Journal of Liver Cancer

Volume 15(1); March 2015

Review Articles

Beyond BCLC in the management of patients with HCC 수술적 치료의 적응증: Dong-Sik Kim; J Liver Cancer. 2015;15(1):1-3. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.1

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Abstract PDF: Although surgical resection can provide best treatment outcome with curative intent, patients with relatively early stage of hepatocellular carcinoma (HCC) can get benefit of this treatment. Barcelona Clinic Liver Cancer (BCLC) staging system limits surgical resection to patients with single HCC with well-preserved liver function, which is often challenged in real practice, especially from Asian countries. During last two decades, surgical outcomes have made remarkable progress approaching zero mortality in many reports. In this review, areas that surgical indications can be expanded beyond BCLC staging system will be discussed, especially in Asian population. (Journal of Liver Cancer 2015;15:1-3)

Surgical Perspectives of Hepatocellular Carcinoma beyond the Barcelona Clinical Liver Cancer Guideline; Focusing on Liver Transplantation: Nam-Joon Yi, Gwang-Woong Lee, Kyoung-Suk Suh; J Liver Cancer. 2015;15(1):4-10. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.4

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Abstract PDF: The management of hepatocellular carcinoma (HCC) is decided according to the evidence base recommendations generated by international societies especially by Barcelona clinical liver cancer (BCLC) guideline. However, the BCLC guideline based on studies of the Western countries, has not been well matched to real life cohort in Korea. In Western countries, a deceased donor liver transplantation has been well allocated to the HCC patients with preserved liver function. Patients with mild to moderate portal hypertension and certain BCLC B patients could be eligible for hepatic resection if a chance for 50% survival rate at 5 years is perceived. If liver transplantation (LT) is back up for liver resection in those patients as a salvage therapy, widening indication of liver resection could be much easily acceptable. On the other hands, new selection criteria of HCC beyond Milan criteria considering tumor biology, has been provided in the field of LT resulting in more than 50% survival rate at 5 years. Herein, surgical perspectives beyond the BCLC recommendation for LT for HCC would be reviewed in the respect of Korean surgeon’s view in this article.

Role of Yttrium-90 Radioembolization in the Management of Hepatocellular Carcinoma: Do Young Kim; J Liver Cancer. 2015;15(1):11-18. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.11

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Abstract PDF: Yttrium-90 radioembolization has emerged as a novel therapy for hepatocellular carcinoma (HCC) of intermediate or advanced stage. Yttrium-90 has characteristics of short half-life and tissue penetration depth. Potent anti-cancer effect by this isotope enables to kill the tumor for 6 months after administration. Although transarterial chemoembolization (TACE) is the standard modality for multinodular HCC without vascular invasion, big size or numerous nodules does not allow enough treatment effect of TACE. Post-embolization syndrome resulting poor quality of life, liver dysfunction and hepatic arterial damage are other pitfalls of TACE. In several studies, radioembolization showed survival comparable to TACE, shorter hospital stay and less treatment sessions. In advanced HCC with portal vein invasion, radioembolization demonstrated similar or better survival compared with sorafenib. The atrophy of lobe treated by radioembolization and hypertrophy in the contralateral lobe can be called radiation lobectomy, which makes it possible to perform a following curative therapy. The role of radioembolization in unresectable HCC in terms of downstaging or bridge to transplantation needs to be further studied. Radioembolization is contraindicated in HCC patients with main portal vein occlusion and with poor liver function. The International guidelines for HCC have some limitations and thus rooms for radioembolization to be incorporated.

