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Volume 18(2); September 2018
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Review Articles
Hepatocellular Carcinoma Prediction Models for Patients with Chronic Hepatitis B Virus Infection in the Era of Potent Antiviral Therapy
Lee, Hye Won , Kim, Beom Kyung
J Liver Cancer. 2018;18(2):87-93.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.87
  • 2,482 Views
  • 112 Downloads
  • 4 Citations
AbstractAbstract PDF
Appropriate prediction of hepatocellular carcinoma (HCC) development is of paramount importance in terms of decision on antiviral therapy and HCC surveillance. To date, many HCC risk prediction models had been derived based on well-known risk factors such as age, male gender, the degree of fibrosis, and serum hepatitis B virus (HBV)-DNA load. Overall, such models showed high negative predictive values of approximately >90%, excluding the possibility of HCC development in 3 to 10 years with considerable accuracy. On the other hands, on the basis that potent antiviral therapy can substantially reduce the risk of HCC, its indications are steadily getting expanded for prevention of disease progression. Since antiviral therapy is a very strong disease modifier, the uniform application of HCC risk scores developed before the era of potent antiviral therapy would overestimate the risk of HCC. Furthermore, the tools to assess the fibrotic burden have remarkably evolved, from subjective determination based upon clinical symptom sign and ultrasonographic finding to more objective and delicate non-invasive tests based upon imaging and/or serological methods. Therefore, in the current era of potent antiviral therapy, the clinical significance of recently developed HCC risk models for patients with chronic HBV infection should be reappraised further.

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  • External validation of CAGE‐B and SAGE‐B scores for Asian chronic hepatitis B patients with well‐controlled viremia by antivirals
    Jung Hyun Ji, Soo Young Park, Won Jeong Son, Hye Jung Shin, Hyein Lee, Hye Won Lee, Jae Seung Lee, Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Beom Kyung Kim
    Journal of Viral Hepatitis.2021; 28(6): 951.     CrossRef
  • An optimized hepatocellular carcinoma prediction model for chronic hepatitis B with well‐controlled viremia
    Hye W. Lee, Soo Y. Park, Myeongjee Lee, Eun J. Lee, Jinae Lee, Seung U. Kim, Jun Y. Park, Do Y. Kim, Sang H. Ahn, Beom K. Kim
    Liver International.2020; 40(7): 1736.     CrossRef
  • External validation of the modified PAGE‐B score in Asian chronic hepatitis B patients receiving antiviral therapy
    Hye Won Lee, Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang‐Hyub Han, Beom Kyung Kim
    Liver International.2019; 39(9): 1624.     CrossRef
  • Changes in real-life practice for hepatocellular carcinoma patients in the Republic of Korea over a 12-year period: A nationwide random sample study
    Beom Kyung Kim, Do Young Kim, Kwang-Hyub Han, Jinsil Seong, Jung Weon Lee
    PLOS ONE.2019; 14(10): e0223678.     CrossRef
Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma
Jung, Jinhong , Yoon, Sang Min
J Liver Cancer. 2018;18(2):94-102.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.94
  • 1,688 Views
  • 78 Downloads
AbstractAbstract PDF
With recent remarkable technological advances in radiation therapy, stereotactic body radiation therapy (SBRT) is regarded as an alternative treatment option for hepatocellular carcinoma (HCC) that is not suitable for curative treatment. Several prospective and retrospective studies on the use of SBRT in patients with HCC showed promising results. Furthermore, on-going prospective studies are examining the role of SBRT as a single ablative modality or a combination treatment in patients with HCC. Here, we summarize previous studies and recent updates and discuss the future perspectives of SBRT for HCC.
Treatment and Surveillance of Hepatocellular Carcinoma in Elderly Patients
Rho, Seoung Yoon , Lee, Hyun Woong , Kim, Kyung Sik
J Liver Cancer. 2018;18(2):103-114.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.103
  • 1,556 Views
  • 54 Downloads
AbstractAbstract PDF
Hepatocellular carcinoma (HCC) is the third most common cancer in the digestive system based on survey of domestic cancer incidence, and the ratio of elderly aged 65 or older is expected to rise steadily, leading to a higher incidence of total hepatocellular carcinoma. The most important thing in treating these older patients with HCC is to assess the benefits and risks of the treatment in advance. In other words, the benefit of treatment should be greater than the reduction of survival period or maladjustment due to treatment. Based on these perspectives, we examined how the detailed treatment of hepatocellular carcinoma differs from that of general treatment in elderly patients. In conclusion, older age was not a definite prognostic factor of survival risk-benefit comparison in the most treatment modalities. However it should be carefully considered and approached about possible complications in treating HCC in elderly patients.
Original Articles
Postoperative Chemoradiotherapy for R1 Resected Intrahepatic Cholangiocarcinoma
Kim, Kyung Su , Kim, Hwi Young , Kim, Kyubo , Yi, Nam Joon , Suh, Kyung Suk , Chie, Eui Kyu
J Liver Cancer. 2018;18(2):115-120.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.115
  • 1,796 Views
  • 63 Downloads
  • 1 Citation
AbstractAbstract PDF
Background
/Aims: To investigative the potential role of postoperative chemoradiotherapy (CCRT) after R1 resection of intrahepatic cholangiocarcinoma (IHCC).
Methods
Between January 2000 and December 2012, medical records of 18 patients who underwent curative surgery with R1 resection for IHCC were retrospectively reviewed.
Results
Median age was 68 years and 12 patients (66.7%) were male. Median tumor size was 5.0 cm (range, 2.2-11.0) and 12 patients (66.7%) had T3 or higher disease. Lymph nodes were involved in four patients (22.2%). Vascular invasion and perineural invasion were present in 10 (55.6%) and 12 patients (66.7%), respectively. Postoperative CCRT given with 5-fluorouracil or gemcitabine were delivered to 7 patients (38.9%). Median radiation dose was 50.4 Gy (range, 45-54). Univariate analysis showed that median loco-regional recurrence-free survival (LRRFS), progression-free survival (PFS) and overall survival (OS) were prolonged for patients treated with CCRT (median LRRFS; 5.6 months vs. not reached, P<0.001, median PFS; 5.6 vs. 8.3 months, P=0.047, median OS; 15.0 vs. 26.6 months, P=0.064).
Conclusions
Postoperative CCRT improved the loco-regional control and PFS in IHCC patients with R1 resection. Further study is warranted to validate the role of postoperative CCRT for these patients.

