Diagnosis Of Primary Hepatocellular Carcinoma Research Articles

The effect of obesity in hospitalized patients with hepatocellular carcinoma: A nationwide analysis.

569 Background: Obesity, a prominent issue in global health, is known to increase the risk factors associated with a variety of cancers, including hepatocellular carcinoma (HCC), the most common type of primary liver cancer. While existing research affirms the heightened risk of developing HCC in individuals with obesity, there remains a significant gap in understanding the specific influences of obesity on the outcomes of patients admitted with primary HCC diagnosis during their index hospital admission. This study explores the mortality rate, length of stay (LOS), and healthcare utilization in HCC patients with and without obesity. Methods: Nationwide Inpatient Sample (NIS) was queried to determine adult hospitalized patients with a primary diagnosis of HCC using ICD-10 codes. The primary outcome was defined as the effect of obesity on inpatient mortality in those patients. Secondary outcomes included LOS, total hospital charge, health care utilization, ICU admission. We evaluated the baseline characteristics using the t-test and chi-square test. Multivariable logistic regression analysis was performed to assess the association of HCC with obesity and inpatient mortality adjusted by age, gender, race, Charlson index, insurance, and household income. Results: A total of 62,050 HCC patients were identified, and 10.9% of these patients had obesity. HCC patients with obesity were younger (64.7 vs. 65 years, p=0.220), more likely to be female (32.2% vs. 24%, p < 0.001), White (59.8% vs. 50.2% p < 0.001), and more likely to have no insurance (28.8% vs. 23.3%, p < 0.001) compared to HCC patients without obesity. HCC with obesity had higher mean Charlson Comorbidity index 5.9 vs. 5.5, p < 0.001). The overall inpatient mortality rate was 8.2% for all patients who are admitted for HCC; lower in HCC with obesity (5.6%) vs HCC without obesity (8.5%) (p < 0.001). Charlson index, Male gender, African–American race, Hospital teaching status, insurance status found to be associated with inpatient mortality among HCC hospitalizations. HCC with obesity had a lower odds ratio with decreased all-cause mortality of 25% compared to HCC without obesity (aOR 0.75, 95% CI 0.58-0.96, p = 0.023). In addition, HCC with obesity was associated with increased LOS mean 6.3 vs. 5.7 days (adjusted difference: 0.6 p < 0.001), and total hospital charges (mean $112,687 vs $88,481, adjusted difference: $21122 p < 0.0001). Also; ICU transfer rate and AKI development were found more in obese cohort and this different was statistically significant. Conclusions: Our study revealed that HCC patients with obesity had a lower inpatient mortality rate compared to those without obesity, despite longer hospital stays and higher costs. These findings hint at a complex interplay between obesity and HCC outcomes, necessitating further in-depth research.

Outcomes and Prognostic Analysis of Surgical Resection for Oligometastasis from Hepatocellular Carcinoma.

This study aimed to evaluate the outcomes of patients who underwent resection for oligometastasis from hepatocellular carcinoma (HCC) and identify the prognostic factors associated with poor survival. Patients who underwent resection for oligometastasis from HCC between January 2000 and April 2021 were retrospectively investigated. Oligometastasis was defined as 1-5 single organ metastases that were detected preoperatively in this study. Clinical characteristics and treatment outcomes were analyzed, and independent risk factors for poor prognosis were identified using cox proportional hazards model. A total of 33 patients were included in this study. Eleven oligometastases were located in the intraabdominal lymph node, 8 in the adrenal gland, 5 in the lung, 4 in the peritoneum, 3 in the pleura, and 1 each in the supraclavicular lymph node and abdominal wall. No re-operation or operative death occurred in this study. The median OS was 44.6 months (range=5.1-150.6 months), and the median survival after primary HCC diagnosis was 116.5 months (range=7.1-253.6 months). The median cumulative incidence of recurrent HCC was 7.2 months (range=0.3-94.7 months). The multivariate analysis showed that an alpha-fetoprotein level ≥20 ng/ml and multiple primary HCC tumors were independent poor prognostic factors. Clinical characteristics and treatment outcomes of patients who underwent resection for oligometastasis from HCC were demonstrated. A high alpha-fetoprotein level and multiple primary HCC tumors were independent poor prognostic factors. Surgical resection can be one of the treatment options for oligometastasis from HCC.

