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Circulating biomarkers in the diagnosis and management of hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol 2022; 19:670-681. [PMID: 35676420 DOI: 10.1038/s41575-022-00620-y] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the most prevalent and lethal causes of cancer-related death worldwide. The treatment of HCC remains challenging and is largely predicated on early diagnosis. Surveillance of high-risk groups using abdominal ultrasonography, with or without serum analysis of α-fetoprotein (AFP), can permit detection of early, potentially curable tumours, but is limited by its insensitivity. Reviewed here are two current approaches that aim to address this limitation. The first is to use old re-emerged empirically derived biomarkers such as AFP, now applied within statistical models. The second is to use circulating nucleic acid biomarkers, which include cell-free DNA (for example, circulating tumour DNA, cell-free mitochondrial DNA and cell-free viral DNA) and cell-free RNA, applying modern molecular biology-based technologies and machine learning techniques closely allied to the underlying biology of cancer. Taken together, these approaches are likely to be complementary. Both hold considerable promise for achieving earlier diagnosis as well as offering additional functionalities including improved monitoring of therapy and prediction of response thereto.
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2
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Zheng T, Zhang X, Wang Y, Wang A. SPOCD1 regulated by miR-133a-3p promotes hepatocellular carcinoma invasion and metastasis. J Int Med Res 2022. [PMCID: PMC8733378 DOI: 10.1177/03000605211053717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the tumorigenic role of spen paralogue and orthologue C-terminal domain-containing 1 (SPOCD1) in hepatocellular carcinoma (HCC) and identify the upstream regulatory mechanism. Methods We analyzed SPOCD1 and miR-133-3p expression in normal and HCC tissues from the Cancer Genome Atlas and UALCAN databases, and in normal hepatocytes and HCC cell lines by real-time quantitative polymerase chain reaction and western blot. We identified the miR-133a-3p-binding site on the SPOCD1 3ʹ-untranslated region using TargetScan. Hierarchical regulation was confirmed by luciferase assay and miR-133a-3p overexpression/silencing. Cell proliferation, migration, invasion, and colony formation were assessed by MTT, scratch, transwell, and clonogenic assays, respectively. Results SPOCD1 was highly expressed in HCC tissues and cell lines, while miR-133a-3p expression was significantly downregulated. Kaplan–Meier analysis indicated that high SPOCD1 expression was significantly associated with poor survival. TargetScan and luciferase reporter assay revealed that SPOCD1 was the downstream target of miR-133a-3p. Overexpression of miR-133a-3p significantly inhibited the expression of SPOCD1, while miR-133a-3p knockdown significantly increased SPOCD1 expression. Conclusion SPOCD1, regulated by miR-133a-3p, promotes HCC cell proliferation, migration, invasion, and colony formation. This study provides the first evidence for the role of the miR-133a-3p/SPOCD1 axis in HCC tumorigenesis.
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Affiliation(s)
- Tianying Zheng
- Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xin Zhang
- Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yonggang Wang
- Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Aijun Wang
- Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China
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3
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Tomas K, Oguz S, Topaloglu S, Calik A, Arslan M, Dinç H, Ozdemir F, Kucukaslan H, Cobanoglu U, Karabulut E, ÖZtÜRk MH. Is it Rational to Perform Liver Resection for Patients with Intermediate and Advanced Stages of Hepatocellular Carcinoma? Am Surg 2020. [DOI: 10.1177/000313482008600427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study aimed to investigate clinical characteristics of hepatocellular carcinoma and the outcome of our aggressive treatment policy which follows the Barcelona Clinic Liver Cancer (BCLC) guidance. In this study, we retrospectively analyzed data of 102 patients who were treated for hepatocellular carcinoma between January 2007 and October 2016. Male predominance (81.4%) and a median age of 61 years were observed. Cirrhosis was evident in 88.2 per cent of patients. Viral hepatitis (77.5%) was the most common underlying etiology. The majority of our patients (71.6%) were in BCLC B and C stages. Liver resection was performed in 53.4 per cent of patients in those stages. Transarterial chemoembolization was the leading interventional treatment. Overall survival rates at three and five years were 75 per cent and 75 per cent in BCLC 0, 69 per cent and 58 per cent in BCLC A, 50 per cent and 41 per cent in BCLC B, and 11 per cent and 11 per cent in BCLC C, respectively. The BCLC treatment algorithm should consider the role of liver resection also for intermediate stages.
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Affiliation(s)
- Kadir Tomas
- Department of Surgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sukru Oguz
- Department of Radiology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Serdar Topaloglu
- Department of Surgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Adnan Calik
- Department of Surgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Mehmet Arslan
- Department of Gastroenterology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Hasan Dinç
- Department of Radiology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Feyyaz Ozdemir
- Department of Oncology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Hakan Kucukaslan
- Department of Surgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Umit Cobanoglu
- Department of Pathology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Erdem Karabulut
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Mehmet Halil ÖZtÜRk
- Department of Radiology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
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4
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Rimassa L, Danesi R, Pressiani T, Merle P. Management of adverse events associated with tyrosine kinase inhibitors: Improving outcomes for patients with hepatocellular carcinoma. Cancer Treat Rev 2019; 77:20-28. [PMID: 31195212 DOI: 10.1016/j.ctrv.2019.05.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 12/24/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Sorafenib, regorafenib, lenvatinib and cabozantinib are tyrosine kinase inhibitors (TKIs) that target, in part, vascular endothelial growth factor receptors, and are approved in various regions of the world for the treatment of advanced HCC. All these agents are associated with a range of adverse events (AEs) that can have a substantial impact on patients' health-related quality of life. Fatigue, diarrhoea, hand-foot skin reaction, nausea, vomiting, decreased appetite, hypertension and weight loss are among the most common AEs experienced with these four TKIs. In this review, we discuss strategies for the management of these AEs in patients with advanced HCC, with the aim of maximizing treatment benefits and minimizing the need for TKI treatment discontinuation. We also consider potential TKI-drug interactions and discuss the use of TKIs in patients with liver dysfunction or who have experienced tumour recurrence after liver transplantation. Use of appropriate AE management strategies and avoidance of contraindicated drugs should help patients with advanced HCC to achieve optimal outcomes with TKIs.
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Affiliation(s)
- Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Romano Danesi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Philippe Merle
- Department of Hepatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, 103 Grande rue de la Croix Rousse, Lyon, France.
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5
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Zhang H, Zhu J, Xi L, Xu C, Wu A. Validation of the Toronto hepatocellular carcinoma risk index for patients with cirrhosis in China: a retrospective cohort study. World J Surg Oncol 2019; 17:75. [PMID: 31039803 PMCID: PMC6492382 DOI: 10.1186/s12957-019-1619-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/17/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The Toronto hepatocellular carcinoma (HCC) risk index (THRI) was developed to predict HCC in patients with cirrhosis. This study aimed to validate the THRI in a 10-year Asian cohort. METHODS A total of 2836 patients with cirrhosis at the First Affiliated Hospital of Soochow University between January 2008 and May 2018 were evaluated. Based on the THRI value at diagnosis, patients were divided into three groups (< 120, low-risk; 120-240, intermediate-risk; > 240, high-risk). Student's t test and Fisher's exact test were applied to compare parameters between the HCC group and the non-HCC group. The receiver operator characteristic (ROC) curve was drafted to identify the value of the THRI in predicting HCC. Logistic regression was utilized to assess the relationship between the development of HCC and THRI values. The incidence of HCC was calculated for the three groups using the Kaplan-Meier method, and curves were compared using the log-rank test. RESULTS Of 520 patients enrolled in this study, 76 patients developed HCC. Patients who developed HCC had a higher THRI score than those who did not develop HCC (279.5 ± 57.1 vs. 232.3 ± 67.6, respectively, p < 0.001). The area under the ROC curve for the THRI to predict HCC was 0.707 ([95% CI 0.645-0.769], p < 0.001), with a sensitivity of 0.842 and a specificity of 0.486 when the cutoff THRI value was 226. Compared to the low-risk group, the high-risk group presented higher odds of developing HCC (adjusting odds ratio 1.026 [95% CI 1.002-1.051], p = 0.036). Differences existed in the cumulative incidence of HCC among the three risk groups (log-rank, p < 0.001). The 5-year cumulative HCC incidence of the low-risk group, intermediate-risk group, and high-risk group was 0%, 13%, and 34%, respectively. CONCLUSION This study validated THRI values for predicting HCC in Asians with cirrhosis, which presented a fine sensitivity to identify the high-risk population of HCC for secondary prevention.
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Affiliation(s)
- Huixian Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215000 Jiangsu China
| | - Jinzhou Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215000 Jiangsu China
| | - Liting Xi
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215000 Jiangsu China
| | - Chunfang Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215000 Jiangsu China
| | - Airong Wu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215000 Jiangsu China
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6
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Wong TC, Chiang CL, Lee AS, Lee VH, Yeung CS, Ho CH, Cheung TT, Ng KK, Chok SH, Chan AC, Dai WC, Wong FC, Luk MY, Leung TW, Lo CM. Better survival after stereotactic body radiation therapy following transarterial chemoembolization in nonresectable hepatocellular carcinoma: A propensity score matched analysis. Surg Oncol 2019; 28:228-235. [PMID: 30851906 DOI: 10.1016/j.suronc.2019.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/30/2018] [Accepted: 01/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study compared outcomes of nonresectable hepatocellular carcinoma (HCC) who had transarterial chemoembolization (TACE) vs. stereotactic body radiation therapy (SBRT) after TACE (TACE + SBRT). METHODS This was a retrospective study of 2 centers in Hong Kong. There were 49 patients who had TACE + SBRT and 202 patients who had TACE alone. Propensity score matching was used to adjust for differences in patients' demographics and tumor characteristics between the 2 groups. The primary outcome was overall survival (OS) and secondary outcomes were progression-free survival (PFS) and treatment-related toxicity. RESULTS After matching, 49 patients were in the TACE + SBRT group and 98 patients in the TACE group with similar baseline characteristics. The 1-&3-year OS were better in TACE + SBRT group (67.2 vs. 43.9% and 36.5 vs. 13.3%, p = 0.003). The 1-&3-year PFS was also better in TACE + SBRT group (32.5 vs. 21.4% and 15.1 vs. 5.1%, p = 0.012). Radiological disease control was better in the TACE + SBRT group (98 vs. 56.7%). Risk of severe toxicity was uncommon in both treatment arms. TACE + SBRT was an independent good prognostic factor for OS and PFS in multivariate analysis, whereas AFP>200 ng/ml, large tumor and multiple tumors predicted worse OS. CONCLUSION TACE + SBRT is safe and results in better survivals in nonresectable HCC patients.
