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Araz F, Soydaş B, Özer B, Karadeli E, Erbay G. Comparison of Characteristics and Survival of New-Onset Hepatocellular Carcinomas With or Without Cirrhosis in a Tertiary Center. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2024; 35:539-550. [PMID: 39128067 PMCID: PMC11363398 DOI: 10.5152/tjg.2024.23451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/04/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND/AIMS Although hepatocellular carcinoma (HCC) usually develops in cirrhotic livers, HCCs could also arise in non-cirrhotic livers. We aimed to compare the characteristics and survival of cirrhotic- and non-cirrhotic HCCs. MATERIALS AND METHODS Data of HCC patients between 2011 and 2021 in a single tertiary center was evaluated retrospectively. Demographic, clinical, laboratory, tumoral and pathological features, and survival outcomes of cirrhotic and non-cirrhotic HCCs were compared. RESULTS The study included 188 HCC patients. Median age was 64 (26-92) years and similar for study groups (P = .208). Both groups had similar male/female ratio. Forty-two patients (22.3%) had HCC in non-cirrhotic liver. Non-cirrhotic HCCs had similar tumor differentiation type, radiological characteristics, Milan, University of California San Francisco, and the Barcelona Clinic Liver Cancer stages, but more unifocal lesion (78.6% vs. 59.6%) and larger tumor size (89.5 (16-240) mm vs. 59.0 (12-290) mm) at presentation compared to non-cirrhotic HCCs. Despite larger tumor size, non-cirrhotic HCC patients had better overall, disease-free and progression-free survival rates than cirrhotic HCCs. Overall survivals for 1 and 3 years were 71.4% and 49.7% for non-cirrhotic and 54% and 28.3% for cirrhotic HCCs, respectively (P = .035). According to Cox analyses, Eastern Cooperative Oncology Group score (P <.001, hazards ratio (HR): 4.05) and curative treatments (P < .001, HR: 0.21) were predictive for overall survival in cirrhotic HCCs. Curative treatment (P = .027, HR: 0.31) was found to be a significant predictor for overall survival in non-cirrhotic HCCs. Vascular invasion was the only independent predictor for disease-free survival (HR: 2.62, 95% CI 1.01-6.93, P = .049) for non-cirrhotic HCCs. CONCLUSION Despite larger tumor size and similar tumor stages, compared to cirrhotic HCCs, non-cirrhotic HCCs were associated with better survival outcomes.
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Affiliation(s)
- Filiz Araz
- Department of Gastroenterology, Başkent University, Adana Turgut Noyan Training and Research Hospital, Adana, Türkiye
| | - Barış Soydaş
- Department of Gastroenterology, Başkent University, Adana Turgut Noyan Training and Research Hospital, Adana, Türkiye
| | - Birol Özer
- Department of Gastroenterology, Başkent University, Adana Turgut Noyan Training and Research Hospital, Adana, Türkiye
| | - Elif Karadeli
- Department of Radiology, Başkent University, Adana Turgut Noyan Training and Research Hospital, Adana, Türkiye
| | - Gürcan Erbay
- Department of Radiology, Başkent University, Adana Turgut Noyan Training and Research Hospital, Adana, Türkiye
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Selvaraj S, Dharmalingam P, Alashetty S, Amirtham U. Synchronous hepatocellular carcinoma and renal cell carcinoma: A cytological marvel. Diagn Cytopathol 2024; 52:E105-E110. [PMID: 38351641 DOI: 10.1002/dc.25286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 04/04/2024]
Abstract
Multiple primary synchronous tumours have always created an inquisitiveness among clinicians, radiologists and pathologists. The diagnosis invariably proposes a challenge to diagnosticians. The coexistence of a primary hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC) is exceedingly rare, with countable number of cases being reported in literature. We report a pioneer case of 75-year-old male, having chronic hepatitis B, diagnosed with synchronous primary RCC and HCC in by fine-needle aspiration cytology (FNAC) and confirmed by immunohistochemistry.
