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1.
Article in English | WPRIM | ID: wpr-921867

ABSTRACT

Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the fourth leading cause of cancer related death worldwide. China covers over half of cases, leading HCC to be a vital threaten to public health. Despite advances in diagnosis and treatments, high recurrence rate remains a major obstacle in HCC management. Multi-omics currently facilitates surveillance, precise diagnosis, and personalized treatment decision making in clinical setting. Non-invasive radiomics utilizes preoperative radiological imaging to reflect subtle pixel-level pattern changes that correlate to specific clinical outcomes. Radiomics has been widely used in histopathological diagnosis prediction, treatment response evaluation, and prognosis prediction. High-throughput sequencing and gene expression profiling enabled genomics and proteomics to identify distinct transcriptomic subclasses and recurrent genetic alterations in HCC, which would reveal the complex multistep process of the pathophysiology. The accumulation of big medical data and the development of artificial intelligence techniques are providing new insights for our better understanding of the mechanism of HCC via multi-omics, and show potential to convert surgical/intervention treatment into an antitumorigenic one, which would greatly advance precision medicine in HCC management.


Subject(s)
Artificial Intelligence , Carcinoma, Hepatocellular/therapy , Gene Expression Profiling , Humans , Liver Neoplasms/genetics , Prognosis
2.
Chinese Journal of Biotechnology ; (12): 3042-3060, 2021.
Article in Chinese | WPRIM | ID: wpr-921405

ABSTRACT

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths and the fifth most common cancer worldwide. Clinically therapeutic options for HCC are very limited, and the overall survival rate of patients is very low. Therefore, early diagnosis and treatment of HCC have important impact on overall survival of patients. At present, alpha-fetoprotein (AFP) is one of the most widely used serological markers for HCC. Many evidences have shown that as a specific onco-protein, AFP has great research value in the occurrence, development, diagnosis and treatment of HCC. Here, we briefly introduce the molecular mechanism of AFP in the regulation of HCC occurrence and development, and its role in tumor escape from immune surveillance. We focus on the application of AFP as an important HCC target or carcino-embryonic antigen (CEA) in HCC clinical diagnosis and treatment.


Subject(s)
Biomarkers, Tumor/genetics , Carcinoma, Hepatocellular/therapy , Early Detection of Cancer , Humans , Liver Neoplasms/therapy , alpha-Fetoproteins
3.
Journal of Integrative Medicine ; (12): 418-427, 2021.
Article in English | WPRIM | ID: wpr-888773

ABSTRACT

OBJECTIVE@#Exercise, as a common non-drug intervention, is one of several lifestyle choices known to reduce the risk of cancer. Mitochondrial division has been reported to play a key role in the occurrence and transformation of hepatocellular carcinoma (HCC). This study investigated whether exercise could regulate the occurrence and development of HCC through mitosis.@*METHODS@#Bioinformatics technology was used to analyze the expression level of dynamin-related protein 1 (DRP1), a key protein of mitochondrial division. The effects of DRP1 and DRP1 inhibitor (mdivi-1) on the proliferation and migration of liver cancer cells BEL-7402 were observed using cell counting kit-8, plate colony formation, transwell cell migration, and scratch experiments. Enzyme-linked immunosorbent assay, Western blot and real-time polymerase chain reaction were used to detect the expression of DRP1 and its downstream phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway. A treadmill exercise intervention was tested in a nude mouse human liver cancer subcutaneous tumor model expressing different levels of DRP1. The size and weight of subcutaneous tumors in mice were detected before and after exercise.@*RESULTS@#The expression of DRP1 in liver cancer tissues was significantly upregulated compared with normal liver tissues (P < 0.001). The proliferation rate and the migration of BEL-7402 cells in the DRP1 over-expression group were higher than that in the control group. The mdivi-1 group showed an inhibitory effect on the proliferation and migration of BEL-7402 cells at 50 μmol/L. Aerobic exercise was able to inhibit the expression of DRP1 and decrease the size and weight of subcutaneous tumors. Moreover, the expression of phosphorylated PI3K (p-PI3K) and phosphorylated AKT (p-AKT) decreased in the exercise group. However, exercise could not change p-PI3K and p-AKT levels after knocking down DRP1 or using mdivi-1 on subcutaneous tumor.@*CONCLUSION@#Aerobic exercise can suppress the development of tumors partially by regulating DRP1 through PI3K/AKT pathway.


