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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Primary Liver Cancer - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
UI - 21243502
AU - Torzilli G
TI -
Japanese approach to hepatocellular carcinoma.
SO - Dig Liver Dis 2001 Mar;33(2):118-20
AD - Presidio Ospedaliero di Lodi, Azienda Sanitaria della Provincia di Lodi,
Italy. torvalgc@tin.it
2
UI - 21280254
AU - Aguayo A; Patt YZ
TI -
Liver cancer.
SO - Clin Liver Dis 2001 May;5(2):479-507
AD - Department of Gastrointestinal Medical Oncology, Division of Medicine,
University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
The prognosis of patients with HCC remains dismal. Even in the subgroups
of patients who have the most favorable characteristics and are eligible
for surgical resection, the 5-year survival rate is less than 25%. For
patients with more advanced disease, the median survival time is less
than 1 year. The good news in HCC research is that the disease can be
prevented. In Taiwan, the rate of HCC in children aged 6 to 9 years
decreased from 5.2 per million population before the neonatal
vaccination program began in 1984 to 1.3 per million population in the
first vaccinated cohort. Treatment of viral hepatitis with IFN may
decrease the rates of long-term development of HCC. Other agents that
may prevent second primary tumors following resection of HCC, such as
polyprenoic acid and acylic retinoid, are also being investigated.
3
UI - 21236016
AU - Finlay IG; Stewart GJ; Ahkter J; Morris DL
TI -
A phase one study of the hepatic arterial administration of
1,25-dihydroxyvitamin D3 for liver cancers.
SO - J Gastroenterol Hepatol 2001 Mar;16(3):333-7
AD - University of New South Wales, Department of Surgery, St George
Hospital, Sydney, Australia.
BACKGROUND AND AIMS: It is well established that exposure to
1,25-dihydroxyvitamin D3 (1,25(OH)2D3) inhibits the proliferation of
human colorectal cancer and hepatoma cell lines, both in vitro and in
vivo. However, clinical trials of the administration of 1,25(OH)2D3 and
analogs for the treatment of malignancy have been limited by the
development of hypercalcemia. 1,25-dihydroxyvitamin D3 is principally
excreted in bile following hepatic catabolism. This suggested the
hypothesis that hepatic regional administration may allow high doses of
1,25(OH)2D3 to be administered for the treatment of liver cancers
without producing hypercalcemia, caused by a clinically significant
first pass effect. This phase one study investigates the effect of
hepatic regional administration of 1,25(OH)2D3 on serum calcium levels,
together with other markers of renal and liver function. METHODS: Six
subjects with hepatic colorectal cancer metastases and one with primary
hepatocellular cancer were given continuous hepatic arterial infusions
of 1,25(OH)2D3, for periods of 1-4 weeks. Blood samples were taken
regularly and assayed for calcium levels, liver function tests and urea
and electrolyte levels. RESULTS: Patients remained normocalcemic at
dosages of up to 10 mcg/day. No patient experienced any side-effects
from the treatment. CONCLUSIONS: Administration of 1,25(OH)2D3 as a
continuous hepatic arterial infusion allows a high dosage to be
administered without inducing hypercalcemia. This route of
administration may allow the potential of 1,25(OH)2D3 in the treatment
of hepatic cancers to be realized.
4
UI - 21271452
AU - Lau WY; Ho S; Leung WT; Chan M; Lee WY; Johnson PJ
TI -
What determines survival duration in hepatocellular carcinoma treated
with intraarterial Yttrium-90 microspheres?
SO - Hepatogastroenterology 2001 Mar-Apr;48(38):338-40
AD - Department of Surgery, Chinese University of Hong Kong, Prince of Wales
Hospital, Shatin, Hong Kong.
BACKGROUND/AIMS: The survival duration of patients with nonresectable
hepatocellular carcinoma confined to the liver and treated with
intraarterial yttrium-90 microspheres was highly variable. METHODOLOGY:
Eighty-two patients treated by this method were analyzed. Thirty-one
patients who lived for one year or longer from the date of first
treatment were classified as 'long survivors' and 51 patients who died
within 1 year were classified as 'short survivors'. RESULTS: Comparison
between the 2 categories suggested that lower pretreatment level of
alpha-fetoprotein and higher tumor-to-normal uptake ratio of yttrium-90
microspheres favored longer survival. Results also indicated that the
treatment was effective even for large tumors and for postoperative
recurrence. Repeated treatment of viable residual or recurrent tumors
offered further palliation and prolongation of survival. CONCLUSIONS:
Pretreatment alpha-fetoprotein level, tumor-to-normal uptake ratio of
yttrium-90 microspheres and the number of treatments determine survival
duration.
5
UI - 21271456
AU - Bartolozzi C; Crocetti L; Cioni D; Donati FM; Lencioni R
TI -
Assessment of therapeutic effect of liver tumor ablation procedures.
SO - Hepatogastroenterology 2001 Mar-Apr;48(38):352-8
AD - Division of Diagnostic and Interventional Radiology, Department of
Oncology, University of Pisa, Via Roma 67, Pisa I-56125, Italy.
Bartolozzi@do.med.unipi.it
Interventional procedures for percutaneous tumor ablation have gained an
increasingly important role in the treatment of liver malignancies.
After interventional therapies, diagnostic imaging has the key role in
determining if the treated lesion is completely ablated or contains
areas of residual viable neoplastic tissue. This is particularly
important since in case of incomplete necrosis of the lesion, treatment
can be repeated, and tumor ablation can be further pursued. The
evaluation of the therapeutic effect of the procedure leads to different
problems according to the histotype of the malignancy. In the case of
hepatocellular carcinoma, detection of residual viable tumor is
facilitated by the typical hypervascular pattern of this neoplasm.
