Hepatocelullar Carcinoma Research Articles

Chemopreventive Properties Curcuma heyneana Rhizome Ethanolic Extract on Hepatocellular Carcinoma Cells, JHH-4

Hepatocellular carcinoma is the most common type of liver cancer. Curcuminoids are natural polyphenol compounds abundant in Curcuma heyneana ethanolic extract (CHE) and are known to inhibit breast and cervical cancer cell proliferation. Based on previous research, curcuminoid compounds have been studied to inhibit the growth of the liver cancer cell model, HepG2. This study aims to examine the potential of CHE as a chemopreventive agent in liver cancer using JHH-4 cell as a model. CHE was obtained by maceration method using ethanol which was then identified for its phytochemical profile using thin layer chromatography (TLC). Then TLC results were quantified to calculate the levels of compounds present in the CHE based on spot intensity with ImageJ software. 2,2-Diphenyl-1-picrylhydrazyl (DPPH) antioxidant assay was conducted to determine the radical scavenging activity of CHE. Cytotoxic activity of CHE on JHH-4 liver cancer cells was tested by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Extraction produces a yield of 10.2 %w/w. CHE contains 4.52 %w/w curcuminoid compound consisting of 0.49 %w/w curcumin, 3.21 %w/w demethoxycurcumin, and 0.82% w/w bisdemethoxycurcumin. CHE exhibited antioxidant activity with an IC50 value of 378.96 μg/mL, meanwhile ascorbic acid as a positive control has an IC50 value of 8.49 μg/mL. Cytotoxic activity of CHE on JHH-4 cells is characterized by an IC50 value of 16.62 μg/mL which is classified as having strong cytotoxic activity. This study concluded that CHE has the potential to be developed as a chemopreventive agent in liver cancer.Keywords: liver cancer, hepatocelullar carcinoma, Chemopreventive, antioxidant,Curcuma heyneana.

The Impact of Probiotic Bifidobacterium on Liver Diseases and the Microbiota.

Recent studies have shown the promising potential of probiotics, especially the bacterial genus Bifidobacterium, in the treatment of liver diseases. In this work, a systematic review was conducted, with a focus on studies that employed advanced Next Generation Sequencing (NGS) technologies to explore the potential of Bifidobacterium as a probiotic for treating liver pathologies such as Non-Alcoholic Fatty Liver Disease (NAFLD), Non-Alcoholic Steatohepatitis (NASH), Alcoholic Liver Disease (ALD), Cirrhosis, and Hepatocelullar Carcinoma (HCC) and its impact on the microbiota. Our results indicate that Bifidobacterium is a safe and effective probiotic for treating liver lesions. It successfully restored balance to the intestinal microbiota and improved biochemical and clinical parameters in NAFLD, ALD, and Cirrhosis. No significant adverse effects were identified. While more research is needed to establish its efficacy in treating NASH and HCC, the evidence suggests that Bifidobacterium is a promising probiotic for managing liver lesions.

THU-503 - Cytomegalovirus reactivation is associated with lower hepatocelullar carcinoma recurrence rates after liver transplantation

THU-503 - Cytomegalovirus reactivation is associated with lower hepatocelullar carcinoma recurrence rates after liver transplantation

P-45 LIVER HEMODYNAMIC AND TRANSJUGULAR LIVER BIOPSY: ROLE IN DIAGNOSTIC AND THERAPEUTIC BEHAVIOR

The hepatic hemodynamic study (HH) and the transjugular liver biopsy (TJLB) are complementary tests used in hepatology that provide valuable information, allowing to obtain diagnoses that change behavior. In our environment there is little experience regarding the performance and results obtained, particularly when it is performed by a hepatologist. To describe the experience and results of the HH and TJLB study in our center. All HH and TJLB studies conducted by one of the authors (AU) from January 2018 to July 2019 were included. Clinical records, HH and TJLB outcome, and behavior change were reviewed. 25 patients and 27 procedures were included; age 55 (20-72) years, 60% women. Procedures: 21 TJLB + HH and 6 HH. Reason for request: etiological study cirrhosis 29.6%, etiology acute hepatitis 18.5%, diagnostic doubt in alcohol hepatitis 11.1%, suspected idiopathic portal hypertension 11.1%, rejection 7.4%, hepatocelullar carcinoma 3,7% and another 18.5%. In 92.6% of the cases, the HH and / or TJLB result made it possible to confirm / rule out diagnosis and change therapeutic behavior. 90.5% of the TJLB results were satisfactory for diagnosis. Only one patient presented a complication: hemobilia that did not require invasive management, and one patient had an incomplete procedure. Our experience shows that the HH study and the TJLB are important complementary tests to change behavior. For this reason, they should be considered, when indicated, in the study of the hepatological patient.

