A case of hepatocellular carcinoma with bleeding gingival metastasis treated by transcatheter arterial embolization

The patient was a terminally ill 80-year-old man with multiple lung metastases from hepatocellular carcinoma, that had developed following hepatitis-C virus-associated cirrhosis. He was admitted to our hospital with gingival bleeding, and we diagnosed gingival metastasis from hepatocellular carcinoma, based on histological examination. The bleeding could not be controlled, and the patient became dyspneic. After transcatheter arterial embolization, his bleeding was successfully controlled until his death due to respiratory failure. Transcatheter arterial embolization was a safe and effective treatment in our case.     

导管灌注化疗栓塞治疗肝癌55例临床分析

目的:为了解介入治疗对进行期肝癌的临床疗效。方法:本文分析了我院55例肝癌经导管灌注化疗及栓塞治疗的临床资料,随访48例。结果:48例中存活时间半年以上者36例,占75％,1年以上者16例,占33.3％,1年半以上者3例,占6.3％。其中单纯灌注化疗6例,存活超过半年者仅5例。灌注化疗 碘油栓塞(二联)15例,存活超过半年者13例,超过1年者6例。灌注化疗 碘油 明胶海绵栓塞(三联)23例,存活超过半年者18例,超过1年者10例,超过1年半者3例。结论:本法治疗肝癌有较好疗效,二联和三联疗法存活时间显著高于单灌疗法。     

The radiological prognostic factors of transcatheter arterial chemoembolization to hepatocellular carcinoma

Transcatheter arterial chemoembolization (TACE) is the recommended treatment modality for intermediate stage hepatocellular carcinoma (HCC). The aim of this study was to determine the HCC radiological characteristics associated with prognosis of patients with intermediate stage HCC receiving TACE. Patients with HCC BCLC stage B from January 2005 to December 2009 were collected. According to mRECIST criteria, patients with complete response and partial response were assigned to the objective response (OR) group, while those with stable disease and progressive disease were assigned to the nonobjective response (non-OR) group. Among a total of 128 enrolled patients, there were 66 (51.6%) and 62 (48.4%) patients in the OR group and non-OR group, respectively. The clinical parameters in the two groups were similar, although HCC size was smaller in the OR group. Logistic analysis found combined radiological characteristics including complete lipiodol retention, tumor feeding artery blockage, and no residual tumor blush were significant correlated with achievement of OR (odds ratio 2.46, 95% CI 1.08–5.61, P = .032). However, no radiological characteristics had significant strength to predict overall survival. Patients with OR after TACE had significantly longer survival time than those with non-OR. Combined characteristics of complete lipiodol retention, tumor feeding artery blockage, and no residual tumor blush had a positive impact on OR in TACE. In patients receiving TACE, those who achieved OR had a better overall survival.     

Evaluation of prognostic factors on recurrence after curative resections for hepatocellular carcinoma

AIM:To select appropriate patients before surgical resection for hepatocellular carcinoma(HCC),especially those with advanced tumors.METHODS:From January 2000 to December 2012,we retrospectively analyzed the medical records of 298 patients who had undergone surgical resections for HCC with curative intent at our hospital.We evaluated preoperative prognostic factors associated with histologic grade of tumor,recurrence and survival,especially the findings of pre-operative imaging studies such as positron emission tomography-computed tomography(PETCT)and magnetic resonance imaging(MRI).And then,we established a scoring system to predict recurrence and survival after surgery dividing the patients into two groups based on a tumor size of 5 cm.RESULTS:Of the 298 patients,129(43.3%)developed recurrence during the follow-up period.The 5 year disease free survival and overall survival were 47.0%and58.7%respectively.In multivariate analysis,a serum alpha-fetoprotein(AFP)level of>100 ng/m L and a standardized uptake value(SUV)of PET-CT of>3.5 were predictive factors for histologic grade of tumor,recurrence,and survival.Tumor size of>5 cm and a relative enhancement ratio(RER)calculated from preoperative MRI were also significantly associated with prognosis in univariate analysis.We established a scoring system to predict prognosis using AFP,SUV,and RER.In those with tumors of>5 cm,it showed predicted both recurrence(P=0.005)and survival(P=0.001).CONCLUSION:The AFP,tumor size,SUV and RER are useful for prognosis preoperatively.An accurate prediction of prognosis is possible using our scoring system in large size tumors.     

Clinicopathologic risk factors and prognostic evaluation in hepatocellular carcinoma recurrence after surgery

ＣｌｉｎｉｃｏｐａｔｈｏｌｏｇｉｃｒｉｓｋｆａｃｔｏｒｓａｎｄｐｒｏｇｎｏｓｔｉｃｅｖａｌｕａｔｉｏｎｉｎｈｅｐａｔｏｃｅｌｕｌａｒｃａｒｃｉｎｏｍａｒｅｃｕｒｅｎｃｅａｆｔｅｒｓｕｒｇｅｒｙＤＡＩＹｉＭｉｎ，ＣＨＥＮＨａｎ，ＷＡＮＧＮｅｎｇＪ...     

