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Aida T, Haruki K, Akaoka M, Furukawa K, Onda S, Shirai Y, Shiozaki H, Takahashi K, Oikawa T, Ikegami T. A novel combined C-reactive protein-albumin ratio and modified albumin-bilirubin score can predict long-term outcomes in patients with hepatocellular carcinoma after hepatic resection. Ann Gastroenterol Surg 2024; 8:143-150. [PMID: 38250682 PMCID: PMC10797842 DOI: 10.1002/ags3.12727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/15/2023] [Accepted: 07/27/2023] [Indexed: 01/23/2024] Open
Abstract
Background Systemic inflammatory response represented by C-reactive protein and albumin ratio (CAR) and modified albumin-bilirubin (mALBI) grade both have been associated with long-term outcome in patients with hepatocellular carcinoma (HCC). In this study, we investigated the prognostic utility of combined score of CAR and mALBI score to predict the prognosis of HCC patients after hepatic resection. Methods This study included 214 patients who had undergone primary hepatic resection for HCC between 2008 and 2018. Systemic inflammatory response and mALBI were evaluated preoperatively and patients were classified into three groups based on the combination of CAR and mALBI score: low CAR and low mALBI grade (score 0), either high CAR or high mALBI grade (score 1), and both high CAR and high mALBI grade ≥2b (score 2). Multivariate Cox proportional hazard models were conducted to assess disease-free and overall survival. Results In multivariate analysis, sex (p < 0.01), HBsAg positivity (p < 0.01), serum AFP level ≥20 ng/mL (p < 0.01), microvascular invasion (p = 0.02), multiple tumors (p < 0.01), type of resection (p < 0.01), and CAR-mALBI score ≥2 (HR 2.19, 95% CI 1.39-3.44, p < 0.01) were independent prognostic factors of disease-free survival, while sex (p = 0.01), HBsAg positivity (p < 0.01), poor tumor differentiation (p = 0.03), multiple tumors (p < 0.01), CAR-mALBI score ≥2 (HR 2.70, 95% CI 1.51-4.83, p < 0.01) were independent prognostic factors of overall survival. Conclusions CAR-mALBI score is associated with disease-free and overall survival in patients with HCC after hepatic resection, suggesting the importance of evaluating both hepatic functional reserve and host-inflammatory state in the risk assessment of HCC patients.
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Affiliation(s)
- Takashi Aida
- Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Koichiro Haruki
- Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Munetoshi Akaoka
- Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Kenei Furukawa
- Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Shinji Onda
- Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Yoshihiro Shirai
- Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Hironori Shiozaki
- Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Keita Takahashi
- Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Tsunekazu Oikawa
- Division of Gastroenterology and Hepatology, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Toru Ikegami
- Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
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Dos Santos ML, França A, Lima Filho ACM, Florentino RM, Diniz PH, Oliveira Lemos F, Gonçalves CAX, Coelho VL, Lima CX, Foureaux G, Nathanson MH, Vidigal PVT, Leite MF. Inositol 1,4,5-trisphosphate receptor type 3 is involved in resistance to apoptosis and maintenance of human hepatocellular carcinoma. Oncol Lett 2022; 23:32. [PMID: 34966448 PMCID: PMC8669656 DOI: 10.3892/ol.2021.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/24/2021] [Indexed: 11/06/2022] Open
Abstract
The expression of the inositol 1,4,5-trisphosphate receptor type 3 (ITRP3) in hepatocytes is a common event in the pathogenesis of hepatocellular carcinoma (HCC), regardless of the type of underlying liver disease. However, it is not known whether ITPR3 expression in hepatocytes is involved in tumor maintenance. The aim of the present study was to determine whether there is an association between ITPR3 expression and clinical and morphological parameters using HCC samples obtained from liver explants from patients (n=53) with different etiologies of underlying chronic liver disease (CLD). ITPR3 expression, mitosis and apoptosis were analyzed in human liver samples by immunohistochemistry. Clinical and event-free survival data were combined to assess the relationship between ITPR3 and liver cancer growth in patients. RNA sequencing analysis was performed to identify apoptotic genes altered by ITPR3 expression in a liver tumor cell line. ITPR3 was highly expressed in HCC tumor cells relative to adjacent CLD tissue and healthy livers. There was an inverse correlation between ITPR3 expression and mitotic and apoptotic indices in HCC, suggesting that ITPR3 contributed to the maintenance of HCC by promoting resistance to apoptosis. This was confirmed by the upregulation of CTSB, CHOP and GADD45, genes involved in the apoptotic pathway in HCC. The expression of ITPR3 in the liver may be a promising prognostic marker of HCC.
