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Ling C, Liu SS, Wang YY, Huo GT, Yang YW, Xu N, Wang H, Wu Y, Miao YF, Fu R, Zhao YW, Fan CF. Overexpression of wild-type HRAS drives non-alcoholic steatohepatitis to hepatocellular carcinoma in mice. Zool Res 2024; 45:551-566. [PMID: 38757223 PMCID: PMC11188599 DOI: 10.24272/j.issn.2095-8137.2024.002] [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: 03/21/2024] [Accepted: 04/07/2024] [Indexed: 05/18/2024] Open
Abstract
Hepatocellular carcinoma (HCC), a prevalent solid carcinoma of significant concern, is an aggressive and often fatal disease with increasing global incidence rates and poor therapeutic outcomes. The etiology and pathological progression of non-alcoholic steatohepatitis (NASH)-related HCC is multifactorial and multistage. However, no single animal model can accurately mimic the full NASH-related HCC pathological progression, posing considerable challenges to transition and mechanistic studies. Herein, a novel conditional inducible wild-type human HRAS overexpressed mouse model (HRAS-HCC) was established, demonstrating 100% morbidity and mortality within approximately one month under normal dietary and lifestyle conditions. Advanced symptoms of HCC such as ascites, thrombus, internal hemorrhage, jaundice, and lung metastasis were successfully replicated in mice. In-depth pathological features of NASH- related HCC were demonstrated by pathological staining, biochemical analyses, and typical marker gene detections. Combined murine anti-PD-1 and sorafenib treatment effectively prolonged mouse survival, further confirming the accuracy and reliability of the model. Based on protein-protein interaction (PPI) network and RNA sequencing analyses, we speculated that overexpression of HRAS may initiate the THBS1-COL4A3 axis to induce NASH with severe fibrosis, with subsequent progression to HCC. Collectively, our study successfully duplicated natural sequential progression in a single murine model over a very short period, providing an accurate and reliable preclinical tool for therapeutic evaluations targeting the NASH to HCC continuum.
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Affiliation(s)
- Chen Ling
- College of Life Sciences, Northwest University, Provincial Key Laboratory of Biotechnology of Shaanxi Province, Xi'an, Shaanxi 710069, China
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), Beijing 102629, China
| | - Su-Su Liu
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), Beijing 102629, China
| | - Yu-Ya Wang
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), Beijing 102629, China
| | - Gui-Tao Huo
- National Center for Safety Evaluation of Drugs, National Institutes for Food and Drug Control (NIFDC), Beijing 100176, China
| | - Yan-Wei Yang
- National Center for Safety Evaluation of Drugs, National Institutes for Food and Drug Control (NIFDC), Beijing 100176, China
| | - Nan Xu
- Division of HIV/AIDS and Sexually Transmitted Virus Vaccines, Institute for Biological Products Control, National Institutes for Food and Drug Control (NIFDC), Beijing 102629, China
| | - Hong Wang
- Division of Laboratory Animal Monitoring, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), Beijing 102629, China
| | - Yong Wu
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), Beijing 102629, China
| | - Yu-Fa Miao
- National Center for Safety Evaluation of Drugs, National Institutes for Food and Drug Control (NIFDC), Beijing 100176, China
| | - Rui Fu
- Division of Laboratory Animal Monitoring, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), Beijing 102629, China
| | - Yu-Wei Zhao
- College of Life Sciences, Northwest University, Provincial Key Laboratory of Biotechnology of Shaanxi Province, Xi'an, Shaanxi 710069, China. E-mail:
| | - Chang-Fa Fan
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), Beijing 102629, China. E-mail:
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Li YN, Wei SM, Fu YK, Zeng ZX, Huang LM, Lv JH, Chen WZ, Wei YG, Zhang ZB, Zhou JY, Wu JY, Yan ML. Long-term surgical outcomes of bile duct tumor thrombus versus portal vein tumor thrombus for hepatocellular carcinoma: a propensity score matching analysis. Front Oncol 2024; 14:1372123. [PMID: 38628666 PMCID: PMC11018934 DOI: 10.3389/fonc.2024.1372123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background Portal vein tumor thrombus (PVTT) seriously affects the prognosis of hepatocellular carcinoma (HCC). However, whether bile duct tumor thrombus (BDTT) significantly affects the prognosis of HCC as much as PVTT remains unclear. We aimed to compare the long-term surgical outcomes of HCC with macroscopic PVTT (macro-PVTT) and macroscopic BDTT (macro-BDTT). Methods The data of HCC patients with macro-BDTT or macro-PVTT who underwent hemihepatectomy were retrospectively reviewed. A propensity score matching (PSM) analysis was performed to reduce the baseline imbalance. The recurrence-free survival (RFS) and overall survival (OS) rates were compared between the cohorts. Results Before PSM, the PVTT group had worse RFS and OS rates than the BDTT group (P = 0.043 and P = 0.008, respectively). Multivariate analyses identified PVTT (hazard ratio [HR] = 1.835, P = 0.016) and large HCC (HR = 1.553, P = 0.039) as independent risk factors for poor OS and RFS, respectively. After PSM, the PVTT group had worse RFS and OS rates than the BDTT group (P = 0.037 and P = 0.004, respectively). The 3- and 5-year OS rates were significantly higher in the BDTT group (59.5% and 52.1%, respectively) than in the PVTT group (33.3% and 20.2%, respectively). Conclusion Aggressive hemihepatectomy provides an acceptable prognosis for HCC patients with macro-BDTT. Furthermore, the long-term surgical outcomes of HCC patients with macro-BDTT were significantly better than those of HCC patients with macro-PVTT.
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Affiliation(s)
- Yi-Nan Li
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Shao-Ming Wei
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Yang-Kai Fu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Zhen-Xin Zeng
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Li-Ming Huang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Jia-Hui Lv
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Wei-Zhao Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Yong-Gang Wei
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Bo Zhang
- Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jian-Yin Zhou
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jia-Yi Wu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Mao-Lin Yan
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
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Miyayama S. Transarterial Therapy for Hepatocellular Carcinoma Invading the Bile Duct. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2024; 9:1-12. [PMID: 38524999 PMCID: PMC10957244 DOI: 10.22575/interventionalradiology.2023-0019] [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: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 03/26/2024]
Abstract
Hepatocellular carcinoma invading the bile duct (bile duct tumor thrombus) is an unfavorable condition. Although overall survival following surgical resection among patients with hepatocellular carcinoma with bile duct tumor thrombus is significantly better than that among those treated with transarterial chemoembolization or chemotherapy, surgical resection can be indicated for selected patients. Additionally, systemic therapy is indicated only for patients with Child-Pugh class A. Therefore, transarterial therapy plays an essential role in the treatment of bile duct tumor thrombus. Transarterial chemoembolization with iodized oil and gelatin sponge particles is an established first-line transarterial treatment that can necrotize most bile duct tumor thrombi. However, we should pay attention to symptoms caused by intraductal hemorrhage during transarterial chemoembolization and the sloughing of necrotized bile duct tumor thrombi.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Japan
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Ye M, Liu C, Liu J, Lu F, Xue J, Li F, Tang Y. Scoparone inhibits the development of hepatocellular carcinoma by modulating the p38 MAPK/Akt/NF-κB signaling in nonalcoholic fatty liver disease mice. ENVIRONMENTAL TOXICOLOGY 2024; 39:551-561. [PMID: 37436232 DOI: 10.1002/tox.23851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND AND STUDY AIM The mechanisms underlying the progression of non-alcoholic fatty liver disease (NAFLD) into hepatocellular carcinoma (HCC) remains confusing and the therapeutics approaches are also challenging. Here, we aimed to investigate the effects of scoparone on the treatment of HCC stemmed from NAFLD and the underlying mechanisms. MATERIALS AND METHODS A model of NAFLD-HCC was created in mice, and these mice were treated with scoparone. Biochemical assays were conducted to assess the levels of biochemical markers. Tumors were evaluated through morphological examination. Histopathological analyses were performed using oil red O, Hematoxylin and Eosin, and Masson coloration assays. Immunohistochemistry (IHC) and RT-PCR were performed to analyze protein expression and measure mRNA expression levels, respectively. RESULTS Scoparone could ameliorate the pathological alterations observed in NAFLD-HCC mouse model. IHC analysis indicated an upregulation of NF-κB p65 expression in both NAFLD and NAFLD-HCC models, which was subsequently reverted by scoparone administration. Furthermore, scoparone treatment resulted in a reversal of the increased mRNA expression levels of NF-κB target genes, including TNF-α, MCP-1, iNOS, COX-2, NF-κB, and MMP-9, which were originally elevated in the NAFLD-HCC condition. Additionally, scoparone exhibited a capacity to counteract the activation of the MAPK/Akt signaling in the NAFLD-HCC model. CONCLUSION These findings suggest that scoparone holds promise as a potential therapeutic agent for NAFLD-associated HCC, and its model of action may involve the regulation of inflammatory pathways governed by the MAPK/Akt/NF-κB signaling cascade.
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Affiliation(s)
- Miaoqing Ye
- Department of Liver Disease, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Chunyan Liu
- First Clinical Medical College, Shaanxi University of Chinese Medicine, Xian yang, China
| | - Jiaojiao Liu
- Department of Liver Disease, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Fenping Lu
- Literature research institute, Shaanxi Academy of Traditional Chinese Medicine, Xi'an, China
| | | | - Fenping Li
- Department of Liver Disease, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Yinghui Tang
- Department of Liver Disease, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
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Dai H, Klause H, Conran RM. Educational Case: Hepatocellular carcinoma. Acad Pathol 2024; 11:100108. [PMID: 38433777 PMCID: PMC10904914 DOI: 10.1016/j.acpath.2024.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 09/29/2023] [Accepted: 12/28/2023] [Indexed: 03/05/2024] Open
Affiliation(s)
- Harrison Dai
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Harrison Klause
- Department of Radiology, Eastern Virginia Medical School, Medical Center Radiologists, Norfolk, VA, USA
| | - Richard M. Conran
- Department of Pathology & Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
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Lee JS, Kim J, Rhu J, Choi GS, Joh JW. Long-Term Outcomes of Liver Transplantation in Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Comparison with Portal Vein Tumor Thrombus. Cancers (Basel) 2023; 15:4225. [PMID: 37686500 PMCID: PMC10486955 DOI: 10.3390/cancers15174225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) remains controversial. This study analyzed the recurrence and overall survival rates through long-term results after LT in HCC patients with BDTT and compared the results after LT in HCC patients with portal vein tumor thrombus (PVTT). We performed a retrospective study of 45 patients with PVTT, 16 patients with BDTT, and 11 patients with coexisting PVTT and BDTT among HCC patients who underwent LT at a single center from 1999 to 2020. The HCC recurrence rates were 40.4% at 1 year, 30.3.3% at 2 years, and 27.6% at 3 years in the PVTT group; 66.7%, 53.3%, and 46.7% in the BDTT group; and 22.2%, 22.2%, and 0% in the coexisting group (p = 0.183). Overall patient survival rates were 68.4% at 1 year, 54.3% at 2 years, and 41.7% at 3 years in the PVTT group; 81.3%, 62.5%, and 48.2% in the BDTT group; and 63.6%, 27.3%, and 0% in the coexisting group (p = 0.157). In the multivariate analysis, the pre-transplantation model for tumor recurrence after liver transplantation (MoRAL) score and model for end-stage liver disease (MELD) score were found to be independent risk factors for recurrence and survival in all groups. HCC patients with BDTT showed no difference in recurrence and survival compared with HCC patients with PVTT at the long-term follow-up after LT.
