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World Journal of Gastroenterology Aug 2013Primary liver cancer is a global disease that is on the increase. Hepatocellular carcinoma (HCC) accounts for most primary liver cancers and has a notably low survival... (Review)
Review
Primary liver cancer is a global disease that is on the increase. Hepatocellular carcinoma (HCC) accounts for most primary liver cancers and has a notably low survival rate, largely attributable to late diagnosis, resistance to treatment, tumour recurrence and metastasis. MicroRNAs (miRNAs/miRs) are regulatory RNAs that modulate protein synthesis. miRNAs are involved in several biological and pathological processes including the development and progression of HCC. Given the poor outcomes with current HCC treatments, miRNAs represent an important new target for therapeutic intervention. Several studies have demonstrated their role in HCC development and progression. While many risk factors underlie the development of HCC, one process commonly altered is iron homeostasis. Iron overload occurs in several liver diseases associated with the development of HCC including Hepatitis C infection and the importance of miRNAs in iron homeostasis and hepatic iron overload is well characterised. Aberrant miRNA expression in hepatic fibrosis and injury response have been reported, as have dysregulated miRNA expression patterns affecting cell cycle progression, evasion of apoptosis, invasion and metastasis. In 2009, miR-26a delivery was shown to prevent HCC progression, highlighting its therapeutic potential. Several studies have since investigated the clinical potential of other miRNAs with one drug, Miravirsen, currently in phase II clinical trials. miRNAs also have potential as biomarkers for the diagnosis of HCC and to evaluate treatment efficacy. Ongoing studies and clinical trials suggest miRNA-based treatments and diagnostic methods will have novel clinical applications for HCC in the coming years, yielding improved HCC survival rates and patient outcomes.
Topics: Animals; Apoptosis; Carcinoma, Hepatocellular; Disease Progression; Genetic Testing; Genetic Therapy; Humans; Iron Overload; Liver; Liver Neoplasms; MicroRNAs; Neoplasm Invasiveness; Predictive Value of Tests
PubMed: 23983424
DOI: 10.3748/wjg.v19.i32.5212 -
Clinical and Molecular Hepatology Sep 2019Gadoxetic acid, a hepatocyte-specific magnetic resonance imaging (MRI) contrast agent, has emerged as an important tool for hepatocellular carcinoma (HCC) diagnosis.... (Review)
Review
Gadoxetic acid, a hepatocyte-specific magnetic resonance imaging (MRI) contrast agent, has emerged as an important tool for hepatocellular carcinoma (HCC) diagnosis. Gadoxetic acid-enhanced MRI is useful for the evaluation of earlystage HCC, diagnosis of HCC precursor lesions, and highly sensitive diagnosis of HCC. Furthermore, functional information provided by gadoxetic acid-enhanced MRI can aid in the characterization of focal liver lesions. For example, whereas lesions lack functioning hepatocytes appear hypointense in the hepatobiliary phase, preserved or enhanced expression of organic anion transporting polypeptides in some HCCs as well as focal nodular hyperplasia lead to hyperintensity in the hepatobiliary phase; and a targetoid appearance on transitional phase or hepatobiliary phase imaging can be helpful for identifying the histopathological composition of tumors. While gadoxetic acid-enhanced MRI may improve the sensitivity of HCC diagnosis and provide new insights into the characterization of focal liver lesions, there are many challenges associated with its use. This article reviews the pros and cons of HCC diagnosis with gadoxetic acid-enhanced MRI and discuss some clues in the radiological differentiation of HCC from HCC mimickers.
