Deterioration of hepatic functional reserve in patients with hepatocellular carcinoma after resection: incidence, risk factors, and association with intrahepatic tumor recurrence

Novel curcumin nanoformulation induces apoptosis, and reduces migration and angiogenesis in liver cancer cells

BACKGROUND

Curcumin has been used in the treatment of several diseases; however, its low pharmacologic profile reduces its therapeutic use. Towards improving its biological activity, nanoformulations have emerged. Thus, we aimed to determine whether curcumin nanoparticles (Cur-NPs) coated with PEG/chitosan improve the treatment of liver cancer (LC) cells and underpin the molecular mechanisms underlying their anti-cancer activity.

METHODS

Cur-NPs were synthesised in the form of Cur-PLGA-PEG/chitosan NPs. The effect of Cur-NPs was assessed in HepG2 and Huh 7 LC cells and THLE-2 normal liver cells.

RESULTS

The size of synthesised Cur-NPS was determined in the standard range of 141.2 ± 47.5 nm. Compared to THLE-2 cells, LC cells treated with Cur-NPs exerted cytotoxicity at 6.25 µg/mL after 48h. Treatment of HepG-2 cells with 2.5 µg/mL of Cur-NPs inhibited cell migration and this inhibition was augmented at 10 µg/mL (p < 0.001). Treatment of chicken embryo with 5 µg/mL Cur-NPs reduced angiogenesis (p < 0.001) of 4-day-old embryos. The nanoformulation upregulated Bax and p53 and downregulated Bcl-2 in a concentration-dependent manner and subsequently induce apoptosis in HepG-2 cells.

CONCLUSION

Treatment of LC cells with Cur-NPs decreased cell proliferation, migration, and angiogenesis, and induced cell death by promoting the proapoptotic pathway.

Prognostic Prediction for Patients with Hepatocellular Carcinoma and Ascites: Role of Albumin-Bilirubin (ALBI) Grade and Easy (EZ)-ALBI Grade

Patients with hepatocellular carcinoma (HCC) often have co-existing ascites, which is a hallmark of liver decompensation. The albumin-bilirubin (ALBI) grade and EZ (easy)-ALBI grade are used to assess liver functional reserve in HCC, but the predictive accuracy of these two models in HCC patients with ascites is unclear. We aimed to determine the prognostic role of ALBI and EZ-ALBI grades in these patients. A total of 4431 HCC patients were prospectively enrolled and retrospectively analyzed. Independent prognostic predictors were identified by the multivariate Cox proportional hazards model. Of all patients, 995 (22.5%) patients had ascites. Grade 1, 2, and 3 ascites were found in 16%, 4%, and 3% of them, respectively. A higher ascites grade was associated with higher ALBI and EZ-ALBI scores and linked with decreased overall survival. In the Cox multivariate analysis, serum bilirubin level > 1.1 mg/dL, creatinine level ≥ 1.2 mg/dL, α-fetoprotein ≥ 20 ng/mL, total tumor volume > 100 cm3, vascular invasion, distant metastasis, poor performance status, ALBI grade 2 and 3, EZ-ALBI grade 2 and 3, and non-curative treatments were independently associated with increased mortality (all p < 0.05) among HCC patients with ascites. The ALBI and EZ-ALBI grade can adequately stratify overall survival in both the entire cohort and specifically in patients with ascites. Ascites is highly prevalent and independently predict patient survival in HCC. The ALBI and EZ-ALBI grade are feasible markers of liver dysfunction and can stratify long-term survival in HCC patients with ascites.

Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis

BACKGROUND

Given the poor synthetic function of cirrhotic liver, successful resection for patients with hepatocellular carcinoma (HCC) necessitates the ability to achieve resections with tumor free margins.

AIM

To validate post hepatectomy liver failure score (PHLF), compare it to other established systems and to stratify risks in patients with cirrhosis who underwent curative liver resection for HCC.

METHODS

Between December 2010 and January 2017, 120 patients underwent curative resection for HCC in patients with cirrhosis were included, the pre-operative, operative and post-operative factors were recorded to stratify patients' risks of decompensation, survival, and PHLF.

