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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Primary Liver Cancer - February 2002
National Cancer Institute®
Last Modified: February 1, 2002
Table of Contents
1
UI - 11778559
AU - Lin Z; Ren Z; Xia J
TI -
[Appraisal of postoperative transcatheter arterial chemoembolization
(TACE) for prevention and treatment of hepatocellular carcinoma
recurrence]
SO - Zhonghua Zhong Liu Za Zhi 2000 Jul;22(4):315-7
AD - Liver Cancer Institute, Zhongshan Hospital, Shanghai Medical University,
Shanghai 200032, China.
OBJECTIVE: To evaluate the effect of postoperative TACE for prevention
and treatment of hepatocellular carcinoma (HCC) recurrence after radical
after radical resection were followed up with serum AFP, liver US and
CT, chest X-ray film, hepatic artery angiography, etc. They were divided
into 2 groups. Patients in group A (n = 68) with no residual tumor were
given prophylactic TACE treatment, 1-2 times at the second and fifth
month after operation. Patients in group B (n = 41) with residual tumor
left were treated with regular TACE, once every 2 months. The 2 groups
of patients were followed up for 6-45 months after operation. RESULTS:
In group A, the real curative resection rate was 62.4%. Tumor recurrence
was found in 10 of the 68 patients, with a total recurrence rate of
14.7% within 3 years after radical resection. The 1-, 2-, and 3-year
cumulative recurrence rate was 7.4%, 13.2% and 14.7%, respectively. The
1-, 2-, and 3-year survival rate was 100%, 93.4% and 85.7%,
respectively, while that in group B was 78.1%, 57.7% and 57.7%,
respectively. The differences between the 2 groups of patients were
statistically significant. The predictive pathological factors hampering
completeness of tumor resection were: tumor size > 5 cm, more than 2
tumor nodules, the presence of satellite nodules, tumor with partial or
without encapsulation and tumor thrombus in portal vein. Hepatic artery
angiography with LP-CT and maintenance of high serum AFP level were the
most sensitive methods for detecting residual tumor after operation.
CONCLUSION: Post-operative TACE is very useful for prevention and
treatment of HCC recurrence. It helps improve survival of surgically
treated HCC patients.
2
UI - 11815984
AU - Bisogno G; Pilz T; Perilongo G; Ferrari A; Harms D; Ninfo V; Treuner J;
TI -
Carli M
Undifferentiated sarcoma of the liver in childhood: a curable disease.
SO - Cancer 2002 Jan 1;94(1):252-7
AD - Pediatric Oncology-Hematology Division, University of Padova, Padova,
Italy. bisogno@unipd.it
BACKGROUND: Undifferentiated (embryonal) sarcoma of the liver (UESL) is
a rare childhood hepatic tumor, and it is generally considered an
aggressive neoplasm with an unfavorable prognosis. METHODS: The Soft
Tissue Sarcoma Italian and German Cooperative Groups enrolled 17
children with UESL in studies conducted between 1979 and 1995. They were
treated using the same multimodal approach as for patients with sarcomas
including conservative surgery at diagnosis, multiagent chemotherapy,
and second-look operation in cases of residual disease. Radiotherapy was
occasionally used (2 of 17 patients). RESULTS: Twelve patients are alive
with follow-up ranging from 2.4 to 20 years. Eight underwent complete
tumor resection either at diagnosis or after preoperative chemotherapy,
and all are currently alive. After initial chemotherapy tumor reduction
was evident in six of nine evaluable cases. Overall three patients died
of disease and one of a surgical complication. One child died in second
complete remission for a non-disease-related cause. CONCLUSIONS: The
current prognosis of UESL no longer should be regarded as poor. Modern
multimodal treatment and supportive therapy have improved survival.
Copyright 2002 American Cancer Society.
3
UI - 11443478
AU - Chung MH; Wood TF; Tsioulias GJ; Rose DM; Bilchik AJ
TI -
Laparoscopic radiofrequency ablation of unresectable hepatic
malignancies. A phase 2 trial.
SO - Surg Endosc 2001 Sep;15(9):1020-6
AD - John Wayne Cancer Institute, Saint John's Health Center, 2200 Santa
Monica Boulevard, Santa Monica, California, 90404, USA.
BACKGROUND: Radiofrequency ablation (RFA) of hepatic malignancies has
been performed successfully via a percutaneous route or at laparotomy.
We analyzed the efficacy and utility of laparoscopic intraoperative
ultrasound and RFA in patients with unresectable hepatic malignancies.
unresectable hepatic malignancies and no evidence of extrahepatic
disease were entered in a phase 2 trial of laparoscopic intraoperative
ultrasound and RFA. Real-time ultrasonography was used to guide RFA, and
lesions were ablated at a temperature of 100 degrees C for 10 min.
