1
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Herrera I, Almenara S, Bellot P, Miralles C, Rodriguez M, Gómez-González L, Palazón JM, Pascual S, Zapater P. Tobacco is a Leading Risk Factor for Liver and Extrahepatic Cancers in Patients With Liver Cirrhosis: A Prospective Cohort Study. J Clin Exp Hepatol 2024; 14:101472. [PMID: 39100888 PMCID: PMC11292550 DOI: 10.1016/j.jceh.2024.101472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/17/2024] [Indexed: 08/06/2024] Open
Abstract
Background & aims This study aims to assess the incidence and characteristics of all cancers, hepatocellular carcinoma (HCC), and extrahepatic cancers in patients with cirrhosis of various etiologies. Methods Prospective cohort study in patients with cirrhosis but no cancer, followed every 6-9 months through the HCC early detection program. Cancer incidence was compared with Spanish population data to calculate standardized incidence ratios (SIR), and cumulative incidence was calculated separately for cancer and competing events. Longitudinal outcomes were assessed with multivariate Fine-Gray and Cox regression models. Results A total of 215 patients (68.4% male, median age 61 years) were included. Cirrhotic etiology was alcohol (38%), hepatitis B or C virus infection (36%), alcohol plus hepatitis B or C virus infection (9%), and other causes (17%). Sixty percent were current or former smokers. Thirty-nine cancers were observed (56% liver cancer), while 3.3 were expected (SIR 11.7; 95% confidence interval [CI] 8.6-16.1). Ten (4.6%) patients were censored for liver transplantation and 34 (15.8%) for death, constituting relevant competing risks. Smoking was significantly associated with overall cancer incidence (smokers: subdistribution hazard ratio [SHR] 3.14, 95% CI 1.33-7.38; former smokers: SHR 2.54, 95% CI 1.08-5.98). In the multivariable regression analysis, viral etiology, Child-Pugh score (B or C versus A), and smoking were associated with liver cancer, and smoking with extrahepatic cancer. Conclusions Patients with cirrhosis have an 11-fold risk of cancer compared to the general population. Risk is increased in liver and non-liver cancers. Active surveillance of any type of cancer and smoking cessation interventions are needed in these patients.
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Affiliation(s)
- Iván Herrera
- Liver Unit, Dr. Balmis General University Hospital, Alicante, Spain
- Institute of Research, Development and Innovation in Healthcare Biotechnology of Elche (IDiBE), University Miguel Hernández de Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Susana Almenara
- Institute of Research, Development and Innovation in Healthcare Biotechnology of Elche (IDiBE), University Miguel Hernández de Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Clinical Pharmacology Unit, Dr. Balmis General University Hospital, Alicante, Spain
| | - Pablo Bellot
- Liver Unit, Dr. Balmis General University Hospital, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- CIBERehd, Health Institute Carlos III, Madrid, Spain
| | - Cayetano Miralles
- Liver Unit, Dr. Balmis General University Hospital, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Maria Rodriguez
- Liver Unit, Dr. Balmis General University Hospital, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - José M. Palazón
- Liver Unit, Dr. Balmis General University Hospital, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Sonia Pascual
- Liver Unit, Dr. Balmis General University Hospital, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- CIBERehd, Health Institute Carlos III, Madrid, Spain
| | - Pedro Zapater
- Institute of Research, Development and Innovation in Healthcare Biotechnology of Elche (IDiBE), University Miguel Hernández de Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Clinical Pharmacology Unit, Dr. Balmis General University Hospital, Alicante, Spain
- CIBERehd, Health Institute Carlos III, Madrid, Spain
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2
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Martínez-Mier G, Esquivel-Torres S, Casanova-Sánchez I, Escobar-Ríos A, Troche-Gutiérrez J, Yoldi-Aguirre C. Carcinoma hepatocelular en hígado no cirrótico: características clínicas y resultados en Veracruz, México. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:4-12. [DOI: 10.1016/j.rgmx.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 10/29/2019] [Accepted: 11/28/2019] [Indexed: 02/06/2023]
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3
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Hepatocellular carcinoma in the noncirrhotic liver: Clinical features and outcomes in Veracruz, Mexico. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2021. [DOI: 10.1016/j.rgmxen.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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4
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Feng X, Ma G, Shi H, Wang Y, Chao X. An Integrative Serum Pharmacology-Based Approach to Study the Anti-Tumor Activity of B. paniculatum Aqueous Bulb Extract on the Human Hepatocellular Carcinoma Cell Line BEL-7404. Front Pharmacol 2020; 11:01261. [PMID: 33123002 PMCID: PMC7569155 DOI: 10.3389/fphar.2020.01261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/30/2020] [Indexed: 12/17/2022] Open
Abstract
The herb Bolbostemma paniculatum (Maxim) Franquet (Cucurbitaceae family), also known as Tu-Bei-Mu (TBM) in Chinese, has shown curative effects to treat several types of cancer as an adjunctive therapy. Thereby we intend to find its effect on the human hepatocellular carcinoma (HCC) and to understand the pharmacological mechanism behind it. In this study, an integrative serum pharmacology-based approach linking serum pharmacology and bioinformatics prediction was employed. Firstly, we used the serum taken introgastrically from the rats dministered by TBM aqueous bulb extract to culture the HCC cell line BEL-7404 and detect its anti-tumor effects. Secondly, the TBM putative targets were predicted using the ETCM database and known therapeutic targets of NPC were collected from the OMIM database. Then, a TBM-HCC putative targets network was constructed using the DAVID and STRING databases. Thirdly, key gene targets were obtained based on topological analysis and pathway enrichment analysis. The expression of 4 representative key targets were validated by Western blotting. As a result, 36 TBM targets and 26 known therapeutic targets of HCC were identified. These key targets were found to be frequently involved in 13 KEGG pathways and 4 biological processes. The expression of four representative key targets: TP53, CASP3, BCL2 and BAX further supports the suppression of TBM on HCC. In general, our study shows the curative effects of TBM against HCC. By using this integrative approach, we may find novel potential therapeutic targets to suppress HCC using TBM as an adjunctive therapy. And it could also help us understand the mechanism of HCC treatments in response to TBM.
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Affiliation(s)
- Xuesong Feng
- Basic Medical Academy, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Guangyuan Ma
- Basic Medical Academy, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Hailong Shi
- Basic Medical Academy, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yuewen Wang
- Basic Medical Academy, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Xu Chao
- Basic Medical Academy, Shaanxi University of Chinese Medicine, Xianyang, China.,The Research Department, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
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5
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Chagas AL, Mattos AAD, Carrilho FJ, Bittencourt PL, Vezozzo DCP, Horvat N, Rocha MDS, Alves VAF, Coral GP, Alvares-DA-Silva MR, Barros FMDR, Menezes MR, Monsignore LM, Coelho FF, Silva RFD, Silva RDCMA, Boin IDFSF, D Albuquerque LAC, Garcia JHP, Felga GEG, Moreira AM, Braghiroli MIFM, Hoff PMG, Mello VBD, Dottori MF, Branco TP, Schiavon LDL, Costa TDFA. BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF HEPATOCELLULAR CARCINOMA. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:1-20. [PMID: 32294682 DOI: 10.1590/s0004-2803.202000000-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.
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Affiliation(s)
- Aline Lopes Chagas
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Angelo Alves de Mattos
- Universidade Federal de Ciências da Saúde de Porto Alegre e Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Flair José Carrilho
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | | | | | | | - Natally Horvat
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - Manoel de Souza Rocha
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Venâncio Avancini Ferreira Alves
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Gabriela Perdomo Coral
- Universidade Federal de Ciências da Saúde de Porto Alegre e Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | | | | | - Marcos Roberto Menezes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil.,Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - Lucas Moretti Monsignore
- Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, São Paulo, SP, Brasil
| | | | - Renato Ferreira da Silva
- Faculdade de Medicina de São José do Rio Preto (FAMERP) e Hospital de Base de São José do Rio Preto (FUNFARME), São José do Rio Preto, SP, Brasil
| | - Rita de Cássia Martins Alves Silva
- Faculdade de Medicina de São José do Rio Preto (FAMERP) e Hospital de Base de São José do Rio Preto (FUNFARME), São José do Rio Preto, SP, Brasil
| | | | | | | | | | - Airton Mota Moreira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | | | - Paulo Marcelo Gehm Hoff
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | | | | | - Tiago Pugliese Branco
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
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Díaz-González Á, Forner A, Rodríguez de Lope C, Varela M. New challenges in clinical research on hepatocellular carcinoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 108:485-93. [PMID: 26653993 DOI: 10.17235/reed.2015.4012/2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This is an updated review of screening, early diagnosis and treatment of hepatocellular carcinoma, focusing on the advancements occurred in the last years and highlighting the challenges in clinical research. Hepatocellular carcinoma (HCC) is nowadays the sixth most frequent cancer worldwide with up to 740,000 new cases diagnosed each year, and it is the third most prevalent cause of cancer-related-death worldwide (1). This neoplasm usually appears linked to an underlying liver disease, being one of the most relevant causes of death in patients diagnosed of liver cirrhosis (2,3). In the last years, important advancements in terms of diagnosis, staging and treatment of HCC, improving the management and outcome of the disease, have been made (4-7). Despite the fact that these improvements have absolutely changed natural history of HCC, there are several areas that still need further advancements. The aim of this document is to discuss some controversial aspects, which in our opinion constitute real challenges in clinical research of HCC.
