Journal of Liver Cancer

Original Article

Role of transarterial chemoembolization for hepatocellular carcinoma with extrahepatic metastases in the era of advancing systemic therapy: Byeong Geun Song, Myung Ji Goh, Wonseok Kang, Dong Hyun Sinn, Geum-Youn Gwak, Yong-Han Paik, Joon Hyeok Lee, Moon Seok Choi; Received March 5, 2024 Accepted May 26, 2024 Published online June 3, 2024; DOI: https://doi.org/10.17998/jlc.2024.05.26 [Epub ahead of print]

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Abstract PDF Supplementary Material: Backgrounds/Aims
Systemic therapy is the current standard treatment for hepatocellular carcinoma (HCC) with extrahepatic metastasis (EHM). However, some patients with HCC and EHM undergo transarterial chemoembolization (TACE) to manage intrahepatic tumors. Herein, we aimed to explore the appropriateness of TACE in patients with HCC and EHM in an era of advanced systemic therapy.
Methods
This study analyzed 248 consecutive patients with HCC and EHM (median age, 58.5 years; male, 83.5%; Child-Pugh A, 88.7%) who received TACE or systemic therapy (83 sorafenib, 49 lenvatinib, 28 immunotherapy-based) between January 2018 and January 2021.
Results
Among the patients, 196 deaths were recorded during a median follow-up of 8.9 months. Patients who received systemic therapy had a higher albumin-bilirubin grade, elevated tumor markers, an increased number of intrahepatic tumors, larger-sized tumors, and more frequent portal vein invasion than those who underwent TACE. TACE was associated with longer median overall survival (OS) than sorafenib (15.1 vs. 4.7 months; 95% confidence interval [CI], 11.1-22.2 vs. 3.7-7.3; hazard ratio [HR], 1.97; P<0.001). After adjustment for potential confounders, TACE was associated with statistically similar survival outcomes to those of lenvatinib (median OS, 8.0 months; 95% CI, 6.5-11.0; HR, 1.21; P=0.411) and immunotherapies (median OS, 14.3 months; 95% CI, 9.5-27.0; HR, 1.01; P=0.973), demonstrating survival benefits equivalent to these treatments.
Conclusions
In patients with HCC and EHM, TACE can provide a survival benefit comparable to that of newer systemic therapies. Accordingly, TACE remains a valuable option in this era of new systemic therapies.

Case Report

Advanced Stage Hepatocellular Carcinoma Successfully Treated with Transarterial Radioembolization and Multi-tyrosine Kinase Inhibitor Therapy: Myung Ji Goh, Wonseok Kang, Dong Hyun Sinn, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik; J Liver Cancer. 2020;20(2):160-166. Published online September 30, 2020; DOI: https://doi.org/10.17998/jlc.20.2.160

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Abstract PDF: Transarterial radioembolization (TARE) with yttrium-90 microspheres has become widely utilized in managing hepatocellular carcinoma (HCC). The utility of TARE is expanding with new insights through experiences from real-world practice and clinical trials, and recently published data suggest that TARE in combination with sorafenib may improve the overall survival in selected patients. Here, we report a case of advanced stage HCC that was successfully treated with TARE and sorafenib. The patient achieved complete response (CR) at 12 months after the initial treatment with TARE and sorafenib, followed by additional transarterial chemoembolization and proton beam therapy for local tumor recurrence at 19-month post-TARE. The patient was followed up every 3 months thereafter and still achieved CR both biochemically and radiologically for the following 12 months. A combination strategy of TARE and systemic therapy may be a useful alternative treatment option for selected patients with advanced stage HCC.

Original Article

Cause of Mortality for Hepatocellular Carcinoma Patients who were Diagnosed within the Milan Criteria: Hyun-Woo Lee, Dong Hyun Sinn, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik; J Liver Cancer. 2016;16(2):101-107. Published online September 30, 2016; DOI: https://doi.org/10.17998/jlc.16.2.101

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7 Citations

Abstract PDF

Background/Aims
Hepatocellular carcinoma (HCC) is a unique condition where the cause of death might not only be due to progressive cancer, but also from liver failure. We evaluated specific causes of death for HCC patients who were initially diagnosed within the Milan criteria.
Methods
A retrospective cohort of 147 patients with mortality who were initially diagnosed with HCC within the Milan criteria between January 2008 and December 2012 at a single institution was reviewed.
Results
During follow-up, 104 patients (70.7%) experienced one or more cirrhotic complications, such as ascites, variceal bleeding, or hepatic encephalopathy. Near mortality, cancer progression (exceeding the Milan criteria) was recorded for 102 patients (69.3%), while cirrhosis progression (greater than two-point increase in Child-Pugh score) was noted in 110 (74.8%) patients. Alphafetoprotein, protein-induced by vitamin K antagonist-II levels and treatment modality were associated with cancer progression, while age and Child-Pugh class were associated with cirrhosis progression. There were 61 patients with in-hospital mortality; cancer progression plus liver failure was noted in 34 patients (55.7%), liver failure without cancer progression was seen in 20 patients (32.8%), and only four patients (6.6%) showed mortality from extrahepatic metastasis without liver failure.
Conclusions
Among HCC patients who were diagnosed within the Milan criteria, most of them had cirrhosis progression near mortality, and significant proportion died without uncontrolled cancer growth, mainly due to liver failure. These findings show the importance of liver function that should be considered in managing HCC patients.

