Journal of Liver Cancer

Original Article

Tenofovir and Entecavir Have Similar Renal Adverse Events on Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization: Young Youn Cho, Young Hwan Choi, Su Jong Yu, Eun Ju Cho, Jeong-Hoon Lee, Yoon Jun Kim, Jung-Hwan Yoon; J Liver Cancer. 2019;19(2):128-135. Published online September 30, 2019; DOI: https://doi.org/10.17998/jlc.19.2.128

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Background/Aims
Tenofovir disoproxil fumarate (TDF) is potentially nephrotoxic in chronic hepatitis B patients. Hepatocellular carcinoma (HCC) patients treated using transarterial chemoembolization (TACE) are at an increased risk of renal injury. The aim of this study was to determine whether TDF is associated with more renal adverse events than entecavir (ETV) in HCC patients treated with TACE.
Methods
In this retrospective single-center study, we selected 53 HCC patients who were treated with TDF from January 2012 to July 2013 and had their first TACE procedure in the same period. These patients were matched by age and sex to patients treated with ETV.
Results
There were no significant differences in baseline characteristics, including HCC factors, and nephrotoxic drug use, between the two groups. The median follow-up period was 17.0 and 20.0 months for the TDF and ETV groups, respectively. There was no difference during the follow-up period between the TDF and ETV groups in the increase in creatinine over 0.5 mg/dL (17.0% and 17.0%, P=1.00, respectively) and the decrease in eGFR over 25% (43.4% and 41.5%, P=0.84, respectively). Multivariate analysis revealed that Child-Pugh class over B (hazard ratio [HR], 7.30; 95% confidence interval [CI] 2.79-19.10; P<0.01) was associated with increase in creatinine, and Child-Pugh class over B (HR, 82.74; 95% CI 12.31-555.83; P<0.01) and Barcelona-Clinic Liver Cancer stage over B (HR, 14.93; 95% CI 1.60-139.51; P=0.02) were associated with decrease in eGFR.
Conclusions
TDF has comparable safety to that of ETV for HCC patients undergoing TACE.

Citations

Citations to this article as recorded by

Big Data Information under Proportional Hazard Mathematical Model in Analysis of Hepatitis B Virus Infection Data of Patients with Interventional Liver Cancer through Antiviral Therapy of Entecavir
Yichi Zhang, Shuai Zhao, Han Ding, Xiaoling Song, Huijie Miao, Xuya Cui, Jian Wang, Bing Han, Enas Abdulhay
Journal of Healthcare Engineering.2021; 2021: 1. CrossRef

Case Reports

Needle-tract Seeding of Hepatocellular Carcinoma at Chest Wall: A Report of Two Cases: Kim, Dae Jung , Kim, Gwangil; J Liver Cancer. 2018;18(1):63-66. Published online March 31, 2018; DOI: https://doi.org/10.17998/jlc.18.1.63

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Abstract PDF: We report two cases of needle-tract seeding after cryoablation and radiofrequency ablation for hepatocellular carcinomas. The seeding nodule appeared 6 and 12 months on the follow-up computed tomographic scan, respectively. In both cases, the seeding nodules were solitary in the chest wall, and could be completely resected.

A Case of Management for Early Recurrence after Hepatic Resection for the Treatment of Small Hepatocellular Carcinoma: Kyung Woo Park, Young Seok Kim, Sang Gyune Kim, Soung Won Jeong, Jae Young Jang, Hong Soo Kim, Sae Hwan Lee, Boo Sung Kim, Jun Cheol Jeong, Min Hee Lee, Jae Myeong Lee, Hee Kyung Kim; J Liver Cancer. 2015;15(2):122-125. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.122

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Abstract PDF: For a small hepatocellular carcinoma (HCC), liver resection shows most favorable outcome in
case
which liver transplantation is not available, although it has also substantial recurrence rate. Here, we report a case of recurred HCC with multiple intrahepatic metastasis at 5 months after surgical resection for small HCC was done. A 55-year-old man with chronic HBV infection received subsegmentectomy for HCC less than 2 cm. A follow-up computed tomography (CT) at 5 months from operation revealed that there were multiple enhancing nodules in entire remnant liver. Intra-arterial injections of adriamycin mixed lipiodol and gelfoam particles were instituted through hepatic artery. We assume that poorly differentiated cellular feature would be attributable to this kind of very early and aggressive recurrence of HCC. (J Liver Cancer 2015;15:122-125)

A Case of Hepatocelluar Carcinoma Mimicking Focal Nodular Hyperplasia: Eui Ju Park, Jae Young Jang, Soung Won Jeong, Sae Hwan Lee, Sang Gyune Kim, Young Seok Kim, Hong Soo Kim, Boo Sung Kim, So Young Jin, Ji Young Hwang; Journal of the Korean Liver Cancer Study Group. 2014;14(1):53-59. Published online March 31, 2014; DOI: https://doi.org/10.17998/jlc.14.1.53

