Primary Hepatic Cancer Research Articles

Evaluating transcatheter arterial chemoembolization for primary hepatic cancer by magnetic resonance diffusion-weighted imaging

Evaluating transcatheter arterial chemoembolization for primary hepatic cancer by magnetic resonance diffusion-weighted imaging

ロピバカインとフェンタニル硬膜外投与の術後疼痛管理―肝機能に応じた鎮痛薬用量設定の必要性―

Despite the generally adequate dosages that have been established for patient-controlled epidural analgesia (PCA) following upper abdominal surgery such as gastrectomy and hepatectomy,in our experience,patients who have undergone gastrectomy need a higher PCA dosage than those who have undergone hepatectomy.The aim of this study was to review the efficacy and dosages of PCA in the case of simultaneous epidural administration of ropivacaine and fentanyl following upper abdominal surgery,and the adverse reactions that appeared.The gastrectomy and hepatectomy patients numbered 51 and 55,respectively,with the hepatectomy comprising that for metastatic hepatic cancer (47 patients) and that for primary hepatic cancer (8 patients).The visual analog scale (VAS) and Prince Henry Scores (PHS) for the patients who underwent hepatectomy were significantly lower than those for patients who underwent gastrectomy.Further,the analgesic effect of PCA,was weaker in patients with metastatic liver cancer than those with primary hepatic cancer,and Indocyanine green retention at 15 minutes (ICG-R) was significantly correlated with the VAS scores of hepatectomy patients.These results suggested that the dosage of PCA following upper abdominal surgery should be determined based on a hepatic function indicator such as ICG-R.

A correlation factor analysis of clinical and virological characteristics on HBeAg-negative and HBeAg-positive primary hepatic cancer

A correlation factor analysis of clinical and virological characteristics on HBeAg-negative and HBeAg-positive primary hepatic cancer

Diagnosis and initial management of cholangiocarcinoma with obstructive jaundice

Cholangiocarcinoma is the second most common primary hepatic cancer. Despite advances in diagnostic techniques during the past decade, cholangiocarcinoma is usually encountered at an advanced stage. In this review, we describe the classification, diagnosis, and initial management of cholangiocarcinoma with obstructive jaundice.

The risk of thrombotic events in patients with primary versus secondary hepatic malignancies who are undergoing surgical resection

15178 Background: The increased risk of thromboses is well documented in patients with malignancies, and those undergoing abdominal surgery. Furthermore, patients requiring hepatic resection for underlying malignant disease have been reported to be at increased risk for thrombotic complications. However, guidelines for thromboprophylaxis in this patient population are still under investigation. A cursory review performed at our institution determined the incidence of thrombotic events to be comparable to that reported in the literature. We, therefore, went further to study if there was a difference in the risk of thromboses between those undergoing resection for primary hepatic cancer, versus metastatic disease. Methods: We performed a retrospective chart review of patients undergoing surgical resection for hepatic malignancies. The primary end point was to determine whether there was a difference in the incidence of thrombotic events between primary and secondary malignancies. Results: A total of 99 patients at our institution underwent surgical resection for either primary or secondary hepatic malignancies in the past 5 years. There were 7 patients who developed thrombotic events within three months of their resection. Of these patients, all 7 underwent resection for secondary hepatic malignancies. Based on the nature of this study, and its lack of standardized thromboprophylaxis, statistical analysis was not performed. Conclusions: Patients undergoing surgical resection of hepatic malignancies appear to be at increased risk of thrombotic events, and may require more specific standardization of their thromboprophylaxis. Furthermore, based on our observation it appears those associated with metastatic disease may derive an even greater benefit from this. Future prospective studies will be required to evaluate this difference in thromboses, and to better define the guidelines for thromboprophylaxis. No significant financial relationships to disclose.