Citations

Citations to this article as recorded by

2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

Journal of Liver Cancer.2023; 23(1): 1. CrossRef
Clinical Outcomes of Hepatitis B Virus–Related Hepatocellular Carcinoma Patients with Undetectable Serum HBV DNA Levels
Jong-In Chang, Dong Hyun Sinn, Hyun Cho, Seonwoo Kim, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik
Digestive Diseases and Sciences.2022; 67(9): 4565. CrossRef
2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

Clinical and Molecular Hepatology.2022; 28(4): 583. CrossRef
2022 KLCA-NCC Korea Practice Guidelines for the Management of Hepatocellular Carcinoma

Korean Journal of Radiology.2022; 23(12): 1126. CrossRef
Stereotactic Ablative Radiotherapy for Oligometastatic Hepatocellular Carcinoma: A Multi-Institutional Retrospective Study (KROG 20-04)
Tae Hyung Kim, Taek-Keun Nam, Sang Min Yoon, Tae Hyun Kim, Young Min Choi, Jinsil Seong
Cancers.2022; 14(23): 5848. CrossRef
Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients
Dong Hyun Sinn, Gyu-Seong Choi, Hee Chul Park, Jong Man Kim, Honsoul Kim, Kyoung Doo Song, Tae Wook Kang, Min Woo Lee, Hyunchul Rhim, Dongho Hyun, Sung Ki Cho, Sung Wook Shin, Woo Kyoung Jeong, Seong Hyun Kim, Jeong Il Yu, Sang Yun Ha, Su Jin Lee, Ho Yeon
PLOS ONE.2019; 14(1): e0210730. CrossRef
Hepatocellular carcinoma with extrahepatic metastasis: Are there still candidates for transarterial chemoembolization as an initial treatment?
Jihye Kim, Dong-Hyun Sinn, Moon Seok Choi, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik, Enzo Tagliazucchi
PLOS ONE.2019; 14(3): e0213547. CrossRef

Case Report

Retraction: A Case of Rapid Progression of Hepatocellular Carcinoma after Radiofrequency Ablation: Keol Lee, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik, Dong Hyun Sinn; J Liver Cancer. 2016;16(1):67-67. Published online March 31, 2016; DOI: https://doi.org/10.17998/jlc.16.1.67

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Abstract PDF: This paper (“A case of rapid progression of hepatocellular carcinoma after radiofrequency ablation” by Lee K, et al from Journal of Liver Cancer 2015;15(2):118-121) has been retracted because of the several figures (Fig. 1A, Fig. 3A, and Fig. 4) of the paper1 were identical to those of the previous published original article2 without agreement of the copyright holder. The authors informed that they will take full responsibility for this unintended duplicate publication of figures caused by lack of communication, and wish to apologize to readers of the journal for any convenience. To preserve scientific integrity, Journal of Liver Cancer agreed with the authors that this paper be retracted.

Original Article

Cirrhosis in Surgically Resected Hepatitis C-Associated Hepatocellular Carcinoma in a Hepatitis B Endemic Area: Dong Hyun Sinn, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Jae-Won Joh, Seung Woon Paik, Byung Chul Yoo, Cheol Keun Park; J Liver Cancer. 2014;14(2):108-114. Published online September 30, 2014; DOI: https://doi.org/10.17998/jlc.14.2.108

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Abstract PDF: Background/Aims
Cirrhosis has generally been considered a prerequisite for hepatitis C virus (HCV)-infected livers to develop hepatocellular carcinoma (HCC), but HCCs that arise in absence of cirrhosis has been reported. We assessed the prevalence and significance of cirrhosis in HCV-related HCC patients who underwent surgical resection.
Methods
A total of 78 HCC patients (65 male [83.3%]; mean age, 64.2 ± 8.6 years) were evaluated for the presence of cirrhosis. Cirrhosis was assessed based on histology, aspartate aminotransferase-to-platelet ratio index (APRI) as well as clinical criteria, such as ascites, varices, thrombocytopenia, splenomegaly, and radiographic configuration of cirrhosis.
Results
Based on histology, cirrhosis, septal fibrosis, periportal fibrosis and no fibrosis was noticed in 33.3%, 60.3%, 5.1% and 1.3% of patients, respectively. The clinical criteria of cirrhosis were present in 76.9% of patients. APRI > 1.0 was seen in 47.4% of patients. There was no evidence of cirrhosis in 18 patients (23.1%), either by histology or clinically. Cirrhosis by histology was an independent factor for overall survival [hazard ratio: 3.87 (95% CI: 1.24 – 12.00), P=0.019].
Conclusions
Quite proportion of HCC patients had no evidence of cirrhosis, either by histology or clinically. Careful follow-up for HCC may be necessary even for non-cirrhotic HCVinfected Korean patients. (J Liver Cancer 2014;14:108-114)