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Affiliation(s)
- Ji Soo Lee
- Department of Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Republic of Korea;
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (J.R.); (G.-S.C.)
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (J.R.); (G.-S.C.)
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (J.R.); (G.-S.C.)
| | - Jae-Won Joh
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea;
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Iizumi T, Okumura T, Hasegawa N, Ishige K, Fukuda K, Seo E, Makishima H, Niitsu H, Takahashi M, Sekino Y, Takahashi H, Takizawa D, Oshiro Y, Baba K, Murakami M, Saito T, Numajiri H, Mizumoto M, Nakai K, Sakurai H. Proton beam therapy for hepatocellular carcinoma with bile duct invasion. BMC Gastroenterol 2023; 23:267. [PMID: 37537527 PMCID: PMC10401805 DOI: 10.1186/s12876-023-02897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023] Open
Abstract
AIM Hepatocellular carcinoma (HCC) with bile duct invasion (BDI) (BDIHCC) has a poor prognosis. Moreover, due to the paucity of reports, there is no consensus regarding optimal management of this clinical condition yet. The aim of this study was to clarify the efficacy and safety of proton beam therapy (PBT) for BDIHCC. METHODS Between 2009 and 2018, 15 patients with BDIHCC underwent PBT at our institution. The overall survival (OS), local control (LC), and progression-free survival (PFS) curves were constructed using the Kaplan-Meier method. Toxicities were assessed using the Common Terminology Criteria of Adverse Events version 4.0. RESULTS The median follow-up time was 23.4 months (range, 7.9-54.3). The median age was 71 years (range, 58-90 years). Many patients were Child A (n = 8, 53.3%) and most had solitary tumors (n = 11, 73.3%). Additionally, most patients had central type BDI (n = 11, 73%). The median tumor size was 4.0 cm (range, 1.5-8.0 cm). The 1-, 2-, and 3-year OS rates were 80.0%, 58.7% and 40.2%, respectively, and the corresponding LC and PFS rates were 93.3%, 93.3%, and 74.7% and 72.7%, 9.7%, and 0.0%, respectively. Acute grade 1/2 dermatitis (n = 7, 46.7%), and grades 2 (n = 1, 6.7%) and 3 (n = 1, 6.7%) cholangitis were observed. Late toxicities such as grade 3 gastric hemorrhage and pleural effusion were observed. No toxicities of grade 4 or higher were observed. CONCLUSIONS PBT was feasible with tolerable toxicities for the treatment of BDIHCC.
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Affiliation(s)
- Takashi Iizumi
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan.
| | - Toshiyuki Okumura
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Naoyuki Hasegawa
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazunori Ishige
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Gastroenterology, Kasumigaura Medical Center, Ibaraki, Japan
| | - Kuniaki Fukuda
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Gastroenterology, Kasumigaura Medical Center, Ibaraki, Japan
| | - Emiko Seo
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hirokazu Makishima
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Hikaru Niitsu
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Mizuki Takahashi
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Yuta Sekino
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | | | - Daichi Takizawa
- Department of Radiation Oncology, Hitachi General Hospital, Tsukuba, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Keiichiro Baba
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Motohiro Murakami
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Takashi Saito
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Kei Nakai
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
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Matsumoto T, Shimizu T, Sato S, Tanaka G, Yamaguchi T, Park KH, Sakuraoka Y, Shiraki T, Mori S, Iso Y, Nemoto T, Kubota K, Nozawa Y, Ishida K, Aoki T. Micro-hepatocellular carcinoma with bile duct tumor thrombus mimicking intrahepatic intraductal papillary neoplasm of the bile duct: a case report. Surg Case Rep 2023; 9:67. [PMID: 37121923 PMCID: PMC10149425 DOI: 10.1186/s40792-023-01646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Microhepatocellular carcinoma with a gross bile duct tumor thrombus is extremely rare, making the correct preoperative diagnosis difficult. CASE PRESENTATION A 78-year-old man was referred to our department for close examination of a liver tumor that was incidentally detected using ultrasonography. Blood tests revealed normal levels of tumor markers. Abdominal ultrasonography showed a 2-cm-sized hyperechoic mass with indistinct borders and hypoechoic margins at the origin of the right hepatic duct. Dynamic computed tomography showed a tumor with arterial phase predominance, a heterogeneous contrast effect, and prolonged enhancement. Cystic structures were observed in the tumors. In addition, localized dilatation of the caudate lobe bile duct was observed near the tumor. Cholangiography showed that the common bile duct, right and left hepatic ducts, and secondary branches did not have dilatation or stenosis. Biopsies of the bile duct revealed no malignancy. Under suspicion of intrahepatic intraductal papillary neoplasm of the bile duct, right hemi-hepatectomy was performed. The extrahepatic bile duct was preserved, because no tumor was found at the margin of the right hepatic duct during intraoperative frozen diagnosis. Macroscopically, the lesion was an 18 × 15 mm tumor occupying a dilated intrahepatic bile duct near the right hepatic duct, with a soft, fine papillary tumor. Based on morphology and immunostaining, tumor matched with moderately differentiated hepatocellular carcinoma. In addition, a 2 mm-sized hepatocellular carcinoma was observed in the liver parenchyma near the bile duct, where the tumor was located. CONCLUSIONS Based on these findings, the patient was diagnosed with small hepatocellular carcinoma with a gross bile duct tumor thrombus. The cystic part seen on the preoperative images was considered as a gap between the bile duct and the tumor thrombus. The patient recovered well with no signs of recurrence 20 months after surgery.
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Affiliation(s)
- Takatsugu Matsumoto
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
| | - Takayuki Shimizu
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Shun Sato
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Genki Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takamune Yamaguchi
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Kyung-Hwa Park
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Yuhki Sakuraoka
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takayuki Shiraki
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Shozo Mori
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Yukihiro Iso
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takehiko Nemoto
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Keiichi Kubota
- Department of Surgery, Tohto Bunkyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yumi Nozawa
- Department of Diagnostic Pathology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Taku Aoki
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
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Jiang W, Fu X, Wang G, Qi H, Chen Z, Gao F. Effect of Biliary Tract Invasion with Obstructive Jaundice on the Prognosis of Patients With Unresectable Hepatocellular Carcinoma. Acad Radiol 2023; 30:483-491. [PMID: 36150964 DOI: 10.1016/j.acra.2022.08.010] [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: 06/15/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES Biliary tract invasion (BTI) is associated with poor outcomes in patients with hepatocellular carcinoma (HCC). However, the presence of a BTI is a neglected variable for staging in the current guidelines. This study aimed to explore the effects of BTI with obstructive jaundice on the prognosis of patients with unresectable HCC. METHODS We retrospectively included 205 patients initially diagnosed with unresectable HCC who presented with obstructive jaundice due to BTI between January 2010 and June 2021. BTI was classified into four types according to the location of the biliary obstruction. Both clinical and treatment factors that affect median overall survival (mOS) were analyzed. RESULTS The mOS of patients with Barcelona Clinic Liver Cancer (BCLC) stages B, C, and D was 9.2 months, 3.4 months, and 1.8 months, respectively (p<.001). The mOS of BTI type I patients was superior to that of BTI type II patients (7.1 months vs. 3.2 months, p=.002). Patients who underwent successful biliary drainage had a longer mOS than those who underwent unsuccessful biliary drainage (10.4 months vs. 2.9 months, p<.001). In the multivariate analysis, BTI type I (p=.009), successful biliary drainage (p=.005), and HCC treatment (p<.001) were significant favorable prognostic factors that affected patient survival. CONCLUSION HCC patients with BTI type II may have a poorer prognosis than those with BTI type I. Effective biliary drainage and anti-cancer treatment may provide survival benefits to these patients. A more detailed staging system for HCC based on the state of BTI is needed.
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Affiliation(s)
- Weiwei Jiang
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiaobo Fu
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Guobao Wang
- Department of Endoscopy, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Han Qi
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Zixiong Chen
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Fei Gao
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
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Proton Beam Therapy in Managing Unresectable Hepatocellular Carcinoma with Bile Duct Invasion. Cancers (Basel) 2022; 14:cancers14071616. [PMID: 35406392 PMCID: PMC8997051 DOI: 10.3390/cancers14071616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/12/2022] [Accepted: 03/21/2022] [Indexed: 12/07/2022] Open
Abstract
Hepatocellular carcinoma (HCC) with bile duct invasion is a rare and notorious subtype of HCC. This study included patients that had unresectable HCC with bile duct invasion and proton beam therapy between November 2015 and February 2021. Twenty patients fit the inclusion criteria. The median tumor size was 6.3 cm. Nine patients (45.0%) had major vascular invasions. All included patients received the radiation dose of 72.6 gray relative biological effectiveness due to the proximity of porta hepatis and tumor. The median follow-up time was 19.9 months. The median overall survival was 19.9 months among deceased patients. The 1-year cumulative local recurrence rates were 5.3%, with only two patients developing in-field failure. The 1-year and 2-year overall survival rates were 79.4% and 53.3%. The 1-year progression-free survival was 58.9%. Four patients developed radiation-induced liver disease. The 1-year cholangitis-free survival was 55.0%. Skin toxicity was the most common acute toxicity and rarely severe. Eight patients developed ≤ grade 3 gastrointestinal ulcers. Proton beam therapy offers desirable survival outcomes for unresectable HCC patients with bile duct invasion. Optimal local tumor control could also be obtained within acceptable toxicities.
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11
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Fang A, Kim IK, Ukeh I, Etezadi V, Kim HS. Percutaneous Management of Benign Biliary Strictures. Semin Intervent Radiol 2021; 38:291-299. [PMID: 34393339 DOI: 10.1055/s-0041-1731087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Benign biliary strictures are often due to a variety of etiologies, most of which are iatrogenic. Clinical presentation can vary from asymptomatic disease with elevated liver enzymes to obstructive jaundice and recurrent cholangitis. Diagnostic imaging methods, such as ultrasound, multidetector computed tomography, and magnetic resonance imaging (cholangiopancreatography), are used to identify stricture location, extent, and possible source of biliary obstruction. The management of benign biliary strictures requires a multidisciplinary team approach and include endoscopic, percutaneous, and surgical interventions. Percutaneous biliary interventions provide an alternative diagnostic and therapeutic approach, especially in patients who are not amenable to endoscopic evaluation. This review provides an overview of benign biliary strictures and percutaneous management by interventional radiologists. Diagnostic evaluation with percutaneous transhepatic cholangiography and treatment options, including biliary drainage, balloon dilation, retrievable/biodegradable stents, and other innovative minimally invasive options, are discussed.