Treatment and surgery of primary hepatic cancer with portal vengus tumor thrombosis

To study the methods of surgery for hepatocellular carcinoma (HCC) with tumor thrombi in portal vein (TTPV). To Analyze and summarize the clinical information from 138 HCC patients with tumor thrombi in portal vein collected during January 1990 and January 2003. Thirty-seven patients receiving palliative therapy died from 1 to 8 months, and average survival time is 3.9 months. 101 patients had operation treatment, 23 of them underwent hepatoma resection, and average survival time was 10.9 months; 78 patients underwent hepatoma resection and removal of tumor thrombi, and average survival time was 26.8 months. 52 of whom underwent hepatic artery and portal vein chemoembolization, the 1-, 3-, 5-year survival rates was 96.2%, 51.9%, 11.5%, the 1-, 3-, 5-year survival rates of the 26 patients who didn't undergo chemoembolization were 76.9%, 23.1%, 0%. Operation treatment can comparatively extend the survival time of hepatocellular carcinoma with tumor thrombi in portal vein patients, and the best choice is hepatoma resection and removal of tumor thrombi, hepatic artery and portal vein chemoembolization after operation can enhance the effect.

Percutaneous Femoral Catheter Placement for Long-Term Chemotherapy Infusions: Preliminary Technical Results

The purpose of our study was to evaluate the feasibility and usefulness of using a port-catheter system equipped with a W-spiral catheter for hepatic chemotherapy; this novel catheter does not require fixation by pericatheter embolization and can be safely withdrawn when not needed. Sixty-one patients (40 men and 2l women; mean age, 59 years) with advanced liver cancers (primary hepatic or biliary cancer [n = 31] and metastatic liver cancer [n = 30]) underwent percutaneous port-catheter placement with the tip of W-spiral catheter inserted into the right gastroepiploic artery and the side-hole opened at the common hepatic artery after embolization of the right gastric artery, pancreaticoduodenal arteries, or aberrant hepatic arteries. Pericatheter embolization for preventing catheter dislodgement was not performed. The technical success of port-catheter placement, clinical patency of the port-catheter system, and technical success of port-catheter removal were evaluated. Percutaneous port-catheter placement using this method was successfully performed in 59 (97%) of 61 patients. Subsequently, chemotherapy was successfully performed through the port in 57 (93%) of 61 patients. Complications during and after the procedure were observed in two (3%) of 61 patients and 12 (20.7%) of 58 patients. Hepatic artery thrombosis occurred in two (3.4%) of 58 patients. The port-catheter removal and the catheter replacement were performed in eight and four patients, respectively, who wanted the procedure. It was completed successfully without any complications. This method of implantation of a port-catheter system appeared to offer clinical advantages of safe catheter removal, femoral artery access, and an acceptable complication rate.

Shift of Th1/Th2 in patients with primary hepatic cancer

目的 研究原发性肝癌(PHC)病人Th1/Th2的漂移.方法以IFN-γ和IL-2代表Th1类细胞因子,IL-4和IL-10代表Th2类细胞因子,以逆转录聚合酶链反应(RT-PCR)检测39例原发性肝癌病人外周血单个核细胞(PBMC)及11例癌组织和癌旁组织中Th1/Th2类细胞因子 mRNA的表达,以6例健康人作为对照.结果 39例PHC病人PBMC中Ⅰ、Ⅱ、Ⅲ期肝癌Th1型细胞因子表达率分别为5/7、20/26、0/6,Th2型细胞因子表达率分别为0/7、2/26、5/6.11例癌组织和癌旁组织的Th1/Th2状态与其PBMC呈正相关(癌组织和PBMC,rs=0.8101,P=0.0025;癌旁组织和PBMC,rs=0.7698,P=0.0056).结论Ⅰ期和Ⅱ期PHC病人PBMC中Th1类细胞因子强势表达,Ⅲ期PHC病人PBMC以Th2类细胞因子表达为主.癌组织和癌旁组织的Th1/Th2状态与其PBMC是一致的。

第１６回全国原発性肝癌追跡調査報告（２０００〜２００１）

第１６回全国原発性肝癌追跡調査報告（２０００〜２００１）

Results of a phase I trial of BAY 43-9006 in combination with doxorubicin in patients with primary hepatic cancer

Results of a phase I trial of BAY 43-9006 in combination with doxorubicin in patients with primary hepatic cancer

Hepatocellular carcinoma: role of hepatitis B and hepatitis C viruses proteins in hepatocarcinogenesis.