肝细胞癌术后复发的临床病理

目的探讨影响人肝细胞癌术后复发和预后的临床病理危险因素．方法应用单因素或多因素显著性检验及Ｗｉｌｃｏｘｏｎｃｏｘ回归检验，对１５６例治疗性切除人肝细胞癌病例进行回顾性临床病理学（包括性别、瘤数、瘤大小、肝包膜浸润及门静脉累及等）分析．结果肝细胞癌１５６例中，首发癌７３例，复发癌８３例，术后复发率５３２％，其中亚临床可再切除复发肝癌６５例，再切除率为７８３％（６５／８３）．全组病例１、２、３、４、５年术后生存率分别为６８４％，５７３％，４６７％，３１５％和２８６％．肝癌术后复发相关的临床病理因素主要是：男性，多个，瘤体大（直径＞５ｃｍ），包膜浸润和门静脉累及等，术后复发率高，无瘤活存时间短（Ｐ＜００５）．结论肝细胞癌术后复发的危险因素为男性，多个（＞２个），体积大（直径＞５ｃｍ），包膜癌浸润和肝门血管癌栓形成等．肝细胞癌术后复发主要为单中心性，肝右前叶为术后复发多发肝段．     

Clinicopathological risk factors and prognostic evaluation in hepatocellular carcinoma recurrence after surgery

AIM: To analyze the clinicopathological risk factors in hepatocellular carcinoma recurrence after surgery.METHODS: We used significance testing (χ² and Student’s t-test) of single and multiple factors, and Wilcoxon Cox tropic examination; a retrospective clinicopathological analysis was performed on 156 cases of hepatocellular carcinoma after hepatectomy.RESULTS: Of the 156 cases, 68.4%, 57.3%, 46.7%, 31.5%, and 28.6% had one, two, three, four, and five postoperative tumor-free years, respectively; the total recurrence rate was 53.2% (83/156). In the 83 recurrent cases, 65 were intrahepatic subclinical, with a resection rate of 78.3% (65/83). The relevant factors involved in recurrence were: male gender, tumor number and size, capsule infiltration, and portal vein involvement. These factors were an obvious influence on the prognosis of the patients with postoperative hepatocellular carcinoma (P < 0.05). In the recurrent liver carcinomas, 63.1% of tumor nodes (41/65) were at the ipsilateral segment of the primary tumor nodes.CONCLUSION: Male gender, tumor number and size, capsule infiltration, and portal vein involvement are factors for postoperative hepatocellular carcinoma recurrence. Recurrence is mainly unicentral. The right front liver lobe is the segment with a high rate of recurrence.     

Transcatheter arterial chemoembolisation for hepatocellular carcinoma in cirrhosis: Survival rate and prognostic factors

BackgroundThe role of prognostic variables in the treatment of hepatocellular carcinoma (HCC) by transarterial chemoembolisation (TACE) is controversial.AimsTo evaluate the survival of patients with HCC on cirrhosis treated with TACE and to analyse the prognostic factors affecting survival.MethodsFrom 1996 to 2006, 580 consecutive patients with HCC in cirrhosis were observed. Of these 194 patients underwent TACE. The primary end-point was survival. Independent predictors of survival were identified using the Cox model.ResultsThe cumulative 1-year, 3-year, and 5-year survival rates were 96%, 60%, and 41%, respectively. The multivariate analysis showed significant reduction of survival among patients with serum bilirubin values >2 mg/dl compared to patients with values <2 mg/dl (Hazard ratio 3.84; CI 95% 1.70–8.66; p-value = 0.001). Multivariate analysis performed in the group of patients treated with TACE alone showed that elevated serum bilirubin (Hazard ratio 2.96; CI 95% 1.20–7.3; p-value 0.02) and incomplete tumour response (Hazard ratio 2.88; CI 95% 1.18–7.05; p-value 0.02) are correlated with a worse outcome.ConclusionsTACE was well tolerated and overall survival rate was 41% after 5 years. Complete tumour response and serum bilirubin <2 mg/dl were identified as predictors of survival.     

Segmental transcatheter arterial embolization for primary hepatocellular carcinoma

ＩＮＴＲＯＤＵＣＴＩＯＮＳｅｇｍｅｎｔａｌｔｒａｎｓｃａｔｈｅｔｅｒａｒｔｅｒｉａｌｅｍｂｏｌｉｚａｔｉｏｎ（ＳＬｐＴＡＥ）ｈａｓｂｅｃｏｍｅｏｎｅｏｆｅｘｃｅｌｅｎｔｉｎｔｅｒｖｅｎｔｉｏｎａｌｍｅｔｈｏｄｓｆｏｒｐｒｉｍａｒｙｈｅｐａｔｏｃｅｌ...     

