Background/Aim The profile of patients with hepatocellular carcinoma (HCC) has changed globally; the role of etiology in predicting prognosis of HCC patients remains unclear. We aimed to analyze the characteristics and prognosis of Korean patients with HCC according to disease etiology.
Methods This retrospective observational study included patients diagnosed with HCC between 2010 and 2014 in a single center in Korea. Patients with HCC aged <19 years old, had coinfection with other viral hepatitis, had missing follow-up data, were Barcelona Clinic Liver Cancer stage D, or died before 1 month were excluded.
Results A total of 1,595 patients with HCC were analyzed; they were classified into the hepatitis B virus (HBV) group (1,183 [74.2%]), hepatitis C virus (HCV) group (146 [9.2%]), and non-B non-C (NBNC) group (266 [16.7%]). The median overall survival of all patients was 74 months. The survival rates at 1, 3, and 5 years were 78.8%, 62.0% and 54.9% in the HBV group; 86.0%, 64.0%, and 48.6% in the HCV group; and 78.4%, 56.5%, and 45.9% in the NBNC group, respectively. NBNC-HCC has a poorer prognosis than other causes of HCC. Survival was significantly longer in the HBV group with early-stage HCC than in the NBNC group. Furthermore, survival was shorter in patients with early-stage HCC and diabetes mellitus (DM) than in those without DM.
Conclusions The etiology of HCC affected clinical characteristics and prognosis to some extent. NBNC-HCC patients showed shorter overall survival than viral-related HCC patients. Additionally, the presence of DM is an additional important prognostic factor in patients with early-stage HCC.
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Hepatocellular carcinoma (HCC) primarily originates in the liver with hepatic differentiation. However, HCCs are not homogenous, and approximately 35% of HCC cases are classified as histopathological variants that present distinct pathologic characteristics. In particular, the lymphocyte-rich variant is the rarest subtype accounting for less than 1% of HCCs, which is not well known to date about molecular features and pathophysiology. Herein, we present a case of a patient who was suspected of metastatic liver cancer and confirmed as lymphocyte-rich HCC pathologically. A 78-year-old woman who underwent a right hemicolectomy for colon cancer was referred to our hospital for a newly detected liver mass. We could not make a decision because of insufficient evidence for diagnosis from imaging studies. After resection, we found that it was a lymphocyte-rich HCC. The pathologic features and prognostic trends of this subtype are also discussed.
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Background/Aim s: Programmed death receptor 1 (PD-1) is a promising new target for treatment of patients with hepatocellular carcinoma (HCC). A high expression level of programmed death-ligand 1 (PD-L1) is a possible prognostic indicator for poor outcome in other malignancies. Here, we investigated the clinical significance of PD-1 and PD-L1 in patients with HCC.
Methods We enrolled patients with HCC who underwent surgical resection at Severance Hospital between 2012 and 2017 and investigated the levels of PD-L1 in HCC tissues (tPD-L1) and PD-L1/PD-1 in serum (sPD-L1/sPD-1). We also aimed to determine whether expression levels correlated with clinical and histological features.
Results A total of 72 patient samples were analyzed. The median sPD-L1 and sPD-1 levels were 25.72 and 341.44 pg/mL, respectively. A positive correlation was detected between tPD-L1 and sPD-1 levels (R2=0.426, P<0.001). The median sPD-1 level increased linearly with tPD-L1 score (P=0.002). During the follow-up period, HCC recurred in eight (11.1%) patients and liverrelated mortality occurred in eight (11.1%) patients. Higher sPD-L1 levels (≥19.18 pg/mL) tended to be associated with liver-related mortality (hazard ratio 6.866; 95% confidence interval, 0.804-58.659, P=0.078). sPD-1 levels of patients treated with nivolumab as a second-line therapy changed serially, and a >50% reduction in sPD-1 levels was observed immediately after nivolumab administration. However, sPD-1 level was not associated directly with prognosis in patients with advanced HCC.