Contrast-enhanced color Doppler ultrasonography can be used to monitor
tumor response, and, in case of partial necrosis, to target the areas of
residual viable tumor. With spiral computed tomography or dynamic
magnetic resonance imaging, residual viable hepatocellular carcinoma
tissue is reliably depicted as it stands out in the arterial phase
images against the unenhanced areas of coagulation necrosis. In the case
of hypovascular metastases, a confident diagnosis of successful ablation
can be made when an area of thermal necrosis exceeding that of the
original lesion is depicted. Peripheral inflammatory reaction following
ablation procedures should not be misinterpreted as tumor progression.
6
UI - 21271464
AU - Chen SD; Tsai SC; Shiau YC; Ho YJ; Kao CH
TI -
Evidence of gallbladder function changes in hepatoma after transcatheter
arterial embolization by quantitative Tc-99m DISIDA cholescintigraphy.
SO - Hepatogastroenterology 2001 Mar-Apr;48(38):393-6
AD - Department of Internal Medicine, Fong Yuan Hospital, Department of
Health, Executive Yuan, Taichung.
BACKGROUND/AIMS: Transcatheter arterial embolization is the treatment of
choice for inoperable hepatocellular carcinoma. Gallbladder infarction
following transcatheter arterial embolization has been reported,
therefore, the gallbladder functions were studied using the quantitative
Tc-99m DISIDA cholescintigraphy in the present study. METHODOLOGY: The
gallbladder functions which were presented as the filling fraction and
the ejection fraction in 24 patients with hepatoma before and after
transcatheter arterial embolization. The patients were separated into
two groups. Group 1: 12 patients received precystic artery transcatheter
arterial embolization and group 2: 12 patients received postcystic
artery transcatheter arterial embolization. RESULTS: After transcatheter
arterial embolization, significantly decreased both gallbladder
functions of filling fraction (61.2 +/- 7.4% and 48.3 +/- 6.5%) and
ejection fraction (47.8 +/- 6.0% and 36.5 +/- 5.3%) were found in group
1 patients. However, no significant change of filling fraction (59.0 +/-
5.0% and 58.8 +/- 7.4%) and ejection fraction (49.9 +/- 2.4% and 49.3
+/- 5.7%) in group 2 patients. CONCLUSIONS: Impaired gallbladder
functions were common in hepatoma patients who received precystic artery
transcatheter arterial embolization, and Tc-99m DISIDA cholescintigraphy
may be useful for evaluating the gallbladder functions in hepatoma
patients who received transcatheter arterial embolization.
7
UI - 21271486
AU - Arata S; Tanaka K; Okazaki H; Kondo M; Morimoto M; Saito S; Numata K;
TI -
Nakamura S; Sekihara H
Risk factors for recurrence of large HCC in patients treated by combined
TAE and PEI.
SO - Hepatogastroenterology 2001 Mar-Apr;48(38):480-5
AD - Third Department of Internal Medicine, Yokohama City University School
of Medicine, Yokohama, Japan.
BACKGROUND/AIMS: In this report, risk factors of intrahepatic recurrence
of a large solitary hepatocellular carcinoma after combination therapy
with transcatheter arterial embolization followed by percutaneous
ethanol injection were studied. METHODOLOGY: The series included 61
patients with an unresectable large solitary hepatocellular carcinoma,
the largest size of which was greater than 3 cm in diameter. All
patients completely responded to combination therapy and recurrence
rates were determined. The following parameters; age, sex, hepatitis B
virus surface antigen, hepatitis C virus antibodies, Child's
classification, alcohol abuse, alanine aminotransferase, aspartate
aminotransferase, alpha-fetoprotein, indocyanine green retention rate,
hepatocellular carcinoma size, hepatocellular carcinoma capsule, total
amount of injected ethanol and the alpha-fetoprotein 1 month after
treatment were evaluated. RESULTS: The 1-, 3-, and 5-year cancer-free
survival rates of all patients were calculated to be 61%, 23%, and 13%,
respectively. Among pretreatment parameters, the log-rank test and
subsequent Cox's proportional hazards model showed that a tumor size of
more than 5 cm in diameter was independently associated with recurrence.
The posttreatment parameters of total amount of injected ethanol was
also shown to be significantly related to recurrence by the log-rank
test. CONCLUSIONS: Lesions more than 5 cm in diameter and insufficient
injected ethanol were associated with intrahepatic recurrence after this
combination therapy.
8
UI - 21271488
AU - Shimoda M; Bando T; Nagata T; Shirosaki I; Sakamoto T; Tsukada K
TI -
Prophylactic chemolipiodolization for postoperative hepatoma patients.
SO - Hepatogastroenterology 2001 Mar-Apr;48(38):493-7
AD - Department of Surgery II, Faculty of Medicine, Toyama Medical and
Pharmaceutical University, 2630 Sugitani, Toyama 930-0192, Japan.
Shimoda9@ms.toyama-mpu.ac.jp
BACKGROUND/AIMS: The efficacy of prophylactic chemolipiodolization
following hepatic resection in patients with hepatocellular carcinoma
was studied. METHODOLOGY: Forty-four of 67 consecutive patients with
hepatocellular carcinoma who underwent hepatectomy between 1980 and 1997
were divided into two groups: group A (n = 21), in which prophylactic
chemolipiodolization was performed during postoperative follow-up (2.4
times on average using a 39 mg mean dose of epirubicin or doxorubicin);
and group B (n = 23), without prophylactic chemolipiodolization. The
clinicopathological background and patient survival were compared
retrospectively. RESULTS: There were no differences in the
clinicopathological background between the two groups. Multiple
intrahepatic recurrence was frequently observed in group B (P < 0.02).