Original Articles

Transarterial Chemoembolization versus Radiofrequency Ablation for Small Hepatocellular Carcinomas with Discrepant Features on Computed Tomography and Magnetic Resonance Imaging: Young Youn Cho, Jung Hee Kwon, Jeong-Hoon Lee, Jeong Min Lee, Jae Young Lee, Hyo-Choel Kim, Jin Wook Chung, Won-mook Choi, Eun Ju Cho, Yoon Jun Kim, Jung-Hwan Yoon, Chung Yong Kim, Hyo-Suk Lee; J Liver Cancer. 2015;15(1):19-29. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.19

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Abstract PDF: Background/Aims
This study compared the outcomes of patients with small hepatocellular carcinomas (HCCs) who were treated using transarterial chemoembolization (TACE) or radiofrequency ablation (RFA).
Methods
This was a post-hoc analysis of a prospective study that evaluated the diagnostic efficacy of magnetic resonance imaging (MRI) and computed tomography (CT). We analyzed 41 small hepatic nodules in 32 patients that showed typical radiologic hallmarks on both CT and gadoxate-enhanced MRI (typical nodules) and 25 small hepatic nodules from 22 patients that showed atypical radiologic hallmarks on CT and typical radiologic hallmarks on MRI (discrepant nodules).
Results
There were no significant differences in the baseline characteristics of the patients with typical and discrepant nodules. Complete response rates 1 month after TACE or RFA were 75.0% (18/24) and 94.1% (16/17; P=0.20), respectively, for the patients with typical nodules and 58.8% (10/17) and 100% (8/8; P=0.05), respectively, for the patients with discrepant nodules. Treatment failure rates after TACE or RFA were 33.3% (8/24) and 5.8% (1/17; P=0.15), respectively, for the patients with typical nodules and 47.0% (8/17) and 0.0% (0/8; P=0.02), respectively, for the patients with discrepant nodules. Among patients achieving complete response, there were no significant differences in the risk of marginal recurrence.
Conclusions
RFA provided higher complete response rates and significantly lower treatment failure rates than TACE for patients with discrepant nodules of HCC. Therefore, a treatment modality such as RFA may be preferable for small HCCs which show discrepancy on two imaging modalities.

Loss of Liver Fatty Acid Binding Protein Expression in Hepatocellular Carcinomas is Associated with a Decreased Recurrence-Free Survival: Haeryoung Kim, Hyejung Lee, Young Nyun Park; J Liver Cancer. 2015;15(1):30-35. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.30

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Abstract PDF

Background/Aims
Loss of liver fatty acid binding protein (LFABP) expression by immunohistochemistry is a useful marker for the identification of hepatocyte nuclear factor 1α (HNF1α)- inactivated hepatocellular adenomas; however, the expression status of LFABP in hepatocellular carcinomas (HCCs) is still unclear. We aimed to investigate the expression status of LFABP in HCCs and examine the clinicopathological characteristics of LFABP-negative HCCs.
Methods
Immunohistochemical stains LFABP, K19 (mouse monoclonal, Dako, Glostrup, Denmark) and EpCAM (mouse monoclonal, Calbiochem, Darmstadt, Germany) were performed on tissue microarray sections from 188 surgically resected HCCs, and the association between LFABP expression status and the clinicopathological features, survival and “stemness”-related marker expression status were analyzed.
Results
Loss of LFABP expression was noted in 30 (16%) out of 188 HCCs. LFABP-negative HCCs were associated with a decreased recurrence-free survival (LFABP-negative: 17.0 ± 4.84 months [95% confidence interval [CI]: 7.5–26.5 months] versus LFABP-positive: 51.0 ± 8.7 months [95% CI: 34.0–68.0 months]; P=0.004). HCCs with LFABP expression loss were more frequently larger and showed more frequent vascular invasion, although not statistically significant; and an inverse correlation was seen between LFABP expression and K19 expression status (P=0.001).
Conclusions
Loss of LFABP expression is seen in HCCs, and is associated with a decreased recurrence-free survival.