Conclusions The results demonstrated that PD-L1 and PD-1 levels changed according to the immunotherapy. However, no significant association with clinical outcome in patients with HCC was detected.
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Hepatocellular carcinoma (HCC) is one of the cancers with poor prognosis. However, surgical
resection is the treatment of choice as curative aim for early HCC with preserved liver function.
A 5 year survival rate after curative resection is over 50%. We experienced a case of rapidly
recurred HCC with bone metastasis after surgical resection. In our case, microscopically
microvessel invasion was present after resection. Microvascular invasion (MVI) is an important
factor to influence survival and/or HCC recurrence. So we suggested the patients with MVI
need to follow up intensively and adjuvant therapy may be considered.
Treatment of hepatocellular carcinoma is often very challenging when the underlying liver
function is decompensated. Recent experimental and clinical studies showed that some
chelating agents, including deferoxamine, display anti-proliferative actions against tumor
cells, thereby exhibiting anti-cancer effect in certain cancers, including hepatocellular
carcinoma. Based on previous studies, we herein offer our experience of positive tumor
marker response after intra-arterial deferoxamine infusion in a patient presenting with
advanced hepatocellular carcinoma with decompensated hepatic function. Validation of
the efficacy of intra-arterial deferoxamine therapy in the setting of advanced hepatocellular
carcinoma with underlying decompensated hepatic function is warranted. (J Liver Cancer
2014;14:127-130)
Myung Eun Song, Sangheun Lee, Mi Na Kim, Dong-Jun Lee, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Chae Yoon Chon, Kwang-Hyub Han, Jinsil Seong, Do Young Kim
Journal of the Korean Liver Cancer Study Group. 2013;13(2):152-157. Published online September 30, 2013
A 63-year-old man patient was referred for treatment of infiltrative hepatocellular carcinoma with hilar invasion after transarterial chemoembolization. Serum alkaline phosphatase and bilirubin were elevated, liver dynamic CT showed infiltrative type mass in left hepatic lobe and right hepatic dome with hilar invasion and left intrahepatic duct dilatation. Also CT showed obliteration of left portal vein and metastasis of lymph node around common bile duct. He was diagnosed as hepatocellular carcinoma (UICC stage IV-A, BCLC stage C). With the percutaneous transhepatic biliary drainage and the concurrent chemoradiation therapy and the 4th cycle of hepatic arterial infusion chemotherapy for infiltrative mass, viable tumor was decreased in resectable size at eight months from initial diagnosis.
Hepatocelluar carcinoma (HCC) is the most common primary liver cancer in the world and the most prevalent cancer among
patients liver cirrhosis. The management of HCC depends on tumor stage and the degree of liver dysfunction. Patients with
intermediate-stage HCC are ineligible for surgical or local ablative treatments. Current treatment guidelines recommend
trans-arterial chemoembolization (TACE) for intermediate stage of HCC. However, tumor recurrence after TACE is universal
and the survival benefit is relatively small. Hence, new strategies are needed to improve the outcome of HCC patients undergoing
TACE. Recently, the combination of target agents with TACE has shown promising overall survival in advanced HCC. It is
necessary to investigate new treat strategy how to increase treatment outcome of advanced HCC by new treat strategy.
Acute pancreatitis is a rare but severe postprocedural complication after transcatheter arterial chemoembolization (TACE) of
hepatocellular carcinoma with an incidence of 1.7-4%. The proposed mechanism of this complication is inadvertent
embolization through collateral vessels or regurgitation of chemotherapeutic agents to the arteries of other organs. Here, we
present a fatal necrotizing pancreatitis case which developed 10 days after TACE, caused by the regurgitation of the
chemotherapeutic agents to the pancreas during the procedure. The patient recovered with conservative care at first, but after
suffering from several times of recurrent pancreatitis, he died of peritoneal septic shock 5 months after the initial pancreatitis
attack.