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Affiliation(s)
- Sivaranjani Selvaraj
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Priya Dharmalingam
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Soumya Alashetty
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Usha Amirtham
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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Malte AL, Højbjerg JA, Larsen JB. Platelet Parameters as Biomarkers for Thrombosis Risk in Cancer: A Systematic Review and Meta-analysis. Semin Thromb Hemost 2024; 50:360-383. [PMID: 36921613 DOI: 10.1055/s-0043-1764381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Cancer-associated thrombosis (CAT) is a major cause of both morbidity and mortality in cancer patients. Platelet count has been investigated as a predictor of CAT in various settings while knowledge on platelet activation parameters is sparse. This report provides a systematic review and meta-analysis on available literature on associations between platelet count and/or function and arterial and venous thrombosis in adult cancer patients. The review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed and Embase were searched up to March 2022. The National Heart, Lung, and Blood Institute's tools were used for quality assessment. In total, 100 studies were included which investigated the association between CAT and platelet count (n = 90), platelet indices (n = 19), and platelet function/activation markers (n = 13) in patients with solid cancers (n = 61), hematological cancers (n = 17), or mixed cancer types (n = 22). Eighty-one studies had venous thrombosis as their outcome measure, while 4 had arterial thrombosis and 15 studies had both. We found significantly elevated odds ratio of 1.50 (95% confidence interval: 1.19-1.88) for thrombosis with higher platelet counts. We saw a tendency toward an association between markers of platelet activation in forms of mean platelet volume and soluble P selectin and both arterial and venous thrombosis. Only one study investigated dynamic platelet function using flow cytometry. In conclusion, platelet count is associated with CAT across different cancer types and settings. Platelet function or activation marker analysis may be valuable in assisting thrombosis risk assessment in cancer patients but is sparsely investigated so far.
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Affiliation(s)
- Anne Lind Malte
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Johanne Andersen Højbjerg
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Julie Brogaard Larsen
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Beudeker BJB, Guha R, Stoyanova K, IJzermans JNM, de Man RA, Sprengers D, Boonstra A. Cryptogenic non-cirrhotic HCC: Clinical, prognostic and immunologic aspects of an emerging HCC etiology. Sci Rep 2024; 14:4302. [PMID: 38383695 PMCID: PMC10881579 DOI: 10.1038/s41598-024-52884-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) in non-cirrhotic livers is rising significantly, but clear risk factors for screening remain elusive. This study sought to characterize non-cirrhotic HCC etiologies. HCC cases from 2009 to 2020 in a Dutch referral center were examined, revealing 371 out of 1654 cases (22%) as non-cirrhotic. Notably, the incidence of non-cirrhotic HCC increased by 61% in the time frame between 2009 and 2020. Interestingly 39% of non-cirrhotic HCC cases had cryptogenic origins. Cryptogenic non-cirrhotic HCC exhibited similarities with non-cirrhotic NAFLD HCC, but displayed advanced tumor stages, lower surgical rates, and a more frequent presence of symptoms, which substantiated in poor survival rates. Advanced cryptogenic non-cirrhotic HCC stages exhibited elevated serum interleukin-6 levels compared to non-cirrhotic HCC with defined etiologies. Comparative analysis encompassing cryptogenic and NAFLD non-cirrhotic HCC cohorts and controls unveiled comparable circulating immune biomarker profiles and PNPLA3 polymorphisms. To conclude, the primary etiology of non-cirrhotic HCC in our cohort has not defined risk factors. This cryptogenic variant exhibits distinct traits, such as advanced tumors and increased symptoms, and most resemble burned-out NAFLD. Understanding this HCC variant is crucial for improving screening and management strategies.
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Affiliation(s)
- Boris J B Beudeker
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rael Guha
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kalina Stoyanova
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dave Sprengers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Cakaloglu Y. Alcohol-related medicosocial problems and liver disorders: Burden of alcoholic cirrhosis and hepatocellular carcinoma in Turkiye. HEPATOLOGY FORUM 2023; 4:40-46. [PMID: 36843895 PMCID: PMC9951893 DOI: 10.14744/hf.2022.2022.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 06/18/2023]
Abstract
The World Health Organization 2018 report stated that 2.3 billion persons over 15 years old consume alcohol, and a total of 3.0-3.3 million people died because of uncontrolled or harmful alcohol intake in 2016. Injuries, accidents, liver cirrhosis, and other medical disorders are mainly responsible for alcohol-related disability and deaths. After emphasizing the importance of alcohol-related disorders and necessary universal precautions, we focus on alcohol consumption features and alcohol-related cirrhosis and hepatocellular carcinoma in Turkiye. It is estimated that alcohol per se is responsible for 12% of cirrhosis and 10% of hepatocellular carcinoma cases. Additional factors such as hepatitis B virus and hepatitis C virus infections have markedly increased the risk of the development of hepatocellular carcinoma in alcoholic cirrhosis.