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Affiliation(s)
- Marcone Loiola Dos Santos
- Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Andressa França
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Antônio Carlos Melo Lima Filho
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Rodrigo M. Florentino
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Paulo Henrique Diniz
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Fernanda Oliveira Lemos
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Carlos Alberto Xavier Gonçalves
- Coordination of Biotechnology, SENAI's Innovation Institute for Biosynthetics and Fibers, SENAI CETIQT, Rio de Janeiro 20961-020, Brazil
| | - Vitor Lima Coelho
- Coordination of Biotechnology, SENAI's Innovation Institute for Biosynthetics and Fibers, SENAI CETIQT, Rio de Janeiro 20961-020, Brazil
| | - Cristiano Xavier Lima
- Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 30 130-100, Brazil
| | - Giselle Foureaux
- Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Michael H. Nathanson
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8056, USA
| | - Paula Vieira Teixeira Vidigal
- Department of Pathological Anatomy and Forensic Medicine of Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 30 130-100, Brazil
| | - M. Fátima Leite
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
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Guo L, Yi X, Chen L, Zhang T, Guo H, Chen Z, Cheng J, Cao Q, Liu H, Hou C, Qi L, Zhu Z, Liu Y, Kong R, Zhang C, Zhou X, Zhang Z, Song T, Xue R, Zhang N. Single-Cell DNA Sequencing Reveals Punctuated and Gradual Clonal Evolution in Hepatocellular Carcinoma. Gastroenterology 2022; 162:238-252. [PMID: 34481846 DOI: 10.1053/j.gastro.2021.08.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Copy number alterations (CNAs), elicited by genome instability, are a major source of intratumor heterogeneity. How CNAs evolve in hepatocellular carcinoma (HCC) remains unknown. METHODS We performed single-cell DNA sequencing (scDNA-seq) on 1275 cells isolated from 10 patients with HCC, ploidy-resolved scDNA-seq on 356 cells from 1 additional patient, and single-cell RNA sequencing on 27,344 cells from 3 additional patients. Three statistical fitting models were compared to investigate the CNA accumulation pattern. RESULTS Cells in the tumor were categorized into the following 3 subpopulations: euploid, pseudoeuploid, and aneuploid. Our scDNA-seq analysis revealed that CNA accumulation followed a dual-phase copy number evolution model, that is, a punctuated phase followed by a gradual phase. Patients who exhibited prolonged gradual phase showed higher intratumor heterogeneity and worse disease-free survival. Integrating bulk RNA sequencing of 17 patients with HCC, published datasets of 1196 liver tumors, and immunohistochemical staining of 202 HCC tumors, we found that high expression of CAD, a gene involved in pyrimidine synthesis, was correlated with rapid tumorigenesis and reduced survival. The dual-phase copy number evolution model was validated by our single-cell RNA sequencing data and published scDNA-seq datasets of other cancer types. Furthermore, ploidy-resolved scDNA-seq revealed the common clonal origin of diploid- and polyploid-aneuploid cells, suggesting that polyploid tumor cells were generated by whole genome doubling of diploid tumor cells. CONCLUSIONS Our work revealed a novel dual-phase copy number evolution model, showed HCC with longer gradual phase was more severe, identified CAD as a promising biomarker for early recurrence of HCC, and supported the diploid origin of polyploid HCC.
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Affiliation(s)
- Lin Guo
- Laboratory of Tumor Cell Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China; Department of Genetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Xianfu Yi
- School of Biomedical Engineering and Technology, Department of Bioinformatics, The Province and Ministry Co-Sponsored Collaborative Innovation Center for Medical Epigenetics, Tianjin Medical University, Tianjin, China
| | - Lu Chen
- Laboratory of Tumor Cell Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China; Department of Hepatobiliary Cancer, Liver Cancer Research Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ti Zhang
- Department of Hepatobiliary Cancer, Liver Cancer Research Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hua Guo
- Laboratory of Tumor Cell Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ziye Chen
- Laboratory of Tumor Cell Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jinghui Cheng
- Translational Cancer Research Center, Peking University First Hospital, Beijing, China
| | - Qi Cao
- Translational Cancer Research Center, Peking University First Hospital, Beijing, China
| | - Hengkang Liu
- Translational Cancer Research Center, Peking University First Hospital, Beijing, China
| | - Chunyu Hou
- Translational Cancer Research Center, Peking University First Hospital, Beijing, China
| | - Lisha Qi
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhiyan Zhu
- Tianjin Research Center of Basic Medical Science, Tianjin Medical University, Tianjin, China
| | - Yucun Liu
- Division of General Surgery, Peking University First Hospital, Beijing, China
| | - Ruirui Kong
- Translational Cancer Research Center, Peking University First Hospital, Beijing, China
| | - Chong Zhang
- Beijing International Center for Mathematical Research, Peking University, Beijing, China
| | - Xiaohua Zhou
- BIOPIC, Beijing Advanced Innovation Center for Genomics, and School of Life Sciences, Peking University, Beijing, China
| | - Zemin Zhang
- Beijing International Center for Mathematical Research, Peking University, Beijing, China
| | - Tianqiang Song
- Department of Hepatobiliary Cancer, Liver Cancer Research Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ruidong Xue
- Translational Cancer Research Center, Peking University First Hospital, Beijing, China.
| | - Ning Zhang
- Laboratory of Tumor Cell Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China; Translational Cancer Research Center, Peking University First Hospital, Beijing, China.
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4
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Wilkinson PD, Duncan AW. Differential Roles for Diploid and Polyploid Hepatocytes in Acute and Chronic Liver Injury. Semin Liver Dis 2021; 41:42-49. [PMID: 33764484 PMCID: PMC8056861 DOI: 10.1055/s-0040-1719175] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatocytes are the primary functional cells of the liver that perform essential roles in homeostasis, regeneration, and injury. Most mammalian somatic cells are diploid and contain pairs of each chromosome, but there are also polyploid cells containing additional sets of chromosomes. Hepatocytes are among the best described polyploid cells, with polyploids comprising more than 25 and 90% of the hepatocyte population in humans and mice, respectively. Cellular and molecular mechanisms that regulate hepatic polyploidy have been uncovered, and in recent years, diploid and polyploid hepatocytes have been shown to perform specialized functions. Diploid hepatocytes accelerate liver regeneration induced by resection and may accelerate compensatory regeneration after acute injury. Polyploid hepatocytes protect the liver from tumor initiation in hepatocellular carcinoma and promote adaptation to tyrosinemia-induced chronic injury. This review describes how ploidy variations influence cellular activity and presents a model for context-specific functions for diploid and polyploid hepatocytes.