Radiotherapy for Liver Cancer: An International Multi-Centre Pooled Analysis of 925 Cases

Primary and secondary liver cancer incidence is growing and has a poor prognosis. The standard use of radiation has been hampered by studies with a wide range of patients, different management protocols and varied outcomes. To overcome this heterogeneity in the literature, larger and higher-level trials are warranted, but, so far, have been difficult to implement. Therefore, pooled analyses may offer the best way to determine the benefit of radiation, identify treatment parameters needed to optimize treatment techniques, and identify patient factors that allow for better patient selection. Patients with liver cancer treated by radiotherapy at centers in Canada, United States and Australia was pooled. Patient and treatment characteristics were noted, as well as the clinical outcomes of local control within 1 year, recurrence and mortality. Stepwise Cox proportional hazards models were used to identify significant predictors for recurrence and mortality. Patients were stratified by center, and primary versus metastatic disease. A total of 925 patients were included in this study. Mean age was 67 years, and 45% had a primary diagnosis of hepatocellular carcinoma. 1-year local control rate was 80%. Median survival was 1.8 years (1.9 years for primary liver cancer, and 1.4 years for metastatic liver cancer). Higher total dose and BED was associated with better survival. Median time to recurrence was 1.5 years. Higher total dose was associated with lower risk of recurrence CONCLUSION: As one of the largest pooled analyses in hepatic cancer, this international multi-center study provides pragmatic data on clinical outcomes of patients receiving radiotherapy for liver cancer. This database may assist in better selection of patients for future studies and answer questions such as what is the optimal dose and which patients benefit from treatment.

Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma in the United States: An Update.

Previous studies have demonstrated a disparity in liver transplantation (LT) for hepatocellular carcinoma (HCC) among races in the United States (U.S.). We aimed to update the literature on the odds, trends, and complications of LT in the treatment of hepatocellular carcinoma (HCC), among individuals of different racial backgrounds. This is a nationwide study of adult individuals admitted for LT with a primary diagnosis of HCC. Using weighted data from the National Inpatient Sample (NIS) database, we compared the odds of LT among different races from 2016 to 2020, using a multivariate regression analysis. We further assessed the trends and outcomes of LT among races. A total of 112,110 adult were hospitalized with a primary diagnosis of HCC. 3020 underwent LT. When compared to Whites, the likelihood of undergoing LT for HCC was significantly reduced in Blacks (OR = 0.60, 95% CI = 0.46-0.78). Further, Blacks had increased mortality rates (7% in Blacks vs. 1% in Whites, p < 0.001), sepsis (11% in Blacks vs. 3% in Whites, p = 0.015), and acute kidney injury (AKI) (54% in Blacks vs. 31% in Whites, p < 0.001) following LT. Individuals identifying as Blacks were less likely to undergo LT for HCC, and more likely to develop complications. Further initiatives are warranted to mitigate the existing disparities among racial groups.

Racial disparities in the outcomes of liver transplantation in the treatment of hepatocellular carcinoma.

4131 Background: According to the National Comprehensive Cancer Network (NCCN), liver transplantation (LT) is currently the treatment of choice for patients with early hepatocellular carcinoma (HCC). A retrospective study in 2016 showed a difference in mortality among races in patients undergoing treatment for HCC. Our study is the first to compare the outcomes of mortality, morbidity and hospital utilization of HCC patients undergoing LT among races in the US. Methods: This is a retrospective longitudinal study of patients with a primary diagnosis of HCC. We retrieved data from the Nationwide Inpatient Sample (NIS) databases from the years 2016 to 2020 using ICD-10 codes. Multivariate regression analysis was applied to compare the outcomes in races, adjusted for patient and hospital confounders. A T-Test and Chi Square test were performed to compare baseline characteristics. We used STATA Version 17.0 Software for analysis. The p-value was set at p &lt; 0.05 for statistical significance. Results: Among a total of 112,110 adults with HCC, 2.8% (n=3,150) underwent LT. Blacks had lower rates of LT. Blacks and Hispanics were found to have a lower income (p= 0.000). No difference in the Charlson Comorbidity index was noted among races (p=0.5519), however, Blacks had more smokers (p=0.0149). Hispanics had a significant increase in THC compared to Whites (coefficient: 102,058 US Dollars, p=0.033, CI95%: -109,404 - 119,787), with no difference in the length of stay among races. Blacks had higher rates of mortality (p=0.004), acute kidney injury (AKI) (p=0.001), and similar rates of transplant complications. Conclusions: Our study showed that while Blacks have lower rates of LT, they have a higher rate of mortality and morbidity following LT. Large scale studies are necessary to help determine factors associated with these findings.