Hepatocellular carcinoma (HCC) is the most important primary hepatic cancer, being a common cancer type worldwide. Many aetiological factors have been related with HCC development, such as cirrhosis, hepatitis viruses and alcohol. Chronic infection with hepatitis B (HBV) and C viruses (HCV) often results in cirrhosis and enhances the probability of developing HCC. The underlying mechanisms that lead to malignant transformation of infected cells, however, remain unclear. HBV is a DNA virus that integrates into the host genome, and this integration is believed, in part, to be carcinogenic. Besides, the virus encodes a 17 kDa protein, HBx, which is known to be a causative agent in the formation of HCC. On the contrary, HCV is a RNA virus that does not integrate into the host genome but likely induces HCC through host protein interactions or via the inflammatory response to the virus. Products encoded in the HCV genome interfere with and disturb intracellular signal transduction. Some HCV proteins, such as the core protein, NS3 and NS5A, have seen to have a regulatory effect on cellular promoters, to interact with a number of cellular proteins, and to be involved in programmed-cell death modulation under certain conditions. The identification of these proteins functions in HCC development and the subsequent development of strategies to inhibit protein-protein interactions may be the first step towards reducing the chronicity and/or of the carcinogenicity of these two viruses.

The NCT Turin Project For Primary And Secondary Hepatic Cancer

The development of new kind of therapy in the treatment of cancer in which a surgical approach in not possible, or which does not respond to chemo or traditional radio therapy, actually is object of international interest; in particular international studies are applied to the neutron capture therapy, known as NCT. The neutron capture therapy is based on the possibility to give, using an adequate source of termic neutronic beams of sufficient intensity able to produce by opportune nuclear reactions characterised by high energetic release, the selective cellular death.

Hepatocellular carcinoma: molecular interactions between hepatitis C virus and p53 in hepatocarcinogenesis

Hepatocellular carcinoma (HCC) is the most important primary hepatic cancer and is a common cancer type worldwide. Many aetiological factors have been related to HCC development, such as liver cirrhosis, hepatitis viruses and alcohol consumption. Inactivation of the p53 tumour suppressor gene is one of the most common abnormalities in many tumours, including HCC. p53 is of crucial importance for the regulation of the cell cycle and the maintenance of genomic integrity. In HCC, hepatitis B and C virus (HBV and HCV) effect carcinogenic pathways, independently leading to anomalies in p53 function. Several authors have reported that some HCV proteins, such as the core, NS5A and NS3 proteins, interact with p53 and prevent its correct function. The mechanisms of action of these HCV proteins in relation to p53 are not completely clear, but they might cause its cytoplasmic retention or accumulation in the perinuclear region where the protein is not functional. The identification of the interactions between p53 and HCV proteins is of great importance for therapeutic strategies aimed at reducing the chronicity and/or carcinogenicity of the virus.

Isolated liver perfusion for non-resectable liver tumours: a review

Many treatments have been proposed for non-resectable primary or secondary hepatic cancer but the results have generally been disappointing. Isolated Hepatic Perfusion (IHP) was first attempted four decades ago but it gained acceptance only recently, after spectacular tumour responses were obtained by isolated limb perfusion with melphalan and tumour necrosis factor (TNF) for melanomas and sarcomas. Surgical isolation of the liver is a technically demanding operation that allows the safe administration of high doses of chemotherapeutics and TNF. Percutaneous techniques using balloon occlusion catheters are simpler but result in higher leakage rates from the perfusion circuit into the systemic circulation. Several phase I–II trials indicate that IHP can yield high tumour response rates, even when there is resistance to systemic chemotherapy. However, no significant advantage in overall survival has been demonstrated so far. IHP offers unique pharmacokinetic advantages for locoregional chemotherapy and biotherapy. It might also allow gene therapy with limited systemic exposure and toxicity. At present, IHP nevertheless remains an experimental treatment modality which should therefore be used in controlled trials only.