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  • Stereotactic radiotherapy for intrahepatic cholangiocarcinoma
    Aditya Borakati, Farid Froghi, Ricky H Bhogal, Vasileios K Mavroeidis
    World Journal of Gastrointestinal Oncology.2022; 14(8): 1478.     CrossRef
Transarterial Chemolipiodolization for Hepatocellular Carcinoma with Central Bile Duct Invasion Causing Conjugated Hyperbilirubinemia: Safety and Prognostic Factors for Survival
Yang, Keungmo , Sung, Pil Soo , Oh, Jung Suk , Chun, Ho Jong , Jang, Jeong Won , Bae, Si Hyun , Choi, Jong Young , Yoon, Seung Kew
J Liver Cancer. 2018;18(2):121-129.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.121
  • 1,524 Views
  • 33 Downloads
  • 2 Citations
AbstractAbstract PDF
Background
/Aims: The treatments and outcomes of hepatocellular carcinoma (HCC) with bile duct invasion are not well known. We aimed to confirm the safety of transarterial chemolipiodolization (TACL) and identify prognostic factors for patients with bile duct invasion treated with TACL.
Methods
Fifty patients with central bile duct invasion treated with TACL between 2005 and 2017 were enrolled. Patients were divided into three groups: hyperbilirubinemia (total bilirubin ≥2.5 mg/dL) with pre-TACL biliary drainage, hyperbilirubinemia without biliary drainage, and without hyperbilirubinemia. Tumor response to TACL, survival outcomes, length of hospitalization, adverse events using Common Terminology Criteria for Adverse Events (CTCAE), and factors affecting overall survival were compared.
Results
TACL-induced changes of mean CTCAE grades for albumin, alanine aminotransferase, creatinine, prothrombin time, and platelet were not significantly different among patients with or without initial hyperbilirubinemia. Serum bilirubin level was not significantly changed after TACL in all the three groups. Overall survival was not significantly different among the three groups (P=0.097). On multivariate analysis, alpha-fetoprotein <400 ng/dL (hazard ratio [HR]=0.477, P=0.048) and highest total bilirubin level of <2.5 mg/dL within one month after TACL (HR=0.335, P=0.004) were significantly associated with longer survival.
Conclusions
TACL was a safe treatment for HCC patients with central bile duct invasion, irrespective of the presence of initial hyperbilirubinemia.