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Affiliation(s)
- Yilmaz Cakaloglu
- Corresponding author: Yilmaz Cakaloglu; VKV Amerikan Hastanesi, Gastroenteroloji ve Hepatoloji Klinigi, Istanbul, Turkiye Phone: +90 542 891 01 51; e-mail:
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Clinical Characteristics of Patients with Hepatocellular Carcinoma: A Single-Center 3-Year Experience from Somalia. Int J Hepatol 2022; 2022:3370992. [PMID: 35411218 PMCID: PMC8994688 DOI: 10.1155/2022/3370992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To evaluate the relationship between prognosticators representing tumor aggressiveness and socio-demographic, laboratory, and imaging findings in patients with hepatocellular carcinoma (HCC). METHODS We retrospectively searched patients with HCC between January 2017 and December 2019 in our tertiary referral hospital. The tumor-related factors and liver damage indicators and their relationship to indicate the value of prognosis were analyzed. RESULTS A total of 268 HCC patients, with a male-to-female ratio of 2.8 : 1. The mean age was 52.6 years. The patient with portal vein thrombosis (PVT) was older, had higher liver laboratory parameters (AST, ALT, total bilirubin, and direct bilirubin), and had larger tumor size. Patients with the larger tumor size had a higher AFP level, had more tumor multifocality. The majority of patients were in Child's A (73.6%) and B (17.2%) classes. The laboratory parameters of HCC patients were increased in Child's C compared to other groups of Child-Pugh classification. CONCLUSIONS The presence of PVT and large-sized tumor in patients with HCC indicated a poorer prognosis than non-PVT group and small tumor sizes.
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Carr BI, Guerra V, Donghia R, Ince V, Akbulut S, Ersan V, Usta S, Isik B, Samdanci E, Yilmaz S. Microscopic Portal Vein Invasion in Relation to Tumor Focality and Dimension in Patients with Hepatocellular Carcinoma. J Gastrointest Surg 2022; 26:333-340. [PMID: 34506030 DOI: 10.1007/s11605-021-05126-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Microscopic portal vein invasion (microPVI) and tumor multifocality are hepatocellular carcinoma (HCC) prognosis factors. To investigate whether microPVI and multifocality are directly related to each other. METHODS We retrospectively analyzed the relationships between microPVI, multifocality, and maximum tumor diameter (MTD) in prospectively collected transplanted HCC patients. RESULTS HCCs with 1, 2, or ≥ 3 foci had more microPVI in larger than in smaller HCCs, with microPVI being present in 52.24% of single large foci. Conversely, microPVI patients had similar percentages of single and multifocal lesions. A linear regression model of MTD, showed microPVI best associated with MTD, with 2.49 as coefficient, whereas multifocality had a 0.83 coefficient. A logistic regression model of microPVI showed significant association with tumor multifocality, especially for small HCCs. Trends for microPVI and multifocality in relation to MTD revealed that both increased with MTD but more significantly for microPVI. Survival was similar in patients with small HCCs, with or without microPVI, but was significantly worse in microPVI patients with larger HCCs. No patient survival differences were found in relation to focality. CONCLUSIONS MTD had stronger associations with microPVI than with multifocality. microPVI was associated with worse survival in patients with large HCCs, but survival was not impacted by number of tumor foci. microPVI and multifocality appear weakly related, having different behavior in relation to MTD and survival.
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Affiliation(s)
- Brian I Carr
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Vito Guerra
- National Institute of Digestive Diseases. IRCCS S. de Bellis Research Hospital, Castellana Grotte, Italy
| | - Rossella Donghia
- National Institute of Digestive Diseases. IRCCS S. de Bellis Research Hospital, Castellana Grotte, Italy
| | - Volkan Ince
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey.
| | - Veysel Ersan
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Sertac Usta
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Burak Isik
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Emine Samdanci
- Department of Pathology, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
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Hwang SH, Hong SB, Han K, Seo N, Choi JY, Lee JH, Park S, Lim YS, Kim DY, Kim SY, Park MS. A New Reporting System for Diagnosis of Hepatocellular Carcinoma in Chronic Hepatitis B With Clinical and Gadoxetic Acid-Enhanced MRI Features. J Magn Reson Imaging 2021; 55:1877-1886. [PMID: 34668595 DOI: 10.1002/jmri.27962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Current major guidelines for diagnosis of hepatocellular carcinoma (HCC) based on imaging findings are different from each other and do not include clinical risk factors as a diagnostic criteria. PURPOSE To developed and validated a new diagnostic score system using MRI and clinical features as applied in chronic hepatitis B patients. STUDY TYPE Retrospective observational study. SUBJECT A total of 418 treatment-naïve patients (out of 902 patients) with chronic hepatitis B having 556 lesions suspected for HCC which were eligible for curative treatment. FIELD STRENGTH/SEQUENCE T1W GRE in- and opposed-phase, T2W FSE, DWI, and T1W 3D-GRE dynamic contrast-enhanced sequences at 1.5 T and 3 T. ASSESSMENT Six radiologists with 7-22 years of experience independently evaluated MR images based on Liver Imaging Reporting and Data System (LI-RADS) version 2018. STATISTICAL TESTS Based