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Affiliation(s)
- Álvaro Díaz-González
- Servicio de Hepatología. Hospital Clínic Barcelona, Unidad de Oncología Hepática (BCLC)
| | - Alejandro Forner
- Hospital Clínic Barcelona. Ciberehd, Unidad de Oncología Hepática (BCLC)
| | | | - María Varela
- Digestivo. Sección de Hepatología, Hospital Universitario Central de Asturias, España
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7
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Kabbage L, El Kouhen M, Taghy A, Znati K, Kabbaj N. A rare presentation of hepatocellular carcinoma in non-cirrhotic liver. Pan Afr Med J 2017; 28:69. [PMID: 29255539 PMCID: PMC5724728 DOI: 10.11604/pamj.2017.28.69.13512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/12/2017] [Indexed: 01/26/2023] Open
Abstract
Hepatocellular carcinoma is the most frequent type of liver malignancy. Most cases of hepatocellular carcinoma are secondary to either viral hepatitis (hepatitis B, C) or alcoholic cirrhosis. Liver cirrhosis due to any other causes is considered as a risk factor for development of hepatocellular carcinoma; however, hepatocellular carcinoma in non cirrhotic livers remains a rare condition. The present case report describes a 59-year-old woman patient admitted to explore right hypochondriac and epigastric pain, with no evidence of pre-existing liver disease and with a good general condition. The computed tomography was very suggestive of a gastro-intestinal stromal tumor. But, at laparotomy, a huge hepatic tumor was discovered. Histopathological study confirmed the presence of primary hepatocellular carcinoma. Hepatocellular carcinoma occurs more frequently on a cirrhotic liver. However, it can occur on a non cirrhotic liver and remains and extremely rare case.
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Affiliation(s)
- Lamia Kabbage
- Faculty of medicine, mohammed V Souissi University Rabat Morocco
- EFD-hepatogastroenterology Unit, ibn sina hospital, Rabat,Morocco
| | - Meryem El Kouhen
- EFD-hepatogastroenterology Unit, ibn sina hospital, Rabat,Morocco
| | - Ahmed Taghy
- Faculty of medicine, mohammed V Souissi University Rabat Morocco
- Clinique chirurgicale B, ibn sina hospital, Rabat, Morocco
| | - Kaoutar Znati
- Faculty of medicine, mohammed V Souissi University Rabat Morocco
- Pathology departement, ibn sina hospital, Rabat, Morocco
| | - Nawal Kabbaj
- Faculty of medicine, mohammed V Souissi University Rabat Morocco
- EFD-hepatogastroenterology Unit, ibn sina hospital, Rabat,Morocco
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8
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Rodríguez de Lope C, Reig M, Matilla A, Ferrer MT, Dueñas E, Mínguez B, F Castroagudín J, Ortiz I, Pascual S, Lledó JL, Gallego A, Arenas JI, Aracil C, Forne M, Muñoz C, Pons F, Sala M, Iñarrairaegui M, Martin-Llahi M, Andreu V, Garre C, Rendón P, Fuentes J, Crespo J, Rodríguez M, Bruix J, Varela M. Clinical characteristics of hepatocellular carcinoma in Spain. Comparison with the 2008-2009 period and analysis of the causes of diagnosis out of screening programs. Analysis of 686 cases in 73 centers. Med Clin (Barc) 2017; 149:61-71. [PMID: 28279536 DOI: 10.1016/j.medcli.2016.12.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE In 2010 we published that 53% of cases of hepatocellular carcinoma (HCC) detected in Spain were diagnosed outside the context of standard screening programs, which consequently leads to lower survival rates. The aim of this study was to analyze the current situation and the causes of diagnosis out of screening programs. MATERIAL AND METHODS Prospective registry of 73 second- and third-level Spanish healthcare centers carried out between October 1, 2014 and January 31, 2015. The baseline characteristics of the disease and the first treatment administered for the incidental primary liver tumors during such period were recorded. RESULTS A total of 720 patients were included in the study: HCC (n=686), intrahepatic cholangiocarcinoma (n=29), hepatic cholangiocarcinoma (n=2), other (n=3). HCC characteristics: male 82%; mean age 67 years; cirrhosis 87%; main etiologies: alcohol 35%, HCV 30%, alcohol and HCV 15%, non-alcoholic fatty liver disease 6%; tumor stage: BCLC-0 11%, A 43%, B 19%, C 16% and D 11%; first treatment: transarterial chemoembolization (23%), percutaneous ablation (22%), symptomatic treatment (20%), resection (11%), sorafenib (11%). Three hundred and fifty-six patients (53%) were diagnosed outside of screening programs, mainly owing to the fact that they suffered from an undiagnosed liver disease (76%) and to the poor adherence to the screening program (18%). These patients were mainly male (P<.001), with an alcoholic etiology (P<.001) and active alcohol consumption (P<.001). Moreover, the disease was predominantly diagnosed at more advanced stages (P<.001) and was addressed with less radical treatments (P<.001). CONCLUSIONS In Spain, the main cause of diagnosis of a HCC outside the context of a screening program is the absence of a prior diagnosis of a liver disease, particularly in alcohol-consuming men. Detecting a liver disease in asymptomatic populations and improving adherence to screening programs are the main areas that must be subject to improvement in order to improve the early detection of HCC.
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Affiliation(s)
- Carlos Rodríguez de Lope
- Servicio de Digestivo, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España
| | - María Reig
- Servicio de Hepatología, Hospital Clínic, Barcelona Clinic Liver Cancer (BCLC), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España
| | - Ana Matilla
- Servicio de Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - María Teresa Ferrer
- Unidad de Gestión Clínica de Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España
| | - Eva Dueñas
- Servicio de Digestivo, Sección de Hepatología, Hospital de Bellvitge, Universitat Autónoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España
| | - Beatriz Mínguez
- Servicio de Medicina Interna-Hepatología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autónoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España
| | - Javier F Castroagudín
- Servicio de Digestivo, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | | | - Sonia Pascual
- Unidad Hepática, Servicio de Digestivo, Hospital General Universitario de Alicante, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Alicante, España
| | - José Luis Lledó
- Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Adolfo Gallego
- Servicio de Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Juan I Arenas
- Servicio de Digestivo, Hospital General Universitario de Donosti, San Sebastián, Guipúzcoa, España
| | - Carles Aracil
- Servicio de Digestivo, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, España
| | - Montserrat Forne
- Servicio de Digestivo, Mútua de Terrassa, Terrassa, Barcelona, España
| | - Carolina Muñoz
- Sección de Hepatología, Servicio de Digestivo, Hospital 12 de Octubre, Madrid, España
| | - Fernando Pons
- Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Margarita Sala
- Servicio de Digestivo, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
| | - Mercedes Iñarrairaegui
- Sección de Hepatología, Servicio de Medicina Interna, Clínica Universitaria de Navarra, Pamplona, Navarra, España
| | - Marta Martin-Llahi
- Servicio de Aparato Digestivo, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, España
| | - Victoria Andreu
- Servicio de Digestivo, Hospital de Viladecans, Viladecans, Barcelona, España
| | - Carmen Garre
- Servicio de Aparato Digestivo, Hospital Virgen de la Arrixaca, Murcia, España
| | - Paloma Rendón
- Servicio de Digestivo, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Javier Fuentes
- Servicio de Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Javier Crespo
- Servicio de Digestivo, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España
| | - Manuel Rodríguez
- Sección de Hepatología, Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, España
| | - Jordi Bruix
- Servicio de Hepatología, Hospital Clínic, Barcelona Clinic Liver Cancer (BCLC), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España
| | - María Varela
- Sección de Hepatología, Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, España.
