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A 52-year-old man who had been using a proton pump inhibitor (PPI) and a potassium-competitive acid blocker (P-CAB) for 14 years underwent esophagogastroduodenoscopy and was found to have three neuroendocrine tumors (NETs) in the gastric body. Following detailed examinations, parietal cell dysfunction was excluded, and the NETs did not meet the criteria for the Rindi classification types I-III. The lesions were ultimately considered to be associated with the long-term use of the PPI and P-CAB. We performed endoscopic submucosal dissection of the lesions, with no recurrence or new lesions noted after discontinuation of the PPI and P-CAB.
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Background and Aim: Molecular-targeted therapies such as sorafenib and lenvatinib have long been used as first-line treatment for advanced hepatocellular carcinoma (aHCC). However, adverse events or limited therapeutic effects may necessitate the change to another therapeutic option, known as post-progression therapy. To investigate the significance of post-progression therapy, we analyzed the outcomes of aHCC patients following first-line molecular-targeted therapy in a real-world study. Methods: This retrospective, multicenter study involved patients with aHCC who received sorafenib or lenvatinib as first-line therapy between January 2011 and September 2021. Results: In total, 513 patients were analyzed: 309 treated with sorafenib and 204 with lenvatinib. The overall response and disease control rates were 15 and 50%, respectively, in the sorafenib group and 30 and 75%, respectively, in the lenvatinib group (P < 0.001). Kaplan-Meier analysis revealed no significant differences in progression-free survival and overall survival (OS) between the two treatments. Multivariate analysis revealed that fibrosis-4 index, disease control rate, post-progression therapy, and use of an immune checkpoint inhibitor (ICI) were significantly associated with OS. OS was significantly longer in patients who received post-progression therapy than in those who did not (log-rank P < 0.001). Most patients who received an ICI as post-progression therapy had previously received lenvatinib. Among lenvatinib-treated patients, OS was significantly longer in patients who received an ICI than in patients received another or no post-progression therapy (P = 0.004). Conclusion: The introduction of newer drugs for post-progression therapy is expected to prolong survival. ICI-based regimens appear to be effective after lenvatinib.
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AIM: A hyperenhanced rim (termed 'HER') in the postvascular phase is detected in some cases of liver metastasis by Sonazoid-enhanced ultrasonography (US). Here, the association of the HER with histological features was investigated to clarify the cause of this characteristic imaging pattern. SUBJECTS AND METHODS: A total of 13 hepatic nodules obtained from 11 patients with metastatic liver cancer who underwent Sonazoid-enhanced US followed by surgical resection were analyzed. The distribution density of CD68-positive cells in the tumor rim and the nontumor area was calculated and compared between the HER-positive and HER-negative groups. The relation between the pathological features of the tumor rim and the rate of necrosis within the tumor was also investigated. RESULTS: In the HER-positive group (n = 8), the distribution density of CD68-positive cells was 2.9 ± 0.9, which was significantly higher than that (1.0 ± 0.3) in the HER-negative group (p < 0.05). Inflammatory cell infiltrates, including CD8-positive lymphocytes, were detected in all the HER-positive cases in the area surrounding the tumor, while fibrosis was observed in all the HER-negative cases. The necrotic area within the tumor was significantly larger in the HER-negative group. CONCLUSION: The HER-positive sign in liver metastases could reflect an increase in Kupffer cells in the tumor rim. The presence of the HER was associated with inflammatory cell infiltrates including CD8-positive lymphocytes surrounding the metastatic liver tumor.