on logistic regression analysis of MRI features and clinical factors, a risk score system was devised in derivation cohorts (268 patients, 352 lesions) and externally validated (150 patients, 204 lesions). The performance of the new score system was assessed by Harell's c-index. Using cutoff value of 12, maintaining positive predictive value ≥95%, the diagnostic performances of the score system were compared with those of LR-5. RESULTS The 15-point diagnostic scoring system used MRI features (lesion size, nonrim arterial phase hyperenhancement, portal venous phase hypointensity, hepatobiliary phase hypointensity, and diffusion restriction) and clinical factors (alpha-fetoprotein and platelet). It showed good discrimination in the derivation (c-index, 0.946) and validation cohorts (c-index, 0.907). Using a risk score of 12 as a cut-off, this system yielded higher sensitivity than LR-5 (derivation cohort, 76.8% vs. 52.1%; validation cohort, 73.4% vs. 49.5%) without significant decrease in specificity (derivation cohort, 93.1% vs. 97.2%, P = 0.074; validation cohort, 91.7% vs. 96.1%, P = 0.299). DATA CONCLUSION A new score system showed improved sensitivity in chronic hepatitis B patients compared to LI-RADS without significant compromise in specificity. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Shin Hye Hwang
- Department of Radiology, Yongin Severance Hospital, Yongin, Gyeonggi-do, South Korea
| | - Seung Baek Hong
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, and Pusan National University School of Medicine, Pusan, South Korea.,Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Nieun Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin-Young Choi
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jei Hee Lee
- Department of Radiology, Ajou University Hospital, Suwon, South Korea
| | - Sumi Park
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Do Young Kim
- Department of Internal Medicine, Severance Hospital, Seoul, South Korea
| | - So Yeon Kim
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Mi-Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Relationships Between Indices of Tumor Aggressiveness in Hepatocellular Carcinoma. J Gastrointest Cancer 2021; 52:1340-1349. [PMID: 34611834 DOI: 10.1007/s12029-021-00720-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) aggressiveness factors include serum levels of alpha-fetoprotein (AFP), maximum tumor diameter (MTD), tumor multifocality, and presence of portal vein thrombosis (PVT). AIMS The interdependence of these factors has not been closely studied. METHODS A large HCC database was examined for the presence of patients with PVT and multifocality and was analyzed retrospectively for the relationship of these 2 parameters to each other and to MTD and survival. RESULTS Multifocality was found to increase with increase in MTD in the whole cohort and especially in patients with PVT. PVT also increased with increasing MTD. Neither increases in multifocality nor in PVT depended on elevated serum AFP levels, although they each increased with higher AFP levels. PVT increased in monofocal tumors as MTD increased but increased further in multifocal tumors. CONCLUSIONS Multifocality and PVT appear to be separate processes, each increasing with increase in MTD and AFP levels. The data support the hypothesis that in hepatocarcinogenesis, various factors cause increase in MTD, that in turn causes increased multifocality and PVT, which are non-co-dependent. However, both multifocality and PVT mechanisms involve both HCC cell growth and invasiveness, multifocality in liver parenchyma, and PVT in the portal vein.
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Akkiz H, Carr BI, Guerra V, Donghia R, Yalçın K, Karaoğullarından U, Altıntaş E, Özakyol A, Şimşek H, Balaban HY, Balkan A, Uyanıkoğlu A, Ekin N, Delik A. Plasma lipids, tumor parameters and survival in HCC patients with HBV and HCV. JOURNAL OF TRANSLATIONAL SCIENCE 2021; 7:10.15761/jts.1000421. [PMID: 34457356 PMCID: PMC8389344 DOI: 10.15761/jts.1000421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND AIMS Hepatocellular carcinoma (HCC) is a consequence of chronic liver disease, particularly from hepatitis B or C and increasingly from obesity and metabolic syndrome. Since lipids are an important component of cell membranes and are involved in cell signaling and tumor cell growth, we wished to evaluate the relationship between HCC patient plasma lipids and maximum tumor diameter and other indices of HCC human biology. METHODS We examined prospectively-collected data from a multi-institutional collaborative Turkish HCC working group, from predominantly HBV-based patients, for plasma lipid profiles, consisting of triglycerides, total cholesterol, LDL-cholesterol (LDL) and HDL-cholesterol (HDL) and compared these with the associated patient maximum tumor diameter (MTD), portal vein thrombosis, alpha-fetoprotein (AFP) and also with patient survival. RESULTS We found that both low HDL (p=0.0002) and high LDL (p=0.003) levels were significantly associated with increased MTD, as well as in a final multiple linear regression model on MTD. The combination of low HDL combined with high HDL levels were significant in a regression model on MTD, PVT and an HCC Aggressiveness Index (Odds Ratio 12.91 compared to an Odds Ratio of 1 for the reference). Furthermore, in a Cox regression model on death, the HDL plus LDL combination had a significantly higher Hazard Ratio than the reference category. CONCLUSIONS Low plasma HDL, high plasma LDL and especially the combination, were significantly related to more aggressive HCC phenotype and the combination was significantly related to a higher Hazard Ratio for death.