Subject(s)
Animals , Apoptosis , Carcinoma, Hepatocellular/therapy , Cell Line, Tumor , Cell Proliferation , Down-Regulation , Dynamins , Liver Neoplasms/therapy , Mice , Phosphatidylinositol 3-Kinase/metabolism , Phosphatidylinositol 3-Kinases/metabolism , Proto-Oncogene Proteins c-akt/metabolism , Signal Transduction
4.
Frontiers of Medicine ; (4): 155-169, 2021.
Article in English | WPRIM | ID: wpr-880972

ABSTRACT

Hepatic resection represents the first-line treatment for patients with resectable hepatocellular carcinoma (HCC). However, the 5-year recurrence rates of HCC after surgery have been reported to range from 50% to 70%. In this review, we evaluated the available evidence for the efficiency of adjuvant treatments to prevent HCC recurrence after curative liver resection. Antiviral therapy has potential advantages in terms of reducing the recurrence rate and improving the overall survival (OS) and/or disease-free survival of patients with hepatitis-related HCC. Postoperative adjuvant transarterial chemoembolization can significantly reduce the intrahepatic recurrence rate and improve OS, especially for patients with a high risk of recurrence. The efficacy of molecular targeted drugs as an adjuvant therapy deserves further study. Adjuvant adoptive immunotherapy can significantly improve the clinical prognosis in the early stage. Randomized controlled trial (RCT) studies evaluating adjuvant immune checkpoint inhibitors are ongoing, and the results are highly expected. Adjuvant hepatic artery infusion chemotherapy might be beneficial in patients with vascular invasion. Huaier granule, a traditional Chinese medicine, has been proved to be effective in prolonging the recurrence-free survival and reducing extrahepatic recurrence. The efficiency of other adjuvant treatments needs to be further confirmed by large RCT studies.


Subject(s)
Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic , Chemotherapy, Adjuvant , Hepatectomy , Humans , Liver Neoplasms/therapy , Neoplasm Recurrence, Local , Treatment Outcome
5.
Frontiers of Medicine ; (4): 170-177, 2021.
Article in English | WPRIM | ID: wpr-880966

ABSTRACT

Nanosecond pulsed electric field (nsPEF) is a novel, nonthermal, and minimally invasive modality that can ablate solid tumors by inducing apoptosis. Recent animal experiments show that nsPEF can induce the immunogenic cell death of hepatocellular carcinoma (HCC) and stimulate the host's immune response to kill residual tumor cells and decrease distant metastatic tumors. nsPEF-induced immunity is of great clinical importance because the nonthermal ablation may enhance the immune memory, which can prevent HCC recurrence and metastasis. This review summarized the most advanced research on the effect of nsPEF. The possible mechanisms of how locoregional nsPEF ablation enhances the systemic anticancer immune responses were illustrated. nsPEF stimulates the host immune system to boost stimulation and prevail suppression. Also, nsPEF increases the dendritic cell loading and inhibits the regulatory responses, thereby improving immune stimulation and limiting immunosuppression in HCC-bearing hosts. Therefore, nsPEF has excellent potential for HCC treatment.


Subject(s)
Animals , Carcinoma, Hepatocellular/therapy , Cell Line, Tumor , Immunity , Liver Neoplasms/therapy , Neoplasm Recurrence, Local
6.
Einstein (Säo Paulo) ; 18: eRC4990, 2020. graf
Article in English | LILACS | ID: biblio-1090070

ABSTRACT

ABSTRACT Transarterial radioembolization (TARE) with yttrium-90 microspheres is a palliative locoregional treatment, minimally invasive for liver tumors. The neoadjuvant aim of this treatment is still controversial, however, selected cases with lesions initially considered unresectable have been enframed as candidates for curative therapy after hepatic transarterial radioembolization. We report three cases in which the hepatic transarterial radioembolization was used as neoadjuvant therapy in an effective way, allowing posterior potentially curative therapies.


RESUMO A radioembolização transarterial hepática com microesferas de ítrio-90 é uma modalidade paliativa de tratamento locorregional minimamente invasiva. O objetivo neoadjuvante deste tratamento ainda é controverso, mas casos selecionados de lesões consideradas inicialmente irressecáveis reenquadram-se como candidatos à terapia curativa após a radioembolização transarterial hepática. Relatamos três casos em que a radioembolização transarterial hepática foi utilizada como terapia neoadjuvante de forma efetiva possibilitando aplicação posterior de terapias potencialmente curativas.