RESULTS

The preoperative model for end-stage liver disease (MELD) score [odds ratio (OR) = 2.7, 95%CI: 1.2-5.7, P = 0.013], tumor diameter (OR = 5.4, 95%CI: 2-14.8, P = 0.001) and duration of hospital stay (OR = 2.5, 95%CI: 1.5-4.2, P = 0.001) were significant independent predictors of hepatic decompensation after resection. While the preoperative MELD score [hazard ratio (HR) = 1.37, 95%CI: 1.16-1.62, P < 0.001] and different grades of PHLF (grade A: HR = 2.33, 95%CI: 0.59-9.24; Grade B: HR = 3.15, 95%CI: 1.11-8.95; Grade C: HR = 373.41, 95%CI: 66.23-2105.43; P < 0.001) and HCC recurrence (HR = 11.67, 95%CI: 4.19-32.52, P < 0.001) were significant independent predictors for survival.

CONCLUSION

Preoperative MELD score and tumor diameter can independently predict hepatic decompensation. While, preoperative MELD score, different grades of PHLF and HCC recurrence can precisely predict survival.

A prognostic nomogram based on LASSO Cox regression in patients with alpha-fetoprotein-negative hepatocellular carcinoma following non-surgical therapy

Background

Alpha-fetoprotein-negative hepatocellular carcinoma (AFP-NHCC) (< 8.78 ng/mL) have special clinicopathologic characteristics and prognosis. The aim of this study was to apply a new method to establish and validate a new model for predicting the prognosis of patients with AFP-NHCC.

Methods

A total of 410 AFP-negative patients with clinical diagnosed with HCC following non-surgical therapy as a primary cohort; 148 patients with AFP-NHCC following non-surgical therapy as an independent validation cohort. In primary cohort, independent factors for overall survival (OS) by LASSO Cox regression were all contained into the nomogram1; by Forward Stepwise Cox regression were all contained into the nomogram2. Nomograms performance and discriminative power were assessed with concordance index (C-index) values, area under curve (AUC), Calibration curve and decision curve analyses (DCA). The results were validated in the validation cohort.

Results

The C-index of nomogram1was 0.708 (95%CI: 0.673–0.743), which was superior to nomogram2 (0.706) and traditional modes (0.606–0.629). The AUC of nomogram1 was 0.736 (95%CI: 0.690–0.778). In the validation cohort, the nomogram1 still gave good discrimination (C-index: 0.752, 95%CI: 0.691–0.813; AUC: 0.784, 95%CI: 0.709–0.847). The calibration curve for probability of OS showed good homogeneity between prediction by nomogram1 and actual observation. DCA demonstrated that nomogram1 was clinically useful. Moreover, patients were divided into three distinct risk groups for OS by the nomogram1: low-risk group, middle-risk group and high-risk group, respectively.

Conclusions

Novel nomogram based on LASSO Cox regression presents more accurate and useful prognostic prediction for patients with AFP-NHCC following non-surgical therapy. This model could help patients with AFP-NHCC following non-surgical therapy facilitate a personalized prognostic evaluation.

Survival analysis following microwave ablation or surgical resection in patients with hepatocellular carcinoma conforming to the Milan criteria

The aim of the present study was to compare the efficacy of microwave ablation (MWA) and surgical resection (RES) for the treatment of hepatocellular carcinoma (HCC) conforming to the Milan criteria and the associated short- and long-term survival rates. The baseline characteristics were obtained from 231 patients with HCC who met the Milan criteria. To compare the mortality rates between groups, survival analysis was conducted using the Kaplan-Meier method and the log-rank test. The factors associated with the survival rate were analyzed using Cox proportional hazard models. A total of 115 patients underwent RES, and 116 were treated with MWA. No significant differences were observed in the 1-, 3- and 5-year OS rates and the 1-year DFS rate between the two groups. The 7- and 10-year OS rates and the 3-, 5-, 7- and 10-year DFS rates of the RES group were significantly higher compared with those in the MWA group (P=0.004, P=0.002, P=0.003 and P=0.002, respectively). In addition, no marked differences were observed in the OS and DFS rates between the two groups of patients with solitary HCC lesions ≤3 cm (P=0.066 and P=0.056) and in the OS of those with solitary lesions of 3–5 cm (P=0.133); however the DFS of patients with single 3–5 cm HCC lesions in the RES group was notably higher compared with the MWA group (P=0.027). The Cox proportional hazard model revealed that age, hepatitis B and C virus infection, tumor size, number, platelet count and the type of treatment intervention were risk factors affecting the survival and recurrence in patients with HCC. These results suggested that RES may provide superior survival benefits compared with MWA for patients with HCC who meet the Milan criteria.