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Affiliation(s)
- Patrick D Wilkinson
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew W Duncan
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
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5
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Blüthner E, Bednarsch J, Malinowski M, Binder P, Pratschke J, Stockmann M, Kaffarnik M. Dynamic liver function is an independent predictor of recurrence-free survival after curative liver resection for HCC - A retrospective cohort study. Int J Surg 2019; 71:56-65. [DOI: 10.1016/j.ijsu.2019.08.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 12/12/2022]
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6
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Wilkinson PD, Delgado ER, Alencastro F, Leek MP, Roy N, Weirich MP, Stahl EC, Otero PA, Chen MI, Brown WK, Duncan AW. The Polyploid State Restricts Hepatocyte Proliferation and Liver Regeneration in Mice. Hepatology 2019; 69:1242-1258. [PMID: 30244478 PMCID: PMC6532408 DOI: 10.1002/hep.30286] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/16/2018] [Indexed: 12/12/2022]
Abstract
The liver contains a mixture of hepatocytes with diploid or polyploid (tetraploid, octaploid, etc.) nuclear content. Polyploid hepatocytes are commonly found in adult mammals, representing ~90% of the entire hepatic pool in rodents. The cellular and molecular mechanisms that regulate polyploidization have been well characterized; however, it is unclear whether diploid and polyploid hepatocytes function similarly in multiple contexts. Answering this question has been challenging because proliferating hepatocytes can increase or decrease ploidy, and animal models with healthy diploid-only livers have not been available. Mice lacking E2f7 and E2f8 in the liver (liver-specific E2f7/E2f8 knockout; LKO) were recently reported to have a polyploidization defect, but were otherwise healthy. Herein, livers from LKO mice were rigorously characterized, demonstrating a 20-fold increase in diploid hepatocytes and maintenance of the diploid state even after extensive proliferation. Livers from LKO mice maintained normal function, but became highly tumorigenic when challenged with tumor-promoting stimuli, suggesting that tumors in LKO mice were driven, at least in part, by diploid hepatocytes capable of rapid proliferation. Indeed, hepatocytes from LKO mice proliferate faster and out-compete control hepatocytes, especially in competitive repopulation studies. In addition, diploid or polyploid hepatocytes from wild-type (WT) mice were examined to eliminate potentially confounding effects associated with E2f7/E2f8 deficiency. WT diploid cells also showed a proliferative advantage, entering and progressing through the cell cycle faster than polyploid cells, both in vitro and during liver regeneration (LR). Diploid and polyploid hepatocytes responded similarly to hepatic mitogens, indicating that proliferation kinetics are unrelated to differential response to growth stimuli. Conclusion: Diploid hepatocytes proliferate faster than polyploids, suggesting that the polyploid state functions as a growth suppressor to restrict proliferation by the majority of hepatocytes.
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Affiliation(s)
- Patrick D. Wilkinson
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219
| | - Evan R. Delgado
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219
| | - Frances Alencastro
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219
| | - Madeleine P. Leek
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219
| | - Nairita Roy
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219
| | - Matthew P. Weirich
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219
| | - Elizabeth C. Stahl
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219
| | - P. Anthony Otero
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219
| | - Maelee I. Chen
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219
| | - Whitney K. Brown
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219
| | - Andrew W. Duncan
- Department of Pathology, McGowan Institute for Regenerative Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219
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Influence of higher BMI for hepatitis B- and C-related hepatocellular carcinomas. Langenbecks Arch Surg 2017; 402:745-755. [DOI: 10.1007/s00423-017-1589-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 05/09/2017] [Indexed: 12/13/2022]
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8
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Dolezal JM, Wang H, Kulkarni S, Jackson L, Lu J, Ranganathan S, Goetzman ES, Bharathi SS, Beezhold K, Byersdorfer CA, Prochownik EV. Sequential adaptive changes in a c-Myc-driven model of hepatocellular carcinoma. J Biol Chem 2017; 292:10068-10086. [PMID: 28432125 DOI: 10.1074/jbc.m117.782052] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/12/2017] [Indexed: 01/09/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a common cancer that frequently overexpresses the c-Myc (Myc) oncoprotein. Using a mouse model of Myc-induced HCC, we studied the metabolic, biochemical, and molecular changes accompanying HCC progression, regression, and recurrence. These involved altered rates of pyruvate and fatty acid β-oxidation and the likely re-directing of glutamine into biosynthetic rather than energy-generating pathways. Initial tumors also showed reduced mitochondrial mass and differential contributions of electron transport chain complexes I and II to respiration. The uncoupling of complex II's electron transport function from its succinate dehydrogenase activity also suggested a mechanism by which Myc generates reactive oxygen species. RNA sequence studies revealed an orderly progression of transcriptional changes involving pathways pertinent to DNA damage repair, cell cycle progression, insulin-like growth factor signaling, innate immunity, and further metabolic re-programming. Only a subset of functions deregulated in initial tumors was similarly deregulated in recurrent tumors thereby indicating that the latter can "normalize" some behaviors to suit their needs. An interactive and freely available software tool was developed to allow continued analyses of these and other transcriptional profiles. Collectively, these studies define the metabolic, biochemical, and molecular events accompanyingHCCevolution, regression, and recurrence in the absence of any potentially confounding therapies.
