Survival Analysis for Patients with Hepatocellular Carcinoma according to Stage, Liver Function and Treatment Modalities / 대한간학회지

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is 3rd leading cause of cancer in Korea and the prognosis for HCC patients is poor. For assessing the present treatment outcome, this study analyzed the three-year survival rate (3-YSR) and the prognostic factors for patients with HCC in Korea. METHODS: Between November 2000 and December 2003, 905 patients with HCC who were diagnosed and treated at the National Cancer Center Korea were enrolled in this study. The clinical variables, tumor characteristics and survival periods were analyzed. RESULTS: The mean age of all patients was 56.2+/-10.3 years and 732 (80.9%) patients were male (M:F=4.2:1). 508 (56.1%) patients died and the median survival period was 15.3 months. The overall 3-YSR of the patients with modified UICC stage I, II, III, IVa and IVb were 67.4%, 65.2%, 30.7%, 9.0% and 5.0%, respectively. The modified UICC stage could not differentiate stage I from II, and stage IVa from IVb, on the 3-YSR. The 3-YSR of the Child-Pugh class A patients with modified UICC stage I or II was 85.4% by surgical resection and it was 69.6% by transcatheter chemoembolization (TACE), respectively (P= .461), and those values for patients with stage III were 49.2% and 36.8%, respectively (P=.081). As compared with systemic chemotherapy or conservative therapy, TACE increased the survival rate more for the Child-Pugh class A patients with stage IV. The independent prognostic factors were serum AFP, portal vein thrombosis, the Child-Pugh classification and the stage of HCC. CONCLUSIONS: This follow-up study will be helpful in assessing the results of treatments for HCC and it will provide data for the establishment of a more effective treatment strategy.

A Case of Clonorchiasis Presenting as Common Hepatic Duct Mass / 대한소화기내시경학회지

The liver fluke, Clonorchis sinensis is an important human parasite and is endemic in Eastern Asia including Korea, China, and Japan. Patients acquire the infestation by eating raw or undercooked freshwater fish. Radiologic examinations usually reveal dilated peripheral intrahepatic bile ducts and normal extrahepatic bile duct. The diagnosis of clonorchiasis may sometimes be difficult and a presentation as an obstructive mass at the common hepatic duct is a rare event. Here we report a case of clonorchiasis of 54-year-old woman presented with epigastric pain. Endoscopic retrograde cholangiography revealed a mass at the common hepatic duct with dilatation of the intrahepatic ducts mimicking cholangiocarcinoma. Using an endoscopic basket, muddy, sludge-like materials were extracted through the papillary orifice. We report this case with a review of literatures.

A Case of Osteoclast-like Giant Cell Tumor of the Pancreas / 대한소화기학회지

Osteoclast-like giant cell tumor of the pancreas is a very rare tumor. Despite their striking morphologic resemblance to certain mesenchymal tumors of bone and tendon sheath, it has been suggested that these tumors may arise from epithelial precursors. This unusual tumor presents in the 6th or 7th decade with a nearly equal gender ratio. Pure forms of osteoclast-like giant cell tumor have a better prognosis because they have a predilection to local spread, are slower to metastasize and rarely metastasize to lymph nodes, but these forms are very rare. We present an osteoclast-like giant cell tumor arising in the body of the pancreas in a 71 year-old male patient. The tumor was composed of two major cell types: atypical mononuclear cells and abundant osteoclast-like multinucleated giant cells. Immunohistochemical studies showed that atypical cells were strongly reactive for vimentin and focally reactive for cytokeratin. In contrast, the giant cells were immunoreactive for CD68, but negative for cytokeratin. Three months later, the tumor size increased and liver metastasis was newly developed. He died at 11 months after the diagnosis.

Clinical Characteristics of Non-B, Non-C Hepatocellular Carcinoma and Detection of HBV, HCV and TTV Viremia / 대한간학회지

BACKGROUND/AIMS: About 15% of Korean hepatocellular carcinoma (HCC) are negative both of Hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (anti-HCV) in their sera. They can be classified as a non-B, non-C hepatocellular carcinoma group (NBNC group). The aims of our study were, firstly, to describe the clinical characteristics of Korean NBNC HCC and compare them with those of HBsAg-positive HCC (HBV group) and anti-HCV-positive HCC (HCV group). Secondly we wanted to assess the frequency of viremia of HBV, HCV and transfusion-transmitted virus (TTV) in NBNC HCC patients. METHODS: We prospectively collected clinical data and sera from 113 NBNC HCC patients and performed PCR for HBV DNA, HCV RNA and TTV DNA. We also collected clinical data from 125 HBsAg-positive HCC patients and 61 anti-HCV-positive HCC patients during a similar period. RESULTS: The mean age of the NBNC HCC group was 59 years, in-between that of the HBV and the HCV groups. A History of heavy alcohol drinking was found in 48% of the NBNC HCC group. This was significantly higher than that of the HBV group, but similar to that of the HCV group. Serum alphaFP level in the NBNC HCC group was more frequently in the normal range compared to that in the HBV and HCV groups. The detection rates of HBV DNA, HCV RNA and TTV DNA in the NBNC HCC group were 17%, 13%, and 67% respectively. CONCLUSIONS: The NBNC HCC patients seemed to comprise a heterogeneous group of various etiologies and clinical presentations. About one third of these patients displayed evidence of viremia of HBV or HCV.