Citations

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  • Proton Beam Therapy in Managing Unresectable Hepatocellular Carcinoma with Bile Duct Invasion
    Ching-Hsin Lee, An-Hsin Chen, Sheng-Ping Hung, Cheng-En Hsieh, Jeng-Hwei Tseng, Po-Jui Chen, Jen-Yu Cheng, Joseph Tung-Chieh Chang, Kun-Ming Chan, Shi-Ming Lin, Chen-Chun Lin, Wei-Ting Chen, Wan-Yu Chen, Bing-Shen Huang
    Cancers.2022; 14(7): 1616.     CrossRef
  • An Analysis for Survival Predictors for Patients with Hepatocellular Carcinoma Who Failed to Sorafenib Treatment in Pre-regorafenib Era
    Chan Uk Lee, Young-Sun Lee, Ji Hoon Kim, Minjin Lee, Sehwa Kim, Young Kul Jung, Yeon Seok Seo, Hyung Joon Yim, Jong Eun Yeon, Kwan Soo Byun
    Journal of Liver Cancer.2019; 19(2): 117.     CrossRef
Multicenter Planning Comparison of Stereotactic Body Radiotherapy for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombosis (KROG 16-17)
Bae, Sun Hyun , Kim, Mi Sook , Jang, Won Il , Kim, Jin Ho , Kim, Woo Chul , Kim, Jin Hee , Jeong, Bae Kwon , Kim, Yong Ho , Jo, Sunmi , Choi, Chul Won , Park, Younghee , Cho, Kwang Hwan
J Liver Cancer. 2018;18(2):130-141.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.130
  • 3,426 Views
  • 47 Downloads
  • 1 Citation
AbstractAbstract PDF
Background
/Aims: To evaluate the technical feasibility of stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) with the major portal vein tumor thrombosis (PVTT).
Methods
Ten institutions affiliated with the Korean Stereotactic Radiosurgery Group were provided the contours of four cases: the first case was the first branch PVTT with sufficient normal liver volume (NLV), the second was the first branch PVTT with insufficient NLV, the third was the main trunk PVTT at confluence level, and the fourth was the main trunk PVTT with entire length. The institutions were asked to make SBRT plans according to their current treatment protocols and to complete facility questionnaires.
Results
Based on institutional protocols, SBRT was feasible in nine institutions for the first case (32-60 Gy in 3-5 fractions), in eight institutions for the second case (32-50 Gy in 3-5 fractions), in seven institutions for the third case (35-60 Gy in 3-5 fractions), and in four institutions for the fourth case (35-42 Gy in 4-5 fractions). The other institutions recommended hypo- or conventional fractionation due to insufficient NLV or gastrointestinal organ proximity. With analysis of the SBRT dose to the central hepatobiliary tract, the major PVTT could theoretically be associated with a high risk of hepatobiliary toxicity.
Conclusions
Although SBRT is a technically feasible option for HCC with the major PVTT, there was a variability among the participating institutions. Therefore, further studies will be necessary to standardize the practice of SBRT for the major PVTT.