Intra-arterial carbon dioxide-enhanced ultrasonogram of hepatocellular carcinoma treated by transcatheter arterial embolization and percutaneous ethanol injection therapy

The purpose of this study was to investigate the value of carbon dioxide-enhanced ultrasonography (CO₂-US) in the evaluation of viable hepatocellular carcinomas (HCC) which were treated by transcatheter arterial embolization (TAE), percutaneous ethanol injection (PEI), or a combination treatment (TAE and PEI). Forty-one patients with 66 HCC were included in the study. They underwent CO₂-US and angiography were performed in all tumours after they were treated by TAE, PEI or a combination treatment. Forty-six tumours were positively enhanced by CO₂-US and 40 of them were positive by angiography. These 46 tumours were proved to be viable tumours either by biopsy or by follow-up studies. The positive predictive value was 100% for CO₂-US and 87.8% in angiography. Twenty tumours were negative by CO₂-US and these were also negative by angiography. Carbon dioxide-enhanced ultrasonography is a more reliable method for detecting the viable portion of the treated HCC compared with conventional angiography.     

Subsegmental transcatheter arterial embolization for small hepatocellular carcinoma

BACKGROUND/AIMS: The evaluation of long-term outcome of subsegmental transcatheter arterial embolization, which was designed to bring about sufficient anti-tumor effect, in the primary cases of small hepatocellular carcinoma. METHODOLOGY: We analyzed and compared the anti-tumor effect and the survival rate in the primary cases of solitary small hepatocellular carcinoma (< or = 3 cm) with cirrhosis treated by subsegmental transcatheter arterial embolization, chemolipiodolization or percutaneous ethanol injection therapy during the last eight years, retrospectively. RESULTS: The complete tumor necrosis by one session of subsegmental transcatheter arterial embolization, which means that treated tumor showed complete response and did not show local recurrence thereafter, was seen in approximately 50% of the cases. The rate of complete tumor necrosis was superior to that in the patients treated by chemolipiodolization although it was lower than that in the patients treated by percutaneous ethanol injection therapy. Both of the 5- and 7-year survival rates in the patients treated by subsegmental transcatheter arterial embolization were 41.2%. It was slightly higher than those in the other treatment groups without significant difference. CONCLUSIONS: Subsegmental transcatheter arterial embolization might be effectively performed as an initial treatment for the primary cases of the solitary small hepatocellular carcinoma when tumor was fully supplied by hepatic arterial blood regardless of small size.     

Prognostic factors for hepatocellular carcinoma recurrence

The recurrence of hepatocellular carcinoma, the sixth most common neoplasm and the third leading cause of cancer-related mortality worldwide, represents an important clinical problem, since it may occur after both surgical and medical treatment. The recurrence rate involves 2 phases: an early phase and a late phase. The early phase usually occurs within 2 years after resection; it is mainly related to local invasion and intrahepatic metastases and, therefore, to the intrinsic biology of the tumor. On the other hand, the late phase occurs more than 2 years after surgery and is mainly related to de novo tumor formation as a consequence of the carcinogenic cirrhotic environment. Since recent studies have reported that early and late recurrences may have different risk factors, it is clinically important to recognize these factors in the individual patient as soon as possible. The aim of this review was, therefore, to identify predicting factors for the recurrence of hepatocellular carcinoma, by means of invasive and non-invasive methods, according to the different therapeutic strategies available. In particular the role of emerging techniques (e.g., transient elastography) and biological features of hepatocellular carcinoma in predicting recurrence have been discussed. In particular, invasive methods were differentiated from non-invasive ones for research purposes, taking into consideration the emerging role of the genetic signature of hepatocellular carcinoma in order to better allocate treatment strategies and surveillance follow-up in patients with this type of tumor.     

Usefulness of pulsed Doppler ultrasound in detection of angiographically evident recurrence of hepatocellular carcinoma after arterial embolization treatment.

Because hepatocellular carcinoma treated by transcatheter arterial embolization often regains its size, routine follow-up is necessary. The usefulness of pulsed Doppler ultrasound for detection of this type of recurrence was compared with ultrasonography and computed tomography in 21 such hepatocellular carcinomas. Of 15 hepatocellular carcinomas diagnosed by angiography as showing recurrence, four were detected with ultrasonography and five were detected with computed tomography. Doppler signals were obtained in the peripheral portions corresponding to tumor vessels or stains on angiograms in 14 of these 15 hepatocellular carcinomas, but they were undetectable in six hepatocellular carcinomas with no recurrence. All signals disappeared after transcatheter arterial embolization. One false-negative hepatocellular carcinoma with pulsed Doppler ultrasound showed faint tumor stains on angiograms; these were also negative on ultrasonography and computed tomography. Pulsed Doppler ultrasound may be superior to ultrasonography and computed tomography as a routine procedure to detect the recurrence of hepatocellular carcinoma treated by transcatheter arterial embolization.     