Bun Kim, Jae Hoon Min, Seung Up Kim, Jun Yong Park, Kwang Hoon Lee, Do Youn Lee, Jin Sub Choi, Young Deuk Choi, Nam Hoon Cho, Young Nyun Park, Sang Hoon Ahn, Kwang Hyub Han, Chae Yoon Chon, Do Young Kim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):51-57. Published online February 28, 2012
Advanced hepatocellular carcinoma (HCC) is difficult to treat and the survival is poor. Here, we present a patient diagnosed as
advanced HCC (stage IIIa) which was supervening with early renal cell cancer (stage I). The patient was treated with
pre-operational transarterial chemoembolization (TACE) and surgical resection (right hepatectomy, right nephrectomy, and
cholecystectomy). Sorafenib were taken continually after surgery. Multiple recurred HCC nodules in remnant liver were detected
2 months later after surgery. Combined treatment modalities including 4 sessions of TACE, and 12 cycles of 5-flurouracil
(FU)/carboplatin based hepatic arterial infusional chemotherapy (HAIC) induced complete response. After the diagnosis of
advanced HCC, the patient survived 36 months and experienced disease-free status for 19 months.
Hepatocellular carcinoma (HCC) develops on chronic liver disease and often accompanies portal hyperternsion. Portal
hypertension induces hypersplenism with splenomegaly. Because hypersplenism results in pancytopenia, especially
thrombocytopenia, it is not easy to decide the hepatic resection for many surgeons in patients with HCC and hypersplenism.
Although liver transplantation is the most ideal treatment for HCC and hypersplenism, liver resection has been performed
commonly because of donor shortage. Splenectomy has performed to control intractable varices as a Hassab’s operation
(=decongestion of upper gastric marginal veins and splenectomy). Recently, as a development of surgical techniques and
equipments, especially laparoscopic surgery, splenectomy has been performed safely and easily. Some studies reported that
splenectomy improved the liver function. Splenectomy in patients with HCC expanded the indication of liver resection and
increased disease free survival (DFS). However, portal vein thrombosis (PVT) is a one of well-recognized complications of
splenectomy and recent prospective study reported the 50% rate of PVT in non-cirrhotic splenectomized patients. Some studies
reported that splenectomy with simultaneously or staged liver resection was performed safely without a significant complication
and operative mortality. We experienced a case that underwent simultaneously liver resection and splenectomy and then
recovered without complication. The further study may be needed to evaluate the role of splenectomy in patients with HCC and
hypersplenism.
The rupture of hepatocellular carcinoma (HCC) has been uncommon complication. Because the diagnosis of early HCC has
been increase due to development of imaging modality and surveillance program, the incidence of ruptured HCC has
been decreased. The paradigm of treatment for ruptured HCC has shifted from surgical hemostasis to transcatheteric
chemoembolization (TACE) at acute phase. After the control of acute phase, the definitive treatment for HCC is still debate.
However, many studies have advocated staged-liver resection. Some studies reported that the patients underwent staged-liver
resection showed a similar survival rate compared with survival rate in patient with non-ruptured HCC. The staged-liver
resection was usually performed in the patients with well-preserved liver function. The decision of optimal time for surgery after
TACE and surgical indications for ruptured HCC after any other primary treatment are controversy. We experienced a cases of
early and massive recurrence HCC in patients with well-preserved liver function and the rupture of HCC. The further study may
be needed to decide the optimal time of surgery after TACE and surgical indication for rutprued-HCC.