Citations

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  • Current status of stereotactic body radiotherapy for the treatment of hepatocellular carcinoma
    Jongmoo Park, Jae Won Park, Min Kyu Kang
    Yeungnam University Journal of Medicine.2019; 36(3): 192.     CrossRef
Case Reports
Sorafenib Treatment in Advanced Hepatocellular Carcinoma with Tumor Thrombus Nearly Occupying the Entire Right Atrium
Kang, Young Mo , Ryu, Soo Hyung , Lee, Bo Kyung , Ko, Kyoung Ho , Park, Tae Young , Moon, Jeong Seop , Cho, Seon Hwa
J Liver Cancer. 2018;18(2):142-145.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.142
  • 1,976 Views
  • 33 Downloads
  • 2 Citations
AbstractAbstract PDF
Advanced hepatocellular carcinoma (HCC) with tumor thrombus extending through the hepatic veins, inferior vena cava, and right atrium (RA) is very rare. However, whether active treatments such as radiation, transcatheter arterial chemoembolization, and sorafenib in advanced HCC with RA involvement prolong survival is uncertain. We present a rare case of advanced HCC with tumor thrombus nearly occupying the entire RA that was treated with sorafenib. The patient received 400 mg sorafenib twice daily. However, her liver enzyme levels continued to increase and abdominal computed tomography showed an increase in the tumor size in the liver and RA. In the present case, active treatment with sorafenib was ineffective; thus, palliative care may be more beneficial in advanced HCC with extensive RA involvement.

