The impact of antiviral therapy on postoperative intrahepatic recurrence of hepatitis B related hepatocellular carcinoma / 中华肝胆外科杂志

Objective To study the impact of antiviral therapy on patients with postoperative intrahepatic recurrence of hepatitis B related hepatocellular carcinoma (HCC).Methods According to the inclusion and exclusion criteria,65 patients with HCC who were managed in our hospital from January 2004 to December 2011 for intrahepatic recurrence and had indications for antiviral treatment were included into this study.The patients were divided into two groups ; the antiviral and the control groups.Relevant data between these two groups such as cumulative survival after recurrence,Child-Pugh grade,HBV-DNA,HBeAg,AFP at the time of recurrence and 6 months later were studied.An analysis on multiple-factors was carried for survival after recurrence at 2 years.Results When compared with the control group,the antiviral group had better cumulative survival in all the cases and in the TACE cases (P ＜ 0.05 respectively).The cumulative survival in the RFA cases was not significantly different between the two groups (P ＞ 0.05).A comparison was carried out in patients who received antiviral therapy which was combined with one or more other therapies (TACE,RFA,reoperation):(a) antiviral therapy only (8 patients) ; (b) combined with one therapy (22 patients) ; (c) combined with two therapies (10 patients) ; (d) combined with three therapies (2 patients).All P values of a:b,a:c,a:d,b:c,b:d were less than 0.05.The blood HBV-DNA of the two groups was significantly different at the time 6 months after recurrence (P ＜ 0.05).The results of multivariate analysis showed the 2-year survival was significantly correlated with recurrent tumor size,primary tumor class,antiviral therapy or not after recurrence,presence of absence of cirrhosis.All P values were less than 0.05.Conclusions Antiviral therapy had remarkable clinical impact on HCC patients with postoperative intrahepatic recurrence and with indication for antiviral treatment.Patients had better prognosis if antiviral therapy was combined with one or more other therapies.

Recurrence after anatomic versus nonanatomic resection for hepatocellular carcinoma: a Meta-analysis / 中华肝胆外科杂志

Objective To compare anatomic resection (AR) and non-anatomic resection (NAR)for hepatocellular carcinoma (HCC) as a factor in preventing intra-hepatic recurrence and local recurrence after the initial surgical procedure.Methods A systematic review and Meta-analysis of nonrandomized trials comparing anatomic resection with non-anatomic resection for HCC published from 1990to 2010 in PubMed and Medline,Coehrane Library,Embase,and Science Citation Index were searched.Intra-hepatic recurrence,including early and late recurrence,and local recurrence were primary outcomes.5-year survival and 5-year disease-free survival were secondary outcomes.Pooled effect was calculated by utilizing either fixed effects model or random effects model.Result Eleven nonrandomized studies including 1576 patients were identified and analyzed.810 patients were in the AR group and 766 were in the NAR group.Patients in the AR group were characterized by lower prevalence of cirrhosis,more favorable hepatic function,and larger tumor size and higher prevalence of macrovascular invasion compared with patients in the NAR group.Anatomic resection significantly reduced the risks of local recurrence (OR,0.27; 95％ CI,-0.17～0.43; P＜0.001) and achieved a better 5-year disease-free survival (OR,2.10; 95％ CI,-1.41 ～3.12; P=0.001) in HCC patients.Also,anatomic resection was marginally effective in decreasing early intra-hepatic recurrence.However,anatomic resection was not advantageous in preventing late intra-hepatic recurrence.No significant differences were found between the AR and NAR groups with respect to postoperative morbidity,mortality,and length of hospitalization.Conclusion Anatomic resection was recommended to be superior to non-anatomic resection in reducing the risks of local recurrence,early intra-hepatic recurrence and achieving a better 5-year disease-free survival in HCC patients.