Subject(s)
Humans , Male , Female , Adult , Aged , Bile Duct Neoplasms/therapy , Chemoembolization, Therapeutic/methods , Cholangiocarcinoma/therapy , Carcinoma, Hepatocellular/therapy , Liver Neoplasms/therapy , Yttrium Radioisotopes , Treatment Outcome , Disease Progression , Neoadjuvant Therapy/methods , Middle Aged
7.
Rev. méd. Urug ; 36(2): 186-190, 2020. graf
Article in Spanish | LILACS, BNUY | ID: biblio-1115822

ABSTRACT

Resumen: El hepatocarcinoma fibrolamelar es una entidad poco frecuente cuya incidencia varía entre 1% y 5% en el porcentaje de todos los hepatocarcinomas. Afecta principalmente a pacientes jóvenes con hígado sano, y en el 50% de los casos su diagnóstico se realiza en etapas avanzadas de la enfermedad. Se presenta el caso de un paciente de 15 años de edad, sano, que consulta por tumoración abdominal de tres meses de evolución, dolor en epigastrio y adelgazamiento. Los estudios de imagen informan tumoración que sustituye el lóbulo izquierdo del hígado con realce heterogéneo en la fase arterial, que infiltra la vena suprahepática izquierda. Además, informa lesiones en los segmentos V y VIII, extensas adenopatías en el hilio hepático, y nódulos a nivel peritoneal y subpleural. Se realizó punción biópsica hepática que confirmó el diagnóstico de hepatocarcinoma fibrolamelar, iniciándose tratamiento oncoespecífico.


Summary: Fibrolamellar hepatocellular carcinoma is a rare entity that represent between 1% to 5% of all hepatocarcinomas. Tipically affects younger patients (10 to 30 year of age) of both sexes, without underlying liver disease. In 50% of the cases the diagnosis is made in advanced stages of the disease. We present the case of a male patient of 15 years of age, healthy, who consulted due to an abdominal tumor of 3 months evolution, epigastric pain and weight loss. The imaging studies report a tumor that replaces the left lobe with heterogeneous enhancement in the arterial phase that infiltrates the left suprahepatic vein. Injuries in segment V and VIII. Extensive lymphadenopathy in the liver liver. Peritoneal and subpleural nodule. Hepatic biopsy puncture was performed confirming fibrolaminar hepatocarcinoma. Start once specific treatment.


Resumo: Entidade pouco frequente cuja incidência varia entre 1% e 5% de todos os hepatocarcinomas. Acomete principalmente pacientes jovens com fígado saudável e em quase 50% dos casos o diagnóstico é feito em estágios avançados da doença. Apresentamos o caso de um paciente do sexo masculino, de 15 anos de idade, saudável, que consultou devido a um tumor abdominal de 3 meses de evolução, dor epigástrica e perda de peso. Os estudos de imagem relatam um tumor que substitui o lobo esquerdo com realce heterogêneo na fase arterial que infiltra a veia supra-hepática esquerda. Lesões do segmento V e VIII. Linfadenopatia extensa no fígado do fígado. Nódulo peritoneal e subpleural. A punção da biópsia hepática foi realizada confirmando o hepatocarcinoma fibrolaminar. Iniciar um tratamento específico.


Subject(s)
Humans , Adolescent , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/therapy
8.
Clinics ; 75: e2192, 2020.
Article in English | LILACS | ID: biblio-1142761

ABSTRACT

More than 18 million people in 188 countries have been diagnosed as having coronavirus disease (COVID-19), and COVID-19 has been responsible for more than 600,000 deaths worldwide. Brazil is now the second most affected country globally. Faced with this scenario, various public health measures and changes in the daily routines of hospitals were implemented to stop the pandemic. Patients with hepatocellular carcinoma (HCC) are at an increased risk for severe COVID-19 as they present with two major diseases: cancer and concomitant chronic liver disease. The COVID-19 pandemic can significantly impact the management of HCC patients from diagnosis to treatment strategies. These patients need special attention and assistance at this time, especially since treatment for tumors cannot be delayed in most cases. The aim of this guideline was to standardize the management of HCC patients during the COVID-19 pandemic. This document was developed, on the basis of the best evidence available, by a multidisciplinary team from Instituto do Câncer do Estado de São Paulo (ICESP), and Instituto Central of the Hospital das Clínicas da Universidade de São Paulo (HC-FMUSP), which are members of the São Paulo Clínicas Liver Cancer Group.


Subject(s)
Humans , Coronavirus Infections , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/epidemiology , Pandemics , Liver Neoplasms/therapy , Liver Neoplasms/epidemiology , Pneumonia, Viral , Brazil/epidemiology , Consensus , Betacoronavirus , SARS-CoV-2 , COVID-19
9.
Chinese Journal of Biotechnology ; (12): 1992-2000, 2020.
Article in Chinese | WPRIM | ID: wpr-878460

ABSTRACT

Hepatocellular carcinoma (HCC) is one of the five most common malignant tumors. According to the latest statistics of the World Health Organization (WHO), the incident and mortality rates of HCC ranks the eighth and third in the world, respectively, which severely affect people's health. Exosomes are extracellular vesicles with a bilayer of phospholipids, which carry active substances such as proteins and nucleic acids derived from their mother cells. These exosomes greatly facilitate the exchange of substances and information between cells, and coordinate physiological and pathological processes in the body. In recent years, a large number of studies have shown that exosomal proteins play important roles in the tumorigenesis, development, diagnosis and treatment of HCC. Here we review the composition and functions of exosomes and the role of exosomal proteins in HCC.