Update on Liver Failure Following Hepatic Resection: Strategies for Prediction and Avoidance of Post-operative Liver Insufficiency

Liver resection is increasingly used for a variety of benign and malignant conditions. Despite advances in preoperative selection, surgical technique and perioperative management, posthepatectomy liver failure (PHLF) is still a leading cause of morbidity and mortality following liver resection. Given the devastating physiological consequences of PHLF and the lack of effective treatment options, identifying risk factors and preventative strategies for PHLF is paramount. In the past, a major limitation to conducting high quality research on risk factors and prevention strategies for PHLF has been the absence of a standardized definition. In this article, we describe relevant definitions for PHLF, discuss risk factors and prediction models, and review advances in liver assessment tools and PHLF prevention strategies.

Metastatic Spread Emerging From Liver Metastases of Colorectal Cancer: Does the Seed Leave the Soil Again?

OBJECTIVE

To investigate whether liver metastases contribute to metastatic spread of colorectal cancer (CRC) by shedding intact tumor cells.

BACKGROUND

Metastases represent the primary cause of death in CRC. Understanding the metastatic activity of metastases and which patients are at high risk for tumor cell dissemination may, therefore, have significant influence on cancer care in the future.

METHODS

Circulating tumor cells (CTCs) were detected in the hepatic inflow (portal venous blood [PVB]) and outflow compartment (hepatic venous blood [HVB]) of a training (n = 55) and validation (n = 50) set using the CellSearch system. Isolated CTC from the HVB were subjected to gene expression analyses by quantitative polymerase chain reaction.

RESULTS

CTC detection rate (37.2% vs 19.6%; P = 0.04) and count (mean: 12.7, SEM: ± 5.9 vs 1.9; ± 1.2; P = 0.01) were significantly higher in HVB compared to PVB. The increased CTC detection rate (54% vs 11.4%; P < 0.001) and CTC count (14.7 ± 5.1 vs 1.1 ± 0.6; P < 0.001) in the HVB compared to the PVB compartment was confirmed in the validation cohort. Expression of epithelial markers and genes involved in cell-to-cell and cell-to-matrix adhesion was reduced in CTC compared to tumor cells in liver metastases. Metastasis size greater than 5 cm was associated with CTC shedding from established liver metastases in the training and validation cohorts.

CONCLUSIONS

Colorectal liver metastases shed intact tumor cells with an invasive phenotype. Metastasis size serves as a surrogate marker for metastatic activity of colorectal liver metastases.

Defining Post Hepatectomy Liver Insufficiency: Where do We stand?

BACKGROUND

Post-hepatectomy liver failure (PHLF) is a major source of morbidity and mortality in patients undergoing liver resection. The aim of this review is to summarize the recent literature available on PHLF including its definition, predictive factors, preoperative risk assessment, severity grading, preventative measures, and management strategies.

METHODS

A systematic literature search was carried out with the search engines PubMed, Medline, and Cochrane Database using the keywords related to "liver failure", "posthepatectomy", and "hepatic resection".

RESULTS

Liver resection is a curative treatment of liver tumors. However, it leads to concurrent death and regeneration of the remaining hepatocytes. Factors related to the patient, liver parenchyma and the extent of surgery can inhibit regeneration leading to PHLF.

CONCLUSION

Given its resistance to treatment and the high postoperative mortality associated with PHLF, great effort has been put in to both accurately identify patients at high risk and to develop strategies that can help prevent its occurrence.