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Affiliation(s)
- Adam Fang
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Il Kyoon Kim
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ifechi Ukeh
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hyun S Kim
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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12
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Thrombus-First Surgery for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus. J Gastrointest Surg 2021; 25:1973-1979. [PMID: 33078320 DOI: 10.1007/s11605-020-04813-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/29/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The optimal surgical method of patients with hepatocellular carcinoma (HCC) and bile duct tumor thrombus (BDTT) is still controversial. This study aims to investigate the impact of different surgical methods on BDTT patients. METHODS A multicenter retrospective study was carried out on HCC patients with BDTT who underwent surgery. The survival outcomes of different operation methods were studied. RESULTS A total of 120 HCC patients with BDTT from 5 different clinical centers were included. The median disease-free survival (DFS) of the bile duct resection (BDR) group was significantly better than that of the non-BDR group (24.6 months vs. 18.9 months, p = 0.034), but the overall survival (OS) was similar between the two groups (33.6 months vs. 32.3 months, p = 0.193). When we divided the non-BDR group into two groups according to the operation sequence of the hepatic tumor and BDTT, we found that the OS of the thrombus-first group was significantly longer than that of the tumor-first group (42.7 months vs. 23.6 months, p = 0.016). When compared with the BDR group, the thrombus-first group showed similar OS (42.7 months vs. 33.6 months, p = 0.653) and DFS (24.7 months vs. 24.6 months, p = 0.150), which may be the reason the OS rate of the BDR group was similar to that of the non-BDR group. CONCLUSIONS A thrombus-first technique could be considered for HCC patients with extrahepatic BDTT, especially for those patients in which the tumor thrombus did not invade the bile duct.
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13
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Hepatocellular carcinoma: metastatic pathways and extra-hepatic findings. Abdom Radiol (NY) 2021; 46:3698-3707. [PMID: 34091729 DOI: 10.1007/s00261-021-03151-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 01/10/2023]
Abstract
Although a small portion of patients with hepatocellular carcinoma (HCC) have radiologically evident extrahepatic disease at the initial presentation, a larger number of them develop metastatic disease later during the course of treatment or after definitive treatment. Furthermore, early metastatic disease could be overlooked by imaging due to small size and non-specificity of findings. Extrahepatic spread of HCC occurs via different pathways and is directly fueled by tumor biology and its molecular characteristics. Early and accurate detection of extrahepatic disease in patients with HCC has significant impact on management and selection of treatment options. Additionally, precise staging of disease will allow for better prediction of survival and outcome. Different pathways of regional and systemic spread of HCC with their proposed mechanisms and relevant underlying molecular derangement will be discussed in this article. Potential roles in management of patients with HCC will be discussed and reviewed in this article.
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14
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Geyer T, Rübenthaler J, Alunni-Fabbroni M, Schinner R, Weber S, Mayerle J, Schiffer E, Höckner S, Malfertheiner P, Ricke J. NMR-Based Lipid Metabolite Profiles to Predict Outcomes in Patients Undergoing Interventional Therapy for a Hepatocellular Carcinoma (HCC): A Substudy of the SORAMIC Trial. Cancers (Basel) 2021; 13:cancers13112787. [PMID: 34205110 PMCID: PMC8199928 DOI: 10.3390/cancers13112787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/25/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary A hepatocellular carcinoma (HCC) is the most common cause of death in patients suffering from chronic liver diseases. In order to improve the prediction of outcomes in HCC patients, there is a need for new biomarkers. This pilot study aimed at identifying serum metabolites for the prediction of outcomes of HCC patients using nuclear magnetic resonance (NMR) spectroscopy. This analysis revealed that high serum concentrations of myo-inositol or dimethylamine were associated with an improved overall survival. In contrast, high concentrations of total cholesterol, LDL-cholesterol and LDL particles (LDL-P) were associated with a decreased overall survival. The identification of novel biomarkers using this NMR-based technology holds promise for opening new directions in the conduction of interventional trials in HCCs. Abstract Background: This exploratory study aimed to evaluate lipidomic and metabolomic profiles in patients with early and advanced HCCs and to investigate whether certain metabolic parameters may predict the overall survival in these patients. Methods: A total of 60 patients from the prospective, randomized-controlled, multicenter phase II SORAMIC trial were included in this substudy; among them were 30 patients with an early HCC who underwent radiofrequency ablation combined with sorafenib or a placebo and 30 patients with an advanced HCC who were treated with a selective internal radiation therapy (SIRT) plus sorafenib vs. sorafenib alone. The blood serum of these patients was analyzed using a standardized nuclear magnetic resonance (NMR) platform. All tested metabolites were correlated with the overall survival. Results: The overall survival (OS) was significantly higher in patients with an early HCC (median OS: 34.0 months) compared with patients with an advanced HCC (median OS: 12.0 months) (p < 0.0001). Patients with high serum concentrations of myo-inositol (MI) had a higher overall survival compared with patients with low concentrations (21.6 vs. 13.8 months) with a Pearson correlation coefficient of 0.331 (p = 0.011). Patients with high serum concentrations of dimethylamine had a higher overall survival compared with patients with low concentrations (25.1 vs. 19.7 months) with a Pearson correlation coefficient of 0.279 (p = 0.034). High concentrations of total cholesterol, LDL-cholesterol and LDL particles (LDL-P) were associated with a decreased overall survival. Conclusions: NMR-based lipidomic and metabolomic profiling has the potential to identify individual metabolite biomarkers that predict the outcome of patients with an HCC exposed to non-invasive therapeutic management.
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Affiliation(s)
- Thomas Geyer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.R.); (M.A.-F.); (R.S.); (P.M.); (J.R.)
- Correspondence: ; Tel.: +49-89-4400-73620
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.R.); (M.A.-F.); (R.S.); (P.M.); (J.R.)
| | - Marianna Alunni-Fabbroni
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.R.); (M.A.-F.); (R.S.); (P.M.); (J.R.)
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.R.); (M.A.-F.); (R.S.); (P.M.); (J.R.)
| | - Sabine Weber
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (S.W.); (J.M.)
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (S.W.); (J.M.)
| | - Eric Schiffer
- Numares AG, Am BioPark 9, 93053 Regensburg, Germany; (E.S.); (S.H.)
| | | | - Peter Malfertheiner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.R.); (M.A.-F.); (R.S.); (P.M.); (J.R.)
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (S.W.); (J.M.)
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.R.); (M.A.-F.); (R.S.); (P.M.); (J.R.)
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15
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Li T, Xu W, Liu C, He J, Wang Q, Zhang D, Sui K, Zhang Z, Sun H, Yang K, Tan L, Shao H. Anticancer Effect of Biodegradable Magnesium on Hepatobiliary Carcinoma: An In Vitro and In Vivo Study. ACS Biomater Sci Eng 2021; 7:2774-2782. [PMID: 34030441 DOI: 10.1021/acsbiomaterials.1c00288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Biliary-stent implantation has become an effective treatment for patients with malignant obstructive jaundice caused by hepatobiliary carcinoma. Stent restenosis due to tumor ingrowth is a common problem. In this study, we assessed a biodegradable form of magnesium (Mg) for its anticancer effect on hepatobiliary carcinoma, compared to the conventional stent material of titanium (Ti). The results showed that a Mg extract inhibited proliferation and induced apoptosis in human cholangiocarcinoma cells, while a Mg plate inhibited cell adhesion and destroyed the cytoskeleton in the process of biodegradation. In animal experiments with H22 tumor-bearing mice, Mg wires implanted in tumors exhibited an inhibitory effect on their growth compared with Ti wires. Fifteen days after implantation of metal wires, the mean tumor volume and weight in the Mg group were significantly smaller than in the Ti group. We observed the dynamic-degradation process of Mg wires in tumors and generation of H2 gas via soft X-ray photography and scanning electron microscopy. Histopathological analyses showed that apoptosis of tumor cells around Mg wires significantly increased, expression of carbonic anhydrase 9 significantly decreased, and the upstream protein hypoxia-inducible factor 1-alpha also decreased to some extent. Taken together, these results indicated that biodegradable Mg had antitumor properties both in vitro and in vivo, suggesting its potential application as a novel material for biodegradable biliary stents.
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Affiliation(s)
- Tian Li
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Wenhan Xu
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, China.,Department of Ultrasound Medicine, Huashan Hospital of Fudan University, Shanghai 200040, China
| | - Chong Liu
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Jintong He
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Qingchuan Wang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110001, China
| | - Danyang Zhang
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Kaida Sui
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Zhoubo Zhang
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Hao Sun
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Ke Yang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110001, China
| | - Lili Tan
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110001, China
| | - Haibo Shao
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, China
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16
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Sun J, Wu J, Liu C, Shi J, Wei Y, Zhou J, Zhang Z, Lau WY, Yan M, Cheng S. Typing of biliary tumor thrombus influences the prognoses of patients with hepatocellular carcinoma. Cancer Biol Med 2021; 18:j.issn.2095-3941.2020.0202. [PMID: 34021538 PMCID: PMC8330528 DOI: 10.20892/j.issn.2095-3941.2020.0202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/16/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To establish a new classification of biliary tumor thrombus (BTT). METHODS Overall survival of patients with BTT was first used to determine whether it correlated with current hepatocellular carcinoma staging systems. Univariate and multivariate analyses were used to determine factors affecting the overall survival (OS) to form the basis of our new classification for BTT. RESULTS All 6 international staging systems showed overlapping survival curves. Univariate followed by multivariate analyses showed that total bilirubin and intrahepatic/extrahepatic BTT were significant risk factors of OS. Based on these data, a new BTT classification was defined as: Type I: intrahepatic BTT; and Type II: extrahepatic BTT involving a common bile duct or common hepatic duct. Type I was further subdivided into type Ia: BTT involving a second-order intrahepatic duct or above, and type Ib: BTT involving a first-order intrahepatic duct. Type II was further subdivided into type IIa and type IIb using a cut-off total bilirubin (TB) > 300 μmol/L. The numbers (percentages) of patients with types I and II BTT were 69 (34.2%) and 133 (65.8%), respectively. The median OS of type I patients was significantly higher than that of type II patients (37.5 months vs. 23.2 months; P = 0.002). Using subgroup analyses, OS outcomes were significantly different between the subgroups of type IIb and type IIa, although there was no significant difference between the type Ia and type Ib subgroups (P = 0.07). CONCLUSIONS A new BTT classification was established to predict prognoses of HCC patients with BTT who underwent liver resection.