Subject(s)
Carcinogenesis/genetics , Carcinoma, Hepatocellular/therapy , Exosomes/metabolism , Humans , Liver Neoplasms/therapy , MicroRNAs/genetics , Proteomics
10.
Singapore medical journal ; : 619-623, 2020.
Article in English | WPRIM | ID: wpr-877439

ABSTRACT

In this paper, we aim to provide professional guidance to clinicians who are managing patients with chronic liver disease during the current coronavirus disease 2019 (COVID-19) pandemic in Singapore. We reviewed and summarised the available relevant published data on liver disease in COVID-19 and the advisory statements that were issued by major professional bodies, such as the American Association for the Study of Liver Diseases and European Association for the Study of the Liver, contextualising the recommendations to our local situation.


Subject(s)
COVID-19/epidemiology , Carcinoma, Hepatocellular/therapy , Chronic Disease , Hepatitis B, Chronic/therapy , Hepatitis C, Chronic/therapy , Humans , Liver Cirrhosis/therapy , Liver Diseases/therapy , Liver Neoplasms/therapy , Liver Transplantation , Singapore/epidemiology
11.
Braz. j. med. biol. res ; 52(12): e8467, 2019. tab, graf
Article in English | LILACS | ID: biblio-1055474

ABSTRACT

The aim of our study was to assess the efficacy, safety, and prognostic factors of drug-eluting bead transarterial chemoembolization (DEB-TACE) in Chinese hepatocellular carcinoma (HCC) patients. Patients (n=102) diagnosed as primary HCC were consecutively enrolled in this retrospective cohort study. Treatment responses were assessed following the modified Response Evaluation Criteria in Solid Tumors. Progression-free survival (PFS) and overall survival (OS) were evaluated, and adverse events (AEs) as well as liver function-related laboratory indexes of all DEB-TACE records (N=131) were assessed. Complete response (CR) rate, objective response rate, and disease control rate were 51.0, 87.3, and 95.1%, respectively, at 1-3 months post DEB-TACE. The mean PFS and OS were 227 (95%CI: 200-255) days and 343 (95%CI: 309-377) days, respectively. Multivariate logistic regression revealed that portal vein invasion and abnormal total protein (TP) were independent predictive factors for worse CR, and multivariate Cox's regression analysis showed that multifocal disease independently correlated with shorter PFS. Most of the liver function-related laboratory indexes worsened at 1 week but recovered at 1-3 months post-treatment, only the percentage of patients with abnormal ALP increased at 1-3 months. In addition, 112 (85.5%), 84 (64.1%), 53 (40.5%), 40 (30.5%), and 16 (12.2%) patients had pain, fever, nausea, vomiting, and other AEs, respectively. DEB-TACE is efficient and safe in Chinese HCC patients, and portal vein invasion, abnormal TP level as well as multifocal disease could be used as unfavorable prognostic factors to DEB-TACE treatment.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Epirubicin/administration & dosage , Chemoembolization, Therapeutic/methods , Carcinoma, Hepatocellular/therapy , Liver Neoplasms/therapy , Antibiotics, Antineoplastic/administration & dosage , Prognosis , Survival Analysis , Retrospective Studies , Cohort Studies , Treatment Outcome
12.
Acta cir. bras ; 34(7): e201900710, 2019. tab, graf
Article in English | LILACS | ID: biblio-1038119

ABSTRACT

Abstract Purpose: To investigate the prognostic value of 17 platelet-based prognostic scores in patients with malignant hepatic tumors after TACE therapy. Methods: In total, 92 patients were divided into death group and survival group according to long-term follow-up results. The AUC was calculated to determine the optimal cut-off values for predicting prognosis. To determine better prognostic models, platelet-based models were analyzed separately after being showed as binary according to cut-off values. Cumulative survival rates of malignant hepatic tumors were calculated using Kaplan-Meier curves and differences were analyzed by the log-rank test. Univariate and multivariate analyses were performed to identify platelet-based prognostic scores associated with overall survival. Results: Univariate analysis showed that APGA, APRI, FIB-4, FibroQ, GUCI, King's score, Lok index, PAPAS, cirrhosis, number of tumors, vascular cancer embolus, AFP, ALP and APTT were significantly related to prognosis. A multivariate analysis showed that the APGA, number of tumors, ALP and APTT were independently associated with overall survival. Conclusion: This study showed that the APGA, a platelet-based prognostic score, was an independent marker of prognosis in patients with malignant hepatic tumors after TACE and was superior to the other platelet-based prognostic scores in terms of prognostic ability.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Aspartate Aminotransferases/blood , Blood Platelets/chemistry , Chemoembolization, Therapeutic/methods , Carcinoma, Hepatocellular/therapy , Liver Neoplasms/therapy , Platelet Count , Prognosis , Biomarkers, Tumor/blood , Retrospective Studies , ROC Curve , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/blood , Kaplan-Meier Estimate , Liver Neoplasms/mortality , Liver Neoplasms/blood
13.
Rev. chil. cir ; 70(5): 457-459, 2018. ilus
Article in Spanish | LILACS | ID: biblio-978015