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9
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The use of β-blockers is associated with a lower risk of developing hepatocellular carcinoma in patients with cirrhosis. Eur J Gastroenterol Hepatol 2016; 28:1194-7. [PMID: 27294486 DOI: 10.1097/meg.0000000000000677] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Patients with cirrhosis by hepatitis C virus infection treated with β-blockers (BB) have been shown to have a reduced incidence of hepatocellular carcinoma (HCC). Also, an association between propranolol therapy and lower incidence of other tumors has been described. AIM To analyze the incidence of HCC according to BB treatment in cirrhosis of any cause. PATIENTS AND METHODS Cirrhotic patients included in the program for early detection of HCC were followed. Patients' data were prospectively registered, including transplantation and death. Patients were classified as chronically taken or not BB and the proportions of patients who remained free of tumor from the diagnosis of cirrhosis until the end of follow-up were compared using Kaplan-Meier analysis and the Breslow test. RESULTS A total of 173 patients (73 treated and 100 untreated BB) were followed. The median duration of follow-up was 11 years. There were no differences between both groups in the overall survival, number of deaths, or liver transplant.Overall, 28 patients developed HCC during the follow-up, 20 patients who were untreated and eight patients treated with BB. The cumulative proportion of cases of HCC between untreated and treated with BB from the diagnosis of cirrhosis was statistically significant (6 vs. 3%, at 5 years; 19 vs. 6% at 10 years; 24 vs. 16% at 15 years; P=0.048). Multivariate analyses showed BB intake as the only significant variable associated with the development of HCC. CONCLUSION Cirrhotic patients treated with BB have a lower cumulative probability of developing HCC during the 10 years after the diagnosis of cirrhosis.
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10
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Forner A, Reig M, Varela M, Burrel M, Feliu J, Briceño J, Sastre J, Martí-Bonmati L, Llovet JM, Bilbao JI, Sangro B, Pardo F, Ayuso C, Bru C, Tabernero J, Bruix J. [Diagnosis and treatment of hepatocellular carcinoma. Update consensus document from the AEEH, SEOM, SERAM, SERVEI and SETH]. Med Clin (Barc) 2016; 146:511.e1-511.e22. [PMID: 26971984 DOI: 10.1016/j.medcli.2016.01.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/22/2016] [Accepted: 01/28/2016] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma is the most common primary malignancy of the liver and one of the most frequent causes of death in patients with liver cirrhosis. Simultaneously with the recognition of the clinical relevance of this neoplasm, in recent years there have been important developments in the diagnosis, staging and treatment of HCC. Consequently, the Asociación Española para el Estudio del Hígado has driven the need to update clinical practice guidelines, continuing to invite all the societies involved in the diagnosis and treatment of this disease to participate in the drafting and approval of the document (Sociedad Española de Trasplante Hepático, Sociedad Española de Radiología Médica, Sociedad Española de Radiología Vascular e Intervencionista y Sociedad Española de Oncología Médica). The clinical practice guidelines published in 2009 accepted as Clinical Practice Guidelines of the National Health System has been taken as reference document, incorporating the most important advances that have been made in recent years. The scientific evidence for the treatment of HCC has been evaluated according to the recommendations of the National Cancer Institute (www.cancer.gov) and the strength of recommendation is based on the GRADE system.
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Affiliation(s)
- Alejandro Forner
- Unidad de Oncología Hepática (Barcelona Clinic Liver Cancer), Servicio de Hepatología, Hospital Clínic, Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - María Reig
- Unidad de Oncología Hepática (Barcelona Clinic Liver Cancer), Servicio de Hepatología, Hospital Clínic, Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - María Varela
- Sección de Hepatología, Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias (HUCA), Universidad de Oviedo, Oviedo, España
| | - Marta Burrel
- Unidad de Oncología Hepática (Barcelona Clinic Liver Cancer), Servicio de Radiodiagnóstico, Hospital Clínic, Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Jaime Feliu
- Servicio de Oncología Médica, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Sociedad Española de Oncología Médica, Madrid, España
| | - Javier Briceño
- Unidad de Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España
| | - Javier Sastre
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Madrid, España
| | - Luis Martí-Bonmati
- Departamento de Radiología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Josep María Llovet
- Unidad de Oncología Hepática (Barcelona Clinic Liver Cancer), Servicio de Hepatología, Hospital Clínic, Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España; Mount Sinai Liver Cancer Program, Division of Liver Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, Estados Unidos
| | - José Ignacio Bilbao
- Unidad de Radiología Vascular e Intervencionista, Departamento de Radiodiagnóstico, Clínica Universidad de Navarra, Pamplona, España
| | - Bruno Sangro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España; Unidad de Hepatología, Departamento de Medicina Interna, Clínica Universidad de Navarra, Pamplona, España
| | - Fernando Pardo
- Servicio de Cirugía Hepatobliopancreática y Trasplante, Clínica Universidad de Navarra, Pamplona, España
| | - Carmen Ayuso
- Unidad de Oncología Hepática (Barcelona Clinic Liver Cancer), Servicio de Radiodiagnóstico, Hospital Clínic, Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Concepció Bru
- Unidad de Oncología Hepática (Barcelona Clinic Liver Cancer), Servicio de Radiodiagnóstico, Hospital Clínic, Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Josep Tabernero
- Servicio de Oncología Médica, Hospital Universitario Vall d'Hebrón, Barcelona, Universidad Autónoma de Barcelona, Barcelona, España
| | - Jordi Bruix
- Unidad de Oncología Hepática (Barcelona Clinic Liver Cancer), Servicio de Hepatología, Hospital Clínic, Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España.
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11
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Hernández-Guerra M, Hernández-Camba A, Turnes J, Ramos LM, Arranz L, Mera J, Crespo J, Quintero E. Application of the Barcelona Clinic Liver Cancer therapeutic strategy and impact on survival. United European Gastroenterol J 2015; 3:284-93. [PMID: 26279838 DOI: 10.1177/2050640615575971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/26/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The Barcelona Clinic Liver Cancer (BCLC) classification of hepatocellular carcinoma (HCC) has proved useful in the management of HCC patients. However, BCLC-recommended first-line treatment is not always applicable in clinical practice. OBJECTIVE We performed a multicentre retrospective analysis of reasons for deviation from first-line treatment in 2008-2012. METHODS One to three-year survival data were analysed using Kaplan-Meier method. RESULTS A total of 407 consecutive HCC patients (66.6 ± 3 years, 83% male) with cirrhosis were included. Tumours were detected during surveillance in 53% of patients, grouped as Child-Pugh A (67%), B (25%) and C (8%); and BCLC A (including stage 0, 44%), B (26%), C (15%) and D (15%). In 31% of patients, first-line treatment was not feasible (51% in early stages) due to: technical reasons (74%); patient non-conformity (20%); medical decision (3%); and disease progression (3%). One to three-year survival of patients not receiving the recommended first-line treatment was similar to that of patients treated according to BCLC recommendations (log-rank, p = 0.229). CONCLUSION In real-life practice one-third of HCC patients could not receive first-line BCLC treatment. In our cohort of patients, similar short and medium-term survival was observed. Long-term prospective studies are required to determine the best alternative treatment option when BCLC first-line treatment is not feasible.
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Affiliation(s)
- Manuel Hernández-Guerra
- Gastroenterology and Hepatology Unit, Hospital Universitario de Canarias, La Laguna, Spain ; Institute of Biomedical Technologies and Center of Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, La Laguna, Spain ; Department of Medicine and Psychiatry, Universidad de La Laguna, La Laguna, Spain
| | | | - Juan Turnes
- Gastroenterology and Hepatology Unit, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Luis Martin Ramos
- Gastroenterology and Hepatology Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Laura Arranz
- Gastroenterology and Hepatology Unit, Hospital Universitario de Canarias, La Laguna, Spain
| | - José Mera
- Gastroenterology and Hepatology Unit, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Javier Crespo
- Gastroenterology and Hepatology Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Enrique Quintero
- Gastroenterology and Hepatology Unit, Hospital Universitario de Canarias, La Laguna, Spain ; Institute of Biomedical Technologies and Center of Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, La Laguna, Spain ; Department of Medicine and Psychiatry, Universidad de La Laguna, La Laguna, Spain
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12
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Umar NK, Badshah MB, Sandrasegaran K, Ghabril M, Agarwal S, Tann M, Lacerda M, Kwo PY. The Presence of Portal Vein Thrombosis Alters the Classic Enhancement Associated with Diagnosis of Hepatocellular Carcinoma. Dig Dis Sci 2015; 60:2196-200. [PMID: 25777258 DOI: 10.1007/s10620-015-3587-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 02/09/2015] [Indexed: 02/07/2023]
Abstract
AIMS To determine whether the presence of portal vein thrombosis (PVT) where venous flow within the liver may be altered may delay the diagnosis of HCC and be associated with more advanced disease. We characterized the incidence and imaging characteristics of patients diagnosed with hepatocellular carcinoma in a cohort of patients with PVT compared with those without PVT. METHODS This is a single-center retrospective study of a subset of HCC patients who underwent dynamic imaging for HCC screening and were found to have PVT. Data abstracted included demographic data, TNM stage, number/type of scans, AFP level, MELD score, and time to diagnosis. RESULTS Eighty-two patients newly diagnosed with HCC on screening were reviewed, of which 37 % (30/82) were found to have portal vein thrombosis. Patients with PVT had higher rates of atypical imaging associated with HCC compared with those without PVT (83 vs 56 %, p = 0.01) and had lower rates of portal venous washout (23 % vs 50 %, p = 0.018). Patients with PVT and HCC were also diagnosed at later TNM stage than those without PVT (70 vs 23 %, p < 0.001) and were significantly less likely to receive orthotopic liver transplant (3.6 vs 42 %, p < 0.001). Fourteen patients had preexisting PV clot without HCC; 16 developed PVT during screening or at diagnosis. Those with preexisting PVT were older (63. vs 55 years) and had higher rates of diagnosis of HCC using MRI (79 vs 21 % with CT, p = 0.01), compared with those without preexisting PVT. CONCLUSION The presence of PVT found on dynamic imaging was associated with advanced stage of HCC at the time of diagnosis. Clinicians should have a high suspicion for HCC diagnosis in new liver lesions with atypical enhancement in the setting of PVT. In this setting, MRI was more frequently associated with HCC diagnosis.
