B-related Hepatocellular Carcinoma Research Articles

Comparison of improved prognosis between hepatitis B- and hepatitis C-related hepatocellular carcinoma.

Treatment strategies for hepatocellular carcinoma (HCC) have been advanced. The aim of this study was to compare the change of the prognosis between hepatitis B-related HCC (B-HCC) and hepatitis C-related HCC (C-HCC) in the last two decades. We enrolled 166 B-HCC patients who underwent percutaneous ablation between 1990 and 2009. Patients were divided into three groups according to the treatment time period: 1990-1995 (cohort 1, n = 19), 1996-2002 (cohort 2, n = 49) and 2003-2009 (cohort 3, n = 98). We enrolled 1219 C-HCC patients who underwent percutaneous ablation during the same period (n = 190, 413 and 616, respectively.). Interferon and nucleoside/nucleotide analog use was investigated. Prognosis was evaluated for each cohort using the Kaplan-Meier method and a multivariate Cox proportional hazard regression model. Two (11%), 24 (49%) and 80 (82%) B-HCC patients received nucleoside/nucleotide analogs during the follow-up period in cohorts 1-3, respectively. Among them 1, 18 and 62 patients achieved viral remission, respectively. Thirty-four (18%), 35 (8%) and 84 (14%) C-HCC patients received interferon therapy, respectively. The 5-year B-HCC (P < 0.001) survival rates were 52.6%, 61.1% and 81.6% for cohorts 1-3, respectively. However, the survival rates were 55.6%, 58.8% and 61.1% for C-HCC (P = 0.12), respectively. The B-HCC prognosis improved dramatically (P < 0.001) over time, whereas the prognosis of C-HCC improved moderately (P = 0.01). The prognosis of B-HCC has improved dramatically over time, whereas that of C-HCC has improved moderately.

Problems of Long Survival Following Surgery in Patients with NonBNonC-HCC: Comparison with HBV and HCV Related-HCC.

Background: The number of patients with hepatocellular carcinoma (HCC) in the absence of both hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (HCVAb) (NBNC-HCC) has been rapidly increasing in Japan. The objective of this study was to compare the clinical and pathological characteristics between patients with the NBNC-HCC, those with HBsAg positive HCC (B-related HCC) and HCVAb positive HCC (C-related HCC). A better understanding will facilitate the development of postoperative strategies to better manage patients with NBNC-HCC.Methods: Consecutive 219 patients with primary HCC: (B-related, n=35; C-related, n = 104; NBNC, n = 80) were treated by hepatic resection or ablation. Clinicopathological characteristics including postoperative course were retrospectively compared between the three groups.Results: When comparing within stage I and II, the NBNC-HCC group had improved recurrence free survival (RFS) compared to the C-related HCC (p = 0.013) but had not been good overall survival (OS). Moreover, the NBNC-HCC group showed higher rate of death due to other cancers and cardiovascular disease (p = 0.011) compared to the C-related HCC. Multivariate analysis revealed that the only prognostic factor for RFS in the NBNC-HCC group was high serum total bilirubin.Conclusions: In the patients with the NBNC-HCC, elevated serum bilirubin could predict poor RFS after surgery. Furthermore, patients must be carefully followed-up not only for HCC but also for the occurrence of other critical diseases including multiple other cancers.

Liver microvessel density in evaluating therapeutic effect of sorafenib combined with argon-helium cryoablation in treatment of advanced hepatocellular carcinoma

Objective To investigate the therapeutic effect of argon-helium cryoablation combined with sorafenib on hepatitis B-related advanced hepatocellular carcinoma(HCC) and to evaluate the role of microvessel density(MVD) in prognostic evaluation.Methods A total of 102 patients with advanced HCC were randomly divided into two groups,with 50 receiving sorafenib plus cryoablation(group SC) and 52 receiving only cryoablation(group C).The endpoint of the treatment was tumor progression or untolerable adverse reaction.Tumor tissues were obtained before treatment.MVD was evaluated by immunohistochemical analysis using CD34 antibody.The therapeutic effects were evaluated according to RECIST criterion every 4-6 weeks.The adverse events were observed in both groups;the therapeutic effect,overall survival time(OS),and time to progression(TTP) were compared between two groups.Results In group SC,complete response(CR) was achieved in 2 patients(4%),partial response(PR) in 9(18%),and stable disease(SD) in 22(44%),with the disease control rate(DCR) being 66% ;in group C,no CR,PR in 4(7.6%),and SD in 19(36.5%),with the DCR being 44.2%(P 0.05).The overall survival(OS) and the time to progression(TTP) were significantly longer in group SC than in group C(12.5 months vs 8.6 months,9.6 months vs 5.3 months;P 0.01).The mean MVD in group CRPR(111/0.74 mm2) was significantly lower than that in group PD(339/0.74 mm2,P 0.01).Patients with lower MVD receiving sorafenib plus cryoablation had longer OS and TTP than those only receiving cryoablation.The OS and TTP in patients with higher MVD had no significant difference between different groups.Conclusion Sorafenib plus cryoablation is a safe and effective therapy for patients with advanced HCC;it can improve the OS and TTP of patients.Patients with higher MVD have a lower response to therapy and poor prognosis.

Non-septicemic Melioidosis Presenting as Cardiac Tamponade

Melioidosis is endemic in Taiwan. It is caused by infection with Burkholderia pseudomallei. A prolonged course of oral eradication therapy to avoid relapse after an intensive intravenous therapy is recommended to treat melioidosis. Melioidosis with cardiac involvement is rare and is often combined with septicemia, for which the mortality rate is 20-60%. The initial clinical presentations of melioidosis mimic Mycobacterium tuberculosis infection, which is the most common etiology of bacterial pericarditis in Taiwan. We present a case of non-septicemic melioidosis that presented as non-suppurative cardiac tamponade and left subcarinal lymphadenopathy. Underlying diseases included hepatitis B-related liver cirrhosis and hepatocellular carcinoma. The patient was successfully treated with 2 weeks of intravenous ceftazidime and 12 weeks of oral doxycycline, trimethoprim-sulfamethoxazole, and amoxicillin/clavulanate. Melioidosis-related pericarditis should be considered in the differential diagnoses of bacterial pericarditis in Taiwan.