Primary liver cancer is a disease in which the cells of liver become cancerous (malignant). Primary liver cancer is different from cancer that has spread from another place in the body to the liver. The liver is found in the upper right side of the abdomen. It is an an important organ which is involved in digesting food and converting it to energy and it also filters and stores blood. Liver cancer is relatively rare, known risk factors for liver cancer are prior hepatitis B or C infections or cirrhosis of the liver. There are two main types of liver cancer in adults: hepatocellular carcinoma and cholangiocarcinoma. Hepatoblastoma is another type of liver cancer which mostly occurs in children. Some types of liver cancer produce abnormaly high levels of alpha-fetoprotein (AFP) which can aid diagnosis.
Liver cancer explained - symptoms, diagnosis and treatment
Macmillan Cancer Support Video: Liver surgeon Aamir Khan explains primary liver cancer, including possible causes such as alcohol and obesity, symptoms, what tests might be done to diagnose liver cancer, and possible treatments such as surgery, chemotherapy or liver transplant.
PubMed Central search for free-access publications about Liver Cancer MeSH term: Liver Neoplasms US National Library of Medicine PubMed has over 22 million citations for biomedical literature from MEDLINE, life science journals, and online books. Constantly updated.
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Foster R, Meyer J, Iyengar P, et al. Localization accuracy and immobilization effectiveness of a stereotactic body frame for a variety of treatment sites. Int J Radiat Oncol Biol Phys. 2013; 87(5):911-6 [PubMed] Related Publications
PURPOSE: The purpose of this study was to analyze the pretreatment setup errors and intrafraction motion using cone beam computed tomography (CBCT) for stereotactic body radiation therapy patients immobilized and localized with a stereotactic body frame for a variety of treatment sites. METHODS AND MATERIALS: Localization errors were recorded for patients receiving SBRT for 141 lung, 29 liver, 48 prostate, and 45 spine tumors representing 1005 total localization sessions. All patients were treated in a stereotactic body frame with a large custom-molded vacuum pillow. Patients were first localized to the frame using tattoos placed during simulation. Subsequently, the frame was aligned to the room lasers according to the stereotactic coordinates determined from the treatment plan. Every patient received a pretreatment and an intrafraction CBCT. Abdominal compression was used for all liver patients and for approximately 40% of the lung patients to reduce tumor motion due to respiration. RESULTS: The mean ± standard deviation pretreatment setup errors from all localizations were -2.44 ± 3.85, 1.31 ± 5.84, and 0.11 ± 3.76 mm in the anteroposterior, superoinferior, and lateral directions, respectively. The mean pretreatment localization results among all treatment sites were not significantly different (F test, P<.05). For all treatment sites, the mean ± standard deviation intrafraction shifts were 0.33 ± 1.34, 0.15 ± 1.45, and -0.02 ± 1.17 mm in the anteroposterior, superoinferior, and lateral directions, respectively. The mean unidimensional intrafraction shifts were statistically different for several of the comparisons (P<.05) as assessed by the Tukey-Kramer test. CONCLUSIONS: Despite the varied tumor locations, the pretreatment mean localization errors for all sites were found to be consistent among the treatment sites and not significantly different, indicating that the body frame is a suitable immobilization and localization device for a variety of tumor sites. Our pretreatment localization errors and intrafraction shifts compare favorably with those reported in other studies using different types of immobilization devices.
Park ES, Lee J, Kang SY, et al. A comparative study of telomerase activity and cytologic diagnosis in malignant ascites. Anal Quant Cytol Histol. 2013; 35(3):146-51 [PubMed] Related Publications
OBJECTIVE: To evaluate telomerase activity as an adjunct in the cytologic diagnosis of malignant ascites. STUDY DESIGN: Malignant ascites collected from 19 gastrointestinal or liver cancer patients with clinical or pathologic evidence of peritoneal metastasis were tested for routine cytology with a liquid-based preparation, and telomerase activity was measured by telomere-repeat amplification protocol (TRAP) and real-time quantitative TRAP (RTQ-TRAP) assays. For comparison, controls from peritoneal washings from 8 early gastric cancer patients were used. RESULTS: Cytological examination detected cancer cells in 8 patients (42%), and 3 cases (16%) were diagnosed as "atypia." With TRAP and RTQ-TRAP assays 16 (84%) and 15 (78%) cases, respectively, were positive for telomerase activity. The sensitivity of telomerase activity by TRAP, RTQ-TRAP assays, and cytology was 84%, 78%, and 58%, respectively. All cases with "atypia" by cytological examination were positive for both TRAP and RTQ-PCR assays. In all negative controls, cytology, TRAP and RTQ-TRAP assays were negative. CONCLUSION: Based on our findings telomerase activity is a more sensitive method than ascitic fluid cytology and therefore can be considered as a useful diagnostic adjunct to current standard diagnostic methods. However, further large cohort studies with clinical correlation are needed to confirm our findings.