Topics: Angiomyolipoma; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; beta Catenin
PubMed: 30661336
DOI: 10.3350/cmh.2018.0107 -
Journal of Hepatology Oct 2012
Topics: Carcinoma, Hepatocellular; Catheter Ablation; Female; Hepatectomy; Humans; Liver Neoplasms; Male; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary
PubMed: 22824817
DOI: 10.1016/j.jhep.2012.07.022 -
The Oncologist 2010Hepatocellular carcinoma (HCC) is a heterogeneous condition, with multiple confounding factors making patient assessment extremely complex. Tumor burden, the presence of... (Review)
Review
Hepatocellular carcinoma (HCC) is a heterogeneous condition, with multiple confounding factors making patient assessment extremely complex. Tumor burden, the presence of symptoms, liver function, and comorbidities must all be considered to ensure accurate patient assessment, thereby providing physicians with a common language on which to base treatment decisions and guide research. Although many staging classifications have been developed, there is no consensus on the best classification to use. The Barcelona Clinic Liver Cancer system is a promising candidate for a standard western classification, because it has been externally validated and is endorsed by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. Similarly, the biomarker-combined Japanese Integrated Staging (JIS) score is the most promising candidate for a standard Asia-Pacific classification, because it has been externally validated and shown to be superior to conventional JIS. Because risk factors vary significantly by region, so too does the predictive power of current staging classifications; any standard global staging classification would need to be validated in both western and Asia-Pacific patients. To date, no such globally validated classification exists. Findings from scientific research have improved our understanding of HCC and enabled us to refine current classifications. The role of tumor markers to predict survival was recently reported, and α-fetoprotein, lens culinaris agglutinin-reactive α-fetoprotein, and des-γ-carboxyprothrombin have now been incorporated into some classifications. Molecular markers have also been linked with poor outcomes and will likely play a role in future classifications. Although more work is required, it is hoped that these and other ongoing research efforts will eventually enable the development of a global staging classification.
Topics: Asia; Biomarkers, Tumor; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Neoplasm Staging; Prognosis; Treatment Outcome; alpha-Fetoproteins
PubMed: 21115578
DOI: 10.1634/theoncologist.2010-S4-23 -
Liver Transplantation : Official... Feb 2004Hepatocellular carcinoma (HCC) is the fifth most common neoplasm in the world, and the third most common cause of cancer-related death. It affects mainly patients with... (Review)
Review
Hepatocellular carcinoma (HCC) is the fifth most common neoplasm in the world, and the third most common cause of cancer-related death. It affects mainly patients with cirrhosis of any etiology. Patients with cirrhosis are thus usually included in surveillance plans aiming to achieve early detection and effective treatment. Only patients who would be treated if diagnosed with HCC should undergo surveillance, which is based on ultrasonography and alpha-fetoprotein every 6 months. Upon diagnosis, the patients have to be staged to define tumor extent and liver function impairment. Thereafter, the best treatment option can be indicated and a prognosis estimate can be established. The present manuscript depicts the Barcelona-Clínic Liver Cancer Group diagnostic and treatment strategy. This is based on the analysis of several cohort and randomized controlled studies that have allowed the continuous refinement of treatment indication and application. Surgical resection is considered the first treatment option for early stage patients. It is reserved for patients with solitary tumors without portal hypertension and normal bilirubin. If these conditions are not met, patients are considered for liver transplantation (cadaveric or live donation) or percutaneous ablation if at an early stage (solitary < or =5 cm or up to 3 nodules < or =3 cm). These patients will reach a 5-year survival between 50 and 75%. If patients are diagnosed at an intermediate stage and are still asymptomatic and have preserved liver function, they may benefit from chemoembolization. Their 3-year survival will exceed 50%. There is no effective treatment for patients with advanced disease and thus, in such instances, the patients have to be considered for research trials with new therapeutic options. Finally, patients with end-stage disease should receive only palliative treatment to avoid unnecessary suffering.
Topics: Administration, Cutaneous; Carcinoma, Hepatocellular; Catheter Ablation; Chemoembolization, Therapeutic; Estrogen Antagonists; Ethanol; Evidence-Based Medicine; Humans; Liver Neoplasms; Liver Transplantation; Neoplasm Staging; Prognosis
PubMed: 14762851
DOI: 10.1002/lt.20034 -
BMC Surgery Dec 2020Mucinous cyst neoplasm of the liver (MCN-L) comprise less than 5% of all cystic liver lesions and is characterized by the presence of ovarian stroma and absence of bile...
BACKGROUND
Mucinous cyst neoplasm of the liver (MCN-L) comprise less than 5% of all cystic liver lesions and is characterized by the presence of ovarian stroma and absence of bile duct communication.
CASE PRESENTATION
Here, we discuss a 45-year-old woman who presented with symptomatic liver mass. Diagnostic workup detected a 4.2 × 3.6 cm septate cyst located in segments I, V, and VIII of the liver in communication with the right hepatic duct. An open right liver resection with total bile duct excision and hilar lymphadenectomy was performed. Pathology revealed a multiloculated cyst with lined mucinous epithelium and ovarian-like stroma, consistent with low-grade MCN-L.
