Hepatocellular Carcinoma Tumor Size Research Articles

Induction of complete tumor necrosis may reduce intrahepatic metastasis and prolong survival in patients with hepatocellular carcinoma undergoing locoregional therapy: a prospective study

BackgroundTransarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective locoregional therapies for hepatocellular carcinoma (HCC). This study aimed to investigate whether HCC patients who had initial complete response to these treatments had a subsequent lower risk of intrahepatic metastasis. Patients and methodsA total of 152 patients who underwent locoregional therapy (94 received PAI and58 received both TACE and PAI) for HCC (tumor size ≤5 cm) were prospectively evaluated. ResultsIn all, 60 (39%) patients had a complete tumor necrosis after treatment. The cumulative incidence of the development of intrahepatic metastasis was lower for patients with complete remission (P = 0.005) and for patients with smaller (≤3 cm) tumor size (P = 0.083). Cox multivariate survival analysis showed that absence of complete remission [relative risk (RR) 2.7; 95% confidence interval (CI) 1.4–5.3; P = 0.003] was the only independent factor that predicted the occurrence of intrahepatic metastasis. Patients with complete remission had a significantly better long-term survival than those without (P = 0.002), and the occurrence of intrahepatic metastasis over time independently predicted a decreased survival (RR 3.2; 95% CI 2.0–6.1; P = 0.019). ConclusionsInduction of complete tumor necrosis in HCC patients undergoing locoregional therapy may decrease the risk of intrahepatic metastasis and improve survival.

Loss of fragile histidine triad expression in hepatocellular carcinoma

目的 探讨肝细胞癌中FHIT基因蛋白(Fhit)表达状况及其与临床病理指标的可能关系.方法采用兔抗人Fhit蛋白抗体和枸橼酸-微波-SP免疫组化方法检测83例福尔马林固定、石蜡包埋的肝细胞癌蜡块标本中Fhit表达状况并分析其与组织学分级、临床分期以及肿瘤大小的关系.结果 83例肝细胞癌组织Fhit表达较正常肝组织明显降低或缺失者为50例(65.2%),与正常肝组织相等者为33例(34.8%).Fhit蛋白低表达癌在癌组织学分级中的分布为Ⅰ级癌46.7% (7/15),Ⅱ级癌53.8%(21/39),Ⅲ级癌75.9%(22/29),各级癌组间比较,相差无显著性(P>0.05).Fhit蛋白低表达癌在临床分期中的分布为Ⅰ～Ⅱ期癌21.6%(8/37),Ⅲ～Ⅳ期癌91.3%(42/46),二组比较,有非常显著性差异(P 50 mm)和(≥30 mm)病例组中的分布分别为75.0%(33/44)和64.9%(46/71),而在≤50 mm组和<30 mm(小肝癌)组中则为43.6%(17/39)和33.3%(4/12),组间比较,均有显著性差异(P均<0.05).结论肝细胞癌Fhit表达状况可能与临床分期以及肿瘤大小相关,提示Fhit表达降低可能对肝细胞癌的演化和进展具有重要作用并可能成为一个新的预后指标。

Retrospective clinicopathologic correlation of gross tumor size of hepatocellular carcinoma: implications for extracranial stereotactic radiosurgery

Purpose/Objective: Extracranial stereotactic radiosurgery is a new radiation technique for the treatment of localized hepatocellular carcinoma (HCC). Accurate assessment of tumor size by imaging is of utmost importance because minimal treatment planning margins are added to the gross tumor. Thus, it is important that the size of the lesion on CT or MRI accurately estimates the true gross pathologic size. The purpose of the present analysis is to compare the size of HCC on gross pathologic examination with the size on preoperative CT or MRI scan.

Expression of survivin messenger RNA correlates with poor prognosis in patients with hepatocellular carcinoma.

Suppression of apoptosis is important for carcinogenesis and tumor growth. Recent studies revealed that survivin not only inhibited apoptosis but also accelerated cancer cell proliferative activity. To investigate the prognostic role of expression of the antiapoptosis gene, survivin, in hepatocellular carcinoma (HCC), the authors analyzed the correlation between the expression pattern of survivin messenger RNA (mRNA) and clinicopathologic findings of patients. Tissues were obtained by surgical resection of livers from 51 patients with HCC and 6 patients without HCC. Expression of survivin mRNA was evaluated using reverse transcription-polymerase chain reaction in 51 tumors, 51 adjacent histologically noncancerous livers, and 6 normal livers. Survivin protein expression was evaluated using Western blotting, and apoptotic cancer cells were detected by immunostaining with polyclonal rabbit anti-single-stranded DNA. Survivin mRNA expression was detected in 21 of 51 (41%) tumors, 2 of 51 (4%) noncancerous livers, and none of the 6 normal livers. Survivin mRNA expression did not correlate with tumor size or stage of HCC. Percentage of apoptotic cancer cells of 30 survivin mRNA-negative tumors (5.2 +/- 3.4%) was significantly higher than that of 21 survivin mRNA-positive tumors (2.2 +/- 2.3%, P = 0.0019). The disease-free 5-year survival rate of 21 patients positive for survivin mRNA (19%) was significantly poorer than that of 30 patients negative for survivin mRNA (39%, P = 0.0148). Survivin mRNA was detected in 57% (17/30) patients with HCC recurrence but in only 19% (4/21) of patients without recurrence (P = 0.0072). These results indicated that survivin mRNA expression could be used as an independent prognostic factor for patients with HCC after hepatectomy.