The recurrence-free survival rates in group A (54.4% and 31.1% at 3 and
5 years, respectively) were significantly higher than those in group B
(15.7% and 7.9%, respectively). The survival rates of group A (95.2% and
80.4% at 3 and 5 years, respectively) were significantly higher than
those in group B (40.1% and 22.9%, respectively). CONCLUSIONS: Our data
suggest that postoperative prophylactic chemolipiodolization can be an
effective treatment in reducing intrahepatic recurrence and may prolong
survival for hepatocellular carcinoma patients following hepatic
resection.
9
UI - 21271491
AU - Tanabe G; Ueno S; Maemura M; Kihara K; Aoki D; Yoshidome S; Ogura Y;
TI -
Hamanoue M; Aikou T
Favorable quality of life after repeat hepatic resection for recurrent
hepatocellular carcinoma.
SO - Hepatogastroenterology 2001 Mar-Apr;48(38):506-10
AD - First Department of Surgery, Kagoshima University, Kagoshima, Japan.
g-tanabe@po11.synapse.ne.jp
BACKGROUND/AIMS: The appropriate choice of treatment for recurrent
hepatocellular carcinoma after hepatic resection remains controversial.
The aim of this study is to clarify prognostic factors and quality of
life in patients with tumor recurrence after hepatic resection for
hepatocellular carcinoma. METHODOLOGY: We retrospectively analyzed 188
patients with hepatocellular carcinoma who underwent curative hepatic
resection between 1988 and 1997. Statistical analysis was performed to
identify prognostic factors involved after recurrence. Furthermore,
quality of life after treatment for recurrence was compared between
patients with repeat hepatic resection or hepatic arterial infusion
chemotherapy. RESULTS: In 123 patients with recurrence, unfavorable
predictors after recurrence are pTNM Stage III/IV at initial surgery,
receiving chemotherapy before initial surgery and presence of
extrahepatic recurrence. In contrast, favorable predictors are 3 years
or more of disease-free interval and repeat hepatic resection. The
incidence of deteriorated performance status in the repeat hepatic
resection group was lower than in the hepatic arterial infusion
chemotherapy group because of better psychological function in patients
undergoing repeat hepatic resection. CONCLUSIONS: Repeat hepatic
resection provides a good prognosis and a favorable quality of life in
patients with recurrence after hepatic resection for hepatocellular
carcinoma.
10
UI - 21271493
AU - Yoshidome S; Tanabe G; Yoshida A; Ueno S; Hamanoue M; Mitue S; Aikou T
TI -
Risk prediction using histology of noncancerous liver before hepatic
resection for hepatocellular carcinoma.
SO - Hepatogastroenterology 2001 Mar-Apr;48(38):518-22
AD - First Department of Surgery, Kagoshima University School of Medicine,
8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan. shinro@po.synapse.ne.jp
BACKGROUND/AIMS: The aim of this study is to elucidate the feasibility
of the risk assessment of hepatic resection by histological evaluation
of noncancerous liver in patients with hepatocellular carcinoma.
METHODOLOGY: The study involved 78 patients with hepatocellular
carcinoma who had undergone a needle biopsy of noncancerous liver before
hepatic resection. The histological activity index score which consists
of four categories indicating the inflammatory activity and the degree
of fibrosis was determined, and its association with complications after
hepatic resection was examined. RESULTS: Postoperative complications
occurred in 26 of the first 52 patients that underwent hepatic
resection. A logistic analysis selected histological activity index
score as an independent factor related to postoperative complications
(Odds ratio 1.31, P < 0.02). Postoperative complications occurred more
frequently in patients with a histological activity index score > or = 6
that had undergone resection of two or more segments (P < 0.05), and
also in those with histological activity index score > or = 10 that had
undergone segmentectomy or subsegmentectomy (P < 0.05). When the
histological activity index score was taken into consideration in
deciding operative procedures for a further 20 patients, the incidence
of postoperative complications reduced considerably to 10%. CONCLUSIONS:
Preoperative histological evaluation of noncancerous liver by a needle
biopsy may be helpful in deciding the operative procedure to avoid
complications after hepatic resection for hepatocellular carcinoma.
11
UI - 21287873
AU - Camma C; Giunta M; Andreone P; Craxi A
TI -
Interferon and prevention of hepatocellular carcinoma in viral
cirrhosis: an evidence-based approach.
SO - J Hepatol 2001 Apr;34(4):593-602
AD - Istituto Metodologie Diagnostichie Avanzate, Consiglio Nazionale delle
Ricerche, Palermo, Italy. camma@ismeda.pa.cnr.it
BACKGROUND/AIMS: To evaluate by meta-analysis of available literature
whether interferon (IFN) reduces the incidence of hepatocellular
carcinoma (HCC) in patients with hepatitis B virus (HBV) or hepatitis C
virus (HCV)-related Child A cirrhosis. METHODS: Three randomized
controlled trials and 15 nonrandomized controlled trials, including 4614
patients and comparing IFN to no treatment, were selected. Data on the
incidence of HCC in IFN treated and untreated patients were extracted
from each study. Meta-analysis by the DerSimonian and Laird risk
difference (RD) method was used to pool observations. RESULTS: A
different incidence of HCC between treated and untreated cirrhotic
patients was observed for HCV (overall RD -12.8%; 95% CI -8.3 to -17.2%,
P < 0.0001) and HBV (overall RD -6.4%; 95% CI -2.8 to -10%, P < 0.001).