Citations

Citations to this article as recorded by

Hepatocellular adenomas: recent updates
Haeryoung Kim, Young Nyun Park
Journal of Pathology and Translational Medicine.2021; 55(3): 171. CrossRef

Case Reports

Hemangioma Diagnosed by Gadoxetate Disodium-Enhanced MRI in a Patient with Chronic Hepatitis C: Jin Won Mo, Soo Hyung Ryu, Dong Won Park, Won Jae Yoon, Jin Nam Kim, Jeong Seop Moon, Jae-Chan Shim; J Liver Cancer. 2015;15(1):36-40. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.36

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Abstract PDF: A hemangioma is the most common benign hepatic tumor. Many hepatic hemangioma tend to be found incidentally, but should be differentiated from malignant tumors, especially in patients with a high risk for malignancy. We presented a 52-year-old woman who diagnosed as hepatic hemangioma. The patient was a chronic alcohol abuser and diagnosed as a hepatic C virus carrier for the first time. Contrast enhanced abdominal computed tomography (CT) revealed a 4cm sized hepatic mass involving both segment 5 and 6. Abdominal CT finding suggested hepatic hemangioma, but could not rule out the malignancy. Because the patient had risk factors for hepatocellular carcinoma, abdominal ultrasonography (US) was performed for further evaluation. But abdominal US also showed atypical finding. For the confirmative diagnosis, dynamic magnetic resonance imaging using gadoxetate disodium (primovist®, Bayer HealthCare, Berlin, Germany) which is the innovative liver cell-specific contrast medium was done, and the patient was diagnosed as hepatic hemangioma.

A Case of Extrahepatic Metastasis of Hepatocellular Carcinoma to the Pronator Quadratus Muscle of Right Wrist: Yonng Wook Song, Byung seok Lee, Seok Hyun Kim, Eaum seok Lee, Heon Young Lee; J Liver Cancer. 2015;15(1):41-45. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.41

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Abstract PDF: Hepatocellular carcinoma (HCC) is usually associated with chronic liver disease such as liver cirrhosis. Primary HCC lesions and even recurrent intrahepatic lesions can be treated successfully by using variable modalities applicable to intrahepatic lesions. HCC can cause intrahepatic multiple occurrence and extrahepatic metastasis. Extrahepatic metastasis occurs in up to about 60% of patients of HCC, and a major of patients with extrahepatic HCC had late intrahepatic stage of tumor. Themost frequent site of extrahepatic metastasis of HCC was the lung. HCC metastasized to soft tissues was unusually reported. Extrahepatic metastasis of HCC, especially to unusual site, should not be overlooked and must be able to be controlled. We experienced a case that HCC was metastasized to the pronator quadratus muscle of right wrist and chould be removed surgically.

Spontaneous Regression of Recurred Hepatocellular Carcinoma with Multiple Lung Metastases: Beom Yong Yoon, Heon Young Lee, Se Woong Hwang, Se Young Park, Hye Jin Kim, Hye Won Jang,, Byung Seok Lee; J Liver Cancer. 2015;15(1):46-51. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.46

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Abstract PDF: Hepatocellular carcinoma (HCC) is the most common form of liver malignancy. Spontaneous regression of HCC is extremely rare phenomenon and mechanism of regression remains obscure. 75-year-old woman previously diagnosed with hepatitis C virus-related liver cirrhosis was found to have single mass in liver with elevation of α-fetoprotein level to 10,320 ng/mL. Transarterial chemoembolization (TACE) was performed. 27 months after TACE recurred HCC with multiple lung nodules were confirmed. The patient refused any therapeutic modality. The patient underwent follow-up without any anti-cancer treatment. 8 months after recurrence follow up computed tomography scan revealed spontaneous regression of HCC and completely disappeared lung nodules. The patient is currently doing well and without any evidence of recurrence. The causes of spontaneous regression of HCC are not well understood. Proposed mechanisms are ischemic injury, biological factors, herbal medicine, immunological variations. Further studies are necessary to improve our understanding of this rare phenomenon.