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Affiliation(s)
- H Akkiz
- Çukurova University, Adana, Turkey
| | - BI Carr
- İnonu University, Malatya, Turkey
| | - V Guerra
- National Institute of Gastroenterology, S. de Bellis Research hospital, Castellana Grotte (BA), Italy
| | - R Donghia
- National Institute of Gastroenterology, S. de Bellis Research hospital, Castellana Grotte (BA), Italy
| | - K Yalçın
- Dikle University, Diyarbakır, Turkey
| | | | | | - A Özakyol
- Eskişehir Osmangazi University, Eskişehir, Turkey
| | - H Şimşek
- Hacettepe University, Ankara, Turkey
| | | | - A Balkan
- Gaziantep University, Gazientep, Turkey
| | | | - N Ekin
- Dikle University, Diyarbakır, Turkey
| | - A Delik
- Çukurova University, Adana, Turkey
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11
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Marasco G, Poggioli F, Colecchia A, Cabibbo G, Pelizzaro F, Giannini EG, Marinelli S, Rapaccini GL, Caturelli E, Di Marco M, Biasini E, Marra F, Morisco F, Foschi FG, Zoli M, Gasbarrini A, Svegliati Baroni G, Masotto A, Sacco R, Raimondo G, Azzaroli F, Mega A, Vidili G, Brunetto MR, Nardone G, Alemanni LV, Dajti E, Ravaioli F, Festi D, Trevisani F. A Nomogram-Based Prognostic Model for Advanced Hepatocellular Carcinoma Patients Treated with Sorafenib: A Multicenter Study. Cancers (Basel) 2021; 13:2677. [PMID: 34072309 PMCID: PMC8199276 DOI: 10.3390/cancers13112677] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022] Open
Abstract
Among scores and staging systems used for HCC, none showed a good prognostic ability in patients with advanced HCC treated with Sorafenib. We aimed to evaluate predictive factors of overall survival (OS) and drug response in HCC patients undergoing Sorafenib included in the Italian Liver Cancer (ITA.LI.CA.) multicenter cohort. Patients in the ITA.LI.CA database treated with Sorafenib and updated on 30 June 2019 were included. Demographic and clinical data before starting Sorafenib treatment were considered. For the evaluation of predictive factors for OS, a time-dependent Cox proportional hazard model was used. A total of 1107 patients were included in our analysis. The mean age was 64.3 years and 81.7% were male. Most patients were staged as BCLC B (205, 18.9%) or C (706, 65.1%). The median time of Sorafenib administration was 4 months (interquartile range (IQR) 2-12), and the median OS was 10 months (IQR: 4-20). A total of 263 patients (33.8%) out of 780 with available evaluation experienced objective tumoral response to Sorafenib. The Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) (hazard ratio (HR) 1.284), maximum tumoral diameter (HR 1.100), plasma total bilirubin (HR 1.119), aspartate amino transferase assessed as multiple of the upper normal value (HR 1.032), alpha-fetoprotein ≥200 ng/mL (HR 1.342), hemoglobin (HR 0.903) and platelet count (HR 1.002) were associated with OS at multivariate Cox regression analysis. Drug response was predicted by maximum tumoral diameter and platelet count. A novel prognostic nomogram for patients undergoing Sorafenib is hereby proposed. The novelty introduced is the comprehensive patient's assessment using common markers of patient's general status, liver damage and function and HCC biology. Further studies are required to test its accuracy and provide external validation.
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Affiliation(s)
- Giovanni Marasco
- Division of Internal Medicine and Digestive Pathophysiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Science, University of Bologna, 40138 Bologna, Italy; (F.P.); (M.Z.); (F.A.); (L.V.A.); (E.D.); (F.R.); (D.F.); (F.T.)
| | - Francesco Poggioli
- Department of Medical and Surgical Science, University of Bologna, 40138 Bologna, Italy; (F.P.); (M.Z.); (F.A.); (L.V.A.); (E.D.); (F.R.); (D.F.); (F.T.)