Clinical characteristics and initial treatment patterns of patients with HCC in Korea: A multi-center real-world database analysis from the LINK research network.

e16116 Background: In Korea, liver cancer is the fifth most frequently diagnosed cancer and has the second highest cancer mortality rate. Despite recent advances in systemic therapy, patients with Hepatocellular carcinoma (HCC) continue to have poor prognoses as many are diagnosed at an advanced disease stage. To better understand the current treatment landscape and contribute to improved patient outcomes, the LINK (Liver Cancer in Korea) research network was established as a longitudinal real-world HCC database with annual data refresh. The aim was to provide current and up-to-date real-world insights into HCC patient characteristics, treatment patterns, and outcomes. Methods: LINK’s data sources are the electronic medical records of three leading academic hospitals (Asan Medical Center, Samsung Medical Center, Severance Hospital). Extracted data are standardized using a study-specific common data model to ensure comparability across hospitals. Adult patients with primary diagnosis of HCC (ICD-10: C22.0) in 2015-2020 were included and followed until death, loss to follow-up, or June 2021, whichever occurred first. Patients without valid treatment records or morphology codes or with other primary cancer diagnosis were excluded. Data on key patient and clinical characteristics, treatments, such as systemic anti-cancer therapy (SACT) regimens, and real-world outcomes were collected. Rule-based algorithms were developed to define initial treatments and lines of therapy in palliative SACT. Results: Of 25,480 HCC patients identified, 10,298 (40%) met eligibility criteria and were included in the analysis. The median age was 60 years and 19% were female. There were 74% of patients classified as Child-Pugh (CP) class A, 16% as B, 1% as C, and 9% with unknown CP at diagnosis. For albumin-bilirubin (ALBI) grade at diagnosis, 49% of patients were classified as grade 1, 45% as 2, 5% as 3, and 1% unknown. Loco-regional therapy was the most common initial treatment, with 54% and 13% of patients receiving transarterial therapy and local ablation therapy, respectively. A total of 628 patients (6%) undergone liver transplantation regardless of preceding treatments and 15% of patients were initially treated with hepatectomy. Only 2% received radiation therapy (RT) or RT in combination with cytotoxic chemotherapy as initial treatment. Among 3,026 patients who received SACT either as an initial (10%) or subsequent treatment, 67%, 20%, and 13% received 1 line, 2 lines, and 3 lines of therapy. The most common first-line SACT was sorafenib, followed by lenvatinib. Conclusions: The LINK database can serve as a multi-center research platform to facilitate fast and reliable real-world evidence generation for HCC patients. Future updates and subgroup analyses of interest can further evaluate the impact of new therapies and changes to HCC treatment guidelines in Korea.

ROLE OF ULTRASONOGRAPHY-GUIDED FINE NEEDLE ASPIRATION CYTOLOGY IN HEPATIC LESIONS: A PROSPECTIVE AND OBSERVATIONAL STUDY AT A TERTIARY HEALTH-CARE CENTRE IN CENTRAL INDIA

Objectives: The liver is a common site for primary as well as secondary malignancies. Ultrasonography (USG)-guided fine needle aspiration cytology (FNAC) is a rapid, accurate, economical, and safe diagnostic procedure for various hepatic lesions. The aims of the study were to categorize and study the cytomorphological features of the hepatic lesions, study the age and sex distribution and analyzing cytological features of the hepatic lesions, and to evaluate the sensitivity, specificity, and diagnostic accuracy of USG-guided FNAC in diagnosing hepatic lesions. Methods: A prospective and observational study of 64 patients with clinically and radiologically diagnosed hepatic lesions and referred for FNAC in department of pathology of a tertiary care hospital. USG-guided FNAC was performed in each patient and cytological features were analyzed. Results: In our study, out of total 64 USG-guided FNAC of liver, metastasis was most common – 33 cases (51.56%), followed by primary hepatocellular carcinoma – 18 cases (28.12%), liver abscess – 6 cases (9.37%), and 7 cases (10.93%) were unsatisfactory smears. Conclusion: USG-guided FNAC, in expert hands being simple, safe, quick, reliable, cost-effective, efficient, and easily available OPD-based procedure and with less number of complications, it has a very important role in accurate diagnosis of primary hepatocellular carcinoma, secondary malignant tumors of liver, and inflammatory lesions of liver.

