Potentially curative treatment in patients with hepatocellular cancer--results from the liver cancer research network.

BACKGROUND: The extent to which potentially curative therapies are used in patients with hepatocellular cancer (HCC) and their related outcomes are unknown in the US. AIM: To determine the rate and outcomes of potentially curative treatment in patients with HCC. METHODS: Eleven US centers followed patients with HCC between 2001 and 2007. We determined rates of liver transplantation, surgical resection, or tumour ablation during follow-up, examined differences in adjusted survival of patients receiving these treatments, and determined the factors associated with receipt of potentially curative treatment. RESULTS: Of the 267 patients, 76 (28%) patients had early HCC, defined as Child A or B cirrhosis, with a solitary HCC or ≤ 3 nodules, each ≤ 3 cm. Of these, 53 (69.7%) received curative treatment. Thirty six percent of patients with non-early HCC received curative treatment. Compared to patients with non-early HCC who did not receive curative treatment, patients with early HCC and curative treatment had the best survival [hazard ratio, HR = 0.19 (95% CI, 0.08-0.42)] followed by patients with advanced HCC who received curative treatment [HR = 0.37 (95% CI, 0.22-0.64)]. Baseline performance status was significantly associated with receipt of curative treatment as well as survival after adjusting for demographics, clinical characteristics, and HCC stage. CONCLUSIONS: In this multicenter database, most of the patients with early HCC received potentially curative treatment. However, only 28% of patients had early HCC. One-third of patients with non-early HCC also underwent curative therapy. Potentially curative treatment improved survival and this effect was seen in patients with early as well as non-early HCC.

Double immunoenzyme staining method for analysis of tissue and blood lymphocyte subsets with monoclonal antibodies.

Double immunoenzymatic method for sequential staining with two different monoclonal murine antibodies and two different enzymes was shown to be useful in defining hematopoietic cell subpopulations in human tissues and blood. The method allows for the identification, localization, and enumeration in the same section of distinct cell populations. Air-dried smears of cell mixtures can be stained. The optimal sequence of enzymes/substrates was: horseradish peroxidase/3-amino-9-ethylcarbazole followed by the alkaline phosphatase-anti-alkaline phosphatase complex/naphthol AS-MX phosphate. Red-and blue-colored reaction products are easy to view in a light microscope. Combinations of two different mouse monoclonal antibodies or of a mouse monoclonal antibody and polyclonal antiserum made in rabbits or goats can be sequentially applied to the same section or smear thus facilitating a definition of the distribution of two cell populations reactive with these antibodies. The relative distribution patterns in tissues of cells bearing distinctive antigens are important in studies of cellular differentiation and of human pathogenetic processes including neoplasia and transplant rejection.

Selective fetal malnutrition: the effect of in vivo ethanol exposure upon in vitro placental uptake of amino acids in the non-human primate.

In vitro uptake (45 and 90 minutes) of amino acids, alpha-amino isobutyric (AIB) and valine (VAL), was measured in six placentae from the nonhuman primate, Macacca fascicularis. Three of the pregnant primates were chronically treated with ethanol before and throughout pregnancy (CHR); one during the last trimester only (LT); and two were controls (C). Compared to the C placentae, the LT placenta had significantly decreased uptake only for AIB at 45 min: 33.4 +/- 6.8% reduction (mean +/- S.E.) (P less than 0.05). In contrast, the CHR placentae demonstrated significantly reduced uptake (P less than 0.01) for both amino acids at both time points. Percent reduction at 45 and 90 min: AIB, 35.2 +/- 6.5% and 32.6 +/- 5.6% and VAL, 38.7 +/- 2.9% and 22.1 +/- 4.1%. The results indicate that chronic in vivo ethanol exposure impairs the in vitro placental uptake of two actively transported amino acids, using an animal with a placenta almost identical to the human.

Skin tags: a cutaneous marker for colonic polyps.

The relation between adenomatous colonic polyps and the development of adenocarcinoma of the colon is well established. An association between skin tags and colonic polyps in patients with acromegaly has also been reported. To ascertain if skin tags are a cutaneous marker for colonic polyps independent of the presence of acromegaly, 100 men referred for colonoscopy were studied. Forty-six patients had colonic polyps and 37 also had skin tags; the correlation was highly significant (p less than 0.005). The sensitivity and specificity of the presence of skin tags serving as a cutaneous marker for adenomatous colonic polyps were both greater than 75%. Thus, at least in this population, skin tags may serve as a means for identifying patients at increased risk for having colonic polyps.

Colonic polyps in patients with acromegaly.

Seventeen patients with acromegaly were prospectively studied with barium enemas and colonoscopy to investigate the possibility that acromegaly is associated with an increased frequency of colonic polyps and colon cancer. Polyps were identified in nine patients and were removed and examined in eight. In five patients the polyps were adenomatous, and in four of the five there were multiple polyps. The presence of polyps closely correlated with the presence of skin tags (p = 0.041) and also with the age of the patient (p less than 0.01). No new cases of colonic cancer were discovered; however, reviewing the records of 44 patients with acromegaly, four cases were previously diagnosed with colon carcinoma. This study identifies a unique group of patients that are at risk for the development of colonic polyps and perhaps colon cancer.