Background/Aim Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOBMRI) further enhances the identification of additional hepatic nodules compared with computed tomography (CT) alone; however, the optimal treatment for such additional nodules remains unclear. We investigated the long-term oncological effect of aggressive treatment strategies for additional lesions identified using EOB-MRI in patients with hepatocellular carcinoma (HCC).
Methods Data from 522 patients diagnosed with solitary HCC using CT between January 2008 and December 2012 were retrospectively reviewed. Propensity score-matched (PSM) analysis was used to compare the oncologic outcomes between patients with solitary HCC and those with additional nodules on EOB-MRI after aggressive treatment (resection or radiofrequency ablation [RFA]).
Results Among the 383 patients included, 59 had additional nodules identified using EOB-MRI. Compared with patients with solitary HCC, those with additional nodules on EOB-MRI had elevated total bilirubin, aspartate transaminase, and alanine transaminase; had a lower platelet count, higher MELD score, and highly associated with liver cirrhosis (P<0.05). Regarding long-term outcomes, 59 patients with solitary HCC and those with additional nodules after PSM were compared. Disease-free survival (DFS) and overall survival (OS) were comparable between the two groups (DFS, 60.4 vs. 44.3 months, P=0.071; OS, 82.8 vs. 84.8 months, P=0.986).
Conclusion The aggressive treatment approach, either resection or RFA, for patients with additional nodules identified on EOBMRI was associated with long-term survival comparable with that for solitary HCC. However, further studies are required to confirm these findings.
Hepatocellular carcinoma (HCC) with distant metastasis is an absolute contraindication for liver transplantation (LT). However, it is still unclear whether LT is feasible or acceptable in such patients, albeit after being treated with a multidisciplinary approach and after any metastatic lesion is ruled out. We report one such successful treatment with living donor LT (LDLT) after completely controlling far-advanced HCC with inferior vena cava tumor thrombosis and multiple lung metastases. The patient has been doing well without HCC recurrence for eight years since LDLT. The current patient could be an anecdotal case, but provides a case for expanding LDLT indications in the context of advanced HCC and suchlike.
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Small graft size and hepatocellular carcinoma outcomes in living donor liver transplantation: a retrospective multicentric cohort study Deok-Gie Kim, Shin Hwang, Kwang-Woong Lee, Jong Man Kim, Young Kyoung You, Donglak Choi, Je Ho Ryu, Bong-Wan Kim, Dong-Sik Kim, Jai Young Cho, Yang Won Nah, Man ki Ju, Tae-Seok Kim, Jae Geun Lee, Myoung Soo Kim, Alessandro Parente, Ki-Hun Kim, Andrea Schl International Journal of Surgery.2024;[Epub] CrossRef
Liver Transplant Beyond the Milan Criteria: Distant Metastases of Hepatocellular Carcinoma (Part II) N. E. Kostrygin, D. A. Valyakis, D. S. Chumachenko, V. V. Polovinkin Innovative Medicine of Kuban.2024; (4): 106. CrossRef
Inferior Vena Cava Thrombectomy and Stenting as Bridge to Liver Transplantation After Radiotherapy-Induced Thrombosis Raphael PH Meier, Shani Kamberi, Josue Alvarez-Casas, Barton F. Lane, Chandra S. Bhati, Saad Malik, William Twaddell, Kirti Shetty, Adam Fang, Hyun S. Kim, Daniel G. Maluf Progress in Transplantation.2023; 33(4): 356. CrossRef
Bun Kim, Jae Hoon Min, Seung Up Kim, Jun Yong Park, Kwang Hoon Lee, Do Youn Lee, Jin Sub Choi, Young Deuk Choi, Nam Hoon Cho, Young Nyun Park, Sang Hoon Ahn, Kwang Hyub Han, Chae Yoon Chon, Do Young Kim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):51-57. Published online February 28, 2012
Advanced hepatocellular carcinoma (HCC) is difficult to treat and the survival is poor. Here, we present a patient diagnosed as
advanced HCC (stage IIIa) which was supervening with early renal cell cancer (stage I). The patient was treated with
pre-operational transarterial chemoembolization (TACE) and surgical resection (right hepatectomy, right nephrectomy, and
cholecystectomy). Sorafenib were taken continually after surgery. Multiple recurred HCC nodules in remnant liver were detected
2 months later after surgery. Combined treatment modalities including 4 sessions of TACE, and 12 cycles of 5-flurouracil
(FU)/carboplatin based hepatic arterial infusional chemotherapy (HAIC) induced complete response. After the diagnosis of
advanced HCC, the patient survived 36 months and experienced disease-free status for 19 months.
Hepatocellular carcinoma (HCC) in pregnancy is very rare. The cirrhosis which is present in the majority of patients with
HCC induces infertility. The diagnostic methods and treatment modalities in HCC during pregnancy are different from those
of usual types of other HCC. A 26-year-old, 32th-gestational-week pregnant female was sent to our hospital because of
abnormal liver function test. A 1.5cm sized mass was identified in segment 6 of liver which was compatible to AJCC stage
I. She did not have any other medical history except Hepatitis B Virus carrier and the HBs Ag of her mother also was
positive. At the 40th gestational week, the female baby was delivered uneventfully. And then she underwent the transarterial
chemoembolization (TACE) following the Rt. Hemihepatectomy. Since she underwent a surgical resection, the tumors have
been recurred in the remnant liver only. Whenever the tumors were founded, the aggressive surgical approaches were
performed including 3 times of hepatic resection with TACE or TACI. She is still alive with good general condition and
normal liver function for 9 years since the first diagnosis was made. Therefore an extremely rare case of hepatocellular
carcinoma in pregnancy is treated successfully because of aggressive therapies.
A 64-year-old male was admitted due to liver mass. He had radical prostatectomy owing to prostate cancer 5 years ago. At that time, the liver mass was found on the right posterior superior segment and had enlarged to 7 cm in diameter at Nov. 2001. The transhepatic chemoembolization with adriamycin 50 mg and gelform was performed but the viable portions of tumor were remained. Total bilirubin was 0.7 mg/dL, Albumin 2.9 g/dL, AST/ALT 24/18 IU/L and AFP 60.31 ng/mL. The ICG R15 was 6.2%. The right lobectomy of liver was done and the pathologic results were sarcomatoid hepatocellular carcinoma. The level of AFP was decreased 2 month after operation but the patient was dead 4 month after operation because of the metastasis to the right psoas muscle and suspected peritoneal seeding.