Overlapping ablations were performed for larger lesions. RESULTS:
Additional tumors were identified in 10 (37%) of the 27 study patients
by laparoscopy and laparoscopic intraoperative ultrasound despite
extensive preoperative imaging. Radiofrequency ablation of 85 hepatic
tumors yielded no mortality and only one case of postoperative bleeding.
During a mean follow-up period of 14 months, four tumors (4.7%) locally
recurred. Of the 27 patients, 11 (41%) remain free of disease at this
writing; (22%) are alive with disease; and 10 (37%) have died with
disease. CONCLUSION: Laparoscopic RFA and intraoperative ultrasound
constitute a safe and accurate method for ablation of unresectable
hepatic tumors.
4
UI - 10986665
AU - Steiner P
TI -
[Transarterial chemoembolization (TACE) and thermoablation]
SO - Internist (Berl) 2000 Aug;41(8):783
5
UI - 11677974
AU - Itamoto T; Katayama K; Fukuda S; Fukuda T; Yano M; Nakahara H; Okamoto
TI -
Y; Sugino K; Marubayashi S; Asahara T
Percutaneous microwave coagulation therapy for primary or recurrent
hepatocellular carcinoma: long-term results.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1401-5
AD - Department of Surgery II, Hiroshima University Faculty of Medicine,
1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
titamoto@mua.biglobe.ne.jp
BACKGROUND/AIMS: To clarify the indication of percutaneous microwave
coagulation therapy for hepatocellular carcinoma. METHODOLOGY:
Thirty-three hepatocellular carcinoma patients who underwent
percutaneous microwave coagulation therapy were enrolled in this study,
including 18 primary and 15 recurrent hepatocellular carcinoma patients.
We examined the local recurrence rates and the long-term results after
the treatment. RESULTS: The overall survival rates of the primary group
at 1, 2, 3, 4 and 5 years were 94.4%, 77.8%, 77.8%, 77.8% and 48.6%,
respectively, whereas those of the recurrent group were 100%, 85.7%,
66.7% and 50.0% at 1, 2, 3 and 4 years, respectively. Local recurrence
after percutaneous microwave coagulation therapy was found in about 50%
of patients in both groups. Seventeen of the 27 patients (63.0%) with a
moderately or poorly differentiated hepatocellular carcinoma tumor had
local recurrence, while none of the 6 patients with a
well-differentiated hepatocellular carcinoma tumor did (P = 0.005).
CONCLUSIONS: Irrespective of primary or recurrent hepatocellular
carcinoma, the indication of percutaneous microwave coagulation therapy
as an alternative to hepatic resection should be limited to cases of a
well-differentiated hepatocellular carcinoma tumor smaller than 2 cm in
diameter.
6
UI - 11677976
AU - Dohmen K; Shirahama M; Shigematsu H; Miyamoto Y; Torii Y; Irie K;
TI -
Ishibashi H
Transcatheter arterial chemoembolization therapy combined with
percutaneous ethanol injection for unresectable large hepatocellular
carcinoma: an evaluation of the local therapeutic effect and survival
rate.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1409-15
AD - Saga Prefectural Hospital Koseikan, Saga, Japan. dohmenk@par.odn.ne.jp
BACKGROUND/AIMS: This study was undertaken to evaluate the effectiveness
of combination therapy with transcatheter arterial chemoembolization
followed by percutaneous ethanol injection in patients with unresectable
large hepatocellular carcinoma by comparing the use of this combined
regimen with transcatheter arterial chemoembolization alone.
METHODOLOGY: Six hundred and thirty-one consecutive patients with
hepatocellular carcinoma lesions observed from Jan 1989 to Dec 1999 (11
years) at the Internal Medicine Department, Saga Prefectural Hospital
Koseikan were retrospectively enrolled in the study. The series included
120 patients with large unresectable hepatocellular carcinoma lesions,
the largest of which were greater than 3 cm in largest dimension.
Fifty-two patients underwent a single transcatheter arterial
chemoembolization followed by percutaneous ethanol injection, which were
compared with 68 patients treated by transcatheter arterial
chemoembolization alone. Both groups of patients with hepatocellular
carcinoma did not differ regarding the base-line characteristics. The
overall survival rates and recurrence ratio of initially treated lesions
were compared in both groups. RESULTS: On overall survival rates by the
Kaplan-Meier method, three- and five-year survival in the transcatheter
arterial chemoembolization and percutaneous ethanol injection group
(59.0%, 32.1%) proved to be significantly longer than those in the
transcatheter arterial chemoembolization group (27.1%, 17.0%). In
addition, during the follow-up local recurrence in the combination group
(23.1%) was significantly lower than that in the transcatheter arterial
chemoembolization group (50.0%). CONCLUSIONS: The combined treatment
with transcatheter arterial chemoembolization and percutaneous ethanol
injection proved to be more effective and safer. Furthermore, a lower
incidence of local recurrence was observed than transcatheter arterial
chemoembolization alone which resulted in an increased survival of the
patients associated with unresectable large hepatocellular carcinoma
lesions.
