Journal of Liver Cancer

A Review of Prognostic Factors Influencing the Longterm Survival of Patients with Hepatocellular Carcinoma: Young Min Park; Journal of the Korean Liver Cancer Study Group. 2001;1(1):1-11. Published online June 30, 2001

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Abstract PDF: Hepatocellular carcinoma (HCC) is a leading cause of cancer death in Korea, a highest endemic area of hepatitis B virus infection throughout the world. Because of the delayed diagnosis and decompensated cirrhosis, the current situation for the longterm survival of HCC patients is not optimistic, but still pessimistic. However, recently, HCC screening became a popular health program especially for a high risk group, so that the detection rate of small-size HCC is increasing, and also the various available therapeutic methods such as hepatic resection, percutaneous ethanol injection therapy (PEIT), and radiofrequency therapy (RFT) are all effective for the early stage of localized HCC. In epidemiological viewpoint, HCC shows a heterogeneous pattern in natural course and in survival. These heterogeneity is correlated with various factors, including age at the diagnosis, sex, tumor stage at the diagnosis, the presence of cirrhosis and hepatic failure, a kind of treatment protocol, and various biological features, including tumor growth pattern, differentiation grade, proliferating activity, tumor cell type, vascular invasion, alpha-fetoprotein, etc. To help the assessment of clinical situation and the prediction of clinical course of individual patients with HCC, this review will introduce various prognostic factors in relation to the survival of HCC patients.

Analysis of 38 Long-Term Survivors after Liver Resections for Hepatocellular Carcinoma: Seong Woo Hong , Hyuck Sang Lee, Yang Won Nah; Journal of the Korean Liver Cancer Study Group. 2001;1(1):12-19. Published online June 30, 2001

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Abstract PDF: Background/Aims
This study was conducted to develop an optimal strategy to achieve a long-term survival after liver resection for hepatocellular carcinoma. Methods: Between July 1975 and March 1995, 109 patients who underwent liver resection for hepatocellular carcinoma at Inje University Seoul Paik Hospital were analyzed retrospectively. Results: Thirty-eight patients (34.9%) survived longer than 5 years after operation. Prognostic factors of statistical significance were the diagnostic clue, ICG R15, TNM stage, extent of tumor, intrahepatic metastasis, portal vein thrombosis, serosal interval. For 63 cases with no intrahepatic metastasis, there was no survival difference between the lobectomy group and the segmentectomy/subsegmentectomy group (36.8% vs. 50.0%). In the subset of patients with satellite nodules confined to one single segment of the liver, 66.7% of the those who underwent lobectomy lived longer than 5 years while only 17.6% of the patients who had a lesser resection survived long-term(p=0.025). Conclusion: For the achievement of a long-term survival in patients with hepatocellular carcinoma, a systematic segmentectomy/subsegmentectomy is adequate for those with no intrahepatic metastasis, while the presence of satellite nodules in one segment calls for a standard hepatic lobectomy.

Radiological Findings of Hypovasscular Hepatocellaler Carcinoma: Hwan Hoon Chung , Yun Hwan Kim; Journal of the Korean Liver Cancer Study Group. 2001;1(1):20-28. Published online June 30, 2001

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Rachological Findings of Hypovascular Hepatocellaler Carcinoma: Nam Hee Won; Journal of the Korean Liver Cancer Study Group. 2001;1(1):29-33. Published online June 30, 2001

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Morphologic Characteristics Hepatocellular Carcinoma with Intrabile Duct Extension and Growth: Jay-chun Chang; Journal of the Korean Liver Cancer Study Group. 2001;1(1):34-40. Published online June 30, 2001

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Surgical Treatment for Hepatocellular Carcinoma with Bile Duct Invasion: Hee Jung Wang; Journal of the Korean Liver Cancer Study Group. 2001;1(1):41-44. Published online June 30, 2001

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Radiotherapy of Hepatocellular Carcinoma invading Biliary Systerm: Jin Sil Seong; Journal of the Korean Liver Cancer Study Group. 2001;1(1):45-50. Published online June 30, 2001

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A Case of Young Adult with Hepatocellular Carcinoma Treated by Chemoembolization: Still Alive for 8 Years: Jae Ryang Juhn, Young Kil Choi; Journal of the Korean Liver Cancer Study Group. 2001;1(1):51-55. Published online June 30, 2001

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Abstract PDF: A 30 year-old-male patient with hepatocellular carcinoma was treated with TACE 6 times and has been still alive for 8 years. He had suffered from chronic hepatitis B which led to cirrhotic liver and esophageal varix(grade Ⅲ). He underwent a splenectomy due to thrombocytopenia. Child-Pugh class of this patient was A and shoed moderate high AFP ( 350 ng/ml and over). A small hypoechoic mass(2cm) was detected in S 8 of the liver by ultrasonography. The mass was hypodense and displayed nodular enhancement on CT. The tumor was hypervascular and was supplied by anterior superior branch of the right hepatic artery. Superselective catheterization and chemoembolization were successfully done with 2 cc of Lipiodol. The hepatic tumor was disappeared after 5 cycles of TACE and he has been lost for 3 years until the recent visit. AFP increased again and a small newly developed mass medial to the previous mass was supplied by the right inferior phrenic artery. Thus, superselective TACE was performed again and Lipiodol was well accumulated. The patient has been well for 8 years.

