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Chemoembolization with Lobaplatin Mixed with Iodized Oil for Unresectable Recurrent Hepatocellular Carcinoma after Orthotopic Liver Transplantation

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JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY 2010年第3期21卷 333-338页

作者： Zhou, Bin Shan, Hong Zhu, Kang-Shun Jiang, Zai-Bo Guan, Shou-Hai Meng, Xiao-Chun Zeng, Xian-Cheng Sun Yat Sen Univ Affiliated Hosp 3 Dept Radiol Guangzhou 510630 Guangdong Peoples R China Sun Yat Sen Univ Affiliated Hosp 3 Liver Transplant Ctr Guangzhou 510630 Guangdong Peoples R China

PURPOSE: To determine whether chemoembolization can benefit patients with unresectable recurrent hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Twenty-eight of 71 patients (39%) with unresectable recurrent HCC following OLT and without contradictions to chemoembolization were included: 14 patients received chemoembolization after OLT (chemoembolization group) and 14 matched control subjects who did not receive chemoembolization (non-chemoembolization group). Tumor response was determined with follow-up computed tomography after each chemoembolization procedure and classified into four grades according to Response Evaluation Criteria in Solid Tumors. Overall survival was evaluated from OLT and from the diagnosis of recurrent HCC. RESULTS: Within a median follow-up of 14.5-months, 12 of the 14 patients in the chemoembolization group (86%) and 13 of the 14 in the non-chemoembolization group (93%) developed new recurrences. Eight of the 14 patients in the chemoembolization group (57%) showed partial tumor response (>30% reduction in the size of target lesions). Moreover, patients who underwent chemoembolization had a significantly longer overall survival after OLT (P=.0133) and after the diagnosis of HCC recurrence (P=.0338) compared to those who did not. No severe complications developed in patients receiving chemoembolization during follow-up. CONCLUSIONS: Lobaplatin-based chemoembolization may elicit effective tumor response for recurrent HCCs and improve the overall survival of patients with unresectable HCC recurrence following OLT.

关键词： overall survival Recurrent Hepatocellular Carcinoma Iodized Oil lobaplatin chemoembolization human-centered computing Optical Line Terminal Liver Transplantation

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Image fusion with volume navigation of contrast enhanced ultrasound (CEUS) with computed tomography (CT) or magnetic resonance imaging (MRI) for post-interventional follow-up after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinomas (HCC): Preliminary results

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CLINICAL HEMORHEOLOGY AND MICROCIRCULATION 2010年第2-3期46卷 101-115页

作者： Ross, C. J. Rennert, J. Schacherer, D. Girlich, C. Hoffstetter, P. Heiss, P. Jung, W. Feuerbach, S. Zorger, N. Jung, E. M. Univ Med Ctr Regensburg Dept Radiol Inst Radiol D-93053 Regensburg Germany Univ Med Ctr Regensburg Interdisciplinary Ctr Clin Ultrasound Dept Internal Med & Radiol 1 D-93053 Regensburg Germany Univ Saarbruecken Saarbrucken Germany

Aim: The assessment of the immediate post-interventional microcirculation and perfusion following transcatheter arterial chemoembolization (TACE) with new real time imaging fusion technique (VNav) of computed tomography (CT) or magnetic resonance imaging (MRI) with contrast enhanced ultrasound (CEUS) compared to follow-up. Material: Following TACE an image fusion of CEUS with CT or MRI of the liver was performed in 20 patients (18 men, 2 women;age 29-75 years) with confirmed hepatocelluar carcinoma (HCC) to evaluate the post-interventional tumor vascularization and perfusion of HCC tumor lesions. Image fusion with CEUS performed immediately was compared with the result at the end of TACE (DSA), with post TACE CT (non-enhanced CT within 24 hours) and with follow up CT (enhanced CT after 6 weeks) after embolization. Ultrasound was performed using a 1-5MHz multifrequency SonoVue transducer (LOGIQ 9/GE) after a bolus injection of 2-4 ml SonoVue (R) with contrast harmonic imaging (CHI). Thirteen examinations were fused with a contrast enhanced CT, 7 with a MRI performed before TACE. Results: The post-interventional volume navigation image fusion of CT or MRI with CEUS showed differences regarding the residual tumor perfusion compared to other modalities. The correlation (Spearman-test) between the perfusion result at the end of TACE, non-enhanced CT after TACE and image fusion with CEUS was 0.42 and 0.50. The difference between the result at the end of TACE and the fusion with CEUS was significant (p < 0.05, Wilcoxon-test). The correlation between fusion of CEUS with CT/MRI and follow-up CT (after 6 weeks) was 0.64, the difference was not significant (p > 0.05). The differences between native CT within 24 hours after TACE and follow up CT after 6 weeks or fusion of CEUS and CT/MRI were significant (p < 0.05). The inter-observer variability was 0.61 at the end of TACE, 0.58 at non-enhanced CT (within 24 hours), 0.87 at fusion CEUS with CT/MRI and 0.74 at follow up CT afte