7
UI - 11677980
AU - Ueno H; Okada S; Okusaka T; Ikeda M; Tanaka N; Sakamoto M; Yoshimori M
TI -
Prognosis of hepatocellular carcinoma with no tumor stain treated by
percutaneous ethanol injection.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1430-4
AD - Department of Internal Medicine, National Cancer Center Hospital, 5-1-1
Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. hiueno@ncc.go.jp
BACKGROUND/AIMS: Some hepatocellular carcinoma nodules do not show tumor
stain by hepatic angiography or enhanced computed tomography. The aim of
this study was to clarify the prognosis of hepatocellular carcinoma with
no tumor stain treated by percutaneous ethanol injection. METHODOLOGY:
Twenty patients who had hepatocellular carcinoma with no tumor stain
percutaneous ethanol injection. Recurrence-free survival, predictive
factors for recurrence and recurrent patterns were examined. Overall
survival was also examined. RESULTS: Ten of the 20 patients showed
intrahepatic recurrences in other parts of the treated lesions, although
no local recurrence was observed. Median recurrence-free survival time,
1-, 3- and 5-year recurrence-free survival rates were 2.8 years, 66%,
43% and 22%, respectively. A serum alpha-fetoprotein level of 20 ng/mL
or less was the only factor that was significantly associated with
prolonged recurrence-free survival. Of the 12 recurrent nodules in 10
patients, 9 occurred in different segments of the treated lesion and 8
were histopathologically confirmed to be well-differentiated
hepatocellular carcinoma. Overall survival rates 1, 3, and 5 years after
percutaneous ethanol injection were 100%, 82%, and 75%, respectively.
CONCLUSIONS: Percutaneous ethanol injection may be useful for the
treatment of hepatocellular carcinoma with no tumor stain.
8
UI - 11792985
AU - Chardot C; Saint Martin C; Gilles A; Brichard B; Janssen M; Sokal E;
TI -
Clapuyt P; Lerut J; Reding R; Otte JB
Living-related liver transplantation and vena cava reconstruction after
total hepatectomy including the vena cava for hepatoblastoma.
SO - Transplantation 2002 Jan 15;73(1):90-2
AD - Centre Hospitalier Universitaire de Bicetre, 78 rue du General Leclerc,
F-94275 Le Kremlin Bicetre, France.
christophe.chardot@bct.ap-hop-paris.fr
BACKGROUND: In most cases of total hepatectomy (TH) required for
hepatoblastoma (HB), the retrohepatic inferior vena cava (IVC) has to be
removed with the native liver for complete tumor excision. Because the
liver graft procured by living donation has no IVC, a reconstruction of
the recipient IVC is needed. We report our experience with
living-related liver transplantation (LRLT) and IVC replacement in such
underwent TH, including IVC and LRLT with IVC replacement for otherwise
irresectable HB after chemotherapy (SIOPEL 2 and 3 protocols). IVC
reconstruction used an allogenic iliac vein procured from a cadaveric
donor (bank graft) in two cases and an internal jugular vein procured
from the donor parent in two cases. Median age and weight at surgery
were 17 months (range 10-60) and 9.6 kg (range 8.3-17.9). RESULTS: In
the living donors, there were two complications of the procurement: one
intra-abdominal biliary collection and one subcutaneous abscess. In all
four children, complete excision of the tumor could be achieved without
any intra-operative complication. One patient died 5 months after LRLT
due to lung metastases. Three patients were alive and well with no
evidence of tumor recurrence 13-24 months after surgery. Reconstructed
IVC was patent in two patients, and asymptomatic thrombosis occurred 2
years after operation in one patient. CONCLUSION: Total hepatectomy
including the retrohepatic IVC is not a technical obstacle to LRLT.
Therefore, scheduled surgery, at the best time after chemotherapy, can
be considered in all patients with otherwise irresectable HBs.
9
UI - 11592607
AU - Bruix J; Sherman M; Llovet JM; Beaugrand M; Lencioni R; Burroughs AK;
TI -
Christensen E; Pagliaro L; Colombo M; Rodes J; EASL Panel of Experts on
HCC
Clinical management of hepatocellular carcinoma. Conclusions of the
Barcelona-2000 EASL conference. European Association for the Study of
the Liver.
SO - J Hepatol 2001 Sep;35(3):421-30
AD - Liver Unit, Digestive Disease Institute, Hospital Clinic, IDIBAPS,
Barcelona, Catalonia, Spain. jbruix@clinic.ub.es
10
UI - 11775842
AU - Cao X; He N; Sun J; Wang S; Ji X; Wang J; Zhang C; Yang J; Lu T; Li J;
TI -
Zhang G
Interventional treatment of huge hepatic cavernous hemangioma.