Two cases of hepatocellular adenomatosis treated with transcatheter arterial embolization

Hepatocellular adenoma is a rare benign tumor of the liver. However, some complications, such as hemorrhage, rupture, and malignant transformation, have been reported previously. Surgical resection is considered to be the best choice of treatment, when adenomas are increasing in size, while resection is difficult to perform when multiple adenomas develop throughout the liver. Here, we report two cases of multiple hepatocellular adenomatosis. One patient had a history of aplastic anemia and the other had glycogen storage disease. We treated them with transcatheter arterial embolization (TAE) to prevent hemorrhage and rupture. After TAE, most parts of the adenomas showed necrotic change. These cases suggest that TAE is an effective treatment of hepatocellular adenomatosis.     

Survival and prognostic factors in patients with hepatocellular carcinoma treated by percutaneous ethanol injection: a 10-year experience.

The treatment of early and intermediate stage hepatocellular carcinoma (HCC) is still debated. Surgical treatments are considered to be the only curative procedures available, and only for a minority of patients. Percutaneous ethanol injection (PEI) is an established technique for the ablation of HCC nodules, and shows survival rates similar to those of resection. The efficacy of PEI in patients with biopsy-proven viral cirrhosis and small to intermediate inoperable HCC was evaluated. One hundred twenty-seven patients (85 men, 42 women, mean age 63 years, range 51 to 92 years, 115 hepatitis C virus-positive, 12 hepatitis B virus-positive) were enrolled between January 1993 and December 2002. They all underwent a standard PEI procedure and were prospectively followed-up. Overall median survival rate was 28 months (range six to 112 months). The following parameters were associated with a significantly longer survival: nodule diameter smaller than 30 mm (P=0.0480), the presence of a perinodular boundary (P=0.0008), serum alpha-fetoprotein less than 20 ng/mL (P=0.0104), a Child-Pugh A class score (P<0.0001) or a Cancer of the Liver Italian Program score of 0 (P<0.0001) and the presence or absence of small esophageal varices (P=0.013). The 19 patients with all these favourable characteristics showed an overall median survival of 61 months. An alpha-fetoprotein below 20 ng/mL was associated with significantly longer disease-free survival (P=0.0009). The Child-Pugh and Cancer of the Liver Italian Program scores were effective in predicting prognosis of these patients. In conclusion, PEI still represents a safe and economically sound treatment for HCC.     

Hepatic arterial embolization for malignant hypercalcemia in hepatocellular carcinoma

Summary A patient who presented with hypercalcemia was found to have an hepatocellular carcinoma. Medical treatment failed to normalize blood calcium levels. Liver resection was not feasible due to major extrahepatic involvement. Selective arterial embolization of the tumor was performed, resulting in correction of the hypercalcemia. This observation suggests that some life-threatening complications of unresectable hepatocellular carcinoma can be treated by arterial embolization of the tumor.     

Staged hepatectomy following arterial embolization for ruptured hepatocellular carcinoma

BACKGROUND/AIMS: While hemostasis by transcatheter arterial embolization is often the first choice in the initial treatment of ruptured hepatocellular carcinoma, post-transcatheter arterial embolization treatment has not fully been established. We studied the prognoses of ruptured hepatocellular carcinoma cases where hepatectomy was possible after transcatheter arterial embolization. METHODOLOGY: We retrospectively reviewed 10 cases of ruptured hepatocellular carcinoma which had been treated in our institution between 1989 and 1998. In all the 10 cases, emergency transcatheter arterial embolization was performed, which successfully achieved hemostasis. RESULTS: Following the achievement of hemostasis by transcatheter arterial embolization, hepatectomy was carried out in 5 cases after evaluation of general condition, functional liver reserve and extent of tumor spread. There was neither operative nor hospital death. One-year and 3-year survival rates were 100% and 40%, respectively, and 50% survival time was 36 months. In the other 5 patients, hepatectomy was decided to be impossible after evaluation of general condition, functional liver reserve and extent of tumor spread; all of them died within 0.5-10 months after transcatheter arterial embolization. CONCLUSIONS: Among the patients with ruptured hepatocellular carcinoma, those in which hepatectomy was decided to be possible after evaluation of general condition, functional liver reserve and extent of tumor spread, following successful hemostasis by transcatheter arterial embolization, had fairly good prognoses.