关键词： X-Ray Computed Tomography image fusion C7orf49 gene Continuing Education Units Perfusion human-centered computing

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Meta-analysis: interferon improves outcomes following ablation or resection of hepatocellular carcinoma

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ALIMENTARY PHARMACOLOGY & THERAPEUTICS 2010年第7期32卷 851-858页

作者： Singal, A. K. Freeman, D. H., Jr. Anand, B. S. Univ Texas Med Branch Dept Internal Med Div Gastroenterol & Hepatol Galveston TX 77555 USA Univ Texas Med Branch Dept Community Hlth & Prevent Med Div Epidemiol & Biostat Galveston TX 77555 USA Baylor Coll Med Dept Gastroenterol & Hepatol Michael E DeBakey VA Med Ctr Houston TX 77030 USA

P>Background Hepatocellular carcinoma (HCC) is third most common cause of tumour-related death in the US with hepatitis C virus (HCV) the most common aetiology. Surgical resection and tumour ablation are curative in patients who cannot be transplanted. With native liver having cirrhosis, HCC recurrence is a potential problem. Aim To perform a systematic review and meta-analysis of studies evaluating efficacy of IFN to prevent HCC recurrence after its curative treatment in HCV-related cirrhosis. Methods Ten studies (n = 645, 301 treated with IFN) on the use of IFN after resection or ablation of HCV-associated HCC were analysed. Results Pooled data showed benefit of IFN for HCC prevention with OR (95% CI) of 0.26 (0.15-0.45);P < 0.00001. The proportion of patients surviving at 5 years (n = 505 in 6 studies) was in favour of IFN with OR of 0.31 [(95% CI 0.21-0.46);P < 0.00001]. Data were homogeneous for HCC recurrence (chi 2 12.05, P = 0.21) and survival (chi 2 6.93, P = 0.44). The benefit of IFN was stronger with sustained virological response compared with nonresponders for HCC recurrence [0.19 (0.06-0.60);P = 0.005] and survival [0.31 (0.11-0.90);P = 0.03]. Conclusion Interferon treatment after curative resection or ablation of HCC in HCV-related cirrhotics prevents HCC recurrence and improves survival.

关键词： Interferons Meta-Analysis Hepatocellular Cancer Relapse curative treatment human-centered computing

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Radioembolization with Use of Yttrium-90 Resin Microspheres in Patients with Hepatocellular Carcinoma and Portal Vein Thrombosis

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JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY 2010年第8期21卷 1205-1212页

作者： Inarrairaegui, Mercedes Thurston, Kenneth G. Bilbao, Jose I. D'Avola, Delia Rodriguez, Macarena Arbizu, Javier Martinez-Cuesta, Antonio Sangro, Bruno Univ Navarra Clin Liver Unit Pamplona Spain Univ Navarra Clin Dept Intervent Radiol Pamplona Spain Univ Navarra Clin Dept Nucl Med Pamplona Spain CIBEREHD Barcelona Spain Sirtex Med US Holdings Wilmington MA USA

PURPOSE: Intraarterial delivery of yttrium-90 (Y-90)-bound microspheres (ie, radioembolization) is a promising treatment for hepatocellular carcinoma (HCC). An early concern was the "embolic" nature of the microspheres, and their potential to reduce hepatic arterial blood flow in patients with compromised portal blood flow secondary to portal vein thrombosis/occlusion (PVT). In this situation, the risk of liver failure could be enhanced, particularly in patients with cirrhosis who have increased hepatic arterial blood flow. This retrospective analysis was undertaken to assess the safety and clinical benefits of radioembolization with Y-90 resin microspheres in HCC with branch or main PVT. MATERIALS AND METHODS: A total of 25 patients presenting with unresectable HCC and compromised portal flow received segmental, lobar, or whole-liver infusion of Y-90 resin microspheres. For the analysis of tumor response, changes in target lesions, appearance of new lesions, and changes in portal vein thrombus were studied. Controlled disease was defined by absence of progression in all these components. RESULTS: Globally, controlled disease was achieved in 66.7% of patients at 2 months and 50% of patients at 6 months. No significant changes were observed in liver-related toxicities according to Common Toxicity Criteria (version 3.0) at 1 and 2 months after treatment. Median survival time was 10 months (95% CI, 6.6-13.3 months). CONCLUSIONS: Radioembolization of unresectable HCC and branch or main PVT with Y-90 resin microspheres was associated with minimal toxicity and a favorable median survival time. Further prospective studies are warranted to validate the findings in this clinically challenging patient population.