Risk Factors for Intrahepatic Recurrence

PURPOSE: Although surgical resection offers patients with HCC the chance of a cure, the post-resection tumor recurrence rate is high, with reported cumulative 5-year tumor recurrence rates ranging from 40 to 70%. The objective of this study was to investigate risk factors for intrahepatic recurrence after resection of hepatocellular carcinoma, especially in patients with hepatitis B virus infection. METHODS: Between January 1999 and December 2003, 59 patients in our Hospital with hepatitis B virus infection underwent liver resection for hepatocellular carcinoma. Clinical, biological, and histopathological characteristics of these patients were collected and tested for their prognostic significance using a Chi-square test and a Student's t-test. Time to recurrence and survival rate were analyzed by the Kaplan-Meier method. RESULTS: Of the 59 patients who underwent liver resection, 24 (41%) experienced intrahepatic recurrence. The 1-, 3-, and 5-year overall survival rates of total enrolled patients were 83%, 63%, and 42%, respectively. The 1-, 3-, and 5-year overall survival rates after recurrence were 87%, 52%, and 20%, respectively. The risk factors for early recurrence were elevated serum aspartate aminotransferase (AST) level (p=0.044) and larger tumor size (p=0.049). For late recurrence, greater tumor size (p=0.039) was the only risk factor. CONCLUSION: Tumor size and serum aspartate aminotransferase are risk factors of intrahepatic recurrence after resection of HCC in patients with chronic hepatitis B virus infection. This finding indicates that patients who have these risk factors should be under more careful supervision and have more aggressive follow-up.

The Risk Factors for the Intrahepatic Recurrence of Hepatocellular Carcinoma after Curative Resection

PURPOSE: Intrahepatic recurrent HCC has been classified according to location, the time to recurrence and the pattern of presentation. The purpose of this study is to classify intrahepatic recurrent HCCs into subgroups that have relatively similar recurrent patterns and to identify the risk factors for each recurrent type. METHODS: A total of 353 patients were retrospectively studied. Intrahepatic recurrent HCC was classified into nodular recurrence ( or =4 nodules; type II) and infiltrative recurrence (type III). The cut-off time between early and late recurrence was chosen to be 12 months following hepatectomy. RESULTS: Among the 134 patients with only intrahepatic recurrence, 94 were type I, 27 were type II and 13 were type III. The median survival time following the recurrence of types I, II and III were 55, 16 and 8 months, respectively. As determined by multivariate analysis, perioperative transfusion and indocyanine green retention at 15 minutes (ICG R 15 >10%) were the independent risk factors for type I; an ICG R 15>10%, microvessel invasion and intrahepatic metastasis were the independent risk factors for type II; an ICG R 15>10% and microscopic portal vein invasion were the independent risk factors for type III. Multivariate analysis revealed that the prognosis of patients with IHR was associated with the recurrent types, the time to recurrence and the serum albumin level at the initial presentation. Following multivariate analysis, an ICG R 15>10% and intrahepatic metastasis were the independent risk factors for early type I recurrence; perioperative transfusion and a higher grade of hepatitis activity were the independent risk factors for late type I recurrence. CONCLUSIONS: The recurrent types and the time to recurrence may help us to predict the cellular origin of intrahepatic recurrent HCC and the prognosis of the patients who suffer with intrahepatic recurrent HCC.

Repeat Resection for Intrahepatic and Omental Recurrence of Ruptured Hepatocelluar Carcinoma after the Initial Surgery

The most serious problem of ruptured hepatocellular carcinoma (HCC) is the difficulty to achieve curative resection due to unplanned emergency operations, the hemodynamic instability, the frequent intrahepatic recurrence and the peritoneal seeding after resection for primary ruptured hepatocelluar carcinoma. Recent articles have suggested that well planned elective hepatic resection after hemodynamic stabilization of a ruptured HCC patient has a good prognosis, and repeat hepatic resection of recurred HCC has good prognosis when the liver function is good. We report here on patient who survived a long time with recurred HCC after 3 bouts of repeated hepatic resection for intrahepatic recurrences and 1 bout of right hemicolectomy for an omental recurrence. (ED note: now it shows good.)