Case Reports

A Case of Hepatocellular Carcinoma With Bile Duct Thrombi Presenting Obstructive Jaundice: Su Rin Shin, Geum-Youn Gwak, Cheol Keun Park, Won Jae Lee, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Won Paik, Byung Chul Yoo; Journal of the Korean Liver Cancer Study Group. 2008;8(1):47-50. Published online June 30, 2008

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Abstract PDF: Although invasion into blood vessels, particularly the portal vein, is a common feature of hepatocellular carcinoma (HCC), intrabile duct invasion has been considered rare. HCC with bile duct thrombi is occasionally misdiagnosed as biliary carcinoma or stone, and tends to have a worse clinical course than HCC without bile duct thrombi, probably attributable to the low resectability rate secondary to poor functional reserve caused by obstructive jaundice, and combined major vascular invasion. However, a few data demonstrated that obstructive jaundice aroused an early detection of HCC, leading to a better survival. Herein, we describe a case of HCC with bile duct thrombi, which was diagnosed at an early stage with obstructive jaundice and had a favorable course after surgical resection.

A Case of Complete Remission after Multiple Sessions of Local Treatment in Metastatic Hepatocellular Carcinoma: Tae Gun Moon, Joon Hyeok Lee, Moon Seok Choi, Kwang Cheol Koh, Jae J. Kim, Seung Woon Paik, Byung Cheol Yoo, Jong Chul Rhee; Journal of the Korean Liver Cancer Study Group. 2006;6(1):70-76. Published online June 30, 2006

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Abstract PDF: With advances in the diagnosis and local treatement of HCC, which have resulted in a prolongation of survival, extrahepatic metastasis of HCC influence the survival of HCC patients. In particular, the frequency of death due to respiratory failure resulting from pulmonary metastases, pain and fractures resulting from bone metastases has been increased gradually. The efficacy of systemic treatment for the extrahepatic metastases is discouraging because of a lack of effective chemotherapeutic agents, reduced hepatic reserve and adverse effects. We report one
case
of the prolonged survival in a patient with hepatocellular carcinoma after treatment of bone and lung metastases.

A Case of Focal Nodular Hyperplasia: Beom Jin Kim, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik, Byung Chul Yoo, Won Jae Lee, Cheol Keun Park; Journal of the Korean Liver Cancer Study Group. 2003;3(1):61-64. Published online July 31, 2003

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Abstract PDF: Focal nodular hyperplasia (FNH) of the liver is a rare benign lesion characterized by nodular hyperplasia of hepatic parenchyma around a central stellate area of fibrosis associated with an anomalous artery. The histological feature of FNH is dominated by a progressive fibrotic process. In the present report, we described a 2.2×2.1 cm sized asymptomatic lesion of FNH observed in a 47-year-old woman with hepatitis B healthy carrier. This lesion was disclosed by various imaging procedures. Under the clinical impression of hepatocellular carcinoma a right. lobe subsegmentectomy was performed. The mass was firm and showed yellow-brownish color and septal fibrosis. It was accompanied with marginal ductal proliferation. These results were consistent with the typical observations in FNH. It also showed small stellate scar with radiating thin fibrous band and formation of small parenchymal nodules. We report a case of FNH of the liver difficult to differentiate hepatocellular carcinoma.

Hepatocellular Carcinoma Arising in Multiple Hepatic Adenomas: Won Hyeok Choi, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik, Byung Cheol Yoo, Won Jae Lee, Cheol Keun Park; Journal of the Korean Liver Cancer Study Group. 2003;3(1):92-94. Published online July 31, 2003

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Abstract PDF: Hepatocellular carcinoma with hepatic adenomas is rare cases, with few reported in English literature. A 47-year-old male was admitted due to increasing size of liver mass. He had open chelecystectomy and hepatico-jejunostomy 17 years ago. On CT finding, there were several hepatic masses. The largest one was 6 cm locating in the right robe. The largest mass revealed hepatocellular carcinoma though ultrasound guided biopsy, so right sectionectomy including S5 was done. Pathologic findings revealed that there were two masses of hepatocellular carcinoma and five adenoma nodules.

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