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World Journal of Gastroenterology Jul 2014The aim of management of hepatocellular carcinoma (HCC) is to improve the prognosis of the patients by radical resection and preserve remnant liver function. Although... (Review)
Review
The aim of management of hepatocellular carcinoma (HCC) is to improve the prognosis of the patients by radical resection and preserve remnant liver function. Although liver transplantation is associated with a lower tumor recurrence rate, this benefit is counteracted by long-term complications. Therefore, hepatectomy could be the first choice of treatment in selected patients with HCC. However, the higher frequency of tumor recurrence and the lower rate of resectability after hepatectomy for HCC led to an unsatisfactory prognosis. New strategies are required to improve the long-term outcome of HCC after hepatectomy. In this paper, we introduce some strategies to increase the low rate of resectability and reduce the high rate of tumor recurrence. Some aggressive treatments for tumor recurrence to extend long-term survival are also involved. We believe that hepatectomy combined with other therapies, such as portal vein embolization, transarterial chemoembolization, radioembolization, antiviral treatment, radiofrequency ablation and salvage transplantation, is a promising treatment modality for HCC and may improve survival greatly.
Topics: Carcinoma, Hepatocellular; Combined Modality Therapy; Hepatectomy; Humans; Liver Neoplasms; Liver Transplantation; Neoplasm Recurrence, Local; Retreatment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 25071316
DOI: 10.3748/wjg.v20.i28.9237 -
Journal of Surgical Oncology Nov 2020The liver is a frequent site of malignancy, both primary and metastatic. The treatment goal of patients with liver cancer may include transarterial radioembolization... (Review)
Review
BACKGROUND AND OBJECTIVES
The liver is a frequent site of malignancy, both primary and metastatic. The treatment goal of patients with liver cancer may include transarterial radioembolization (TARE). There are limited reports on the safety of hepatectomy following TARE. Our study's purpose is to review patients who have received TARE followed by hepatectomy.
METHODS
A retrospective study was performed on patients diagnosed with any liver cancer from 2013 to 2019 who underwent TARE followed by hepatectomy. Postoperative complications were prospectively collected. Descriptive statistics and the Kaplan-Meier test were used to assess survival outcomes.
RESULTS
Twelve patients were treated with a TARE followed by a hepatectomy (nine with ≥4 segments resected). Diagnoses included: six HCC, four cholangiocarcinoma, one metastatic neuroendocrine tumor, and one metastatic colorectal cancer. There were no 90-day post-hepatectomy mortalities and the overall morbidity was 66% (16% severe ≥MAGS 3). Hepatectomy-specific complications after hepatectomy included two (16%) bile leaks and no post-hepatectomy liver failures. The median recurrence free survival was 26 months. Overall survival at 1-year was 78% and at 3 years was 47%.
CONCLUSIONS
Our results support the safety of hepatectomy in select patients after TARE. Additional comparison to patients who receive hepatectomy as a first-line treatment for liver cancers should be investigated.
Topics: Carcinoma, Hepatocellular; Combined Modality Therapy; Embolization, Therapeutic; Female; Follow-Up Studies; Hepatectomy; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Radiotherapy Dosage; Retrospective Studies; Survival Rate
PubMed: 32662066
DOI: 10.1002/jso.26115 -
Bioscience Trends Jul 2021Hepatocellular carcinoma (HCC) is a common malignant tumor with a high morbidity and mortality in China and elsewhere in the world. Due to its tumor heterogeneity and... (Review)
Review
Hepatocellular carcinoma (HCC) is a common malignant tumor with a high morbidity and mortality in China and elsewhere in the world. Due to its tumor heterogeneity and distant metastasis, patients with HCC often have a poor prognosis. A surgical treatment such as a radical hepatectomy is still the treatment of choice for patients with HCC in current clinical practice. However, the high rate of recurrence and rate of metastasis after surgery diminishes the survival of and prognosis for these patients. In an era of targeted therapy and immunotherapy, the surgical treatment of HCC must change. This review focuses on the definition, feasibility, and criteria with which to evaluate neoadjuvant therapy for HCC in order to provide a new perspective on surgical treatment of HCC.