ABSTRACT

Objetivo: Reportar un caso clínico de hepatocarcinoma fibrolamelar metastásico y su manejo multidisciplinario. Caso clínico: Paciente de 24 años de edad con dolor abdominal, distensión abdominal y fiebre. Se le realizó tomografía computarizada de abdomen donde se encontró tumoración hepática irregular. Se realizó laparotomía con evidencia de múltiples implantes en cavidad abdominal y se diagnosticó mediante estudio histopatológico hepatocarcinoma fibrolamelar metastásico. Se decidió realizar citorreducción más quimioterapia hipertérmica intraperitoneal (HIPEC). La sobrevida de la paciente fue de 11 meses. Discusión: El hepatocarcinoma fibrolamelar es un tumor raro. Aún no hay consenso sobre el mejor tratamiento en pacientes con metástasis que tengan buena funcionalidad. El manejo actual se basa en la quimioterapia sistémica y la resección quirúrgica en casos localizados. En el caso de nuestra paciente, la cirugía citorreductora más HIPEC se realizó con la intención de mejorar la supervivencia. Se necesita más evidencia para definir esta estrategia como tratamiento estándar.


Aim: To report a clinical case of metastatic fibrolamellar hepatocarcinoma and its multidisciplinary management. Case report: 24 year-old patient with abdominal pain, bloating and fever. A computed tomography of the abdomen was performed; an irregular hepatic tumor was found. A laparotomy was performed with evidence of multiple implants in the abdominal cavity and the histopathology report was metastatic fibrolamellar hepatocarcinoma. It was decided to perform cytoreductive surgery plus HIPEC. The patient's survival was 11 months. Discussion: Fibrolamellar hepatocarcinoma is a rare tumor. There is still no consensus on the treatment of choice in patients with metastases with good functionality status. Current management is based on systemic chemotherapy and surgical resection in localized cases. In the case of our patient, cytoreductive surgery plus HIPEC was performed with the intention of improving survival. More evidence is needed to define this strategy as standard treatment.


Subject(s)
Humans , Female , Adult , Carcinoma, Hepatocellular/therapy , Cytoreduction Surgical Procedures/methods , Hyperthermia, Induced/methods , Liver Neoplasms/therapy , Antineoplastic Agents/therapeutic use , Peritoneal Neoplasms/secondary , Peritoneal Neoplasms/therapy , Magnetic Resonance Imaging , Treatment Outcome , Fatal Outcome , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/pathology , Hepatectomy , Liver Neoplasms/diagnosis , Liver Neoplasms/pathology
14.
Clinics ; 72(8): 454-460, Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-890722

ABSTRACT

OBJECTIVES: This study sought to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the Barcelona Clinic Liver Cancer system treatment guidelines and to examine the impact of adherence on the survival of patients in different stages of the disease. METHODS: This study included all patients referred for the treatment of hepatocellular carcinoma between 2010 and 2012. Patients (n=364) were classified according to the Barcelona Clinic Liver Cancer guidelines. Deviations from the recommended guidelines were discussed, and treatment was determined by a multidisciplinary team. The overall survival curves were estimated with the Kaplan-Meier method and were compared using the log-rank test. RESULTS: The overall rate of adherence to the guidelines was 52%. The rate of adherence of patients in each scoring group varied as follows: stage 0, 33%; stage A, 45%; stage B, 78%; stage C, 35%; and stage D, 67%. In stage 0/A, adherent patients had a significantly better overall survival than non-adherent patients (hazard ratio=0.19, 95% confidence interval (CI): 0.09-0.42; p<0.001). Among the stage D patients, the overall survival rate was worse in adherent patients than in non-adherent patients (hazard ratio=4.0, 95% CI: 1.67-9.88; p<0.001), whereas no differences were observed in patients in stages B or C. CONCLUSIONS: The rate of adherence to the Barcelona Clinic Liver Cancer staging system in clinical practice varies according to clinical disease stage. Adherence to the recommended guidelines positively impacts survival, especially in patients with early-stage disease.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/therapy , Guideline Adherence/statistics & numerical data , Liver Neoplasms/mortality , Liver Neoplasms/therapy , Brazil , Carcinoma, Hepatocellular/pathology , Follow-Up Studies , Kaplan-Meier Estimate , Liver Neoplasms/pathology , Neoplasm Staging , Retrospective Studies , Time Factors , Treatment Outcome
15.
Rev. Col. Bras. Cir ; 44(4): 360-366, jul.-ago. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-896595