Multiradiographic Diagnosis of Primary Hepatocellular Carcinoma and Evaluation of Its Postoperative Observation after Interventional Treatment.

Objective To investigate the focal imaging performance of MRI and CT multiphase dynamic enhancement scan examination in primary liver cancer patients, analyze its clinical diagnostic value, and provide a basis for early diagnosis of the disease. Methods 236 patients with primary liver cancer admitted to our hospital from May 2019 to November 2021 were randomly divided into two groups, the control group was given MRI multiphase dynamic enhancement scan diagnostic method, and the observation group was given CT scan combined with the MRI diagnostic method. The patients' examination results and pathological examination results were compared and analyzed, and the therapeutic effects of patients in the two groups after interventional treatment were compared. Results After the imaging and pathological examinations of patients in both groups, it was found that the diagnostic accuracy of patients in the observation group and the therapeutic effect after interventional treatment were significantly better than those in the control group. Conclusions Compared with CT multiphase dynamic enhancement scan, MRI multiphase dynamic enhancement scan can show multidirectional and multiangle lesions in primary hepatocellular carcinoma patients, with better characteristics of blood supply to hepatocellular carcinoma and a higher accuracy rate.

The effect of portal vein thrombosis in hospitalized hepatocellular carcinoma patients: A nationwide analysis.

e16161 Background: Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and the 6th most common cancer-related death worldwide with 5-year relative survival of 20.3%. Although portal vein tumor thrombus is deemed as poor risk factor for HCC patients, the association of portal vein thrombosis (PVT) and HCC regarding inpatient mortality and morbidity outcomes is not well studied in hospitalized population. This study aimed to analyze the mortality, length of stay (LOS), and health care utilization in HCC patients with and without PVT. Methods: Nationwide Inpatient Sample (NIS) was queried to determine adult hospitalized patients with a primary diagnosis of HCC using ICD-10 codes. The primary outcome was defined as the effect of PVT on inpatient mortality in those patients. Secondary outcomes included LOS, total hospital charge, health care utilization, ICU admission. We evaluated the baseline characteristics using the t-test and chi-square test. Multivariable logistic regression analysis was performed to assess the association of HCC with PVT and inpatient mortality adjusted by age, gender, race, Charlson index, insurance, and household income. Results: A total of 10,205 HCC patients were identified, and 16.3% of these patients had PVT. HCC patients with PVT were younger (63.3 vs. 64.8 years, p &lt; 0.001), more likely to be male (78.7% vs. 74%, p &lt; 0.001), African American (20.3% vs. 15.8% p &lt; 0.001), have low-income (p &lt; 0.001) and more likely to have Medicaid insurance (23.8% vs. 19.1%, p &lt; 0.001) compared to HCC patients without PVT. HCC with PVT had high Charlson Comorbidity index of &gt; 7 (29.6% vs. 19.7%) (p &lt; 0.001). The overall inpatient mortality rate was 8.1% for all patients who are admitted for HCC; higher in HCC with PVT (10.6%) vs HCC without PVT (7.6%) (p &lt; 0.001). Age, Charlson index, African–American race found to be associated with inpatient mortality among hospitalized patients with HCC. HCC with PVT had a higher odds ratio with increased all-cause mortality of 43% compared to HCC without PVT (OR 1.43, 95% CI 1.19-1.72, p &lt; 0.001), and the adjusted odds ratio was 1.25 (95% CI 1.03-1.52, p = 0.025). In addition, HCC with PVT was associated with increased LOS mean 6.3 vs. 5.6 days (adjusted difference: 0.5 p = 0.004), but total hospital charges were less in HCC patients with PVT (mean $75585 vs $91040, adjusted difference: $13437 p &lt; 0.0001). There was no significant difference in ICU transfers and disposition. Conclusions: Hospitalized HCC patients with PVT have higher odds of inpatient mortality, LOS, and healthcare utilization than HCC patients without PVT. Age, higher Charlson index, African–American race were associated with inpatient mortality in HCC admissions. HCC with PVT should be identified and considered as a higher risk of mortality. Further efforts should be made to prolong survival, increase quality of life, and decrease hospital stay.