关键词： microparticles Blood Flow Hepatocellular Cancer Yttrium 90 Blood Circulation Yttrium-90 Microspheres RADIOEMBOLIZATION Resin Portal Vein Thrombosis human-centered computing Portal Vein Microspheres Patients

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Health Insurance Status Affects Staging and Influences Treatment Strategies in Patients with Hepatocellular Carcinoma

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ANNALS OF SURGICAL ONCOLOGY 2010年第12期17卷 3104-3111页

作者： Zaydfudim, Victor Whiteside, Martin A. Griffin, Marie R. Feurer, Irene D. Wright, J. Kelly Pinson, C. Wright Vanderbilt Univ Dept Surg Med Ctr Div Hepatobiliary Surg & Liver Transplantat Nashville TN 37240 USA Vanderbilt Univ Med Ctr Dept Med Nashville TN 37240 USA Vanderbilt Univ Med Ctr Dept Prevent Med Nashville TN 37240 USA Vanderbilt Univ Med Ctr Ctr Educ & Res Therapeut Nashville TN 37240 USA Vanderbilt Univ Med Ctr Dept Biostat Nashville TN 37240 USA Vet Affairs Tennessee Valley Hlth Care Syst Mid S Geriatr Res Educ Nashville TN USA Vet Affairs Tennessee Valley Hlth Care Syst Ctr Clin Nashville TN USA Vet Affairs Tennessee Valley Hlth Care Syst Clin Res Ctr Excellence Nashville TN USA Tennessee Dept Hlth Off Canc Surveillance Tennessee Canc Registry Nashville TN USA

Lack of health insurance is associated with poorer outcomes for patients with cancers amenable to early detection. The effect of insurance status on hepatocellular carcinoma (HCC) presentation stage and treatment outcomes has not been examined. We examined the effect of health insurance status on stage of presentation, treatment strategies, and survival in patients with HCC. The Tennessee Cancer Registry was queried for patients treated for HCC between January 2004 and December 2006. Patients were stratified by insurance status: (1) private insurance;(2) government insurance (non-Medicaid);(3) Medicaid;(4) uninsured. Logistic, Kaplan-Meier, and Cox models tested the effects of demographic and clinical covariates on the likelihood of having surgical or chemotherapeutic treatments and survival. We identified 680 patients (208 private, 356 government, 75 Medicaid, 41 uninsured). Uninsured patients were more likely to be men, African American, and reside in an urban area (all P < 0.05). The uninsured were more likely to present with stage IV disease (P = 0.005). After adjusting for demographics and tumor stage, Medicaid and uninsured patients were less likely to receive surgical treatment (both P < 0.01) but were just as likely to be treated with chemotherapy (P a parts per thousand yen 0.243). Survival was significantly better in privately insured patients and in those treated with surgery or chemotherapy (all P < 0.01). Demographic adjusted risk of death was doubled in the uninsured (P = 0.005). Uninsured patients with HCC are more likely to present with late-stage disease. Although insurance status did not affect chemotherapy utilization, Medicaid and uninsured patients were less likely to receive surgical treatment.

关键词： Hepatocellular Cancer Insurance Coverage Staging Medicaid patient treatment Medically Uninsured human-centered computing Cox Proportional Hazards Models Surgery Patients

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CT evaluations of focal liver reactions following stereotactic body radiotherapy for small hepatocellular carcinoma with cirrhosis: relationship between imaging appearance and baseline liver function

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BRITISH JOURNAL OF RADIOLOGY 2010年第996期83卷 1063-1071页