CONCLUSIONS
This case shows that unusual location and bile duct communication can be present in MCN-L.
Topics: Bile Ducts, Intrahepatic; Female; Hepatectomy; Humans; Liver Neoplasms; Middle Aged
PubMed: 33308210
DOI: 10.1186/s12893-020-01003-3 -
Experimental and Clinical... Jul 2023Patients with neuroendocrine tumors with unresec-table liver involvement can benefit from liver transplant. There is a specific set of guidelines for neuroendocrine... (Review)
Review
Patients with neuroendocrine tumors with unresec-table liver involvement can benefit from liver transplant. There is a specific set of guidelines for neuroendocrine tumors with liver metastasis that involve less than 50% of the liver. However, beyond those guidelines, there are reports of exceptional criteria patients who benefited from liver transplant. Here, we present 2 unusual cases of patients with exceptional circumstances and with neuroendocrine tumors who underwent liver transplant. The first case describes a patient with an extremely rare neuroen-docrine tumor of the proximal common bile duct that caused liver biliary cirrhosis. The patient underwent tumor resection and liver transplant concurrently. The second case describes a patient with a neuroendocrine tumor of unknown primary origin with more than 50% hepatic involvement who received a liver transplant after downstaging. In our center, patients with unresectable hepatic metastases from neuroendoc-rine tumors are currently selected for liver transplant based on well-established criteria. However, these 2 cases did not meet the criteria for consideration of liver transplant; thus, multidisciplinary team sessions were held to discuss these 2 cases. After a period of nonsurgical treatment and evaluation of the tumor behavior, we selected the patients as candidates for liver transplant based on the favorable tumor behavior and favorable response to treatment. For both patients, we did not observe any signs of tumor recurrence during follow-up. The outcomes were acceptable, and the patients tolerated treatment well. Considering the favorable tumor pathology (G1 phase and low Ki67 index), we suggest that more studies should be conducted to evaluate the outcomes of patients with low-grade tumors and that the criteria for patients with low-grade tumors could be extended based on such future data.
Topics: Humans; Neuroendocrine Tumors; Liver Transplantation; Neoplasm Recurrence, Local; Liver Neoplasms
PubMed: 37584538
DOI: 10.6002/ect.2023.0110 -
Clinical and Molecular Hepatology Apr 2023Hepatocellular carcinoma (HCC) is a major public health burden in Hong Kong, and chronic hepatitis B is the most common HCC etiology in our region. With the high case... (Review)
Review
Hepatocellular carcinoma (HCC) is a major public health burden in Hong Kong, and chronic hepatitis B is the most common HCC etiology in our region. With the high case load, extensive local expertise on HCC has been accumulated. This article summarized local guidelines and real-life practice on HCC management in Hong Kong. For HCC surveillance, liver ultrasound and serum alpha-fetoprotein for periodic screening is recommended in viral hepatitis or cirrhotic patients, and this is adhered to in clinical practice. HCC diagnosis is not covered in local guidelines, yet our practice is in-line with regional guidelines, where diagnosis is usually achieved by cross-sectional imaging and without the need for histology. Our guidelines recommend using the Hong Kong Liver Cancer Staging for pre-treatment staging, yet we routinely use other widely-adopted systems such as the Barcelona Clinic Liver Cancer Staging and the Tumor-Node-Metastasis Staging as well. Our local guidelines have provided clear treatment algorithms for the whole range of HCC therapies, including resection, ablation, transplant, transarterial chemoembolization, transarterial radioembolization, stereotactic body radiation therapy, targeted therapy, and immunotherapy. Real-life treatment choices are largely in line with the guidelines, although treatment protocols are individualized, and availability of specific therapies can vary between centers. Overall, HCC guidelines in Hong Kong are tailored based on local expertise and our unique patient population. The guidelines are up-to-date and provide practical pathways to assist our routine practice. Regular updates of local guidelines are warranted to account for the rapidly evolving paradigm of HCC management.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Hong Kong; Chemoembolization, Therapeutic; Neoplasm Staging
PubMed: 36577426
DOI: 10.3350/cmh.2022.0399 -
BMJ Open May 2021The association between ABO blood group and risk of liver cancer is unclear, although few studies have reported positive results. This study examined the relationship...