Expression of c-Met in hepatocellular carcinoma / 한국간담췌외과학회지

BACKGROUND/AIMS: The c-met proto-oncogene encodes the tyrosine kinase receptor for hepatocyte growth factor (HGF), a potent mitogen and motogen for epithelial cells. Because of its profound effects on cell growth and motility, HGF may be important in the development of cancer metastases in hepatocellular carcinoma (HCC). We examined the expression of the c-met proto-oncogene product (c-Met) in the patients with HCCs to determine the relationship between the level of expression of c-Met and clinicopathological features, and patient outcome following hepatectomy. METHODS: Fifty patients with surgically resected hepatocellular carcinoma at Seoul National University Hospital from January 1997 to December 1998 were included in this study. Western blotting was used to examine the c-Met expression of tumor and surrounding tissues. The clinicopathologic features and treatment results of the patients were analyzed by medical records. Patients were divided into two groups, low c-met HCC and high c-met HCC. RESULTS: c-Met was not overexpressed in HCC compared to surrounding tissue. The expression of c- Met in tumor tissue was correlated with well-differentiated HCCs, and adversely correlated with tumor necrosis by transcatheter arterial chemoembolization (TACE). There was no correlation between c-Met expression and intrahepatic recurrence. CONCLUSION: In conclusion, these results indicate that c-Met expression in HCC is not correlated with intrahepatic recurrence, and tumor necrosis by TACE reduces c-Met expression in tumor tissue. More large-scaled study is needed for exact relation between c-Met expression and clinicopathologic features of HCCs.

Management Of Intrahepatic Recurrence after Surgical Resection of Primary Hepatic Malignancy / 한국간담췌외과학회지

BACKGROUND: Surgical resection is generally accepted as the first choice of treatment for primary hepatic malignancy. But liver resection of primary hepatic malignancy is associated with a high incidence of recurrence, that has a poor prognosis. The goal of this research was to assess the rationale and result of treatment of recurrence following resection of primary hepatic malignancy. PATIENTS & METHODS: This was a retrospective study of 258 patients who had done hepatic resection with primary hepatic malignancy from 1990. Jan to 1999. Dec. And retrospective analysis of 72 patients with recurrent intrahepatic malignancy after hepatic resection. We exclude extrahepatic recurrence. The treatment methods of intrahepatic recurrence are variable. They include repeated hepatic resection, transcatheter arterial chemoembolization, percutaneous injection therapy of alcohol or hot saline, holmium-166 injection therapy, systemic chemotherapy and combined therapy. RESULTS: The cases of hepatic re-resection are 8, the cases of transcatheter arterial chemoembolization are 19, the cases of percutaneous injection therapy of alcohol or hot saline are 7, the cases of holmium- 166 injection therapy are 6, the cases of systemic chemotherapy are 13 and the cases of combined therapy are 13. In the poor general condition, 6 patients, only conservative therapy was applied. The survival rate of 72 patients with recurrent intrahepatic malignancy after hepatic resection is 61.6%, 46.6%, 33.5%, 26.9%, 15.5%, 2.7% at 3 month, 6 month, 9month, 1year, 2year, 3year. The survival rate of the cases of hepatic re-resection is 100%, 85.7%, 71.4%, 71.4%, 47.6%. The survival rate of transcatheter arterial chemoembolization is 89.5%, 73.0%, 61.8%, 61.8%, 44.1%. 11.0%. The survival rate of percutaneous injection therapy of alcohol or hot saline is 100%, 71.4%, 42.9%, 42.9%, 14.3%, 0%. The survival rate of holmium-166 injection therapy is 66.7%, 66.7%, 66.7%, 33.3%, 33.3%. The survival rate of systemic chemotherapy is 53.9%, 38.5%, 30.8%, 15.4%, 15.4%, 0%. The survival rate of combined therapy is 100%, 84.6%, 69.2%, 69.2%, 41.5%, 0%. And the survival rate of conservative therapy is 54.1%, 39.8%, 19.9%, 14.2%, 7.6%, 3.8%. CONCLUSION: We got results that the hepatic resection, holmium-166 injection therapy, and transcatheter arterial chemoembolization combined therapy were better than systemic chemotherapy and percutaneous injection therapy of alcohol or hot saline in longterm survival rate.