Hepatocellular carcinoma(HCC) is one of the cancers with poor prognosis. Transarterial chemoembolization(TACE) has been
widely used for treating unresectable HCC. Although TACE is considered as a less invasive and relative safe procedure, severe
complications such as hepatic failure, pulmonary embolism, liver abscess, biloma formationcan occur rarely after TACE. These
complications sometimes may lead to fatal clinical situation, even death. We reported a case of HCC recurred extensively during
treatment of biliary complication after TACE. A 44-year-old male with HCC was admitted due to fever for 3 days after
undergoing TACE. Three weeks before the admission, he had been diagnosed with HCC recurrence which presented as two
arterial enhancing nodules in MRI and treated with TACE. CT scan showed 7 cm sized air containing fluid collections with
necrosis suggestive of liver abscess and 15 cm sized biloma formation. Because the patient was in septic shock at admission,
percutaneous catheter drainage was performed with use of broad spectrum antibiotics. After treatment of 3 months, the sizes of
hepatic abscess and biloma were remarkably decreased. However, 1 month later, large size tumor recurrence and perihepatic
lymph node metastasis were found on a follow-up CT scan. In this case, the cause of rapid growing recurrence after TACE is
uncertain, but the development of unanticipated complication seems to affect the progression to poor prognosis. Therefore, early
recognization of predisposing factors with proper management would be needed to prevent these serious complications after
TACE.
Hepatocellular carcinoma (HCC) is the third most common malignancy in Korea. Despite recent advances in the area of
HCC, a considerable number of HCC patients require non-surgical treatments and systemic therapies because of poor liver
function or intermediate to advanced cancer stages at the time of diagnosis. Unfortunately, chemotherapy for advanced HCC
has limited response rates and provides a marginal survival benefit. Several studies have supported potential advantages of
hepatic arterial infusion chemotherapy (HAIC), designed to improve chemotherapy benefits by increasing the amount of
chemotherapy delivered to the site of the tumor and to minimizes the side-effects of the chemotherapy. However, there hasn’t
been any report showing different responses between systemic chemotherapy and HAIC for the same patient. Herein, we
report a case of HCC showing progressive disease in systemic chemotherapy, but partial response in HAIC with the same
regimen for the same patient with portal vein thrombosis. This case implies HAIC might be alternative option for HCC
patient showing ineffective response to systemic chemotherapy, even with the same regimen.
Hepatocellular carcinoma (HCC) is very rare in young age. Most young patients tend to receive the evaluation only when
they experience intractable or persistent symptoms. Therefore, HCC in young patients is often diagnosed at advanced stage
and thus, young HCC patients have a worse prognosis than older HCC. However, because young HCC patients show
well-preserved liver function than older HCC, they are tolerable to more aggressive treatments. We report a case of advanced
HCC in 13-year and 8-month old male who has been a B-viral carrier. Despite the tumor size decreased after concurrent
chemoradiation therapy, multiple lung and brain metastases developed. He underwent radiofrequency ablations on lung
metastases and gamma-knife surgery on brain metastasis, and he has received systemic and intra-arterial chemotherapy. The
screening and early diagnosis of HCC in young age is needed especially for B-viral carrier with a family history of HCC.
Most patients with advanced hepatocellular carcinoma (HCC) are not suitable candidates for surgical treatment
at the time of diagnosis because of poor liver function, extensive tumor involvement of the liver, vascular
involvement, and/or intra/extrahepatic metastasis. We attempted localized concurrent chemo-radiation therapy
(CCRT) followed by hepatic arterial infusion chemotherapy (HAIC) in patients having locally advanced HCC with
vascular involvement and preserved hepatic function. We report a case of locally advanced HCC patient who
became surgically resectable by downstaging after localized CCRT followed by HAIC. Localized CCRT was
performed with a total radiation dose of 4,500 cGy (180 cGy × 25 times) and hepatic arterial infusion of
5-fluorouracil (5-FU, 500 mg/day) via implantable port system during the first and the last weeks of the
radiotherapy. Following localized CCRT, the patient was scheduled to receive HAIC with 5-FU (500 mg/m2 for
5 hours, days 1~3) and cisplatin (60 mg/m2 for 2 hours, day 2) every 4 weeks. Marked contraction of HCC was
noted on follow up computerized tomography (CT) and positron emission tomography (PET) after localized CCRT
and HAIC, and subsequently surgical resection with curative aim was performed. The patient is in complete
remission status without recurrence to date.