| | - Antonio Colecchia
- Gastroenterology Unit, Borgo Trento University Hospital Verona, 37126 Verona, Italy;
| | - Giuseppe Cabibbo
- Gastroenterology & Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, University of Palermo, 90133 Palermo, Italy;
| | - Filippo Pelizzaro
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy;
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Sara Marinelli
- Division of Internal Medicine, Hepatobiliary and Immunoallergologic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Gian Ludovico Rapaccini
- Division of Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | | | | | - Elisabetta Biasini
- Unit of Infectious Diseases and Hepatology, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy;
| | - Fabio Marra
- Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Firenze, 50139 Florence, Italy;
| | - Filomena Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Napoli “Federico II”, 80138 Napoli, Italy;
| | | | - Marco Zoli
- Department of Medical and Surgical Science, University of Bologna, 40138 Bologna, Italy; (F.P.); (M.Z.); (F.A.); (L.V.A.); (E.D.); (F.R.); (D.F.); (F.T.)
- Division of Internal Medicine, Neurovascular and Hepatometabolic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Antonio Gasbarrini
- Division of Internal Medicine and Gastroenterology, Policlinico Gemelli, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | | | - Alberto Masotto
- Gastroenterology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, 37024 Verona, Italy;
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, 71100 Foggia, Italy;
| | - Giovanni Raimondo
- Division of Clinical and Molecular Hepatology, University of Messina, 98124 Messina, Italy;
| | - Francesco Azzaroli
- Department of Medical and Surgical Science, University of Bologna, 40138 Bologna, Italy; (F.P.); (M.Z.); (F.A.); (L.V.A.); (E.D.); (F.R.); (D.F.); (F.T.)
- Division of Gastroenterology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Mega
- Division of Gastroenterology, Bolzano Regional Hospital, 39100 Bolzano, Italy;
| | - Gianpaolo Vidili
- U.O.C. Clinica Medica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, 07100 Sassari, Italy;
| | - Maurizia Rossana Brunetto
- Hepatology and Liver Physiopathology Laboratory and Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy;
| | - Gerardo Nardone
- Hepato-Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Luigina Vanessa Alemanni
- Department of Medical and Surgical Science, University of Bologna, 40138 Bologna, Italy; (F.P.); (M.Z.); (F.A.); (L.V.A.); (E.D.); (F.R.); (D.F.); (F.T.)
- Division of Gastroenterology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elton Dajti
- Department of Medical and Surgical Science, University of Bologna, 40138 Bologna, Italy; (F.P.); (M.Z.); (F.A.); (L.V.A.); (E.D.); (F.R.); (D.F.); (F.T.)
- Division of Gastroenterology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Science, University of Bologna, 40138 Bologna, Italy; (F.P.); (M.Z.); (F.A.); (L.V.A.); (E.D.); (F.R.); (D.F.); (F.T.)
| | - Davide Festi
- Department of Medical and Surgical Science, University of Bologna, 40138 Bologna, Italy; (F.P.); (M.Z.); (F.A.); (L.V.A.); (E.D.); (F.R.); (D.F.); (F.T.)
| | - Franco Trevisani
- Department of Medical and Surgical Science, University of Bologna, 40138 Bologna, Italy; (F.P.); (M.Z.); (F.A.); (L.V.A.); (E.D.); (F.R.); (D.F.); (F.T.)
- Division of Semeiotics, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
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Akkiz H, Carr BI, Bag HG, Karaoğullarından Ü, Yalçın K, Ekin N, Özakyol A, Altıntaş E, Balaban HY, Şimşek H, Uyanıkoğlu A, Balkan A, Kuran S, Üsküdar O, Ülger Y, Güney B, Delik A. Serum levels of inflammatory markers CRP, ESR and albumin in relation to survival for patients with hepatocellular carcinoma. Int J Clin Pract 2021; 75:e13593. [PMID: 32583494 PMCID: PMC7758189 DOI: 10.1111/ijcp.13593] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Hepatocellular carcinoma is associated with several chronic inflammatory conditions. It is increasingly understood that the inflammation may be part of the carcinogenic process and prognostically important. OBJECTIVE To evaluate the serum levels of three inflammation markers in relation to survival in HCC patients. METHODS We retrospectively examined the serum levels of CRP, albumin and ESR, both singly and in combination, in relation to patient survival. RESULTS Survival worsened with increase in CRP or ESR or decrease in albumin levels. Combinations of CRP plus albumin or CRP plus ESR were associated with an even greater range of survival (3-fold), together with significant differences in maximum tumor diameter (PVT) and percent of patients with portal vein thrombosis (PVT). The triplet of CRP plus albumin plus ESR was associated with a sevenfold difference in survival, comparing low vs high parameter levels. These significant differences were found in patients with small or large tumors. CONCLUSIONS Combinations of CRP with albumin or ESR or all three parameters together significantly related to differences in survival and to differences in MTD and percent PVT, in patients with both small and large size HCCs.