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Affiliation(s)
- Tiffany Cl Wong
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong
| | - Chi-Leung Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Queen Mary Hospital, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
| | - Ann-Shing Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
| | - Victor Hf Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | | | - Connie Hm Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
| | - Tan-To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong
| | - Kelvin Kc Ng
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong
| | - Siu-Ho Chok
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong
| | - Albert Cy Chan
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong
| | - Wing-Chiu Dai
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong
| | - Frank Cs Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
| | - Mai-Yee Luk
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - To-Wai Leung
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - Chung-Mau Lo
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong.
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7
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Abstract
This Review presents current epidemiological trends of the most common liver diseases in Asia-Pacific countries. Hepatitis B virus (HBV) remains the primary cause of cirrhosis; despite declining prevalence in most Asian nations, this virus still poses a severe threat in some territories and regions. Mortality resulting from HBV infection is declining as a result of preventive measures and antiviral treatments. The epidemiological transition of hepatitis C virus (HCV) infection has varied in the region in the past few decades, but the medical burden of infection and the prevalence of its related cancers are increasing. The lack of licensed HCV vaccines highlights the need for novel treatment strategies. The prevalence of nonalcoholic fatty liver disease (NAFLD) has risen in the past decade, mostly owing to increasingly urbanized lifestyles and dietary changes. Alternative herbal medicine and dietary supplements are major causes of drug-induced liver injury (DILI) in some countries. Complications arising from these chronic liver diseases, including cirrhosis and liver cancer, are therefore emerging threats in the Asia-Pacific region. Key strategies to control these liver diseases include monitoring of at-risk populations, implementation of national guidelines and increasing public and physician awareness, in concert with improving access to health care.
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8
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Zhu R, Weng D, Lu S, Lin D, Wang M, Chen D, Lv J, Li H, Lv F, Xi L, Zhou J, Ma D, Li N. Double-Dose Adenovirus-Mediated Adjuvant Gene Therapy Improves Liver Transplantation Outcomes in Patients with Advanced Hepatocellular Carcinoma. Hum Gene Ther 2018; 29:251-258. [PMID: 29446997 DOI: 10.1089/hum.2017.114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Ruidong Zhu
- 1 Beijing YouAn Hospital affiliated with Capital Medical University , Beijing, P.R. China
| | - Danhui Weng
- 2 Tumor Molecular Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei, P.R. China
| | - Shichun Lu
- 1 Beijing YouAn Hospital affiliated with Capital Medical University , Beijing, P.R. China
| | - Dongdong Lin
- 1 Beijing YouAn Hospital affiliated with Capital Medical University , Beijing, P.R. China
| | - Menglong Wang
- 1 Beijing YouAn Hospital affiliated with Capital Medical University , Beijing, P.R. China
| | - Dongdong Chen
- 1 Beijing YouAn Hospital affiliated with Capital Medical University , Beijing, P.R. China
| | - Jun Lv
- 1 Beijing YouAn Hospital affiliated with Capital Medical University , Beijing, P.R. China
| | - Hongjun Li
- 1 Beijing YouAn Hospital affiliated with Capital Medical University , Beijing, P.R. China
| | - Fudong Lv
- 1 Beijing YouAn Hospital affiliated with Capital Medical University , Beijing, P.R. China
| | - Ling Xi
- 2 Tumor Molecular Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei, P.R. China
| | - Jianfeng Zhou
- 2 Tumor Molecular Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei, P.R. China
| | - Ding Ma
- 2 Tumor Molecular Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei, P.R. China
| | - Ning Li
- 1 Beijing YouAn Hospital affiliated with Capital Medical University , Beijing, P.R. China
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9
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Aggressive intrahepatic therapies for synchronous hepatocellular carcinoma with pulmonary metastasis. Clin Transl Oncol 2017; 20:729-739. [DOI: 10.1007/s12094-017-1779-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/19/2017] [Indexed: 12/12/2022]
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10
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Ren B, Zou G, Xu F, Huang Y, Xu G, He J, Li Y, Zhu H, Yu P. Serum levels of anti-sperm-associated antigen 9 antibody are elevated in patients with hepatocellular carcinoma. Oncol Lett 2017; 14:7608-7614. [PMID: 29344208 DOI: 10.3892/ol.2017.7152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 01/19/2017] [Indexed: 02/06/2023] Open
Abstract
At present, there is a high incidence of viral hepatitis and high mortality rates due to hepatocellular carcinoma (HCC) in China. In the current study, the quantification of antibodies against the cancer-testis antigen sperm-associated antigen 9 (SPAG9), alone and combined with α-fetoprotein (AFP), were evaluated as biomarkers for the diagnosis of HCC. The levels of anti-SPAG9 antibody and AFP were quantified in serum samples from patients with HCC and hepatitis or cirrhosis, as well as healthy volunteers. The results revealed that the serum levels of anti-SPAG9 immunoglobulin G antibody in patients with HCC were significantly higher compared with those in patients with hepatitis/cirrhosis and healthy controls. Using receiver operator characteristic curves, the area under the curve (AUC, 0.870) of SPAG9 as a diagnostic marker of HCC was significant [P<0.001; 95% confidence interval (CI), 0.793-0.947], whereas the AUC of AFP was 0.832 (P<0.001; 95% CI, 0.736-0.928). Serum anti-SPAG9 antibody levels exhibited significant potential for the differential diagnosis of HCC, with an AUC value of 0.729, (P=0.008; 95% CI, 0.559-0.899). Similarly, serum AFP levels exhibited significant value for the differential diagnosis of HCC, with an AUC value of 0.842 (P<0.001; 95% CI, 0.732-0.953). When combined with quantification of AFP, the diagnostic sensitivity and specificity of anti-SPAG9 levels were increased. In summary, the results suggested that anti-SPAG9 antibody is a potential early diagnostic marker of HCC.
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Affiliation(s)
- Biqiong Ren
- Clinical Laboratory, Hunan Provincial Second People's Hospital, Changsha, Hunan 410007, P.R. China.,Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Guoying Zou
- Clinical Laboratory, Hunan Provincial Second People's Hospital, Changsha, Hunan 410007, P.R. China.,Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Fei Xu
- Clinical Laboratory, Hunan Provincial Second People's Hospital, Changsha, Hunan 410007, P.R. China.,Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Yiran Huang
- Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Guofeng Xu
- Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Junyu He
- Clinical Laboratory, Hunan Provincial Second People's Hospital, Changsha, Hunan 410007, P.R. China.,Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Yong Li
- Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Haowen Zhu
- Clinical Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China.,Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
| | - Ping Yu
- Department of Immunology, School of Basic Medicine, Central South University, Changsha, Hunan 410078, P.R. China
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11
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Lo CH, Yang JF, Liu MY, Jen YM, Lin CS, Chao HL, Huang WY. Survival and prognostic factors for patients with advanced hepatocellular carcinoma after stereotactic ablative radiotherapy. PLoS One 2017; 12:e0177793. [PMID: 28545098 PMCID: PMC5435316 DOI: 10.1371/journal.pone.0177793] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/03/2017] [Indexed: 01/14/2023] Open
Abstract
Objective To evaluate the survival outcomes and prognostic factors of patients with advanced hepatocellular carcinoma (HCC) who underwent stereotactic ablative radiotherapy (SABR). Methods This retrospective study evaluated patients with advanced HCC who underwent SABR between December 2007 and July 2015. All patients had Barcelona Clinic Liver Cancer stage C disease and Child–Turcotte–Pugh (CTP) class A–B function. In-field control (IFC), overall survival (OS), prognostic factors, and toxicity were evaluated. Results In this study of 89 patients, the 3-year IFC rate was 78.1%, and the 1-year and 3-year OS rates were 45.9% and 24.3%, respectively. The multivariate analysis revealed that CTP class, the presence of main portal vein tumor thrombosis, and the presence of extrahepatic spread were independent predictors of OS. The expected median OS values among patients with ≥2, 1, and 0 predictors were 4.2, 8.6, and 26.4 months, respectively (p <0.001). Conclusions SABR may be useful for patients with advanced HCC, and patient selection could be based on the CTP classification, main portal vein tumor thrombosis, and extrahepatic spread.
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Affiliation(s)
- Cheng-Hsiang Lo
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jen-Fu Yang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Yueh Liu
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Radiation Oncology, Yee Ren Hospital, Taoyuan, Taiwan
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsing-Lung Chao
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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12
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Xu K, Watanabe-Galloway S, Rochling FA, Zhang J, Farazi PA, Peng H, Wang H, Luo J. Practice, Knowledge, and Barriers for Screening of Hepatocellular Carcinoma Among High-Risk Chinese Patients. Ann Glob Health 2017; 83:281-292. [PMID: 28619403 DOI: 10.1016/j.aogh.2017.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is among the leading causes of cancer deaths in China. Considering its poor prognosis when diagnosed late, Chinese guidelines recommend biannual screening for HCC with abdominal ultrasound and serum α-fetoprotein (AFP) test for high-risk populations. OBJECTIVES To investigate the practice, knowledge, and self-perceived barriers for HCC screening among high-risk hospital patients in China. METHODS An interview-based questionnaire was conducted among Chinese patients with chronic hepatitis B and/or chronic hepatitis C infection from outpatient clinics at 2 tertiary medical institutions in Shanghai and Wuhan, China. FINDINGS Among 352 participating patients, 50.0% had routine screening, 23.3% had irregular screening, and 26.7% had incomplete or no screening. Significant determinants for screening included higher level of education, underlying liver cirrhosis, a family history of HCC, and better knowledge concerning viral hepatitis, HCC, and HCC screening guidelines. Moreover, factors associated with better knowledge were younger age, female gender, urban residency, education level of college or above, annual household income of greater than 150,000 RMB, and longer duration of hepatitis infection. The 3 most common barriers reported for not receiving screening were not aware that screening for HCC exists (41.5%), no symptoms or discomfort (38.3%), and lack of recommendation from physicians (31.9%). CONLUSIONS Health care professionals and community leaders should actively inform patients regarding the benefits of HCC screening through design of educational programs. Such interventions are expected to increase knowledge about HCC and HCC screening, as well as improve screening adherence and earlier diagnosis.