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Affiliation(s)
- Nadia K Umar
- Department of Medicine, Indiana University School of Medicine, 975W. Walnut, IB 327, Indianapolis, IN, 46202-5121, USA
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13
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Forner A, Vilana R, Solé M, Bruix J. Reply to: ''Poor contrast enhanced ultrasonography! There is no limit to its decline in the diagnosis of hepatocellular carcinoma on cirrhosis!''. J Hepatol 2015; 62:1453-4. [PMID: 25703082 DOI: 10.1016/j.jhep.2015.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 12/04/2022]
Affiliation(s)
- Alejandro Forner
- Liver Unit, Barcelona Clinic Liver Cancer (BCLC) group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
| | - Ramón Vilana
- Radiology Department, Barcelona Clinic Liver Cancer (BCLC) group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Manel Solé
- Pathology Department, Barcelona Clinic Liver Cancer (BCLC) group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Jordi Bruix
- Liver Unit, Barcelona Clinic Liver Cancer (BCLC) group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
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14
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Darnell A, Forner A, Rimola J, Reig M, García-Criado Á, Ayuso C, Bruix J. Liver Imaging Reporting and Data System with MR Imaging: Evaluation in Nodules 20 mm or Smaller Detected in Cirrhosis at Screening US. Radiology 2015; 275:698-707. [PMID: 25658038 DOI: 10.1148/radiol.15141132] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) with magnetic resonance (MR) imaging for hepatic nodules 20 mm or smaller detected during ultrasonographic (US) surveillance in patients with cirrhosis. MATERIALS AND METHODS Between November 2003 and January 2010, patients with cirrhosis with a newly US-detected solitary hepatic nodule 20 mm or smaller were included in this institutional ethics committee-approved study. All patients provided written informed consent before the study; the need to obtain consent for reanalysis of the data was waived. Patients underwent MR imaging and fine-needle biopsy (the reference standard). Nodules without pathologic confirmation were followed up with MR imaging every 6 months. A LI-RADS category was retrospectively assigned to nodules seen at MR imaging. The diagnostic accuracy for each LI-RADS category was described by sensitivity, specificity, and positive and negative predictive values with 95% confidence intervals. RESULTS Final diagnoses of 133 nodules in 159 patients were as follows: 102 hepatocellular carcinomas (HCCs), three intrahepatic cholangiocarcinomas (ICCs), one neuroendocrine metastasis, and 27 benign lesions (median MR imaging follow-up, 95 months). None (0%) of five LI-RADS category 1 lesions, three (25%) of 12 category 2 lesions, 29 (69%) of 42 category 3 lesions, 24 (96%) of 25 category 4 lesions, and 44 (98%) of 45 category 5 lesions were HCCs. One category 3 lesion was ICC, one category 5 lesion was a neuroendocrine metastasis, and two (50%) of four lesions categorized as other malignancies were HCCs. In patients with nodules detected at surveillance US, LI-RADS category 4 criteria were as effective as category 5 criteria for HCC diagnosis. Combining both categories would improve sensitivity without impairing specificity or positive or negative predictive value for HCC diagnosis (42.3%, 98.2%, 97.8%, and 47.4% vs 65.4%, 96.4%, 97.1%, and 59.6%, respectively). CONCLUSION In patients with cirrhosis with US-detected nodules 20 mm or smaller, both LI-RADS category 4 and category 5 have high specificity for HCC. In addition, a relevant proportion of lesions categorized as LI-RADS category 2 or 3 or as other malignancies were HCCs. Thus, active diagnostic work-up, including biopsy to allow prompt treatment, is recommended in such patients. Online supplemental material is available for this article.
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Affiliation(s)
- Anna Darnell
- From the Department of Radiology, Barcelona Clinic Liver Cancer group, Hospital Clinic Barcelona, University of Barcelona, Spain (A.D., J.R., A.G.C., C.A.); Liver Unit, Barcelona Clinic Liver Cancer Group, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, c/Villarroel 170, Escala 7, Planta 3, 08036 Barcelona, Spain (A.F., M.R., J.B.); and Networked Biomedical Research Center in Hepatic and Liver Diseases, Barcelona, Spain (A.F., J.R., M.R., C.A., J.B.)
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15
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[Therapeutic decisions in the treatment of hepatocellular carcinoma and patterns of sorafenib use. Results of the international observational GIDEON trial in Spain]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 38:263-73. [PMID: 25583146 DOI: 10.1016/j.gastrohep.2014.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/27/2014] [Accepted: 11/03/2014] [Indexed: 12/19/2022]
Abstract
INTRODUCTION GIDEON is a non-interventional, prospective, international study that evaluated the safety of sorafenib in patients with unresectable hepatocellular carcinoma (HCC) in daily clinical practice, including Child-Pugh B patients. OBJECTIVES To analyze data collected in Spain on the safety and efficacy of sorafenib and treatment patterns. METHODS Data were collected during follow-up on demographic and disease characteristics, the initial dose used, treatment-emergent adverse events (AEs) and dose modifications. Overall survival was evaluated, as well as time to disease progression. Efficacy and safety were analyzed according to the Child-Pugh classification and the initial dose. RESULTS We included 143 patients from 19 Spanish hospitals. A total of 24.5% of the patients were Child-Pugh B. An initial dose of 400 mg/12 h was used in 90.9% of patients. In Child-Pugh A patients, dose modifications occurred more frequently and the treatment duration was longer. The incidence of AEs and drug-related AEs were similar in Child-Pugh A and B patients, although serious AEs were more frequent in Child-Pugh B patients. The most common AEs were diarrhea, fatigue and hand-foot skin reactions. The median overall survival was 384 days and was higher in Child-Pugh A patients (593 vs. 211 days in Child-Pugh B). The median time to disease progression was 177 days, similar in both subgroups. CONCLUSION The safety profile of sorafenib in Spanish patients with unresectable HCC is independent of liver function. Child-Pugh status does not seem to influence the approach to sorafenib dosage or time to progression but does seem to be a strong prognostic factor for survival.
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16
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Bouomrani S, Kilani I, Nouma H, Slama A, Beji M. [Non fibrolamellar hepatocellular carcinoma on a healthy liver]. Pan Afr Med J 2014; 18:155. [PMID: 25419293 PMCID: PMC4236843 DOI: 10.11604/pamj.2014.18.155.2762] [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: 04/25/2013] [Accepted: 12/21/2013] [Indexed: 01/10/2023] Open
Abstract
Le carcinome hépatocellulaire (CHC) survient le plus souvent sur foie de cirrhose. Sa survenue sur un foie sain est exceptionnelle et pose un véritable défit diagnostique pour le clinicien. Nous rapportons l'observation d'un patient de 53 ans, sans antécédents pathologiques notables qui fût admis pour exploration d'une douleur de l'hypochondre droit évoluant depuis quelques mois avec une exacerbation récente, associée à un amaigrissement important et une altération de l’état général. L'examen clinique notait une hépatomégalie ferme et douloureuse. L’échographie abdominale montrait une masse hétérogène du secteur latéral droit du foie faisant 10 cm de grand axe. La TDM abdominale montrait une masse tissulaire, hétérogène, à vascularisation artérielle importante, mesurant 10 cm de diamètre et occupant le secteur latéral droit du foie. Cette tumeur comprime la branche portale droite sans signes d'extension. Il n'y avait pas d'adénopathie ni d’épanchement intra abdominal. La ponction biopsique écho-guidée avait conclu à un CHC non fibrolamellaire. Le bilan biologique, en particulier les transaminases, le taux de prothrombine, l’électrophorèse des protéines sanguine et l'alpha foeto-protéine, était sans anomalies. Les sérologies de l'hépatites virales B et C ainsi que la recherche des auto anticorps spécifiques des hépatites auto immunes et le bilan cuprique étaient aussi négatives. Vue l’âge, le stade avancé de la tumeur et l'altération de l’état général la conduite thérapeutique était de s'abstenir.