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Abstract PDF: Recently, detection of an incidental hepatic tumor has rapidly increased with the introduction of multi-modality imaging techniques. And then, it is very important to determine whether these tumors are malignant or benign lesions. In some cases, differentiation from other hepatic tumors such as focal nodular hyperplasia or hepatic adenoma and hepatocellular carcinoma can be extremely difficult, both clinical and radiologic finding. Therefore, it is suggested that combination of multi-modality imaging study than using only a single imaging test. Despite advanced imaging studies such as computed tomography (CT), magnetic resonance imaging (MRI), contrast enhanced ultrasonography, and positron emission tomography (PET) showed a high sensitivity and specificity, role of liver biopsy is still remained to confirm the diagnosis. The use of liver biopsy in the diagnosis of hypervascular hepatic tumors is controversial. However if the tumors was shown rapid growth tendency and heterogeneous radiological appearance, liver biopsy or surgical resection should be considered to provide final diagnosis and prompt curative treatment. We report a case of a hepatocelluar carcinoma showing similar radiologic characteristics to focal nodular hyperplasia in patients without high risk factors of hepatocelluar carcinoma.

Original Article

The Comparison of Overall Survival between Child C with Early Stage HCC and Child A with Advanced Stage HCC: Eui Ju Park, Jae Young Jang, Soung Won Jeong, Jin Woo Choo, Jin Nyoung Kim, Soon Ha Kwon, Byoung Moo Lee, Sae Hwan Lee, Sang Gyune Kim, Sang-Woo Cha, Young Seok Kim, Young Deok Cho, Hong Soo Kim, Boo Sung Kim; Journal of the Korean Liver Cancer Study Group. 2013;13(2):136-144. Published online September 30, 2013; DOI: https://doi.org/10.17998/jlc.13.2.136

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Abstract PDF: Background/Aims
The prognosis of hepatocellular carcinoma (HCC) is affected by stage as well as liver function. We analyzed the survival outcome of early stage HCC in Child class C patients and advanced HCC in Child class A patients.
Methods
Among 453 HCC patients with good performance status, Group A included 33 consecutive Child class C patients with early stage (I, II) HCC, and Group B included 45 consecutive Child class A patients with advanced stage (III, IV) HCC. We investigated the clinical characteristics, cirrhotic complications, and prognostic factors related with survival in each group, and compared overall survival between two groups.
Results
Age, prothrombin time, total bilirubin and Model for End-Stage Liver Disease (MELD) scores were significantly higher in Group A. Male sex, platelet count, albumin, sodium (Na), hepatitis B virus, alpha fetoprotein (AFP) and portal vein thrombosis were significantly higher in Group B. Complications of cirrhosis such as variceal bleeding, ascites, and hepatic encephalopathy were increased in Group A (P<0.05). Patients with an elevated AFP (>400 ng/mL) tended to exhibit poor survival as it increased in Group A (P=0.084). MELD scores>15 (Hazard ratio[HR] 17.84, 95% confidence interval [CI] 3.70-85.93, P<0.001), stage IV (HR:3.27, 95% CI 1.10-9.75, P=0.033), and absence of HCC treatment (HR: 3.70, 95% CI 1.06-12.50, P=0.040) were independent poor prognostic factors in Group B. Median overall survival was 24.6 months (95% CI 10.6-38.4) for Group A and 13.5 months (95% CI 4.6-22.3) for Group B (P=0.278). In the HCC treatment group, there were no significant differences of median overall survival between Group A and Group B, respectively (27.1 vs. 15.7 months, P=0.338). In patients with conservative treatment, Group A and Group B had a significantly different median overall survival of 13.6 and 2.5 months, respectively (P=0.012). In patients of Group B, median overall survival was significantly higher in patients who received treatment of HCC compared to those who did not, respectively (15.7 vs. 2.5 months, P<0.001).
Conclusions
Overall median survival was not different between both groups. However, in Child class A patients with advanced stage HCCs, the cumulative median survival was higher in patients who received treatment of HCC compared to those who did not. Therefore, advanced stage HCC patients with good liver function should be considered for HCC treatments.

Case Report

A Case of Unresectable Hepatocellular Carcinoma Treated by Repeated Transcatheter Arterial Chemoembolization Using DC beads® Followed with Resection: Jeong-Yeop Song, Young Seok Kim, Jae Myeong Lee, Soo Ji Jin, Kyu Sung Choi, Yun Nah Lee, Sang Hyune Kim, Sung Won Jeong, Jae Young Jang, Sae Hwan Lee, Hong Soo Kim, Boo Sung Kim; Journal of the Korean Liver Cancer Study Group. 2013;13(1):65-69. Published online February 28, 2013; DOI: https://doi.org/10.17998/jlc.13.1.65

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Abstract PDF: In patients with unresectable hepatocellular carcinoma (HCC) and no anti-cancer treatment, the prognosis is quite poor. But in some cases, repeated sessions of transcatheter arterial chemoembolization (TACE) reduce the tumor size even to resectable, and post-TACE resection may prolong the survival time. We present a case of 50-year-old HBV carrier woman with abdominal distension. The diagnosis was huge HCC with intrahepatic metastasis. Repeated intra-arterial injections of adriamycin mixed lipiodol or DC beads® (100-300/300-500/500-700 μm, ©BIOCOMPATIBLES UK LTD) were instituted through ten sessions for 13 months. The tumor size became reduced with a partial response after 10th TACE and post-TACE resection was performed. No visible HCCs and decreased tumor markers were noted on the examinations 3 months after the resection.