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Affiliation(s)
- Kerui Xu
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE.
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Fedja A Rochling
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Jianjun Zhang
- Department of Hepatology, Hubei Third People's Hospital, Wuhan, Hubei, China
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Hongyan Peng
- Department of Hepatology, Hubei Third People's Hospital, Wuhan, Hubei, China
| | - Hongmei Wang
- Department of Health Services Research & Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Jiangtao Luo
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE
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Fan SS, Liao CS, Cao YD, Xiao PL, Deng T, Luo RC, Duan HX. A low serum Tat-interacting protein 30 level is a diagnostic and prognostic biomarker for hepatocellular carcinoma. Oncol Lett 2017; 13:4208-4214. [PMID: 28599422 PMCID: PMC5453031 DOI: 10.3892/ol.2017.6024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 01/26/2017] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to evaluate the diagnostic and prognostic value of Tat-interacting protein 30 (HTATIP2/TIP30) levels alone and in combination with α-fetoprotein (AFP) for the evaluation of hepatocellular carcinoma (HCC) patients. ELISA and immunohistochemical measurements on the serum and tissue of HTATIP2/TIP30 protein from HCC patients and normal controls were made. Receiver operating characteristic (ROC) curve analyses of AFP and HTATIP2/TIP30 were performed, as well as logistic regression analysis of APF combined with HTATIP2/TIP30. Log-rank analysis was used to correlate the prognosis with various levels of HTATIP2/TIP30. HTATIP2/TIP30 levels were significantly lower in the HCC group compared with the control group (4.50±2.63 vs. 9.50±2.04 ng/ml, P<0.001). ROC analysis revealed an optimal cut-off point at 7.27 ng/ml HTATIP2/TIP30 for separating the HCC from the control groups. The sensitivity and specificity were 84.6 and 93.7% (P<0.001), respectively. ROC areas of HTATIP2/TIP30 (0.928, P<0.001) were significantly higher than those for AFP (P<0.001). The area under the curve of the HTATIP2/TIP30 and AFP combination was 0.950 (P<0.001). Log-rank tests revealed that the recurrence-free survival time of the group with HTATIP2/TIP30>5.71 ng/ml was significantly higher than that of the control group (P<0.001). This is the first study to demonstrate that HTATIP2/TIP30 levels in serum may be an effective biomarker for the diagnosis and prognosis of HCC.
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Affiliation(s)
- Sha-Sha Fan
- Department of Oncology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China.,Department of Oncology, Traditional Chinese Medicine-Integrated Hospital, Southern Medical University, Guangzhou, Guangdong 510315, P.R. China
| | - Chu-Shu Liao
- Blood Disease Laboratory, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - You-De Cao
- Medical Clinical Laboratory, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Pei-Ling Xiao
- Department of Oncology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Tan Deng
- Department of Oncology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Rong-Cheng Luo
- Department of Oncology, Traditional Chinese Medicine-Integrated Hospital, Southern Medical University, Guangzhou, Guangdong 510315, P.R. China
| | - Hua-Xin Duan
- Department of Oncology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
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14
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Furukawa K, Shiba H, Horiuchi T, Shirai Y, Haruki K, Fujiwara Y, Sakamoto T, Gocho T, Yanaga K. Survival benefit of hepatic resection for hepatocellular carcinoma beyond the Barcelona Clinic Liver Cancer classification. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:199-205. [PMID: 28160422 DOI: 10.1002/jhbp.436] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Barcelona Clinic Liver Cancer (BCLC) classification is the most widely used staging system for hepatocellular carcinoma (HCC), but its prognostic ability in patients after resection has not been yet validated. The aim of this study was to evaluate the BCLC classification among patients after resection. METHODS The subjects were 196 patients who underwent hepatic resection for HCC between April 2003 and December 2014 at Jikei University Hospital. All patients were classified into a tumor stage according to the BCLC classification. Overall survival rate was calculated according to stages defined by the BCLC classification. RESULTS Overall survival rates at 1, 3 and 5-year were 100%, 95.2% and 95.2% in BCLC 0, 96.7%, 90.0% and 78.4% in BCLC A solitary, 86.2%, 86.2% and 86.2% in BCLC A multiple, 100.0%, 78.8% and 78.8% in BCLC B and 86.5%, 63.3% and 57.6% in BCLC C, respectively. Postoperative complications and mortality rates in relation to BCLC stage were comparable. CONCLUSION The BCLC treatment algorithm should consider the role of resection also for multiple early, intermediate and advanced stages.
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Affiliation(s)
- Kenei Furukawa
- Department of Surgery, Jikei University School of Medicine 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroaki Shiba
- Department of Surgery, Jikei University School of Medicine 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takashi Horiuchi
- Department of Surgery, Jikei University School of Medicine 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshihiro Shirai
- Department of Surgery, Jikei University School of Medicine 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Koichiro Haruki
- Department of Surgery, Jikei University School of Medicine 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuki Fujiwara
- Department of Surgery, Jikei University School of Medicine 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Taro Sakamoto
- Department of Surgery, Jikei University School of Medicine 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takeshi Gocho
- Department of Surgery, Jikei University School of Medicine 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, Jikei University School of Medicine 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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15
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Subbiah V, Chuang HH, Gambhire D, Kairemo K. Defining Clinical Response Criteria and Early Response Criteria for Precision Oncology: Current State-of-the-Art and Future Perspectives. Diagnostics (Basel) 2017; 7:diagnostics7010010. [PMID: 28212290 PMCID: PMC5373019 DOI: 10.3390/diagnostics7010010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 02/07/2023] Open
Abstract
In this era of precision oncology, there has been an exponential growth in the armamentarium of genomically targeted therapies and immunotherapies. Evaluating early responses to precision therapy is essential for “go” versus “no go” decisions for these molecularly targeted drugs and agents that arm the immune system. Many different response assessment criteria exist for use in solid tumors and lymphomas. We reviewed the literature using the Medline/PubMed database for keywords “response assessment” and various known response assessment criteria published up to 2016. In this article we review the commonly used response assessment criteria. We present a decision tree to facilitate selection of appropriate criteria. We also suggest methods for standardization of various response assessment criteria. The relevant response assessment criteria were further studied for rational of development, key features, proposed use and acceptance by various entities. We also discuss early response evaluation and provide specific case studies of early response to targeted therapy. With high-throughput, advanced computing programs and digital data-mining it is now possible to acquire vast amount of high quality imaging data opening up a new field of “omics in radiology”—radiomics that complements genomics for personalized medicine. Radiomics is rapidly evolving and is still in the research arena. This cutting-edge technology is poised to move soon to the mainstream clinical arena. Novel agents with new mechanisms of action require advanced molecular imaging as imaging biomarkers. There is an urgent need for development of standardized early response assessment criteria for evaluation of response to precision therapy.
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Affiliation(s)
- Vivek Subbiah
- Departments of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Hubert H Chuang
- Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | | | - Kalevi Kairemo
- Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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16
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Li L, Zhao GD, Shi Z, Qi LL, Zhou LY, Fu ZX. The Ras/Raf/MEK/ERK signaling pathway and its role in the occurrence and development of HCC. Oncol Lett 2016; 12:3045-3050. [PMID: 27899961 PMCID: PMC5103898 DOI: 10.3892/ol.2016.5110] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide and has a very poor prognosis. Its occurrence has been on the increase in recent years. Surgical resection and liver transplantation are the primary methods of treatment for HCC patients, but can only be applied to 15% of patients. The median survival time of unresectable or metastasizing HCC patients is only a few months. Existing systemic treatment methods are not effective for advanced HCC patients and a new method of treatment is needed for these patients. It has been established that the HCC occurs in multiple stages, however, the pathogenesis at a molecular level is not clear and many key factors are yet to be determined. In the past 30 years, it has become evident that the Ras/Raf/MEK/extracellular signal-regulated kinase (ERK) signaling pathway plays a significant role in the occurrence and development of HCC. This review focused on the association between the Ras/Raf/MEK/ERK signaling pathway and HCC.
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Affiliation(s)
- Lei Li
- Department of General Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei 056029, P.R. China
| | - Guo-Dong Zhao
- Department of General Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei 056029, P.R. China
| | - Zhe Shi
- Department of General Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei 056029, P.R. China
| | - Li-Li Qi
- Department of General Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei 056029, P.R. China
| | - Li-Yuan Zhou
- Department of General Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei 056029, P.R. China
| | - Ze-Xian Fu
- Department of General Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei 056029, P.R. China
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17
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Prognostic sub-classification of intermediate-stage hepatocellular carcinoma: a multicenter cohort study with propensity score analysis. Med Oncol 2016; 33:114. [PMID: 27601241 PMCID: PMC5013141 DOI: 10.1007/s12032-016-0827-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/24/2016] [Indexed: 12/13/2022]
Abstract
There is significant heterogeneity in the clinicopathological characteristics of intermediate hepatocellular carcinoma (IHCC). This also translates to treatment as transarterial chemoembolization (TACE) is used as first-line therapy for patients with IHCC; however, in Asia liver resection (LR) is preferred. Prognostic tools are required to help guide clinicians in deciding treatment options. This study evaluates the prognostic impact of the Intermediate Stage Score (ISS) on overall survival (OS) in a large, multicenter cohort study of patients with IHCC treated with TACE or surgery LR. Consecutive patients from centers in Japan, Korea, Italy and the United Kingdom who underwent TACE or LR between 2001 and 2015 were enrolled. Propensity score (PS) adjustment was used to remove residual confounding and applied to LR (n = 162) and TACE (n = 449) to determine the prognostic significance of ISS. Among 611 patients, 75 % were men and 25 % women, with a mean age of 70 years. ISS is a valid prognostic tool in the BCLC-B population with a median OS ISS 1-51, 2-38.3, 3-24.3, 4-15.6, 5-16 months (p < 0.0001). ISS was analyzed within each treatment modality, and this was a valid prognostic score among those treated with TACE and LR (p < 0.001 vs. p = 0.008). In the PS-adjusted model, ISS retained its prognostic utility in TACE and LR groups (p < 0.001 vs. p = 0.007). ISS optimizes prognostic prediction in IHCC, reducing clinical heterogeneity, and is a useful tool for patients treated for TACE or LR.
