Backgrounds/Aims To evaluate the safety and effectiveness of superselective ablative chemo-ethanol embolization (SACE) for the treatment of patients with recurrent single hepatocellular carcinoma (rHCC).
Methods This retrospective study included 22 patients (19 men; median age, 63 years [range, 38-86]) with Child-Pugh class of A/ B/C (16/3/3) that underwent SACE between January and June 2023 for recurrent single HCCs measuring ≤5 cm in diameter using a mixture of 99% ethanol and ethiodized oil/doxorubicin emulsion. The primary endpoint was the 6-month tumor response, and the secondary endpoints were the 1-month tumor response and treatment-related safety. This study was approved by our institutional review board, and the requirement for informed consent was waived.
Results SACE was successfully performed in 22 patients (95.2%). The complete response rates at 1-month and 6-month after treatment were 100.0% and 83.3%, respectively. At 6-month, local tumor progression occurred in one patient and intrahepatic distant metastasis was found in six patients (30.0%). No 6-month mortalities were reported. No adverse events greater than grade 2 or laboratory deteriorations were observed. Biliary complications or liver abscesses were not observed.
Conclusions SACE for a single rHCC was highly effective in achieving a favorable 6-month tumor response and showed acceptable adverse events. However, further prospective studies are required to verify these findings.
Background/Aim Hepatocellular carcinoma (HCC) tumor thrombi located in the first branch of the portal vein (Vp3) or in the main portal trunk (Vp4) are associated with poor prognosis. This study aimed to investigate the clinicopathological characteristics and risk factors for HCC recurrence and mortality following liver resection (LR) in patients with Vp3 or Vp4 HCC.
Methods The study included 64 patients who underwent LR for HCC with Vp3 or Vp4 portal vein tumor thrombosis (PVTT).
Results Fifty-eight patients (90.6%) had Vp3 PVTT, whereas the remaining six patients exhibited Vp4 PVTT. The median tumor size measured 8 cm, with approximately 36% of patients presented with multiple tumors. Fifty-four patients (84.4%) underwent open LR, whereas 10 patients underwent laparoscopic LR. In the Vp4 cases, combined LR and tumor thrombectomy were performed. The 3-year cumulative disease-free survival rate was 42.8% for the Vp3 group and 22.2% for the Vp4 group. The overall survival (OS) rate at 3 years was 47.9% for the Vp3 group and 60.0% for the Vp4 group. Intrahepatic metastasis has been identified as an important contributor to HCC recurrence. High hemoglobin levels are associated with high mortality.
Conclusion LR is a safe and effective treatment modality for selected patients with Vp3 or Vp4 HCC PVTT. This suggests that LR is a viable option for these patients, with favorable outcomes in terms of OS.
Background/Aim There has been a long-standing debate about the association of directacting antiviral (DAA) therapy and hepatocellular carcinoma (HCC) recurrence. This study aimed to investigate the association between DAA therapy and HCC recurrence after curative therapy.
Methods We retrospectively enrolled 1,021 patients with HCV-related (hepatitis C virus) HCC who underwent radiofrequency ablation (RFA), liver resection, or both as the first treatment modality from January 2007 to December 2016 and without a history of HCV therapy before HCC treatment from a nationwide database. The effect of HCV treatment on HCC recurrence and all-cause mortality was also investigated.
Results Among the 1,021 patients, 77 (7.5%) were treated with DAA, 14 (1.4%) were treated with interferon-based therapy, and 930 (91.1%) did not receive HCV therapy. DAA therapy was an independent prognostic factor for lower HCC recurrence rate (hazard ratio [HR], 0.04; 95% confidence interval [CI], 0.006-0.289; P=0.001 for landmarks at 6 months after HCC treatment and HR, 0.05; 95% CI, 0.007-0.354; P=0.003 for landmarks at 1 year). Furthermore, DAA therapy was associated with lower all-cause mortality (HR, 0.049; 95% CI, 0.007-0.349; P=0.003 for landmarks at 6 months and HR, 0.063; 95% CI, 0.009-0.451; P=0.006 for landmarks at 1 year).
