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Editorial
- Congratulatory remarks
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Kyung Sik Kim
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J Liver Cancer. 2024;24(2):119-119. Published online September 13, 2024
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DOI: https://doi.org/10.17998/jlc.2024.09.10
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Original Article
- Confirmation of HIF-1α Independent Pathway in the Progression of HepG2 Cells by Hypoxic Condition
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Sang Woo Lee, Jae Uk Chong, Seon Ok Min, Kyung Sik Kim
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J Liver Cancer. 2016;16(1):31-37. Published online March 31, 2016
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DOI: https://doi.org/10.17998/jlc.16.1.31
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Abstract
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- Background/Aims
When hepatocellular carcinoma (HCC) is exposed to hypoxic condition,
HIF-1α is activated and results in angiogenesis and increased tumor burden. Although
inhibition of HIF-1α may reduce tumor growth, there are some limitations to control tumor
growth completely. For a more effective therapy for HCC, we investigated HIF-1α independent
pathway related tumor growth with angiogenesis.
Methods
We cultured HepG2 cells (HCC cell line) in both normoxia and hypoxia conditions.
These cells were divided into three groups: a echinomycin treated group, a echinomycin and
quinazoline treated group and a control group without any treatments. Growth morphologies
of cells were observed with a microscope after 24 hours. Immunocytochemistry assay
was done to detect the angiogenesis during inhibition of HIF-1α and/or NF-κB in hypoxia
condition, and compared with results in normoxia condition.
Results
In normoxia, the expression of HIF-1α on tumor growth was not found. In hypoxia,
inhibition of HIF-1α reduced the tumor growth compared to the control group. But, inhibition
of both HIF-1α and NF-κB did not show apparent reduction of tumor growth as shown in HIF-
1α only group.
Conclusions
Signaling pathways related to cancer cell growth exist through a vast network.
Inhibition of one target molecule may result in over-expression of other molecules related
to the tumor growth. For an effective therapy in blocking of the tumor growth, more
comprehensive understanding of the network related to signaling pathways on tumor growth
is necessary. (J Liver Cancer 2016;16:31-37)
Case Reports
- A Case of Concurrent Liver Resection and Splenectomy in Patients with Hepatocellular Carcinoma and Decompensated Liver Cirrhosis
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Sung Hoon Kim, JIn Hong Lim, Sang Hoon Ahn, Kyung Sik Kim
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Journal of the Korean Liver Cancer Study Group. 2011;11(2):160-164. Published online September 30, 2011
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Abstract
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- Hepatocellular carcinoma (HCC) develops on chronic liver disease and often accompanies portal hyperternsion. Portal
hypertension induces hypersplenism with splenomegaly. Because hypersplenism results in pancytopenia, especially
thrombocytopenia, it is not easy to decide the hepatic resection for many surgeons in patients with HCC and hypersplenism.
Although liver transplantation is the most ideal treatment for HCC and hypersplenism, liver resection has been performed
commonly because of donor shortage. Splenectomy has performed to control intractable varices as a Hassab’s operation
(=decongestion of upper gastric marginal veins and splenectomy). Recently, as a development of surgical techniques and
equipments, especially laparoscopic surgery, splenectomy has been performed safely and easily. Some studies reported that
splenectomy improved the liver function. Splenectomy in patients with HCC expanded the indication of liver resection and
increased disease free survival (DFS). However, portal vein thrombosis (PVT) is a one of well-recognized complications of
splenectomy and recent prospective study reported the 50% rate of PVT in non-cirrhotic splenectomized patients. Some studies
reported that splenectomy with simultaneously or staged liver resection was performed safely without a significant complication
and operative mortality. We experienced a case that underwent simultaneously liver resection and splenectomy and then
recovered without complication. The further study may be needed to evaluate the role of splenectomy in patients with HCC and
hypersplenism.
- A Case of Early and Massive Recurred Hepatocellular Carcinoma in Patients with Ruptured Hepatocellular Carcinoma Underwent Staged-Surgical Resection
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Sung Hoon Kim, Jin Hong Lim, Sang Hoon Ahn, Kyung Sik Kim
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Journal of the Korean Liver Cancer Study Group. 2011;11(2):155-159. Published online September 30, 2011
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Abstract
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- The rupture of hepatocellular carcinoma (HCC) has been uncommon complication. Because the diagnosis of early HCC has
been increase due to development of imaging modality and surveillance program, the incidence of ruptured HCC has
been decreased. The paradigm of treatment for ruptured HCC has shifted from surgical hemostasis to transcatheteric
chemoembolization (TACE) at acute phase. After the control of acute phase, the definitive treatment for HCC is still debate.