Long-term Risk of Hepatocellular Carcinoma Following Direct-Acting Antiviral Therapy in Compensated Liver Cirrhosis Induced by Hepatitis C Virus Infection

Background: Considering the excellent safety profile and the high efficacy rates, great benefits were expected with the availability of the new direct-acting antivirals (DAAs) in treating hepatitis C virus (HCV) infection. Following the publication of two articles in 2016 on the high incidence rates of hepatocelullar carcinoma (HCC) following DAAs, several papers revealed contradictory results, thereby casting shadows on the role of DAAs in hepatocarcinogenesis. Objectives: The present study aimed to assess the incidence and risk factors of HCC in patients with HCV genotype 1b infection and compensated cirrhosis with the sustained virological response (SVR) following DAAs. Methods: This multicentric prospective study encompassed 479 patients with HCV genotype 1b compensated cirrhosis treated with paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD) +/- ribavirin (RBV) for 12 weeks in two tertiary centers in Northeastern Romania. The patients were prospectively followed up in the Institute of Gastroenterology Iasi, Romania, from November 2015 to December 2020. Results: During the follow-up period (mean 60.11 ± 3.87 months), 23 patients (4.8%) developed HCC. The 1-, 3-, and 5-year cumulative incidence rates of HCC were 1.1, 1.9, and 2.6%, respectively. At the time of the diagnosis, 15 patients (65%) had a single tumor, 12 patients (52.2%) were within the Milan criteria, and nine persons (39%) had Barcelona liver cancer stage 0-A. In this regard, the mean AFP level was 35.3 ± 93.1 ng/mL. A multivariate analysis, age above 65 years, and a cutoff point of AFP ≥ 10 ng/mL at the end of treatment were independent factors associated with HCC. A majority of the patients (n = 11, 47.8%) received curative treatment by surgical resection. In this study, histopathological examination identified a moderately differentiated tumor (G2) in 5 patients, five patients had a poorly differentiated tumor (G3), and only one patient had a well-differentiated tumor (G1). Conclusions: Our study revealed no evidence of the high incidence rate of HCC after the long-term follow-up of patients with HCV-related liver cirrhosis and SVR following DAA treatment. However, the cumulative 5-year risk remained above the cutoff point, and this makes the HCC screening cost-effective. The HCC occurrence appears to be associated with aging and a moderately increased AFP level at EOT (≥ 10 ng/mL).

Hepatocelullar carcinoma is a major risk factor for the development of portal ven thrombosis in cirrhotic patients

Hepatocelullar carcinoma is a major risk factor for the development of portal ven thrombosis in cirrhotic patients

Abstract 899: Remarkable anti-tumor response in a HCC transgenic mouse model treated with GNS561 in combination with anti-PD1