In HCV-related cirrhosis, the rate of HCC development was lower in
sustained responders to IFN than in untreated patients (overall RD
-19.1%; 95% CI -13.1 to -25.2%, P < 0.00001), with low heterogeneity
among trials (P=0.053), and also in nonresponders vs. untreated patients
(overall RD -11.8%; 95% CI -6.4 to -19.1%, P < 0.0001), although with
significant heterogeneity. Inconsistency among the studies was a major
problem, both for HCV (chi2 = 58.16 with 13 DF; P < 0.0001) and HBV
(chi2 = 26.4 with 6 DF; P = 0.0001) related cirrhosis, and also when
follow-up was shorter than 60 months. Consistent results were only
observed when assessing data from European reports: in this subgroup no
preventive effect of HCC was shown for HBV (overall RD -4.8%; 95% CI
-11.1-1.5%, P, not significant), and only a weak effect for HCV (overall
RD -10%; 95% CI -5.9 to -14.2%; P < 0.0001). CONCLUSIONS: Literature
data pooling suggests a slight preventive effect of IFN on HCC
development in patients with HCV-related cirrhosis. The magnitude of
this effect is low and the observed benefit might be due to spurious
associations. The preventive effect is more evident among sustained
responders to IFN. IFN does not seem to affect the rate of HCC in
HBV-related cirrhosis.
12
UI - 21287875
AU - Valla DC; Degos F
TI -
Chemoprevention of hepatocellular carcinoma in hepatitis C virus-related
cirrhosis: first, eliminate the virus.
SO - J Hepatol 2001 Apr;34(4):606-9
13
UI - 21393544
AU - Srivastava DN; Gandhi D; Seith A; Pande GK; Sahni P
TI -
Transcatheter arterial embolization in the treatment of symptomatic
cavernous hemangiomas of the liver: a prospective study.
SO - Abdom Imaging 2001 Sep-Oct;26(5):510-4
AD - Department of Radiodiagnosis, All India Institute of Medical Sciences,
Ansari Nagar, New Delhi 110029, India.
BACKGROUND: This prospective study evaluated the clinical and radiologic
results of transcatheter arterial embolization (TAE) for the treatment
of symptomatic cavernous hemangiomas of the liver. The technique, its
complications, and effectiveness also were analyzed. METHODS: Eight
patients (five male, three female; mean age +/- SD = 47.75 +/- 8.59
years) with symptomatic cavernous hemangiomas of the liver were treated
by TAE with polyvinyl alcohol particles or gelfoam and steel coils
(single session) followed by supportive treatment. Tumor
characterization (including the extent and number of lesions) was done
on triple-phase helical computed tomography or gadolinium-enhanced
dynamic magnetic resonance imaging. RESULTS: The lesions were located in
the right lobe in five patients, left lobe in one, and both lobes in
two. The largest diameter of the lesions was 6-18 cm (9.28 +/- 5.13 cm).
The treatment response was assessed on follow-up ultrasound and color
Doppler and/or contrast-enhanced helical computed tomography. There were
no treatment-related deaths and morbidity was minimal. Embolization was
the only method of treatment in seven patients; however, one patient had
surgery after TAE because the symptoms were only partly relieved.
Indications for embolization were abdominal pain (eight patients), rapid
tumor enlargement (four of eight), and recurrent jaundice (one of
eight). Symptomatic improvement was documented in all patients after
embolization. Symptoms did not worsen in any patient. The mean size of
the tumor did not show any statistically significant change on follow-up
radiologic examinations. However, in one patient, the tumor
significantly regressed in size after embolization. CONCLUSION: TAE of
hepatic cavernous hemangioma is a useful procedure in the therapy of
symptomatic hemangiomas.
14
UI - 21424857
AU - Gonzalez KB; Woodall M
TI -
Hepatocellular carcinoma: surgical treatment options.
SO - Nurs Clin North Am 2001 Sep;36(3):593-602, xii
AD - Department of Surgical Oncology, The University of Texas MD Anderson
Cancer Center, Houston, Texas 77030-4009, USA. kbgonzal@mdanderson.org
Hepatocellular carcinoma is one of the most common and lethal cancers
worldwide. Survival rates generally are poor because of late diagnosis,
tumor volume, and location. Early detection combined with surgical
treatment advances, however, can provide longer disease-free survival.
15
UI - 21455847
AU - Cheng SJ; Pratt DS; Freeman RB Jr; Kaplan MM; Wong JB
TI -
Living-donor versus cadaveric liver transplantation for non-resectable
small hepatocellular carcinoma and compensated cirrhosis: a decision
analysis.
SO - Transplantation 2001 Sep 15;72(5):861-8
AD - New England Medical Center, Tufts University School of Medicine, 750
Washington St, PO Box 302, Boston, MA 02111, USA.
BACKGROUND: Cadaveric liver transplantation is effective for
nonresectable early hepatocellular carcinoma. However, the scarcity of
cadaveric organs has prompted some centers to use living donors, which
guarantees transplantation, but entails a risk to the donor. In the
absence of controlled trials, decision analysis can be used to help
explicate the tradeoffs involved when considering living donor versus
cadaveric liver transplantation for nonresectable early hepatocellular
carcinoma. METHODS: Using a Markov model, a hypothetical cohort of
patients with Child's A cirrhosis and a single 3.5-cm tumor received one
of three strategies: 1) no transplant; 2) intent to perform cadaveric
liver transplantation; or 3) living donor liver transplantation. Data
were obtained from natural history and retrospective studies. All
probabilities in the model were varied simultaneously using a Monte
Carlo simulation. RESULTS: Living-donor liver transplantation was the
best strategy, improving life expectancy by 4.5 years compared with
cadaveric liver transplantation. This strategy remained dominant even
when varying severity of cirrhosis, age, tumor doubling time, tumor
growth pattern, blood type, regional transplant volume, initial tumor
size, and rate of progression of cirrhosis. CONCLUSIONS: Living-donor
liver transplantation should confer a substantial survival advantage for
patients with compensated cirrhosis and non-resectable early stage
hepatocellular carcinoma.
