Massive Hepatocellular Carcinoma Research Articles

Hepatic Artery Infusion Chemotherapy Sequential Hepatic Artery Embolization Combined with Operation in the Treatment of Recurrent Massive Hepatocellular Carcinoma Achieved Pathological Complete Response: A Case Report

Hepatic Artery Infusion Chemotherapy Sequential Hepatic Artery Embolization Combined with Operation in the Treatment of Recurrent Massive Hepatocellular Carcinoma Achieved Pathological Complete Response: A Case Report

CD4+CD25+ regulatory T cells decreased future liver remnant after associating liver partition and portal vein ligation for staged hepatectomy

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an innovative surgical approach for the treatment of massive hepatocellular carcinoma (HCC), the key to successful planned stage 2 ALPPS is future liver remnant (FLR) volume growth, but the exact mechanism has not been elucidated. The correlation between regulatory T cells (Tregs) and postoperative FLR regeneration has not been reported.To investigate the effect of CD4+CD25+ Tregs on FLR regeneration after ALPPS.Clinical data and specimens were collected from 37 patients who developed massive HCC treated with ALPPS. Flow cytometry was performed to detect changes in the proportion of CD4+CD25+ Tregs to CD4+ T cells in peripheral blood before and after ALPPS. To analyze the relationship between peripheral blood CD4+CD25+ Treg proportion and clinicopathological information and liver volume.The postoperative CD4+CD25+ Treg proportion in stage 1 ALPPS was negatively correlated with the amount of proliferation volume, proliferation rate, and kinetic growth rate (KGR) of the FLR after stage 1 ALPPS. Patients with low Treg proportion had significantly higher KGR than those with high Treg proportion (P = 0.006); patients with high Treg proportion had more severe postoperative pathological liver fibrosis than those with low Treg proportion (P = 0.043). The area under the receiver operating characteristic curve between the percentage of Tregs and proliferation volume, proliferation rate, and KGR were all greater than 0.70.CD4+CD25+ Tregs in the peripheral blood of patients with massive HCC at stage 1 ALPPS were negatively correlated with indicators of FLR regeneration after stage 1 ALPPS and may influence the degree of fibrosis in patients' livers. Treg percentage was highly accurate in predicting the FLR regeneration after stage 1 ALPPS.

Development and validation of web-based prognostic nomograms for massive hepatocellular carcinoma (≥10 cm): A retrospective study based on the SEER database.

Massive hepatocellular carcinoma (MHCC, a maximum tumor size of at least 10 cm) tends to have a poor prognosis. Therefore, this study aims to construct and validate prognostic nomograms for MHCC. Clinic data of 1292 MHCC patients between 2010 and 2015 were got from the surveillance, epidemiology, and end results (SEER) cancer registration database. The whole set was separated into the training and validation sets at a ratio of 2:1 randomly. Variables, significantly associated with cancer-specific (CSS) and overall survival (OS) of MHCC were figured out by multivariate Cox regression analysis and were taken to develop nomograms. The concordance index (C-index), calibration curve, and decision curve analysis (DCA) were taken to validate the predictive abilities and accuracy of the nomograms. Race, alpha-fetoprotein (AFP), grade, combined summary stage, and surgery were identified as independent factors of CSS, and fibrosis score, AFP, grade, combined summary stage, and surgery significantly correlated with OS in the training cohort. They then were taken to construct prognostic nomograms. The constructed model for predicting CSS exhibited satisfactory performance with a C-index of 0.727 (95% CI: 0.746-0.708) in the training group and 0. 672 (95% CI: 0.703-0.641) in the validation group. Besides, the model for predicting OS of MHCC also showed strong performance both in the training group (C-index: 0.722, 95% CI: 0.741-0.704) and the validation (C-index: 0.667, 95% CI: 0.696-0.638) group. All calibration curves and decision curves performed satisfactory predictive accuracy and clinic application values of the nomograms. The web-based nomograms for CSS and OS of MHCC were developed and validated in this study, which prospectively could be tested and may serve as additional tools to assess patient's individualized prognosis and make precise therapeutic selection to improve the poor outcome of MHCC.

Development of a risk score to predict portal vein tumor thrombosis in patients with hepatocellular carcinoma.