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Affiliation(s)
- Juxian Sun
- Department of Hepatic Surgery VI, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jiayi Wu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, China
- Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Chang Liu
- Department of Hepatic Surgery VI, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jie Shi
- Department of Hepatic Surgery VI, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yonggang Wei
- Department of Hepatobiliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianyin Zhou
- Department of Hepatobiliary Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
| | - Zhibo Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350002, China
| | - Wan Yee Lau
- Department of Hepatic Surgery VI, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200433, China
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Maolin Yan
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, China
- Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Shuqun Cheng
- Department of Hepatic Surgery VI, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200433, China
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17
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Wu JY, Sun JX, Bai YN, Huang XX, Wu JY, Wei YG, Zhang ZB, Zhou JY, Wang YD, Cheng SQ, Yan ML. Long-Term Outcomes of Anatomic Versus Nonanatomic Resection in Hepatocellular Carcinoma Patients with Bile Duct Tumor Thrombus: A Propensity Score Matching Analysis. Ann Surg Oncol 2021; 28:7686-7695. [PMID: 33929619 DOI: 10.1245/s10434-021-09874-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/28/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anatomic resection (AR) of the liver is generally recommended in hepatocellular carcinoma (HCC) patients. However, the benefits of AR and nonanatomic resection (NAR) in HCC patients with bile duct tumor thrombus (BDTT) are unknown. This study aimed to compare long-term outcomes of AR and NAR in HCC patients with BDTT after curative resection. PATIENTS AND METHODS A total of 175 consecutive HCC patients with BDTT after curative resection between April 2009 and December 2017 were included. One-to-one propensity score matching (PSM) was performed to minimize the influence of potential confounders. Recurrence-free survival (RFS) and overall survival (OS) were compared between the cohorts. RESULTS After PSM, 120 patients were analyzed. The AR group had better RFS than the NAR group (P = 0.010). Even though there was no statistically significant difference in OS (P = 0.140, power = 0.33), the 3- and 5-year OS rates in the AR group (52.4% and 44.2%, respectively) were obviously higher than those in the NAR group (35.4% and 30.4%, respectively). When patients were further stratified according to tumor size, better RFS and OS were observed in patients with small (≤ 5 cm) tumors after AR (P < 0.001 and P = 0.004, respectively). Multivariate analysis identified AR (P = 0.024) as an independent favorable prognostic factor for RFS in HCC patients with BDTT. CONCLUSIONS AR is recommended for HCC patients with BDTT, especially in patients with small (≤ 5 cm) tumors.
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Affiliation(s)
- Jia-Yi Wu
- Shengli Clinical Medical College of Fujian Medical University, Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Ju-Xian Sun
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yan-Nan Bai
- Shengli Clinical Medical College of Fujian Medical University, Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Xiao-Xiao Huang
- Shengli Clinical Medical College of Fujian Medical University, Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Jun-Yi Wu
- Shengli Clinical Medical College of Fujian Medical University, Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Yong-Gang Wei
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zhi-Bo Zhang
- Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian-Yin Zhou
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, China
| | - Yao-Dong Wang
- Shengli Clinical Medical College of Fujian Medical University, Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
| | - Mao-Lin Yan
- Shengli Clinical Medical College of Fujian Medical University, Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China.
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Matsumi A, Kato H, Ueki T, Ishida E, Takatani M, Fujii M, Wato M, Toyokawa T, Harada R, Tsugeno H, Matsubara M, Matsushita H, Okada H. Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study. BMC Gastroenterol 2021; 21:28. [PMID: 33441096 PMCID: PMC7807901 DOI: 10.1186/s12876-020-01594-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022] Open
Abstract
Background Only a few reports have assessed the effectiveness of endoscopic biliary drainage (EBD) in hepatocellular carcinoma (HCC) patients with obstructive jaundice and liver dysfunction. Methods This was a retrospective study based on the clinical databases from the Okayama University Hospital and 10 affiliated hospitals. All patients received EBD for jaundice or liver dysfunction. The indication for EBD was aggravation of jaundice or liver dysfunction with intrahepatic bile duct (IHBD) dilation. The technical and clinical success rate, complications, factors associated with clinical failure, and survival duration were evaluated. Results A total of 107 patients were enrolled in this study. Technical success was achieved in 105 of 107 patients (98.1%). Clinical success was achieved in 85 of 105 patients (81%). Complications related to endoscopic retrograde cholangiography (ERC) occurred in 3 (2.8%) patients. Child–Pugh class C (odds ratio 3.90, 95% confidence interval [CI] 1.47–10.4, p = 0.0046) was the only factor associated with clinical failure, irrespective of successful drainage. The median survival duration was significantly longer in patients with clinical success than in those without clinical success (5.0 months vs. 0.93 months; hazard ratio [HR] 3.2, 95% CI 1.87–5.37). HCC Stage I/II/III (HR 0.57, CI 0.34–0.95, p = 0.032), absence of portal thrombosis (HR 0.52, CI 0.32–0.85, p = 0.0099), and clinical success (HR 0.39, CI 0.21–0.70, p = 0.0018) were significant factors associated with a long survival. Conclusions EBD for obstructive jaundice and liver dysfunction in patients with HCC can be performed safely with a high technical success rate. Clinical success can improve the survival duration, even in patients expected to have a poor prognosis. Trial registration Retrospectively registered.
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Affiliation(s)
- Akihiro Matsumi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Toru Ueki
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Etsuji Ishida
- Department of Gastroenterology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masahiro Takatani
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Masakuni Fujii
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Masaki Wato
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Tatsuya Toyokawa
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Ryo Harada
- Department of Gastroenterology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Hirofumi Tsugeno
- Department of Internal Medicine, Tsuyama Central Hospital, Tsuyama, Japan
| | - Minoru Matsubara
- Department of Internal Medicine, Sumitomo Besshi Hospital, Niihama, Japan
| | | | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Koo CS, Ho KY, Pang YH, Huang DQ. Extraction of intra-biliary hepatocellular carcinoma by endoscopic retrograde cholangiopancreatography. BMC Gastroenterol 2020; 20:408. [PMID: 33287724 PMCID: PMC7720534 DOI: 10.1186/s12876-020-01552-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background Hepatocellular carcinoma with biliary ductal invasion is rare and associated with a significantly lower survival rate.
Case presentation We present an unusual case of a patient with hepatocellular carcinoma and biliary invasion, who had his diagnosis confirmed by histological analysis from tissue extracted by endoscopic retrograde cholangiopancreatography. An 87-year-old male presented with a 1-day history of right upper quadrant pain and jaundice. His past medical history included recurrent gallstone cholangitis and a previous cholecystectomy. An abdominal CT demonstrated a dilated intrahepatic biliary tree with left proximal intrahepatic hyperdensities, as well as a 3 cm hepatocellular carcinoma. He was initially suspected to have concurrent gallstone cholangitis and a newly diagnosed hepatocellular carcinoma. Endoscopic retrograde cholangiopancreatography and balloon trawling of the intraductal lesions extracted necrotic tumour-like tissue which was histologically consistent with hepatocellular carcinoma. The extraction of the intra-biliary portion of HCC resulted in complete resolution of his jaundice, enabling further treatment with nivolumab, which would not have been possible if the obstruction was not cleared. The patient is currently well and has completed his 6th cycle of nivolumab. Conclusion Obstructive jaundice is an uncommon presentation for patients with HCC. it is key for clinicians to be aware of the possibility of intrabiliary invasion in order obtain an early diagnosis and to reduce any delay in treatment.
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Affiliation(s)
- Chieh Sian Koo
- Division of Gastroenterology and Hepatology, National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - Khek Yu Ho
- Division of Gastroenterology and Hepatology, National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yin Huei Pang
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Daniel Q Huang
- Division of Gastroenterology and Hepatology, National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore. .,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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20
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The efficacy of the combination of percutaneous transhepatic biliary drainage and 125I stranded seeds for malignant bile duct obstruction treatment. J Contemp Brachytherapy 2020; 12:225-232. [PMID: 32695193 PMCID: PMC7366027 DOI: 10.5114/jcb.2020.96862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To investigate the efficacy of percutaneous transhepatic biliary drainage (PTBD) combined with iodine-125 (125I) stranded seeds for the treatment of malignant bile duct obstruction (MBO). Material and methods A retrospective study was performed on 58 consecutive MBO patients. Twenty patients underwent PTBD combined with 125I stranded seeds (group A). Thirty-eight patients underwent percutaneous trans-hepatic biliary drainage (group B). Total bilirubin, direct bilirubin, and indirect bilirubin levels were compared preoperatively, 1-week, 1-month, and 3-months post-operatively. Carbohydrate antigen 19-9 (CA19-9), cancer antigen 125 (CA125), and carcino-embryonic antigen (CEA) levels were compared at preoperative and 3-month post-operative stages. The time free from biliary obstruction and survival times were compared. Results The differences in total bilirubin, direct bilirubin, and indirect bilirubin levels between the two groups were not significant preoperatively (p = 0.857, p = 0.719, and p = 0.870), and 1-week post-operatively (p = 0.259, p = 0.395, and p = 0.145). However, 1-month (p = 0.012, p = 0.005, and p = 0.049) and 3-months post-operatively (p < 0.001, p = 0.001, and p = 0.001), group A was lower than group B. Differences in CA19-9, CA125, and CEA levels between the two groups were not significant preoperatively (p = 0.229, p = 0.116, and p = 0.273) and 3-months post-operatively (p = 0.159, p = 0.342, and p = 0.306). The median biliary obstruction free time was 7.0 months for group A and 5.0 months for group B (p < 0.001). The median survival time was 9.0 months for group A and 6.0 months for group B (p = 0.001). Conclusions PTBD combined with 125I stranded seeds seem to reduce bilirubin levels and prevents biliary obstruction, promoting survival.
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Surgical Outcomes of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus: A Korea-Japan Multicenter Study. Ann Surg 2020; 271:913-921. [PMID: 30216223 DOI: 10.1097/sla.0000000000003014] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify optimal surgical methods and the risk factors for long-term survival in patients with hepatocellular carcinoma accompanied by macroscopic bile duct tumor thrombus (BDTT). SUMMARY BACKGROUND DATA Prognoses of patients with hepatocellular carcinoma accompanied by BDTT have been known to be poor. There have been significant controversies regarding optimal surgical approaches and risk factors because of the low incidence and small number of cases in previous reports. METHODS Records of 257 patients from 32 centers in Korea and Japan (1992-2014) were analyzed for overall survival and recurrence rate using the Cox proportional hazard model. RESULTS Curative surgery was performed in 244 (94.9%) patients with an operative mortality of 5.1%. Overall survival and recurrence rate at 5 years was 43.6% and 74.2%, respectively. TNM Stage (P < 0.001) and the presence of fibrosis/cirrhosis (P = 0.002) were independent predictors of long-term survival in the Cox proportional hazards regression model. Both performing liver resection equal to or greater than hemihepatectomy and combined bile duct resection significantly increased overall survival [hazard ratio, HR = 0.61 (0.38-0.99); P = 0.044 and HR = 0.51 (0.31-0.84); P = 0.008, respectively] and decreased recurrence rate [HR = 0.59 (0.38-0.91); P = 0.018 and HR = 0.61 (0.42-0.89); P = 0.009, respectively]. CONCLUSIONS Clinical outcomes were mostly influenced by tumor stage and underlying liver function, and the impact of BDTT to survival seemed less prominent than vascular invasion. Therefore, an aggressive surgical approach, including major liver resection combined with bile duct resection, to increase the chance of R0 resection is strongly recommended.
