Local Recurrence Of Hepatocellular Carcinoma Research Articles

Risk factors and therapeutic results of early local recurrence after transcatheter arterial chemoembolization.

To identify factors affecting early local recurrence after transcatheter arterial chemoembolization (TACE) and investigate treatments and outcomes for local recurrence. Early local recurrence and no early local recurrence groups drawn from 134 patients who were initially diagnosed with hepatocellular carcinoma (HCC) and showed a complete response (CR) to TACE treatment between January 1, 2006, and January 31, 2012, were analyzed by univariate and multivariate analyses. Additionally, the subsequent treatment for patients with recurrence was analyzed, and in cases in which TACE had been performed, the cumulative recurrence rates were calculated using the Kaplan-Meier method and compared with those of the primary lesion. The 1-, 2-, and 3-year survival rates were 92.3%, 60.2%, and 39.8%, respectively, in the early local recurrence group, which were significantly lower than those in both the late local and no local recurrence groups (P < 0.001). On multivariate analyses, non-compact lipiodol uptake, large tumor size, and an alpha-fetoprotein > 20 ng/mL after achieving a CR were significant predictors. When TACE was performed for early and late locally recurrent lesions, a CR was observed in 15 patients (41.7%) and 11 patients (78.6%), and the cumulative recurrence rates at 6, 12, and 24 mo were 17.9%, 43.3%, and 71.2%, respectively, which did not differ significantly from those after the first CR of 20.5%, 44.0%, and 58.6%, respectively (P = 0.639). Closer monitoring and active treatments must be provided to patients with risk factors for early local recurrence of HCC.

Therapeutic response assessment of RFA for HCC: contrast-enhanced US, CT and MRI.

Radiofrequency ablation (RFA) is commonly applied for the treatment of hepatocellular carcinoma (HCC) because of the facile procedure, and the safety and effectiveness for the treatment of this type of tumor. On the other hand, it is believed that HCC cells should spread predominantly through the blood flow of the portal vein, which could lead to the formation of intrahepatic micrometastases. Therefore, monitoring tumor response after the treatment is quite important and accurate assessment of treatment response is critical to obtain the most favorable outcome after the RFA. Indeed, several reports suggested that even small HCCs of ≤ 3 cm in diameter might carry intrahepatic micrometastases and/or microvascular invasion. From this point of view, for preventing local recurrences, RFA should be performed ablating a main tumor as well as its surrounding non-tumorous liver tissue where micrometastases and microvascular invasion might exist. Recent advancement of imaging modalities such as contrast-enhanced ultrasonic, computed tomography, and magnetic resonance imaging are playing an important role on assessing the therapeutic effects of RFA. The local recurrence rate tends to be low in HCC patients who were proven to have adequate ablation margin after RFA; namely, not only disappearance of vascular enhancement of main tumor, but also an adequate ablation margin. Therefore, contrast enhancement gives important findings for the diagnosis of recurrent HCCs on each imaging. However, hyperemia of non-tumorous liver surrounding the ablated lesion, which could be attributed to an inflammation after RFA, may well obscure the findings of local recurrence of HCCs after RFA. Therefore, we need to carefully address to these imaging findings given the fact that diagnostic difficulties of local recurrence of HCC. Here, we give an overview of the current status of the imaging assessment of HCC response to RFA.

Local recurrence of hepatocellular carcinoma in the tumor blood drainage area following radiofrequency ablation

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. HCC is generally considered to spread via the bloodstream and local recurrence often occurs in the blood drainage area determined by computed tomography during hepatic arteriography (CTHA), despite complete ablation of the primary nodule. This study was conducted in order to prospectively assess the rate of local recurrence in the blood drainage area depicted by delayed-phase CTHA. The participants comprised 364 consecutive patients (260 men and 104 women; mean age, 67.4±8.6 years), enrolled between April, 2002 and December, 2011. The participants were divided into two groups, according to whether the ablation area covered the entire blood drainage area as defined by delayed-phase CTHA (group A) or not (group B). Local tumor progression was compared between the two groups. The median time to recurrence was significantly shorter for group B (434 days) compared to that for group A (1,474 days; P=0.0037). The cumulative local recurrence rates for group A were 0, 0 and 1.5% at 1, 3 and 5 years postoperatively, respectively, whereas the recurrence rates for group B were 3.8, 17.0 and 22.8% at 1, 3 and 5 years, respectively (P<0.0001). In conclusion, the safety margin for radiofrequency ablation should be defined as the blood drainage area and ablation should aim at acquiring adequate safety margins.