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Affiliation(s)
- Salem Bouomrani
- Service de Médecine Interne, Hôpital Militaire de Gabes 6000, Tunisie
| | - Ichrak Kilani
- Service de Gastroentérologie, Hôpital Militaire de Gabès 6000, Tunisie
| | - Hanène Nouma
- Service de Médecine Interne, Hôpital Militaire de Gabes 6000, Tunisie
| | - Alaeddine Slama
- Service de Médecine Interne, Hôpital Militaire de Gabes 6000, Tunisie
| | - Maher Beji
- Service de Médecine Interne, Hôpital Militaire de Gabes 6000, Tunisie
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17
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Forner A, Díaz-González A, Liccioni A, Vilana R. Prognosis prediction and staging. Best Pract Res Clin Gastroenterol 2014; 28:855-65. [PMID: 25260313 DOI: 10.1016/j.bpg.2014.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 07/28/2014] [Accepted: 08/15/2014] [Indexed: 01/31/2023]
Abstract
Staging and prognosis assessment are critical steps in the management of patients with hepatocellular carcinoma. This cancer is a complex disease usually associated with chronic liver disease, and any attempt to assess the prognosis should consider tumour burden, degree of liver function impairment and evaluation of cancer-related symptoms. In addition, for any staging system to be meaningful it has to link staging with treatment indication and this should be based on robust scientific data. Currently, the only proposal that serves both aims is the Barcelona Clinic Liver Cancer (BCLC) staging system. It divides patients into very early/early, intermediate, advanced and end-stage. Very early/early stage HCC patients should be considered for potentially curative options such as resection, transplantation and ablation. Patients at intermediate stage benefit from chemoembolization, while patients at an advanced stage or who cannot benefit of options of higher priority have sorafenib as standard of care. Finally, patients at end-stage should receive best supportive care.
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Affiliation(s)
- Alejandro Forner
- Liver Unit, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
| | - Alvaro Díaz-González
- Liver Unit, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain
| | - Alexandre Liccioni
- Liver Unit, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain
| | - Ramón Vilana
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Radiology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, University of Barcelona, Spain
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18
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Forner A, Gilabert M, Bruix J, Raoul JL. Treatment of intermediate-stage hepatocellular carcinoma. Nat Rev Clin Oncol 2014; 11:525-35. [PMID: 25091611 DOI: 10.1038/nrclinonc.2014.122] [Citation(s) in RCA: 340] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC)-closely associated with liver cirrhosis and, in fact, the main cause of death in patients with such disease-is now recognized as one of the most-prevalent and lethal neoplasms worldwide. Prognosis and allocation of the multiple available treatment options for patients with HCC are influenced not only by tumour stage, but also by the degree of liver-function impairment. Therefore, accurate assessment and classification of disease is important for patient management. According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, intermediate-stage HCC is defined as extensive multifocal disease without vascular invasion in patients with preserved liver function and absence of cancer-related symptoms; in this context, transarterial chemoembolization (TACE) is considered the standard treatment. The use of drug-eluting beads has enabled standardization of this procedure, resulting in higher reproducibility and tolerability of the treatment. Nevertheless, not all patients with intermediate-stage HCC are good candidates for TACE and, for such patients in whom TACE is not appropriate or has failed, other treatments can be considered, including sorafenib. Radioembolization is a promising alternative that deserves further prospective studies. Herein, we review the current approaches used to accurately stratify patients with intermediate-stage HCC and subsequently allocate the most-appropriate treatments. The key developments in therapeutic strategies are also discussed.
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Affiliation(s)
- Alejandro Forner
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Centre for Biomedical Research Network for Hepatic and Digestive Diseases, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Marine Gilabert
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte Marguerite, 13009 Marseille, France
| | - Jordi Bruix
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Centre for Biomedical Research Network for Hepatic and Digestive Diseases, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Jean-Luc Raoul
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte Marguerite, 13009 Marseille, France
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19
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Forner A, Gilabert M, Bruix J, Raoul JL. Treatment of intermediate-stage hepatocellular carcinoma. Nat Rev Clin Oncol 2014. [PMID: 25091611 DOI: 10.1038/nrclinonc.2014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC)-closely associated with liver cirrhosis and, in fact, the main cause of death in patients with such disease-is now recognized as one of the most-prevalent and lethal neoplasms worldwide. Prognosis and allocation of the multiple available treatment options for patients with HCC are influenced not only by tumour stage, but also by the degree of liver-function impairment. Therefore, accurate assessment and classification of disease is important for patient management. According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, intermediate-stage HCC is defined as extensive multifocal disease without vascular invasion in patients with preserved liver function and absence of cancer-related symptoms; in this context, transarterial chemoembolization (TACE) is considered the standard treatment. The use of drug-eluting beads has enabled standardization of this procedure, resulting in higher reproducibility and tolerability of the treatment. Nevertheless, not all patients with intermediate-stage HCC are good candidates for TACE and, for such patients in whom TACE is not appropriate or has failed, other treatments can be considered, including sorafenib. Radioembolization is a promising alternative that deserves further prospective studies. Herein, we review the current approaches used to accurately stratify patients with intermediate-stage HCC and subsequently allocate the most-appropriate treatments. The key developments in therapeutic strategies are also discussed.
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Affiliation(s)
- Alejandro Forner
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Centre for Biomedical Research Network for Hepatic and Digestive Diseases, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Marine Gilabert
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte Marguerite, 13009 Marseille, France
| | - Jordi Bruix
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Centre for Biomedical Research Network for Hepatic and Digestive Diseases, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Jean-Luc Raoul
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte Marguerite, 13009 Marseille, France
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Abstract
Hepatocellular carcinoma (HCC) is a highly prevalent and lethal neoplasia. Several studies have shown that HCC is the main cause of death in patients with cirrhosis. A better knowledge of the natural history of the tumor and the development of staging systems has allowed to refine the prognosis of the patients. The Barcelona Clinic Liver Cancer system (BCLC) has become the preferred staging system since it takes into account the tumor characteristics, the degree of liver impairment and the physical performance. It has been endorsed by several scientific associations and research consortia as it does not just define prognosis, but, more interestingly, it links staging with prognosis assessment and treatment recommendation. Curative therapies such as resection, transplantation and ablation can improve survival in patients diagnosed at an early HCC stage and may offer a long-term cure with overall survival that may exceed 70% at 5 years. Patients with intermediate stage HCC benefit from chemoembolization and proper selection of candidates permits a 50% survival at 3-4 years. Finally, patients diagnosed at an advanced stage benefit from sorafenib, an oral available, multikinase inhibitor with antiangiogenic and antiproliferative effects. Current research efforts are aimed at further refining prognosis prediction through molecular profiling and enhanced clinical characterization. At the same time, better knowledge of the molecular mechanisms of cancer should result in a further improvement of the current life expectancy of patients.
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Affiliation(s)
- Alexandre Liccioni
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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21
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Méndez-Sánchez N, Ridruejo E, Alves de Mattos A, Chávez-Tapia NC, Zapata R, Paraná R, Mastai R, Strauss E, Guevara-Casallas LG, Daruich J, Gadano A, Parise ER, Uribe M, Aguilar-Olivos NE, Dagher L, Ferraz-Neto BH, Valdés-Sánchez M, Sánchez-Avila JF. Latin American Association for the Study of the Liver (LAASL) clinical practice guidelines: management of hepatocellular carcinoma. Ann Hepatol 2014. [PMID: 24998696 DOI: 10.1016/s1665-2681(19)30919-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third most common cause of cancer death, and accounts for 5.6% of all cancers. Nearly 82% of the approximately 550,000 liver cancer deaths each year occur in Asia. In some regions, cancer-related death from HCC is second only to lung cancer. The incidence and mortality of HCC are increasing in America countries as a result of an ageing cohort infected with chronic hepatitis C, and are expected to continue to rise as a consequence of the obesity epidemic. Clinical care and survival for patients with HCC has advanced considerably during the last two decades, thanks to improvements in patient stratification, an enhanced understanding of the pathophysiology of the disease, and because of developments in diagnostic procedures and the introduction of novel therapies and strategies in prevention. Nevertheless, HCC remains the third most common cause of cancer-related deaths worldwide. These LAASL recommendations on treatment of hepatocellular carcinoma are intended to assist physicians and other healthcare providers, as well as patients and other interested individuals, in the clinical decision-making process by describing the optimal management of patients with liver cancer.