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18
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Du X, Yang X, Cheng W, Huang N, Zhou L, Zhang J. Spectral CT imaging in cervical computed tomography angiography: comparison of spectral CT monochromatic imaging and conventional CT polychromatic imaging. Int J Clin Pract 2016; 70 Suppl 9B:B44-9. [PMID: 27577513 DOI: 10.1111/ijcp.12854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/15/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To compare the image quality of spectral CT monochromatic imaging and conventional CT polychromatic imaging for analysing CTAs in patients with cervical cancer. METHODS In this IRB approved prospective study, 60 patients who had been diagnosed with cervical cancer underwent pelvic arterial CTA between May 2013 and July 2013. They were randomly divided into two groups; one group (30 patients) received 120 kVp polychromatic imaging (conventional CT group) and the other group (30 patients) received spectral CT imaging (spectral CT group), while all patients in both the groups received injections of 1 ml/kg of contrast agent. A total of 101 sets of monochromatic images (40-140 keV) were obtained via data reconstruction in the spectral CT group, and the monochromatic images with the best contrast-to-noise ratio (CNR) between the common iliac artery and pelvic fat (i.e. the best monochromatic energy) were selected. The best monochromatic images for the spectral CT group and the polychromatic images for the conventional CT group were postprocessed and visualised in MIP, VR and CPR mode. The CT attenuation value, noise and CNR of bilateral common iliac arteries were measured with the best monochromatic energy, as well as with 70 keV, in the spectral CT group and in the conventional CT group. The quality of the CT images was evaluated with a 5-point scale. The CTDIvol and the dose-length product (DLP) of the two groups were measured, and the results were statistically analysed. RESULTS When images were at 50±1 keV, the common iliac artery and pelvic fat had the highest CNR, which was 72.00% higher than the images at 70 keV (P=.001) in the spectral group, and thus, the images at 50±1 keV were considered to have the best monochromatic energy. The average CT value of the internal iliac artery, which had the best monochromatic energy from the spectral CT group, was higher than that of the images from the conventional CT group (603.96±62.68 vs 251.24±28.77; P<.001), and the differences in the CNR (73.97±11.83 vs 45.21±16.63) and the subjective score (3.10±1.73 vs 2.80±1.63) were statistically significant (both P<.05). There were no significant differences in the CTDIvol (10.48±2.86 vs 12.38±1.88 mGy) or the DLP (317.76±95.50 vs 332.25±21.25 mGy cm) between the spectral and the conventional CT groups. CONCLUSION Monochromatic spectral CT imaging has excellent soft tissue contrast and good spatial resolution and can visualise the arteries and branches supplying the tumours more clearly in patients with cervical cancer. Compared with polychromatic images, monochromatic spectral CT images are higher quality, which helps the treatment of patients with cervical cancer.
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Affiliation(s)
- Xiaosong Du
- MR & CT Room, Shanxi Cancer Hospital, Taiyuan, Shanxi, China
| | - Xiaotang Yang
- MR & CT Room, Shanxi Cancer Hospital, Taiyuan, Shanxi, China
| | - Weiling Cheng
- MR & CT Room, Shanxi Cancer Hospital, Taiyuan, Shanxi, China
| | | | - Lifang Zhou
- MR & CT Room, Shanxi Cancer Hospital, Taiyuan, Shanxi, China
| | - Jianxin Zhang
- MR & CT Room, Shanxi Cancer Hospital, Taiyuan, Shanxi, China
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19
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Chow PKH, Choo SP, Ng DCE, Lo RHG, Wang MLC, Toh HC, Tai DWM, Goh BKP, Wong JS, Tay KH, Goh ASW, Yan SX, Loke KSH, Thang SP, Gogna A, Too CW, Irani FG, Leong S, Lim KH, Thng CH. National Cancer Centre Singapore Consensus Guidelines for Hepatocellular Carcinoma. Liver Cancer 2016; 5:97-106. [PMID: 27386428 PMCID: PMC4906434 DOI: 10.1159/000367759] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the 6th most common cancer in the world, but the second most common cause of cancer death. There is no universally accepted consensus practice guidelines for HCC owing to rapid developments in new treatment modalities, the heterogeneous epidemiology and clinical presentation of HCC worldwide. However, a number of regional and national guidelines currently exist which reflect practice relevant to the epidemiology and collective experience of the consensus group. In 2014, clinicians at the multidisciplinary Comprehensive Liver Cancer Clinic (CLCC) at the National Cancer Centre Singapore (NCCS) reviewed the latest published scientific data and existing international and regional practice guidelines, such as those of the National Comprehensive Cancer Network, American Association for the Study of Liver Diseases and the Asian Pacific Association for the Study of the Liver, and modified them to reflect local practice. These would serve as a template by which treatment outcomes can be collated and benchmarked against international data. The NCCS Consensus Guidelines for HCC have been successfully implemented in the CLCC since their publication online on 26(th) September 2014, and the guidelines allow outcomes of treatment to be compared to international data. These guidelines will be reviewed periodically to incorporate new data.
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Affiliation(s)
- Pierce K. H. Chow
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore,Department of Hepatopancreatobiliary/Transplantation Surgery, Singapore General Hospital, Singapore,Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore,*Pierce K. H. Chow, MBBS, PhD, Division of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore (Singapore), Tel. +65 6326 6091, E-Mail
| | - Su Pin Choo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - David C. E. Ng
- Department of Nuclear Medicine & PET, Singapore General Hospital, Singapore
| | - Richard H. G. Lo
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Han Chong Toh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - David W. M. Tai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Brian K. P. Goh
- Department of Hepatopancreatobiliary/Transplantation Surgery, Singapore General Hospital, Singapore
| | - Jen San Wong
- Department of Hepatopancreatobiliary/Transplantation Surgery, Singapore General Hospital, Singapore
| | - Kiang Hiong Tay
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Anthony S. W. Goh
- Department of Nuclear Medicine & PET, Singapore General Hospital, Singapore
| | - Sean X. Yan
- Department of Nuclear Medicine & PET, Singapore General Hospital, Singapore
| | - Kelvin S. H. Loke
- Department of Nuclear Medicine & PET, Singapore General Hospital, Singapore
| | - Sue Ping Thang
- Department of Nuclear Medicine & PET, Singapore General Hospital, Singapore
| | - Apoorva Gogna
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Chow Wei Too
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Sum Leong
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Kiat Hon Lim
- Department of Pathology, Singapore General Hospital, Singapore
| | - Choon Hua Thng
- Division of Oncologic Radiology, National Cancer Centre Singapore, Singapore
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20
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Hepatocellular Carcinoma in Pakistan: National Trends and Global Perspective. Gastroenterol Res Pract 2016; 2016:5942306. [PMID: 26955390 PMCID: PMC4756136 DOI: 10.1155/2016/5942306] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) ranks second amongst all causes of cancer deaths globally. It is on a rise in Pakistan and might represent the most common cancer in adult males. Pakistan contributes significantly to global burden of hepatitis C, which is a known risk factor for HCC, and has one of the highest prevalence rates (>3%) in the world. In the absence of a national cancer registry and screening programs, prevalence of hepatitis and HCC only represents estimates of the real magnitude of this problem. In this review, we present various aspects of HCC in Pakistan, comparing and contrasting it with the global trends in cancer care. There is a general lack of awareness regarding risk factors of HCC in Pakistani population and prevalence of hepatitis C has increased. In addition, less common risk factors are also on a rise. Majority of patients present with advanced HCC and are not eligible for definitive treatment. We have attempted to highlight issues that have a significant bearing on HCC outcome in Pakistan. A set of strategies have been put forth that can potentially help reduce incidence and improve HCC outcome on national level.
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21
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Belousova EL, Karmazanovskij GG, Kubyshkin VA, Chzhao AV, Vishnevskij VA, Karel'skaya NA, Davydenko PI. [Opportunities of magnetic resonance imaging in differential diagnosis of focal liver masses]. Khirurgiia (Mosk) 2015:78-84. [PMID: 26331173 DOI: 10.17116/hirurgia2015778-84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- E L Belousova
- A.V. Vishnevskiy Institute of Surgery, Moscow, Russia
| | | | - V A Kubyshkin
- A.V. Vishnevskiy Institute of Surgery, Moscow, Russia
| | - A V Chzhao
- A.V. Vishnevskiy Institute of Surgery, Moscow, Russia
| | | | | | - P I Davydenko
- A.V. Vishnevskiy Institute of Surgery, Moscow, Russia
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22
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Park JW, Chen M, Colombo M, Roberts LR, Schwartz M, Chen PJ, Kudo M, Johnson P, Wagner S, Orsini LS, Sherman M. Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study. Liver Int 2015; 35:2155-66. [PMID: 25752327 PMCID: PMC4691343 DOI: 10.1111/liv.12818] [Citation(s) in RCA: 794] [Impact Index Per Article: 88.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 02/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) is the second most common cause of cancer deaths worldwide. The global HCC BRIDGE study was a multiregional, large-scale, longitudinal cohort study undertaken to improve understanding of real-life management of patients with HCC, from diagnosis to death. METHODS Data were collected retrospectively from January 2005 to September 2012 by chart reviews of eligible patients newly diagnosed with HCC at participating institutions. RESULTS Forty-two sites in 14 countries contributed final data for 18 031 patients. Asia accounted for 67% of patients, Europe for 20% and North America for 13%. As expected, the most common risk factor was hepatitis C virus in North America, Europe and Japan, and hepatitis B virus in China, South Korea and Taiwan. The most common Barcelona Clinic Liver Cancer stage at diagnosis was C in North America, Europe, China and South Korea, and A in Taiwan and Japan. Across all stages, first HCC treatment was most frequently transarterial chemoembolization in North America, Europe, China and South Korea, percutaneous ethanol injection or radiofrequency ablation in Japan and resection in Taiwan. Survival from first HCC treatment varied significantly by region, with median overall survival not reached for Taiwan and 60, 33, 31, 24 and 23 months for Japan, North America, South Korea, Europe and China respectively (P < 0.0001). CONCLUSIONS Initial results from the BRIDGE study confirm previously reported regional trends in patient demographic characteristics and HCC risk factors, document the heterogeneity of treatment approaches across regions/countries and underscore the need for earlier HCC diagnosis worldwide.