ABSTRACT

RESUMO Objetivo: comparar o resultado do transplante de fígado por hepatocarcinoma em pacientes submetidos ou não ao tratamento loco-regional e downstaging, em relação à sobrevida e risco de recidiva na fila de transplante. Métodos: estudo retrospectivo dos pacientes portadores de hepatocarcinoma submetidos a transplante hepático na região metropolitana de São Paulo, entre janeiro de 2007 e dezembro de 2011, a partir de doador falecido. A amostra foi constituída de 414 pacientes. Destes, 29 foram incluídos na lista por downstaging. Os demais 385 foram submetidos ou não ao tratamento loco-regional. Resultados: as análises dos 414 prontuários demonstraram um predomínio de pacientes do sexo masculino (79,5%) e com média de idade de 56 anos. O tratamento dos nódulos foi realizado em 56,4% dos pacientes em fila de espera para o transplante. O método mais utilizado foi a quimio-embolização (79%). Os pacientes submetidos ao tratamento loco-regional tiveram redução significativa no tamanho do maior nódulo (p<0,001). Não houve diferença estatística entre grupos com e sem tratamento loco-regional (p=0,744) e em relação à mortalidade entre pacientes incluídos no Critério de Milão ou ao downstaging (p=0,494). Conclusões: não houve diferença na sobrevida e ocorrência de recidiva associadas ao tratamento loco-regional. Os pacientes incluídos através do processo de downstaging apresentaram resultados de sobrevida comparáveis àqueles previamente classificados como Critério de Milão/Brasil.


ABSTRACT Objective: to compare the outcome of liver transplantation for hepatocarcinoma in submitted or not to locoregional treatment and downstaging regarding survival and risk of recurrence in transplant waiting list patients. Methods: retrospective study of patients with hepatocarcinoma undergoing liver transplantation in the metropolitan region of São Paulo, between January 2007 and December 2011, from a deceased donor. The sample consisted of 414 patients. Of these, 29 patients were included in the list by downstaging. The other 385 were submitted or not to locoregional treatment. Results: the analysis of 414 medical records showed a predominance of male patients (79.5%) with average age of 56 years. Treatment of the lesions was performed in 56.4% of patients on the waiting list for transplant. The most commonly used method was chemoembolization (79%). The locoregional patients undergoing treatment had a significant reduction in nodule size greater (p<0.001). There was no statistical difference between groups with and without locoregional treatment (p=0.744) and on mortality among patients enrolled in the Milan criteria or downstaging (p=0.494). Conclusion: there was no difference in survival and recurrence rate associated with locoregional treatment. Patients included by downstaging process had comparable survival results to those previously classified as Milan/Brazil criteria.


Subject(s)
Carcinoma, Hepatocellular/therapy , Liver Neoplasms/therapy , Survival Rate , Retrospective Studies , Waiting Lists , Liver Transplantation , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/pathology , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Neoplasm Staging
16.
Ann. hepatol ; 16(3): 421-429, May.-Jun. 2017. tab, graf
Article in English | LILACS | ID: biblio-887254

ABSTRACT

ABSTRACT Background. Evidence supporting benefit of hepatocellular carcinoma (HCC) surveillance in reducing mortality is not well-established. The effect of HCC surveillance in reducing mortality was assessed by an inverse probability of treatment weighting (IPTW)- based analysis controlled for inherent bias and confounders in observational studies. Material and methods. This retrospective cohort study was conducted on 446 patients diagnosed with HCC between 2007 and 2013 at a major referral center. Surveillance was defined as having at least 1 ultrasound test within a year before HCC diagnosis. Primary outcome was survival estimated using the Kaplan-Meier method with lead-time bias adjustment and compared using the log-rank test. Hazard ratio (HR) and 95% confidence interval (Cl) were computed using conventional Cox and weighted Cox proportional hazards analysis with IPTW adjustment. Results. Of the 446 patients, 103 (23.1%) were diagnosed with HCC through surveillance. The surveillance group had more patients with the Barcelona-Clinic Liver Cancer stage A (80.6% vs. 33.8%, P < 0.0001), more patients eligible for potentially curative treatment (73.8% vs. 44.9%, P < 0.0001), and longer median survival (49.6 vs. 15.9 months, P < 0.0001). By conventional multivariate Cox analysis, HR (95% Cl) of surveillance was 0.63 (0.45-0.87), P = 0.005. The estimated effect of surveillance remained similar in the IPTW-adjusted Cox analysis (HR: 0.57; 95% Cl: 0.43-0.76, P < 0.001). Conclusions. HCC surveillance by ultrasound is associated with a 37% reduction in mortality. Even though surveillance is recommended in all guidelines, but in practice, it is underutilized. Interventions are needed to increase surveillance rate for improving HCC outcome.