16
UI - 21446991
AU - Yamamoto M; Takasaki K; Ohtsubo T; Katsuragawa H; Fukuda C; Katagiri S
TI -
Effectiveness of systematized hepatectomy with Glisson's pedicle
transection at the hepatic hilus for small nodular hepatocellular
carcinoma: retrospective analysis.
SO - Surgery 2001 Sep;130(3):443-8
AD - Department of Surgery, Institute of Gastroenterology, Tokyo Women's
Medical University, Tokyo, Japan.
BACKGROUND: The effectiveness of systematized hepatectomy with
transection of Glisson's pedicle at the hepatic hilus in patients with
small nodular hepatocellular carcinoma (HCC) has not been confirmed.
METHODS: Surgical outcomes were reviewed in 204 patients with single
nodular HCCs less than 5 cm in greatest diameter, including 68 patients
with tumors that showed extranodular growth and 136 patients with tumors
that did not, who had undergone curative hepatectomy (partial hepatic
resection, n = 114; systematized hepatectomy, n = 90) from 1990 through
1994. RESULTS: The rates of microscopic vascular invasion and
intrahepatic metastasis were significantly higher in patients who had
single nodular HCCs with extranodular growth (34% and 49%) than in
patients who had single nodular HCCs without extranodular growth (13%, P
=.001, and 4%, P <.001). The 5-year survival rate in patients who had
single nodular HCCs with extranodular growth was significantly greater
after systematized hepatectomy (67%) than after partial hepatic
resection (21%, P =.0002). Multivariate analysis showed that the type of
operation was an independent prognostic factor in patients with single
nodular HCCs with extranodular growth (P =.0008). CONCLUSIONS:
Systematized hepatectomy with Glisson's pedicle transection at the
hepatic hilus should be performed in patients who have single small
nodular HCCs with extranodular growth because these tumors often invade
within the liver sector containing the tumor.
17
UI - 21458874
AU - Okada S
TI -
Cancer chemoprevention as adjuvant therapy for hepatocellular carcinoma.
SO - Jpn J Clin Oncol 2001 Aug;31(8):357-8
18
UI - 21458875
AU - Okuno M; Sano T; Matsushima-Nishiwaki R; Adachi S; Akita K; Okano Y;
TI -
Kojima S; Moriwaki H
Apoptosis induction by acyclic retinoid: a molecular basis of 'clonal
deletion' therapy for hepatocellular carcinoma.
SO - Jpn J Clin Oncol 2001 Aug;31(8):359-62
AD - First Department of Internal Medicine, Gifu University School of
Medicine, Gifu, Japan.
We have shown previously that administration of acyclic retinoid to
cirrhotic patients who had undergone curative treatment of preceding
hepatocellular carcinoma (HCC) induced the disappearance of serum
lectin-reactive alpha-fetoprotein (AFP-L3) and subsequently reduced the
incidence of second liver cancers. AFP-L3 is a tumor marker that
indicates the presence of occult tumors below the detection limit by
diagnostic images. Therefore, we have proposed a new concept of 'clonal
deletion' therapy with acyclic retinoid for the cancer chemoprevention
against HCC. Such eradication of AFP-L3-producing latent malignant (or
premalignant) cells from the liver suggested a new strategy to prevent
HCC, which may be involved in the same category as cancer chemotherapy.
In the present series of studies, we explored the molecular mechanism of
'clonal deletion' and found a novel mechanism of apoptosis induction by
the retinoid. We have demonstrated a modification of a retinoid
receptor, RXRalpha, by mitogen-activated protein (MAP) kinase-dependent
phosphorylation, resulting in the loss of transactivating activity. This
may lead HCC cells to be resistant to natural retinoic acid. However,
acyclic retinoid restored the function of phosphorylated RXRalpha and
induced its downstream pro-apoptotic genes including tissue
transglutaminase, an enzyme that is implicated in apoptosis. Tissue
transglutaminase-dependent apoptosis in HCC cells was independent of the
activation of caspases. This novel mechanism of retinoid-induced
apoptosis may give a clue to understand the molecular mechanism of
clonal deletion.
19
UI - 21384113
AU - Yamamoto Y
TI -
[Liver resection in liver cirrhosis]
SO - Chirurg 2001 Jul;72(7):784-93
AD - Department of Gastroenterological Surgery, Kyoto University Graduate
School of Medicine, Kyoto, Japan. mai@kuhp.kyoto-u.ac.jp
The benefits of liver resection for patients with hepatocellular
carcinoma (HCC) and concomitant liver cirrhosis have been questionable
due to high rates of postoperative complications. As a result of advance
in surgical techniques, along with improved perioperative management and
increased knowledge of the pathophysiology of liver cirrhosis, liver
resection in cirrhotic patients has become a safer surgical procedure
during the 1990s. This article introduces our techniques of parenchymal
resection in patients with liver cirrhosis, avoiding inflow occlusion of
the hepatic circulation by using a Cavitron Ultrasonic Surgical
Aspirator (CUSA) and bipolar cautery that is equipped with a mechanism
for channeling water at the point of cauterization. Analysis of survival
rates showed that surgical resection was more advantageous than
treatment such as percutaneous ethanol injection, although the discovery
of multicentric carcinogenesis in livers with hepatitis C viral
infection required us to reconsider surgical indications for HCC and
concomitant liver cirrhosis.
20
UI - 21384114
AU - Kraus TW; Golling M; Klar E
TI -
[Definition of surgical degree of freedom by functional anatomy in liver
resection surgery]
SO - Chirurg 2001 Jul;72(7):794-805
AD - Chirurgische Universitatsklinik, Heidelberg.