Conclusions DAA therapy after curative HCC treatment can decrease HCC recurrence and all-cause mortality compared to interferon-based therapy or no antiviral therapy. Therefore, clinicians should consider administering DAA therapy after curative HCC treatment in patients with HCV-related HCC.
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Background/Aims Surgical resection, transplantation, and radiofrequency ablation (RFA) are generally accepted as amenable treatments for small hepatocellular carcinoma (HCC). Recently drug-eluting beads (DEB) which had several treatment advantages were introduced for transarterial chemoembolization (TACE). The aim of this study was to evaluate feasibility and safety of DEB-TACE compared with RFA for the treatment of single small HCC.
Methods In this pilot non-randomized trial, we assessed retrospective data of 40 patients who underwent DEB-TACE (n=21) or RFA (n=19) for single small (≤3 centimeter in greatest dimension) HCC. The primary outcomes were tumor response and time to recurrence. The secondary outcome was treatment-related complications.
Results Complete response rate to DEB-TACE and RFA after first follow-up assessment was 90.5% and 94.7%, respectively (P=1.000). During mean follow-up of 87.6 months (95% confidence interval: 74.4-102), 7 patients experienced local recurrence. The 6- and 12-month cumulative local recurrence rate was 5.0% and 21.8% in DEB-TACE vs. 11.1% and 17.0% in RFA group (P=0.877). A total 14 distant intrahepatic recurrences were developed and 12- and 24-month cumulative distant intrahepatic recurrence rate was 20.6% and 42.7% in DEBTACE vs. 17.2% and 36.3% in RFA group (P=0.844). Two patients experienced gangrenous cholecystitis after DEB-TACE requiring cholecystectomy as treatment-related adverse event.
Conclusions Tumor response and recurrence rate after single session of DEB-TACE or RFA were similar. DEB-TACE could be applied selectively in patients with a single small HCC if the other therapeutic modality is unfeasible.
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Background/Aims Multiplication of α-fetoprotein, des-γ-carboxy prothrombin, and tumor volume (ADV score) is a surrogate marker for post-resection prognosis of hepatocellular carcinoma (HCC). This study aimed to validate the predictive power of the ADV score-based prognostic prediction model for patients with solitary huge HCC.
Methods Of 3,018 patients, 100 patients who underwent hepatic resection for solitary HCC ≥13 cm between 2008 and 2012 were selected.
Results The median tumor diameter and tumor volume were 15.0 cm and 886 mL, respectively. Tumor recurrence and overall survival (OS) rates were 70.7% and 66.0% at one year and 84.9% and 34.0% at five years, respectively. Microvascular invasion (MVI) was the only independent risk factor for disease-free survival (DFS) and OS. DFS and OS, stratified by ADV score with 1-log intervals, showed significant prognostic contrasts (P=0.007 and P=0.017, respectively). DFS and OS, stratified by ADV score with a cut-off of 8-log, showed significant prognostic contrasts (P=0.014 and P=0.042, respectively). The combination of MVI and ADV score with a cut-off of 8-log also showed significant prognostic contrasts in DFS (P<0.001) and OS (P=0.001) considering the number of risk factors. Prognostic contrast was enhanced after combining the MVI and ADV score.
Conclusions The prognostic prediction model with the ADV score could reliably predict the risk of tumor recurrence and long-term patient survival outcomes in patients with solitary huge HCCs ≥13 cm. The results of this study suggest that our prognostic prediction models can be used to guide surgical treatment and post-resection follow-up for patients with huge HCCs.
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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.
Hepatocellular carcinoma (HCC) is one of the cancers with poor prognosis. However, surgical
resection is the treatment of choice as curative aim for early HCC with preserved liver function.
A 5 year survival rate after curative resection is over 50%. We experienced a case of rapidly
recurred HCC with bone metastasis after surgical resection. In our case, microscopically
microvessel invasion was present after resection. Microvascular invasion (MVI) is an important
factor to influence survival and/or HCC recurrence. So we suggested the patients with MVI
need to follow up intensively and adjuvant therapy may be considered.
