Clinical characteristics of patients who developed hepatocellular carcinoma after hepatitis C virus eradication with interferon therapy: current status in Japan.

OBJECTIVE: We attempted to elucidate the clinical features of chronic hepatitis C patients who develop hepatocellular carcinoma (HCC) after achieving a sustained viral response (SVR) to interferon (IFN) therapy. METHODS: The clinical features of 130 patients at 19 hospitals who developed HCC after obtaining an SVR were retrospectively reviewed. RESULTS: Overall, 107 (82%) of the 130 patients were men, with 92 (71%) being ≥60 years of age and 76, 38 and 16 developing HCC within 5, 5-10 and 10-16.9 years after IFN therapy, respectively. Before receiving IFN therapy, 92 (71%) patients had cirrhosis and/or a low platelet count (<15×10(4) cells/µL). Lower albumin (<3.9 g/dL) and higher alpha fetoprotein (AFP) (≥10 ng/mL) levels were identified in a multivariate analysis to be independent variables of the development of HCC within five years after IFN therapy. Among 4,542 SVR patients, HCC occurred in 109 (2.4%) during a 5.5-year follow-up period, thus resulting in an occurrence rate of 4.6% for men and 0.6% for women. CONCLUSION: SVR patients with lower albumin or higher AFP levels require careful assessments to prevent early HCC development after IFN therapy. HCC occurrence within >10 years of IFN therapy is not uncommon, and the risk factors remain uncertain, thus suggesting that all SVR patients should undergo long-term follow-up examinations for HCC development.

[A resected case of recurrent intrahepatic cholangiocellular carcinoma with a cholangiocellular carcinoma component after transcatheter arterial embolization and radiofrequency ablation].

We report a resected case of intrahepatic cholangiocarcinoma (ICC) with a cholangiolocellular carcinoma (CoCC) component. A 77-year-old man had been followed up regularly for chronic hepatitis C for 20 years. In April 2008, a hepatic tumor of 30-mm diameter was detected in segment 2 by computed tomography scan. The tumor was enhanced in the early phase and the enhancement was prolonged. He was treated with transcatheter arterial embolization following the diagnosis of hepatocellular carcinoma (HCC). He had a local recurrence in the same segment (S2) in March 2009, and transcatheter arterial embolization and radiofrequency ablation were performed. In March 2011, abdominal dynamic computed tomography and magnetic resonance imaging showed a sectoral lesion in S2/4 with early and prolonged enhancement. Following the preoperative diagnosis of local recurrence of HCC, he underwent left lobectomy of the liver. Histopathologically, strongly atypical glandular epithelial cells and mucin production were observed, and these cells grew invasively into the liver parenchyma. Furthermore, tumor cells in the peripheral area grew and replaced adjacent hepatic cells, and anastomosing cavities of glands were found on the gitter stein. For these reasons, the histopathological diagnosis was ICC with a CoCC component.

Clinical features of hepatocellular carcinoma with extrahepatic metastases.

BACKGROUND: There are few detailed clinical reports about extrahepatic metastases of hepatocellular carcinoma (HCC). The purpose of the present study was to elucidate the clinical features of extrahepatic metastases of HCC. METHODS: The clinical records of 482 patients who had been diagnosed as having HCC during the period from January 1995 to March 2001 were retrospectively reviewed. Extrahepatic metastases had been detected in 65 patients. Clinical features of those 65 patients were analyzed. RESULTS: Patients with extrahepatic metastases had more advanced intrahepatic tumors at the first diagnosis of HCC: 73.8% of the patients with extrahepatic metastases had tumors of intrahepatic tumor stage T3 or T4 according to the TNM classification, while only 28.5% of the patients without extrahepatic metastases had tumors of T3 or T4 (P < 0.001). Vessel invasion was also detected at the first diagnosis of HCC more frequently in the patients with extrahepatic metastasis (P < 0.001). The frequent metastatic sites were lung (53.8%), bone (38.5%), and lymph node (33.8%). Other metastatic sites were the adrenal gland, peritoneum, skin, brain and muscle. The median survival time and 1-year survival rate were 7 months (range: 1-59 months) and 24.9%, respectively. Patients with Child-Pugh grade B and C (P = 0.0018) and patients with positive serum alpha-fetoprotein (P = 0.011) had significantly poor prognosis. CONCLUSIONS: Extrahepatic metastases of HCC are not rare. The possibility of extrahepatic metastases and the clinical features of extrahepatic metastases should be considered when examining patients with HCC, particularly those with advanced intrahepatic tumors, to enable precise evaluation of the spread of HCC and determination of the appropriate treatment method.