Value of 18F‐FDG‐PET/CT in the detection of recurrent hepatocellular carcinoma after hepatectomy or radiofrequency ablation: A comparative study with contrast‐enhanced ultrasound

To evaluate the role of positron emission tomography/computer tomography with fluorine-18 fluorodeoxyglucose ((18) F-FDG-PET/CT) in detecting hepatocellular carcinoma (HCC) recurrence after hepatectomy and/or radiofrequency ablation (RFA) and to compare its efficacy with contrast-enhanced ultrasound (CEUS). A total of 36 HCC patients were included in this study. All patients underwent both (18) F-FDG-PET/CT and CEUS at least once for the diagnosis of HCC recurrence. The time interval between PET/CT and CEUS was 14 ± 3 days. All patients were followed up for at least 24 months. In all, 32 patients were confirmed to have HCC recurrence by pathology and clinical follow-up. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of (18) F-FDG-PET/CT for intrahepatic HCC recurrence were 96.7%, 83.3%, 96.7%, 83.3% and 94.4%, respectively. The corresponding values of CEUS were 56.7%, 100%, 100%, 31.6% and 63.9%, respectively. The sensitivity and accuracy of (18) F-FDG-PET/CT for the diagnosis of HCC recurrence were significantly higher than those of CEUS (P < 0.01, respectively). Compared with CEUS, (18) F-FDG-PET/CT has higher sensitivity and accuracy in detecting the local recurrence of HCC after hepatectomy and/or RFA. It can be used to detect recurrent extrahepatic lesions of HCC effectively.

High CD44s expression is associated with the EMT expression profile and intrahepatic dissemination of hepatocellular carcinoma after local ablation therapy

Local ablation therapy (LAT) is a widely used treatment for hepatocellular carcinoma (HCC) because it is less invasive than hepatic resection. The precise molecular mechanism underlying local HCC recurrence after LAT is largely unknown. The CD44 standard isoform (CD44s) is involved in epithelial-mesenchymal transition (EMT) in HCC. We investigate the significance of CD44s expression and EMT expression profile in local HCC recurrence after LAT. We studied the expression levels of CD44s, EMT expression profile (E-cadherin(low)/vimentin(high) expression) and their association with clinicopathological factors in 30 HCC samples from patients with locally recurrent HCCs after LAT following hepatic resection. The alterations of CD44s expression was compared with those in initial HCCs from 150 patients without prior any anticancer treatment including LAT. A high CD44s expression was significantly associated with the EMT expression profile (P = 0.002), and it was also detected with a higher frequency in the locally recurrent HCCs after LAT compared to initial HCCs (P < 0.001). In addition, high CD44s expression was associated with the intrahepatic dissemination of HCC after LAT (P = 0.006). These results suggest that high CD44s expression is associated with the aggressive recurrence pattern via EMT after LAT for HCC.

Is Gadoxetate Disodium–Enhanced MRI Useful for Detecting Local Recurrence of Hepatocellular Carcinoma After Radiofrequency Ablation Therapy?