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Affiliation(s)
| | - Huabo Wang
- From the Divisions of Hematology/Oncology and
| | | | | | - Jie Lu
- From the Divisions of Hematology/Oncology and
| | | | | | | | - Kevin Beezhold
- Bone Marrow and Stem Cell Transplantation, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania 15224
| | - Craig A Byersdorfer
- Bone Marrow and Stem Cell Transplantation, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania 15224
| | - Edward V Prochownik
- From the Divisions of Hematology/Oncology and .,the Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, and.,the University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15232
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9
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Suh SW, Lee KW, Lee JM, You T, Choi Y, Kim H, Lee HW, Lee JM, Yi NJ, Suh KS. Prediction of aggressiveness in early-stage hepatocellular carcinoma for selection of surgical resection. J Hepatol 2014; 60:1219-24. [PMID: 24548529 DOI: 10.1016/j.jhep.2014.01.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/13/2014] [Accepted: 01/27/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS In early-stage hepatocellular carcinoma (eHCC), radiofrequency ablation (RFA) has comparable outcomes to surgical resection (SR); however, micrometastases may be present, resulting in tumor recurrence after local ablation. Therefore, we investigated predictors of aggressiveness in eHCC to select patients at high risk of recurrence after RFA who would benefit from SR. METHODS First, we analyzed 128 patients with newly diagnosed eHCC (single tumor with a diameter <3 cm) who underwent SR between January 2006 and December 2011. Risk factors for micrometastasis (representative of tumor aggressiveness) such as microvascular invasion or poor histologic grade were investigated. We then analyzed 201 eHCC patients who underwent RFA between July 2007 and December 2011. Identified risk factors were validated to determine their influence on tumor recurrence. RESULTS The only significant risk factor for tumor aggressiveness in the SR group was the product of serum levels of α-fetoprotein (AFP) and prothrombin induced by vitamin K absence-II (PIVKA-II) (A∗P ≥1600; hazard ratio [HR] 4.764; 95% confidence interval [CI], 1.867-12.161; p=0.001). This product also showed statistical significance for predicting recurrence in the RFA group (HR 2.296; 95% CI, 1.237-4.262; p=0.008). Patients with RFA and A∗P ≥1600 had significant early tumor recurrence (p=0.008) and poor late survival outcomes (p=0.001) compared with other patients. CONCLUSIONS The product of AFP and PIVKA-II levels is a useful predictor of aggressiveness in eHCC, which predicts tumor recurrence after RFA. Therefore, it should be considered when selecting SR as first-line treatment.
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Affiliation(s)
- Suk-Won Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Tae You
- Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Hyeyoung Kim
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul 156-707, Republic of Korea
| | - Hae Won Lee
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul 156-707, Republic of Korea
| | - Jeong-Min Lee
- Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
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10
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Du ZG, Wei YG, Chen KF, Li B. Risk factors associated with early and late recurrence after curative resection of hepatocellular carcinoma: a single institution's experience with 398 consecutive patients. Hepatobiliary Pancreat Dis Int 2014; 13:153-61. [PMID: 24686542 DOI: 10.1016/s1499-3872(14)60025-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Surgical resection is an important curative treatment for hepatocellular carcinoma (HCC); however, some patients experience an unexpected recurrence even after hepatectomy. The present study aimed to investigate risk factors and predictive criteria for early and late recurrence of HCC after resection. METHODS A retrospective analysis of 398 Chinese patients who received curative resection for HCC was conducted. Patients were divided into three groups: without recurrence, early recurrence, and late recurrence. Prognostic factors and predictive criteria for early and late recurrence were statistically analyzed. RESULTS The cumulative recurrence-free survival rates at 1, 2, 3, 4, and 5 years were 75.5%, 58.2%, 54.1%, 40.5%, and 28.7%, respectively. The distribution of the time to recurrence suggested that recurrence could be divided into early phase (before 2 years; n=164) and late phase (after 2 years; n=83). Cox's multivariate proportional hazard model analysis revealed that multiplicity of tumors (P=0.004) and venous infiltration (P=0.002) were independent risk factors associated with early recurrence. In contrast, indocyanine green retention rate at 15 minutes (P=0.007), serum albumin level (P=0.045), and HBeAg status (P=0.028) proved to be significant independent adverse prognostic factors for late recurrence. Patients with at least 1 of the 2 early recurrence risk factors (multiplicity of tumors ≥ 2 and venous infiltration) or with 2 or more late recurrence risk factors are often susceptible to recurrence (P=1.36e-4 and 1.0e-6, respectively). CONCLUSIONS Early and late recurrences correlate with different risk factors and predictive criteria. Early recurrence primarily results from intrahepatic metastases, while late recurrence may be multicentric in origin.
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Affiliation(s)
- Zheng-Gui Du
- Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China.