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22
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Cui W, Xu R, Wang Y, Shi F, Li J, Chen X. Percutaneous endobiliary radiofrequency ablation and stents in management of hepatocellular carcinoma with bile duct tumor thrombus: Initial single-institution experience. Asia Pac J Clin Oncol 2020; 16:259-265. [PMID: 32368843 DOI: 10.1111/ajco.13330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 02/09/2020] [Indexed: 12/19/2022]
Abstract
AIM Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is a rare condition, but it can lead to hepatic failure and is associated with poor prognosis. Treatment for HCC with BDTT remains a challenge. This study aimed to retrospectively evaluate the safety and feasibility of percutaneous endobiliary radiofrequency ablation (EB-RFA) and biliary metal stent placement as an alternative treatment for patients with HCC with BDTT. METHODS From October 2014 to December 2016, nine patients (all men, mean age 53.2 ± 12.0; range 40-70) who underwent percutaneous EB-RFA and biliary metal stent placement for HCC with BDTT were included. Stent patency, overall survival, technical and clinical success rate and complications were investigated. RESULTS Median stent patency from the time of the first EB-RFA was 6.0 months (95% CI, 5.4-6.6 months) and survival from the time of diagnosis was 6.0 months (95% CI, 2.2-9.8 months). Two of 9 patients underwent bilateral EB-RFA and stent placement, one underwent unilateral EB-RFA and stent-in-stent procedure, and one EB-RFA as treatment for biliary metal stent occlusion. One patient who presented with stent occlusion underwent repeat ablations 182 days after the first ablation procedure and 53 days after the re-ablation procedure. Combination therapy was administered to five patients. The technical and clinical success rate were 100% and 89% per patient. After treatment, serum direct bilirubin levels were notably decreased in eight patients. No major complications were observed. Minor complications included one bile duct bleeding, three postoperative abdominal pain and two cholangitis. CONCLUSION Percutaneous EB-RFA and biliary metal stent placement might be technically safe and feasible therapeutic options for patients with HCC with BDTT.
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Affiliation(s)
- Wei Cui
- Department of Interventional Therapy, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510080, China.,Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rongde Xu
- Department of Interventional Therapy, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510080, China
| | - Yu Wang
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Feng Shi
- Department of Interventional Therapy, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510080, China
| | - Jiaping Li
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Chen
- Department of Interventional Therapy, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510080, China
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Lu WP, Tang HW, Yang ZY, Jiang K, Chen YL, Lu SC. A proposed modification for the Barcelona Clinic Liver Cancer staging system: Adding bile duct tumor thrombus status in patients with hepatocellular carcinoma. Am J Surg 2020; 220:965-971. [PMID: 32336518 DOI: 10.1016/j.amjsurg.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Barcelona Clinic Liver Cancer (BCLC) staging system is widely applied to stage hepatocellular carcinoma (HCC). However, it may be inaccurate when applied to East Asian HCC patients. In this study, a large Chinese HCC cohort was analyzed to evaluate possible modifications for the BCLC staging system. METHODS Between January 1995 and December 2009, 622 HCC patients who underwent hepatectomy were enrolled. Prognostic risk factors were analyzed using univariate and multivariate analyses. The ability of the modified system to predict survival was evaluated by determining the area under the receiver operating characteristic curve. RESULTS Patients without bile duct tumor thrombus (BDTT; 1-, 3- and 5-year overall survival, 80%, 60% and 48%, respectively) showed a substantial survival advantage over those with BDTT (1-, 3- and 5-year overall survival, 77%, 42% and 23%, respectively; χ2 = 6.280, P = 0.012). In BCLC stage 0-A patients, significant differences were identified between the BDTT group and the non-BDTT group, while no such differences were found in BCLC stage B patients. Based on this finding, BCLC stage 0-A BDTT patients were recategorized into stage B. The modified BCLC classification featured better performance in the prediction of overall survival than the original system (modified BCLC χ2 = 53.596, P < 0.001; original BCLC χ2 = 46.335, P < 0.001). The ability to predict mortality was also slightly higher using the modified BCLC system. CONCLUSIONS Modification of the BCLC system to include BDTT status might further enhance its prognostic ability.
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Affiliation(s)
- Wen-Ping Lu
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Hao-Wen Tang
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Zhan-Yu Yang
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Kai Jiang
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yong-Liang Chen
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shi-Chun Lu
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
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Satiya J, Schwartz I, Tabibian JH, Kumar V, Girotra M. Ablative therapies for hepatic and biliary tumors: endohepatology coming of age. Transl Gastroenterol Hepatol 2020; 5:15. [PMID: 32258519 DOI: 10.21037/tgh.2019.10.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Ablative therapies refer to minimally invasive procedures performed to destroy abnormal tissue that may arise with many conditions, and can be achieved clinically using chemical, thermal, and other techniques. In this review article, we explore the different ablative therapies used in the management of hepatic and biliary malignancies, namely hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), with a particular focus on radiofrequency ablation (RFA) and photodynamic therapy (PDT) techniques.
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Affiliation(s)
- Jinendra Satiya
- Internal Medicine, University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, West Palm Beach, FL, USA
| | - Ingrid Schwartz
- Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - James H Tabibian
- Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Vivek Kumar
- Gastroenterology and Hepatology, UPMC Susquehanna, Williamsport, PA, USA
| | - Mohit Girotra
- Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL, USA
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Elshimi E, Morad W. Cost Analysis of Biliary Drainage Using Metal versus Plastic Stents in Hepatocellular Carcinoma Patients with Obstructive Jaundice. Gastrointest Tumors 2020; 7:1-10. [PMID: 32399460 PMCID: PMC7206597 DOI: 10.1159/000503862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/25/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The optimal method of biliary drainage for biliary obstruction caused by hepatocellular carcinoma (HCC) is controversial, and the possible endoscopic application of plastic and metal stents is the least invasive procedure to improve patients' quality of life. AIM Our objective was to study cost evaluation based on a clinical efficacy of both procedures in a randomized trial comparing both approaches in patients with biliary obstruction caused by HCC. METHODS The strategy of management was based on clinical effectiveness of biliary drainage with either metal or plastic stents in 90 patients over a 1-year follow-up period. Total (direct and indirect) costs were evaluated. RESULTS The direct costs were EGP 40,857.84 and 21,802.62 per patient with plastic and metal stents, respectively. Concerning the indirect costs, EGP 888 and 454 were spent for each patient with plastic and metal stents, respectively. The differences in the costs resulted from patients with plastic stent insertion requiring more second endoscopic retrograde cholangiopancreatography procedures and more medication, medical consultation, and hospitalization during the year of follow-up. CONCLUSIONS Based on this analysis, the use of metal stents rather than plastic stents in biliary drainage is more cost effective for this group of patients.
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Affiliation(s)
- Esam Elshimi
- Hepatology Department, National Liver Institute, Menoufia University, Shebin Al-Kom, Egypt
| | - Wesam Morad
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Shebin Al-Kom, Egypt
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26
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Zhou X, Wang J, Tang M, Huang M, Xu L, Peng Z, Li ZP, Feng ST. Hepatocellular carcinoma with hilar bile duct tumor thrombus versus hilar Cholangiocarcinoma on enhanced computed tomography: a diagnostic challenge. BMC Cancer 2020; 20:54. [PMID: 31969123 PMCID: PMC6977349 DOI: 10.1186/s12885-020-6539-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 01/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) with hilar bile duct tumor thrombus (HBDTT) often mimic hilar cholangiocarcinoma (hilar CC). The purpose of this study is to analyze the Computed Tomography (CT) characteristics of HCC with HBDTT and to identify imaging features to aid its differentiation from hilar CC on enhanced CT. METHODS We retrospectively identified 58 cases with pathologically proved HCC with HBDTT between 2011 and 2018. Seventy-seven cases of pathologically proven hilar CCs were selected during the same period. The clinical features and CT findings of the two groups were reviewed and compared. RESULTS HCC with HBDTTs are more commonly found in men (87.9% vs 63.6%, p = 0.001) with lower age of onset (49.84 vs 58.61 years; p < 0.001) in comparison to hilar CCs. Positive correlation were identified between HCC with HBDTTs and chronic HBV infection (72.4% vs 11.7%; p < 0.001), increased serum AFP (67.2% vs 1.3%; p < 0.001), CA19-9 level (58.6% vs 85.7%; p < 0.001) and CEA level (3.4% vs 29.9%; p = 0.001), parenchymal lesion with intraductal lesion (100% vs 18.2%; p < 0.001), washout during the portal venous phase (84.5% vs 6.5%; p < 0.001), thickened bile duct wall (8.6% vs 93.5%; p < 0.001), intrahepatic vascular embolus (44.8% vs 7.8%; p < 0.001), splenomegaly (34.5% vs 2.6%, p < 0.001). A scoring system consisting of the five parameters obtained from characteristics mentioned above was trialed. The sensitivity and specificity for diagnosing HCC with HBDTT were 96.39, 100 and 92.5% respectively when the total score was 2 or more. CONCLUSIONS HCC with HBDTTs are often distinguishable from hilar CCs based on washout during portal venous phase without thickened bile duct wall. HBV infection and serum AFP level facilitate the differentiation.
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Affiliation(s)
- Xiaoqi Zhou
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Jifei Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Mimi Tang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Mengqi Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Ling Xu
- Faculty of Medicine and Dentistry, University of Western Australia, Perth, Australia
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
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Imaging-Negative Hepatocellular Carcinoma Presents as an Intrabiliary Mass. ACG Case Rep J 2019; 6:e00068. [PMID: 31616745 PMCID: PMC6658063 DOI: 10.14309/crj.0000000000000068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/28/2019] [Indexed: 01/15/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related death and one of the most prevalent cancers worldwide. HCC prognosis remains poor with an average survival rate between 6 and 12 months. Obstructive jaundice, as a main clinical feature, is uncommon in HCC. HCC with bile duct invasion is much rarer than HCC with vascular invasion. We present a case where a patient's HCC was diagnosed by endoscopic retrograde cholangiopancreatography and digital cholangioscopy because his HCC manifested as an obstructing lesion in the intrahepatic duct, but not in the liver.
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Yazawa T, Ohta T, Ariizumi SI, Takahashi Y, Higuchi R, Yamamoto M. A staged approach with initial tumor thrombectomy followed by hepatectomy for icteric-type hepatocellular carcinoma: A case report. Int J Surg Case Rep 2019; 64:1-5. [PMID: 31585354 PMCID: PMC6796648 DOI: 10.1016/j.ijscr.2019.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Biliary drainage for patients with icteric-type hepatocellular carcinoma (HCC) is sometimes difficult, because the drainage tube makes contact with the tumor thrombus (TT) and effective drainage cannot be achieved due to hemobilia. PRESENTATION OF CASE We performed endoscopic naso-biliary drainage for an icteric-type HCC patient; however, the serum bilirubin level was not decreased due to bleeding from the TT. Therefore, we performed tumor thrombectomy in the bile duct and transection of the right hepatic bile duct prior to right hepatectomy. After the first operation, the bilirubin level was decreased, and liver function was recovered so that the patient could undergo right hepatectomy 4 months after the first operation. The postoperative course was uneventful after the second operation and the patient was discharged from the hospital on the 30th postoperative day. The patient is well without recurrence 10 years after surgery. CONCLUSION Biliary drainage is one of the key points for successful treatment of icteric-type HCC patients. A staged approach with initial tumor thrombectomy followed by hepatectomy should be considered as one of the options for icteric-type HCC.