Topics: Carcinoma, Hepatocellular; China; Disease-Free Survival; Feasibility Studies; Hepatectomy; History, 20th Century; History, 21st Century; Humans; Liver Neoplasms; Medical Oncology; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Practice Guidelines as Topic; Prognosis; Time Factors
PubMed: 33716267
DOI: 10.5582/bst.2021.01083 -
BioMed Research International 2018Liver cancer is the second leading cause of cancer-related death worldwide. The high frequency of recurrence and metastasis is the main reason for poor prognosis. Liver... (Review)
Review
Liver cancer is the second leading cause of cancer-related death worldwide. The high frequency of recurrence and metastasis is the main reason for poor prognosis. Liver cancer stem cells (CSCs) have unlimited self-renewal, differentiation, and tumor-regenerating capacities. The maintenance of CSCs may account for the refractory features of liver cancer. Despite extensive investigations, the underlying regulatory mechanisms of liver CSCs remain elusive. miRNA and lncRNA, two major classes of the ncRNA family, can exert important roles in various biological processes, and their diverse regulatory mechanisms in CSC maintenance have acquired increasing attention. However, to the best of our knowledge, there is a lack of reviews summarizing these findings. Therefore, we systematically recapitulated the latest studies on miRNAs and lncRNAs in sustaining liver CSCs. Moreover, we highlighted the potential clinical application of these dysregulated ncRNAs as novel diagnostic and prognostic biomarkers and therapeutic targets. This review not only sheds new light to fully understand liver CSCs but also provides valuable clues on targeting ncRNAs to block or eradicate CSCs in cancer treatment.
Topics: Animals; Humans; Liver Neoplasms; MicroRNAs; Neoplastic Stem Cells; RNA, Long Noncoding; RNA, Neoplasm
PubMed: 29888282
DOI: 10.1155/2018/8686027 -
Magyar Onkologia Mar 2018Recently the prevalence of oligometastatic patients is increasing. A common site of distant spread is the liver. The standard of care is curative surgical resection,... (Review)
Review
Recently the prevalence of oligometastatic patients is increasing. A common site of distant spread is the liver. The standard of care is curative surgical resection, however, the resecability rate is only 10-20%. Alternatively, radiofrequency ablation (RFA) or transarterial chemoembolization (TACE) may be used. Stereotactic ablative body radiotherapy (SABRT) makes it possible to deliver curative radiation dose without radiation injury to the healthy liver tissue. We delivered SABRT to three patients with inoperable hepatic metastases. The primary tumors were rectal (2) and lung (1). The dose was 3x20 Gy every other day. We observed one grade 1 side effect. All the metastases showed complete remission and no local recurrence or late side effect occurred during the one year of follow-up. One patient is tumor-free, one has stable disease, in one patient two new hepatic metastases appeared and receives chemo-biological therapy. SABRT of liver metastases is safe and highly effective. It can be expected that in the near future it will become one of the standard treatments of hepatic tumors.
Topics: Chemoembolization, Therapeutic; Humans; Liver Neoplasms; Neoplasm Metastasis; Radiosurgery; Treatment Outcome
PubMed: 29570188
DOI: No ID Found -
Frontiers in Bioscience (Landmark... Jan 2019Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide and has a relatively poor survival rate. Aside from liver transplantation, the most... (Review)
Review
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide and has a relatively poor survival rate. Aside from liver transplantation, the most effective and leading curative measure for HCC is the chemotherapeutic agent sorafenib, which is a multikinase inhibitor used for treating late-stage HCC. However, the effects of sorafenib are short-lived because of rapid acquisition of multi-drug resistance (MDR) by tumor cells. MicroRNAs (miRNAs) have emerged as crucial regulatory molecules for almost every biochemical pathway in humans. The progression of HCC and acquired MDR are critically influenced by miRNAs through regulation of key genes in cell regulatory pathways. This review explores the involvement of miRNAs in the development of HCC and their role in key signaling pathways leading to MDR in HCC.