Predictive power of prothrombin time and serum total bilirubin for postoperative mortality after major hepatectomy with extrahepatic bile duct resection

BACKGROUND

In 2011, the International Study Group of Liver Surgery defined posthepatectomy liver failure using the prothrombin time-international normalized ratio (PT-INR) and total serum bilirubin concentration (T-Bil). Data analyzing the clinical impact of PT-INR and T-Bil on postoperative mortality, however, remain limited, especially for major hepatectomy with extrahepatic bile duct resection (HEBR).

METHODS

Prospectively collected data from 545 patients who underwent HEBR in a single institution from 2002 to 2011 were analyzed. Receiver operating characteristics (ROC) analyses of PT-INR and T-Bil on postoperative days (POD) 1, 3, and 5 were used to determine optimal cu-off values for predicting postoperative mortality.

RESULTS

Most of the treated diseases were biliary tract cancers, including perihilar cholangiocarcinoma (n = 418), gallbladder carcinoma (n = 52), and intrahepatic cholangiocarcinoma (n = 27). The mean values for PT-INR and T-Bil on POD 1, 3, and 5 were significantly greater in the patients who died owing to postoperative complications than in the patients who survived. On POD 5, the area under the ROC curve for predicting postoperative mortality and the optimal cutoff value for PT-INR were 0.876 and 1.68, respectively, whereas those of T-Bil were 0.889 and 4.0 mg/dL, respectively. A combination of PT-INR and T-Bil showed strong predictive power (ie, >40% of the patients with values beyond the cutoff value for both PT-INR and T-Bil on POD 5 died).

CONCLUSION

We recommend monitoring both PT-INR and T-Bil to predict accurately which patients are at a high risk after HEBR.

Lipiodolized transarterial chemoembolization in hepatocellular carcinoma patients after curative resection

PURPOSE

To explore the effect of lipiodolized transarterial chemoembolization (lip-TACE) in hepatocellular carcinoma (HCC) patients at different risk of recurrence after curative resection.

METHODS

One thousand nine hundred and twenty-four consecutive HCC patients who underwent curative resection were retrospectively analyzed. Patients who underwent resection only were classified into control group, while those received adjuvant lip-TACE were classified into intervention group. Patients were further stratified into 4 groups, that is, tumor ≤5 cm with low or high risk factors, as well as tumor >5 cm with low or high risk factors for recurrence. Tumor number and microscopic tumor thrombus were defined as risk factors for recurrence. The effect of adjuvant lip-TACE on early (<2 year) or late (≥2 year) recurrence was evaluated.

RESULTS

There was no significant difference in recurrence curve between intervention group and control group in each stratum. Adjuvant lip-TACE showed an overall survival benefit in patients with tumor >5 cm and presenting high risk factors, mainly for those with time to recurrence (TTR) <2 years after operation. For them, the median survival was 17 months in the intervention group and 11 months in the control group (P = 0.010). For patients who were confirmed to be recurrence-free at 2 years after operation, it had the negative effect for survival (HR = 1.75, P = 0.004).

CONCLUSION

Adjuvant lip-TACE had no preventive effect on recurrence, but may be of benefit to detect early recurrence.

Renal failure in patients with hepatocellular carcinoma and ascites undergoing transarterial chemoembolization

BACKGROUND

Ascites is often present in patients with hepatocellular carcinoma (HCC) with cirrhosis. Advanced cirrhosis may predispose to renal dysfunction. Acute renal failure (ARF) may occur after transarterial chemoembolization (TACE) for HCC because of radiocontrast agents. This study aimed to investigate the incidence and risk factors of ARF and prognostic predictors in HCC patients with ascites undergoing TACE.

METHODS

A total of 591 HCC patients receiving TACE were enrolled.