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Affiliation(s)
- Joong-Won Park
- Center for Liver Cancer, National Cancer CenterGoyang, Korea
| | - Minshan Chen
- Sun Yat-Sen University Cancer CenterGuangzhou, China
| | - Massimo Colombo
- Policlinic IRCCS Maggiore Hospital, University of MilanMilan, Italy
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo ClinicRochester, MN, USA
| | | | | | - Masatoshi Kudo
- Kinki University School of MedicineOsaka-Sayama, Osaka, Japan
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23
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Hepatic Resection Improved the Long-Term Survival of Patients with BCLC Stage B Hepatocellular Carcinoma in Asia: a Systematic Review and Meta-Analysis. J Gastrointest Surg 2015; 19:1271-80. [PMID: 25943910 DOI: 10.1007/s11605-015-2811-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/20/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Hepatic resection has been increasingly performed in patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), but the current evidence supporting its efficacy remains controversial. The aim of this systematic review was to investigate the long-term survival and safety of hepatic resection compared to transarterial chemoembolization (TACE) alone for BCLC stage B HCC. METHODS Eligible trials that compared hepatic resection with TACE alone for intermediate HCC were identified from the Embase, PubMed, Web of Science, and Cochrane databases. The study outcomes included overall survival (OS) rate and treatment-related complication rate. Hazard ratios (HRs) with a 95% confidence interval were used to measure the pooled effect according to a random-effects or fixed-effects model, depending on the heterogeneity among the included studies. The heterogeneity among these trials statistically was evaluated using the χ(2) and I (2) tests. Sensitivity analyses were also performed. RESULTS A total of 9 studies containing 4958 patients were included. The comparison between hepatic resection and TACE revealed a pooled HR for 3-year OS of 0.403 (95% CI 0.364-0.446, p = 0.000; I (2) = 0 %, p = 0.643) and a pooled HR for 5-year OS of 0.433 (95% CI 0.394-0.475, p = 0.000; I (2) = 0%, p = 0.468). An AFP level >400 ng/ml and being HBV-positive were factors significantly correlated with overall survival. For treatment-related complications, the overall odds ratio (OR) for hepatic resection versus TACE was 0.990 (95% CI 0.934-1.049; p = 0.728; I (2) = 64.5%, p = 0.060). CONCLUSION Hepatic resection likely improved overall survival compared with TACE alone in BCLC stage B HCC patients, but did not increase the incidence of treatment-related complications. An AFP level >400 ng/ml and HBV positivity were significantly correlated with poor OS.
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Xie H, Xing C, Wei B, Xu X, Wu L, Wu J, Chen L, Cao G, Chen H, Meng X, Yin S, Zhou L, Zheng S. Polymorphisms of FGFR1 in HBV-related hepatocellular carcinoma. Tumour Biol 2015; 36:8881-6. [PMID: 26069105 DOI: 10.1007/s13277-015-3643-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/03/2015] [Indexed: 02/05/2023] Open
Abstract
Hepatitis B virus (HBV)-induced hepatocellular carcinoma (HCC) is one of the most commonly diagnosed cancers in China. It is important to understand the genetic mechanisms underlying the development and progression of HBV-related HCC and to identify new biomarkers for clinical treatment. The important role of fibroblast growth factor receptors (FGFRs) has been widely recognized in many types of cancers, but the association between FGFR polymorphisms and HCC carcinogenesis has been rarely reported. In this study, 199 patients with HBV-associated cirrhosis, 203 with HBV-associated HCC, and 184 healthy controls with no liver diseases were enrolled as participants. Using SNaPshot assays, five SNPs (rs13317, rs7825208, rs1047057, rs1047111, and rs1966265) of growth factor receptor genes were genotyped. Our results showed that the G/A and G/G genotypes at rs7825208 of FGFR1 were negatively correlated with HBV-related HCC (odds ratio (OR) = 0.45, 95% confidence interval (CI) = 0.22-0.93, P = 0.027). However, after Bonferroni correction, these significant differences no longer existed (P > 0.05). Our results indicated that these five polymorphisms of fibroblast growth factor receptor genes do not play any independent roles in the tumorigenesis and progression of HBV-related HCC in Han Chinese patients.
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Affiliation(s)
- Haiyang Xie
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunyang Xing
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Bajin Wei
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Liming Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Leiming Chen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Guoqiang Cao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Hai Chen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Xueqin Meng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Shengyong Yin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China.
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Huh J, Kim KW, Kim J, Yu E. Pathology-MRI Correlation of Hepatocarcinogenesis: Recent Update. J Pathol Transl Med 2015; 49:218-29. [PMID: 26018513 PMCID: PMC4440933 DOI: 10.4132/jptm.2015.04.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/14/2015] [Indexed: 02/07/2023] Open
Abstract
Understanding the important alterations during hepatocarcinogenesis as well as the characteristic magnetic resonance imaging (MRI) and histopathological features will be helpful for managing patients with chronic liver disease and hepatocellular carcinoma. Recent advances in MRI techniques, such as fat/iron quantification, diffusion-weighted images, and gadoxetic acid-enhanced MRI, have greatly enhanced our understanding of hepatocarcinogenesis.
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Affiliation(s)
- Jimi Huh
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea ; Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihun Kim
- Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea ; Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunsil Yu
- Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea ; Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Zhang DZ, Wei XD, Wang XP. Comparison of hepatic resection and transarterial chemoembolization for solitary hepatocellular carcinoma. World J Gastroenterol 2015; 21:4635-4643. [PMID: 25914473 PMCID: PMC4402311 DOI: 10.3748/wjg.v21.i15.4635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/04/2014] [Accepted: 01/16/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the outcomes of hepatic resection and transarterial chemoembolization (TACE) for solitary hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer (BCLC) staging system.
METHODS: A consecutive sample of 540 patients with solitary HCC who underwent liver resection (n = 312) or TACE (n = 128) were included in the present study. Baseline characteristics, tumor characteristics, and post-operative complications were compared between the two groups. The Kaplan-Meier method was used for long-term survival analysis. Independent prognostic predictors were identified using the Cox proportional hazards model (univariate and multivariate analyses).
RESULTS: The TACE and liver resection groups had similar baseline demographic and clinicopathological characteristics. The TACE group showed a significantly lower rate of major complications than the liver resection group (3.9% vs 17.4%, P < 0.001). Univariate and multivariate analyses indicated that TACE did not contribute to poor overall survival compared with liver resection; however, a solitary tumor diameter of greater than 6 cm should be considered a risk factor for poor overall survival (HR = 1.328, 95%CI: 1.002-1.783, P = 0.048). The liver resection and TACE groups had comparable overall survival rates at 1 year, 3 years, and 5 years (86.2%, 62.8%, and 44.0% vs 88.3%, 59.8%, and 40.6%, respectively, P = 0.419). In cases with tumor diameters equal to or less than 6 cm, the liver resection group showed a survival benefit compared with the TACE group at 1 year, 3 years, and 5 years (P = 0.030). The 1-, 3-, and 5-year overall survival rates of HCC cases with tumor diameters of more than 6 cm were similar among the liver resection and TACE groups (P = 0.467).
CONCLUSION: A tumor diameter of 6 cm should be the cutoff for deciding between liver resection and TACE.
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Gomaa AI, Waked I. Recent advances in multidisciplinary management of hepatocellular carcinoma. World J Hepatol 2015; 7:673-87. [PMID: 25866604 PMCID: PMC4388995 DOI: 10.4254/wjh.v7.i4.673] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/17/2014] [Accepted: 01/15/2015] [Indexed: 02/06/2023] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) is increasing, and it is currently the second leading cause of cancer-related death worldwide. Potentially curative treatment options for HCC include resection, transplantation, and percutaneous ablation, whereas palliative treatments include trans-arterial chemoembolization (TACE), radioembolization, and systemic treatments. Due to the diversity of available treatment options and patients' presentations, a multidisciplinary team should decide clinical management of HCC, according to tumor characteristics and stage of liver disease. Potentially curative treatments are suitable for very-early- and early-stage HCC. However, the vast majority of HCC patients are diagnosed in later stages, where the tumor characteristics or progress of liver disease prevent curative interventions. For patients with intermediate-stage HCC, TACE and radioembolization improve survival and are being evaluated in addition to potentially curative therapies or with systemic targeted therapy. There is currently no effective systemic chemotherapy, immunologic, or hormonal therapy for HCC, and sorafenib is the only approved molecular-targeted treatment for advanced HCC. Other targeted agents are under investigation; trials comparing new agents in combination with sorafenib are ongoing. Combinations of systemic targeted therapies with local treatments are being evaluated for further improvements in HCC patient outcomes. This article provides an updated and comprehensive overview of the current standards and trends in the treatment of HCC.
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Affiliation(s)
- Asmaa I Gomaa
- Asmaa I Gomaa, Imam Waked, Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom 35111, Egypt
| | - Imam Waked
- Asmaa I Gomaa, Imam Waked, Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom 35111, Egypt
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Yau T, Tang VYF, Yao TJ, Fan ST, Lo CM, Poon RTP. Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology 2014; 146:1691-700.e3. [PMID: 24583061 DOI: 10.1053/j.gastro.2014.02.032] [Citation(s) in RCA: 489] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 02/07/2014] [Accepted: 02/07/2014] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS We aimed to develop a prognostic classification scheme with treatment guidance for Asian patients with hepatocellular carcinoma (HCC). METHODS We collected data from 3856 patients with HCC predominantly related to hepatitis B treated at Queen Mary Hospital in Hong Kong from January 1995 through December 2008. Data on patient performance status, Child-Pugh grade, tumor status (size, number of nodules, and presence of intrahepatic vascular invasion), and presence of extrahepatic vascular invasion or metastasis were included, and randomly separated into training and test sets for analysis. Cox regression and classification and regression tree analyses were used to account for the relative effects of factors in predicting overall survival times and to classify disparate treatment decision rules, respectively; the staging system and treatment recommendation then were constructed by integration of clinical judgments. The Hong Kong Liver Cancer (HKLC) classification was compared with the Barcelona Clinic Liver Cancer (BCLC) classification in terms of discriminatory ability and effectiveness of treatment recommendation. RESULTS The HKLC system had significantly better ability than the BCLC system to distinguish between patients with specific overall survival times (area under the receiver operating characteristic curve values, approximately 0.84 vs 0.80; concordance index, 0.74 vs 0.70). More importantly, HKLC identified subsets of BCLC intermediate- and advanced-stage patients for more aggressive treatments than what were recommended by the BCLC system, which improved survival outcomes. Of BCLC-B patients classified as HKLC-II in our system, the survival benefit of radical therapies, compared with transarterial chemoembolization, was substantial (5-year survival probability, 52.1% vs 18.7%; P < .0001). In BCLC-C patients classified as HKLC-II, the survival benefit of radical therapies compared with systemic therapy was even more pronounced (5-year survival probability, 48.6% vs 0.0%; P < .0001). CONCLUSIONS We collected data from patients with HCC in Hong Kong to create a system to identify patients who are suitable for more aggressive treatment than the currently used BCLC system. The HKLC system should be validated in non-Asian patient populations and in patients with different etiologies of HCC.