A Case of Concurrent Chemoradiation Therapy for Locally Advanced Hepatocellular Carcinoma with Portal Vein Thrombosis: Tae Young Yang, Suk Pyo Shin, Joo Ho Lee, Yun Bin Lee, Hana Park, Seong Gyu Hwang, Kyu Sung Rim; J Liver Cancer. 2015;15(1):52-56. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.52

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Abstract PDF: Patients with advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) have an extremely poor prognosis. Although the Barcelona Clinic Liver Cancer guideline recommends sorafenib in advanced HCC with PVT, which has provided survival benefits of 2 or 3 months compared to the placebo group, many liver cancer centers in Asia still select multimodality approaches including transarterial chemoembolization, radiofrequency ablation, radiation therapy (RT) as well as systemic/intra-arterial chemotherapy. Recently advanced RT technologies have shown potential to improve survival without severe radiationrelated toxicity. For locally advanced HCC patients with PVT, concurrent chemoradiotherapy (CCRT) has been applied as a loco-regional treatment and provides potential cures. We herein report our recent experience of a patient accompanying large HCC with PVT who successfully undergone CCRT followed by hepatic arterial infusion chemotherapy.

3 Cases of Portal Vein Thrombosis in Hepatocellular Carcinoma and Liver Cirrhosis Treated with Anticoagulation: Byung Moo Ahn, Eaum Seok Lee, Seok Hyun Kim, Byung Seok Lee, Heon Young Lee; J Liver Cancer. 2015;15(1):57-63. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.57

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Abstract PDF

The reported prevalence of PVT is in the range of 0.6-15.8% in patient with liver cirrhosis or portal hypertension. If the patient has hepatocellular carcinoma, thrombus is likely to be malignant thrombus. Malignancy, frequently of hepatic origin, is responsible for 21-24% of over all cases. The overall mortality rate of chronic PVT has been reported to be less than 10%, but is increased to 26% when associated with hepatocellular carcinoma and cirrhosis. However, no treatment guideline has been established on anticoagulant therapy for PVT in patients with concomitant hepatocellular carcinoma and cirrhosis. Because actually it is not easy to distinguish between malignant thrombus and benign thrombus in clinical aspect, PVT in hepatocellular carcinoma are still debatable whether or not treatment when it diagnosed. We present 3 cases of portal vein thrombosis successfully treated with anticoagulation in hepatocellular carcinoma and liver cirrhosis, and we include a literature review.

Citations

Citations to this article as recorded by

Evaluation of Low-Molecular-Weight Heparin for Treatment of Portal Vein Thrombosis in Liver Cirrhosis Patients
Ji Min Han, Youngil Koh, Sung Hwan Kim, Sung Yun Suh, Yoon Sook Cho, Jeong-Hoon Lee, Su Jong Yu, Jung-Hwan Yoon, Hye Sun Gwak
Medicina.2023; 59(2): 292. CrossRef

A Case of Achieving Complete Remission with Combination of Stereotactic Body Radiation Therapy and Transarterial Chemoemoblization in Patients with 4.8 cm Sized Infiltrative Hepatocellular Carcinoma with Arteriovenous Shunt: Sang Youn Hwang, Seon-Mi Lee, Jung Woo Im, Joon Suk Kim, Ki Jeong Jeon, Sang Bu Ahn, Eun Kyeong Ji, Hyun-Cheol Kang, Cheol-Won Chol, Gwang-Mo Yang; J Liver Cancer. 2015;15(1):64-69. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.64

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Abstract PDF: Infiltrative hepatocellular carcinoma (HCC) patients have a poor prognosis because most patients present with advanced disease. Although tumor size is small, ablation therapy is difficult because it is difficult to delineate tumor boundary and tumor often combined vascular invasion. Therefore many clinicians still try locoregional therapy (LRT) such as transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT and sorafenib in this situation. Stereotactic body radiation therapy (SBRT) is new technology providing very highly conformal ablative radiation dose and is expected to salvage modality for HCC showed incomplete response of TACE due to combined arteriovenous (AV) shunts. Based on above suggestions, we herein offer our experience of a complete remission of tumor by combination of SBRT and TACE in a patient with infiltrative HCC. Further study, maybe regarding a combination of locoregional and systemic therapy is necessary on how to manage infiltrative HCC with AV shunts.

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