 DOI: 10.1002/ags3.12065] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/29/2018] [Indexed: 01/27/2023] Open
Abstract
Treatment strategy for hepatocellular carcinoma (HCC) requires optimal selection of therapies based on various factors related to tumor condition and liver functional reserve. Although several evidence-based guidelines have been proposed for the treatment of HCC, the criteria and range of indications differ among these guidelines according to the circumstances of each country. In European nations and the USA, patients with the Barcelona Clinic Liver Cancer stage 0-A are subjects for surgical resection, whereas in Asian countries, even those with the intermediate stage are regarded as surgical candidates. Furthermore, since the recent introduction and rapidly widely spreading use of laparoscopic liver resection, this technique has become an important treatment option for surgical resection. In this review article, we overview the current topics of treatment of HCC with a special focus on surgical therapy.
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Affiliation(s)
- Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Toshiro Ogura
- Department of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Keiichi Akahoshi
- Department of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Tokyo Medical and Dental University Tokyo Japan
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250
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Lee JH, Kim YR, Lee GM, Ryu JH, Cho EY, Lee YH, Yoon KH. Coefficient of variation on Gd-EOB MR imaging: Correlation with the presence of early-stage hepatocellular carcinoma in patients with chronic hepatitis B. Eur J Radiol 2018; 102:95-101. [PMID: 29685552 DOI: 10.1016/j.ejrad.2018.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To study whether the measurement of hepatic fibrosis on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) magnetic resonance (MR) imaging using the coefficient of variation (CV) might be correlated with the presence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). MATERIALS AND METHODS This study included 104 patients with and without CHB, who were divided into 4 groups: control group, CHB without liver cirrhosis (LC; Group I), CHB with LC (Group II), and CHB with LC and HCC (Group III). MR images were analyzed to measure the inhomogeneity of signal intensities calculated using the CV map of the liver parenchyma. Intergroup comparisons of CV values were performed using ANOVA. The diagnostic performance of the CV map and alpha-fetoprotein (AFP) for diagnosing HCC was evaluated using the receiver operating characteristic (ROC) curve. RESULTS On the hepatobiliary phase of Gd-EOB-DTPA-enhanced T1-weighted imaging, the mean CV values of the control group and Groups I, II, and III were 3.9 ± 0.99, 3.97 ± 1.09, 5.58 ± 2.05, and 6.80 ± 2.34, respectively (P = 0.000). On ROC analysis of the CV value for predicting HCC, the value of the area under the curve (AUC) on Gd-EOB-DTPA MR imaging was 0.788 (95% CI: 0.697-0.862). The sensitivity and specificity were 84.2% and 63.6%, respectively, at a CV cutoff value >4.75. The value of AUC determined using AFP was 0.766. CONCLUSION The CV value for hepatic fibrosis on Gd-EOB-DTPA MR imaging may be correlated with the presence of HCC in patients with CHB, and shows comparable diagnostic performance to AFP analysis.
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Affiliation(s)
- Jung Hun Lee
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Youe Ree Kim
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Guy Mok Lee
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jong Hyun Ryu
- Imaging Science Research Center, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Eun Young Cho
- Department of Gastroenterology, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Young Hwan Lee
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Kwon-Ha Yoon
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Republic of Korea; Imaging Science Research Center, Wonkwang University Hospital, Iksan, Republic of Korea.
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