Review Article

Is Hepatocellular Carinoma in Young Patients More Aggressive than Old Patients?: Jung Min Lee, Do Young Kim; Journal of the Korean Liver Cancer Study Group. 2009;9(1):24-28. Published online June 30, 2009

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Abstract PDF: In Korea, hepatocellular carcinoma (HCC) is a fourth leading malignancy with poor prognosis of 5 year survival reaching just 18.9%. The peak incidence is 6th decade and the incidence drops with decreasing age. However, young patients with HCC are not uncommonly encountered in clinical practice, and notably, even though managements with all available modalities are undertaken in these patients, the prognosis does not seem to be better. As such, many physicians feel that the behavior of HCC in young patients takes a more aggressive course than that in old patients. From this perspective, we performed a systemic review of previous literatures focusing on the question whether or not HCC in young patients is more aggressive; it was found that young patients with HCC had presentation of more advanced stage, more preserved liver function, but poor or equivocal survival rate. In the multivariate analysis, however, the poor outcome resulted not from young age, but from advanced stage, which was supported by similar or better outcome when the prognosis was compared with the same stage between young and old patients. Consequently, it could be inferred that an earlier detection of the tumor through earlier starting point of surveillance might improve the prognosis of young patients with HCC. However, a matter of cost-effectiveness should also be considered, which necessitates a further analysis on this issue.

Case Reports

A Case of Hepatocelluar Carcinoma with Portal Vein Tumor Thrombus arterial: Jong Kyu Park, Young Seok Kim, Sang Gyune Kim, Seung Won Jeong, Jae Young Jang, Hyun Jong Choi, Jong Ho Moon, Hong Soo Kim, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim; Journal of the Korean Liver Cancer Study Group. 2009;9(1):49-52. Published online June 30, 2009

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Abstract PDF: Recent progress in imaging techniques has permitted the diagnosis of hepatocelluar carcinoma (HCC) at an early stage. However, portal vein invasion is still found in 12.5~39.7%. HCC with tumor thrombosis of the portal vein has a poor prognosis. Previous studies showed that the median survival time of patients with HCC with involving portal vein was 2.7~4 months if effective treatment was not administered. Thus, for such HCC with portal vain invasion, an effective therapy that will maintain quality of life is required. We report a case of HCC with portal vein tumor thrombus treated by intra-arterial chemotherapy.

Two Cases of Bone Metastasis of Hepatocellular Carcinoma without Intrahepatic Recurrence: Byoung Kuk Jang, Woo Jin Chung, Kyung Sik Park, Kwang Bum Cho, Jae Seok Hwang, Sung Hoon Ahn, Young Hwan Kim, Jin Soo Choi, Jung Hyeok Kwon; Journal of the Korean Liver Cancer Study Group. 2006;6(1):89-94. Published online June 30, 2006

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Abstract PDF: Extrahepatic metastases of hepatocellular carcinoma (HCC) are now increasing due to prolonged survival. Extrahepatic metastases of HCC frequently develop in patients with more advanced stage and sometimes occur without intrahepatic recurrence. We report two cases bone metastasis of HCC without intrahepatic recurrence after treatment.

Hepatic Failure after Chemotherapy in Patient with HBV-related HCC: Report of 1 Case: Sang Kyun Yu, Hwang Rae Chun, Chang Won Baeck, Soon Ho Um; Journal of the Korean Liver Cancer Study Group. 2005;5(1):45-48. Published online June 30, 2005

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Abstract PDF: Hepatitis B virus (HBV) reactivation is a well described complication in cancer patitient who receive cytotoxic chemotherapy and may result in varying degree of liver damage. Liver damage due to HBV exacerbation is a 2-stage process. The initial stage occurs during intense cytotoxic therapy and is characterized by enhancing viral replication, as reflected by increases in serum levels of HBV DNA, HBeAg, which presumably result in widespread infection of hepatocytes. The second stage is related to restoration of immune function following withdrawl of cytotoxic therapy, which cause rapid immune-mediated destruction of infected hepatocyte. Clinically, this may lead to hepatitis, hepatic failure, and even death. We report a case of hepatic failure after chemotherapy in patient with HBV-related hepatocelluar carcinoma.

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