However, many studies have advocated staged-liver resection. Some studies reported that the patients underwent staged-liver
resection showed a similar survival rate compared with survival rate in patient with non-ruptured HCC. The staged-liver
resection was usually performed in the patients with well-preserved liver function. The decision of optimal time for surgery after
TACE and surgical indications for ruptured HCC after any other primary treatment are controversy. We experienced a cases of
early and massive recurrence HCC in patients with well-preserved liver function and the rupture of HCC. The further study may
be needed to decide the optimal time of surgery after TACE and surgical indication for rutprued-HCC.
Review Article
- 2009 Treatment Guideline for Hepatocellular Carcinoma: Surgical Resection and Liver Transplantation
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Sung Hoon Kim, Kyung Sik Kim
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Journal of the Korean Liver Cancer Study Group. 2010;10(1):6-10. Published online June 30, 2010
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Abstract
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- The effort we are trying to set up the treatment guideline for hepatocellular carcinoma has produced various guidelines after
drawing a conclusion from Barcelona EASL meeting in 2000. Especially in Korea, the Korean Liver Cancer Study Group
and the National Cancer Center have collaborated on making treatment guideline for hepatocellular carcinoma in the early
stage of setting up the guideline, 2003, and it was a great help to treatment, study and education. However, a need of
revision had been raised due to many changes in the latest treatments and an accumulation of international and domestic
experience. After the proposal of amending the treatment guideline for Hepatocellular carcinoma in the Cancer Control Forum
of the National Cancer Control Planning Board on October 17th, 2008, “2009 Guideline” has been reported in the Conference
of the Korean Liver Cancer Study Group held on June 27th, 2009. When revising the guideline, there are some suggestions
of continuous modification to reflect evidence based medical knowledge, and recently there are some debates about the drawback
of the surgical field which was not handled in EASL and AASLD Guidelines. Therefore, it will broaden your understanding
of liver surgical resection and liver transplantation and it will also be a place for the discussion of disputable issues.
Case Reports
- A Case of Early Recurred Hepatocellular Carcinoma with Initial Expectation of Good outcome by Surgical Resection
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Jung Min Lee, Jun Yong Park, Do Young Kim, Kyung Sik Kim, Young Nyun Park, Myeong-Jin Kim, Chae Yoon Chon, Kwang-Hyub Han
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Journal of the Korean Liver Cancer Study Group. 2009;9(1):41-44. Published online June 30, 2009
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Abstract
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- Hepatocellular carcinoma (HCC) is one of the cancers with poor prognosis as HCC develops on base of cirrhosis in
majority cases, which requires multidisciplinary approach. If feasible, however, surgical resection is the choice of treatment,
and many previous studies and guidelines offered appropriate indications for surgical resection; firstly, preservation of liver
function should be confirmed with traditional Child-Pugh classification or more recently with Indocyanine Green retention test
or absence of portal hypertension. Secondly, several variables about the size, number, and vascular invasion of tumor should
be taken into consideration. It is suggested that to lessen the risk of recurrence gross vascular invasion be absent and the
number of tumor be single. Regarding the size of tumor, although risk of dissemination increases with size, some tumors
may grow as a single mass and thus the size of tumor is not a clear-cut limiting factor. Based on above suggestions, we
herein offer our experience of a patient with initial hopeful expectation of good outcome with surgical resection, but who
eventually turned out to result in disseminated tumor recurrence. Further study, maybe regarding a combination of adjuvant
or neoadjuvant transarterial chemoembolization/chemotherapy or radiotherapy, is necessary on how to manage such patient.
- A Case of Hepatocellular Carcinoma in a Pregnant Patient in Twenties
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Kang Kook Choi, Young Ju Hong, Sae Byeol Choi, Nam Joon Yi, Shin Hwang, Young Nyun Park, Jin Sub Choi, Kyung Suk Suh, Chae Yoon Chon, Kyung Sik Kim
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Journal of the Korean Liver Cancer Study Group. 2009;9(1):76-81. Published online June 30, 2009
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Abstract
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- 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.