The purpose of our study was to determine whether gadoxetate disodium-enhanced MRI improves the detection of locally recurrent hepatocellular carcinoma (HCC) after radiofrequency ablation therapy. Forty-two consecutive patients (26 men and 16 women; mean age, 70.9 years) who had undergone radiofrequency ablation therapy for HCC were examined by gadoxetate disodium-enhanced MRI. Three independent radiologists reviewed two sets of MR images separately. Set 1 contained unenhanced T1-weighted, T2-weighted, and contrast-enhanced extracellular phase images, and set 2 contained unenhanced T1-weighted, T2-weighted, and contrast-enhanced extracellular and hepatocyte phase images. Diagnostic accuracies were determined by receiver operating characteristic (ROC) curve analysis. Of the 61 ablated lesions included, 10 developed local recurrence and 51 did not. Sensitivity (60-80% and 70-80% for sets 1 and 2, respectively), specificity (90-98% and 92-100%), and accuracy (87-95% and 89-97%) were not improved by adding hepatocyte phase images. Rather, mean area under the ROC curve (AUC) significantly decreased from 0.94 for set 1 to 0.82 for set 2 (p = 0.046), and the AUC of the radiologist with the least experience significantly decreased from 0.91 to 0.75 (p = 0.037). For gadoxetate disodium-enhanced MRI, the detection of local recurrence of HCC after radiofrequency ablation therapy was not found to be improved by including hepatocyte phase images. Furthermore, detection may be further impaired when a less-experienced radiologist interprets the images.

Salvage Hepatectomy for Local Recurrent Hepatocellular Carcinoma After Ablation Therapy

The results of salvage hepatectomy for local recurrent hepatocellular carcinoma after incomplete percutaneous ablation therapy are still unclear. We conducted a retrospective analysis of 197 consecutive patients with hepatocellular carcinoma who underwent either salvage hepatectomy after prior incomplete percutaneous ablation therapy (salvage group; n=23) or primary hepatectomy as the initial treatment (primary group; n=174). The two groups were compared with respect to intraoperative data, operative mortality and morbidity, and long-term survival. The salvage group showed a significantly longer operation time (385 vs. 300 min; P=0.006) and a significantly greater intraoperative blood loss volume (402 vs. 265 ml; P=0.024). The postoperative mortality rate was zero in both groups, and the morbidity rates were similar. Although the 1-, 3-, and 5-year disease-free survival rates after hepatectomy were significantly worse in the salvage group than in the primary group (65%, 41%, and 33% vs. 81%, 51%, and 45%, respectively; P=0.031), the overall survival rates after hepatectomy did not differ significantly (91%, 91%, and 67% vs. 96%, 79%, and 65%, respectively; P=0.790). The 1-, 3-, and 5-year overall survival and disease-free survival rates after percutaneous ablation therapy were also not different from those in the primary group (100, 96, and 83%, P=0.115; and 96, 60, and 45%, P=0.524, respectively). The short-term and long-term results of salvage hepatectomy after incomplete percutaneous ablation therapy are equivalent to those of primary hepatectomy. Salvage hepatectomy is an acceptable treatment for patients with local recurrence of hepatocellular carcinoma after ablation therapy.

Histopathology of the Tissue Adhering to the Multiple Tine Expandable Electrodes Used for Radiofrequency Ablation of Hepatocellular Carcinoma Predicts Local Recurrence

To assess the ability to predict the local recurrence of hepatocellular carcinoma by analyzing tissues adhering to the radiofrequency ablation probe after complete ablation. From May 2002 to March 2011, tissue specimens adhering to the radiofrequency ablation probe from 284 radiofrequency ablation sessions performed for hepatocellular carcinomas ≤3 cm in size were analyzed. The specimens were classified as either viable tumor tissue or complete necrosis, and the local recurrence rates were calculated using the Kaplan-Meier method. From the tumors ≤3 cm in size, viable tissue was present in 6 (2.1%) of 284 specimens, and the local recurrence rates after 1 and 2 years of follow-up were 6.7% and 11.2%, respectively. Local recurrence developed significantly earlier in the viable tissue group. The recurrence rate was not significantly different based on whether transcatheter arterial chemoembolization was performed. The histopathology of the tissue adhering to the radiofrequency ablation probes used for hepatocellular carcinoma treatment can predict local recurrence. Additional aggressive treatment for patients with viable tissue can therefore improve the overall survival.