Absence of Therapeutic Efficacy of the Somatostatin Analogue Lanreotide in Advanced Primary Hepatic Cholangiocellular Cancer and Adenocarcinoma of the Gallbladder Despite In Vivo SomatostatinReceptor Expression

Background : Carcinoma of the biliary system is a rare tumour entity, and patients with advanced disease face a dismal prognosis. Because of the absence of standard chemotherapy for advanced biliary caracinoma and reports of expression of receptors for somatostatin (SST), we performed a phase II study to evaluate the clinical potential of the long-acting SST analogue lanreotide (LAN) for treatment of this disease. Methods : Twenty consecutive patients with histologically verified primary hepatic cholangio-cellular cancer or primary adenocarcinoma of the gallbladder were enrolled in the study. Before initiation of therapy, SST-receptor scintigraphy using 111 In-DOTA-LAN was carried out in eight patients to check for in vivo expression of SST receptors. Thirty milligrams of a slow-release formulation of LAN was administered by deep intramuscular injection every 2 weeks until progression or patients wished to withdraw. Restaging by means of computed tomography was performed every 8 weeks, and response was assessed according to World Health Organisation standard criteria. In addition, weight, performance status, analgesic intake and subjective pain perception were recorded every 4 weeks, along with evaluation of tumour markers CEA and Ca 19-9. Results : Tumour sites were visualized by means of 111 In-DOTA-LAN in all 8 patients. A total of 161 injections were administered, the median number per patient being 5 (range 2-36). Side effects were generally mild, only two patients complained of mild nausea and one patient had meteorism attributed to therapy. Therapeutic results, however, were disappointing, with only one patient demonstrating complete remission (CR), which lasted for 18 months before diagnosis of recurrence. Four patients had stable disease (SD) lasting between 3.5 and 9+ months accompanied by weight gain and improvement in performance status in 2 cases, while the remaining 15 patients progressed during therapy. The median time to progression was 2.5 months (range 1-18), and the median survival was 4.5 months (range 1.5-18+ months). No clear-cut correlation between scan result and therapeutic outcome could be demonstrated, as not only the patient with CR and two with SD, but also five patients with progressive disease had a positive scan result. Conclusion : Our data show that adenocarcinomas of the gallbladder and hepatic cholangiocellular carcinomas express SST receptors in vivo as judged by 111 In-DOTA-LAN scintigraphy. Despite this fact, LAN did not display therapeutic activity in this study.

Advances in nuclear oncology: microspheres for internal radionuclide therapy of liver tumours.

Liver metastases cause the majority of deaths from colorectal cancer, and response to chemotherapy and external radiotherapy is poor. An alternative is internal radionuclide therapy using (90)Y labeled microspheres. These microspheres are very stable and have a proven efficacy in the field of treatment of primary or metastatic hepatic cancer. Whilst these glass spheres showed encouraging results in patients, their high density is a serious drawback. Currently, other materials with lower densities and other radioisotopes are being investigated in order to optimize this promising new therapy. Three major radiolabeled microsphere materials, viz. glass, resin-based and polymer-based, are now available for therapy or are being tested in animals. In this review the preparation, stability and degradation of these spheres are discussed.

MRNA expression of three glycosyltransferases in human hepatoma tissues

Background: The sugar-chain structures of many glycoproteins are altered in the hepatoma tissues. The molecular mechanism by which these alterations occur remains largely unknown. Methods: Messeger RNA expression of N-acetylglucosaminyltransferase (GlcNAcT-V), N-acetylglucosaminyltransferase III (GlcNAcT-III) and α1–6 fucosyltransferase (α1–6 FucT), were investigated in normal liver tissues samples ( n=7), primary hepatic cancer (PHC) tissues ( n=15) and noncancerous tissues surrounding PHC ( n=15) by reverse transcriptase-polymerase chain reaction (RT-PCR). Results: The mRNA expression of the three glycosyltransferases in PHC tissues were enhanced by 3- to 10-fold in comparison with that in normal liver tissues. There were significantly higher mRNA expressions of GlcNAcT-V in invasive PHC than non-invasive. Conclusions: The change of glycoprotein sugar-chain structures in PHC may be related to the abnormal mRNA expression of some glycosyltransferases and the levels of mRNA expression of GlcNAcT-V associated with PHC invasiveness.