Portal vein tumor thrombosis (PVTT) is a common complication of hepatocellular carcinoma and is one of the most negative prognostic factors. The management of patients with PVTT is challenging. The aim of the study was to develop a score predictive of tumor thrombosis. Data from a large cohort of 2243 hepatocellular carcinoma patients (all stages) recorded in the Progetto Epatocarcinoma Campania (January 2013-April 2021) database were analyzed. To construct the score, univariate generalized estimated equation models, the bootstrap approach for internal validation, and a regression coefficient-based scoring system were used. PVTT (any location) was found in 14.4% of cases and was related to shorter survival. Males, younger patients, and symptomatic cases were more prevalent among the PVTT group. At multivariate analysis, size ≥5 cm, massive or infiltrative hepatocellular carcinoma growth, and alpha-fetoprotein ≥400 ng/mL were significantly associated with PVTT. A risk prediction score of PVTT based on eight variables was developed. Using a continuous score, the risk was associated with an odds ratio (OR) of 1.30 (1.27-1.34; P < 0.001). Considering a dichotomous score >8 versus a score ≤8 the OR for PVTT was 11.33 (8.55-15.00; P < 0.001). The risk score for PVTT might be useful for clinicians to optimize hepatocellular carcinoma management by picking out patients with more aggressive cancers and higher mortality rates. Prospective validation of the score is needed before its application in daily clinical practice.

Histological subtypes of hepatocellular carcinoma: Their clinical and prognostic significance

Assigning a hepatocellular carcinoma (HCC) to an appropriate subtype is important because this guarantees the diagnosis and treatment and allows decisions regarding the prognosis of the patient. HCC subtyping is usually based on the World Health Organization (WHO) classification and the 2019 fifth edition is the latest version. However, the WHO classification system is still in evolution and has limited clinical relevance. We aimed to evaluate the clinical relevance of HCC subtyping and to reappraise some of the major subtypes of HCC. Our archived cases (n = 589) were reclassified according to the 2019 WHO system. The percentage of each subtype was mostly similar to that in the WHO classification. However, on the contrary to the 2019 WHO system, clear cell type HCC was associated with more frequent recurrence or metastasis. Meanwhile, macrotrabecular massive HCC was related to poor prognosis as demonstrated in the 2019 WHO system and should be described in the pathology report. For steatohepatitic HCC, there is a debate on whether it is a true subtype because the steatohepatitis morphology may or may not be present in the background liver. In our study, 44 % of steatohepatitic HCCs (n = 19/43) presented underlying steatohepatitis. Additionally, the background cirrhosis did not influence survival in the HCC patients, although the 2019 WHO system indicates the presence of cirrhosis as a poor prognostic factor. In conclusion, although it is not perfect yet, HCC subtyping based on the 2019 WHO system provides valuable information to manage patients with HCC.

A Case of Target Immunotherapy Combined with Interventional Therapy for Massive Liver Cancer

This article reports a case of massive hepatocellular carcinoma. After intervention combined with targeted and immunotherapy, it was successfully cured by surgical resection, which provides some experience for the comprehensive treatment of liver cancer, and also improves the understanding of systematic treatment of liver cancer, so as to improve the understanding and diagnosis of the disease.

Abdominal lymphatic pathway in Fontan circulation using non-invasive magnetic resonance lymphangiography.

Lymphatic congestion is known to play an important role in the development of late Fontan complications. This study aimed to (1) develop a gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) contrast three-dimensional heavily T2-weighed MR technique that can detect abnormal lymphatic pathway in the abdomen while simultaneously evaluating hepatocellular carcinoma (HCC) and to (2) propose a new classification of abnormal abdominal lymphatic pathway using a non-invasive method in adults with Fontan circulation. Twenty-seven adults with Fontan circulation who underwent Gd-EOB-DTPA abdominal MR imaging were prospectively enrolled in this study. We proposed MR lymphangiography that suppresses the vascular signal on heavily T2-weighted imaging after EOB contrast. The patients were classified as follows: grade 1 with almost no lymphatic pathway, grade 2 with a lymphatic pathway mainly around the bile duct and liver surface, and grade 3 with a lymphatic pathway mainly around the vertebral body and inferior vena cava. The grade 3 group showed the lowest oxygen saturation level, highest central venous pressure, highest incidence of massive ascites, HCC, and focal nodular hyperplasia. This group also tended to have patients with the oldest age and highest cardiac index; however, the difference was not statistically significant. As for the blood test, the grade 3 group showed the lowest platelet count and serum albumin level and the highest fibrosis-4 index. A novel technique, Gd-EOB-DTPA MR lymphangiography, can detect abnormal abdominal lymphatic pathways in Fontan circulation, which can reflect the severity of failing Fontan.