RESULTS

In a mean follow-up duration of 19+/-17 months, 239 (40.4%) patients undergoing TACE died. Ascites, which was present in 91 (15.4%) patients at entry, independently predicted a poor prognosis in the Cox proportional hazard model [risk ratio (RR): 1.71, P=0.002]. Of these, 11 (12.6%) of 87 patients with complete follow-up developed ARF after TACE. Serum albumin level <3.3 g/dl (odds ratio: 7.3, P=0.009) was the only independent risk factor associated with ARF in the logistic regression analysis. ARF (RR: 2.17, P=0.036), alpha-fetoprotein >400 ng/ml (RR: 1.84, P=0.04), multiple tumours (RR: 2.11, P=0.013), tumour size > or = 5 cm (RR: 2.32, P=0.006) and serum sodium level <139 mmol/L (RR: 2.4, P=0.005) were independent poor prognostic predictors for HCC patients with ascites receiving TACE.

CONCLUSIONS

Pre-existing ascites is associated with increased mortality in HCC patients receiving TACE. In HCC patients with ascites, hypoalbuminaemia is associated with the occurrence of post-TACE ARF. Post-TACE ARF is a poor prognostic predictor in this subset of HCC patients.

Analysis of nontarget embolization mechanisms during embolization and chemoembolization procedures

Complications of embolization and chemoembolization remain a problem even with the development of low-profile catheter material and the introduction of new embolization agents. In recent years many new embolization materials have become available for clinical use, so the possibilities and limitations of these new materials must be understood to allow safe and effective embolization. Although up to now some scientific work has been published reporting the basic risk of embolization procedures, the underlying pathomechanism remains the object of speculation. Besides complications like drug toxicity, allergic reactions, and bleeding of the puncture site, the characteristics of embolization materials must be known to understand the potential complications of nontarget embolization and reflux of embolization material. This article gives an overview of established and new embolization materials, their potential risks, and the underlying pathophysiology.

The MELD-Na is an independent short- and long-term prognostic predictor for hepatocellular carcinoma: a prospective survey

BACKGROUND AND AIM

Serum sodium has been suggested to incorporate into the model for end-stage liver disease to enhance its prognostic ability for cirrhosis. A mathematical equation based on model for end-stage liver disease and sodium, known as "MELD-Na", was developed for outcome prediction for cirrhosis. The severity of liver cirrhosis is a key component to predict survival in patients with hepatocellular carcinoma. This study investigated the prognostic role of MELD-Na for hepatocellular carcinoma.

PATIENTS AND METHODS

A total of 535 unselected hepatocellular carcinoma patients were prospectively enrolled to evaluate the performance of MELD-Na.

RESULTS

The MELD-Na was better than model for end-stage liver disease in predicting 6-month mortality by comparing the area under receiver operating characteristic curve (0.782 vs. 0.761, p=0.101). MELD-Na, but not model for end-stage liver disease, was an independent predictor associated with 6-month mortality in multivariate logistic regression analysis (odds ratio: 1.14, p=0.001). In the survival analysis, MELD-Na also independently predicted mortality, with an additional risk of 4.3% per unit increment of the score (p<0.001). Patients with MELD-Na scores between 10 and 20 and scores >20 had 2.1-fold (p<0.001) and 7.5-fold (p<0.001) risk of mortality, respectively, compared to patients with a score <10 in the Cox proportional hazard model.

CONCLUSION

The MELD-Na score is a feasible and independent prognostic predictor for both short- and long-term outcome predictions in patients with hepatocellular carcinoma.

Surgical resection of hepatocellular carcinoma

The incidence of hepatocellular carcinoma (HCC) is increasing in the United States, primarily due to hepatitis C-related liver disease. Nearly 85%-90% of patients with HCC have underlying chronic liver disease or cirrhosis. Advanced tumor burden or prohibitive hepatic dysfunction precludes operative resection in most patients with HCC. Surgical resection is a treatment option with curative intent in patients with HCC not associated with cirrhosis or in patients with well-compensated liver disease. Tumor extent and hepatic function must be assessed preoperatively to avoid postresection hepatic failure, an often fatal condition that may require urgent liver transplantation. Appropriately selected candidates for liver resection have 5-year postoperative survival rates of 40%-70%, but recurrence rates approach 70%, especially in patients with cirrhosis. For this reason, the best resection for patients with HCC and cirrhosis is orthotopic liver transplantation, which has 5-year posttransplant survival rates of 65%-80% in well-selected candidates.