Contrast‐enhanced sonography‐guided radiofrequency ablation for the local recurrence of previously treated hepatocellular carcinoma undetected by b‐mode sonography

BACKGROUND.: The purpose of this study was to assess the usefulness of contrast-enhanced sonography (CEUS) with Sonazoid to demonstrate local recurrence of hepatocellular carcinoma previously treated with radiofrequency ablation (RFA) and not seen on conventional sonography, prior to repeat RFA. METHODS.: This study included 16 cirrhotic patients with 17 cases of hypervascular locally recurrent hepatocellular carcinoma found by contrast-enhanced multidetector row CT (MDCT) but not seen on noncontrast sonography. We used Kupffer-phase imaging and vascular-phase imaging after re-injection. The morphologic patterns of local recurrence detected on CEUS were compared with those on MDCT. We performed repeat RFA guided by CEUS using Kupffer-phase imaging after re-injection. RESULTS.: We were able to detect on CEUS the location of all local recurrences with positive enhancement after re-injection. The morphologic patterns of local recurrence on CEUS were in concordance with those found on MDCT in all lesions. Repeat percutaneous RFA was successfully performed in all lesions. CONCLUSIONS.: The CEUS appearance of local recurrences correlated well with those on MDCT. A wider use of CEUS to guide repeat of percutaneous RFA may be possible with Sonazoid.

Radiofrequency ablation induces dedifferentiation of hepatocellular carcinoma

Radiofrequency ablation (RFA) has been reported to be a minimally invasive and effective procedure for the treatment of hepatocellular carcinoma (HCC). However, the pattern of recurrence and complications following RFA have yet to be fully identified. During the period January 2000 to December 2006, we performed HCC resections in 15 patients who developed local recurrence after RFA, as well as in 144 patients without RFA. In patients with local recurrence of HCC after RFA, the tumors showed a more invasive growth, more vascular invasion and less differentiation compared with tumors of patients without RFA. In 6 of the 15 patients with recurrence after RFA, needle biopsy of the HCC was performed before tumor ablation. In five of these 6 patients, dedifferentiation of the tumor was observed. These findings suggest that heat shock due to RFA induces dedifferentiation of HCC. Recurrence after RFA may result in an aggressive tumor that precludes any possibility of cure. RFA must not be considered a suitable alternative to surgery in patients with a low surgical risk. Instead, RFA should be performed according to strict indications by skilled operators using the latest devices.

Local recurrence of hepatocellular carcinoma after radiofrequency ablation

A 51-year-old Chinese male with a 20-year history of hepatitis B was diagnosed with hepatocellular carcinoma in the right anterior portion of the liver, sized 3.5 cm × 3.2 cm, and was treated with radiofrequency ablation (RFA) on December 18, 2001. The patient did not receive antiviral therapy for hepatitis B virus after RFA. The treated lesion reduced gradually and reached its minimum size of 1.7 cm × 1.5 cm seven years later on November 18, 2008. However computed tomography findings revealed that a recurrence lesion of 6.0 cm × 4.8 cm which was histologically confirmed overlapped the previous treated lesion at the 8th year on December 3, 2009. Although recurrence at 8 years after curative RFA is a rare event, such a possibility must be kept in mind. To find and treat the recurrence lesion promptly, long-term and close monitoring is warranted after RFA. Meanwhile, the recurrence-prevention therapy is as important as close monitoring for those patients with a history of hepatitis B.

Therapeutic Results of Computed-Tomography-Guided Transcatheter Arterial Chemoembolization for Local Recurrence of Hepatocellular Carcinoma After Initial Transcatheter Arterial Chemoembolization: The Results of 85 Recurrent Tumors in 35 Patients

The aim of this study was to retrospectively evaluate the long-term results of transcatheter arterial chemoembolization (TACE) for the treatment of local recurrence of hepatocellular carcinoma (HCC) after the first TACE. Between September 1992 and October 2004, 85 recurrent HCC nodules of 35 patients were treated by TACE. During the median follow-up period of 15.5 months (range 1.9-58.6 months), 58 of the 85 treated tumors developed local recurrence again after the second TACE. The overall 6-, 12-, and 36-month recurrence-free rates of these tumors after the second TACE were 47.0%, 36.2%, and 25.8%, respectively. Local recurrence of HCC after the first TACE was treated by a second TACE with equivalent efficacy as that of the initial TACE, if segmental chemoembolization was achieved. We regard TACE as the treatment of choice for the management of local recurrence of HCC.