The most effective therapy in patients with hepatocellular carcinoma (HCC) is curative
resection of liver cancer. However, the long-term prognosis is not good in high intrahepatic
recurrence. The recurrence rate after curative resection of HCC is 70-100% and the average
survival time was about 15.8 months in early relapse after curative resection. Extra hepatic
metastases in HCC is associated not uncommon, in general, lungs are the most common
organ, lymph nodes, bone, and adrenal gland is relatively often observed. Extrahepatic
recurrence after curative resection of HCC has been reported in 14-26% of the total recurrent
cancer. Most of the recurrent cancer is multiple and the median survival time of patients
after the extrahepatic recurrence is about 4-5 months it found that the prognosis is very
poor. Therefore, the authors report a case showed long term survival in patients with early
intrahepatic recur and extrahepatic metastasis after curative resection of HCC.
Hepatocellular carcinoma (HCC) has poor prognosis, even after curative resection. Early
recurrence after curative treatment is a major cause of the poor prognosis. Pathologic factors
such as vessel invasion, satellite nodule, size of tumor and pathologic grade are prognostic
factors predicting early recurrence and poor prognosis. We share our experience of two case s which both showed early recurrence after curative hepatic resection, but eventually
demonstrated different prognosis. Since the most common cause of death after potentially
curative treatment is tumor recurrence, suppression of tumor recurrence might be linked
to survival gain. Currently, there is no adjuvant therapy for HCC endorsed by international
guidelines. However, recent studies have shown that antiviral treatment for hepatitis B virusrelated
HCC and immunotherapy using autologous cytokine-induced killer cell reduced
HCC recurrence. Further study is needed to select patients who will benefit from adjuvant
treatments.
Kyung Woo Park, Young Seok Kim, Sang Gyune Kim, Soung Won Jeong, Jae Young Jang, Hong Soo Kim, Sae Hwan Lee, Boo Sung Kim, Jun Cheol Jeong, Min Hee Lee, Jae Myeong Lee, Hee Kyung Kim
J Liver Cancer. 2015;15(2):122-125. Published online September 30, 2015
For a small hepatocellular carcinoma (HCC), liver resection shows most favorable outcome in case which liver transplantation is not available, although it has also substantial recurrence
rate. Here, we report a case of recurred HCC with multiple intrahepatic metastasis at 5 months
after surgical resection for small HCC was done. A 55-year-old man with chronic HBV infection
received subsegmentectomy for HCC less than 2 cm. A follow-up computed tomography (CT)
at 5 months from operation revealed that there were multiple enhancing nodules in entire
remnant liver. Intra-arterial injections of adriamycin mixed lipiodol and gelfoam particles were
instituted through hepatic artery. We assume that poorly differentiated cellular feature would
be attributable to this kind of very early and aggressive recurrence of HCC. (J Liver Cancer
2015;15:122-125)
Hepatocellular carcinoma (HCC) have relatively well known causative factors such as chronic
hepatitis B, chronic hepatitis C, alcoholic liver disease, Non-alcoholic fatty liver disease (NAFLD),
liver cirrhosis and so on. Recently, interesting reports that HCC in the absence of cirrhosis
or other chronic liver disease and HCC associated with NAFLD and metabolic syndrome are
increasing in USA. So far, there is no report about these issues in Korea. We present a 65 yearold
obesity male who had no preceding chronic liver disease history. He was diagnosed as
primary HCC and the mass was removed completely. However, HCC recurred shortly after
operation. Multiple recurred HCC were treated with transcatheter arterial chemoembolization.