The Role of Cytology in the Diagnosis of Metastatic Hepatocellular Carcinoma

The diagnosis of primary hepatocellular carcinoma (HCC) in high risk patients, such as those with chronic hepatitis B or C with/without cirrhosis of the liver, can be made with relevant image studies alone; however, morphologic confirmation by cytology or histopathology is essential to the diagnosis of metastatic HCC because the treatment of the latter differs from that of primary extrahepatic malignancy. Although both cytology and histopathology are important tools in the diagnosis of malignancy, histopathology almost always plays a confirmatory and pivotal role, and also a gold standard in cyto-histological correlation. We present two patients of metastatic HCC to rare sites; endobronchus in one, and neck lymph nodes, face and the abdominal wall in the other. Repeated bronchial biopsy in the first patient and excisional biopsy from the metastatic sites of the second patient failed to make a conclusive diagnosis of metastatic HCC. However, bronchial brushing in the first patient and fine needle aspiration cytology from the respective metastatic sites of the second patient consistently showed characteristic HCC features and provided clinicians with the rationale for ongoing treatment. The diagnostic issues and possible pitfalls are discussed. Cytology and histopathology appear equipollent; sometimes cytology can play a diagnostic role when histopathology fails its expected role in this scenario.

Serum Tumor Markers for Early Diagnosis of Primary Hepatocellular Carcinoma.

Primary hepatocellular carcinoma (HCC) is one of the most frequently occurring pernicious tumors in the world. It is typically very insidious in the early stages with no obvious symptoms. Its development and metastasis are very rapid. Upon diagnosis, most patients have already reached a local advanced stage or have established distant metastases. The treatment of HCC is limited, with poor prognosis and short natural survival time. In order to improve the efficiency of early diagnosis, it is particularly significant to choose economic and effective diagnosis methods. Ultrasound, magnetic resonance imaging, and computed tomography are usually used in the clinic, but these methods are extremely limited in the diagnosis of HCC. Tumor markers have become the main effective early clinical diagnosis method. Potential serum tumor markers include alpha fetoprotein heterogeneity, Golgi protein 73, phosphatidylinositol proteoglycan (GPC-3), osteopontin, abnormal prothrombin, and heat shock protein. These tumor markers provide new ideas and methods for the diagnosis of HCC. A combination of multiple markers can make up for the deficiency of single marker detection and provide a new strategy for the prognosis and auxiliary diagnosis of HCC. This review introduces protein tumor markers utilized over the past five years.

Serum TSGF and miR-214 levels in patients with hepatocellular carcinoma and their predictive value for the curative effect of transcatheter arterial chemoembolization.

The purpose of this study is to evaluate the expression of tumor-specific growth factor (TSGF) and microRNA-214 (miR-214) in the serum of patients with primary hepatocellular carcinoma (PHC) and their predictive values for the curative effect of transcatheter arterial chemoembolization (TACE). A retrospective analysis of the clinical data of 87 PHC patients were treated with TACE. According to the curative effect 1 month after TACE, PHC patients were divided into disease control group (n=56) and disease progression group (n=31). The expression levels of TSGF and miR-214 were detected by qRT-PCR before or after treatment with TACE in disease control group and disease progression group. The predictive value of TSGF and miR-214 for the efficacy of TACE were evaluated by the receiver operating characteristic (ROC) curve. The Kaplan-Meier survival curve was drawn according to the critical value of ROC. The effect of pretreatment levels of TSGF and miR-214 was analyzed on the three-year survival rate of patients. After TACE treatment, the mRNA expressive of serum TSGF were increased in progression group, while the levels of miR-214 were decreased compared with control group (P<0.05). Importantly, at one month after TACE treatment, the levels of TSGF were decreased in control group and progression group, while the expression of miR-214 was increased compared with in both groups before TACE treatment(P<0.05). The result of ROC analysis showed that for predicting the curative effect of TACE, the levels of TSGF and miR-214 expression were (181.32, 0.63) (0.849 and 0.807) and (0.759-0.938, 0.707-0.907) in the cutoff values, AUCs and 95% confidence intervals, respectively. The result of Kaplan-Meier analysis showed that the 3-year survival rate of the low TSGF group was up-regulated than that of the high TSGF group [65.12% (31/44) vs. 30.23% (13/43); χ2=5.014; P=0.025]. The 3-year survival rate of the miR-214 high expression group was up-regulated than that of the miR-214 low expression group [61.70% (29/47) vs. 30.00% (12/40); χ2=6.928; P=0.008]. Serum TSGF and miR-214 could be used as potential biomarkers for PHC diagnosis and prognosis.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Presenting with Primary Diagnosis of Hepatocellular Carcinoma