Change of tumor-infiltrating lymphocyte of associating liver partition and portal vein ligation for staged hepatectomy for hepatocellular carcinoma.

BACKGROUNDThe role of tumor-infiltrating lymphocytes (TILs) in the growth and progression of hepatocellular carcinoma (HCC) has attracted widespread attention.AIMTo evaluate the feasibility of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for massive HCC by exploring the role of TIL in the tumor microenvironment.METHODSFifteen massive HCC patients who underwent ALPPS treatment and 46 who underwent hemi-hepatectomy were selected for this study. Propensity score matching was utilized to match patients in ALPPS and hemi-hepatectomy groups (1:1). Quantitative analysis of TILs in tumor and adjacent tissues between the two groups was performed by immunofluorescence staining and further analyses with oncological characteristics. In the meantime, trends of TILs in peripheral blood were compared between the two groups during the perioperative period.RESULTSContinuous measurement of tumor volume and necrosis volume showed that the proportion of tumor necrosis volume on the seventh day after stage-I ALPPS was significantly higher than the pre-operative value (P = 0.024). In the preoperative period of stage-I ALPPS, the proportion of tumor necrosis volume in the high CD8+ T cell infiltration group was significantly higher than that in the low group (P = 0.048).CONCLUSIONTIL infiltration level maintained a dynamic balance during the preoperative period of ALPPS. Compared with right hemi-hepatectomy, the ALPPS procedure does not cause severe immunosuppression with the decrease in TIL infiltration and pathological changes in immune components of peripheral blood. Our results suggested that ALPPS is safe and feasible for treating massive HCC from the perspective of immunology. In addition, high CD8+ T cell infiltration is associated with increasing tumor necrosis in the perioperative period of ALPPS.

State-of-the-art review on the correlations between pathological and magnetic resonance features of cirrhotic nodules.

Hepatocellular carcinoma (HCC) has become the second greatest cause of cancer-related mortality worldwide and the newest advancements in liver imaging have improved the diagnosis of both overt malignancies and premalignant lesions, such as cirrhotic or dysplastic nodules, which is crucial to improve overall patient survival rate and to choose the best treatment options. The role of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) has grown in the last 20 years. In particular, the introduction of hepatospecific contrast agents has strongly increased the definition of precursor nodules and detection of high-grade dysplastic nodules and early HCCs. Nevertheless, the diagnosis of liver tumours in cirrhotic patients sometimes remains challenging for radiologists, thus, in doubtful cases, biopsy and histological analysis become critical in clinical practice. This current review briefly summarizes the history of imaging and histology for HCC, covering the newest techniques and their limits. Then, the article discusses the links between radiological and pathological characteristics of liver lesions in cirrhotic patients, by describing the multistep process of hepatocarcinogenesis. Explaining the evolution of pathologic change from cirrhotic nodules to malignancy, the list of analyzed lesions provides regenerative nodules, low-grade and high-grade dysplastic nodules, small HCC and progressed HCC, including common subtypes (steatohepatitic HCC, scirrhous HCC, macrotrabecular massive HCC) and more rare forms (clear cell HCC, chromophobe HCC, neutrophil-rich HCC, lymphocyte-rich HCC, fibrolamellar HCC). The last chapter covers the importance of the new integrated morphological-molecular classification and its association with radiological features.

Risk factors and outcome in dogs with recurrent massive hepatocellular carcinoma: A Veterinary Society of Surgical Oncology case-control study.