作者： Sanuki-Fujimoto, N. Takeda, A. Ohashi, T. Kunieda, E. Iwabuchi, S. Takatsuka, K. Koike, N. Shigematsu, N. Keio Univ Dept Radiol Shinjuku Ku Tokyo 1608582 Japan Oita Prefectural Hosp Dept Radiol Oita 8700855 Japan Ofuna Chuo Hosp Dept Radiol Kanagawa Japan Ofuna Chuo Hosp Dept Gastroenterol & Hepatol Kanagawa Japan

This study aimed to assess the imaging appearances of focal liver reactions following stereotactic body radiotherapy (SBRT) for small hepatocellular carcinoma (HCC) and to examine relationships between imaging appearance and baseline liver function. We retrospectively studied 50 lesions in 47 patients treated with SBRT (3040 Gy in 5 fractions) for HCC, who were followed up for more than 6 months. After SBRT, all patients underwent regular follow-ups with blood tests and dynamic CT scans. At a median follow-up of 18.1 months (range 6.2-43.7 months), all lesions but one were controlled. 3 density patterns describing focal normal liver reactions around HCC tumours were identified in pre-contrast, arterial and portal-venous phase scans: iso/iso/iso in 4 patients (Type A), low/iso/iso in 8 patients (Type B) and low/iso (or high)/high in 38 patients (Type C). Imaging changes in the normal liver surrounding the treated HCC began at a median of 3 months after SBRT, peaked at a median of 6 months and disappeared 9 months later. Liver function, as assessed by the Child-Pugh classification, was the only factor that differed significantly between reactions to treatment showing "non-enhanced'' (Type A and B) and "enhanced'' (Type C) appearances in CT. Hence, liver tissue with preserved function is more likely to be well enhanced in the delayed phase of a dynamic contrast-enhanced CT scan. The CT appearances of normal liver seen in reaction to the treatment of an HCC by SBRT were therefore related to background liver function and should not be misread as recurrence of HCC.

关键词： Hematologic Tests Stereotactic Body Radiotherapy liver normal Median liver function human-centered computing X-Ray Computed Tomography

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Optimal management of hepatocellular carcinoma: Challenges and opportunities

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JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 2010年第8期25卷 1336-1338页

作者： Lin, Chih-Lin Kao, Jia-Horng Natl Taiwan Univ Coll Med Grad Inst Clin Med Taipei 10002 Taiwan Taipei City Hosp Ren Ai Branch Dept Gastroenterol Taipei Taiwan Natl Chengchi Univ Dept Psychol Taipei 11623 Taiwan Natl Taiwan Univ Hosp Dept Internal Med Taipei 100 Taiwan Natl Taiwan Univ Hepatitis Res Ctr Taipei 10002 Taiwan Natl Taiwan Univ Dept Med Res Taipei 10002 Taiwan

See article in J. Gastroenterol. Hepatol. 2010;25: 1426-1434.

关键词： Survival Rate Natural history poor prognosis Hepatocellular Cancer human-centered computing

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Activity of sulfotransferase 1A1 is dramatically upregulated in patients with hepatocellular carcinoma secondary to chronic hepatitis B virus infection

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CANCER SCIENCE 2010年第2期101卷 412-415页

作者： Wang, Xiang-Rui Qu, Zeng-Qiang Li, Xiao-Dong Liu, Hai-Lin He, Ping Fang, Bei-Xiong Xiao, Jie Huang, Wei Wu, Meng-Chao Shanghai Jiao Tong Univ Renji Hosp Shanghai 200030 Peoples R China Second Mil Med Univ Eastern Hepatobiliary Surg Hosp Shanghai Peoples R China Second Mil Med Univ Inst Canc Shanghai Peoples R China Shanghai Jiao Tong Univ Peoples Hosp 9 Shanghai 200030 Peoples R China

The phase I metabolizing enzyme and phase II metabolizing enzyme play vital roles in carcinogenesis, but little is known about the changes of their activities in patients with hepatocellular carcinoma (HCC) secondary to chronic hepatitis B virus (HBV) infection. In this study phenacetin, a probe drug (1 g for men and 0.85 g for women orally), was applied for the detection of sulfotransferase 1A1 (SULT1A1) and cytochrome P4501A2 (CYP1A2) activities in 82 healthy participants and 148 HCC, 106 cirrhosis, and 41 chronic hepatitis B patients. In addition, a prospective cohort study for susceptibility to HCC was performed in 205 patients with cirrhosis secondary to chronic HBV infection. Compared with the healthy participants, SLUT1A1 activity increased by 9.7-fold in the HCC patients (P < 0.01). CYP1A2 activity did not significantly differ between the healthy participants and HCC patients. CYP1A2 activity decreased by 91.2% (P < 0.01) and 67.7% (P < 0.05) in the patients with cirrhosis and chronic hepatitis B, respectively;SULT1A1 activity did not increase significantly. During an approximate 2-year follow up, three of the 46 cirrhosis patients with elevated SULT1A1 activity and normal CYP1A2 activity developed HCC, but none of the 159 cirrhosis patients used as parallel controls did (P = 0.012). These results indicate that SLUT1A1 activity is dramatically upregulated in patients with HCC secondary to chronic HBV infection. The upregulation of SULT1A1 activity is not caused by the tumor itself. The interaction between SULT1A1 and CYP1A2 can play an important role in hepatocarcinogenesis in the Chinese population. (Cancer Sci 2010;101: 412-415)