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13
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Ince V, Akbulut S, Otan E, Ersan V, Karakas S, Sahin TT, Carr BI, Baskiran A, Samdanci E, Bag HG, Koc C, Usta S, Ozdemir F, Barut B, Gonultas F, Sarici B, Kutluturk K, Dogan MS, Ozgor D, Dikilitas M, Harputluoglu M, Aladag M, Kutlu R, Varol I, Dirican A, Aydin C, Isik B, Ara C, Kayaalp C, Emre S, Yilmaz S. Liver Transplantation for Hepatocellular Carcinoma: Malatya Experience and Proposals for Expanded Criteria. J Gastrointest Cancer 2020; 51:998-1005. [PMID: 32519232 DOI: 10.1007/s12029-020-00424-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Survival was examined from a Turkish liver transplant center of patients with HCC, to identify prognostic factors. Data from 215 patients who underwent predominantly live donor liver transplant for HCC at our institute over 12 years were included in the study and prospectively recorded. They were 152 patients within and 63 patients beyond Milan criteria. Patients beyond Milan criteria were divided into two groups according to presence or absence of tumor recurrence. Recurrence-associated factors were analyzed. These factors were then applied to the total cohort for survival analysis. We identified four factors, using multivariate analysis, that were significantly associated with tumor recurrence. These were maximum tumor diameter, degree of tumor differentiation, and serum AFP and GGT levels. A model that included all four of these factors was constructed, the 'Malatya criteria.' Using these Malatya criteria, we estimated DFS and cumulative survival, for patients within and beyond these criteria, and found statistically significant differences with improved survival in patients within Malatya criteria of 1, 5, and 10-year overall survival rates of 90.1%, 79.7%, and 72.8% respectively, which compared favorably with other extra-Milan extended criteria. Survival of our patients within the newly defined Malatya criteria compared favorably with other extra-Milan extended criteria and highlight the usefulness of serum AFP and GGT levels in decision-making.
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Affiliation(s)
- Volkan Ince
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey.
| | - Sami Akbulut
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Emrah Otan
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Veysel Ersan
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Serdar Karakas
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Tolga Tevfik Sahin
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Brian I Carr
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Adil Baskiran
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Emine Samdanci
- Department of Pathology, Medical School, Inonu University, Malatya, Turkey
| | - Harika Gozukara Bag
- Department of Bioistatistics, Medical School, Inonu University, Malatya, Turkey
| | - Cemalettin Koc
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Sertac Usta
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Fatih Ozdemir
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Bora Barut
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Fatih Gonultas
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Baris Sarici
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Koray Kutluturk
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Murat Sait Dogan
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Dincer Ozgor
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Mustafa Dikilitas
- Department of Medical Oncology, Medical School, Inonu University, Malatya, Turkey
| | - Murat Harputluoglu
- Department of Gastroenterology, Medical School, Inonu University, Malatya, Turkey
| | - Murat Aladag
- Department of Gastroenterology, Medical School, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Medical School, Inonu University, Malatya, Turkey
| | - Ilknur Varol
- Department of Pediatric Gastroenterolgy, Medical School, Inonu University, Malatya, Turkey
| | - Abuzer Dirican
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Cemalettin Aydin
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Burak Isik
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Cengiz Ara
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Sukru Emre
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
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14
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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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15
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Platelets and Hepatocellular Cancer: Bridging the Bench to the Clinics. Cancers (Basel) 2019; 11:cancers11101568. [PMID: 31618961 PMCID: PMC6826649 DOI: 10.3390/cancers11101568] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023] Open
Abstract
Growing interest is recently being focused on the role played by the platelets in favoring hepatocellular cancer (HCC) growth and dissemination. The present review reports in detail both the experimental and clinical evidence published on this topic. Several growth factors and angiogenic molecules specifically secreted by platelets are directly connected with tumor progression and neo-angiogenesis. Among them, we can list the platelet-derived growth factor, the vascular endothelial growth factor, the endothelial growth factor, and serotonin. Platelets are also involved in tumor spread, favoring endothelium permeabilization and tumor cells’ extravasation and survival in the bloodstream. From the bench to the clinics, all of these aspects were also investigated in clinical series, showing an evident correlation between platelet count and size of HCC, tumor biological behavior, metastatic spread, and overall survival rates. Moreover, a better understanding of the mechanisms involved in the platelet–tumor axis represents a paramount aspect for optimizing both current tumor treatment and development of new therapeutic strategies against HCC.