(J Liver Cancer 2015;15:112-117)
Hepatocellular carcinoma(HCC) is one of the cancers with poor prognosis. Transarterial chemoembolization(TACE) has been
widely used for treating unresectable HCC. Although TACE is considered as a less invasive and relative safe procedure, severe
complications such as hepatic failure, pulmonary embolism, liver abscess, biloma formationcan occur rarely after TACE. These
complications sometimes may lead to fatal clinical situation, even death. We reported a case of HCC recurred extensively during
treatment of biliary complication after TACE. A 44-year-old male with HCC was admitted due to fever for 3 days after
undergoing TACE. Three weeks before the admission, he had been diagnosed with HCC recurrence which presented as two
arterial enhancing nodules in MRI and treated with TACE. CT scan showed 7 cm sized air containing fluid collections with
necrosis suggestive of liver abscess and 15 cm sized biloma formation. Because the patient was in septic shock at admission,
percutaneous catheter drainage was performed with use of broad spectrum antibiotics. After treatment of 3 months, the sizes of
hepatic abscess and biloma were remarkably decreased. However, 1 month later, large size tumor recurrence and perihepatic
lymph node metastasis were found on a follow-up CT scan. In this case, the cause of rapid growing recurrence after TACE is
uncertain, but the development of unanticipated complication seems to affect the progression to poor prognosis. Therefore, early
recognization of predisposing factors with proper management would be needed to prevent these serious complications after
TACE.
Jae Hong Ahn, Hyung Joon Yim, Seung Young Kim, Jeong Han Kim, Yeon Seok Seo, Seung Hwa Lee, Hwan Hoon Chung, Tae Jin Song, Hong Sik Lee, Sang Woo Lee, Soon Ho Um, Jai Hyun Choi, Ho Sang Ryu
Journal of the Korean Liver Cancer Study Group. 2009;9(1):29-32. Published online June 30, 2009
Hepatic resection is a standard curative therapy for hepatocellular carcinoma (HCC) although only 10~30% of patients are
indicated due to advanced stage or poor hepatic reserve. Five year survival rate after resection was reported as a mean of
55% (25~93%), but cases of early recurrence after hepatic resection had poor prognosis. As early recurrence after hepatic
resection is the one of the most important factors that determines the prognosis, many investigators have been trying to
determine the factors associated with early recurrence. We report a case of early multiple recurrence of HCC after curative
hepatic resection probably due to microvascular invasion of tumor and too close resection margin. We would like to suggest
that additional prophylactic measures need to be sought in this group of patients because these factors may influence on early
recurrence.
Jaejun Shim, Byung-Ho Kim, Young Hwangbo, Sang Wook Lee, Young Ju Lee, Seung Hyung Ha, Jae Young Jang, Seok Ho Dong, Hyo Jong Kim, Young Woon Chang, Rin Chang, Sang Mok Lee
Journal of the Korean Liver Cancer Study Group. 2009;9(1):33-36. Published online June 30, 2009
Long term results of hepatic resection for hepatocellular carcinoma (HCC) are not satisfactory due to a high incidence of
postoperative recurrence. To improve the prognosis in patients who underwent hepatic resection, identification of risk factors
for recurrence and development of effective preventive strategies are required. A single nodular mass was found in the right
hepatic lobe of 53-year old male with B viral cirrhosis by surveillance ultrasonography. Dynamic abdominal CT showed a
3 cm-sized hypervascular mass in the right posteroinferior segment (S6). AFP was 359 ng/mL. Child-Pugh classification was
A, and ICG R15 was 18.8%. After preoperative transarterial chemoembolization (TACE), right hepatic wedge resection was
performed. Resection margin was free of tumor. Microinvasions in the surrounding vessels, lymphatics, bile ducts were not
found and microsatellite nodules were absent in the resected specimen. Although there were no risk factors that associated
with high postoperative recurrence, multifocal intrahepatic recurrence in the right lobe and left medial lobe occurred at 7
months after hepatic resection. He underwent two sessions of TACE.
Radiofrequency ablation (RFA) is the preferred method of local ablation for patients with small (<3 cm sized)
hepatocellular carcinoma (HCC) when surgical resection cannot be applied. If RFA procedure is sufficiently completed, it
provides lower local tumor recurrence, and longer overall as well as disease-free survival. We experienced a case of early
stage HCC which recurred at 2 months after successful RFA procedure, and rapidly metastasized to lung and brain.