Abstract Introduction:Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer, leading to 75,000 deaths annually. Immunotherapeutic intervention has emerged as a novel effective treatment to delay the progression of aggressive tumors and suppress tumor recurrence and metastasis. However, few clinical immunotherapy trials have been conducted in HCC patients and there is an unmet need for novel therapeutic strategies. Combinations of conventional and novel treatments with immune-oncologic agents are now regarded as a therapy that can dramatically improve the outcome of patients with HCC.GNS561 is a lysosomotropic small molecule that was investigated in the context of antitumor activity alone or in combination with a PD-1 inhibitor using a transgenic immunocompetent mouse model (ASV-B). Materials and Methods: 40 ASV-B mice were treated with either the vehicle (p.o. water pH= 4, 5 days per week), GNS561 (p.o. 50 mg/kg/5 days per week), mouse anti-PD1 antibody (i.p. 10 mg/kg/twice a week [BIW]) or a combination of GNS561 and mouse anti-PD1 (p.o. 50 mg/kg/5 days per week and i.p. 10 mg/kg/BIW respectively) for 8 weeks. Tumor burden was evaluated by measuring the liver volume and blood flow velocity in the coeliac trunk by US/doppler 4 and 8 weeks (W8) after treatment start, the macronodules count and liver weight at sacrifice (W8). Intra and peritumoral CD8+ cells were counted. Results: All treatments were well tolerated. No significant response was observed with the anti-PD1 monotherapy compared with the vehicle. At W8, GNS561 alone or in combination with an anti-PD-1 showed a significant rapid and durable tumor response based on the macronodule count, decreased liver blood flow in the coeliac trunk, liver volume and weight (-59% and -77%; -18% and -31%; -36% and -37%; -37% and -52%, respectively). Based on preliminary mechanistic data, GNS561 alone or in combination showed an increase in the count of CD8+ cells penetrating the tumor site compared to the vehicle and the anti-PD1 alone, suggesting GNS561 may reinstore the anti-PD1 activity by facilitating CD8+ cells to reach the tumor site to exert their antitumoral activity. Conclusion: GNS561 alone or in combination with an anti-PD1 showed a significant antitumoral response. A combination of GNS561 with an anti-PD1 could then be of clinical interest in the treatment of hepatocelullar carcinoma. Citation Format: Madani Rachid, Annemilaï Tijeras-Raballand, Cindy Serdjebi, Sonia Brun, Christelle Ansaldi, Eric Raymond, Philippe Halfon. Remarkable anti-tumor response in a HCC transgenic mouse model treated with GNS561 in combination with anti-PD1 [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 899.

Higher Risk of Hepatocellular Carcinoma Progression in the Population of Untreated Immune-Tolerant Phase Chronic Hepatitis B Patients: An Evidence Based

Background: Hepatitis B infection is a major health problem worldwide, currently occurring in 350-400 millions of people. If not treated properly, hepatitis B infection may progess into chronic hepatitis B (CHB)—which may developed into hepatocelullar carcinoma (HCC). The first phase of CHB, the immune-tolerance (IT) phase, is marked with minimal necroinflammatic activity and a lower risk in the development of a more chronic liver condition, by hence antiviral therapy is not recommended. Recent studies however, shows that there are apparently histological activity and immune specific response towards HBV, accompanied by extensive clonal expansion of hepatitis in the IT phase, hence questioning its risk for the development of HCC. This evidence-based case report is meant to comprehensively review the effect of antiviral treatment in IT-phase CHB patients from available studies.Method: Pubmed, ProQuest, Cochrane, Scopus, Sciencedirect and EBSCOhost were comprehensively searched for systematic review and cohort prognostic researches studying the impact of anti-virals treatment for CHB patients in IT-phase. Three studies were selected and critically appraised. Data were then summarized descriptively.Results: The three studies included in this study were retrospective cohort studies. One study stated that the treated IT-phase group had significantly reduced risk for HCC (HR = 0.234; log-rank p = 0.046), compared to the untreated IT-phase group. One study found that untreated IT phase is asscociated with significantly higher risk of HCC (HR = 2.54; 95% CI: 1.54 to 4.18; p 0.001) compared to the treated immune-active (IA) phase group. The last study stated a higher adjusted hazard ratio (aHR) of the UIT in predicting HCC risk was 2.327 (95% CI 0.475–11.391; p = 0.297), if compared to the IA group.Conclusion: While studies shows apparent results regarding the treatment of CHB patients in the IT-phase and its benefit in reducing cumulative incidence of HCC, its clinical advantage is soon to be discovered. The results were inconclusive, and the initiation of treatment in CHB patients within the IT-phase cannot yet be recommended until further research.

P883 Hepatocellular carcinoma presenting as a tumor thrombus extending from the inferior vena cava to the right atrium in echocardiography