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16
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Oncological Outcomes of Hepatic Resection vs Transplantation for Localized Hepatocellular Carcinoma. Transplant Proc 2019; 51:1147-1152. [PMID: 31101189 DOI: 10.1016/j.transproceed.2019.01.093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Scarce data are available comparing outcomes of hepatic resection vs orthotopic liver transplantation (OLT) for localized hepatocellular carcinoma (HCC) patients both meeting and exceeding the Milan criteria. This study compared the clinical and oncological outcomes of patients undergoing hepatic resection vs transplantation localized HCC. METHOD Between January 2005 and February 2017, clinical and oncological outcomes of patients who underwent liver resection (n = 38) vs OLT (n = 28) for localized HCC were compared using a prospectively maintained database. RESULTS A total of 66 patients (with a median age of 62) who met the study criteria were analyzed. Comparable postoperative complications (13.2% vs 28.6%, P = .45) and perioperative mortality rates (7.9% vs 10.7%, P = .2) were noted for the resection vs OLT groups. While Child-Pugh Class A patients were more prevalent in the resection group (78.9% vs 7.1%, P = .0001), the rate of patients who met the Milan criteria was higher in the OLT group (89.3% vs 34.25, P = .0001). Recurrence rates were 36.8% in the resection group and 3.6% in the OLT group at the end of the median follow-up period (32 vs 39 months, respectively). The HCC-related mortality rate was significantly higher in the resection group (39.5% vs 10.7%, P = .034). However, a subgroup analysis of patients who met the Milan criteria revealed similar rates of recurrence and HCC-related mortality (15.4% vs 8%, P = .63). Based on logistic regression analysis, number of tumors (P = .034, odds ratio: 2.1) and "resection"-type surgery (P = .008, odds ratio: 20.2) were independently associated with recurrence. CONCLUSION Compared to liver transplantation, hepatic resection for localized hepatocellular carcinoma is associated with a higher rate of recurrence and disease-related mortality.
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17
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Suner A, Carr BI, Akkiz H, Uskudar O, Kuran S, Tokat Y, Tokmak S, Ballı T, Ulku A, AkCam T, Delik A, Arslan B, Doran F, YalCın K, Ekinci N, Yilmaz S, Ozakyol A, Yücesoy M, BahCeci HI, Polat KY, Şimsek H, Ormeci N, Sonsuz A, Demir M, KılıC M, Uygun A, Demir A, Altıntas E, Karakulah G, Temel T, Bektas A. Inflammatory markers C-reactive protein and PLR in relation to HCC characteristics. ACTA ACUST UNITED AC 2018; 5. [PMID: 30662766 PMCID: PMC6333412 DOI: 10.15761/jts.1000260] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Several markers of systemic inflammation, including blood C-reactive protein, platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) have been identified as independent prognosticators for hepatocellular carcinoma (HCC). Methods To attempt to understand the significance of these markers, they were examined in relation to 4 tumour parameters, namely maximum tumour diameter (MTD), tumour multifocality, portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels. Results Using linear and logistic regression models, we found that C-reactive protein and PLR on single variables, were statistically significantly related to the tumour parameters. In a logistic regression final model, CRP was significantly related to MTD, AFP and PVT, and the Glasgow Index significantly related to MTD and AFP. Results of the area under the receiver operating characteristic curves (ROC), showed that the areas for PLR and CRP were statistically significant for high versus low MTD and for presence versus absence of PVT. CRP alone was significant for high versus low AFP. Conclusions These analyses suggest that the prognostic usefulness of the inflammatory markers PLR and CRP (but not NLR) may be due to their reflection of parameter values for tumour growth and invasiveness.
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Affiliation(s)
- Aslı Suner
- Ege University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, İzmir, Turkey
| | - Brian I Carr
- Liver Transplant Inst, Inonu University, Malatya, Turkey
| | - Hikmet Akkiz
- Cukurova University, Gastroenterology Department, Adana, Turkey
| | - Oguz Uskudar
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Sedef Kuran
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Yaman Tokat
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Salih Tokmak
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Tugsan Ballı
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Abdulalh Ulku
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Tolga AkCam
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Anıl Delik
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Burcu Arslan
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Figen Doran
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | | | | | - Sezai Yilmaz
- Inonu University Malatya, 44210 Battalgazi/Malatya, Turkey
| | - Ayşegul Ozakyol
- Eskisehir Osmangazi University, Meselik Yerleskesi, 26040 Odunpazarı/Eskisehir, Turkey
| | - Mehmet Yücesoy
- Erciyes University, Talas Blv., 38030 Melikgazi/Kayseri, Turkey
| | | | | | | | | | | | | | | | - Ahmet Uygun
- Haydarpaşa Sultan Abdülhamid Egitim Araştırma Hospital, Turkey
| | - Ali Demir
- Konya Necmettin Erbakan University, Turkey
| | | | - Gokhan Karakulah
- Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
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