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Affiliation(s)
- Thomas Yau
- Department of Surgery and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Vikki Y F Tang
- Department of Surgery and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong; Clinical Trials Centre, The University of Hong Kong, Hong Kong
| | - Tzy-Jyun Yao
- Clinical Trials Centre, The University of Hong Kong, Hong Kong
| | - Sheung-Tat Fan
- Department of Surgery and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Chung-Mau Lo
- Department of Surgery and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Ronnie T P Poon
- Department of Surgery and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong.
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Intra-arterial chemotherapy with doxorubicin and cisplatin is effective for advanced hepatocellular cell carcinoma. ScientificWorldJournal 2014; 2014:160138. [PMID: 24967421 PMCID: PMC4055608 DOI: 10.1155/2014/160138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 04/28/2014] [Accepted: 05/01/2014] [Indexed: 12/13/2022] Open
Abstract
Advanced hepatocellular carcinoma (HCC) remains a fatal disease even in the era of targeted therapies. Intra-arterial chemotherapy (IACT) can provide therapeutic benefits for patients with locally advanced HCC who are not eligible for local therapies or are refractory to targeted therapies. The aim of this retrospective study was to analyze the effect of IACT with cisplatin and doxorubicin on advanced HCC. Methods. Patients with advanced HCC who were not eligible for local therapies or were refractory to sorafenib received doxorubicin (50 mg/m2) and cisplatin (50 mg/m2) infusions into the liver via the transhepatic artery. Between January 2005 and December 2011, a total of 50 patients with advanced HCC received this treatment regimen. The overall response rate (ORR) was 22% in all treated patients. In patients who received at least 2 cycles of IACT, the ORR was 36.7%, and the disease control rate was 70%. Survival rate differed significantly between patients who received only one cycle of IACT (group I) and those who received several cycles (group II). The median progression-free survival was 1.3 months and 5.8 months in groups I and II, respectively (P < 0.0001). The median overall survival was 8.3 months for all patients and was 3.1 months and 12.0 months in groups I and II, respectively (P < 0.0001). The most common toxicity was alopecia. Four patients developed grade 3 or 4 leukopenia. Worsening of liver function, nausea, and vomiting were uncommon side effects. This study demonstrated clinical efficacy and tolerable side effects of repeated IACT with doxorubicin and cisplatin in advanced HCC. Our regimen can be an alternative choice for patients with adequate liver function who do not want to receive continuous infusion of IACT.
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Li L, Diao W, Zen K. Micro-ribonucleic acids: potential noninvasive biomarkers for hepatocellular carcinoma. J Hepatocell Carcinoma 2014; 1:21-33. [PMID: 27508173 PMCID: PMC4918264 DOI: 10.2147/jhc.s44463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies globally. Each year, more than 500,000 people worldwide are diagnosed with HCC. The onset of HCC is typically unnoticeable, and the prognosis is usually poor. The early diagnosis of HCC and dynamic monitoring of this disease can contribute to more effective therapeutic interventions and improve patient outcomes. To achieve early diagnosis, more sensitive, specific, and easily detectable biomarkers are necessary. Recently, scientists have focused on identifying novel, sensitive, and minimally invasive or noninvasive biomarkers. Micro-ribonucleic acids (miRNAs) are a class of endogenous noncoding single-stranded RNAs that regulate gene expression at the posttranscriptional level. By negatively regulating target-gene expression, miRNAs play a critical role in diverse biological processes, including apoptosis, proliferation, differentiation, and developmental timing. Unique changes in miRNA expression in serum or plasma samples from HCC patients have been reported, suggesting that miRNAs may serve as novel noninvasive biomarkers for diagnosing HCC and evaluating therapeutic responses or as potential therapeutic targets in HCC. This review focuses on recent progress in understanding the role of miRNAs in HCC pathogenesis and progression, and highlights their diagnostic and prognostic value for HCC patients.
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Affiliation(s)
- Limin Li
- Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, People's Republic of China
| | - Wenli Diao
- Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, People's Republic of China
| | - Ke Zen
- Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, People's Republic of China
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Xie HY, Xing CY, Wei BJ, Xu X, Wu J, Chen LM, Cao GQ, Chen H, Chen KJ, Yin SY, Wu LM, Zhou L, Zheng SS. Association of IGF1R polymorphisms with the development of HBV-related hepatocellular carcinoma. ACTA ACUST UNITED AC 2014; 84:264-70. [PMID: 24758241 DOI: 10.1111/tan.12360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/04/2014] [Accepted: 03/25/2014] [Indexed: 02/05/2023]
Affiliation(s)
- H.-Y. Xie
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - C.-Y. Xing
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - B.-J. Wei
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - X. Xu
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - J. Wu
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - L.-M. Chen
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - G.-Q. Cao
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - H. Chen
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - K.-J. Chen
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - S.-Y. Yin
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - L.-M. Wu
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - L. Zhou
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
| | - S.-S. Zheng
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health. Key Laboratory of Organ Transplantation, Collaborative innovation center for Diagnosis treatment of infectious diseases; Zhejiang University School of Medicine; Hangzhou China
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Song P, Feng X, Zhang K, Song T, Ma K, Kokudo N, Dong J, Tang W. Perspectives on using des-γ-carboxyprothrombin (DCP) as a serum biomarker: facilitating early detection of hepatocellular carcinoma in China. Hepatobiliary Surg Nutr 2014; 2:227-31. [PMID: 24570947 DOI: 10.3978/j.issn.2304-3881.2013.08.11] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 08/15/2013] [Indexed: 12/16/2022]
Abstract
Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths in China. Evidence has shown that surgical resection and liver transplantation may offer the best potential for treating HCC but are only available to patients whose tumors are detected early. Over the past few decades, although a series of measures for standardized management of HCC has been implemented in China, most patients with HCC in China still present with advanced-stage disease, thus strategies to screen for and diagnose HCC at an earlier stage are urgently needed in China when curable interventions can be offered to achieve long-term disease-free survival for patients with HCC. In China, the serum biomarker α-fetoprotein (AFP) is considered a useful and feasible tool for HCC screening and early diagnosis. However, the sensitivity and specificity of AFP vary widely, and the total AFP is not always specific, especially when HCC is in its early stages. Globally, numerous studies have reported that the combination of des-γ-carboxyprothrombin (DCP) and AFP may have a higher sensitivity than AFP alone, and suggested DCP could also be used to assess the progression of HCC. However, DCP has not been approved in China until now. Differ from most of Western countries, people with HBV infection are the largest population at risk of developing HCC China. In order to assess the screening and diagnostic value of DCP in Chinese patients with HCC, a first large-scale, multi-center study was launched in China in 2012, results showed that DCP can help to detect HCC in its early stages and facilitate definitive treatment. The clinical use of DCP is urgently needed to facilitate early detection of HCC in China.
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Affiliation(s)
- Peipei Song
- Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Xiaobin Feng
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Keming Zhang
- Hepatobiliary Surgery Department, 302 Military Hospital of China, Beijing 100071, China
| | - Tianqiang Song
- Department of Hepatobiliary Tumor, Tianjin Medical University Cancer Hospital, Tianjin 300060, China
| | - Kuansheng Ma
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Jiahong Dong
- Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100039, China
| | - Wei Tang
- Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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Ocho M, Togayachi A, Iio E, Kaji H, Kuno A, Sogabe M, Korenaga M, Gotoh M, Tanaka Y, Ikehara Y, Mizokami M, Narimatsu H. Application of a Glycoproteomics-Based Biomarker Development Method: Alteration in Glycan Structure on Colony Stimulating Factor 1 Receptor as a Possible Glycobiomarker Candidate for Evaluation of Liver Cirrhosis. J Proteome Res 2014; 13:1428-37. [PMID: 24422531 DOI: 10.1021/pr400986t] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Makoto Ocho
- Research Center for Medical
Glycoscience (RCMG), National Institute of Advanced Industrial Science
and Technology, Tsukuba, Ibaraki, Japan
| | - Akira Togayachi
- Research Center for Medical
Glycoscience (RCMG), National Institute of Advanced Industrial Science
and Technology, Tsukuba, Ibaraki, Japan
| | - Etsuko Iio
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Hiroyuki Kaji
- Research Center for Medical
Glycoscience (RCMG), National Institute of Advanced Industrial Science
and Technology, Tsukuba, Ibaraki, Japan
| | - Atsushi Kuno
- Research Center for Medical
Glycoscience (RCMG), National Institute of Advanced Industrial Science
and Technology, Tsukuba, Ibaraki, Japan
| | - Maki Sogabe
- Research Center for Medical
Glycoscience (RCMG), National Institute of Advanced Industrial Science
and Technology, Tsukuba, Ibaraki, Japan
| | - Masaaki Korenaga
- The Research Center for Hepatitis and
Immunology, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Masanori Gotoh
- Research Center for Medical
Glycoscience (RCMG), National Institute of Advanced Industrial Science
and Technology, Tsukuba, Ibaraki, Japan
| | - Yasuhito Tanaka
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yuzuru Ikehara
- Research Center for Medical
Glycoscience (RCMG), National Institute of Advanced Industrial Science
and Technology, Tsukuba, Ibaraki, Japan
| | - Masashi Mizokami
- The Research Center for Hepatitis and
Immunology, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Hisashi Narimatsu
- Research Center for Medical
Glycoscience (RCMG), National Institute of Advanced Industrial Science
and Technology, Tsukuba, Ibaraki, Japan
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34
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Zhang K, Song P, Gao J, Li G, Zhao X, Zhang S. Perspectives on a combined test of multi serum biomarkers in China: Towards screening for and diagnosing hepatocellular carcinoma at an earlier stage. Drug Discov Ther 2014; 8:102-9. [DOI: 10.5582/ddt.2014.01026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zhu WW, Guo JJ, Guo L, Jia HL, Zhu M, Zhang JB, Loffredo CA, Forgues M, Huang H, Xing XJ, Ren N, Dong QZ, Zhou HJ, Ren ZG, Zhao NQ, Wang XW, Tang ZY, Qin LX, Ye QH. Evaluation of midkine as a diagnostic serum biomarker in hepatocellular carcinoma. Clin Cancer Res 2013; 19:3944-54. [PMID: 23719264 PMCID: PMC6314491 DOI: 10.1158/1078-0432.ccr-12-3363] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the value of serum midkine (MDK) as a diagnostic biomarker in hepatocellular carcinoma, particularly for those with negative alpha-fetoprotein (AFP) and at an early stage. EXPERIMENTAL DESIGN MDK expression in tumors was assessed by immunohistochemistry from 105 patients with hepatocellular carcinomas or liver cirrhosis. Serum MDK levels were detected by ELISA in 933 participants including hepatocellular carcinomas and hospital controls from different medical centers. Sensitivities and specificities of serum MDK in diagnosing hepatocellular carcinoma according to AFP level and Barcelona Clinic Liver Cancer (BCLC) stage were analyzed. RESULTS MDK levels were significantly elevated in hepatocellular carcinoma tissues as well as serum samples. The sensitivity of serum MDK for hepatocellular carcinoma diagnosis was much higher than that of AFP (86.9% vs. 51.9%) with similar specificities (83.9% vs. 86.3%). Notably, serum MDK had an outstanding performance in distinguishing AFP-negative hepatocellular carcinomas from different controls: In those AFP-negative hepatocellular carcinomas, the sensitivity could reach as high as 89.2%. Moreover, receiver operating characteristic (ROC) curve analysis also showed that serum MDK had a better performance compared with AFP in distinguishing early-stage hepatocellular carcinomas as well as small hepatocellular carcinomas. Even in very early-stage hepatocellular carcinomas, MDK showed an obviously higher sensitivity compared with AFP (80% vs. 40%). Furthermore, serum MDK level was significantly decreased in patients with hepatocellular carcinomas after curative resection and re-elevated when tumor relapse occurred. CONCLUSIONS Serum MDK is significantly elevated in most hepatocellular carcinomas, including those with negative AFP and at an early stage, which may serve as a novel diagnostic marker in early diagnosis and postoperative monitoring of hepatocellular carcinomas.