Review Article
- Hepatic Resection Following Adjuvant Treatments in Hepatocellular Carcinoma
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Sae-Byeol Choi, Kyung Sik Kim
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Journal of the Korean Liver Cancer Study Group. 2008;8(1):32-38. Published online June 30, 2008
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Abstract
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- The optimal treatment of hepatocellular carcinoma has become increasingly complex with myriad of available
treatment options. Although recently the liver transplantation has been accepted the best treatment for survival,
the shortage of donor limits the extension of this procedures. As the neoadjuvant chemotherapy is being
increasingly employed to downsize colorectal metastasis, the clinical trials have been extended to the
hepatocellular carcinoma. Therefore we reviewed the use of liver resection following tumor downstaging with
chemotherapeutic agents and Radiation therapy to treat unresectable HCC.
Key Words: Hepatic resection․Downstaging․Transarterial chemoembolization․Radiation
Case Reports
- A Case of Curative Resection of Advanced Hepatocellular Carcinoma After Localized Concurrent Chemo-Radiation Therapy
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Wonseok Kang, Ki Tae Yoon, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Chae Yoon Chon, Kyung Sik Kim, Young Nyun Park, Jin Sil Seong, Kwang Hyub Han
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Journal of the Korean Liver Cancer Study Group. 2008;8(1):98-101. Published online June 30, 2008
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Abstract
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- Most patients with advanced hepatocellular carcinoma (HCC) are not suitable candidates for surgical treatment
at the time of diagnosis because of poor liver function, extensive tumor involvement of the liver, vascular
involvement, and/or intra/extrahepatic metastasis. We attempted localized concurrent chemo-radiation therapy
(CCRT) followed by hepatic arterial infusion chemotherapy (HAIC) in patients having locally advanced HCC with
vascular involvement and preserved hepatic function. We report a case of locally advanced HCC patient who
became surgically resectable by downstaging after localized CCRT followed by HAIC. Localized CCRT was
performed with a total radiation dose of 4,500 cGy (180 cGy × 25 times) and hepatic arterial infusion of
5-fluorouracil (5-FU, 500 mg/day) via implantable port system during the first and the last weeks of the
radiotherapy. Following localized CCRT, the patient was scheduled to receive HAIC with 5-FU (500 mg/m2 for
5 hours, days 1~3) and cisplatin (60 mg/m2 for 2 hours, day 2) every 4 weeks. Marked contraction of HCC was
noted on follow up computerized tomography (CT) and positron emission tomography (PET) after localized CCRT
and HAIC, and subsequently surgical resection with curative aim was performed. The patient is in complete
remission status without recurrence to date.
- Two cases of Vessel invasion of Hepatocellular carcinoma
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Sae Byeol Choi, Jae Yeon Seok, Kyung Sik Kim, Young Nyun Park, Kwang-Hyub Han, Jong Tae Lee
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Journal of the Korean Liver Cancer Study Group. 2007;7(1):71-76. Published online June 30, 2007
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Abstract
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- Despite growing information on the clinical behavior of hepatocellular carcinoma(HCC), the histologic features
associated with survival are not well characterized. Several different staging systems are suggested for use in
predicting the prognosis of HCC. American Joint Committee on Cancer/International Union Against Cancer
Staging System (AJCC/UICC) 6th edition divided T stages according to vessel invasion, T1 without microvessel
invasion, T2 showing microvessel invasion and T3 showing major vessel invasion. The vessel invasion is
generally considered a poor prognostic factor for HCC. Our report of the two patients with HCC run along similar
terms. The patient diagnosed HCC with microvessel invasion underwent left lateral sectionectomy. Although the
presence of microvessel invasion was found, this patient has survived without any recurrence for over 5 years
now. The other patient underwent S8 segmentectomy and lived 10 years disease-free. After 10 years, although
an intrahepatic recurred HCC successfully treated with local therapy, the recurred and newly developed multiple
lesions were found again leading to a decision to perform operation. The HCC invaded into the portal vein and
constituted portal vein thrombosis. The patient expired after 3 months postoperatively due to intrahepatic
dissemination of the tumor. Therefore the impact of the vascular invasion on long-term survivors remains to be
determined.
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