Topics: Animals; Antineoplastic Agents; Carcinoma, Hepatocellular; Cell Line, Tumor; Drug Resistance, Neoplasm; Gene Expression Regulation, Neoplastic; Humans; Liver Neoplasms; MicroRNAs; Protein Kinase Inhibitors
PubMed: 30468662
DOI: 10.2741/4724 -
AMIA ... Annual Symposium Proceedings.... 2017Cancer stage information is important for clinical research. However, they are not always explicitly noted in electronic medical records. In this paper, we present our...
Cancer stage information is important for clinical research. However, they are not always explicitly noted in electronic medical records. In this paper, we present our work on automatic classification of hepatocellular carcinoma (HCC) stages from free-text clinical and radiology notes. To accomplish this, we defined 11 stage parameters used in the three HCC staging systems, American Joint Committee on Cancer (AJCC), Barcelona Clinic Liver Cancer (BCLC), and Cancer of the Liver Italian Program (CLIP). After aggregating stage parameters to the patient-level, the final stage classifications were achieved using an expert-created decision logic. Each stage parameter relevant for staging was extracted using several classification methods, e.g. sentence classification and automatic information structuring, to identify and normalize text as cancer stage parameter values. Stage parameter extraction for the test set performed at 0.81 F1. Cancer stage prediction for AJCC, BCLC, and CLIP stage classifications were 0.55, 0.50, and 0.43 F1.
Topics: Algorithms; Carcinoma, Hepatocellular; Datasets as Topic; Humans; Liver Neoplasms; Medical Records; Neoplasm Staging; Prognosis; Radiology; Washington
PubMed: 29854257
DOI: No ID Found -
Role of Endoglin (CD105) in the Progression of Hepatocellular Carcinoma and Anti-Angiogenic Therapy.International Journal of Molecular... Dec 2018The liver is perfused by both arterial and venous blood, with a resulting abnormal microenvironment selecting for more-aggressive malignancies. Hepatocellular carcinoma... (Review)
Review
The liver is perfused by both arterial and venous blood, with a resulting abnormal microenvironment selecting for more-aggressive malignancies. Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer, the sixth most common cancer globally, and the third leading cause of cancer-related mortality worldwide. HCC is characterized by its hypervascularization. Improving the efficiency of anti-angiogenic treatment and mitigation of anti-angiogenic drug resistance are the top priorities in the development of non-surgical HCC therapies. Endoglin (CD105), a transmembrane glycoprotein, is one of the transforming growth factor β (TGF-β) co-receptors. Involvement of that protein in angiogenesis of solid tumours is well documented. Endoglin is a marker of activated endothelial cells (ECs), and is preferentially expressed in the angiogenic endothelium of solid tumours, including HCC. HCC is associated with changes in CD105-positive ECs within and around the tumour. The large spectrum of endoglin effects in the liver is cell-type- and HCC- stage-specific. High expression of endoglin in non-tumour tissue suggests that this microenvironment might play an especially important role in the progression of HCC. Evaluation of tissue expression, as well as serum concentrations of this glycoprotein in HCC, tends to confirm its role as an important biomarker in HCC diagnosis and prognosis. The role of endoglin in liver fibrosis and HCC progression also makes it an attractive therapeutic target. Despite these facts, the exact molecular mechanisms of endoglin functioning in hepatocarcinogenesis are still poorly understood. This review summarizes the current data concerning the role and signalling pathways of endoglin in hepatocellular carcinoma development and progression, and provides an overview of the strategies available for a specific targeting of CD105 in anti-angiogenic therapy in HCC.