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11
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Risk factors of recurrence after curative resection of hepatocellular carcinoma in Taiwan. Am J Med Sci 2011; 341:301-4. [PMID: 21441859 DOI: 10.1097/maj.0b013e3181ff5d93] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The purpose of this study was to explore the potential risk factors of hepatocellular carcinoma (HCC) recurrence after curative resection of primary HCC. METHODS This was a hospital-based retrospective cohort study. The authors analyzed the medical records of all the subjects with HCC initially treated by hepatic resection at a medical center in Taiwan from 1995 to 2006. In all, 222 subjects were enrolled in this study. The total observational period was 3 years. RESULTS There were 172 men (77.5%) and 50 women (22.5%). The mean age was 57.0 ± 13.7 years (range, 15-79 years). Among 222 subjects, the overall recurrence rates were 28.8% (64/222), 42.3% (94/222) and 47.7% (106/222) at 1, 2 and 3 years, respectively. Multivariate logistic regression analysis exhibited that tumor size ≥ 5 cm [odds ratio (OR) = 2.31, 95% confidence interval (CI) = 1.27-4.17], liver cirrhosis (OR = 2.11, 95% CI = 1.18-3.79) and preoperative aspartate aminotransferase level ≥ 34 IU/L (OR = 2.02, 95% CI = 1.01-4.04) were independent risk factors of HCC recurrence. CONCLUSION Patients who have larger tumor size, liver cirrhosis and higher preoperative aspartate aminotransferase level should be carefully followed up because they are at high risk of HCC recurrence postoperatively.
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Ng KK, Poon RT, Lo CM, Yuen J, Tso WK, Fan ST. Analysis of recurrence pattern and its influence on survival outcome after radiofrequency ablation of hepatocellular carcinoma. J Gastrointest Surg 2008; 12:183-91. [PMID: 17874276 DOI: 10.1007/s11605-007-0276-y] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 07/19/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is an effective local ablation therapy for hepatocellular carcinoma (HCC) with favorable long-term outcome. There is no data on the analysis of recurrence pattern and its influence on long-term survival outcome after RFA in HCC patients. AIM OF STUDY To evaluate the tumor recurrence pattern and its influence on long-term survival in patients with HCC treated with RFA. PATIENTS AND METHODS From April 2001 to January 2005, 209 patients received RFA using internally cooled electrode as the sole treatment modality for HCC. Among them, 117 patients (56%) had unresectable HCC because of bilobar disease, poor liver function, and/or high medical risk for resection; whereas 92 patients (44%) underwent RFA as the primary treatment for small resectable HCC. The ablation procedure was performed through percutaneous (n=101), laparoscopic (n=17), or open approaches (n=91). The tumor recurrence pattern and long-term survival were analyzed. Multivariate analysis was carried out to identify independent prognostic factors affecting the overall survival of patients. RESULTS The mortality and morbidity rates were 0.9 and 15.7%, respectively. Complete tumor ablation was achieved in 192 patients (92.7%). With a median follow-up period of 26 months, local recurrence occurred in 28 patients (14.5%). Same segment and different segment intrahepatic recurrence occurred in 30 patients (15.6%) and 78 patients (40.6%), respectively. Twenty patients (10.4%) developed distant extrahepatic metastases. The overall 1-, 3-, and 5-year survival rates were 87.2, 66.6, and 42%, respectively. Different segment intrahepatic recurrence and distant recurrence after RFA carried significant poor prognostic influence on overall survival outcome. Using multivariate analysis, Child-Pugh grade (risk ratio [RR]=2.918, 95% confident interval [CI] 1.704-4.998, p=0.000), tumor size (RR=1.231, 95% CI 1.031-1.469, p=0.021), and pattern of recurrence (risk ratio [RR]=1.464, 95% CI 1.156-1.987, P=0.020) were identified as independent prognostic factors for overall survival. CONCLUSION The tumor recurrence pattern after RFA carries significant prognostic value in relation to overall survival. Long-term regular surveillance and aggressive treatment strategy are required for patients with different segment intrahepatic recurrence to optimize the benefits of RFA.
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Affiliation(s)
- Kelvin K Ng
- Department of Surgery, The University of Hong Kong Medical Center, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
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Lin LW, Lin XY, He YM, Gao SD, Lin XD. Biological characteristics of HCC by ultrasound-guided aspiration biopsy and its clinical application. World J Gastroenterol 2003; 9:941-5. [PMID: 12717834 PMCID: PMC4611401 DOI: 10.3748/wjg.v9.i5.941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To probe the pathological biological characteristics of hepatocellular carcinoma (HCC) by the ultrasound-guided aspiration biopsy and assess the clinical application value of this method.
METHODS: The biopsy and DNA analysis by flow cytometry (FCM) were taken in 46 cases with HCC nodules, including 26 cases and 20 cases with nodules ≤ 3 cm and > 3 cm in diameters respectively, and 12 cases with intrahepatic benign hyperplastic nodules. They were taken in 22 cases of 46 cases with HCC before and after the therapy. Fine-needles and automatic histological incised biopsy needles were used. The fresh biopsy tissue was produced into the single cell suspension, which was sent for DNA detection and ratio analysis of cell period. The ratio of each DNA period of cell proliferation of each group was calculated and compared with each other. The DNA aneuploid (AN) and apoptosis cell peak were observed and their percentages were calculated.