SO - Chin Med J (Engl) 2000 Oct;113(10):927-9
AD - Department of Radiology, General Hospital, Tianjin Medical University,
Tianjin 300052, China.
OBJECTIVE: To study the methods of interventional treatment of huge
hepatic cavernous hemangioma (HCH). METHOD: A total of 14 patients with
HCH were treated with lipiodol-ultrafluid (10-15 ml), bleomycin A (PYM
16-32 mg), and gelatin-sponge particles. RESULTS: DSA hepatic
arteriography showed multiple vascular lakes in the early arterial
phase, so-called "to hang the fruits on the branches", which persisted
for a long time. CT scan showed a significant reduction in tumor size in
8 of the 14 patients after the treatment. CONCLUSION: Embolization with
lipiodol-ultrafluid, PYM and gelatin sponge particles is one of the best
methods for the treatment of HCH.
11
UI - 11720452
AU - Farinati F; Gianni S; De Giorgio M; Fiorentini S
TI -
Megestrol treatment in patients with hepatocellular carcinoma.
SO - Br J Cancer 2001 Nov 16;85(10):1606-8
12
UI - 11813186
AU - Chan KL; Fan ST; Tam PK; Chiang AK; Chan GC; Ha SY
TI -
Management of spontaneously ruptured hepatoblastoma in infancy.
SO - Med Pediatr Oncol 2002 Feb;38(2):137-8
AD - Center of Study of Liver Disease, Department of Surgery, University of
Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, SAR, China.
klchan@hkucc.hku.hk
13
UI - 9383352
AU - Jaeck D; Bronowicki JP; Boudejma K; Bachellier P; Chone L; Nisand G;
TI -
Bazin C; Pflumio F; Uhl G; Wenger JJ; Boissel P; Bigard MA; Gaucher P;
Vetter D; Wolf P; Doffoel M
Comparison of resection, liver transplantation and transcatheter oily
chemoembolisation in the treatment of hepatocellular carcinoma.
SO - Wiad Lek 1997;50 Suppl 1 Pt 1():413-5
AD - Centre de Chirurgie Viscerale et de Transplantation, Hopitaux
Universitaires de Strasbourg.
14
UI - 11778243
AU - Fan J; Wu Z; Zhou J
TI -
[Comparison of several therapeutic methods for hepatocellular carcinoma
with tumor thrombi in portal vein]
SO - Zhonghua Zhong Liu Za Zhi 2000 May;22(3):247-9
AD - Zhongshan Hospital & Liver Cancer Institute, Shanghai Medical
University, Shanghai 200032, China.
OBJECTIVE: To compare the therapeutic effect and significance of
different treatment methods for hepatocellular carcinoma (HCC) with
portal vein tumor thrombi (PVTT). METHODS: One hundred and forty-seven
HCC patients with tumor thrombi in the main portal vein or the first
branch of portal vein were divided into four groups. A, conservative
treatment group (n = 18); B, hepatic artery ligation (HAL) and/or
hepatic artery infusion (HAI) group (n = 18), periodically received
postoperative chemoembolizations; C, excision of HCC with removal of
PVTT group (n = 79); D, transcatheter hepatic arterial chemoembolization
or portal vein infusion (PVI) or HAI after operation group (n = 32).
RESULTS: The median survival period was 2, 5, 12, and 16 months in group
A, B, C, D, respectively. Their 1-, 3- and 5-year survival rates was
5.6%, 0 and 0 in group A; 22.2%, 5.6% and 0 in group B; 53.9%, 26.9% and
16.6% in group C; 82.8%, 48.8% and 41.3% in group D, respectively. The
survival rates differed significantly between the 4 groups (P < 0.05).
CONCLUSION: Resection of cancer with removal of tumor thrombi for HCC
with PVTT significantly improves the curative effect and quality of
life. Local hepatic chemotherapy or chemoembolization after tumor
resection with removal of tumor thrombi may further prolong survival
period.
15
UI - 11778245
AU - Wang C; Shao Y; Lan Z
TI -
[Surgical treatment of patients with stage IV a liver carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2000 May;22(3):252-4
AD - Tumor Hospital, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing 100021, China.
OBJECTIVE: To study the result of surgical treatment of patients with
stage IV a primary liver carcinoma (PLC). METHODS: Twenty-seven patients
with stage IV a PLC treated in 1989-1998 were retrospectively studied.
The patients could be divided into 2 groups: (1) The resected group(19
cases) and (2) cytoreductive group(8 cases). Intra-operative
B-ultrasound was used to prevent missing of any tumor nodules.
Unresectable residual nodules were treated by ethanol injection.
Multidisciplinary treatment was given in the perioperative period.
RESULTS: The overall 1-, 2- and 3-year survival rate of the 27 patients
was 71.4%, 55.6% and 7.7% respectively. The 1-, 2- and 3-year survival
rate of the resected and cytoreductive group of patients was 73.3%,
58.3%, 10.0% and 66.7%, 50.0%, 0% (P > 0.05) respectively. Complications
occurred in 22.0% of the treated patients. There was no operative and
hospitalization mortality. CONCLUSIONS: Surgical resection or
cytoreductive operation with adjuvant therapy is effective as the first
choice of treatment for stage IV a PLC.