Thomas.Kraus@med.uni-heidelberg.de
Liver resections have developed to very complex and differentiated
operations, clearly adapted to individual anatomical and physiological
conditions. In parallel, perioperative morbidity has been dramatically
reduced. Intraoperative strict consideration of various details of
hepatic anatomy, particularly of functional liver anatomy, has proved to
be of particular importance when liver surgery reaches indication and
technical limits. The term "functional anatomy" stands for a form of
hepatic substructurization, which is primarily based on the existence of
hemodynamically independent regions of liver parenchyma. A selection of
some of the most important details and facts of functional liver anatomy
and secondary derived guidelines for surgical strategy and technique is
presented in an overview, with special focus on liver resection.
21
UI - 21419010
AU - Shuto T; Hirohashi K; Kubo S; Tanaka H; Yamamoto T; Higaki I; Takemura
TI -
S; Kinoshita H
Treatment of adrenal metastases after hepatic resection of a
hepatocellular carcinoma.
SO - Dig Surg 2001;18(4):294-7
AD - Second Department of Surgery, Osaka City University Medical School,
Osaka, Japan. shutou@med.osaka-cu.ac.jp
BACKGROUND: The adrenal gland is a common site of extrahepatic
metastases from a hepatocellular carcinoma (HCC). However, treatment of
adrenal metastases has not been well characterized. METHODS: Of 562
patients who underwent hepatic resection for a HCC, 91 developed
extrahepatic metastases. We reviewed the medical records of 10 patients
with adrenal metastases (9 males and 1 female; mean age 63 years at the
time of hepatic resection). RESULTS: The mean diameter of the primary
tumors was 5 cm, and all were located in the right lobe of the liver.
The mean interval from hepatic resection to recurrence was 18 months.
Seven patients underwent treatment of intrahepatic recurrence. To treat
the adrenal metastases, surgical resection was performed in 4 patients,
and transcatheter arterial embolization was performed in 1 patient. The
patients treated had no other extrahepatic metastases. The mean diameter
of the resected adrenal tumors was 6 cm. There was no hospital
mortality. With surgical resection, 1 patient has been alive 63 months
after recurrence. CONCLUSIONS: Adrenal metastases from a HCC were often
large at the time of diagnosis. Since surgical resection was a safe
procedure, and some patients could be alive for a long time, it should
be performed whenever possible. Copyright 2001 S. Karger AG, Basel
22
UI - 21467982
AU - Yamamoto J; Okada S; Shimada K; Okusaka T; Yamasaki S; Ueno H; Kosuge T
TI -
Treatment strategy for small hepatocellular carcinoma: comparison of
long-term results after percutaneous ethanol injection therapy and
surgical resection.
SO - Hepatology 2001 Oct;34(4 Pt 1):707-13
AD - Hepatobiliary and Pancreatic Surgery Division and Oncology Division,
National Cancer Center Hospital, Tokyo, Japan. jyamamoto@jfcr.or.jp
This comparative study was conducted to clarify the efficacy of
percutaneous ethanol injection (PEI) and surgical resection in the
treatment of small hepatocellular carcinomas (HCC). Thirty-nine patients
treated by PEI and 58 who underwent hepatic resection for small HCC
(smaller than 3 cm and 3 or less in number) during the same period were
enrolled. The surgery group included more patients with large and
multiple bilobar nodules than the PEI group. The histological
differentiation of the treated tumors became worse in the surgery
patients than in those treated by PEI. On the other hand, the PEI group
included more patients with a poor hepatic reserve, according to
Child-Pugh grading, the ICG test, and the serum total bilirubin value.
The 1-, 3-, and 5-year overall survival rates were almost identical
between the 2 cohorts (100%, 82.1%, and 59.0%, respectively, in the PEI
group; 96.6%, 84.4%, and 61.5%, respectively, in the surgery group) (P
=.96). During the follow-up period, 33 of 39 (85%) and 41 of 58 (71%)
patients developed tumor recurrence after PEI and surgery, respectively.
Cumulative 1-, 3-, and 5-year tumor-free survival rates in the PEI group
were 63.4%, 30.3%, and 9.7 %, whereas those in the surgery group were
75.5%, 44.7%, and 25.7%, respectively (P =.10). Our overall findings
show that local therapy can achieve an actual 5-year survival rate of
around 60% for patients with small HCC with the proper selection of
treatment. A prospective randomized comparative trial is required to
settle this longstanding issue.
23
UI - 21263169
AU - Czauderna P; Popadiuk S; Korzon M; Stoba C; Szymik-Kantorowicz S;
TI -
Sawicz-Birkowska K; Lopatka B; Boguslawska-Jaworska J; Kowalczyk J;
Sopylo B; Madziara W; Juszkiewicz P; Swiatkiewicz V; Skotnicka-Klonowicz
G; Wlodarczyk A
Multicenter retrospective analysis of various primary pediatric
malignant hepatic tumors--management in a series of 47 Polish patients
(1985-1995).
SO - Eur J Pediatr Surg 2001 Apr;11(2):82-5
AD - Polish Pediatric Group of Solid Tumors, Medical University of Gdansk.
Forty-seven children treated in various Polish centers between 1985 and
1995 for primary malignant liver tumors were retrospectively analyzed.
Hepatoblastoma (HB) prevailed--it was found in 39 cases. There were 6
hepatocarcinoma (HCC) cases and 2 cases of undifferentiated sarcoma
(UDS). In 44% of HB patients the tumor involved both liver lobes. 18% of
children with HB presented with pulmonary metastases at diagnosis.
Chemotherapy was applied in 92% of cases (preoperatively in 67%). Tumor
resection was performed in 56% of HB patients. Overall survival of
patients with hepatoblastoma was 43.6%, while it was 50% for
hepatocarcinoma and 100% for undifferentiated sarcoma (2 cases only).
Mean observation time was 58 months. The hepatoblastoma subgroup, being
the largest (83% of all cases), was analyzed separately for prognostic
factors. Completeness of tumor excision strongly influenced survival.