A Long-Term Survival Case of Hepatocellular Carcinoma with Adrenal Gland Recurrence: Hee-Bok Chae, Seon Mee Park, Sei Jin Youn; Journal of the Korean Liver Cancer Study Group. 2001;1(1):56-59. Published online June 30, 2001

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Abstract PDF: A 59 year-old-male patient with liver cirrhosis was admitted due to altered mentality for 1 day. Thirty-seven months ago, he was diagnosed as hepatocellular carcinoma. At the time of the initial diagnosis, physical findings were normal. Biochemical tests showed as AST (86 IU/L), ALT (68 IU/L), bilirubin (0.5 mg/dL) and AFP (268 ng/ml). Abdomen CT showed a 5 cm-sized mass at S 6. He was trated with preoperative TACE and posterior segmentectomy 1 month after TACE. The excised liver specimen showed that most of the tumor was dead due to previous TACE, the growth pattern was trabecular, and the Edmondsons differentiation grade was Ⅲ/Ⅳ. At 18 months after the operation, the CT scan showed the right adrenal gland metastasis and he was treated with hot saline injection to the adrenal gland metastasis. From 22 months to 24 months after the operation, he was treated with both external radiotherapy (total does 3000 cGy) and subcutaneous injection of interferon ( 3 million units, 3 times a week). At 28 months after the operation, TACE was done via right adrenal artery. At 33 months after the operation, the final CT showed that adrenal gland mass was growing much larger against all of these treatment modalities. Following that he suffered from spontaneous bacterial peritonitis and two episodes of hepatic encephalopathy. At 37 months after the operation, he expired due to deep encephalopathy and massive esophageal variceal bleeding. In conclusion, we report this patient as a long-term survival case after the recurrence of hepatocellular carcinoma at right adrenal gland.

One Case Report of Hepatocellular Carcinoma Showing Both Hypo and Hyper-vascular Tumors in the Liver: Tae Yong Moon , Suck Hong Lee, Jun Woo Lee, Chang Won Kim; Journal of the Korean Liver Cancer Study Group. 2001;1(1):60-63. Published online June 30, 2001

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Abstract PDF: So many cases of hepatocellular carcinoma have been resulted intra- or extrahepatic recurrence soon following radical therapeutic procedure such as surgical resection or transcatheter arterial chemoembolization(TACE). Recently, the cause is considered to decreasing angiogenesis inhibitors by complete ablation of primary tumor with angiogenesis factor production. We have experienced one case of hepatocellular carcinomas showing double hypo- and hypervascular masses in the liver. While the hypervascular tumor is still growing, the hypovascular tumor may be statyed to tumor dormancy by intrinsic angiogenesis inhibitor. When original hypervascular tumor was ablated with TACE, another hypovascular tumor switched to hypervascular one appearing tumor feeder on angiography.

A case of Hypovascular Hepatocellular Carcinoma: Hwan Hoon Chung , Yoon Hwan Kim, Yong Sun Kim, Soon Ho UM, Nam Hee Won; Journal of the Korean Liver Cancer Study Group. 2001;1(1):64-67. Published online June 30, 2001

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Abstract PDF: A 54 year-old-male patient was referred to our hospital, because a hepatic mass had been found on US at a local clinic. He was a heavy drinker, but he has never experienced any significant diseases so far. Anti-HBs Ab was positive and HBsAg and anti-HCV Ab were negative. AFP level was normal. US showed a 2.3 cm sized hyperechoic nodule in the lateral segment of left lobe of the liver. Attenuation of the nodule was lower than that of normal hepatic parenchyma on triphasic CT scan. No definite hypervasculairity was seen on the angiogram, CTHA and single level dynamic CTHA. sono-guided needle biopsy was done for the lesion, and it was confirmed to be hepatocellular carcinoma, Edmondson grade 1. Left lateral segmentectomy was performed and the patient was dischaged 11 days after the operation. There has been no evidence of recurrence during 1 year-follow-up