Treatment of ruptured hepatocellular carcinoma

The problem of whether surgical or conservative treatment is indicated for ruptured hepatocellular carcinoma (HCC) has not been analyzed from the viewpoint of long-term development of hepatitis viral infection from liver fibrosis to liver cirrhosis. Although transcatheter arterial embolization (TAE) for hemostasis followed by two-stage hepatectomy has been established as the best treatment for ruptured HCC, there still remain difficulties in the treatment of some patients. Twelve patients with ruptured HCC who were surgically or conservatively treated were retrospectively analyzed in terms of modality of treatment, liver function, extension of HCC, complications, survival rate, and cause of death. Tumor rupture can occur either in the early phase or in the terminal phase during the development from liver fibrosis to liver cirrhosis, while tumor rupture occurs at the advanced stage in terms of HCC extension. TAE for emergent hemostasis or prevention of re-bleeding was performed in ten patients, while TAE was contraindicated in one patient and emergent laparotomy for hemostasis was performed in one patient. In four patients, elective extended surgical resection was performed, because liver function was evaluated as clinical stage 1 according to the General rules for the clinical and pathological study of primary liver cancer of the Liver Cancer Study Group of Japan. In seven patients, conservative or medical treatment was selected, because liver function was evaluated as poor. The surgically treated group, who could tolerate extensive operation, survived longer than the conservatively treated group. While TAE remains the best method to employ for hemostasis, it still has limitations. Hence, we should be mindful of other possible modalities for hemostasis and their outcomes. Rupture of HCC at an early phase in the development of liver fibrosis is a good indication for elective surgical treatment and should be distinguished from rupture in the terminal phase of liver cirrhosis, which should be treated conservatively. Although elective surgical treatment can be performed in selected patients, tumor size and location of HCC, in addition to liver function, should be taken into consideration.

Percutaneous microwave coagulation therapy for hepatocellular carcinoma: Evaluation of irradiated region with dynamic CT

We evaluated the size of irradiated regions after percutaneous microwave coagulation therapy (PMCT) to determine the optimal irradiation time in proportion to the tumor size in hepatocellular carcinoma (HCC). We reviewed the findings on dynamic CT within 5 days and one month after PMCT for 23 lesions in 20 patients with HCC. The tumor area was irradiated with microwaves for 2 to 9 minutes according to the tumor size. There was correlation between the size of hypoattenuation area after the treatment and irradiation time. Hyperattenuation surrounding the hypoattenuation area was frequently observed within 5 days after PMCT and made it difficult to evaluate the anti-tumor effect exactly. The finding almost disappeared one month after PMCT and we should evaluate the effect of treatment with dynamic CT in both periods.

Significant correlation between serum basic fibroblast growth factor and tumor size in hepatocellular carcinoma: [formula omitted], K.H. Lai, N.H. Chow 1, H.B. Yang 1, G.H. Lo, J.S. Cheng, R.L. Huang, C.F. Chang, S.M. Chen, C.K. Lin, M. Lin 2, Y.F. Yang 2. Division of Gastroenterology, Department of Medicine, Department of Emergency Medicine 2, Veterans General Hospital-Kaohsiung, Department of Pathology 1,

Significant correlation between serum basic fibroblast growth factor and tumor size in hepatocellular carcinoma: [formula omitted], K.H. Lai, N.H. Chow 1, H.B. Yang 1, G.H. Lo, J.S. Cheng, R.L. Huang, C.F. Chang, S.M. Chen, C.K. Lin, M. Lin 2, Y.F. Yang 2. Division of Gastroenterology, Department of Medicine, Department of Emergency Medicine 2, Veterans General Hospital-Kaohsiung, Department of Pathology 1,

Serum α-L-fucosidase activity and tumor size in hepatocellular carcinoma

The serum level of alpha-L-fucosidase activity has been suggested as a useful marker in the diagnosis of hepatocellular carcinoma, although the precise mechanism behind the elevation of this parameter has not been determined. We found that the serum alpha-L-fucosidase activity level was significantly higher in 67 patients with hepatocellular carcinoma (695.1 +/- 245.5 nmol/ml/hr) than in 47 patients with cirrhosis (389.1 +/- 188.2 nmol/ml/hr; p < 0.001) and in 54 controls (202.0 +/- 104.6 nmol/ml/hr; p < 0.001). However, alpha-L-fucosidase activity was not correlated with tumor size (r = 0.134), whereas the alpha-fetoprotein level was correlated with tumor size (r = 0.580, p < 0.001). When 515.8 nmol/ml/hr was taken as the cutoff value (mean value in the controls plus 3 standard deviations), alpha-L-fucosidase activity was above the cutoff value in 12 of the 17 patients with a hepatocellular carcinoma less than 2 cm in diameter, in 28 of the 37 patients with a hepatocellular carcinoma less than 3 cm in diameter and in 52 of the 67 patients with hepatocellular carcinoma. In contrast, only 10 of the 47 patients with cirrhosis had levels above the cutoff value. These findings suggest that an increase in serum alpha-L-fucosidase activity in patients with cirrhosis may be a marker for detecting a hepatocellular carcinoma, especially a small tumor, because alpha-fetoprotein and des-gamma-carboxy-prothrombin are less promising as tumor markers.

Serum α-?-fucosidase activity and tumor size in hepatocellular carcinoma

Serum α-?-fucosidase activity and tumor size in hepatocellular carcinoma