Abstract Case A 74 year-old white male with COPD, type 2 Diabetes, Atrial Fibrillation and a Pacemaker presented to our hospital for a routine echocardiography follow-up for mild to moderate Aortic Stenosis. His past social history was positive for moderate alcohol consumption but negative for tattoos, recent travel, illicit drug use, blood transfusion or chemical exposure. During evaluation in the echocardiography lab the patient had symptoms of dyspnea, fatigue and abdominal distension. He was hemodynamically stable and physical examination was positive for signs os ascites and inferior limb oedema, but disclosed no scleral icterus, asterixis, spider angiomata or overt hepatomegaly. There was a recent weight gain of 10kg. Cardiac and pulmonary auscultation was unrevealing. The echocardiogram revealed moderate left ventricle dysfunction (EF ∼40%), moderate aortic stenosis and a dilated inferior vena cava (31mm) with an image of a mobile mass in the confluence of the central hepatic vein with the inferior vena cava with extension to the right atrium. Initial blood chemistry and blood count revealed macrocytic anaemia; slight increased y-GT, C-reactive protein and NT-proBNP (6210pg/mL). The patient was admitted and anticoagulation with subcutaneous enoxaparin was initiated with echocardiographic follow-up. An abdominal ultrasound was performed which a hyperecogenic mass (71x47mm) adjacent to the right and left supra-hepatic veins, highly suggestive of hepatocelullar carcinoma. A triple-phase abdominal CT confirmed a nodular lesion 70x50mm on segment VIII, compatible with hepatocellular carcinoma (Fig.1). A cardiac magnetic resonance was performed documenting the tumor extension to the inferior vena cava and right atrium, suggestive of tumor thrombus (Fig.2). Multidisciplinary meeting enrolled the patient in palliative care. The right heart failure picture was refractory to medical treatment and the patient progressed to multi organ failure and a consumptive state. He died approximately 20 days after diagnosis. Discussion Intravascular tumor extension, also known as Tumor thrombus (TT) is a rare complication of some forms of cancer. In the late stages of Hepatocellular carcinoma (HCC) a TT can form in the portal or hepatic vein. These are usually detected during tumor workup or during evaluation of cardiorespiratory symptoms in a patient with a known abdominal carcinoma. Tumor invasion to the portal system is quite common while invasion to the inferior vena cava (IVC) and/or heart without invasion of the portal system is rare. Tumor extension to the RA or IVC, most patients were either symptomatic, had cirrhosis, or both. Our patient presented mainly with signs of right heart failure refractory to medical treatment and had no signs of portal invasion or hypertension in the various image modalities. The prognosis for a HCC with extension to the IVC or RA is grim, with a 1 to 4 months of mean survival regardless of treatment choice. Abstract P883 Figure.

Diagnostic Accuracy of Doppler Ultrasonography in Predicting Presence of Esophageal Varices in Patients with Hepatitis-C Induced Cirrhosis.

To determine the diagnostic accuracy of Doppler ultrasonography in predicting presence of esophageal varices in patients with hepatitis-C induced cirrhosis. Descriptive analytical study. Department of Radiology, Jinnah Hospital, Lahore, from May 2016 to October 2016. Patients aged 15-70 years, who presented with cirrhosis and proved to be cirrhosis caused by Hepatitis-C of any gender and duration of disease more than 6 months, were included. Patients with hepatocelullar carcinoma or portal vein thrombosis, having received treatment for esophageal varices, and unwilling to undergo endoscopy were excluded. All the patients then underwent Doppler ultrasonography to calculate splenoportal index and findings were correlated with endoscopy findings. Out of 200 patients, 137 (68.50%) were males and 63 (31.50%) were females. In Doppler ultrasonography positive patients, 113 were true positive and 8 were false positive. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Doppler ultrasonography in predicting presence of esophageal varices was 88.98%, 89.04%, 93.00%, 82.28% and 89.00%, respectively. Doppler ultrasonography is the non-invasive modality of choice with high diagnostic accuracy in predicting presence of esophageal varices in hepatitis-C induced cirrhosis.

Consensus on clinical application of transient elastography detecting liver fibrosis: a 2018 update

Transient elastography is a noninvasive, rapid ultrasonic elastography, and assess liver fibrosis by detetcting liver stiffness. Current consensus focuses on understanding influence factors on operation and diagnosis, recommendations for clinical application on detetcting liver fibrosis of chronic liver disease and monitoring development of related complication hepatocelullar carcinoma, high risk esophageal varices, and also summarizes the potential aplication on liver disease screening and liver fibrosis regression assessment.