Postresection hepatic failure: successful treatment with liver transplantation

Postoperative liver failure (PLF) is a rare but often fatal complication of major hepatic resection. Use of orthotopic liver transplantation (OLT) for PLF remains undefined. We conducted a retrospective review of 435 patients who underwent hepatic resection between 1990 and 2004; 9 of them (2.0%) developed PLF. Indications for resection included primary hepatic malignancies (8), colonic metastases (2), and echinococcic cyst (1); all resections were multisegmental, 6 were extended, and 2 were lobectomies. A total of 7 patients underwent OLT at a mean of 25 days after resection. Patients developing PLF had significantly lower preoperative platelet counts and significant elevations of total bilirubin, direct bilirubin, prothrombin time, and international normalized ratio (INR) by postoperative day 2. Pathological cirrhosis and extended right lobectomy were associated with significantly increased risk of PLF. Following OLT, there were no in-hospital deaths, but 1 patient required retransplantation for primary nonfunction. Mean survival with and without OLT was 42.2 and 1.4 months, respectively (P = 0.03). Following OLT, 1- and 5-yr patient survivals were 88% and 40%, respectively; 1- and 5-yr graft survivals were 75% and 34%, respectively. In conclusion, patients with low platelets, biopsy-proven cirrhosis, or those undergoing extended resection are at increased risk for PLF. OLT for PLF has significant morbidity but allows salvage of an otherwise fatal condition.

The sequential changes of the model for end-stage liver disease score correlate with the severity of liver cirrhosis in patients with hepatocellular carcinoma undergoing locoregional therapy

BACKGROUND

The model for end-stage liver disease (MELD) has been used to prioritize cirrhotic patients awaiting liver transplantation. It is not clear whether MELD correlates with liver functional reserve that changes over time. This study investigated the correlation of sequential changes between MELD and Child-Turcotte-Pugh (CTP) scores in patients with hepatocellular carcinoma (HCC).

METHODS

A total of 192 HCC patients undergoing transarterial chemoembolization or percutaneous injection therapy were studied.

RESULTS

The MELD and CTP scores of study patients at pretreatment, early (median, 2 wk) and late (median, 8 wk) stage after treatment were 10.1+/-3.5, 12.9+/-3.2, and 11.7+/-3.1, and 6.2+/-1.1, 7.5+/-1.1, and 6.9+/-1.2, respectively. There was a significant correlation of the serial changes for the period between pretreatment and early stage (rho=0.605, P<0.001), and between early to late stage (rho=0.512, P<0.001) after treatment. The corresponding increase and decrease of MELD score was 2.1 and 2.0, respectively, per unit change of the CTP score. The correlation was still significant in the stratified analysis according to various clinical parameters. In the Cox multivariate model, tumor size >5 cm [relative risk (RR)=2.58, P<0.001], multiple HCCs (RR=1.78, P=0.013), CTP class B or C (RR=3.06, P<0.001), and MELD score >15 (RR=2.17, P=0.023) were independent poor prognostic predictors.

CONCLUSIONS

Serial determinations of the MELD score well correlate with the changes of CTP score. The MELD score may be useful in measuring liver functional reserve and outcome prediction in HCC patients undergoing locoregional therapy.

Proposal of a modified Child-Turcotte-Pugh scoring system and comparison with the model for end-stage liver disease for outcome prediction in patients with cirrhosis