Subject(s)
Humans , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/diagnostic imaging , Thailand , Time Factors , Cohort Effect , Proportional Hazards Models , Predictive Value of Tests , Retrospective Studies , Ultrasonography/standards , Practice Guidelines as Topic , Risk Assessment , Kaplan-Meier Estimate , Early Detection of Cancer/methods , Liver Neoplasms/mortality , Liver Neoplasms/therapy , Liver Neoplasms/diagnostic imaging , Neoplasm Staging
17.
Ann. hepatol ; 16(2): 255-262, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-887230

ABSTRACT

ABSTRACT Background. Hepatocellular carcinoma (HCC) is the most common malignancy that develops in cirrhotic livers. Its clinical and epidemiological characteristics and mortality rates vary according to geographical region. The objective of this study was to evaluate the clinical profile, epidemiological characteristics, laboratory parameters, treatment and survival of patients with HCC. Material and methods. Patients with HCC seen between 2000 and 2012 were studied. The Kaplan-Meier method was used for survival analysis according to variables in question. Results. The study included 247 patients with a mean age of 60 ± 10 years. There was a predominance of males (74%). The main etiologies of HCC were HCV infection (55%), excessive alcohol consumption (12%), and HBV infection (8%). Liver cirrhosis was present in 92% of cases. The mean tumor number and diameter were 2 and 5 cm, respectively. Patients meeting the Milan criteria corresponded to 43% of the sample. Liver transplantation was performed in 22.4% of patients of the Milan subset and in 10% of the whole sample. The overall mean survival was 60 months, with a 1-, 3- and 5-year survival probability of 74%, 40% and 29%, respectively. Lower survival was observed among patients with alcoholic etiology. Survival was higher among patients submitted to liver transplantation (P < 0.001), TACE (P < 0.001), or any kind of treatment (P < 0.001). However, no difference was found for surgical resection (P = 0.1) or sorafenib (P = 0.1). Conclusion. Patients with HCC were mainly older men diagnosed at an advanced stage. Treatment was associated with better overall survival, but few patients survived to be treated.


Subject(s)
Humans , Liver Transplantation , Chemoembolization, Therapeutic , Carcinoma, Hepatocellular/therapy , Ablation Techniques , Hepatectomy , Liver Neoplasms/therapy , Antineoplastic Agents/therapeutic use , Phenylurea Compounds/therapeutic use , Time Factors , Brazil/epidemiology , Risk Factors , Treatment Outcome , Chemoembolization, Therapeutic/adverse effects , Chemoembolization, Therapeutic/mortality , Niacinamide/analogs & derivatives , Carcinoma, Hepatocellular/etiology , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/pathology , Tumor Burden , Kaplan-Meier Estimate , Tertiary Care Centers , Hepatectomy/adverse effects , Hepatectomy/mortality , Liver Neoplasms/etiology , Neoplasm Staging , Antineoplastic Agents/adverse effects
18.
Ann. hepatol ; 16(2): 247-254, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-887229

ABSTRACT

ABSTRACT Background & Aim. Transarterial chemoembolization (TACE) or sorafenib is recommended for hepatocellular carcinoma BCLC stages B and C respectively. We studied the role of combination of TACE and sorafenib in BCLC stages B/C. Material and methods. We undertook an observational study on a cohort of cirrhotics with HCC from August 2010 through October 2014. Patients in BCLC stages B/C who had received TACE and/or sorafenib were included. mRECIST criteria were used to assess tumor response. The primary end point was overall survival. Results. Out of 124 patients, 47.6% were in BCLC-B and 52.4% in BCLCC. Baseline characteristics were comparable. The predominant etiology was cryptogenic (37.2% and 38.5%, p = NS). 49.1% in BCLC-B and 56.9% in BCLC-C had received TACE+sorafenib. In BCLC-B, the overall survival improved from 9 months (95% CI 6.3-11.7) using TACE only to 16 months (95% CI 12.9-19.1) using TACE+sorafenib (p < 0.05). In BCLC-C, addition of TACE to sorafenib improved the overall survival from 4 months (95%CI 3-5) to 9 months (95%CI 6.8-11.2) (p < 0.0001). As per mRECIST criteria, patients on TACE+sorafenib had reduced progressive disease (37.8% vs. 83.3%), improved partial response (43.2% vs. 3.3%) and one had complete response compared to those on sorafenib alone (p < 0.0001) in BCLC-C but not in BCLC-B group. Hand foot syndrome was noted in 27.7% patients on sorafenib and post TACE syndrome in 80.2% patients, but both were reversible. No major adverse events were noted. Conclusion. TACE+sorafenib was more effective than TACE or sorafenib alone in HCC BCLC stages B or C with a significant survival benefit and improved tumour regression especially in BCLC-C patients.