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Affiliation(s)
| | - Ezequiel Ridruejo
- Hepatology Section, Department of Medicine. Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno "CEMIC". Ciudad Autónoma de Buenos Aires, Argentina; Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Pilar, Argentina
| | | | | | - Rodrigo Zapata
- Hepatology and Liver Transplantation Unit. University of Chile School of Medicine, German Clinic. Santiago, Chile
| | - Raymundo Paraná
- Associate Professor of School of Medicine - Federal University of Bahia Head of the Gastro-Hepatologist Unit of the University Bahia University Hospital
| | - Ricardo Mastai
- Transplantation Unit. German Hospital.Buenos Aires, Argentina
| | - Edna Strauss
- Clinical hepatologist of Hospital do Coraçao - São Paulo - Brazil. Professor of the Post Graduate Course in the Department of Pathology at the School of Medicine, University of São Paulo
| | | | - Jorge Daruich
- Hepatology Department, Clinical Hospital San Martín. University of Buenos Aires Buenos Aires, Argentina
| | - Adrian Gadano
- Section of Hepatology, Italian Hospital of Buenos Aires. Buenos Aires, Argentina
| | - Edison Roberto Parise
- Professor Associado da Disciplina de Gastroenterologia da Universidade Federal de São Paulo, Presidente Eleito da Sociedade Brasileira de Hepatologia
| | - Misael Uribe
- Digestive Diseases and Obesity Clinic, Medica Sur Clinic Foundation. México City, Mexico
| | - Nancy E Aguilar-Olivos
- Digestive Diseases and Obesity Clinic, Medica Sur Clinic Foundation. México City, Mexico
| | - Lucy Dagher
- Consultant Hepatologist. Metropolitan Policlinic- Caracas- Venezuela
| | - Ben-Hur Ferraz-Neto
- Director of Liver Institute - Beneficencia Portuguesa de São Paulo. Chief of Liver Transplantation Team
| | - Martha Valdés-Sánchez
- Department of Pediatric Oncology National Medical Center "Siglo XXI". Mexico City, Mexico
| | - Juan F Sánchez-Avila
- Hepatology and Liver Transplantation Department National Institute of Nutrition and Medical Sciences "Salvador Zubirán" Mexico City, Mexico
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Hepatocellular carcinoma (HCC) in non-cirrhotic liver: clinical, radiological and pathological findings. Eur Radiol 2014; 24:1446-54. [DOI: 10.1007/s00330-014-3173-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/17/2014] [Accepted: 04/02/2014] [Indexed: 01/10/2023]
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23
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Incidence of hepatocellular carcinoma in HIV-infected patients with cirrhosis: a prospective study. J Acquir Immune Defic Syndr 2014; 65:82-6. [PMID: 24419065 DOI: 10.1097/qai.0b013e3182a685dc] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
: This study assesses the incidence of hepatocellular carcinoma (HCC) in a prospective cohort of HIV-infected patients, the majority receiving antiretroviral therapy, with liver cirrhosis from different etiologies, enrolled between 2004 and 2005 with median follow-up of 5 years. We followed 371 patients, 25.6% with decompensated cirrhosis at baseline. The incidence rate of HCC was 6.72 per 1000 person-years [95% confidence interval (CI): 2.6 to 10.9]. There was a trend toward a higher cumulative probability of developing HCC at 6 years of follow-up (considering death and liver transplant as competing risks) in patients with decompensated versus compensated cirrhosis at baseline (6% vs. 2%, P < 0.06).
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Grado de homogeneidad de los grupos españoles de trasplante hepático en el tratamiento del hepatocarcinoma. Med Clin (Barc) 2013; 141:406-10. [DOI: 10.1016/j.medcli.2013.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/18/2013] [Accepted: 03/21/2013] [Indexed: 12/12/2022]
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25
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Muros-Ortega M, Díaz-Carrasco MS, Capel A, Calleja MÁ, Martínez F. Effectiveness and safety of doxorubicin loaded beads in hepatocellular carcinoma. Int J Clin Pharm 2013; 35:1105-12. [DOI: 10.1007/s11096-013-9831-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/22/2013] [Indexed: 02/08/2023]
Affiliation(s)
- María Muros-Ortega
- Pharmacy Department, Fresenius Medical Care Services Murcia SL, C/Valle de Ordesa, 45, 30740, San Pedro del Pinatar, Murcia, Spain,
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26
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Martí-Bonmatí L, Sanz-Requena R, de Gracia BP, Carot-Sierra JM. Magnetic resonance pharmacokinetic imaging clusterization of hepatocellular carcinomas as a means to grade tumor aggressiveness. Expert Rev Gastroenterol Hepatol 2012; 6:711-6. [PMID: 23237256 DOI: 10.1586/egh.12.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hepatocellular carcinoma (HCC) management takes into account clinical and radiological findings, such as tumor stage, hepatic functional status and clinical symptoms. It is necessary to evaluate the number, size and location of the lesions. However, lesion aggressiveness is not considered in this therapeutic workflow, although the biology and the growth rate of the lesions have an important impact on survival. The aim of this work was to establish if the quantitative pharmacokinetic assessment of dynamic contrast-enhanced magnetic resonance images of HCC can separate lesions with different microvascular properties and biological evolution. Forty five patients with HCC and dynamic contrast-enhanced MRI examinations were included and several pharmacokinetic parameters were calculated. Statistical clusterization techniques were applied and two clearly distinct groups were obtained by using vascular properties and average lesion size. These groups differed by the proportion of deceased patients, although no statistically significant differences were found between the average survival times of both groups.
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Rimola J, Forner A, Tremosini S, Reig M, Vilana R, Bianchi L, Rodríguez-Lope C, Solé M, Ayuso C, Bruix J. Non-invasive diagnosis of hepatocellular carcinoma ≤ 2 cm in cirrhosis. Diagnostic accuracy assessing fat, capsule and signal intensity at dynamic MRI. J Hepatol 2012; 56:1317-23. [PMID: 22314420 DOI: 10.1016/j.jhep.2012.01.004] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 12/30/2011] [Accepted: 01/05/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS To prospectively assess the diagnostic accuracy of the incorporation of additional magnetic resonance imaging (MRI) parameters in those based on contrast enhancement pattern for the diagnosis of solitary nodules between 5 and 20mm, detected during surveillance in patients with cirrhosis. METHODS Between November 2003 and January 2010, we prospectively included 159 cirrhotic patients with a newly detected solitary nodule between 5 and 20mm in diameter by screening ultrasonography (US). Hepatic MRI and fine-needle biopsy were performed in all patients. RESULTS Final diagnoses were hepatocellular carcinoma (HCC) (n=103), other malignant lesions (intrahepatic cholangiocarcinoma/metastases) (n=4), and benign lesions (n=52). The specific enhancement pattern (arterial enhancement followed by washout) yielded a sensitivity and specificity of 58.3% and 96.4%, respectively. Peritumoral capsule was present in 43 HCC and in 2 non-HCC lesions. Intralesional fat was detected in 24 nodules; 5 nodules were non-HCC. Finally, the presence of both capsule and fat was observed in 10 cases, all of them HCC (100% specificity), but all of them also displayed the specific enhancement pattern, thus adding no sensitivity or specificity. CONCLUSIONS Conclusive non-invasive diagnosis of HCC in cirrhosis should be based only on the contrast enhancement pattern, while other characteristics at MRI do not increase the diagnostic accuracy.
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Affiliation(s)
- Jordi Rimola
- Radiology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain.
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Alsinet C, Villanueva A. [Genomic prognostic markers in hepatocellular carcinoma]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 35:94-101. [PMID: 22178501 DOI: 10.1016/j.gastrohep.2011.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/09/2011] [Indexed: 12/19/2022]
Abstract
Recently, interest in hepatocellular carcinoma (HCC) has grown due to its high mortality and increased incidence. Unlike other malignancies, HCC mainly arises in the context of chronic liver injury, complicating its management and the prediction of prognosis. The Barcelona Clinic Liver Cancer (BCLC) staging classification currently offers an efficient decision-making guide in these patients. However, preoperative identification of patients with a higher risk of recurrence after resection and of those who could benefit from liver transplantation despite not meeting the Milan criteria would be useful. New high-throughput genomic technologies that can be applied to paraffin-embedded tissue have facilitated the identification of gene signatures and other biomarkers able to predict prognosis in HCC patients. None of these biomarkers, based on transcriptome, microRNAs or metilome, has been incorporated into clinical practice, although in future they may be able to complement the prognostic value of clinical and pathologic variables.
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Affiliation(s)
- Clara Alsinet
- Laboratori de Recerca Translacional d'Oncología Hepàtica, Grupo BCLC, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, España
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Sánchez-Delgado J, Calzado S, de Haro C, Mas M, Miquel M, Casas M, Vergara M, Dalmau B, Gil M. [Long survival after resection of cranial metastases from hepatocellular carcinoma. Case report and review of the literature]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 35:12-6. [PMID: 22177938 DOI: 10.1016/j.gastrohep.2011.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 10/22/2011] [Accepted: 11/06/2011] [Indexed: 01/08/2023]
Abstract
The life expectancy of patients with hepatocellular carcinoma (HCC) has increased in the last few years due to recent treatment advances. However, extrahepatic metastases from tumors, previously described only occasionally, are becoming more frequent in clinical practice. The choice between an active or passive approach to these metastatic lesions can sometimes present clinicians with a difficult dilemma. We discuss the case of a male patient with multifocal HCC and cranial metastasis from a primary liver tumor and who, after surgery and radiotherapy over the metastatic lesion, has survived for more than 3 years.