Involvement of both lobes of the liver and multifocality of the tumor
were other adverse prognostic factors.
24
UI - 21371118
AU - Wang H
TI -
[Clinical observation on effect of comprehensive immunotherapy in
treating hepatic carcinoma after embolism chemotherapy]
SO - Zhongguo Zhong Xi Yi Jie He Za Zhi 1998 Jul;18(7):411-3
AD - Henan Provincial Tumor Hospital, Zhengzhou 450003.
OBJECTIVE: To probe the relationship between survival period and immune
function of hepatic carcinoma patients after embolism chemotherapy.
METHODS: One hundred and eight patients of hepatocarcinoma were randomly
divided into three groups. Group A was given simple embolism
chemotherapy (ECT), immunotherapy and Chinese herbal medicine were given
to Group B and C respectively after ECT. RESULTS: The short-term
effective rate of Group A, B and C was 61.1%, 83.3% and 80.6%
respectively, three-year survival rate 28.6%, 39.1% and 47.3%, median
length of survival 11, 17 and 15 months respectively. The difference in
terms of these indices were significant. Observation on immune function
after treatment showed that patients received ECT alone had a lower
immunity than those supplemented with immunotherapy or Chinese herbal
medicine. CONCLUSIONS: Period of survival of hepatocarcinoma patients is
related with their immune function. Patients with better immunity could
enjoy a relatively extended period of survival.
25
UI - 21410261
AU - Schrem H; Schutze S; Klempnauer J
TI -
[What's new in hepatobiliary surgery?]
SO - Zentralbl Chir 2001 Aug;126(8):569-70
26
UI - 21439863
AU - Lystad E; Hostmark AT; Jebens E
TI -
Apoptotic effects of dichloro stearic and dichloro myristic acid in
human hepatoma cells (HepG2).
SO - Pharmacol Toxicol 2001 Aug;89(2):85-91
AD - Department of Preventive Medicine and Epidemiology, University of Oslo,
P.O. Box 1130 Blindern, N-0318 Oslo, Norway.
Chlorinated fatty acids represent the major fraction of extractable
organically bound chlorine in fish. After dietary intake such fatty
acids may accumulate in adipose tissue, and even be transferred from
mother to child via breast milk. We have previously reported that
9,10-dichloro stearic acid and 5,6-dichloro myristic acid inhibited cell
growth. The aim of the present work was to investigate whether the
growth inhibitory effect of these modified fatty acids might involve
apoptosis. Human hepatoma cells (HepG2) were cultured for 4 days before
addition of chlorinated fatty acids, and then cultured for another day
before harvested. Morphological analysis was mainly done by light
microscopy. In addition, fluorescence microscopy and electrophoretic
analysis of DNA were carried out. The effect of 0.3 and 0.6 mmol/l was
studied. Both chlorinated fatty acids seemed to cause a
concentration-dependent increase in the relative abundance of pycnotic
and broken nuclei, as well as nuclear fragments, with the strongest
effect of dichloro stearic acid. Apoptosis by the chlorinated fatty
acids was however less than that of docosahexaenoic acid, a known
apoptosis effector. In conclusion, chlorinated fatty acids seem to
possess the ability to cause apoptosis.
27
UI - 21468692
AU - Weber SM; Jarnagin WR; Klimstra D; DeMatteo RP; Fong Y; Blumgart LH
TI -
Intrahepatic cholangiocarcinoma: resectability, recurrence pattern, and
outcomes.
SO - J Am Coll Surg 2001 Oct;193(4):384-91
AD - Hepatobiliary Service, Memorial Sloan-Kettering Cancer Center, New York,
NY, USA.
Intrahepatic cholangiocarcinoma (IHC) is a rare primary hepatic tumor of
bile duct origin for which resection is the most effective treatment.
But resectability, outcomes after resection, and recurrence patterns
have not been well described. Patients with IHC were identified from a
prospective database. Demographic data, tumor characteristics, and
with hepatic tumors underwent exploration and were found to have pure
IHC on pathologic analysis. Patients with mixed hepatocellular and
cholangiocarcinoma tumors were excluded. At exploration, 20 patients
were unresectable for an overall resectability rate of 62% (33 of 53).
Median survival for patients submitted to resection was 37.4 months
versus 11.6 months for patients undergoing biopsy only (p = 0.006;
median followup for surviving patients, 15.6 months). Actuarial 3-year
survival was 55% versus 21%, respectively. Factors predictive of poor
survival after resection included vascular invasion (p = 0.0007),
histologically positive margin (p = 0.009), or multiple tumors (p =
0.003). After resection, 20 of 33 patients (61%) recurred at a median of
12.4 months. Sites of recurrence included the liver (14),
retroperitoneal or hilar nodes (4), lung (4), and bone (2). The median
disease-free survival was 19.4 months, with a 3-year disease-free
survival rate of 22%. Factors predictive of recurrence were multiple
tumors (p = 0.0002), tumor size (p = 0.001), and vascular invasion (p =
0.01). About two-thirds of patients who appeared resectable on
preoperative imaging were amenable to curative resection at the time of
operation. Although complete resection improved survival, recurrence was
common. The majority of recurrences were local or regional, which may
help guide future adjuvant therapy strategies.
28
UI - 20102125
AU - Liu CL; Fan ST; Ng IO; Lo CM; Poon RT; Wong J
TI -
Treatment of advanced hepatocellular carcinoma with tamoxifen and the
correlation with expression of hormone receptors: a prospective
randomized study.
SO - Am J Gastroenterol 2000 Jan;95(1):218-22
AD - Centre of Liver Diseases, and Department of Surgery, University of Hong
Kong Medical Centre, Queen Mary Hospital, China.