Local recurrence after surgical excision of canine massive hepatocellular carcinoma (HCC) has been poorly studied in veterinary medicine with scant information published regarding risk factors for and outcome following recurrence. The aim of this case–control study was to describe the time to recurrence, evaluate potential risk factors for recurrence, and report the outcome in dogs with massive HCC. Medical records for 75 dogs who developed recurrence and 113 dogs who did not develop recurrence were reviewed. Statistical analyses were performed to determine risk factors for recurrence as well as the median time to develop recurrence and overall survival time (OS). None of the risk factors evaluated were significant for the development of recurrence. The median time to develop recurrence was 367 days (range 32–2096 days). There was no significant difference in median OS for dogs who developed recurrence vs. those who did not (851 vs. 970 days). For dogs with recurrent HCC, treatment at recurrence trended toward prolonged OS but was not significantly different from dogs not undergoing treatment at recurrence. There was no significant difference in median OS for dogs with histologically complete vs. incomplete tumour excision (990 vs. 903 days). Although specific risk factors for recurrence were not identified, elevations in liver values were noted in patients with recurrent disease and could act as a noninvasive surveillance tool. Recurrence was noted earlier in dogs who had routine post‐operative surveillance (228 vs. 367 days). Routine surveillance for recurrence is recommended especially in dogs where further intervention is possible and should extend beyond 1 year. Patients with massive HCC have a good long‐term prognosis regardless of incomplete excision, pulmonary metastasis, or recurrent local disease.

A gadoxetic acid–enhanced MRI–based multivariable model using LI-RADS v2018 and other imaging features for preoperative prediction of macrotrabecular–massive hepatocellular carcinoma

PurposeTo identify imaging features of macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) using LI-RADS v2018 and other imaging features and to develop a gadoxetic acid–enhanced MRI (EOB-MRI)-based model for pretreatment prediction of MTM-HCC. Materials and methodsA total of 93 patients with pathologically proven HCC (39 MTM-HCC and 54 non-MTM-HCC) were retrospectively evaluated with EOB-MRI at 3 T. Imaging analysis according to LI-RADS v2018 was evaluated by two readers. Univariate and multivariate analyses were performed to determine independent predictors for MTM-HCC. Different logistic regression models were built based on MRI features, including model A (enhancing capsule, blood products in mass and ascites), model B (enhancing capsule and ascites), model C (blood products in mass and ascites), and model D (blood products in mass and enhancing capsule). Diagnostic performance was assessed by receiver operating characteristic (ROC) curves. ResultsAfter multivariate analysis, absence of enhancing capsule (odds ratio = 0.102, p = 0.010), absence of blood products in mass (odds ratio = 0.073, p = 0.030), and with ascites (odds ratio = 55.677, p = 0.028) were identified as independent differential factors for the presence of MTM-HCC. Model A yielded a sensitivity, specificity, and AUC of 35.90% (21.20,52.80), 94.44% (84.60, 98.80), and 0.731 (0.629, 0.818). Model A achieved a comparable AUC than model D (0.731 vs. 0.699, p = 0.333), but a higher AUC than model B (0.731 vs. 0.644, p = 0.048) and model C (0.731 vs. 0.650, p = 0.005). ConclusionThe EOB-MRI-based model is promising for noninvasively predicting MTM-HCC and may assist clinicians in pretreatment decisions.

Effect of camrelizumab plus transarterial chemoembolization on massive hepatocellular carcinoma

ObjectiveTo investigate the efficacy of camrelizumab plus transarterial chemoembolization (TACE) on massive hepatocellular carcinoma (HCC) patients. MethodsA total of 92 cases with massive HCC from October 2019 to January 2021 were prospectively enrolled and randomly divided into the study group (n = 46) and the control group (n = 46). The control group received TACE while the study group were treated with camrelizumab plus TACE. The primary end points were clinical efficacy and adverse events. And the secondary end points were liver function, and alpha fetoprotein (AFP), carcino-embryonic antigen (CEA), carbohydrate antigen 19–9 (CA19–9) levels before and after treatment. ResultsAll participants were followed-up for 7 to 24 months, with a median of 12 months. Patients in the study group received TACE for 1–3 times, with an average of (2.01 ± 0.09) times, while patients in the control group receive TACE for 2–4 times, with an average of (3.78 ± 0.12) times, and the control group received significantly more TACEs (χ2 = 5.518, P = 0.019). During the follow-up, the response rate and disease control rate of the study group were significantly higher than those of the control group (χ2 = 5.518, P = 0.019; χ2 = 4.467, P = 0.041). Before treatment, the levels of total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alpha-fetoprotein (AFP), CEA, and CA19–9 were comparable between the groups (P > 0.05). After treatment, the levels of TBIL, ALT, AST, AFP, CEA, and CA19–9 decreased, and the above indicators in the study group were significantly lower than those in the control group (P < 0.05). All patients showed transient liver damage, vomiting, nausea, fever and abdominal pain after surgery, and their symptoms were relieved after symptomatic treatment. Adverse events occurred in 9 cases in the study group, and 3 cases in the control group (χ2 = 3.419, P = 0.064). ConclusionCompared with TACE alone, camrelizumab plus TACE treatment can significantly improve the liver function of patients with massive HCC and enhance the treatment effect, which is worthy of clinical promotion.