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Affiliation(s)
- Takehisa Yazawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Takehiro Ohta
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Shun-Ichi Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yutaka Takahashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
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Bhattarai S, Graham RP, Sigel CS, Shi J, Gonzalez RS, Xue Y, Krasinskas AM, HooKim K, Adsay V, Reid MD. Bile duct involvement by hepatocellular carcinoma: A rare occurrence and poor prognostic indicator in bile duct brushing samples. Cancer Cytopathol 2019; 127:691-699. [PMID: 31518056 DOI: 10.1002/cncy.22185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) rarely involves the biliary tree and may be inadvertently sampled on bile duct brushings (BDBs). METHODS The pathology archives of 5 institutions were searched for BDBs with HCC involvement. RESULTS A total of 17 BDBs from 14 patients were obtained. There was a male:female ratio of 6:1; the median age of the patients was 59.5 years (range, 22-80 years). The median hepatic tumor size was 6.2 cm (range, 2.2-13.0 cm). HCC risk factors included viral hepatitis (5 patients), cirrhosis (5 patients), hemochromatosis (1 patient), and alcoholic steatohepatitis (1 patient). Jaundice with elevated bilirubin, liver enzymes, and α-fetoprotein was common. Endoscopic retrograde cholangiopancreatography demonstrated bile duct dilatation, polypoid intraductal masses (5 samples), clots/debris (2 samples), or strictures (4 samples). All BDBs had single and clustered large cells with naked atypical nuclei, granular cytoplasm, high nuclear/cytoplasmic ratios, and nuclei with prominent macronucleoli. Less common findings included clear/microvesicular cytoplasm (35%), papillae (29%), and anisonucleosis (35%). Classic HCC features (widened trabeculae [35%], endothelial wrapping [24%], multinucleation [24%], and cytoplasmic bile pigment [35%]) were uncommon. A total of 11 BDBs were diagnosed as malignant (10 with HCC and 1 with cholangiocarcinoma), 2 were diagnosed as atypical, and 1 BDB was diagnosed as negative; approximately two-thirds were found to have polysomy on fluorescence in situ hybridization. Approximately 71% of patients died of disease at a median of 3.5 months. CONCLUSIONS HCC may extend into the intrahepatic and/or extrahepatic biliary tree, causing masses and/or strictures that may be sampled on BDB. Although cytologically malignant, the classic features of HCC are uncommon, which can cause misdiagnosis. Cytopathologists should be mindful of this differential when evaluating BDBs, particularly when concomitant liver masses and/or HCC risk factors are present. Because of the associated high mortality and rapid rate of death, its presence should be conveyed clearly in pathology reports.
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Affiliation(s)
| | | | - Carlie S Sigel
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jiaqi Shi
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Raul S Gonzalez
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Yue Xue
- Department of Pathology, Emory University Hospital, Atlanta, Georgia
| | | | - Kim HooKim
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Volkan Adsay
- Department of Pathology, Koç University, Istanbul, Turkey
| | - Michelle D Reid
- Department of Pathology, Emory University Hospital, Atlanta, Georgia
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A case of acute perforated cholecystitis with intracystic tumor thrombus of hepatocellular carcinoma. Int Cancer Conf J 2019; 8:43-45. [PMID: 31149546 DOI: 10.1007/s13691-018-0352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022] Open
Abstract
A 72-year-old man with hepatocellular carcinoma (HCC) was diagnosed with acute perforated cholecystitis requiring emergency surgery. Unexpectedly, a bile duct tumor thrombus was found to have spread into the intracystic space, mimicking a gall stone and presumably causing the severe acute cholecystitis. We herein report an extremely rare subtype of bile duct tumor thrombus of HCC.
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Abstract
The diagnostic approach to pancreaticobiliary disease requires a multidisciplinary team in which the cytopathologist plays a crucial role. Fine-needle aspiration, obtained by endoscopic ultrasound, is the diagnostic test of choice for pancreatic lesions. Preoperative clinical management depends on many factors, many of which rely on accurate cytologic assessment. Pancreaticobiliary cytology is wrought with diagnostic pitfalls. Clinical history, imaging studies, cytology samples, and ancillary tests, including immunohistochemistry, biochemical analysis, and genetic sequencing, are integral to forming a complete diagnosis and guiding optimal patient management. This article reviews clinical aspects and the diagnostic work-up of commonly encountered diagnostic entities within the field of pancreatic cytology.
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Affiliation(s)
- Raza S Hoda
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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Hong HP, Park K. Percutaneous placement of self-expandable metallic stents in patients with obstructive jaundice due to hepatocellular carcinoma. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungmin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Girotra M, Soota K, Dhaliwal AS, Abraham RR, Garcia-Saenz-de-Sicilia M, Tharian B. Utility of endoscopic ultrasound and endoscopy in diagnosis and management of hepatocellular carcinoma and its complications: What does endoscopic ultrasonography offer above and beyond conventional cross-sectional imaging? World J Gastrointest Endosc 2018; 10:56-68. [PMID: 29467916 PMCID: PMC5807886 DOI: 10.4253/wjge.v10.i2.56] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/28/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma constitutes over 90% of the primary liver tumors, the rest being cholangiocarcinoma. It has an insidious presentation, which is responsible for the delayed presentation. Hence, the management strategy relies on screening to diagnose it an early stage for curative resection and/or treatment with local ablative techniques or chemotherapy. However, even with different screening programs, more than 60% of tumors are still detected at an advanced stage, leading to an unchanged mortality rate, thereby implying a room for improvement in the screening and diagnostic process. In the last few years, there has been evolution of utility of endoscopy, specifically endoscopic ultrasonography along with Fine needle aspiration, for this purpose, which we comprehensively review in this article.
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Affiliation(s)
- Mohit Girotra
- Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Kaartik Soota
- Division of Gastroenterology and Hepatology, University of Iowa School of Medicine, Iowa City, IA 52242, United States
| | - Amaninder S Dhaliwal
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198, United States
| | - Rtika R Abraham
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | | | - Benjamin Tharian
- Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
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Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat Dis Int 2018; 17:17-21. [PMID: 29428098 DOI: 10.1016/j.hbpd.2018.01.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/25/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management. DATA SOURCES A PubMed was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were evaluated. RESULTS The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier, the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production (TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders, nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma, albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases. CONCLUSION The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy.
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Affiliation(s)
- Efstathios T Pavlidis
- Aristotle University of Thessaloniki, Medical School, Second Surgical Propedeutic Department, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Theodoros E Pavlidis
- Aristotle University of Thessaloniki, Medical School, Second Surgical Propedeutic Department, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece.
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Efficacy of 125I Versus Non- 125I Combined with Transcatheter Arterial Chemoembolization for the Treatment of Unresectable Hepatocellular Carcinoma with Obstructive Jaundice. Dig Dis Sci 2018; 63:321-328. [PMID: 29305738 DOI: 10.1007/s10620-017-4899-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/21/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the therapeutic effects of 125I versus non-125I combined with transcatheter arterial chemoembolization (TACE) for the treatment of unresectable hepatocellular carcinoma (HCC) with obstructive jaundice. METHODS A retrospective analysis was conducted using the records of 54 consecutive patients who were initially diagnosed with HCC with obstructive jaundice between May 2009 and July 2016. Twenty-one cases (group A) were treated with percutaneous transhepatic biliary drainage (PTBD) followed by 125I radioactive seed strip implantation through the PTBD tube. After the total serum bilirubin level was reduced to normal and the liver function recovered to Child-Pugh class A or early B, TACE was conducted. In 33 cases (group B) PTBD was performed in combination with TACE without applying the 125I radioactive seeds. The duration of biliary patency and survival were analyzed. RESULTS The technical success rate in both groups was 100%. The median biliary patency time was 6.000 ± 0.315 months (95% CI 5.382-6.618 months) in group A and 4.000 ± 0.572 months (95% CI 2.879-5.121 months) in group B; the two groups were significantly different (P = 0.001). The median survival was 11.000 ± 0.864 months (95% CI 9.306-12.694 months) in group A and 9.000 ± 0.528 months (95% CI 7.965-10.035 months) in group B; the two groups were significantly different (P = 0.022). CONCLUSIONS The combination of 125I with TACE was more effective than TACE without the radioactive seeds for treating patients with unresectable HCC with obstructive jaundice. Future prospective trials with larger samples will be required to validate these results.
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Li J, Huang L, Yan J, Qiu M, Yan Y. Liver resection for hepatocellular carcinoma: personal experiences in a series of 1330 consecutive cases in China. ANZ J Surg 2018; 88:E713-E717. [PMID: 29363237 DOI: 10.1111/ans.14381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/10/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Liver resection to treat early stage hepatocellular carcinoma (HCC) is widely practised but surgery for intermediate and advanced stages of HCC is not included in the treatment algorithm of the Barcelona Clinic Liver Cancer, which has been adopted in official guidelines; nevertheless, resection beyond early stages is frequently undertaken and documented. METHODS Between January 2001 and December 2014, all the HCC patients who underwent liver resection for the first time by Dr Yiqun Yan and his surgical team were enrolled. Clinical data were prospectively collected as well as the follow-up results. RESULTS A total of 1330 consecutive patients were included in the study, of which 452 (34.0%) suffered complications after liver resection with a mortality of 0.7%. The overall survival rates at 1-, 3- and 5-year were 91.2, 63.3 and 36.9%, respectively, while the disease-free survival rates at 1-, 3- and 5-year were 67.7, 33.7 and 13.8%, respectively. Cases were classified into Barcelona Clinic Liver Cancer stage A (548 patients, 41.2%), stage B (613 patients, 46.1%) and stage C (169 patients, 12.7%). The overall survival time at 5-year were 49.8, 32.8 and 10.6%, respectively, in patients with stage A, B and C tumours. CONCLUSION Liver resection to treat HCC is safe in patients with preserved liver function and good functional status. Liver resection should be the first line therapy in patients with single (regardless of tumour size) and resectable 2-3 tumours as well as vascular tumour thrombus if the tumour thrombus does not invade the major trunks.
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Affiliation(s)
- Jing Li
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Liang Huang
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Jianjun Yan
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Maixuan Qiu
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Yiqun Yan
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
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Role of endoscopic biliary drainage in advanced hepatocellular carcinoma with jaundice. PLoS One 2017; 12:e0187469. [PMID: 29095941 PMCID: PMC5667855 DOI: 10.1371/journal.pone.0187469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 10/20/2017] [Indexed: 12/25/2022] Open
Abstract
Background Patients with advanced hepatocellular carcinoma (HCC) with jaundice have an extremely poor prognosis. Although biliary drainage can resolve obstructive jaundice, signs of obstruction may not be evident. This study evaluated the role of endoscopic biliary drainage in patients with advanced HCC and obstructive jaundice. Methods From 2010 to 2015, 74 patients underwent endoscopic biliary drainage for obstructive jaundice due to advanced HCC. Jaundice resolution was defined as complete response and total bilirubin concentration below 3 mg/dl. Results The technical success rate in the 74 patients was 92.1% (70/76). Of the 70 patients who underwent successful biliary drainage, 48 (68.6%) and 22 (31.4%) were Child-Pugh classes B and C, respectively, and 10 (14.3%) and 60 (85.7%) were BCLC stages B and C, respectively. Intrahepatic bile duct (IHD) dilatation was observed in 35 patients (50%). After drainage, the complete response rate was 35.7% (25/70). The mean time to resolution was 17.4 ±8.5 days. However, jaundice was re-aggravated in 74.3% (15/25) after a mean 103.5 ±96.4 days. Multivariate analysis showed that the absence of ascites, presence of IHD dilatation, normal range of prothrombin time, and lower MELD score were significantly associated with complete response. The overall survival rate was 15.7% (11/70) and the median survival time is 28 days (95% confidence interval 2.6–563 days). Complete response and HCC treatment after drainage were significantly associated with survival. Conclusion Effective endoscopic biliary drainage is an important palliative treatment in patients with advanced HCC and obstructive jaundice, especially those with IHD dilatation and preserved liver function, as determined by ascites, prothrombin time, and MELD score.