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Affiliation(s)
- Wen-Wei Zhu
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | - Jia-Jian Guo
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | - Lei Guo
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | - Hu-Liang Jia
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | - Ming Zhu
- Department of Biostatistics, School of Public Health, Fudan University
| | - Ju-Bo Zhang
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | | | - Marshonna Forgues
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland
| | - Hua Huang
- Department of Abdominal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xu-Jian Xing
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | - Ning Ren
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | - Qiong-Zhu Dong
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | - Hai-Jun Zhou
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | - Zheng-Gang Ren
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | - Nai-Qing Zhao
- Department of Biostatistics, School of Public Health, Fudan University
| | - Xin Wei Wang
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland
| | - Zhao-You Tang
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | - Lun-Xiu Qin
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
| | - Qing-Hai Ye
- Liver Cancer Institute and Zhongshan Hospital, Institutes of Biomedical Science
- Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education
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Abstract
With the higher incidences of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) in the East compared with the West, Asian centers have made significant contributions to the management of these malignancies. The major risk factor for HCC is hepatitis B infection in Asia in contrast to hepatitis C in Western populations. Barcelona Clinic for Liver Cancer (BCLC) staging that guides the treatment of patients with HCC in the West is considered too conservative by many Asian centers. In Asia, liver resection is widely offered to patients with multifocal, bilobar tumor or tumor invasion to the portal vein. The criteria for liver transplantation for HCC are also often more extended in Asian centers. Asian surgeons pioneered the development of living donor liver transplantation, which plays a major role in the management of early HCC associated with severe cirrhosis in Asia due to shortage of deceased donor graft. Asian centers have also made significant contributions to the modern management of CCA. A more aggressive surgical approach is generally adopted in Asia, including radical lymphadenectomy for intrahepatic CCA and simultaneous hepatic artery and portal vein resection with hepatectomy for hilar CCA. Eastern and Western centers should collaborate in further studies to establish the optimal treatment strategies for hepatobiliary malignancies.
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Affiliation(s)
- Tiffany C L Wong
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Bae SH, Kim MS, Cho CK, Kim KB, Lee DH, Han CJ, Park SC, Kim YH. Feasibility and efficacy of stereotactic ablative radiotherapy for Barcelona Clinic Liver Cancer-C stage hepatocellular carcinoma. J Korean Med Sci 2013; 28:213-9. [PMID: 23400333 PMCID: PMC3565132 DOI: 10.3346/jkms.2013.28.2.213] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 11/26/2012] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study was to assess the feasibility and efficacy of stereotactic ablative radiotherapy (SABR) for liver tumor in patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). We retrospectively reviewed the medical records of 35 patients between 2003 and 2011. Vascular invasion was diagnosed in 32 patients, extrahepatic metastases in 11 and both in 8. Thirty-two patients were categorized under Child-Pugh (CP) class A and 3 patients with CP class B. The median SABR dose was 45 Gy (range, 30-60 Gy) in 3-5 fractions. The median survival time was 14 months. The 1- and 3-yr overall survival (OS) rate was 52% and 21%, respectively. On univariate analysis, CP class A and biologically equivalent dose ≥ 80 Gy(10) were significant determinants of better OS. Severe toxicity above grade 3, requiring prompt therapeutic intervention, was observed in 5 patients. In conclusion, SABR for BCLC-C stage HCC showed 1-yr OS rate of 52% but treatment related toxicity was moderate. We suggest that patients with CP class A are the best candidate and at least SABR dose of 80 Gy(10) is required for BCLC-C stage.
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Affiliation(s)
- Sun Hyun Bae
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Chul Koo Cho
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Kum Bae Kim
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Dong Han Lee
- CyberKnife Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Chul Ju Han
- Department of Internal Medicine, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Su Cheol Park
- Department of Internal Medicine, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Young Han Kim
- Department of Radiology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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McCaughan GW. Early hepatocellular carcinoma - is there such a thing as too early? J Hepatol 2013; 58:210-1. [PMID: 23159769 DOI: 10.1016/j.jhep.2012.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 11/08/2012] [Indexed: 01/15/2023]
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39
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Song P, Gao J, Inagaki Y, Kokudo N, Hasegawa K, Sugawara Y, Tang W. Biomarkers: evaluation of screening for and early diagnosis of hepatocellular carcinoma in Japan and china. Liver Cancer 2013; 2:31-9. [PMID: 24159594 PMCID: PMC3747538 DOI: 10.1159/000346220] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Over the past few decades, the screening for and early diagnosis of hepatocellular carcinoma (HCC) has attracted attention worldwide, and especially in Asian countries such as Japan and China. Such approaches can help detecting HCC at an earlier stage when curable interventions can be offered to achieve long-term disease-free survival for patients. Biomarkers have been used to screen for and diagnose HCC in various countries. In Japan, the combined tests of des-Γ-carboxyprothrombin (DCP) and α-fetoprotein (AFP) or Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3) have been shown to achieve a high level of sensitivity and specificity. These tests have routinely been used to screen for HCC and are covered by Japan's national health insurance. Due to the routine practice of screening for HCC among high-risk patients, HCC nodules have been detected in the early stages in more than 60% of patients in Japan. In contrast, although several remarkable advances in the management of HCC have been made in China over the past few decades, most HCC patients still present with advanced-stage disease. AFP is the only serum biomarker that has widely been used to screen for and diagnose HCC in China. In recent years, several molecular biological studies have further investigated the clinical usefulness of DCP, and they have found that it may facilitate the screening for and diagnosis of HCC and assist with the assessment of HCC progression. DCP can serve as a biomarker to detect HCC in an early stage and facilitate definitive treatment. The wide implementation of DCP is expected, especially in China where 55% of HCC cases worldwide live.
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Affiliation(s)
| | | | | | | | | | | | - Wei Tang
- *Dr. Wei Tang, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan), E-Mail
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40
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Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies, with an increasing incidence. With advances in surgical techniques and instrumentation and the development of molecular-target drugs, a number of potentially curative treatments have become available. Management of HCC patients depends on the stage of their tumor. Liver resection remains the first choice for very early-stage HCC, but it is being challenged by local ablative therapy. For early-stage HCC that meet the Milan criteria, liver transplantation still offers a better outcome; however, local ablative therapy can be a substitute when transplantation is not feasible. Local ablation is also used as a bridging therapy toward liver transplantation. HCC recurrence is the main obstacle to successful treatment, and there is currently no effective means of preventing or treating HCC recurrence. Transarterial therapy is considered suitable for intermediate-stage HCC, while sorafenib is recommended for advanced-stage HCC. This stage-based approach to therapy not only provides acceptable outcomes but also improves the quality of life of HCC patients. Because of the complexity of HCC, therapeutic approaches must be adapted according to the characteristics of each individual patient. This review discusses the current standards and trends in the treatment of HCC.
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Affiliation(s)
| | | | - Peter Schemmer
- *Deptment of General and Transplant Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, Heidelberg 69120 (Germany), Tel. +49 0 6221 56 6110, E-Mail
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Hypovascular hepatic nodule showing hypointensity in the hepatobiliary phase of gadoxetic acid-enhanced MRI in patients with chronic liver disease: Prediction of malignant transformation. Eur J Radiol 2012; 81:3072-8. [DOI: 10.1016/j.ejrad.2012.05.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 05/05/2012] [Accepted: 05/05/2012] [Indexed: 12/17/2022]
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Abstract
With the recent dramatic advances in diagnostic modalities, the diagnosis of hepatocellular carcinoma (HCC) is primarily based on imaging. Ultrasound (US) plays a crucial role in HCC surveillance. Dynamic multiphasic multidetector-row CT (MDCT) and magnetic resonance imaging (MRI) are the standard diagnostic methods for the noninvasive diagnosis of HCC, which can be made based on hemodynamic features (arterial enhancement and delayed washout). The technical development of MDCT and MRI has made possible the fast scanning with better image quality and resolution, which enables an accurate CT hemodynamic evaluation of hepatocellular tumor, as well as the application of perfusion CT and MRI in clinical practice. Perfusion CT and MRI can measure perfusion parameters of tumor quantitatively and can be used for treatment response assessment to anti-vascular agents. Besides assessing the hemodynamic or perfusion features of HCC, new advances in MRI can provide a cellular information of HCC. Liver-specific hepatobiliary contrast agents, such as gadoxetic acid, give information regarding hepatocellular function or defect of the lesion, which improves lesion detection and characterization. Diffusion-weighted imaging (DWI) of the liver provides cellular information of HCC and also has broadened its role in lesion detection, lesion characterization, and treatment response assessment to chemotherapeutic agents. In this article, we provide an overview of the state-of-the art imaging techniques of the liver and their clinical role in management of HCC.