16
UI - 10915728
AU - Ikeda K; Arase Y; Saitoh S; Kobayashi M; Suzuki Y; Suzuki F; Tsubota A;
TI -
Chayama K; Murashima N; Kumada H
Interferon beta prevents recurrence of hepatocellular carcinoma after
complete resection or ablation of the primary tumor-A prospective
randomized study of hepatitis C virus-related liver cancer.
SO - Hepatology 2000 Aug;32(2):228-32
AD - Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan, and
Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
ikedakenji@tora.email.ne.jp
Because hepatocellular carcinoma often recurs after surgical resection
or ethanol injection therapy, we conducted a prospective randomized
controlled trial of interferon (IFN) in patients with chronic liver
disease caused by hepatitis C virus (HCV). Twenty eligible patients with
cirrhosis were randomized into two groups: 10 patients treated with 6
million units of natural IFN-beta twice a week for 36 months and 10
patients without IFN therapy. One patient within the treatment group
discontinued interferon therapy after 19 months of treatment because of
a mild degree of retinopathy. None of the patients in either group lost
HCV-RNA until the end of the observation. Although 7 (70.0%) of 10
patients in the nontreatment group showed tumor recurrence, only 1
(10.0%) of 10 patients with IFN therapy developed tumor recurrence
during a median observation period of 25.0 months. Cumulative recurrence
rates of the treated and untreated groups were 0% and 62.5% at the end
of the first year, and 0% and 100% at the second year, respectively
(log-rank test, P =.0004). In conclusion, intermittent administration of
IFN suppressed tumor recurrence after treatment with surgery or ethanol
injection in patients with HCV-related chronic liver disease.
17
UI - 10915756
AU - Everson GT
TI -
Maintenance interferon for chronic hepatitis C: more issues than
answers?
SO - Hepatology 2000 Aug;32(2):436-8
18
UI - 11172357
AU - Okada S; Sato T; Yamamoto S
TI -
Adjuvant interferon for hepatocellular carcinoma.
SO - Hepatology 2001 Feb;33(2):481-2
19
UI - 11780473
AU - Ho S; Lau WY; Leung WT
TI -
Comments on "Hepatic radioembolization with yttrium-90 glass
microspheres for treatment of primary liver cancer" by Cao et al, Chin
Med J 1999; 112: 430-432.
SO - Chin Med J (Engl) 2001 Apr;114(4):433-4
20
UI - 11817790
AU - Puliyel JM; Taneja V; Jindal K; Thomas N
TI -
Hepatitis B leading to hepatocellular carcinoma: calculating the risk.
SO - Indian J Gastroenterol 2001 Nov-Dec;20(6):251-2
21
UI - 11768566
AU - Kuyvenhoven JPh; Lamers CB; van Hoek B
TI -
Practical management of hepatocellular carcinoma.
SO - Scand J Gastroenterol Suppl 2001;(234):82-7
AD - Dept. of Gastroenterology and Hepatology, Leiden University Medical
Centre, The Netherlands. j.p.kuyvenhoven@lumc.nl
Primary hepatocellular carcinoma (HCC) is one of the ten commonest
tumours in the world and occurs mainly in patients with cirrhosis. To
date, in Western countries, curative treatment options include partial
liver resection or liver transplantation in selected patients with small
tumours. Unfortunately, most patients are detected with non-resectable
or non-transplantable HCC due to disease extension, hepatic dysfunction
or comorbid factors. These patients may benefit from local ablative
therapy, such as percutaneous ethanol injection or radiofrequency
ablation, with curative intent in patients with small tumours. In
advanced HCC chemoembolization has a high response rate, but there is no
clear evidence of a survival benefit. In this review we discuss
practical considerations in the treatment of HCC and propose an
algorithm for the selection of different treatment modalities.
22
UI - 11812959
AU - Ho WL; Wu CC; Yeh DC; Chen JT; Huang CC; Lin YL; Liu TJ; P'eng FK
TI -
Roles of the glucocorticoid receptor in resectable hepatocellular
carcinoma.
SO - Surgery 2002 Jan;131(1):19-25
AD - Department of Surgery and Pathology, Taichung Veterans General Hospital,
Chung-Shan Medical College, Taichung, Taiwan.
BACKGROUND: The glucocorticoid receptor (GR) was discovered in the
cytosol of hepatocellular carcinoma (HCC) cells more than 10 years ago.