Up-to-date Knowledge on the Pathological Diagnosis of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) has heterogeneous molecular and pathological features and biological behavior. Large-scale genetic studies of HCC were accumulated, and a pathological-molecular classification of HCC was proposed. Approximately 35% of HCCs can be classified into distinct histopathological subtypes according to their molecular characteristics. Among recently identified subtypes, macrotrabecular massive HCC, neutrophil-rich HCC, vessels encapsulating tumor clusters HCC, and progenitor phenotype HCC (HCC with CK19 expression) are associated with a poor prognosis, whereas the lymphocyte-rich HCC subtype is related to a better prognosis. This review provides up-to-date knowledge on the pathological diagnosis of HCC according to the updated World Health Organization Classification of Digestive System Tumors 5th ed.

Clinical effects and prognosis of stereotactic body radiotherapy combined with transarterial chemoembolization for massive hepatocellular carcinoma

AbstractObjectiveWith the development of interventional therapy and precise radiotherapy, such as 3‐D conformal intensity‐modulated radiation therapy and stereotactic body radiotherapy (SBRT), transarterial chemoembolization (TACE) combined with radiotherapy has become an important method of comprehensive treatment for advanced liver cancer. However, few studies focus on the treatment of massive hepatocellular carcinoma (HCC) with SBRT. In this study, we investigated the effects and prognostic factors of whole‐body gamma‐knife SBRT combined with TACE in the treatment of massive HCC.MethodsA retrospective analysis was carried out in 81 patients with massive, who received super gamma‐knife (type SGS‐I) SBRT after TACE treatment between 2 January 2011 and 30 June 2016. The curative effects were evaluated using the Modified Response Evaluation Criteria in Solid Tumors criteria. The alpha‐fetoprotein and alanine aminotransferase levels were measured before and after treatment. Patients were followed up for overall survival and 1‐, 3‐, and 5‐year survival rates. Adverse reactions were evaluated using the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer criteria.ResultsA total of 81 patients were evaluated, including 29 patients with complete response, 48 patients with partial response, two patients with stable disease, and two patients with progressive disease; the total response rate was 95.06%. The 1‐year local control rate was 71.60%. The overall survival rates at 1, 3, and 5 years were 81.48%, 40.74%, and 16.67%, respectively. The median survival time was 15.0 months (95% CI 10.1–19.8 months). Progression‐free time was 11.0 months (95% CI 9.5–14.4 months). The alpha‐fetoprotein level after treatment was (85.53 ± 21.36) μg/L and was significantly lower than that before treatment (635.62 ± 125.83 μg/L; t = 8.189, P = 0.002). The alanine aminotransferase levels were 70.34 ± 16.60 and (54.95 ± 12.02) U/L before and after treatment, respectively, and were not significantly different (t = 1.348, P = 0.624). Multivariate analysis showed that a portal vein tumor thrombus (χ2 = 4.727, P = 0.016) and the Child–Pugh grade of liver function (χ2 = 4.893, P = 0.013) were adverse prognostic factors of overall survival. The 1‐year local control rates and the median survival times were 72.03% and 71.17%, and 16 and14 months, respectively, for the clinical target volumes ≥120 cm3 and &lt;120 cm3 subgroups; there were no statistical differences in these parameters (P = 0.923 and P = 0.845, respectively). The main adverse reactions during treatment were gastrointestinal effects, fatigue, and radioactive liver injury, mainly grades 1–2. The adverse reactions could be relieved by symptomatic treatment.ConclusionsSBRT with a super gamma‐knife combined with TACE for the treatment of massive HCC had a significant clinical effect and mild side‐effects. Therefore, this approach is worthy of clinical promotion and application.