Evaluating local hepatocellular carcinoma recurrence post‐transcatheter arterial chemoembolization: Is diffusion‐weighted MRI reliable as an indicator?

To evaluate the detectability of local hepatocellular carcinoma (HCC) recurrence after transcatheter arterial chemoembolization (TACE) by diffusion-weighted MR imaging in correlation with those of gadolinium-enhanced MR imaging. Respiratory-triggered diffusion-weighted MR images (b factor, 500 s/mm(2); number of averaging, six were obtained in 25 patients with 39 HCCs. Two independent radiologists evaluated diffusion-weighted MR images, gadolinium-enhanced MR images after TACE, and assigned confidence levels for postoperative HCC recurrence. Apparent diffusion coefficients (ADCs) in HCCs were also measured. Sensitivities and specificities were compared using an extension of the McNemar test. Observer performance was also determined by ROC curve analysis. Local recurrences in 14 HCCs and complete tumor necrosis in 25 HCCs after TACE were determined. Sensitivity for the detection of local HCC recurrence was higher on gadolinium-enhanced MR imaging (82%) than on diffusion-weighted MR imaging (60.7%) for the two readers in combination and separately (P < 0.05). Specificities were comparably high for both sequences. Az values were higher for gadolinium-enhanced MR images (0.92) than for diffusion-weighted MR images (0.74) for readers in combination and separately (P < 0.05). Mean ADC values showed an increase after TACE (P < 0.001). Diffusion-weighted MR imaging was not found to be a reliable predictor of local HCC recurrence after TACE as compared with gadolinium-enhanced MR imaging.

Insufficient radiofrequency ablation therapy may induce further malignant transformation of hepatocellular carcinoma

Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is a thermoablative technique to kill tumor tissue by generating areas of coagulative necrosis. Recent reports have raised concern that RFA may lead to a local recurrence of HCC with an aggressive phenotype and unfavorable prognosis, suggesting that RFA may induce further malignant transformation of HCC. However, the biological effects of RFA on HCC cells have not been directly analyzed. The aim of this study was to determine whether heat stress of the type associated with RFA induces malignant transformation of HCC. We assessed the sensitivity of three HCC cell lines (HepG2, Alexander, and Huh7) to heat treatment for 10 min. We then determined the temperature at which a heat-resistant subline can be generated. We established and expanded sublines that survived heat treatment. And their proliferation rates, heat sensitivities, and invasive capacities were further examined. All HepG2 died after 48 degrees C treatment, whereas 49 degrees C treatment was required to kill all Alexander and HuH7. We generated 20 sublines for each parental cell line. A HepG2 subline, HepG2#18, proliferated 100% faster than parental HepG2. Moreover, HepG2#18 survived after 50 degrees C treatment, whereas all parental HepG2 died after heat treatments at 48 degrees C or higher. Our results showed that even a single heat treatment could induce further transformation of an HCC cell line. Our results suggest that an insufficient treatment of HCC by RFA that enables survival of some cells might induce further malignant transformation in vivo.

Risk factors for the local recurrence of hepatocellular carcinoma after single-session percutaneous radiofrequency ablation with a single electrode insertion

Radiofrequency ablation (RFA) is a new local therapy for hepatocellular carcinoma (HCC). In this study, we investigated the risk factors associated with local recurrence of HCC after single-session RFA with a single electrode insertion. From April 2003 to December 2007, we treated 138 HCC lesions by single-session RFA with a single electrode insertion using the Cool-tip RFA, RTC 2000 and RTC 3000 Systems. Risk factors for the local recurrence of these lesions and complications after RFA were analyzed. The mean size of the 138 lesions was 16.9±5.4 mm in diameter (range 7-33 mm). Local recurrence rates were 6.6 and 22.0% at 1 and 2 years, respectively, during the mean follow-up period of 16.4 months. Univariate analysis showed that tumor diameter (≥20 mm), tumor location, pre-treatment AFP-L3 fraction level and ablation pattern were significant variables. Multivariate analysis of these four variables identified only the tumor diameter as an independent risk factor for local recurrence. Complications occurred in 2.2% of the lesions (3/138). Single-session RFA is an effective treatment for HCC in that it reduces serious complications. This study demonstrated that a tumor size ≥20 mm influenced the local recurrence of single-session RFA with a single electrode insertion.