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Han SY, Song GA, Kim DU, Baek DH, Lee MW, Kim GH. Bile Duct Patency Maintained after Intraductal Radiofrequency Ablation in a Case of Hepatocellular Cholangiocarcinoma with Bile Duct Invasion. Clin Endosc 2017; 51:201-205. [PMID: 28854773 PMCID: PMC5903080 DOI: 10.5946/ce.2017.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 06/29/2017] [Accepted: 07/02/2017] [Indexed: 12/20/2022] Open
Abstract
Combined hepatocellular-cholangiocarcinoma (HCC-CC) with bile duct invasion (BDI) is rare. In unresectable cases, biliary stent placement and photodynamic therapy (PDT) are used for resolving obstructive jaundice. However, stent occlusion remains problematic, and PDT is expensive and time-consuming. Intraductal radiofrequency ablation (RFA) is an emerging procedure for palliation in these patients. It has potential benefits including less expense, lower rates of severe complication, longer maintenance of ductal patency, and easier technique compared with PDT or stenting alone. We report a 67-year-old man who underwent repeated intraductal RFA for HCC-CC and HCC with BDI, for whom bile duct patency was maintained without additional biliary procedures.
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Affiliation(s)
- Sung Yong Han
- Department of Internal Medicine, Pusan National University Hospital, Biomedical Research Institute, and Pusan National University School of Medicine, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University Hospital, Biomedical Research Institute, and Pusan National University School of Medicine, Busan, Korea
| | - Dong Uk Kim
- Department of Internal Medicine, Pusan National University Hospital, Biomedical Research Institute, and Pusan National University School of Medicine, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University Hospital, Biomedical Research Institute, and Pusan National University School of Medicine, Busan, Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University Hospital, Biomedical Research Institute, and Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University Hospital, Biomedical Research Institute, and Pusan National University School of Medicine, Busan, Korea
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Wang C, Yang Y, Sun D, Jiang Y. Prognosis of hepatocellular carcinoma patients with bile duct tumor thrombus after hepatic resection or liver transplantation in Asian populations: A meta-analysis. PLoS One 2017; 12:e0176827. [PMID: 28472122 PMCID: PMC5417567 DOI: 10.1371/journal.pone.0176827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/18/2017] [Indexed: 12/15/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) in the clinic is rare, and surgical treatment is currently considered the most effective treatment. However, the influence of BDTT on the prognosis of HCC patients who underwent surgery remains controversial in previous studies. Therefore, this paper uses meta-analysis method to elucidate this controversy. Methods In this study, we conducted a literature search on databases PubMed, Embase and Web of Science from inception until September 2016. Each study was evaluated with Newcastle-Ottawa Scale (NOS). The pooled effect was calculated, and the association between BDTT and overall survival (OS) or disease-free survival (DFS) was reevaluated using meta-analysis for hazard ratio (HR) and 95% confidence interval (CI). Results A total of 11 studies was included containing 5295 patients. The (HR) for OS and DFS was 3.21 and 1.81, 95%CI was 2.34–4.39 and 1.17–2.78 respectively. Conclusions The results showed that HCC patients with BDTT had a worse prognosis than those without BDTT after hepatic resection or liver transplantation (LT).
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Affiliation(s)
- Chenglin Wang
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, P. R. China
| | - Yu Yang
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, P. R. China
| | - Donglin Sun
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, P. R. China
| | - Yong Jiang
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, P. R. China
- * E-mail:
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Chotirosniramit A, Liwattanakun A, Lapisatepun W, Ko-Iam W, Sandhu T, Junrungsee S. A single institution report of 19 hepatocellular carcinoma patients with bile duct tumor thrombus. J Hepatocell Carcinoma 2017; 4:41-47. [PMID: 28331844 PMCID: PMC5349699 DOI: 10.2147/jhc.s126308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Obstructive jaundice caused due to bile duct tumor thrombus (BDTT) in a hepatocellular carcinoma (HCC) patient is an uncommon event. This study reports our clinical experiences and evaluates the outcomes of HCC patients with BDTT in a single institution. Methods A retrospective review of 19 HCC patients with secondary obstructive jaundice caused due to BDTT during a 15-year period was conducted. Results At the time of diagnosis, 14 (73.7%) patients had obstructive jaundice. Eighteen (94.7%) patients were preoperatively suspected of “obstruction of the bile duct”. Sixteen patients (84.2%) underwent a hepatectomy with curative intent, while two patients underwent removal of BDTT combined with biliary decompression and another patient received only palliative care as his liver reserve and general condition could not tolerate the primary tumor resection. The overall early recurrence (within 1 year) after hepatectomy occurred in more than half (9/16, 56.3%) of our patients. The 1-year survival rate of patients was 75% (12/16). The longest disease-free survival time was >11 years. Conclusion Identification of HCC patients with obstructive jaundice is clinically important because proper treatment can offer an opportunity for a cure and favorable long-term survival.
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Affiliation(s)
- Anon Chotirosniramit
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Akkaphod Liwattanakun
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worakitti Lapisatepun
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wasana Ko-Iam
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Trichak Sandhu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sunhawit Junrungsee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Kim AY, Jeong WK. Intraductal malignant tumors in the liver mimicking cholangiocarcinoma: Imaging features for differential diagnosis. Clin Mol Hepatol 2016; 22:192-7. [PMID: 27044773 PMCID: PMC4825168 DOI: 10.3350/cmh.2016.22.1.192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ah Yeong Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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NEOADJUVANT TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION FOR BILIARY TUMOR THROMBOSIS: A RETROSPECTIVE STUDY. Int J Technol Assess Health Care 2016; 32:212-217. [PMID: 27766992 DOI: 10.1017/s0266462316000374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Curative hepatectomy and tumor thrombectomy for hepatocellular carcinoma with complicating biliary tumor thrombosis (HCC/BTT) is associated with high surgical morbidity and mortality. This retrospective study evaluated the effectiveness and safety of neoadjuvant transcatheter arterial chemoembolization (TACE) in HCC/BTT patients scheduled for curative resection. METHODS Thirty consecutive patients with diagnosed HCC/BTT were hospitalized for neoadjuvant TACE and elective curative liver resection (group A; n=20) or curative liver resection alone (group B; n=10). The primary outcome measure was median survival. RESULTS Group A had a significantly shorter overall operative time (160±25 versus 190±35 min; p < .01) and duration of inflow control (14.3±3.6 versus 25.1±5.1 min; p < .01) and significantly less intraoperative blood loss (150±35 versus 520±75 ml; p < .01) and transfusion (100±40 versus 375±55 ml; p < .01) as compared to group B. Among patients undergoing both thrombectomy and curative resection, the median survival of group A was significantly longer than that of group B (28.5 [9-54] versus 21.5 [6-39] months; p < .01); among those who received thrombectomy alone, the median survival of group A was also significantly longer than that of group B (12.8 [6-25] versus 4.5 [2-7] months; p < .01). CONCLUSIONS Neoadjuvant TACE significantly reduced the surgical risk of curative liver resection and significantly prolonged median survival in HCC patients with complicating BTT.
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Duval F, Cruz-Vega DE, González-Gamboa I, González-Garza MT, Ponz F, Sánchez F, Alarcón-Galván G, Moreno-Cuevas JE. Detection of Autoantibodies to Vascular Endothelial Growth Factor Receptor-3 in Bile Duct Ligated Rats and Correlations with a Panel of Traditional Markers of Liver Diseases. DISEASE MARKERS 2016; 2016:6597970. [PMID: 27212785 PMCID: PMC4860220 DOI: 10.1155/2016/6597970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/05/2016] [Indexed: 12/14/2022]
Abstract
There is a need for new noninvasive biomarkers (NIBMs) able to assess cholestasis and fibrosis in chronic cholestatic liver diseases (CCLDs). Tumorigenesis can arise from CCLDs. Therefore, autoantibodies to tumor-associated antigens (TAA) may be early produced in response to abnormal self-antigen expression caused by cholestatic injury. Vascular endothelial growth factor receptor-3 (VEGFR-3) has TAA potential since it is involved in cholangiocytes and lymphatic vessels proliferations during CCLDs. This study aims to detect autoantibodies directed at VEGFR-3 during bile duct ligation- (BDL-) induced cholestatic injury in rat sera and investigate whether they could be associated with traditional markers of liver damage, cholestasis, and fibrosis. An ELISA was performed to detect anti-VEGFR-3 autoantibodies in sera of rats with different degree of liver injury and results were correlated with aminotransferases, total bilirubin, and the relative fibrotic area. Mean absorbances of anti-VEGFR-3 autoantibodies were significantly increased from week one to week five after BDL. The highest correlation was observed with total bilirubin (R (2) = 0.8450, P = 3.04e - 12). In conclusion, anti-VEGFR-3 autoantibodies are early produced during BDL-induced cholestatic injury, and they are closely related to cholestasis, suggesting the potential of anti-VEGFR-3 autoantibodies as NIBMs of cholestasis in CCLDs and justifying the need for further investigations in patients with CCLD.
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Affiliation(s)
- Florent Duval
- Catedra de Terapia Celular, Escuela de Medicina, Tecnológico de Monterrey, Avenida Morones Prieto 3000 Pte., 64710 Monterrey, NL, Mexico
| | - Delia Elva Cruz-Vega
- Catedra de Terapia Celular, Escuela de Medicina, Tecnológico de Monterrey, Avenida Morones Prieto 3000 Pte., 64710 Monterrey, NL, Mexico
| | - Ivonne González-Gamboa
- Centro de Biotecnología y Genómica de Plantas (CBGP), UPM-INIA, Campus de Montegancedo, Autovía M40, Km 38, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - María Teresa González-Garza
- Catedra de Terapia Celular, Escuela de Medicina, Tecnológico de Monterrey, Avenida Morones Prieto 3000 Pte., 64710 Monterrey, NL, Mexico
| | - Fernando Ponz
- Centro de Biotecnología y Genómica de Plantas (CBGP), UPM-INIA, Campus de Montegancedo, Autovía M40, Km 38, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Flora Sánchez
- Centro de Biotecnología y Genómica de Plantas (CBGP), UPM-INIA, Campus de Montegancedo, Autovía M40, Km 38, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Gabriela Alarcón-Galván
- Servicio de Anatomía Patológica y Citopatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Madero y Dr. Aguirre Pequeño, 64460 Monterrey, NL, Mexico
| | - Jorge E. Moreno-Cuevas
- Catedra de Terapia Celular, Escuela de Medicina, Tecnológico de Monterrey, Avenida Morones Prieto 3000 Pte., 64710 Monterrey, NL, Mexico
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Wong KC. How to apply clinical cases and medical literature in the framework of a modified "failure mode and effects analysis" as a clinical reasoning tool--an illustration using the human biliary system. J Med Case Rep 2016; 10:85. [PMID: 27048215 PMCID: PMC4822271 DOI: 10.1186/s13256-016-0850-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/25/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Clinicians use various clinical reasoning tools such as Ishikawa diagram to enhance their clinical experience and reasoning skills. Failure mode and effects analysis, which is an engineering methodology in origin, can be modified and applied to provide inputs into an Ishikawa diagram. METHOD The human biliary system is used to illustrate a modified failure mode and effects analysis. The anatomical and physiological processes of the biliary system are reviewed. Failure is defined as an abnormality caused by infective, inflammatory, obstructive, malignancy, autoimmune and other pathological processes. The potential failures, their effect(s), main clinical features, and investigation that can help a clinician to diagnose at each anatomical part and physiological process are reviewed and documented in a modified failure mode and effects analysis table. Relevant medical and surgical cases are retrieved from the medical literature and weaved into the table. RESULTS A total of 80 clinical cases which are relevant to the modified failure mode and effects analysis for the human biliary system have been reviewed and weaved into a designated table. The table is the backbone and framework for further expansion. Reviewing and updating the table is an iterative and continual process. The relevant clinical features in the modified failure mode and effects analysis are then extracted and included in the relevant Ishikawa diagram. CONCLUSIONS This article illustrates an application of engineering methodology in medicine, and it sows the seeds of potential cross-pollination between engineering and medicine. Establishing a modified failure mode and effects analysis can be a teamwork project or self-directed learning process, or a mix of both. Modified failure mode and effects analysis can be deployed to obtain inputs for an Ishikawa diagram which in turn can be used to enhance clinical experiences and clinical reasoning skills for clinicians, medical educators, and students.