Hepatocellular Carcinoma with Extrahepatic Bile Duct Invasion: Correlation of Radiologic and Pathologic Findings: Sun Woo Bang, Ho Kyun Kim, Hyuck Sang Lee, Mee Joo, Hye Kyung Lee; Journal of the Korean Liver Cancer Study Group. 2001;1(1):68-71. Published online June 30, 2001

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A Case of Hepatocellular Carcinoma of Intrahepatic Duct Invasion Treated with Early Surgical Resection: Woo Chul Chung, Young Min Park, Si Hyun Bae, Jong Young Choi, Doo Ho Park, Dong Goo Kim; Journal of the Korean Liver Cancer Study Group. 2001;1(1):72-76. Published online June 30, 2001

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Abstract PDF: A 40-year old patient with chronic hepatitis B was admitted to our hospital due to right quardrant abdominal pain and jaundice for 2 days. One month ago, he had been treated for acute cholangitis. Total bilirubin was 6.69 mg/dL, AST/ALT level 150/165 IU/L, and AFP 6.7ng/mL. Abdomen CT showed that diffusely irregular tortuous dilatation of IHBD was noted in S 6, more markedly in the peripheral portion, with rather higher density than fluid within lumen, suggesting mucin producing biliary tumor. ERCP demonstrated that a long segment movable filling defect was present at CHD, proximal CBD and posterior right intrahepatic duct. Suggesting sludge and posterior inferior segment of right intrahepatic duct was not visualized with filling defects. At that point we suspected that his diagnosis was cholangiocarcinoma. So we carried out the surgical resection. The pathologic results were hepatocellular carcinoma with bile duct invasion. Because of the incomplete resection of hepatocellular carcinoma, TAC was performed twice during the next 2 months. After then he has been taken care at OPD with good condition. This case shows that hepatocellular carcinoma is early detected by bile duct dilatation on CT and successfully treated by surgical intervention and TAC.

A case of Hepatocellular Carcinoma with Bile Duct Invasion Treated with Transcather Arterial Embolization and Surgical Resection: Joon Woo Lee, Joon Koo Han, Byung Ihn Choi; Journal of the Korean Liver Cancer Study Group. 2001;1(1):77-79. Published online June 30, 2001

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Abstract PDF: A 51-year-old-male was admitted due to epigastric discomfort. He had history of alcoholism. Physical findings revealed that he had tenderness on right upper quadrant with jaundice. Total bilirubin was 8.3 mg/dL, AST/ALT was 40/53 IU/L, and AFP was 38,925 ng/ml. Computed tomography showed ill-defined mass in the right hepatic lobe and intraductal mass measuring 3cm in diameter in common bile duct. PTBD was performed via B3 and on cholangiogram, there was abrupt cut-off at confluence level of common hepatic duct. After PTBD, jaundice was relieved. After then, TACE and surgical resection was done. There was a large mass measuring 6cm in the right hepatic lobe with intraductal extention to common bile duct. After then, the patient survives 30 months up to date and is still alive.

A Case of Extrahepatic Biliary Obstruction by Hepatocellular Carcinoma: Heon Young Lee, Nam Jae Kim, Byung Seok Lee, Jae Kyu Sung, In Sang Song, Dae Yeong Kang; Journal of the Korean Liver Cancer Study Group. 2001;1(1):80-84. Published online June 30, 2001

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Abstract PDF: A 47 year-old female patient admitted due to right upper quadrant and epigastric pain for 3-4 days. She was in shock state on admission and had tenterness on right upper quadrant with jaundice. Blood WBC was 16,900/mm3. Hb was 12.8 g/dL and Platelet count was 94,000/mm3. Serum AST and ALT were 135 and 108 IU/L respectively, and total bilirubin was 7.1 mg/dL. Abdominal CT showed multiple intrahepatic stones with low density lesion at S 6 & 7 and distal intrahepatic duct dilatation. Also distal common bile duct stones with duct dilatation were noted. PTC demonstrated large two filling defect at the common hepatic duct and one another filling defect at the distal common bile duct. PTC also revealed nonvisualization of right posteroinferior intrahepatic duct. Under the diagnosis of multiple right intrahepatic and common bile duct stones with cholangitis, liver abscess, septic shock, we performed PTBD and administration of antibiotics. Because of continuing febrile condition, we studied of abdominal CT that showed more increase size of low density lesion at right lobe of liver and metastatic lymphadenopathy at portahepatis, portocaval and diaphragmatic areas. Aspiration of abscess was tried, but could not gain put, hence biopsy was performed. Pathologic diagnosis was hepatocellular carcinoma. Operation of remval of the bile duct tumor and stones, cholecystectomy with T-tube drainage, right hepatic artery ligation was performed. After operation, she was fair and T-tube was kept.

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