Risk factors for local and distant recurrence of hepatocellular carcinomas after local ablation therapies

Hepatocellular carcinoma (HCC) recurs frequently after local ablation therapies. Recurrence following the therapies may be of two types: local recurrence and distant recurrence. The aim of the current study is to separately elucidate the predisposing factors for each recurrence. Among the 2141 consecutive patients with HCC who were admitted to our institute and affiliated hospital between May 1997 and April 2004, 621 patients who had undergone local ablation therapies as the initial treatment were enrolled. Correlations between the clinical backgrounds of the patients and the type of recurrence were analyzed by the Cox proportional hazard model. A multivariate analysis revealed that tumor size (>30 mm; risk ratio 2.80; 95% confidence interval, 1.77-4.45; P < 0.0001), tumor number (> or =2; 1.74, 1.23-2.47, P = 0.002), and the serum alpha-fetoprotein level (>100 ng/mL; (1.62, 1.09-2.41, P = 0.014), which were classified as "tumor factors", were significant predisposing factors for the local recurrence of HCC. In contrast, a low platelet count (<100,000/microL; 1.34, 1.04-1.74, P = 0.03) and the presence of ascites (1.73, 1.16-2.57, P = 0.008), which were classified as "background factors", as well as tumor size (1.83, 1.11-3.01, P = 0.02) and tumor number (2.23, 1.72-3.00, P < 0.0001) were predisposing factors for distant recurrence. The predisposing factors for local and distant recurrence of HCC differ and different precautions must be observed to prevent recurrence, depending on the HCC status and background liver functions.

Local Recurrence of Hepatocellular Carcinoma after Segmental Transarterial Chemoembolization: Risk Estimates Based on Multiple Prognostic Factors

ObjectiveTo determine the prognostic factors for local recurrence of nodular hepatocellular carcinoma after segmental transarterial chemoembolization.Materials and MethodsSeventy-four nodular hepatocellular carcinoma tumors ≤ 5 cm were retrospectively analyzed for local recurrence after segmental transarterial chemoembolization using follow-up CT images (median follow-up of 17 months, 4-77 months in range). The tumors were divided into four groups (IA, IB, IIA, and IIB) according to whether the one-month follow-up CT imaging, after segmental transarterial chemoembolization, showed homogeneous (Group I) or inhomogeneous (Group II) iodized oil accumulation, or whether the tumors were located within the liver segment (Group A) or in a segmental border zone (Group B). Comparison of tumor characteristics between Group IA and the other three groups was performed using the chi-square test. Local recurrence rates were compared among the groups using the Kaplan-Meier estimation and log rank test.ResultsLocal tumor recurrence occurred in 19 hepatocellular carcinoma tumors (25.7%). There were: 28, 18, 17, and 11 tumors in Group IA, IB, IIA, and IIB, respectively. One of 28 (3.6%) tumors in Group IA, and 18 of 46 (39.1%) tumors in the other three groups showed local recurrence. Comparisons between Group IA and the other three groups showed that the tumor characteristics were similar. One-, two-, and three-year estimated local recurrence rates in Group IA were 0%, 11.1%, and 11.1%, respectively. The difference between Group IA and the other three groups was statistically significant (p = 0.000).ConclusionAn acceptably low rate of local recurrence was observed for small or intermediate nodular tumors located within the liver segment with homogeneous iodized oil accumulation.