: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon systemic allergic reaction, which usually occurs due to a specific medication. The most common presentation is fever, skin eruption, and lymphadenopathy that presents two to eight weeks after exposure to the culprit drug. In some cases, evidence of internal organ involvement including renal failure, respiratory symptoms, or liver involvement may present. These symptoms may present weeks to months after the exposure or even discontinuing the drug, which makes the diagnosis challenging. This report presents a young man with first presentation of icter and elevated liver enzymes, whose laboratory and imaging studies failed to diagnose the disease. A liver biopsy was performed and the pathologist reported hepatocellular carcinoma (HCC). A high level of serum alpha-fetoprotein was consistent with the histologic findings, but concerning the uncommon clinical setting, the pathologic specimen was reviewed by another pathologist, which reported hepatocyte regeneration following hepatitis. This finding was consistent with elevated serum alpha-fetoprotein. A retrospective review revealed the history of using ceftriaxone nine months before the presentation and his final diagnosis was the DRESS syndrome with a dramatic response to corticosteroid treatment.

Role of GALAD serological model in the clinical diagnosis of primary hepatocellular carcinoma

Objective To explore the value of GALAD model, including gender, age, AFP, AFP-L3 and DCP in diagnosis of primary hepatocellular carcinoma and prediction of microvascular invasion (MVI). Methods Using retrospective study method, 5 919 patients with primary hepatocellular carcinoma (HCC) who received radical operation from January 2015 to December 2018 in Eastern Hepatobiliary Surgery Hospital were enrolled into study group. At the same time, 1 745 patients with benign liver diseases (BLDs) were enrolled into control group. The concentration of DCP was detected by Lumipulse G1200 automatic immune analyzer, and the concentration of AFP was detected by Cobas e601 automatic immune analyzer. AFP-L3 was detected by affinity adsorption centrifugation. The non-parametric Mann Whitney test was used to compare the difference between two groups. The chi square test was used to compare the rates. The diagnostic value of single serological marker and GALAD model for primary hepatocellular carcinoma was analyzed. The predictive effect of GALAD model on MVI of primary hepatocellular carcinoma was evaluated. Results Compared with single serum marker, the diagnostic value of GALAD model is higher. When the cutoff value is -0.33, the diagnostic sensitivity, specificity and accuracy reach to 91.9% (5 440/5 919), 86.8% (1 515/1 745) and 90.7% (6 955/7 664), respectively. The area under the curve can reach 0.960 [95%CI (0.955-0.964)]. Compared with no MVI (MO) group, the value of GALAD model in MVI low-risk group (M1), MVI high-risk group (M2) and MVI (M1+2) were significantly higher (Z values were-12.517, -22.883, -21.655, P<0.05), Galad model predicts MVI (M2) in high risk group,AUC was 0.717 [95%CI (0.701-0.733)] (M0 ratio M2). Conclusion GALAD model has better diagnostic performance in primary hepatocellular carcinoma and has certain predictive value for microvascular invasion. Key words: Carcinoma, hepatocellular; Liver neoplasms; Neoplasm invasiveness; Microvessels; alpha-Fetoproteins; Prothrombin

Актуальные проблемы и перспективы применения методов ядерной медицины в диагностике и лечении гепатоцеллюлярной карциномы: аналитический обзор