High expression of TRAF4 in hepatocelullar carcinoma as an independent negative survival and recurrence predictor

Objective: To identify potential tumor markers for the development and recurrence of hepatocelullar carcinoma (HCC), this research studied the relationship between the expression of the tumor necrosis factor receptor-associated factor 4 (TRAF4) and tumor angiogenesis together with its survival time of HCC patients. Methods: The expressions of TRAF4, vascular endothelial growth factor and CD34 were performed upon 90 patients with curative liver resection between August 2006 and November 2009 by immunohistochemical method in locally advanced HCC and adjacent non-tumoral liver. The expression of TRAF4 was determined by the Spearman rank correlation. Their prognostic factors on disease free survival (DFS) and overall survival (OS) were guaranteed by Kaplan-Meier and Cox regression analyses. The detection of the levels of vascular endothelial growth factor and CD34 was fulfilled in 90 cases of HCC. Results: TRAF4 expression was both significantly higher in HCC than in surrounding non-tumor tissues (57.8% vs. 22.2 %; P<0.001) and significantly correlated with tumor size and tumor staging. High TRAF4 was correlated with reduced DFS rate (P=0.001) and overall OS rate (P<0.001) and were displayed in Kaplan-Meier survival analysis. Conclusions: TRAF4 is involved with multifarious clinicopathologic features. TRAF4 expression, as an independent adverse prognostic factor, DFS and OS in HCC, is associated with increased tumor angiogenesis. The combined detection of TRAF4 in locally advanced HCC is a trustworthy predictive factor for the tumor development and recurrence.

Percutaneous microwave or radiofrequency ablation liver partition and portal vein embolization for planned hepatectomy

Objective To explore the clinical outcome of percutaneous microwave/radiofrequency ablation liver partition and portal vein embolization for planned hepatectomy (PAPEP)for the treatment of hepatocelullar carcinoma (HCC) with insufficient future liver remnant (FLR). Methods The retrospective descriptive research method was taken. The clinical data of 2 patients of giant primary HCC (FLR complicated with cirrhosis) who were admitted to the Zhejiang Province People′s Hospital from November 2015 to January 2016 were collected. Treatment plan: ultrasound-guided percutaneous microwave ablation (PMA) or percutaneous radio-frequency ablation (PRA) was performed on patients under intravenous anesthesia, at the same time portal vein embolization (PVE) was conducted. FLR was measured by rescan of computed tomography (CT) at 7-9 days postoperatively, according to FLR hyperplasia and general situation of the patient, right trisegmentectomy and expanded right hemihepatectomy were implemented respectively. Observation indicatiors indicators included (1)standard liver volume (SLV) and FLR before PRA/PVE treatment, (2)liver function, body temperature, FLR and time of FLR hyperplasia after PRA/PVE treatment, (3)liver function, body temperature, complications, FLR and duration of hospital stay after hepatectomy. Follow-up using outpatient examination and telephone interview was performed to detect carcinoma recurrence and other follow-up contents up to March 2016. Results (1)Before PRA+ PVE, SLVs of 2 patients were 1 103 mL and 1 132mL, FLRs of 2 patients were respectively 417 mL and 297 mL which occupied the SLV at the percentage of 37.8% and 26.2% respectively. (2)After PRA+ PVE treatment, there were no changes in liver function and fever. After PRA+ PVE treatment, FLR of 2 patients increased to 652 mL and 522 mL, respectively, which occupied the SLV at the percentage of 59.1% and 46.1% respectively, with increased rates of 56.4% and 75.6% and time of FLR hyperplasia of 10 days and 17 days. The two patients received successful hepatectomy, without intraoperative red blood cell infusion. (3)At postoperative day 3, albumin (Alb), alanine transaminase (ALT), aspartate transaminase (AST) and total bilirubin (TBil) of liver function were 28.0 g/L, 63 U/L, 39 U/L and 19.0 μmol/L in patient 1 with a temperature of 38 degree, and 24.3 g/L, 78 U/L, 11 U/L and 38.1 μmol/L in patient 2 with a normal temperature. Liver function of 2 patients was improved after conservative treatment. No severe complications were occurred. Rescan of CT showed the FLR of patients continued increasing. The duration of hospital stay of 2 patients was 10 days and 14 days, respectively. Conclusion PAPEP for HCC with insufficient FLR is safe and effective. Key words: Liver neoplasms; Associating liver partition and portal vein ligation for staged hepatectomy; Microwave ablation; Radiofrequency ablation; Future liver remrant; Planned hepatectomy

Prevalence of HBsAg, knowledge, and vaccination practice against viral hepatitis B infection among doctors and nurses in a secondary health care facility in Lagos state, South-western Nigeria.