However, the influence of the GR on the prognosis of HCC after liver
resection remains unclear. METHODS: Ninety-two consecutive patients with
HCC who survived liver resection and who did not receive any
preoperative neoadjuvant therapy were enrolled in this study. The GR
level in cytosol of cancerous tissue was determined by the
dextran-coated charcoal method. The clinicopathologic characteristics
and long-term prognosis of patients with GR-positive tumors (GR-positive
group) were compared with those of patients with GR-negative tumors
(GR-negative group). RESULTS: GR was found in 63 patients (68.5%) with a
mean +/- SEM concentration of 26.97 +/- 4.05 fmol/g protein. There were
no significant differences in patient clinicopathologic characteristics
between GR-positive and GR-negative groups. The 5-year disease-free and
actuarial survival rates for GR-positive and GR-negative groups were
21.6% and 44.4% (P =.002) and 57.2% and 83.3% (P =.0003), respectively.
After multivariate analysis was performed, GR positivity was found to be
an independent prognostic factor of disease-free and actuarial survival
after liver resection for HCC. CONCLUSIONS: The GR can be found in the
cytosol of most HCCs and is an independent prognostic factor of HCC
after liver resection. Patients with GR-positive HCC have lower survival
rates than those with GR-negative HCC.
23
UI - 11812960
AU - Wakabayashi H; Ishimura K; Okano K; Karasawa Y; Goda F; Maeba T; Maeta H
TI -
Application of preoperative portal vein embolization before major
hepatic resection in patients with normal or abnormal liver parenchyma.
SO - Surgery 2002 Jan;131(1):26-33
AD - First Department of Surgery, Kagawa Medical University, Japan.
BACKGROUND: Clinical parameters influencing the effect of preoperative
portal vein embolization (PVE) in hypertrophying the nonembolized lobe
of patients with either normal or abnormal liver parenchyma and its
effect upon portal pressure were examined to identify the patient
population for whom this approach is most suited. METHODS: The study
population included 43 patients undergoing major hepatectomy after PVE.
Patients were divided into 2 groups according to their liver parenchyma:
17 patients with normal liver parenchyma (N group) and 26 patients with
damaged liver parenchyma due to viral hepatitis (D group). We calculated
the correlation between volumetric increases in the nonembolized (left)
lobe after PVE (hypertrophic ratio = post-PVE left lobe volume/pre-PVE
left lobe volume) using computed tomography volumetry before and 2 weeks
after PVE. Clinical parameters also were examined to identify those
parameters modifying the hypertrophic ratio in each group, and changes
in portal pressure by PVE and the subsequent hepatectomy were recorded.
Finally, by comparing patients with or without postoperative liver
failure after hepatectomy, the influence of the hypertrophic ratio and
portal pressure on the outcome of subsequent hepatectomy was examined.
RESULTS: The hypertrophic ratio was 1.34 +/- 0.23 in the N group, and
1.25 +/- 0.21 in the D group. This difference was not significant.
Multiple regression analysis revealed that the parenchymal volumetric
rate of the right lobe (PVR) in the D group and both PVR and prothrombin
time in the N group were independent parameters predicting the
hypertrophic ratio. The portal pressure increased immediately after PVE
and was similar in both groups to levels after hepatectomy. Six patients
in the D group experienced postoperative liver dysfunction. In 5 of
these 6 patients, the hypertrophic ratio was below 1.2, and the portal
pressure was higher than that in patients without liver dysfunction.
CONCLUSIONS: PVE induces hypertrophy of the nonembolized lobe of both
abnormal and normal liver parenchyma, and the effect was predictable.
Postoperative liver failure appeared to be more severe in patients
having a lower hypertrophic ratio and higher portal pressure in abnormal
liver parenchyma, however. PVE also may have diagnostic use in
predicting portal pressure after hepatectomy, which may be associated
with surgical outcome.
24
UI - 11446923
AU - Figueras J; Busquets J; Ramos E; Torras J; Ibanez L; Llado L; Rafecas A;
TI -
Fabregat J; Serano T; Dalmau A; Valls C; Jaurrieta E
[Clinical study of 437 consecutive hepatectomies]
SO - Med Clin (Barc) 2001 Jun 16;117(2):41-4
AD - Jefe Clinico de Cirugia General y Digestiva, Hospital Prineps d'Espanya,
Barcelona, Spain.
BACKGROUND: The aim of this prospective study was to analyze the risk of
liver resection in unselected patients. PATIENTS AND METHOD: From 1990
to 2000, 437 consecutive hepatectomies were performed in our center.
Most frequent indications were liver metastases (n = 288),
hepatocellular carcinoma (n = 62), Klatskin tumor (n = 17), gallblader
carcinoma (n = 139) and other malignant tumors (n = 6). The indication
was a benign tumor in 51 patients. In 357 cases the liver parenchyma was
normal, 51 patients had an underlying cirrhosis and 17 patients had an
obstructive jaundice. RESULTS: Overall mortality was 3.6% (15 cases).