In the presented review of publications, together with a brief analysis of the incidence, risk factors for the occurrence and methods of diagnosis of hepatocellular carcinoma (HCC), current problems and prospects for the application of nuclear medicine methods in the diagnosis and treatment of this disease are indicated. Hepatocellular carcinoma is one of the most common malignant tumors of the liver and is characterized by a rapidly progressing course with an unfavorable life expectancy. A variety of clinical manifestations of the disease creates certain difficulties in the early diagnosis of HCC. Although HCC screening is most commonly used to determine the level of alpha-fetoprotein (AFP), ultrasound (US), bolus CT and MRI, experience in the use of radionuclide imaging diagnostics, including positron emission tomography, is important in clinical practice (PET), which, not being the main method of primary diagnosis of HCC, however, confirmed their relevance in the differential diagnosis between a benign tumor and metastasis with unclear diagnostic data, as well as in the process of monitoring treatment and in the diagnosis of distant metastases. Conceptual issues in determining the treatment strategy of patients with HCC, depending on the staging of the disease, the prospects for optimizing treatment strategies and traditional methods of treating HCC in detail and in depth are covered in various publications, including publications of domestic authors. Based on this, the authors of the article limited themselves to a brief analysis of the use of embolization and radiation therapy methods for treating HCC, the active development of which in the last decade, as well as promising early results of treatment, suggest that radiation therapy can be considered as the main treatment method for HCC traditional methods. &#x0D; Further study and development of radionuclide methods for the diagnosis and therapy of HCC, as well as the search and study of new radiopharmaceuticals for diagnosis and regional intraarterial radiotherapy is one of the promising directions in modern approaches to the diagnosis and treatment of HCC.

Value of ultrasound combined with MRI in the diagnosis of primary and recurrent hepatocellular carcinoma.

Ultrasound (US) combined with magnetic resonance imaging (MRI) in the diagnosis of primary hepatocellular carcinoma (PHCC) and recurrent hepatocellular carcinoma (RHCC) were compared. The clinical data of 329 patients with hepatocellular carcinoma (HCC) admitted to Qingdao Women and Children's Hospital from June 2015 to December 2017 were collected. One hundred and sixty patients with PHCC were regarded as the PHCC group, and the other 169 patients with RHCC were regarded as the RHCC group. US and MRI were used in the imaging diagnosis of both groups and the results of US combined with MRI, US, and MRI alone were compared. The lesion size in the PHCC group was significantly higher than that in the RHCC group (P<0.05). The MRI fast-in and fast-out rates of the two groups were significantly higher than those of the other three methods (P<0.05). The coincidence rate of MRI in the two groups was higher than that of computed tomography (CT), US, and US combined with MRI (P<0.05). The coincidence rates of CT, US, MRI, and US combined with MRI in PHCC group were significantly higher than those in RHCC group. In PHCC group, MRI was superior to the other methods in the detection of micro HCC (P<0.05). In RHCC group, MRI was significantly better than US in the detection of micro HCC (P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of MRI were significantly better than the other three methods (P<0.05). MRI alone has the best diagnostic efficacy for micro HCC-type lesions. The diagnostic efficacy of MRI, US, CT, and US combined with MRI in PHCC was better than those in RHCC. In addition to imaging examination, the diagnosis of RHCC should be combined with other indicators for comprehensive diagnosis.

Implementation of sorafenib treatment for advanced hepatocellular carcinoma: an illustration of current practice in Taiwan.

BackgroundSorafenib is the first regimen listed in the treatment algorithm for hepatocellular carcinoma (HCC) worldwide. This study aimed to assess the efficacy of sorafenib treatment for advanced HCC in a clinical practice using a nationwide population study.MethodsAll patients registered with a diagnosis of primary HCC and identified as having been prescribed sorafenib between August 2012 and December 2015 were selected from a national database and retrospectively reviewed. Outcomes related to prescription of sorafenib for these patients were further assessed.ResultsA total of 9,738 patients were enrolled and analyzed. As a result, 32.33% of patients had an initial treatment response and were eligible for the prescribed second term (240 tablets/ term) of sorafenib and 8.91% of patients received more than three terms of sorafenib. Meanwhile, the duration of sorafenib usage beyond 6 months was noted in 15.49% of patients, including 10.59% of patients with a period of usage between 6 and 12 months and 4.9% of patients with more than 12 months usage. Survival analysis showed that patients who received locoregional therapy plus sorafenib had significantly better survival rates than those who underwent only sorafenib treatment. Certain patients who underwent hepatectomy (n=12) or liver transplantation (n=13) were subsequently free of HCC.ConclusionThe disease control rate of sorafenib in advanced HCC patients in this study seemed similarly poorer as what has been previously reported by clinical trials. The combination of sorafenib and additional treatments could perhaps provide survival benefits and possibly cure disease in combination with surgical management.