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Affiliation(s)
- Jordi Sánchez-Delgado
- Unidad de Hepatología, Servicio de Aparato Digestivo, Universitat Autònoma de Barcelona, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.
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Gómez Rodríguez R, Romero Gutiérrez M, González de Frutos C, de Artaza Varasa T, de la Cruz Perez G, Ciampi Dopazo JJ, Lanciego Pérez C, Gómez Moreno AZ. [Clinical characteristics, staging and treatment of patients with hepatocellular carcinoma in clinical practice. Prospective study of 136 patients]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:524-31. [PMID: 21940068 DOI: 10.1016/j.gastrohep.2011.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/05/2011] [Accepted: 06/07/2011] [Indexed: 12/12/2022]
Abstract
UNLABELLED Hepatocellular carcinoma (HCC) is the most frequent cause of mortality in patients with liver cirrhosis. There are no prospective series from a single tertiary hospital in Spain. MATERIAL AND METHODS We performed a prospective study of patients with HCC in our center. Clinical and epidemiological characteristics, diagnostic method, staging according to the Barcelona Clinic Liver Cancer (BCLC) system and treatment were analyzed. RESULTS A total of 136 patients were included (80.9% men). The mean age was 66.62 ± 11.68 years and 91.2% were cirrhotic. Hepatitis C virus (HCV) was the leading cause of liver disease (38.97%). The suspected diagnosis was established by a surveillance program in 63.2%. Noninvasive American Association criteria for the Study of Liver Diseases (AASLD) were the main diagnostic method (73.5%). According to the BCLC, 58.1% were in the early stage (0-A), 21.3% in stage B, 12.5% in stage C and 8.1% in stage D. Early stage patients had followed a surveillance program more frequently than those with non-early stages (79.75% versus 44.35%, p <0.001). Potentially curative initial treatment was used in 45.58%, the most common treatment being percutaneous ethanol injection (23.13%). CONCLUSIONS Most patients with HCC in our hospital have cirrhosis, the most frequent cause being HCV. HCC surveillance in at-risk patients could increase diagnosis of HCC at an early stage. We achieved an early diagnosis in more than half of cases. The most common initial treatment was percutaneous therapy.
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Role of Organ Transplantation in the Treatment of Malignancies – Hepatocellular Carcinoma as the Most Common Tumour Treated with Transplantation. Pathol Oncol Res 2011; 18:1-10. [DOI: 10.1007/s12253-011-9441-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 07/25/2011] [Indexed: 12/22/2022]
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Grau JJ, Caballero M, Tagliapetra A. Nuevos fármacos antineoplásicos antidiana. Indicaciones clínicas en el tratamiento de tumores sólidos. Med Clin (Barc) 2011; 137:370-6. [DOI: 10.1016/j.medcli.2011.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 01/11/2011] [Accepted: 01/25/2011] [Indexed: 10/17/2022]
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Feliu J, Sastre J, Maurel J, Isla D. Hepatocellular and biliary tract carcinomas: SEOM clinical guidelines. Clin Transl Oncol 2011; 13:536-44. [PMID: 21821487 DOI: 10.1007/s12094-011-0694-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
While hepatocellular carcinoma (HCC) is a relatively common tumour with an annual incidence in the EU of 8 cases/100,000 inhabitants, bile tract carcinoma (BTC) is much less common, with an incidence of 4 cases per 100,000 inhabitants per year. In both cases, when planning treatment it is essential to perform accurate staging, evaluate hepatic functional reserve and performance status, and obtain the opinion of the patient. The only curative treatment is surgery. However, several interventional radiological techniques can help to achieve local disease control and the alleviation of symptoms. In addition, sorafenib (HCC) and chemotherapy (BTC) may contribute to prolong survival in patients with disseminated disease. Therefore, the therapeutic strategy should always be discussed and planned within a multidisciplinary tumour board.
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Affiliation(s)
- Jaime Feliu
- Medical Oncology Department, Hospital Universitario La Paz (IdiPAZ), RETICC, Madrid, Spain.
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Estudio descriptivo de la experiencia sobre carcinoma hepatocelular en hígado no cirrótico. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:322-8. [DOI: 10.1016/j.gastrohep.2011.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/05/2011] [Accepted: 02/08/2011] [Indexed: 11/19/2022]
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Innala E, Andersson C. Screening for hepatocellular carcinoma in acute intermittent porphyria: a 15-year follow-up in northern Sweden. J Intern Med 2011; 269:538-45. [PMID: 21198994 DOI: 10.1111/j.1365-2796.2010.02335.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To evaluate the benefit of screening for hepatocellular carcinoma (HCC) in gene carriers of acute intermittent porphyria (AIP) and estimate the annual incidence of HCC in this group. SUBJECTS All AIP gene carriers aged ≥55 years from the northernmost county in Sweden, Norrbotten, were invited for screening in this prospective study every 1-1.5 years during the period 1994-2009. We registered all HCC cases amongst AIP gene carriers in the northern region of Sweden (four counties). We compared gene carriers with repeated screening intervals of <2 years (Group A) with controls (Group B; i.e. gene carriers who had never been screened, those screened for the first time or screened at intervals of >2 years, or dropouts). The screening included radiological examination of the liver and relevant laboratory tests. RESULTS A total of 62 AIP subjects participated in the study, comprising 33% of the total AIP population aged >55 years in the northern region of Sweden. HCC was diagnosed in 22 AIP subjects (12 men and 10 women), mean age 69 (59-82) years. Amongst these subjects, 73% had experienced prior AIP attacks. The incidence rate ratio for HCC was 64 (52 in men and 93 in women). There were no cases of hepatitis B/C or alcohol abuse. Liver cirrhosis was rare. Liver resection could be performed in most subjects in Group A. Fourteen patients died of HCC, one in Group A and 13 in Group B. Compared with those who were not screened regularly, screening was associated with improved 3-year and 5-year survival (P = 0.005 and 0.038). CONCLUSIONS Screening for HCC in carriers of AIP enables early diagnosis and a choice of potentially curative treatments with improved prognosis. We recommend annual screening using liver imaging for AIP gene carriers >50 years of age.
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Affiliation(s)
- E Innala
- Department of Clinical Science, Obstetrics and Gynecology, Family Medicine, Umeå University, Umeå, Sweden
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[Comparison of doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) with conventional transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma]. RADIOLOGIA 2011; 53:246-53. [PMID: 21295802 DOI: 10.1016/j.rx.2010.07.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 07/14/2010] [Accepted: 07/18/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare conventional transarterial chemoembolization (TACE) with doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) for the treatment of hepatocellular carcinoma, evaluating the tumor response, complications after treatment, and survival. MATERIAL AND METHODS We present 72 patients diagnosed with hepatocellular carcinoma treated consecutively between January 2000 and December 2009. We studied 25 patients treated with TACE (Group A) and 47 patients treated with DEB-TACE (Group B); adriamycin (doxorubicin) was the chemotherapy agent used in both groups. All patients had compensated cirrhosis of the liver classified on the Child-Pugh score. The results were analyzed according to the RECIST criteria. Statistical analyses consisted of ANOVA, chi-square tests, Student's t-tests, and Kaplan-Meier log-rank tests. RESULTS Patient's age, tumor size, number of tumors, and hepatic reserve were similar in the two groups. The mean number of sessions per patient was 1.32 ± 0.67 in Group A versus 2.13 ± 0.95 in Group B. The mean dose of adriamycin per patient was 50.60 ± 29.95 mg in Group A and 231.91 ± 110.2mg in Group B. A complete response of the tumor to treatment was observed in 5.6% of the patients in Group A and in 13.9% of those in Group B. According to the RECIST criteria, no significant differences were found. DEB-TACE was better tolerated and had fewer immediate complications (p=0.001). No significant differences were found in the survival of patients in the two groups (Group A: mean 686.24 days, median 709 days; Group B: mean 765.32 days, median 672 days. CONCLUSION In patients with unresectable hepatocellular carcinoma, DEB-TACE is safe and better tolerated than conventional TACE; moreover, it seems to lead to greater necrosis of the tumors.