RESULTS: The ratios of S and G2/M periods of DNA, which reflect cell hyperproliferation, in the group with HCC tumors > 3 cm in diameter were markedly higher than those of the group with HCC nodules ≤ 3 cm in diameter and the group with the benign hyperplastic nodules (P < 0.01 except A:B of S period, P < 0.05). The ratios of the middle group were also apparently higher than those of the latter group (P < 0.01). The ratio of DNA AN of 46 cases with HCC nodules was 34.8% (16/46). None of the cases with the intrahepatic hyperplastic nodules appeared AN. The DNA AN appeared more apparently with the growth of the tumors. The AN ratio of the group with tumors > 3 cm in diameter was 55% (11/20), markedly higher than that of the group with tumors ≤ 3 cm in diameter which was 19.2% (5/26) (P < 0.01). The FCM DNA analysis of 22 specimens of hepatic carcinoma tissue before therapy showed that the aneuploid peaks appeared in 5 cases (22.7%). The ratio of G1 period rose after therapy while the S period and G2/M ratios fell (P < 0.01). The aneuploid peak disappeared in the 5 cases after the therapy, while the apoptosis peaks in 12 cases (54.5%) appeared.
CONCLUSION: Addition to supply the information of the pathological morphology of the tumor, the ultrasound-guided fine-needle aspiration tissue could be sent for FCM DNA analysis to comprehend its pathological biological characteristics. This can not only provide the clinic the reliable information about the occurrence, development, diagnosis, curative effect and prognosis of tumors but also supply biological information for clinic to choose therapeutic schemes.
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Affiliation(s)
- Li-Wu Lin
- Fujian Provincial Ultrasonic Medicine Institute, Ultrasound Department, Union Hospital of Fujian Medical University, Fuzhou, China.
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Sangiovanni A, Colombo E, Radaelli F, Bortoli A, Bovo G, Casiraghi MA, Ceriani R, Roffi L, Redaelli A, Rossini A, Spinzi G, Minoli G. Hepatocyte proliferation and risk of hepatocellular carcinoma in cirrhotic patients. Am J Gastroenterol 2001; 96:1575-80. [PMID: 11374702 DOI: 10.1111/j.1572-0241.2001.03780.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES High hepatocyte proliferation has been recently proposed as a risk factor for the development of hepatocellular carcinoma (HCC). The aim of this study was to assess whether hepatocyte proliferation is an independent risk factor for HCC when considered together with clinical and demographic characteristics. METHODS We retrospectively evaluated 97 consecutive patients with a histological diagnosis of cirrhosis and preserved liver function, enrolled in a surveillance program for early diagnosis of HCC. Hepatocyte proliferation was evaluated by flow-cytometric analysis in liver samples collected at the time of histological diagnosis of cirrhosis. All patients were followed with abdominal US and serum alpha-fetoprotein (AFP) assays every 6 months. RESULTS During a mean follow-up of 53 months (range, 12-120 months), 12 patients developed HCC, giving an annual incidence of 2.8%. The mean S-phase fraction was 2.5%+/-1.6 in patients who developed HCC and 0.9%+/-0.6 in those who did not (p < 0.0001). By univariate analysis, S-phase fraction 1.8% or higher and AFP higher than 20 ng/ml were the only two variables significantly correlated with the development of HCC (p < 0.0001, p < 0.0001). Multivariate analysis found that both variables were independently associated with HCC development (p < 0.003 and p < 0.005, respectively), with hazard ratios of 8.0 and 7.3 (confidence intervals, 2.1-31.2 and 1.8-29.2). Among patients with high AFP and/or high S-phase fraction, 11 (39%) developed HCC, compared with only one (1%) with a low S-phase fraction and normal AFP, corresponding to HCC yearly incidences of 9.5% and 0.3% (p < 0.00009). CONCLUSIONS Patients with high S-phase fraction and/or above-normal serum AFP are at higher risk of developing HCC and should be offered a close surveillance program.
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Affiliation(s)
- A Sangiovanni
- Department of Pathology, Valduce Hospital, Como, Italy
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15
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Ouchi K, Sugawara T, Fujiya T, Kamiyama Y, Kakugawa Y, Mikuni J, Yamanami H, Nakagawa K. Prediction of recurrence and extratumor spread of hepatocellular carcinoma following resection. J Surg Oncol 2000; 75:241-5. [PMID: 11135264 DOI: 10.1002/1096-9098(200012)75:4<241::aid-jso3>3.0.co;2-c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES The prognosis of patients with hepatocellular carcinoma (HCC) undergoing hepatectomy depends mostly on tumor recurrence. Portal vein invasion (Vp) and intrahepatic metastasis (IM) might strongly reflect the invasiveness of HCC, but the number of patients in the present series in whom either of these factors were detected was small. In this study, we defined Vp and IM as the extratumor spread, and we focused on the relationship between recurrence in patients after hepatectomy and the extratumor spread and the mitotic activities of cancer cells, in the hope that careful monitoring of recurrence might be possible by simply analyzing histology of the resected specimens. METHODS Univariate and multivariate analyses were used to determine the factors potentially related to recurrence in 50 patients who underwent hepatectomy for HCC. RESULTS The cumulative recurrence rate at 5 years was 81.0%. In univariate analysis, absence of the extratumor spread, mitotic index of four or less, and curative resection were significantly correlated with low incidence of recurrence. In multivariate analysis, the extratumor spread was the only significant variable influencing recurrence. The mitotic index in HCCs with the extratumor spread was significantly higher than the mitotic index in HCCs without the extratumor spread. CONCLUSIONS As a predictive factor for recurrence after resection of HCC, the extratumor spread that reflects the malignant potential of cancer cells was found to be more accurate than is any single invasiveness parameter such as Vp or IM.