Mortality in benign tumors was lacking. The prevalence of postoperative
complications was 43.9%, which was mainly influenced by malignancy
(46.9% vs 21.6%, p = 0.001) and type of tumor (Klastkin tumor, p #
0.001). Major liver resection (p < 0.001), blood transfusion (p <
0.001), age over 60 years (p = 0.001) and the type of hepatectomy (p <
0.001) also increased significantly the morbidity.The prevalence of
biliary fistula was 11.2%, which was mainly related to the type of
hepatectomy (major hepatectomy; p = 0.002) and a biliary-enteric
anastomosis (p < 0.001). The prevalence of hepatic insufficiency was
3.6%, and chief risk factors for its development were underlying liver
disease and major liver resection (p = 0.017). CONCLUSIONS: Mortality
after hepatectomy in experienced centers is low. Morbidity is mainly
related to the amount of parenchyma resected, type of hepatectomy,
underlying liver disease and associated procedures. Liver resection
should be performed preferentially in centers with high volume by
specialized surgeons.
25
UI - 11481085
AU - Margarit C
TI -
[Hepatectomy: indications, techniques and results]
SO - Med Clin (Barc) 2001 Jul 7;117(5):175-8
26
UI - 11783027
AU - Chen M; Li J; Zhang Y
TI -
[Transarterial chemoembolization with high dose iodized oil for the
treatment of large hepatocellular carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2001 Mar;23(2):165-7
AD - Cancer Center, Sun Yet-sen University of Medical Sciences, Guangzhou
510060, China.
OBJECTIVE: To report the method and result of high dose iodized oil
chemoembolization for the treatment of large hepatocellular carcinoma.
METHODS: From 1993 to 1998, 163 patients with unresectable
hepatocellular carcinoma were treated by transarterial chemoembolization
(TACE) with more than 20 ml lipiodol. RESULTS: TACE with high dose
lipiodol was well tolerated by the treated patients. In patients whose
liver function was of Child A stage, or in patients whose residual
indocyanine green level 15 min after injection was less than 20%, the
frequency of post-treatment hepatic insufficiency was not significantly
different from that of patients treated with routine dose of lipiodol.
On CT scan at 4 wk after TACE, more lipiodol was located in the liver.
The 1-, 2-,3-year survival rate of patients in Child A stage was 79.8%,
50.3%, and 38.5%, respectively, as compared to 57.5%, 24.8% and 8.37%,
respectively in patients treated with routine dose of lipiodol (P =
0.0136). CONCLUSION: High dose lipiodol TACE for the treatment of large
hepatocellular carcinoma is practically acceptable with better
therapeutic effect but its use should be limited to those patients with
compensated liver function.
27
UI - 11788696
AU - Loewe C; Cejna M; Schoder M; Thurnher MM; Lammer J; Thurnher SA
TI -
Arterial embolization of unresectable hepatocellular carcinoma with use
of cyanoacrylate and lipiodol.
SO - J Vasc Interv Radiol 2002 Jan;13(1):61-9
AD - Department of Radiology, Section of Interventional Radiology, University
of Vienna, Waehringer Guertel 18 - 20, A-1090 Vienna, Austria.
christian.loewe@univie.ac.at
PURPOSE: To assess the potential of transarterial permanent embolization
with use of a mixture of cyanoacrylate and lipiodol for treatment of
unresectable primary hepatocellular carcinoma (HCC). MATERIALS AND
METHODS: In a retrospective study, 36 patients with histologically
proven HCC were treated with transarterial embolization (TAE) of the
hepatic arteries. None of these patients were candidates for surgical
resection and some had advanced disease with multinodular disease or
bulky tumor, thrombosis of a segmental branch of the portal vein, and/or
extrahepatic spread. To induce permanent and more peripheral
embolization, cyanoacrylate, an adhesive polymerizing on contact with
blood, was used in TAE. From 1990 to 1998, a total of 76 embolization
procedures were performed. Cumulative survival rates were calculated.
RESULTS: Most of the patients presented with a self-limited
postembolization syndrome. Severe procedure-related complications were
found after four treatment sessions (5.2%). The 30-day perioperative
mortality rate was 2.7%. The mean follow-up period was 20.3 months
(range, 1-68 mo), with a median survival of 26 months. The median
survival was also estimated for different Okuda stages of disease: stage
II (n = 26) versus stage III (n = 5) disease (32 vs 9 months; P <.05);
patients with (n = 9) or without (n = 27) extrahepatic metastasis (10 vs
26 months; P <.05); and patients with (n = 10) or without (n = 26)
thrombosis of a segmental branch of the portal vein (7 versus 34 months
[P <.005]). CONCLUSION: TAE with use of cyanoacrylate and lipiodol for
unresectable HCC is a feasible treatment modality. This retrospective
report indicates beneficial effects on survival even in patients with
advanced disease.
28
UI - 11766086
AU - Kimoto T; Yamanoi A; Uchida M; Makino Y; Ono T; Kohno H; Nagasue N
TI -
Repeated hepatic dearterialization for unresectable carcinomas of the
liver: report of a 10-year experience.