Citations

Citations to this article as recorded by  
  • Clinical outcome and toxicity of radiotherapy for inferior vena cava tumor thrombus in HCC patients
    So Jung Lee, Hong Seok Jang, Yoo Kyung Choi
    Medicine.2021; 100(25): e26390.     CrossRef
  • miR-4454 Promotes Hepatic Carcinoma Progression by Targeting Vps4A and Rab27A
    Haoming Lin, Rui Zhang, Wenrui Wu, Liming Lei, Grzegorz Węgrzyn
    Oxidative Medicine and Cellular Longevity.2021; 2021: 1.     CrossRef
The Natural Course of Hepatocellular Carcinoma in a Super-Elderly Patient
Park, Yoo Min , Choi, In Zoo , Shim, Jae Jun , Kim, Byung Ho
J Liver Cancer. 2018;18(2):146-150.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.146
  • 1,287 Views
  • 30 Downloads
AbstractAbstract PDF
As the mean life expectancy increases, the incidence of hepatocellular carcinoma (HCC) in superelderly patients (>85 years old) is expected to increase in Korea. However, their clinical features, treatments, and treatment outcomes are unclear. Herein, we present a case of a large single HCC and its natural course in an 86-year-old man who refused any treatment following histologic diagnosis.
A Case of Achieving Partial Remission with Sequential Treatment of Transarterial Chemoemoblization after Transarterial Radioembolization in Old Patient with Hepatocellular Carcinoma with Multiple Metastasis
Hwang, Sang Youn , Lee, Seon Mi , Im, Jung Woo , Jeon, Ki Jeong , Ahn, Sang Bu , Park, Jin Young
J Liver Cancer. 2018;18(2):151-156.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.151
  • 1,139 Views
  • 15 Downloads
AbstractAbstract PDF
The number of older adults with hepatocelluar carcinoma (HCC) has been increasing with longer life expectancy and earlier diagnosis and treatment. However, older patients have lesser function reserve of multiple organ systems, more disability rate. Therefore, the treatment of elderly HCC patients remains a challenge worldwide. Recently, studies suggests that the survival outcome of older patients may be comparable to that of younger patients and active treatment may achieve promising rates of local and systemic control in selected patients. Based on above suggestions, we herein offer our experience of a case achieved partial remission by sequential therapy of transarterial chemoembolization after transarterial radioemoblization in elderly HCC patient with multiple metastasis. Further study, maybe regarding a combination of locoregional and systemic treatment, is necessary on how to manage HCC in elderly patients.
A Case of Small Hepatocellular Carcinoma Who Showed Complete Response by Combined Therapy of Transarterial Chemoembolization and Stereotactic Body Radiotherapy
Cha, Jun Young , Jun, Baek Gyu , Gong, Eun Jeong , Seo, Hyun Il , Park, Jong Kyu , Lee, Sang Jin , Kim, Young Don , Han, Koon Hee , Jeong, Woo Jin , Cheon, Gab Jin , Choi, Won Sik
J Liver Cancer. 2018;18(2):157-161.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.157
  • 1,348 Views
  • 22 Downloads
AbstractAbstract PDF
In hepatocellular carcinoma (HCC), surgical resection or local ablation therapy is limited because of severe liver dysfunction or tumor location. Transarterial chemoembolization (TACE) has beed used widely as palliative treatment. Stereotactic Body Radiotherapy (SBRT) is a more recent and effective treatment for early stage HCC. We report a case with small HCC with complete response by TACE combined with SBRT.
Complete Remission with Transarterial Chemoembolization in a Patient with Hepatocellular Carcinoma Who Showed Early Recurrence following Surgical Resection
Kim, Hee Yeon , Kim, Chang Wook , Kim, Sungkeun , Lee, Soo Lim , Ku, Young Mi , Won, Yoo Dong
J Liver Cancer. 2018;18(2):162-167.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.162
  • 1,112 Views
  • 22 Downloads
AbstractAbstract PDF
Although surgical resection is a curative treatment option for solitary hepatocellular carcinoma, high recurrence rate contributes to dismal long-term prognosis after curative resection. Early recurrence within 2 years after surgery is associated with intrahepatic metastasis of primary tumor. Liver regeneration after hepatic resection can accelerate tumorigenesis in remnant liver. Treatment strategies for intrahepatic recurrence after curative resection include salvage transplantation, repeated resection, local ablation, and transarterial chemoembolization (TACE). Here, we report a 51-year-old male who was presented with a single large tumor located at segment 4. The patient was initially treated with surgical resection, but intrahepatic recurrence occurred only 4 months after surgery. He achieved complete remission with repeated TACE and has survived without recurrence for 4 years so far.
Multiple Hepatic Metastasis and Lymphatic Metastasis of Solid Pseudopapillary Neoplasm of Pancreas
Kim, You Gyung , Kim, Byung Ik , Kim, Seul Ki , Kim, Hak Soo , Kim, Hong Ju , Cho, Yong Kyun , Jeon, Yu Gyu
J Liver Cancer. 2018;18(2):168-174.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.168
  • 2,307 Views
  • 42 Downloads
  • 1 Citation
AbstractAbstract PDF
Solid pseudo-papillary neoplasm (SPN) of pancreas is a rare epithelial neoplasm of pancreas with a low malignant potential, occurs most commonly in young females. Here, we report a rare case of woman who has severe hepatomegaly due to multiple hepatic metastases of SPN of pancreas. At the time of diagnosis, a SPN was detected at only pancreas and there was no evidence of metastasis. So, she received subtotal pancreatectomy and total splenectomy. After 2 years of follow up, multiple small hepatic metastases were presented. In spite of three times of radiofrequency ablation, the burden of hepatic metastasis has increased continuously and multiple intra-abdominal lymph nodes metastases were detected, and ascites and peripheral edema occurred. However, because of benign feature of SPN and extremely rare incidence of recurrence and metastasis, there is no specific treatment guideline for metastatic SPN. Through multidisciplinary care service, we planned to do radiotherapy followed by a transarterial chemoembolization (TACE). But the patient could not have a scheduled radiation therapy due to deterioration of liver function. So changing the strategy of treatment, followed by TACEs were done alone. Although the size of SPN is not reduced, the extent of SPN and complication of SPN (ascites, peripheral edema, abdominal pain and so on) are being controlled.

Citations

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  • Solid Pseudopapillary Epithelial Neoplasm of the Pancreas in the Paediatric Population: A Report of Two Cases
    Ravi Maharaj, Nahmorah J Bobb, Christo Cave, Keshan V Ramnarace, Jamar Critchlow
    Cureus.2022;[Epub]     CrossRef

JLC : Journal of Liver Cancer