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Affiliation(s)
- K Ouchi
- Department of Surgery, Miyagi Cancer Center Hospital, Natori, Japan.
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Koike Y, Shiratori Y, Sato S, Obi S, Teratani T, Imamura M, Hamamura K, Imai Y, Yoshida H, Shiina S, Omata M. Risk factors for recurring hepatocellular carcinoma differ according to infected hepatitis virus-an analysis of 236 consecutive patients with a single lesion. Hepatology 2000; 32:1216-23. [PMID: 11093727 DOI: 10.1053/jhep.2000.20237] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patients with hepatocellular carcinoma (HCC) frequently experience intrahepatic HCC recurrence even after complete ablation of primary lesions. Because the oncogenic process may be different for hepatitis B viral (B-viral) and hepatitis C viral (C-viral) HCC, the present study was conducted to elucidate the factors contributing to HCC recurrence with respect to the infected hepatitis virus. Two hundred thirty-six patients with a single HCC lesion who underwent complete ablation of the tumor by PEIT and/or PMCT or surgical resection at Tokyo University and its affiliated hospitals from 1993 to 1997 were enrolled. The patients were classified into 3 groups: the B-viral group, C-viral group, and NBNC group. After complete removal of tumors, the patients were followed for a mean period of 39 months. The factors contributing to HCC recurrence were analyzed by univariate and multivariate analysis using the Cox proportional hazard model. The rate of intrahepatic recurrence in enrolled patients at 1, 3, and 5 years was 19%, 50%, and 64%, respectively. The intrahepatic recurrence rate in C-viral and B-viral HCC was higher than that in the NBNC-related HCC. Fibrosis staging, pathological grading of HCC, and serum AFP levels were significantly linked to intrahepatic recurrence by univariate analysis, and fibrosis staging was strongest in the multivariate analysis for C-viral HCC (P = .004). In contrast, fibrosis staging did not affect the recurrence in B-viral (P = .51) and NBNC-related (P = .77) HCC. Risk factors for HCC recurrence differed according to the infected viral state.
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Affiliation(s)
- Y Koike
- Department of Gastroenterology, University of Tokyo, Tokyo, Japan.
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Poon RTP, Fan ST, Ng IOL, Lo CM, Liu CL, Wong J. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer 2000. [DOI: 10.1002/1097-0142(20000801)89:3<500::aid-cncr4>3.0.co;2-o] [Citation(s) in RCA: 521] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Honda M, Kaneko S, Matsushita E, Kobayashi K, Abell GA, Lemon SM. Cell cycle regulation of hepatitis C virus internal ribosomal entry site-directed translation. Gastroenterology 2000; 118:152-62. [PMID: 10611164 DOI: 10.1016/s0016-5085(00)70424-0] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS Translation of the hepatitis C virus (HCV) polyprotein is mediated by an internal ribosome entry site (IRES) that is located within the 5' nontranslated segment of the viral RNA. This RNA segment is known to form binary complexes with isolated 40S ribosome subunits in vitro, but there is little understanding of how the process of virus translation is regulated in vivo. METHODS We established 2 stably transformed cell lines from Huh-7 cells that constitutively express dicistronic RNA transcripts containing sequences encoding 2 reporter proteins (Renilla luciferase and firefly luciferase) separated by a functional HCV IRES. The translation of the upstream Renilla luciferase reading frame is initiated in these cells by the usual cellular cap-dependent mechanism, whereas translation of the downstream firefly luciferase reading frame is initiated by the IRES. RESULTS Compared with cap-dependent translation, the activity of the IRES was greatest in actively growing cells and relatively reduced in resting cells. In synchronized cultures of these stably transformed cells, the IRES activity varied with the cell cycle and was greatest during the mitotic (M) phases and lowest during the quiescent (G(0)) phases. CONCLUSIONS These findings suggest that HCV translation is regulated by cellular proteins that vary in abundance during the cell cycle and that viral translation may be enhanced by factors that stimulate the regeneration of hepatocytes in patients with chronic hepatitis C.
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Affiliation(s)
- M Honda
- First Department of Internal Medicine, Kanazawa University, Kanazawa, Japan.
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Attallah AM, Tabll AA, Salem SF, El-Sadany M, Ibrahim TA, Osman S, El-Dosoky IM. DNA ploidy of liver biopsies from patients with liver cirrhosis and hepatocellular carcinoma: a flow cytometric analysis. Cancer Lett 1999; 142:65-9. [PMID: 10424782 DOI: 10.1016/s0304-3835(99)00165-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Flow cytometric DNA analysis was used to assess cellular kinetics of needle liver biopsies from patients with liver cirrhosis and hepatocellular carcinoma (HCC). An abnormal DNA content was shown in 44.5% of liver cirrhosis cases and in 78.6% of tumor sites. The number of proliferating cells (S + G2M%) was significantly increased in cirrhotic liver (P < 0.05). Dysplasia was found in 66% of cirrhotic specimens. All negative dysplasia specimens showed a diploid pattern while 69% of positive dysplastic specimens were aneuploid (P < 0.001). In conclusion, cell proliferation, aneuploidy and liver cell dysplasia are important indicators in liver cirrhosis for the development of HCC.