SO - Surg Today 2001;31(11):984-90
AD - Second Department of Surgery, Shimane Meidcal University, Izumo, Japan.
The effectiveness of repeated hepatic dearterialization (RHD) therapy
was evaluated in 26 patients with unresectable primary and secondary
liver tumors. RHD was performed in 12 patients with hepatocellular
carcinoma (HCC), 7 with hepatic metastases from colorectal carcinoma,
and 7 with hepatic metastases from gastric carcinoma. It was repeatedly
carried out by occluding the hepatic artery for 1 h twice daily. All
patients concurrently received an intra-arterial infusion of anticancer
drugs. More than 50% remission of the hepatic tumors, defined as a
partial response (PR), was demonstrated in 8 patients (31%). A higher PR
was seen in hepatic tumors from metastatic gastric cancer (5 out of 7
patients; 71%). Most patients who suffered severe complications had HCC
with liver cirrhosis. These preliminary results suggest that RHD with
intra-arterial chemotherapy is an acceptable palliative treatment for
patients with unresectable liver metastasis from gastric cancer;
however, the majority of patients with HCC are not responsive to such
treatment, primarily because most have underlying cirrhosis predisposing
to the development of postoperative complications at an unacceptably
high rate.
29
UI - 11797653
AU - Tungjitkusolmun S; Staelin ST; Haemmerich D; Tsai JZ; Webster JG; Lee FT
TI -
Jr; Mahvi DM; Vorperian VR
Three-Dimensional finite-element analyses for radio-frequency hepatic
tumor ablation.
SO - IEEE Trans Biomed Eng 2002 Jan;49(1):3-9
AD - Department of Electronics Engineering, King Mongkut's Institute of
Technology Ladkrabang, Bangkok, Thailand.
Radio-frequency (RF) hepatic ablation, offers an alternative method for
the treatment of hepatic malignancies. We employed finite-element method
(FEM) analysis to determine tissue temperature distribution during RF
hepatic ablation. We constructed three-dimensional (3-D)
thermal-electrical FEM models consisting of a four-tine RF probe,
hepatic tissue, and a large blood vessel (10-mm diameter) located at
different locations. We simulated our FEM analyses under
temperature-controlled (90 degrees C) 8-min ablation. We also present a
preliminary result from a simplified two-dimensional (2-D) FEM model
that includes a bifurcated blood vessel. Lesion shapes created by the
four-tine RF probe were mushroom-like, and were limited by the blood
vessel. When the distance of the blood vessel was 5 mm from the nearest
distal electrode 1) in the 3-D model, the maximum tissue temperature
(hot spot) appeared next to electrodes A. The location of the hot spot
was adjacent to another electrode 2) on the opposite side when the blood
vessel was 1 mm from electrode A. The temperature distribution in the
2-D model was highly nonuniform due to the presence of the bifurcated
blood vessel. Underdosed areas might be present next to the blood vessel
from which the tumor can regenerate.
30
UI - 11783120
AU - Ren Z; Lin Z; Ye S
TI -
[Transcatheter arterial chemoembolization for postoperative residual
tumor of hepatocellular carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2001 Jul;23(4):332-4
AD - Liver Cancer Institute, Zhongshan Hospital, Fudan Univesity, Shanghai
200032, China.
OBJECTIVE: To understand and analyze the survival and prognostic factors
of postoperative residual tumor of hepatocellular carcinoma treated by
transcatheter arterial chemoembolization. METHODS: Transcatheter
arterial chemoembolization was performed in 74 patients who were
identified as having residual lesions by ultrasonography, hepatic
arterial angiography or enhanced computed tomography about two months
after resection of hepatocellular carcinoma. Kaplan-Meier method was
used for survival and Cox regression model for prognostic factors.
RESULTS: The 1-, 2- and 3-year survival rates were 78.0%, 57.6%, 37.0%,
with a median survival of 33 months. Univariate analysis indicated that
a primary tumor over > 5 cm in diameter, vascular involvement by the
primary tumor and TNM extent of the residual lesion were important
factors indicating a bad prognosis, where as the combination of other
treatment methods such as percutaneous ethanol injection (PEI), and/or
radiotherapy indicated a better prognosis. However, multivariate
analysis showed that vascular involvement by the primary tumor and the
other combined local treatments were independent factors of prognosis.
CONCLUSION: Transcatheter arterial chemoembolization is effective in
treating the postoperative residual tumor of hepatocellular carcinoma.
Further improvement is observed if combined with other local therapies
such as percutaneous ethanol injection or radiotherapy.
31
UI - 11832474
AU - Eng SC; Kowdley KV
TI -
Expansion of criteria for liver transplantation in HCC: a slippery
slope?
SO - Gastroenterology 2002 Feb;122(2):579-82
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