IntroductionHepatitis B Virus, a highly infectious blood-borne virus poses a major threat to public health globally due to its high prevalence rate and grave consequence in causing liver cirrhosis and hepatocelullar carcinoma, the third cause of cancer death worldwide. The aim is determine the prevalence of HBsAg, knowledge, and vaccination practices against viral hepatitis B infection among doctors and nurses in a health care facility.MethodsStudy design was a descriptive cross-sectional study among all the doctors and nurses in the health care facility. Data was collected using pre-tested, structured, self-administered questionnaire and blood samples were taken from respondents and tested using commercial enzyme-linked immunosorbent assay (ELIZA) test kit to determine prevalence of hepatitis B surface antigen after informed consent. Ethical approval was obtained from Health Research and Ethics Committee of the Lagos University Teaching Hospital. Responses of the respondents to the knowledge and vaccination practices against viral hepatitis B infection were scored and graded as poor (<50%), fair (50-74%) and good (≥75%). The study was carried out in January, 2014.ResultsA total of 134 out of the 143 recruited respondents participated in the study. Prevalence of HBsAg was 1.5%. Among the respondents, 56.7% had good knowledge and 94.8% reported poor practice of vaccination against viral hepatitis B infection. Mean knowledge and vaccination practices scores (%) were 72.54+7.60 and 29.44+14.37 respectively. Only 29% of the respondents did post vaccination testing for anti HBsAg.ConclusionPrevalence of HBsAg was low. Knowledge of viral hepatitis B was fair, and practice of post hepatitis B vaccination testing was poor. It is therefore recommended that the state ministry of health should organise further health education programme, institute compulsory occupational hepatitis B vaccination programme and post vaccination anti-HBS testing to ensure adequate antibody level in this adult population.

Epidemiology of Viral Hepatitis and Liver Diseases in Bangladesh.

Bangladesh is a South Asian country with a homogeneous population. However, some difference has been demonstrated in the distribution of liver disease in different parts of the country. Hepatitis E remains the principal cause of acute hepatitis in Bangladesh, while chronic liver disease in Bangladesh, including hepatocelullar carcinoma, is predominantly due to hepatitis B virus. Hepatitis B has been extensively studied and characterized in Bangladesh, and some major clinical trials with HBV-related antigens have also been conducted.How to cite this articleAl-Mahtab M. Epidemiology of Viral Hepatitis and Liver Diseases in Bangladesh. Euroasian J Hepato-Gastroenterol 2015;5(1):26-29.

Alpha-1 Acid Glycoprotein Cut-off Value as Diagnostic Biomarker in Hepatocelular Carcinoma with Liver Cirrhosis

Background: Hepatocellular carcinoma (HCC) remains a major problem throughout the world, especially in diagnostic and therapeutic management. Previous studies stated that alpha-1 acid glycoprotein (AAG) was a potensial biomarker in diagnostic of HCC. This study assessed the best cut-off value of AAG as a diagnostic biomarker of HCC with liver cirrhosis.Method: This was a cross-sectional, diagnostic study, conducted from January to October 2013 in Cipto Mangunkusumo Hospital. The subjects were HCC with liver cirrhosis patients and as control were liver cirrhosis patients. Abdominal ultrasonography (USG), abdominal 3 phase contrast computerized tomography (CT) scan, and liver biopsy, if necessary, were done. All patients were having AAG examination, then the result was analyzed using receiver operating characteristic (ROC) curve and assessment of some cut-off values was done.Results: There were 25 HCC with liver cirrhosis patients and 37 liver cirrhosis patients as control included in this study. HCC with liver cirrhosis patients were 92% male and 8% were female, over 50 years old (72%). HBV infection was the most common etiology and most of the patients had multiple nodules in the liver (80%). ROC curve showed the area under the curve (AUC) was 81.44%.Conclusion: The best cut-off value of AAG to be aware of HCC with liver cirrhosis was 61 mg/dL and as a diagnostic was 136 mg/dL. Keywords: hepatocelullar carcinoma, alpha-1 acid glycoprotein, cut-off

Pretreatment neutrophil to lymphocyte ratio and prognosis of patients with advanced hepatocelullar carcinoma treated with sorafenib.

e15144 Background: Inflammation has a critical role in tumor biological behavior. In particular, neutrophil-lymphocyte ratio (NLR), an inflammation index, has been shown to influence clinical outco...