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Affiliation(s)
- A M Attallah
- Biotechnology Research Center, New Damietta City, Egypt
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Nagasue N, Kohno H, Tachibana M, Yamanoi A, Ohmori H, El-Assal ON. Prognostic factors after hepatic resection for hepatocellular carcinoma associated with Child-Turcotte class B and C cirrhosis. Ann Surg 1999; 229:84-90. [PMID: 9923804 PMCID: PMC1191612 DOI: 10.1097/00000658-199901000-00011] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate prognostic factors after resection of hepatocellular carcinoma (HCC) in patients with Child-Turcotte class B and C cirrhosis. SUMMARY BACKGROUND DATA Although hepatic resection remains the mainstay in the treatment of HCC and can be performed with low morbidity and mortality rates in patients without cirrhosis, its role is poorly defined for patients with severe cirrhosis. METHODS From 1986 to 1996, partial hepatectomy was performed for HCC in 63 patients with Child-Turcotte class B (n = 46) and C (n = 17) cirrhosis. There were 46 men and 17 women, with an average age of 61.2 years (range 35 to 79 years). Associated conditions were diabetes mellitus in 45, esophageal varices in 32, severe hypersplenism in 26, cholelithiasis in 13, gastroduodenal ulcer in 6, and hiatal hernia, gastric lymphoma, splenic abscess, and pancreatic cyst each in 1. Concomitant surgical procedures were performed for most of these conditions. RESULTS Major complications occurred in 17 patients (27%), six (9.5%) of whom died within 1 month after surgery. The overall in-hospital death rate was 14.3%. Liver failure and intraabdominal sepsis were mostly fatal complications. The overall and disease-free survival rates, respectively, were 70.2% and 64.5% at 1 year, 43.5% and 23.8% at 3 years, and 21.4% and 14.9% at 5 years. Multivariate analysis with the Cox regression model revealed that favorable factors for survival were Child class B, no transcatheter arterial embolization before surgery, young age, and low alanine aminotransferase (ALT) level before surgery. CONCLUSIONS Hepatic resection can provide a favorable result in young patients with HCC complicating Child class B cirrhosis with low hepatitis activity, but transcatheter arterial embolization before surgery should be avoided in such patients.
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Affiliation(s)
- N Nagasue
- Second Department of Surgery, Shimane Medical University, Izumo, Japan
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Lee NH, Chau GY, Lui WY, King KL, Tsay SH, Wu CW. Surgical treatment and outcome in patients with a hepatocellular carcinoma greater than 10 cm in diameter. Br J Surg 1998; 85:1654-7. [PMID: 9876069 DOI: 10.1046/j.1365-2168.1998.00918.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) over 10 cm in diameter at the time of diagnosis continues to account for a number of patients undergoing hepatic resection. This study evaluated the clinicopathological features and outcome following surgery for large HCC. METHODS Forty patients with a large HCC (greater than 10 cm) (group 1) resected between 1991 and 1996 were studied retrospectively. They were compared with 245 patients who had smaller HCCs (10 cm or less) (group 2). RESULTS No patient in group 1 had hepatitis C infection compared with 22.9 per cent in group 2 (P=0.001). Patients in group 1 were significantly younger, had higher alpha-fetoprotein levels (16750 versus 1864 ng/ml; P < 0.001), better liver function, a higher incidence of multiple tumours (27 of 40 versus 42.0 per cent; P=0.003) and venous invasion (35 of 40 versus 52.2 per cent; P < 0.001), and underwent more major resections (37 of 40 versus 26.5 per cent; P < 0.001) than those in group 2. Morbidity and mortality rates and hospital stay were comparable in the two groups. For group 1, the 1-, 3- and 5-year disease-free survival rates were 42, 30 and 28 per cent respectively. Multiple tumours, venous invasion and impaired liver function were factors associated with recurrence. CONCLUSION Large HCC had specific clinicopathological features. In selected patients, resection is safe and offers the chance of long-term disease-free survival.
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Affiliation(s)
- N H Lee
- Department of Surgery, Veterans General Hospital Taipei and College of Medicine, National Yang-Ming University, Taiwan
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Saito T, Mizuno S, Notani K, Fukuda H, Kobayashi I, Shindoh M, Kohgo T. Flow cytometric analysis of cell cycle fractions in oral leukoplakia. Int J Oral Maxillofac Surg 1998; 27:217-21. [PMID: 9662018 DOI: 10.1016/s0901-5027(98)80015-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Flow cytometric analysis of cell cycle fractions and DNA ploidy was performed on 39 biopsy specimens of oral leukoplakia. The aneuploidy rate of these leukoplakias was 9/39 (23.1%) and the mean DNA index of the aneuploid lesions was 1.34. The aneuploidy rate was significantly higher in severely dysplastic lesions (8/17) than in mildly dysplastic (1/15, P<0.02) and nondysplastic (0/7, P<0.05) lesions. No significant differences in the percentages of each cell cycle fraction were seen between the diploid and the aneuploid leukoplakias. However, the S-phase fraction of the severely dysplastic lesions (23.0%) among the diploid leukoplakias was higher than those of the mildly dysplastic (12.4%) and nondysplastic (15.5%) lesions, and the difference between the severely dysplastic and the mildly dysplastic lesions was statistically significant (P<0.001). These results suggest that flow cytometric analysis of cell cycle fractions and DNA ploidy might offer additional information for assessing the malignant potential of oral leukoplakias.
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Affiliation(s)
- T Saito
- First Department of Oral Surgery, Hokkaido University School of Dentistry, Sapporo, Japan
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