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Affiliation(s)
- Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea.
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43
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Abstract
Based on recent clinical practice guidelines, imaging is largely replacing pathology as the preferred diagnostic method for determination of hepatocellular carcinoma (HCC). A variety of imaging modalities, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography, are currently used to examine patients with chronic liver disease and suspected HCC. Advancements in imaging techniques such as perfusion imaging, diffusion imaging, and elastography along with the development of new contrast media will further improve the ability to detect and characterize HCC. Early diagnosis of HCC is essential for prompt treatment, which may in turn improve prognosis. Considering the process of hepatocarcinogenesis, it is important to evaluate sequential changes via imaging which would help to differentiate HCC from premalignant or benign lesions. Recent innovations including multiphasic examinations, high-resolution imaging, and the increased functional capabilities available with contrast-enhanced US, multidetector row CT, and MRI have raised the standards for HCC diagnosis. Although hemodynamic features of nodules in the cirrhotic liver remain the main diagnostic criterion, newly developed cellspecific contrast agents have shown great possibilities for improved HCC diagnosis and may overcome the diagnostic dilemma associated with small or borderline hepatocellular lesions. In the 20th century paradigm of medical imaging, radiological diagnosis was based on morphological characteristics, but in the 21st century, a paradigm shift to include biomedical, physiological, functional, and genetic imaging is needed. A multidisciplinary team approach is necessary to foster an integrated approach to HCC imaging. By developing and combining new imaging modalities, all phases of HCC patient care, including screening, diagnosis, treatment, and therapy, can be dramatically improved.
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Affiliation(s)
| | - Byung Ihn Choi
- *Byung Ihn Choi, MD, Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul 110-744 (Korea), Tel. +82 2 2072 2515, E-Mail
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44
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Chiu CY, Kuo KK, Kuo TL, Lee KT, Cheng KH. The activation of MEK/ERK signaling pathway by bone morphogenetic protein 4 to increase hepatocellular carcinoma cell proliferation and migration. Mol Cancer Res 2012; 10:415-27. [PMID: 22241220 DOI: 10.1158/1541-7786.mcr-11-0293] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common visceral malignancies worldwide, with a very high incidence and poor prognosis. Bone morphogenesis protein 4 (BMP4), which belongs to the TGF-β superfamily of proteins, is a multifunctional cytokine, which exerts its biologic effects through SMAD- and non-SMAD-dependent pathways, and is also known to be involved in human carcinogenesis. However, the effects of the BMP4 signaling in liver carcinogenesis are not yet clearly defined. Here, we first show that BMP4 and its receptor, BMPR1A, are overexpressed in a majority of primary HCCs and that it promotes the growth and migration of HCC cell lines in vitro. We also establish that BMP4 can induce HCC cyclin-dependent kinase (CDK)1 and cyclin B1 upregulation to accelerate cell-cycle progression. Our study indicates that the induction of HCC cell proliferation is independent of the SMAD signaling pathway, as Smad4 knockdown of HCC cell lines still leads to the upregulation of CDK1 and cyclin B1 expression after BMP4 treatment. Using mitogen-activated protein/extracellular signal-regulated kinase (MEK) selective inhibitors, the induction of CDK1, cyclin B1 mRNA and protein were shown to be dependent on the activation of MEK/extracellular signal-regulated kinase (ERK) signaling. In vivo xenograft studies confirmed that the BMPR1A-knockdown cells were significantly less tumorigenic than the control groups. Our findings show that the upregulation of BMP4 and BMPR1A in HCC promotes the proliferation and metastasis of HCC cells and that CDK1 and cyclin B1 are important SMAD-independent molecular targets in BMP4 signaling pathways, during the HCC tumorigenesis. It is proposed that BMP4 signaling pathways may have potential as new therapeutic targets in HCC treatment.
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Affiliation(s)
- Chiang-Yen Chiu
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
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45
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Han KH, Kudo M, Ye SL, Choi JY, Poon RTP, Seong J, Park JW, Ichida T, Chung JW, Chow P, Cheng AL. Asian consensus workshop report: expert consensus guideline for the management of intermediate and advanced hepatocellular carcinoma in Asia. Oncology 2011; 81 Suppl 1:158-64. [PMID: 22212951 DOI: 10.1159/000333280] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) is a highly prevalent disease in many Asian countries, accounting for 80% of victims worldwide. Screening programs improve the detection of early HCC and have a positive impact on survival, but the majority of HCC patients in Asia still present with advanced stage disease. The treatment outcomes of HCC are affected by multiple variables, including liver function, performance status of the patient, and tumor stage. Therefore, it is not easy to apply a multidisciplinary therapeutic approach for optimal management. At present, limited numbers of HCC patients are eligible for curative therapies such as surgery or ablation in Asia. Therefore, most patients are eligible for only palliative treatments. For optimal management, the treatment choice is guided by staging systems and treatment guidelines. Numerous staging systems have been proposed and treatment guidelines vary by region. According to the Barcelona Clinic Liver Cancer (BCLC) guideline based on evidence from randomized clinical trials, only transarterial chemoembolization (TACE) is recommended for intermediate stage HCC and sorafenib for advanced stage HCC. However, treatment guidelines from Asian countries have adopted several other therapeutic modalities such as a surgical approach, hepatic arterial infusion chemotherapy, external radiation, and their combinations based on clinical experiences for intermediate and advanced stage HCC. Although TACE is the main therapeutic modality in the intermediate stage, overall therapeutic outcomes depend on the tumor size. In the advanced stage, the prognosis depends on the tumor status, e.g. major vessel invasion or extrahepatic spread. Thus, a new staging system representing prognoses suitable for Asian HCC patients and a corresponding optimal treatment algorithm should be further investigated using evidence-based data, which will finally bring about an Asian consensus for the management of intermediate and advanced stage HCC.
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Affiliation(s)
- Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Kim DY, Han KH. Sorafenib, doesn't it have any competitor in advanced hepatocellular carcinoma? J Gastroenterol Hepatol 2011; 26:1585-6. [PMID: 22011294 DOI: 10.1111/j.1440-1746.2011.06901.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Fatima S, Lee NP, Luk JM. Dickkopfs and Wnt/β-catenin signalling in liver cancer. World J Clin Oncol 2011; 2:311-25. [PMID: 21876852 PMCID: PMC3163259 DOI: 10.5306/wjco.v2.i8.311] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/07/2011] [Accepted: 07/14/2011] [Indexed: 02/06/2023] Open
Abstract
Liver cancer is the fifth and seventh most common cause of cancer in men and women, respectively. Wnt/β-catenin signalling has emerged as a critical player in both the development of normal liver as well as an oncogenic driver in hepatocellular carcinoma (HCC). Based on the current understanding, this article summarizes the possible mechanisms for the aberrant activation of this pathway with specific focus on HCC. Furthermore, we will discuss the role of dickkopfs (DKKs) in regulating Wnt/β-catenin signalling, which is poorly understood and understudied. DKKs are a family of secreted proteins that comprise at least four members, namely DKK1-DKK4, which act as inhibitors of Wnt/β-catenin signalling. Nevertheless, not all members antagonize Wnt/β-catenin signalling. Their functional significance in hepatocarcinogenesis remains to be further characterized for which these studies should provide new insights into the regulatory role of DKKs in Wnt/β-catenin signalling in hepatic carcinogenesis. Because of the important oncogenic roles, there are an increasing number of therapeutic molecules targeting β-catenin and the Wnt/β-catenin pathway for potential therapy of HCC.
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Affiliation(s)
- Sarwat Fatima
- Sarwat Fatima, Nikki P Lee, Department of Surgery, The University of Hong Kong, Hong Kong, China
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48
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Montomoli J, Erichsen R, Nørgaard M, Høyer M, Hansen JB, Jacobsen JB. Survival of patients with primary liver cancer in central and northern Denmark, 1998-2009. Clin Epidemiol 2011; 3 Suppl 1:3-10. [PMID: 21814464 PMCID: PMC3144772 DOI: 10.2147/clep.s20623] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective Primary liver cancer (PLC) is a serious disease with high mortality. During the last decade, improvements in the diagnostic procedures and treatment of PLC may have improved survival. However, few updated longitudinal studies examined this issue. In a population-based setting, we studied changes in the prognoses over time. Methods Between 1998 and 2009, we identified all patients with PLC in the central and northern Denmark regions, with a combined population of 1.8 million. We determined age- and period-stratified survival, and computed mortality rate ratios (MRRs) with 95% confidence intervals (CIs), using Cox proportional hazard regression to assess changes over time, while controlling for age and gender. We conducted the analyses for PLC overall and separately for hepatocellular carcinoma (HCC) and cholangiocarcinoma, respectively. Results We included 1064 patients with PLC. Their median age was 69 years (range 17–94 years). The number of patients diagnosed with PLC in the period 2007–2009 was approximately 40% higher than the number in 1998–2000. One-year survival increased from 16% in 1998–2000 to 28% in 2007–2009, corresponding to an adjusted 1-year MRR of 0.65 (95% CI: 0.54–0.79). In patients aged <60 years, we found the most pronounced increase in 1-year survival, from 14% to 49% in women and from 19% to 41% in men. The 3- and 5-year survival in the entire cohort increased from 5% to a predicted 11% and from 2% to a predicted 7% during our study period, respectively. Accordingly, the expected 3- and 5-year adjusted MRRs were 0.68 (95% CI: 0.57–0.82) and 0.68 (95% CI: 0.57–0.81), respectively. One-, 3-, and 5-year survival improved during the study period for both HCC and cholangiocarcinoma. Conclusion PLC survival remains poor in the Danish population, although we observed an increase over the period 1998–2009, particularly in young people.
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Affiliation(s)
- Jonathan Montomoli
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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