Administration of tegafur/uracil after transcatheter arterial embolization inhibit plasma vascular endothelial growth factor level and local recurrence of hepatocellular carcinoma

4153 Background: Transcatheter arterial embolization (TAE) of the hepatic artery has been accepted as an effective treatment for advanced hepatocellular carcinoma (HCC). However, it is difficult to achieve complete tumor necrosis by TAE alone, and embolized vessel recanalization and collateral circulation formation are the main factors of HCC growth and recurrence after TAE. On the other hand, recent studies have shown that Uracil/Tegafur (UFT) inhibits tumor angiogenesis. In the present study, therefore, we examined whether administration of UFT after TAE inhibit of plasma Vascular Endothelial Growth Factor (VEGF) level and prevent recurrence of HCC or not. Methods: Twenty patients with advanced HCC, who had been repeated only TAE therapy more than two times, were enrolled. After obtaining informed concent, UFT (300mg/day) was randomly administrated to ten patients (UFT group) on the 3day after TAE, and not administrated to ten patients (control group). Peripheral blood samples were taken from all patients before and 1, 3, 7 and 14days after TAE. Plasma VEGF level was measured with ELISA. And period of local recurrence were compared between UFT group and control group. Results: Plasma VEGF levels in the control group significantly increased and reached the peak value on the 7 to 14day after TAE(p<0.01). In contrast, there were no significant increases of plasma VEGF levels in the UFT group. On the other hand, the period of recurrence in the control group was 69 days on average. In the UFT group, the average period of recurrence was significantly extended(127days, p<0.05), and there were three patients in the UFT group without local recurrence during the follow-up period. Conclusions: These data suggest that UFT administration after TAE improve local recurrence of HCC by inhibition tumor angiogenesis. No significant financial relationships to disclose.

Traitement du carcinome hépatocellulaire sur cirrhose

The incidence of hepatocellular carcinoma (HCC) in cirrhotic patients is increasing. Despite advances in imaging and laboratory screening which allow earlier diagnosis, the surgeon is all too often confronted with an HCC of advanced stage or arising in the setting of severe cirrhosis; this severely limits the treatment possibilities. Treatment options are constrained not only by the characteristics of the tumor but also by hepatocellular reserve, severity of portal hypertension, and the general condition of the host. “Curative treatments“ envisage the complete eradication of the malignancy; they include liver transplantation, resection, or tumor destruction by radiofrequency or alcohol ablation. They are most effective in the early stages of HCC. Total hepatectomy and transplantation, by far the most complex surgical therapy, also has the best results avoiding the all-too-frequent local recurrence of HCC in the residual liver. Other medical and interventional treatments (chemo-embolization, radiotherapy with lipiodol) can only slow the progress of the HCC. Goals for the future include more precise and directed screening of the population at risk, and better chemopreventive and chemotherapeutic treatments.

Power Doppler signals after percutaneous ethanol injection therapy for hepatocellular carcinoma predict local recurrence of tumors: a prospective study using 199 consecutive patients

Background/Aims : This study was prospectively conducted to elucidate the relationship between pre-/post-treatment power Doppler signals of hepatocellular carcinoma (HCC) and local recurrence. Methods : One hundred ninety-nine consecutive patients with 359 HCC lesions receiving percutaneous ethanol injection therapy (PEIT) as a first-line option were enrolled. Arterial power Doppler signals in the tumor were found in 130 nodules, but not detected in 229. After confirmation of complete tumor necrosis on dynamic CT, Doppler signals in nodules were re-evaluated. Patients received periodical examinations to detect HCC recurrence. Results : Local HCC recurrence was observed in 36 lesions; 22%(28/130) of the pretreatment signal positive lesions, in contrast to 3.5%(8/229) of the pretreatment signal negative lesions ( P <0.01). Out of 130 signal positive nodules, signals disappeared in 120 (92%) after PEIT, but were present in ten (8%). During the 25-month follow up, local recurrence was detected in 19 (16%) from the former, in contrast to nine (90%) from the latter ( P <0.001). Uni- and multivariate Cox analysis revealed that the presence of pre-/post-treatment power Doppler signals, histological differentiation and tumor number were independent factors for local recurrence. However, 3-year recurrence rate of new lesions was 51%, but no predictors were identified. Conclusions : Residual Doppler signals in tumor after PEIT were related to the local HCC recurrence.