Subject(s)
Humans , Phenylurea Compounds/therapeutic use , Niacinamide/analogs & derivatives , Carcinoma, Hepatocellular/therapy , Protein Kinase Inhibitors/therapeutic use , Liver Neoplasms/therapy , Antineoplastic Agents/therapeutic use , Phenylurea Compounds/adverse effects , Time Factors , Treatment Outcome , Chemoembolization, Therapeutic/adverse effects , Chemoembolization, Therapeutic/mortality , Niacinamide/adverse effects , Niacinamide/therapeutic use , Carcinoma, Hepatocellular/etiology , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/pathology , Protein Kinase Inhibitors/adverse effects , Tumor Burden , Kaplan-Meier Estimate , Liver Neoplasms/etiology , Liver Neoplasms/mortality , Neoplasm Staging , Antineoplastic Agents/adverse effects
19.
Ann. hepatol ; 16(1): 157-159, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-838098

ABSTRACT

Abstract: Lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC) is a rare primary hepatic neoplasm with female predominance and relatively good prognosis. We report a 73-year-old female with chronic hepatitis B who developed metastatic lesions 5 years after underwent resection for LEL-HCC. The metastatic lesions showed a spectrum of morphologic findings, which could be mistaken for other entities such as lymphoma, particularly in lesions with single-cell infiltrative pattern and abundant tumor-infiltrating lymphocytes. Immunohistochemical study to confirm the origin of the neoplastic cells is important to make the diagnosis. We also highlighted the clinicopathologic correlation and potential therapeutic implication of programmed death ligand-1 expression in LEL-HCC.


Subject(s)
Humans , Female , Aged , Biomarkers, Tumor/analysis , Carcinoma, Hepatocellular/chemistry , B7-H1 Antigen/analysis , Liver Neoplasms/chemistry , Biopsy , Immunohistochemistry , Predictive Value of Tests , Carcinoma, Hepatocellular/secondary , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/virology , Hepatitis B, Chronic/complications , Liver Neoplasms/pathology , Liver Neoplasms/therapy , Liver Neoplasms/virology , Lymphatic Metastasis
20.
Ann. hepatol ; 16(1): 107-114, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-838092

ABSTRACT

Abstract: Background. Sarcopenia is a complication and independent risk factor for mortality in patients with liver cirrhosis. Aim. To assess the prevalence and influence of sarcopenia on overall survival in a cohort of cirrhotic patients with hepatocellular carcinoma managed in a tertiary center. Material and methods. Abdominal computed tomography of 92 consecutive hepatocellular carcinoma cirrhotic patients, enrolled and followed from 2004 to 2014, were retrospectively studied with a software analyzing the cross-sectional areas of muscles at third lumbar vertebra level. Data was normalized for height, skeletal muscle index (SMI) calculated and presence of Sarcopenia measured. Sarcopenia was defined by SMI ≤ 41 cm2/m2 for women and ≤ 53 cm2/m2 for men with body mass index (BMI) ≥ 25, and ≤ 43 cm2/m2 for men and women with BMI < 25, respectively. Results. Median age at diagnosis was 71.9 years (30.7-86.4) and BMI 24.7 (17.5-36.7), comparable in women 23.1, (17.5-36.7) and men 24.7 (18.4-36.7). A class of CHILD score and BCLC A prevailed (55.4% and 41.3%, respectively); metastatic disease was found in 12% of cases. Sarcopenia was present in 40.2% of cases, mostly in females (62.9%; p = 0.005). Mean overall survival was reduced in sarcopenic patients, 66 (95% CI 47 to 84) vs. 123 (95% CI 98 to 150) weeks (p = 0.001). At multivariate analysis, sarcopenia was a predictor of reduced overall survival, independent of age (p = 0.0027). Conclusions. This retrospective study shows high prevalence of sarcopenia among cirrhotic patients with hepatocellular carcinoma. Presence of sarcopenia was identified as independent predictor of reduced overall survival. As easily measurable by CT, sarcopenia should be determined for prognostic purposes in this patient population.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/mortality , Sarcopenia/mortality , Liver Cirrhosis/mortality , Liver Neoplasms/mortality , Prognosis , Rome/epidemiology , Time Factors , Tomography, X-Ray Computed , Prevalence , Multivariate Analysis , Retrospective Studies , Risk Factors , Carcinoma, Hepatocellular/secondary , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/diagnostic imaging , Risk Assessment , Kaplan-Meier Estimate , Sarcopenia/diagnostic imaging , Tertiary Care Centers , Liver Cirrhosis/diagnostic imaging , Liver Neoplasms/pathology , Liver Neoplasms/therapy , Liver Neoplasms/diagnostic imaging
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