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Ferrer Puchol M, la Parra C, Esteban E, Vaño M, Forment M, Vera A, Cosín O. Comparison of doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) with conventional transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma. RADIOLOGIA 2011. [DOI: 10.1016/s2173-5107(11)70014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Reig M, Matilla A, Bustamante J, Castells L, de La Mata M, Delgado M, Moreno JM, Forner A, Varela M. [Recommendations for the management of Sorafenib in patients with hepatocellular carcinoma]. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:741-52. [PMID: 20851505 DOI: 10.1016/j.gastrohep.2010.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 05/29/2010] [Indexed: 12/21/2022]
Affiliation(s)
- María Reig
- Unidad de Oncología Hepática (BCLC), Servicio de Hepatología, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), IDIBAPS, Universidad de Barcelona, Barcelona, España
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Vilana R, Forner A, García Á, Ayuso C, Bru C. Carcinoma hepatocelular: diagnóstico, estadificación y estrategia terapéutica. RADIOLOGIA 2010; 52:385-98. [DOI: 10.1016/j.rx.2010.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 03/19/2010] [Accepted: 05/10/2010] [Indexed: 02/08/2023]
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Tratamiento percutáneo e intraarterial del carcinoma hepatocelular. RADIOLOGIA 2010; 52:399-413. [DOI: 10.1016/j.rx.2010.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 05/10/2010] [Accepted: 05/14/2010] [Indexed: 01/14/2023]
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MR imaging in liver cirrhosis: classical and new approaches. Insights Imaging 2010; 1:233-244. [PMID: 22347919 PMCID: PMC3259325 DOI: 10.1007/s13244-010-0034-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 06/29/2010] [Accepted: 07/12/2010] [Indexed: 01/12/2023] Open
Abstract
Objective The typical histological features of chronic hepatitis and cirrhosis are variable degrees of hepatocellular necrosis and inflammation (activity or grade of disease), fibrosis (stage of disease), and associated fat and iron deposition. These features influence the liver’s appearance and must be assessed separately by imaging biomarkers in order to be clinically useful. Hepatic morphologic alterations and features of portal hypertension identify most cases of established cirrhosis. Nowadays, research is focused on developing ways to improve detection of early and intermediate stages of fibrosis as well as hepatocyte dysfunction. Even more, most imaging-related measurements are subject to complex interactions and are influenced by different pathologic processes, such as fatty infiltration, edema, necrosis and iron accumulation. Methods and results MR experience throughout the last 15 years at the Dr Peset University Hospital is reviewed. Conclusion Nowadays, several biomarkers have been developed to grade the liver status in cirrhosis. This review will focus on these topics.
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[Treatment of hepatocellular carcinoma using precision transcatheter arterial chemoembolization (TACE): results of two years' experience in a general hospital]. RADIOLOGIA 2010; 52:425-31. [PMID: 20673581 DOI: 10.1016/j.rx.2010.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 05/11/2010] [Accepted: 05/14/2010] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To present our experience in the use of microspheres preloaded with adriamycin (DC Bead(®)) in the transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma, in a two-year prospective multidisciplinary study in consecutive patients to evaluate the efficacy, safety, and tolerance of this procedure. MATERIAL AND METHODS From May 2007 to January 2010, we performed 30 TACE procedures in 17 patients (3 women and 14 men; mean age, 68 years; age range, 56-85 years). We performed a mean of 1.76 procedures per patient using the precision TACE protocol. Outcomes were evaluated using the RECIST-EASL criteria by clinical, laboratory, CT, and MRI follow-up at 1, 3, 6, and 12 months. RESULTS The procedure was considered an initial technical success in all cases. The total dose was delivered in seven cases; in the remaining cases, the total dose was not reached (mean dose, 80mg). An objective response was observed in 64.7% of patients: a complete response was observed in 29.41% and a partial response in 35.29%. Disease was stabilized in 23.52% and progressed in 11.76%. We observed two cases of abscess/necrosis and one of ischemic cholecystitis. There were no deaths or cases of liver failure related with the procedure. CONCLUSIONS TACE using microspheres preloaded with adriamycin (DC Beads®) is safe and effective, given the low rate of complications, good tolerance in patients, and increased tumor response.
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Forner A, Rodríguez De Lope C, Reig M, Bruix J. [Treatment of advanced hepatocellular carcinoma]. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:461-8. [PMID: 20227796 DOI: 10.1016/j.gastrohep.2009.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Accepted: 12/12/2009] [Indexed: 12/28/2022]
Abstract
In the last few years, much progress has been made in the diagnosis and treatment of hepatocellular carcinoma (HCC). Due to these advances, HCC is no longer regarded as a disease with an extremely poor prognosis and has become the focus of some of the most active basic and clinical research in recent years. The most important advance is possibly the demonstration that sorafenib, a multikinase inhibitor with antiproliferative and antiangiogenic properties, is an effective treatment, able to increase survival in patients with advanced-stage HCC. This increased survival has demonstrated that these drugs, which act selectively on the molecular pathways involved in tumoral progression, can be effective in the treatment of HCC and has opened the door to the evaluation of these molecular agents, alone or in combination, in HCC. The present article provides a review of the treatment of advanced-stage HCC, with special emphasis on the distinct agents that are currently under evaluation.
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Affiliation(s)
- Alejandro Forner
- Unidad de Oncología Hepática (BCLC), Servicio de Hepatología, ICMDM, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, España.
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Vilana R, Forner A, García Á, Ayuso C, Bru C. Hepatocellular Carcinoma: Diagnosis, staging, and treatment strategy. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70029-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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45
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Varela M, Reig M, de la Mata M, Matilla A, Bustamante J, Pascual S, Turnes J, Aracil C, Del Val A, Pascasio JM, Rodríguez M, Bruix J. [Treatment approach of hepatocellular carcinoma in Spain. Analysis of 705 patients from 62 centers]. Med Clin (Barc) 2009; 134:569-76. [PMID: 20036398 DOI: 10.1016/j.medcli.2009.10.042] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 10/19/2009] [Accepted: 10/20/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Hepatocellular carcinoma (HCC) is the leading cause of death in patients with cirrhosis and its current situation in Spain is not well known. Therefore, a national registry was created to assess the characteristics of patients with de novo HCC. PATIENTS AND METHOD Between 1/10/2008 and 31/1/2009, 62 centers reported the baseline demographic, clinical and tumor characteristics, the first choice of treatment and eligibility for transplantation (OLT) of HCC diagnosed during this time. RESULTS There were 705 new cases of HCC, 78% men, mean age 65 years, 89% cirrhosis (58% Child-Pugh class A, 42% HCV, 30% alcohol). Only 334 cases (47%) were diagnosed by screening. The size of the main nodule and BCLC stage were significantly lower in the screening group than in the rest (p<0.001). The applicability of radical therapies (resection and percutaneous ablation) was significantly higher (47.5% versus 24.6%, p<0.001) as well as the evaluation for OLT (31% versus 12%, p<0.001). The screening did not differ according to gender (p=0.204) or age (<50 years, <65, <75, >75 years) (p=0.171). Chemoembolization was the most common treatment: initial tumors (46.4%), tumors >5 cm (15.7%), multifocal HCC (37.9%) and as a bridge to OLT (33%). CONCLUSION The majority of HCC patients are diagnosed in Spain out of early detection programs, and this limits the chance for early diagnosis and effective therapy.
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Affiliation(s)
- María Varela
- Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, España.
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Documento de consenso de la Sociedad Española de Trasplante Hepático. Lista de espera, trasplante pediátrico e indicadores de calidad. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:702-16. [DOI: 10.1016/j.gastrohep.2009.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 06/25/2009] [Indexed: 12/13/2022]
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Documento de consenso de la Sociedad Española de Trasplante Hepático. Lista de espera, trasplante pediátrico e indicadores de calidad. Cir Esp 2009; 86:331-45. [DOI: 10.1016/j.ciresp.2009.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 06/25/2009] [Indexed: 02/08/2023]
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Fernández-Ruiz M, Guerra-Vales JM, Vila-Santos J, Colina-Ruizdelgado F. [Prognostic prediction in patients with hepatocellular carcinoma not amenable to locoregional treatment]. Med Clin (Barc) 2009; 133:581-5. [PMID: 19748634 DOI: 10.1016/j.medcli.2009.06.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 06/12/2009] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with hepatocellular carcinoma (HCC) not amenable to locoregional therapy have some specific clinical characteristics (advanced cirrhosis or extrahepatic spread) that lead us to ascertain the prognostic efficacy of the different staging systems proposed for this entity. PATIENTS AND METHOD We analyze 100 patients (69 males) with a mean age of 70.2 (10.7) years. Tumor staging was performed at baseline according to the following systems: Okuda, Cancer of the Liver Italian Program (CLIP), Barcelona Clinic Liver Cancer (BCLC), and Japan Integrated Staging (JIS) score. We determine the area under the receiver operating characteristic curve (AUC) using the 6 and 12-month mortality as endpoint. RESULTS The BCLC system had the best predictive power for mortality both at 6 (AUC, 0.871) and 12 months (AUC, 0.924) from diagnosis. In the Cox multivariate analysis, this model showed an independent prognostic effect [hazard ratio: 9.14 for BCLC stage C versus A (p<0.001), and 9.53 for stage D versus A (p=0.004)]. CONCLUSIONS The BCLC system provided the best prognostic stratification for patients with HCC not amenable to locoregional therapy.
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Affiliation(s)
- Mario Fernández-Ruiz
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, España.
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