关键词： SULT1A1 gene Cytochrome P 450 CYP1A2 Chronic Hepatitis B Patients Secondary Carcinoma sulfotransferase 1A1 Simian B disease human-centered computing

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Comparison of Serum Tumor Markers for Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma

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AMERICAN SURGEON 2010年第11期76卷 1210-1213页

作者： Tao, Lian-Yuan Cai, Lei He, Xiao-Dong Liu, Wei Qu, Qiang Chinese Acad Med Sci Peking Union Med Coll Hosp Dept Gen Surg Beijing 100730 Peoples R China Peking Union Med Coll Beijing 100730 Peoples R China

Serum tumor markers such as alpha-fetoprotein (AFP), carcinoembryonic antigen, carbohydrate antigen (CA) 19-9, CA242, and CA50 were analyzed to evaluate their diagnostic values in single and combined tests for distinguishing intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC). Preoperative serum levels of AFP, carcinoembryonic antigen, CA19-9, CA242, and CA50 were measured in 45 ICC and 76 HCC patients. The serum levels and the positive rate of AFP, CA19-9, and CA242 were significantly different between the ICC patients and HCC patients. Although AFP () was the most sensitive assay for distinguishing ICC from HCC (91.1%), its specificity was significantly lower than that of CA242 (+) and CA19-9 (+). The combination of AFP () and CA242 (+) afforded a high specificity of 94.3 per cent and showed highest accuracy (78.5%). Evaluation of patients without liver cirrhosis also showed similar results. The diagnostic value of CA242 (+) is better than that of CA19-9 (+) and AFP () in distinguishing ICC from HCC. Combined detection of AFP () and CA242 (+) can improve the specificity and accuracy of diagnosing ICC.

关键词： International Criminal Court Serum levels diagnostic value CA-19-9 Antigen Tumor markers human-centered computing

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Laparoscopic Right Hemihepatectomy for Hepatocellular Carcinoma

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ANNALS OF SURGICAL ONCOLOGY 2010年第8期17卷 2090-2091页

作者： Han, Ho-Seong Yoon, Yoo-Seok Cho, Jai Young Ahn, Keun Soo Seoul Natl Univ Coll Med Dept Surg Bundang Hosp Seoul South Korea

Although laparoscopic liver resection has been widely adopted, laparoscopic right hepatectomy remains a challenging procedure. This video shows the relevant technical maneuvers in each step of a total laparoscopic right hepatectomy. A 47-year-old man was admitted for evaluation of an incidental hepatic mass noted on a health screening test. Two months ago, transarterical chemoembolization was performed for a 3.5-cm hepatocellular carcinoma (HCC), which was located in S7-8;a follow-up abdominal computed tomography (CT) revealed incomplete necrosis of the HCC. The laboratory studies were positive for hepatitis B viral markers and a normal level of alpha-fetoprotein level. The preoperative liver function was Child-Pugh class A. A laparoscopic right hemihepatectomy was performed for this lesion. An anatomic resection of the right liver was possible with selective control of a Glissonian pedicle to the right liver. The operating time was 305 min. The estimated intraoperative blood loss was approximately 300 ml;an intraoperative transfusion was not necessary. The postoperative pathology confirmed a 3.5 x 2.8 x 2.7 cm HCC with safe margins. The patient was discharged on the 9th postoperative day without any postoperative complications. A laparoscopic right hepatectomy is feasible for patients with HCC, although the operative technique is still demanding.

关键词： Hepatocellular Cancer Hemorrhage Hepatectomy laparoscopic surgery alternative control right hemihepatectomy liver function human-centered computing Laboratory Research Hepatitis B

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