OBJECTIVE
The association between ABO blood group and risk of liver cancer is unclear, although few studies have reported positive results. This study examined the relationship between ABO blood group and liver cancer in hepatitis B surface antigen (HBsAg)-positive individuals.
DESIGN
A high-risk population-based cohort study.
SETTING
The study was started in 2007 and closed in 2019; the number of observed person-years as obtained by ABO blood group.
PARTICIPANTS
The study included 3663 individuals with positive HBsAg, including men aged 30-70 and women aged 40-70.
OUTCOME MEASURES
The frequencies of ABO group in the cohort population and patients with liver cancer were calculated, respectively. χ test was used to compare differences, and the relative risk (95% CI) for development of liver cancer was evaluated.
RESULTS
The frequency distribution of blood types A, B, O and AB was 1118 (30.52%), 1073 (29.29%), 1104 (30.14%) and 368 (10.05%), respectively, among 3663 cohort individuals. In the cohort, patients with liver cancer (n=336) were of the following frequencies: type A: 104 (30.95%); type B: 97 (28.87%); type O: 95 (28.27%); and type AB: 40 (11.90%). No significant difference was found between patients with liver cancer and other individuals. The annual incidence rate of liver cancer was 906.34 per 100 000 person-years, and for blood type A, B, O and AB the rates were 917.76, 893.78, 846.02 and 1093.43 per 100 000 person-years, respectively. The relative risk (95% CI) was 0.97 (0.74 to 1.29), 0.92 (0.70 to 1.22) and 1.19 (0.82 to 1.72) for blood types B, O and AB, respectively, compared with blood type A.
CONCLUSION
There were no significant differences in the frequency distribution of ABO blood groups in patients with liver cancer within this high-risk cohort, which demonstrates lack of positive association between ABO blood group and risk of liver cancer.
Topics: ABO Blood-Group System; Cohort Studies; Female; Hepatitis B Surface Antigens; Humans; Liver Neoplasms; Male; Prospective Studies; Risk Factors
PubMed: 33980521
DOI: 10.1136/bmjopen-2020-044039 -
HPB : the Official Journal of the... Nov 2012Biliary mucinous cystic neoplasms (BMCNs) are recently redefined rare liver tumours in which insufficient recognition frequently leads to an incorrect initial or delayed... (Review)
Review
OBJECTIVES
Biliary mucinous cystic neoplasms (BMCNs) are recently redefined rare liver tumours in which insufficient recognition frequently leads to an incorrect initial or delayed diagnosis. A concise review of the subtle, sometimes non-specific, clinical, serologic and radiographic features will allow for a heightened awareness and more comprehensive understanding of these entities.
METHODS
Literature relating to the presentation, diagnosis, treatment, pathology and outcomes of BMCNs and published prior to March 2012 was reviewed.
RESULTS
Biliary mucinous cystic neoplasms most commonly occur in females (≥60%) in the fifth decade of life. Clinical symptoms, serologic markers and imaging modalities are unreliable for diagnosis of BMCNs, which leads to misdiagnosis in 55-100% of patients. Perioperative cyst aspiration is not recommended as invasive BMCNs can only be differentiated from non-invasive BMCNs by microscopic evaluation for the presence of ovarian-type stroma. Intraoperative biopsy and frozen section(s) are essential to differentiate BMCNs from other cystic liver lesions. The treatment of choice is complete excision and can result in excellent survival with initial correct diagnosis.
CONCLUSIONS
A low threshold for considering BMCN in the differential diagnosis of cystic liver lesions and increased attentiveness to its subtle diagnostic characteristics are imperative. The complete surgical resection of BMCNs and the use of appropriate nomenclature are necessary to improve outcomes and accurately define prognosis.
Topics: Biopsy; Diagnosis, Differential; Diagnostic Imaging; Female; Frozen Sections; Humans; Liver; Liver Neoplasms; Middle Aged; Neoplasm Invasiveness; Neoplasms, Cystic, Mucinous, and Serous; Predictive Value of Tests; Treatment Outcome
PubMed: 23043661
DOI: 10.1111/j.1477-2574.2012.00532.x