Peripheral Neuropathy And Monoclonal Igm Gammopathy: Clinical And Laboratory Data From A Neurological Unit In A General Hospital

BACKGROUND: It has been known for decades that monoclonal IgM gammopathies are associated with peripheral neuropathies. However, available data are from ultraspecialized laboratories, while little is reported about their epidemiology. PATIENTS AND mETHODS: Since 1988 we have recorded a registry of the patients referred for a peripheral neuropathy. Database included clinical, electrophysiological, laboratory, immunological and pathological data. All the patients were followed‐up with clinical visits or at least phone interview every six months. In case of death we evaluated death certificates and contacted general practitioners. Results: In the period from 1988–1999 we saw and followed‐up 512 patients with clinical ascertained peripheral neuropathy. Of those patients, 35 (6.8%) had a MGUS: 18 IgG, 10 IgM, and 7 IgA. The patients with IgM paraprotein were all men, except 1 woman, aged 48 to 71 years at the onset of symptoms. Eight patients had a predominantly sensitive neuropathy and two patients a motor neuropathy. Of the 8 patients with sensitive neuropathy, 3 had a demyelinating disease and antiMAG antibodies, 4 an axonal disease and antisulphatide antibodies, and 1 an axonal neuropathy with both antiMAG and antisulphatide antibodies. The two patients with motor neuropathy had both an axonal disease and anti‐GM1 antibodies. The patients with sensory neuropathy were treated with periodic plasmaphoresis plus i.v. cyclophosphamide every 4–6 months. The patients with motor neuropathy were treated every month with i.v. immunoglobulins alternated with i.v. cyclophosphamide. Follow‐up of those patients lasted 12 to 108 months. Four patients died: 3 with antisulfatide antibodies because of a developing cancer (2 a primary hepatic cancer and 1 a bladder neoplasm) and 1 with anti‐GM1 antibodies for respiratory failure. The remaining patients showed a slowly progressive invalidating disease especially with the loss of hand ability. Conclusions: The patients with monoclonal IgM gammopathy are a minority among those observed because of a peripheral neuropathy in a General Hospital. Prognosis is severe either because of growing dependency or of life shortening (directly or for developing cancer). Aggressive therapies probably deserve multicentric studies.

MR-guided microwave ablation therapy for hepatic tumor through multiple access route

Microwave Ablation is one of the useful treatments of hepatic tumor. It has been used as an interventional device for thermoablation therapy under ultrasonographic or laparoscopic guidance. We have done clinical studies of MR-guided microwave ablation therapy of hepatic tumors since January 2000. From January through September 2000, 18 patients with liver tumors were hospitalized in the 1st Department of Surgery at Shiga University of Medical Science. There were 13 cases of metastatic hepatic tumor. All of which had previously had primary surgery. The other 5 cases were primary hepatic cancer. All patients were selected because percutaneous ethanol injection therapy (PEIT) or transcathetal arterial embolization (TAE) was ineffective, and surgical resection could not be done because of hepatic dysfunction.We had already performed MR-guided microwave ablation therapy to hepatic tumors located in every segment of the liver. However, percutaneous puncture of the tumors in the subphrenic area was not easy with the abdominal approach. In these cases, a combination of thoracoscopic and MR-guidance has been beneficial. MR compatible endoscope made us easily to puncture hepatic tumors located in every segment of the liver. MR-guided microwave ablation therapy is a feasible treatment for hepatic tumors.

Clinical evaluation of several tumor markers in the diagnosis of primary hepatic cancer

Clinical evaluation of several tumor markers in the diagnosis of primary hepatic cancer