The model for end-stage liver disease (MELD) has a better predictive accuracy for survival than the Child-Turcotte-Pugh (CTP) system and has been the primary reference for organ allocation in liver transplantation. The CTP system, with a score range of 5-15, has a ceiling effect that may compromise its predictive power. In this study, we proposed a refined CTP scoring method and investigated its predictive ability. An additional point was given to patients with serum albumin < 2.3 g/dL, bilirubin > 8 mg/dL or prothrombin time prolongation > 11 seconds. The modified CTP system, containing class D, was compared to the MELD and original CTP system in 436 patients. There was a significant correlation between the MELD and modified CTP score (rho = 0.59, P< 0.001). Using mortality as the endpoint, the area under receiver operating characteristic curve for modified CTP system was 0.895 compared with 0.872 for MELD (P = 0.450) and 0.809 for original CTP system (P < 0.001) at 3 months; the area was 0.890, 0.837 and 0.756, respectively (P = 0.051 and < 0.001, respectively) at 6 months. The risk ratio per unit increase for the modified CTP score was 2.7 and 3.08 at 3 and 6 months respectively (P < 0.001). In conclusion, the modified CTP system can be proposed as an alternative prognostic model for cirrhotic patients. By extending the score range according to the influence of the laboratory-derived variables, the modified CTP system has a better performance than the original system and is as efficient as the MELD for outcome prediction.

Clinical analysis of the risk factors for recurrence of HCC and its relationship with HBV

AIM: To comprehend the risk factors of recurrence of hepatocellular carcinoma (HCC) and its relationship with the infection patterns of hepatitis B virus (HBV).

METHODS: All materials of 270 cases of postoperative HCC were statistically analyzed by SPSS software. Recurrence and metastasis were classified into early ( ≤2 years) and late phase (>2 years). Risk factors for recurrence and metastasis after surgery in each group were analyzed.

RESULTS: Out of 270 cases of HCC, 162 cases were followed up in which recurrence and metastasis occurred in 136 cases. There were a lot of risk factors related to recurrence and metastasis of HCC; risk factors contributing to early phase recurrence were serum AFP level, vascular invasion, incisal margin and operative transfusion, gross tumor classification and number of intrahepatic node to late phase recurrence. The HBV infective rate of recurrent HCC was 94.1%, in which “HBsAg, HBeAb, HBcAb” positive pattern reached 45.6%. The proportion of HBV infection in solitary large hepatocellular carcinoma (SLHCC) evidently decreased compared to nodular hepatocellular carcinoma (NHCC) (P<0.05).

CONCLUSION: The early and late recurrence and metastasis after hepatectomy of HCC were associated with different risk factors. The early recurrence may be mediated by vascular invasion and remnant lesion, the late recurrence by tumor’s clinical pathology propert, as multicentric carcinogenesis or intrahepatic carcinoma de novo. HBV replication takes a great role in this process. From this study, we found that SLHCC has more satisfactory neoplasm biological behavior than NHCC.

Percutaneous ablation therapy for hepatocellular carcinoma: current practice and future perspectives

Worldwide, hepatocellular carcinoma (HCC) is a common, refractory, malignant tumor. Surgical resection is feasible in only a few patients, because of limited hepatic reserve and multifocality of tumors at diagnosis. Percutaneous ablation therapies, including injection of ethanol (PEI) or acetic acid (PAI), radiofrequency ablation (RFA), and microwave coagulation therapy (MCT), have been the major treatments for unresectable HCC in the past decade. PEI is well established for small (<3 cm) HCC, and PAI is equally as effective as PEI, but with fewer treatment sessions. RFA has recently been suggested to have excellent tumor-ablating ability because it produces a fixed and predictable tumor necrosis zone. Although RFA is also effective for medium-sized HCC, the overall complication rate may be higher than previously assumed. MCT is similar to RFA in its clinical application and potential adverse effects. A combination approach using percutaneous ablation therapy and transcatheter arterial embolization was shown to be effective for large HCC. Other approaches, such as injection of hot saline or yttrium-90 microspheres, cryoablation, or interstitial laser photocoagulation, are less often used nowadays. Multimodal, image-guided, tailored therapy, rather than a fixed treatment algorithm, might be more practical for unresectable HCC. In conclusion, although longterm survival is possible in selected patients with HCC, the overall prognosis remains suboptimal, especially in patients with unfavorable tumor characteristics. While newer anti-tumor therapies with improved efficacy are needed, information about a more rational approach to the use of existing therapeutic options may help to enhance treatment strategies for HCC.