African Americans are less likely to receive curative treatment for hepatocellular carcinoma.

AIMTo determine if racial disparities continue to exist in the treatment of hepatocellular carcinoma (HCC).METHODSA retrospective database analysis using the Nationwide Inpatient Sample was performed including patients with a primary diagnosis of HCC. Univariate and multivariate analyses were utilized to determine racial disparities in liver decompensation, treatment, inpatient mortality, and metastatic disease.RESULTSA total of 62604 patients with HCC were included consisting of 32428 Caucasian, 9726 African-American, 8988 Hispanic, and 11462 patients of other races. Caucasian patients were more likely to undergo curative therapies of liver transplant (OR: 2.66, 95%CI: 1.92-3.68), resection (OR: 1.82, 95%CI: 1.48-2.23), and ablation (OR: 1.77, 95%CI: 1.36-2.30) than African-American patients. Hispanic patients were more likely to undergo transplant (OR: 2.18, 95%CI: 1.40-3.39) and ablation (OR: 1.46, 95%CI: 1.05-2.03) than African-American patients. Patients of other races were more likely to receive a liver transplant (OR: 2.41, 95%CI: 1.62-3.61), resection (OR: 1.79 95%CI: 1.39-2.32), and ablation (OR: 2.03, 95%CI: 1.47-2.80) than African-American patients. There are no differences in the rates of transarterial chemoembolization between races.CONCLUSIONRacial disparities in HCC treatment exist despite emphasis to support equality in healthcare. African-American patients are less likely to undergo curative treatments for HCC.

Disparities in the treatment of hepatocellular carcinoma based on geographical region are decreasing.

Geographic differences have existed in the management of hepatocellular carcinoma (HCC), and efforts to reduce regional disparities have been initiated. The aim of this study is to use the Nationwide Inpatient Sample to determine if regional disparities in the treatment of HCC continue to exist. A retrospective database analysis using the Nationwide Inpatient Sample was performed that included patients with a primary diagnosis of HCC. Logistic regression models were utilized to determine geographic disparities in liver decompensation, treatment, inpatient mortality, and metastatic disease. This study's locational reach of 62604 patients included 22769 patients from the South (36%), 14554 in the Northeast (23%), 14041 in the West (22%), and 11240 in the Midwest (18%). Patients who received treatment in the West were more likely to have inpatient mortality (OR 1.28, 95% CI 1.03, 1.53) than patients who received treatment in the Midwest. No significant differences were observed between rates of resection, ablation, and transarterial chemoembolization when comparing by region. Rates of liver transplantation were lower in the West compared with the Midwest (OR 0.51, 95% CI 0.29, 0.87). There was no significant difference between other regions. Geographic disparities in the treatment of HCC are improving.

Diagnostic value of imaging examinations in patients with primary hepatocellular carcinoma.

Primary hepatocellular carcinoma (PHC) includes hepatocellular carcinoma, intrahepatic cholangiocarcinoma and other pathological types and is characterized by rapid progression. Most of the clinical diagnoses are made at late stage or when distant metastasis occurs, increasing the difficulty of treatment and resulting in a poor prognosis. Therefore, the early diagnosis of PHC plays an important role in timely treatment and the improvement of prognosis. The gold standard for the diagnosis of primary liver cancer is liver biopsy, but it has limitations as an invasive examination. Presently, imaging has become the first choice for the diagnosis of liver cancer. We here summarize the new methods and techniques of imaging in diagnosis and evaluation of primary liver cancer in recent years, including ultrasonography, computed tomography perfusion imaging, diffusion-weighted imaging technology-voxel incoherent motion, diffusion tensor imaging, iterative decomposition of water and fat with echo asymmetry and least squares estimation-iron quantification, dynamic enhanced magnetic resonance imaging and hepatocyte-specific contrast medium imaging. Imaging diagnosis can not only evaluate the degree of differentiation, blood supply and perfusion, and invasiveness of the lesion, but also predict the prognosis, evaluate liver function, and provide references for clinical diagnosis and treatment.