A case of intraventricular dissemination arising from hepatocelullar carcinoma effectively treated with intrathecal administration of methotrexate

A case of intraventricular dissemination arising from hepatocelullar carcinoma effectively treated with intrathecal administration of methotrexate

Evaluation of five DNA extraction methods for detection of H. pylori in formalin-fixed paraffin-embedded (FFPE) liver tissue from patients with hepatocellular carcinoma

Since Helicobacter spp. DNA was identified in liver tissue resected from patients with hepatocelullar carcinoma (HCC), researchers have suggested a role of this bacterium in hepatic carcinogenesis. Archives of formalin-fixed, paraffin-embedded (FFPE) tissues represent an extraordinary source for clinical studies providing many advantages. However, DNA extraction from FFPE tissues is laborious, time-consuming and still remains a challenge. The aim of this study was to evaluate five protocols for DNA extraction from FFPE liver obtained from patients with HCC in order to detect Helicobacter pylori DNA. These methods were: (1) QIAamp FFPE Tissue Kit, (2) QIAamp DNA Mini Kit, (3) Wizard SV Genomic DNA Purification System, (4) RealiaPrep FFPE gDNA Miniprep System and (5) phenol–chloroform. H. pylori detection was performed using 16S rRNA gene amplification by PCR. The highest total amount of DNA was obtained using the phenol–chloroform method. Analyses of 16S rRNA gene amplification did not show statistically significant differences among the methods (p=0.466), although the highest percentage of positive cases (70%) was found in samples extracted with phenol-chloroform. We suggest that of the five methods evaluated, phenol/chloroform is the most suitable for detection of H. pylori in FFPE liver from patients with HCC.

Mo1776 Quantitative Gene Expression of Liver Enriched Transcription Factors Could Be Used to Predict Tumor Recurrence After Curative Treatment of Hepatocellular Carcinoma

Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and has a good prognosis only when is treated curatively. The development of new systems that can predict the likelihood of recurrence after curative treatment, including molecular prognostic factors, is much needed. The liver enriched transcription factors (LETFs) are critical in inducing and maintaining hepatic phenotype during liver organogenesis and their expression level in HCC could have prognostic implications. The aim of our work was to investigate the expression profile of liver enriched transcription factors FoxA2, HNF6 (ONECUT1), C/Ebp-alpha and HNF1-beta in hepatocelullar carcinoma specimens from liver resections or liver explants after liver transplantations, in comparison to non-tumoral liver tissue from the same patients. Methods: The study group included 22 patients, 12 with liver resection and 10 with liver transplantation for HCC with a mean follow-up after treatment of 20 months. Total RNA was isolated from tumoral and non-tumoral tissue fragments and gene expression has been quantified by qRT-PCR, using beta-actin as reference gene. A higher than 5-fold change in relative gene expression has been considered significant. A statistical model for prediction of tumor recurrence has been developped by logistic regression using quantitative RT-PCR data. The clinical utility of the model has been evaluated by the C-statistic (equivalent of the area under the ROC curve). Results: In 14 patients (63.6%) a higher than 5-fold change in relative gene expression has been detected. A significat up-regulation of the studied liver enriched transcription factors has been found in 4 patients (18.1%). A significat down regulation has been identified in 11 patients (50%) out of which HNF6 down regulation was detected in 4 patients (18.1%) and HNF1beta down regulation in 8 patients (36.3%). Only in one patient (4.5%) dramatical changes in LETFs expression has been detected FoxA2 and HNF6 were not detectable and C/Ebp-alpha and HNF1beta expression had a 100 fold decrease. The patient had a tumor recurrence in 4 months after the treatment. Based on qRT-PCR data a statistical model to predict recurence after curative treatment has been generated. The significant variables in the model were HNF6 and FoxA2 expression. The model has a C-statistic of 0.98 suggesting an excelent clinical utility. A cut-off level of 0.67 of the prognostic score had a 80% sensitivity and a 94.1% specificity in predicting recurrence of HCC after curative treatment. Conclusions: A significant change in LETF gene expression has been identified in 63.6% of patients curatively treated for hepatocellular carcinoma. A prognostic score using HNF6 and FoxA2 quantitative expression could be proposed for prospective validation.