OBJECTIVES: A prospective randomized study was performed to test the
hypothesis that tamoxifen might improve the survival of patients with
advanced hepatocellular carcinoma (HCC) and to correlate the response of
treatment with the expression of hormone receptors. METHODS: One hundred
nineteen patients with advanced and otherwise untreatable HCC were
included in a placebo-controlled, single-blind trial. The patients were
randomized to tamoxifen group (61 patients) and control group (58
patients) and were prescribed with a daily dose of 30 mg of tamoxifen
and placebo, respectively. Immunohistochemical tests for estrogen and
progesterone receptors were performed on the tumor tissues obtained from
66 patients. All patients were closely monitored and the survival
outcome of the two groups of patients was compared and stratified
according to the hormonal receptor status. RESULTS: There was no
difference in the 1-month mortality rates (32.8% vs. 43.1%, p = 0.246)
and the median survival (44 days vs. 41 days, p = 0.703) between the
tamoxifen group and the control group. Furthermore, the expression of
hormone receptors in the tumors did not affect the survival outcome of
the patients treated with tamoxifen. None of the patients who survived
longer than 3 months had tumor that had partial response to tamoxifen
treatment on follow-up imaging study. CONCLUSIONS: Tamoxifen has no
efficacy in the treatment of patients with advanced HCC and response to
treatment was not affected by the expression of hormone receptors.
29
UI - 97361703
AU - Marsh JW; Dvorchik I; Casavilla A; Fung JJ; Iwatsuki S
TI -
Should reimbursement be denied for liver transplantation in patients
with hepatocellular carcinoma?
SO - JAMA 1997 Jul 16;278(3):203-5
30
UI - 99347682
AU - Mitchell P
TI -
Alleged unlicensed gene-therapy trial comes to light.
SO - Lancet 1999 Jul 17;354(9174):225
31
UI - 21444703
AU - Pohl J; Zuna I; Stremmel W; Rudi J
TI -
Systemic chemotherapy with epirubicin for treatment of advanced or
multifocal hepatocellular carcinoma.
SO - Chemotherapy 2001 Sep-Oct;47(5):359-65
AD - Department of Medicine, University Hospital, Heidelberg, Germany.
juergenpohl@med.uni-heidelberg.de
BACKGROUND: The purpose of this retrospective study was to determine the
response rate and effect on survival of chemotherapy with epirubicin in
non-resectable advanced hepatocellular carcinoma (HCC). METHODS:
Fifty-two patients with non-resectable disease were treated with
epirubicin. A treatment cycle consisted of 20 mg/m(2) i.v. on days 1, 8
and 15 and was repeated every 4 weeks to a maximum dose of 1,000
mg/m(2). Forty-four patients were eligible for analysis. RESULTS: Out of
44 patients, 1 (2.3%) achieved a complete response, 3 (6.8%) had partial
responses and 16 (36%) had stable disease (SD). For patients with
successful disease control (complete and partial responders and patients
with SD), the median survival was 16.2 months; for non-responders, it
was 6.1 months (p < 0.003). Eight (88.9%) of 9 patients with
alpha-fetoprotein (AFP) levels <50 microg/l achieved successful disease
control compared to 12 (34.9%) out of 35 patients with initially
elevated AFP (p < 0.0001). CONCLUSION: Epirubicin appears to be an
active therapeutic option for patients with non-resectable HCC.
Especially the subgroup of patients with low levels of AFP may benefit
from this treatment. Copyright 2001 S. Karger AG, Basel
32
UI - 21450110
AU - Cioni D; Lencioni R; Rossi S; Garbagnati F; Donati F; Crocetti L;
TI -
Bartolozzi C
Radiofrequency thermal ablation of hepatocellular carcinoma: using
contrast-enhanced harmonic power doppler sonography to assess treatment
outcome.
SO - AJR Am J Roentgenol 2001 Oct;177(4):783-8
AD - Division of Diagnostic and Interventional Radiology, Department of
Oncology, Transplants, and Advanced Technologies in Medicine, University
of Pisa, Via Roma 67, I-56125 Pisa, Italy.
OBJECTIVE: We evaluated the accuracy of contrast-enhanced harmonic power
Doppler sonography in assessing the outcome of radiofrequency thermal
ablation of hepatocellular carcinoma. SUBJECTS AND METHODS: Fifty
patients with 65 hepatocellular carcinoma nodules (1-5 cm in diameter;
mean diameter, 2.5 cm) were studied using unenhanced and
contrast-enhanced harmonic power Doppler sonography before and after IV
administration of a microbubble contrast agent. The examinations were
repeated after treatment of the tumors with radiofrequency ablation.
Findings of the Doppler studies were compared with those of dual-phase
helical CT, which were used as points of reference for assessing
treatment outcome. RESULTS: Before radiofrequency treatment,
intratumoral blood flow was revealed by unenhanced power Doppler
sonography in 48 (74%) of 65 hepatocellular carcinoma nodules. After
injection of the contrast agent, intratumoral enhancement was observed
in 61 (94%) of 65 hepatocellular carcinomas (p < 0.01). After
radiofrequency treatment, all 51 (84%) of the 61 hepatocellular
carcinomas found to be necrotic on helical CT scans failed to show
enhancement on power Doppler sonograms. In nine of the 10 lesions that
showed a residual viable tumor on helical CT scans, persistent
intratumoral enhancement-matching the enhancing areas on helical CT
images-was revealed by power Doppler sonography. These nine
hepatocellular carcinomas were subjected to repeated radiofrequency
thermal ablation with the guidance of contrast-enhanced power Doppler
sonography. Complete necrosis was seen after the second treatment
session in six of the nine lesions. CONCLUSION: Contrast-enhanced
harmonic power Doppler sonography is an accurate technique for assessing
the outcome of radiofrequency thermal ablation of hepatocellular
carcinoma and may be useful in guiding additional treatment in patients
with incomplete response to i
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