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Affiliation(s)
- Kam Cheong Wong
- Bathurst Rural Clinical School, Western Sydney University, Bathurst, NSW, Australia. .,School of Rural Health, University of Sydney, Orange, NSW, Australia. .,George Street Medical Practice, Bathurst, NSW, Australia.
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Navadgi S, Chang CC, Bartlett A, McCall J, Pandanaboyana S. Systematic review and meta-analysis of outcomes after liver resection in patients with hepatocellular carcinoma (HCC) with and without bile duct thrombus. HPB (Oxford) 2016; 18:312-6. [PMID: 27037199 PMCID: PMC4814614 DOI: 10.1016/j.hpb.2015.12.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/16/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This meta-analysis aimed to compare perioperative and survival outcomes in patients who underwent hepatectomy with and without Bile Duct Tumour Thrombus (BDTT). METHODS A comprehensive search of Cochrane Library, PubMed, MEDLINE and EMBASE was performed to identify relevant articles. The perioperative, postoperative and long term outcomes were compared. RESULTS Eleven studies including 6051 patients met the inclusion criteria. The perioperative outcomes were comparable between the 2 groups. The BDTT group had higher proportion poorly differentiated tumours (OR = 1.87, X(2) = 10.00, df = 6, p = 0.002, I(2) = 40%), Lymphovascular invasion (LVI) (OR = 4.85, X(2) = 28.21, df = 9, p = <0.001, I(2) = 68%) and Macrovascular invasion (MVI) (OR = 5.41, X(2) = 8.73, df = 9, p = <0.001, I(2) = 0%). There was no difference in 1 and 3 year survival, however 5-yr survival was poorer in the BDTT group (OR = 0.37, X(2) = 37.04, df = 7, p = <0.001, I(2) = 81%). The mean difference (MD) in overall survival in the BDTT group was -20 months [-32.31, -7.06], p = 0.002, I(2) = 95%. CONCLUSION Patients with HCC with BDTT had more advanced stage HCC with adverse histological features including higher rates of MVI, LVI and poor differentiation. Hepatectomy in this group of patients offers similar survival at 3 years but inferior long-term survival and should be considered when feasible.
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Affiliation(s)
- Suresh Navadgi
- Department of Hepatobiliary Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Chi-Chun Chang
- Department of Hepatobiliary Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Adam Bartlett
- Department of Hepatobiliary Surgery, Auckland City Hospital, Auckland, New Zealand; New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John McCall
- Department of Hepatobiliary Surgery, Auckland City Hospital, Auckland, New Zealand; New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sanjay Pandanaboyana
- Department of Hepatobiliary Surgery, Auckland City Hospital, Auckland, New Zealand; New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Wang YY, Zhong JH, Su ZY, Huang JF, Lu SD, Xiang BD, Ma L, Qi LN, Ou BN, Li LQ. Albumin–bilirubin versus Child–Pugh score as a predictor of outcome after liver resection for hepatocellular carcinoma. Br J Surg 2016; 103:725-734. [PMID: 27005482 DOI: 10.1002/bjs.10095] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/21/2015] [Accepted: 12/01/2015] [Indexed: 01/27/2023]
Abstract
Abstract
Background
The Child–Pugh (CP) score is used widely to assess liver function and predict postoperative outcomes in patients with hepatocellular carcinoma (HCC). Recently, the albumin–bilirubin (ALBI) score has been validated as a predictor of overall survival in these patients. This study aimed to compare the ability of the ALBI and CP scores to predict outcomes in patients with HCC after liver resection with curative intent.
Methods
Consecutive patients who underwent liver resection with curative intent for HCC between January 2007 and July 2013 were included in this retrospective study. The performance of the ALBI score in predicting postoperative liver failure (PHLF) and long-term survival was compared with that of the CP score.
Results
A total of 1242 patients were enrolled. Of these, 166 (13·4 per cent) experienced PHLF. The area under the receiver operating characteristic (ROC) curve of the ALBI score for predicting PHLF was greater than that of the CP score (0·723 versus 0·607; P < 0·001). Similar to findings for CP grade, the incidence and severity of PHLF increased with increasing ALBI grade. The ALBI grade stratified patients into at least two distinct overall survival cohorts (P < 0·001), whereas the CP grade did not. The ALBI grade also classified patients with CP grade A disease into two distinct overall survival cohorts (P < 0·001), and overall survival rates in the group with poorer survival were similar to those in the majority of patients with CP grade B disease. Both CP and ALBI scores had low power in predicting disease-free survival.
Conclusion
The ALBI grade predicted PHLF and overall survival in patients with HCC undergoing liver resection with curative intent more accurately than the CP grade.
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Affiliation(s)
- Y-Y Wang
- Department of Hepatobiliary Surgery, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, China
| | - J-H Zhong
- Department of Hepatobiliary Surgery, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, China
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Centre, Nanning, China
| | - Z-Y Su
- Pharmaceutical College, Guangxi Medical University, Nanning, China
| | - J-F Huang
- Pharmaceutical College, Guangxi Medical University, Nanning, China
| | - S-D Lu
- Department of Hepatobiliary Surgery, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, China
| | - B-D Xiang
- Department of Hepatobiliary Surgery, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, China
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Centre, Nanning, China
| | - L Ma
- Department of Hepatobiliary Surgery, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, China
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Centre, Nanning, China
| | - L-N Qi
- Department of Hepatobiliary Surgery, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, China
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Centre, Nanning, China
| | - B-N Ou
- Pharmaceutical College, Guangxi Medical University, Nanning, China
| | - L-Q Li
- Department of Hepatobiliary Surgery, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, China
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Centre, Nanning, China
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Hansen C, Ronot M, Toso C, Rubbia-Brandt L, Boudabbous S, Terraz S. Endobiliary hepatocellular carcinoma: A rare tumor mimicking cholangiocarcinoma. Diagn Interv Imaging 2016; 97:365-7. [PMID: 26851819 DOI: 10.1016/j.diii.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 12/30/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Affiliation(s)
- C Hansen
- Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland
| | - M Ronot
- Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland; Department of Radiology, AP-HP, University Hospitals Paris Nord Val-de-Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - C Toso
- Department of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland; Hepato-pancreatico-biliary center, University Hospitals of Geneva, Geneva, Switzerland; University of Medicine, Geneva University, Geneva, Switzerland
| | - L Rubbia-Brandt
- Department of Pathology, University Hospitals of Geneva, Geneva, Switzerland; Hepato-pancreatico-biliary center, University Hospitals of Geneva, Geneva, Switzerland; University of Medicine, Geneva University, Geneva, Switzerland
| | - S Boudabbous
- Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland
| | - S Terraz
- Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland; Hepato-pancreatico-biliary center, University Hospitals of Geneva, Geneva, Switzerland; University of Medicine, Geneva University, Geneva, Switzerland
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Fu LY, Mitchell KA, Cai G. Clear cell hepatocellular carcinoma diagnosed by bile duct brushing cytology. Diagn Cytopathol 2015; 44:147-51. [DOI: 10.1002/dc.23397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/22/2015] [Accepted: 11/15/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Li-Ying Fu
- Department of Pathology; Yale University School of Medicine; New Haven Connecticut
| | - Kisha A. Mitchell
- Department of Pathology; Yale University School of Medicine; New Haven Connecticut
| | - Guoiping Cai
- Department of Pathology; Yale University School of Medicine; New Haven Connecticut
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Rammohan A, Sathyanesan J, Rajendran K, Pitchaimuthu A, Perumal SK, Balaraman K, Ramasamy R, Palaniappan R, Govindan M. Bile duct thrombi in hepatocellular carcinoma: is aggressive surgery worthwhile? HPB (Oxford) 2015; 17:508-13. [PMID: 25639610 PMCID: PMC4430781 DOI: 10.1111/hpb.12383] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/30/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Obstructive jaundice as a result of bile duct tumour thrombus (BDTT) is an unusual clinical entity and an uncommon presenting feature of hepatocellular carcinoma (HCC). This study evaluates the outcome of hepatectomy for HCC with obstructive jaundice as a result of BDTT in non-cirrhotic livers. METHODS Between 1997 and 2012, out of 426 patients with HCC in non-cirrhotic livers, 39 patients with BDTT (Group I n = 39), who underwent a hepatectomy, were analysed and compared with the non-BDTT group (Group II n = 387). RESULTS The demographic profile and biochemical parameters between Group I and Group II were compared; apart from the presence of jaundice at presentation and an elevated serum bilirubin, there were no significant differences. Post-operative morbidity and mortality were 11 (28.2%) and 2 (5.1%), respectively, in Group I. There were no differences between the groups with regards to the operative variables and short-term outcomes. The 1-, 3- and 5-year survival rates in Group I were 82%, 48% and 10%, respectively, with a median survival of 28.6 months and were significantly poorer than Group II (90%, 55% and 38%, respectively, with a median survival of 39.2 months). CONCLUSION The mere presence of BDTT in HCC does not indicate an advanced or inoperable lesion. When technically feasible, a formal hepatic resection is the preferred first-line treatment option in these patients.
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Affiliation(s)
- Ashwin Rammohan
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia,Correspondence, Ashwin Rammohan, Division of HPB Diseases, The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt. Stanley Medical College & Hospital, Old Jail Road Chennai 600001, India. Tel.: +91 9884173583. Fax: +91 4425289595. E-mail:
| | - Jeswanth Sathyanesan
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Kamalakannan Rajendran
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Anbalagan Pitchaimuthu
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Senthil K Perumal
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Kesavan Balaraman
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Ravi Ramasamy
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Ravichandran Palaniappan
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Manoharan Govindan
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
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