Expression of P-glycoprotein and p53 Protein in Stage IV Hepatocellular Carcinoma Treated with Systemic Chemotherapy / 대한간학회지

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is a drug-resistant tumor. The expression of a multidrug resistant gene, P-glycoprotein (P-gp) is a major mechanism of drug resistance. The aims of our study were, firstly, to observe the expression rate of P-gp in HCC tissue obtained by percutaneous fine needle aspiration (PCNA) from stage IV HCC patients; secondly to examine the association between P-gp and chemotherapeutic response; and finally to investigate the correlation between p53 protein expression and P-gp expression. Subjects and METHODS: We studied 29 cases of stage IV HCC treated by systemic chemotherapy. Expression of P-gp and p53 were evaluated by immunohistochemical staining of HCC tissue with human monoclonal antibody, JSB-1 (Anti P-gp) and DO-7 (Anti p53), respectively. We analyzed the results of immunohistochemical staining of HCC tissues of the patients in relation to chemotherapeutic response and other clinical characteristics. RESULTS: The expression rate of P-gp was 27.6%. Partial response to anti-cancer chemotherapy was observed in 16.7% of the patients. Although we could not see a statistically significant association between P-gp expression and chemotherapeutic response, none of the responsive patients showed P-gp expression. p53 protein expression was found in 45% of the patients. There was no significant correlation between p53 protein expression and P-gp expression. CONCLUSIONS: Although the number of our study subjects was small, chemotherapy- responsive patients didn't show P-gp expression. P-gp expression might be used as a predictor of response to potentially toxic anti-cancer chemotherapy in HCC patients. Further study is warranted to confirm our results.

Effects of Scleral Buckling on Eyeball in Young Rabbits

There has been a series of reports indicating that scleral buckling[SB] surgery may induce high myopia in advanced retinopathy of prematurity. The mechanism of SB on refraction, however, has not been clearly known. We investigated the effects of SB on eyeball in young rabbits, including mechanism of refractive change. In 9 rabbits with 5 weeks old[Group A]and 11 rabbits with 8 weeks old[Group B], SB was performed for right eyes of all rabbits with encircling band, 2.5 mm in width.Left eyes of these were followed up for control group. Spherical equivalent, corneal power, and axial length were measured before SB and at 2, 4, and 8 weeks postoperatively. We compared these measures between experimental and control groups, and analyzed the influence of age at operation. In control group, corneal refractive power was decreased, axial length was increased, and spherical equivalent developed emmetropization in aging. High myopia was developed in all eyes with SB, and the increase of axial length was the major factor in myopia.These changes were greater in group A than group B.In experimental group, the degree of myopia was increased at 4 and 8 weeks postoperatively, but corneal power and axial length were not statistically changed. In conclusion, the SB in younger rabbits induced higher degree of axial myopia.These findings may suggest that SB in infant could induce significant axial myopia and secondary amblyopia, especially younger age.

Comparative Study of Combined Cataract Surgery in Primary Angle-Closure Glaucoma

Trabeculectomy, as an operation precedure for glaucoman, decrease intraocular pressure(IOP)effectively. But the amount of decrease in IOP is different according to the etiology of glaucoma. Thirty four primary angle-closure glaucoma patients (37 eyes)who had undergone trabeculectomy only or trabeculecomy combined with cataract surgery and had been subsequently followed up for least 6 months, were enrolled in this study. In 12 patients(14 eyes) among 16 patients (18 eyes, Group 1) who had undergone trabeculecto-my only, IOP was controlled without glaucoma medication, while glaucoma medication was needed in the other 4 patients (4 eyes). Among 18 patients (19 eyes, Group 2) who had undergone trabeculectomy combined with cataract surgery, IOP were controlled without glaucoma medication 9 patients (10 eyes); controlled with medication in 8 patients (8 eyes); and not controlled even with 1 patient (1 eye). The amount of decrease in IOP was no statistically different between the two groups. Group 2 had deeper anterior chamber than Group 1 (p<0.01). The above results suggest that the combined pro-cedure may benefit in primary angle-closure glaucoma patients, especially old complicated patients.