Continuous elevation of procalcitonin in cirrhosis combined with hepatic carcinoma: a case report

BackgroundSerum levels of procalcitonin (PCT) are considered a useful biomarker for the diagnosis of bacterial infection or inflammation. There are few reports of high PCT levels in end-stage liver disease regardless of bacterial infection. Here, we present a case of extremely high PCT levels (> 100 ng/mL) in a patient with severe cirrhosis combined with hepatic carcinoma.Case presentationA 65-year-old man developed end-stage cirrhosis with hepatic carcinoma. Radiographic imaging showed a massive hepatocellular carcinoma with multiple loci lack of indications of resection. Hence, transcatheter hepatic arterial chemoembolization was performed three times over a period of 4 months. Before and after interventional therapies, the biochemistry laboratory results were only slightly abnormal except for persistently high PCT concentrations (> 100 ng/mL), irrespective of the evidence for bacterial infection or sepsis.ConclusionsThis case suggests that continuously high levels of PCT (> 100 ng/mL) may be present in advanced liver disease, particularly in complex situations such as decompensated cirrhosis and liver cancer, in the absence of severe infection or sepsis. This knowledge could expand the significance of PCT in liver disease.

A preliminary study on percutaneous transhepatic drainage combined with sequential percutaneous nephroscopy in treatment of refractory liver abscess

Objective To investigate the clinical effect of percutaneous transhepatic drainage combined with sequential percutaneous nephroscopy for necrosectomy and drainage in the treatment of refractory liver abscess after transcatheter arterial embolization (TACE). Methods A retrospective analysis was performed for three patients with refractory liver abscess after TACE in The Affiliated 3201 Hospital of Xi'an Jiaotong University School of Medicine from January 2018 to December 2020, and among the three patients, one had the formation of liver abscess after TACE for hepatic metastases after pancreaticoduodenectomy, one had liver abscess after repeated TACE for massive hepatocellular carcinoma, and one had secondary liver abscess after TACE for traumatic hepatic rupture. All three patients received percutaneous transhepatic drainage and sequential percutaneous nephroscopy for the treatment of refractory liver abscess, and their specific treatment process was summarized. Results All three patients were diagnosed with refractory liver abscess based on CT, routine blood test, procalcitonin, blood culture, and clinical manifestation. Percutaneous transhepatic catheterization under the guidance of conventional ultrasonography or CT and effective antibiotics had an unsatisfactory therapeutic effect, and after sequential percutaneous nephroscopy was performed for necrosectomy and drainage, liver abscess was cured and the patients had good prognosis. Conclusion For refractory liver abscess after TACE, when routine puncture treatment has an unsatisfactory therapeutic effect or a patient cannot tolerate surgical operation, percutaneous transhepatic drainage combined with sequential percutaneous nephroscopy is safe and effective in the treatment of refractory liver abscess.

Gingival metastasis from primary hepatocellular carcinoma: a case report and literature review of 30 cases

BackgroundGingival metastasis from primary hepatocellular cancer (HCC) is rare, highly malignant, and generally has no distinct symptoms. Not performing a biopsy can lead to misdiagnosis. This article reports an 87-year-old male with gingival metastasis from HCC. To gain a better insight into this disease, we also conducted a literature review of 30 cases and discussed the clinical and pathological characteristics, diagnosis, treatment and prognosis of this unusual form of liver cancer.Case presentationAn 87-year-old man was hospitalized with a chief complaint of chronic constipation and diffuse lower extremity edema. His past medical history included a three-year hepatitis B infection and a cerebral infarction 17 years prior. Imaging examination detected a massive hepatocellular carcinoma in the right liver lobe and multiple metastases in the lungs. Oral examinations revealed a reddish, cherry-sized exophytic mass on the right upper gum. The mass was tentatively diagnosed as a primary gingival tumor and was ultimately confirmed by biopsy as a metastatic carcinoma originating in the liver. The patient decided, with his guardians, to receive palliative care and not to remove the mass. Unfortunately, the patient accidentally bit the mass open; profuse bleeding ensued and local pressure exerted a poor hemostatic effect. The patient’s condition worsened, and he eventually died of multiple organ failure. We also performed a literature review and discussed 30 cases of gingival metastases from HCC. The findings indicated that these lesions affected males more than females, with a ratio of 6:1, and infiltrated the upper gingivae (63.1%) more than the lower gingivae (36.7%). Survival analysis indicated that the overall survival for patients with upper gingival metastasis was worse than for those with lower gingival metastasis, and patients receiving treatments for primary liver cancer or metastatic gingival tumors had better overall or truncated survival times.ConclusionGingival metastasis from primary hepatocellular carcinoma is rare, and its diagnosis has presented challenges to clinicians. To avoid a potential misdiagnosis, a biopsy is mandatory regardless of whether a primary cancer is located. Early diagnosis and treatment for primary liver cancer or metastatic gingival lesions may improve survival expectations.