Topics: Angiogenesis Inhibitors; Carcinoma, Hepatocellular; Endoglin; Gene Expression Regulation, Neoplastic; Humans; Liver Neoplasms; Neoplasm Proteins; Neovascularization, Pathologic
PubMed: 30563158
DOI: 10.3390/ijms19123887 -
World Journal of Gastroenterology Mar 2016Liver transplantation (LT) has been accepted as an effective therapy for hepatocellular carcinoma (HCC). The Milan criteria (MC) are widely used across the world to... (Review)
Review
Liver transplantation (LT) has been accepted as an effective therapy for hepatocellular carcinoma (HCC). The Milan criteria (MC) are widely used across the world to select LT candidates in HCC patients. However, the MC may be too strict because a substantial subset of patients who have HCC exceed the MC and who would benefit from LT may be unnecessarily excluded from the waiting list. In recent years, many extended criteria beyond the MC were raised, which were proved to be able to yield similar outcomes compared with those patients meeting the MC. Because the simple use of tumor size and number was insufficient to indicate HCC biological features and to predict the risk of tumor recurrence, some biological markers such as Alpha-fetoprotein, Des-Gamma-carboxy prothrombin and the neutrophil-to-lymphocyte ratio were useful in selecting LT candidates in HCC patients beyond the MC. For patients with advanced HCC, downstaging therapy is an effective way to reduce the tumor stage to fulfill the MC by using liver-directed therapy such as transarterial chemoembolization, radiofrequency ablation and percutaneous ethanol injection. This article reviews the recent advances in LT for HCC beyond the MC.
Topics: Biomarkers, Tumor; Carcinoma, Hepatocellular; Decision Support Techniques; Humans; Liver Neoplasms; Liver Transplantation; Neoadjuvant Therapy; Neoplasm Staging; Patient Selection; Predictive Value of Tests; Risk Factors; Treatment Outcome; Tumor Burden
PubMed: 27022214
DOI: 10.3748/wjg.v22.i12.3325 -
Liver Transplantation : Official... Sep 2015Downstaging can facilitate liver transplantation (LT) for patients outside of Milan criteria with hepatocellular carcinoma (HCC); however, the optimal protocol and... (Meta-Analysis)
Meta-Analysis Review
Downstaging can facilitate liver transplantation (LT) for patients outside of Milan criteria with hepatocellular carcinoma (HCC); however, the optimal protocol and downstaging outcomes are poorly defined. We aimed to characterize rates of successful downstaging to within Milan criteria and post-LT recurrence and survival among patients who underwent downstaging. We performed a systematic literature review using the MEDLINE and Embase databases from January 1996 through March 2015 and a search of national meeting abstracts from 2010 to 2014. Rates of downstaging success (defined as a decrease of tumor burden to within Milan) and post-LT recurrence with 95% confidence intervals (CIs) were calculated. Prespecified subgroup analyses were conducted by treatment modality, study design, and patient characteristics. Thirteen studies (n = 950 patients) evaluating downstaging success had a pooled success rate of 0.48 (95% CI, 0.39-0.58%). In subgroup analyses, there was no significant difference comparing transarterial chemoembolization (TACE) versus transarterial radioembolization (TARE; P = 0.51), but there were higher success rates in prospective versus retrospective studies (0.68 versus 0.44; P < 0.001). The 12 studies (n = 320 patients) evaluating post-LT HCC recurrence had a pooled recurrence rate of 0.16 (95% CI, 0.11-0.23). There was no significant difference in recurrence rates between TACE and TARE (P = 0.33). Post-LT survival could not be aggregated because of heterogeneity in survival data reporting. Current data have heterogeneity in baseline tumor burden, waiting time, downstaging protocols, and treatment response assessments. There are also notable limitations including inconsistent reporting of inclusion criteria, downstaging protocols, and outcome assessment criteria. In conclusion, the success rate of downstaging HCC to within Milan criteria exceeds 40%; however, posttransplant HCC recurrence rates are high at 16%. Downstaging protocols for HCC should be systematically studied and optimized to minimize the risk of post-LT HCC recurrence.
Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Liver Transplantation; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 25981135
DOI: 10.1002/lt.24169