Lenvatinib combined nivolumab injection followed by extended right hepatectomy is a feasible treatment for patients with massive hepatocellular carcinoma: a case report.

Hepatocellular carcinoma (HCC) is a highly aggressive malignant tumor. The survival of advanced HCC is very poor. In this case study, we describe the treatment of a 69-year-old woman diagnosed with massive hepatocellular carcinoma, the use of lenvatinib in combination with nivolumab injection in the preoperative adjuvant treatment of advanced massive hepatocellular carcinoma, and the final taking extended right hepatectomy. Molecular targeted drugs and immunotherapy controlled patient’s condition to create time and conditions for surgery. After surgery, AFP was greatly reduced, no recurrence of the residual liver and no metastasis in the distance. This treatment is the gospel of patients with advanced liver cancer.

Vessels Encapsulating Tumor Clusters (VETC) Is a Powerful Predictor of Aggressive Hepatocellular Carcinoma.

We investigated the clinical significance of a vascular growth pattern of hepatocellular carcinoma (HCC), the vessels that encapsulate tumor clusters (VETC), previously linked to HCC metastatic dissemination. VETC was assessed in a large multi-institutional cohort of 541 resected HCCs from Italy, Korea and Japan, and matched against a full spectrum of clinical and pathological variables. The VETC phenotype (defined as≥55% tumor area by CD34 immunostaining) was easily reproducible and reliably detectable in whole sections and small-sized tissues of tissue microarray. VETC HCCs represented 18.9% of the whole series, the lowest proportion occurring in the cohort with smallest tumors (8.7%, Japanese series). VETC was significantly associated with several clinical and pathological features such as high alfa-fetoprotein (AFP) level, tumor size greater than 5 cm, poor differentiation, macrotrabecular pattern, less compact pattern, less inflammatory infiltrates, and frequent microvascular invasion. VETC was associated with early recurrence (hazard ratio [HR]: 1.52 [1.06-2.19], P=0.023), disease-free survival (HR: 1.66 [1.21-2.27], P=0.002), and overall survival (HR: 2.26 [1.37-3.72], P=0.001) at multivariable analysis. VETC affected the survival in HCC patients stratified for etiology (hepatitis C virus/hepatitis B virus), vascular invasion, and specific molecular phenotypes (β-catenin/GS+). This distinct vascular pattern was enriched in the recently reported macrotrabecular massive HCC subtype, which was seen in 7.8% (42 of 541) of patients and associated with high AFP levels and poor differentiation. Conclusion: The VETC pattern was found to be easily detectable in a consistent fraction of HCC and a powerful pathological finding affecting survival. This study suggests that the heterogeneous pattern of angiogenesis is involved in HCC behavior.

Transcatheter arterial chemoembolization combined with simultaneous cone beam computed tomography-guided multipolar microwave ablation for massive hepatocellular carcinoma (≥10 cm): Safety and primary clinical results

PurposeTo explore the safety and clinical efficacy of transcatheter arterial chemoembolization (TACE)combined with simultaneous cone beam computed tomography (CBCT)-guided multipolar microwave ablation (MWA)in the treatment of massive hepatocellular carcinoma (HCC). Materials and methodsRecords of nine patients who underwent TACE combined with simultaneous CBCT-guided multipolar MWA for massive HCC, between January and June 2015, were retrospectively reviewed. Technical success rate, blood levels of liver function indicators, complications, and tumor response one month after treatmentwere investigated. ResultsThe technical success rate of TACE combined with simultaneous MWA was 100%. The mean procedure time was 195.0 min (range, 125–350 min), the mean hospital stay after the treatment was 4.0 ± 1.0 days (range, 3–7 days), and no serious complications occurred. Minor complications were experienced by some patients but were relieved after conservative treatment. One month after treatment, enhanced CT revealed a complete response rate of 66.7% (6/9), a partial response rate of 22.2% (2/9), and a stable disease rate of 11.1% (1/9). Mild and reversible injury of liver function occurred in these patients. ConclusionTACE combined with simultaneous CBCT-guided MWA for massive HCC was feasible and safe, and yielded a high response rate.