Chamadol N, Somsap K, Laopaiboon V, Sukeepaisarnjaroen W Sonographic findings of hepatocellular carcinoma detected in ultrasound surveillance of cirrhotic patients. J Med Assoc Thai. 2013; 96(7):829-38 [PubMed] Related Publications
BACKGROUND: Hepatocellular carcinoma (HCC) is associated with high mortality. Patients with hepatitis B or C viral cirrhosis have an increased risk of developing HCC. Ultrasound is the most widely used screening method, and is recommended by many guidelines. OBJECTIVE: To study the sonographic findings ofHCC detected in ultrasound surveillance of cirrhotic patients. MATERIAL AND METHOD: Retrospective assessment of ultrasoundfindings of all nodules that were diagnosed HCC by either dynamic imaging (CTor MRI) or biopsy between October 2008 and July 2011. Nodules were classified based on echogenicity and other sonographic characteristics. RESULTS: Of 92 nodules, 42 (45.7%) were hyperechoic, 29 (31.5%) hypoechoic, 20 (21.7%) heterogeneous echoic and 1 (1.1%) isoechoic. Heteroechoic nodules were more common among nodules over 3.0 cm (p = 0.0037) while hypoechoic nodules tended to be the smaller ones. About half (48/92) of the nodules had a hypoechoic halo and occurred significantly more commonly among hyperechoic and heteroechoic nodules (p< 0. 001). Posterior enhancement was found in 54 nodules (58. 7%0), also more common in nodules >3.0 cm (p = 018). Lateral shadowing occurred in 40 nodules (43.5%). CONCLUSION: The sonographic findings of HCC nodules in the present studies varied, but the prevalence of hyperechoic nodules was higher than in most of other studies. The authors emphasize the necessity of performing dynamic imaging for any nodule detected in a cirrhotic liver in order to exclude their neoplastic nature, no matter what it may look like.
The widening web of epigenetic regulatory mechanisms also encompasses ethanol-induced changes in the gastrointestinal (GI)-hepatic system. In the past few years, increasing evidence has firmly established that alcohol modifies several epigenetic parameters in the GI tract and liver. The major pathways affected include DNA methylation, different site-specific modifications in histone proteins, and microRNAs. Ethanol metabolism, cell-signaling cascades, and oxidative stress have been implicated in these responses. Furthermore, ethanol-induced fatty liver (i.e., steatohepatitis) and progression of liver cancer (i.e., hepatic carcinoma) may be consequences of the altered epigenetics. Modification of gene and/or protein expression via epigenetic changes also may contribute to the cross-talk among the GI tract and the liver as well as to systemic changes involving other organs. Thus, epigenetic effects of ethanol may have a central role in the various pathophysiological responses induced by ethanol in multiple organs and mediated via the liver-GI axis.
Wang H, Chen G, Wang H, Liu C RITA inhibits growth of human hepatocellular carcinoma through induction of apoptosis. Oncol Res. 2013; 20(10):437-45 [PubMed] Related Publications
RBP-J-interacting and tubulin-associated (RITA) is a novel RBP-J-interacting protein that downregulates Notch-mediated transcription. The current study focuses on the antitumor effect of RITA in human hepatocellular carcinoma (HCC) and aims to explore its molecular mechanism. Thirty paired HCC and adjacent non-tumoral liver samples were analyzed by real-time quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). RITA overexpression was induced by transfection of a pcDNA3.1-Flag-RITA plasmid into HepG2 cells. RITA knockdown was achieved by siRNA transfection. mRNA and protein expression of target genes were quantified by qRT-PCR and Western blotting, respectively. Cell proliferation and apoptosis were measured using MTT assay and flow cytometry. Our results demonstrate that adjacent nontumoral liver samples exhibited increased RITA expression compared to HCC tissues (p < 0.05); RITA levels were associated with tumor differentiation status. Overexpression of RITA suppressed cell proliferation and promoted early apoptosis, while its silencing promoted cell growth dramatically (p < 0.05). RITA overexpression upregulated p53 and reduced cyclin E levels, whereas silencing of RITA had the opposite effect on p53 and cyclin E expression. Our in vitro results represent the first evidence that RITA might suppress tumor growth and induce apoptosis in HCCs, and may be a potent antitumoral agent for HCC treatment that deserves further exploration.
Li F, Guo Z, Wang H Influencing elements and treatment strategies associated with the relapse of hepatocellular carcinoma after surgery. Hepatogastroenterology. 2013 Jul-Aug; 60(125):1148-55 [PubMed] Related Publications
UNLABELLED: BACKGROUND/ AIMS: Long-term prognosis after surgical resection of Hepatocellular Carcinoma remains unsatisfactory, mainly because of the high postoperative incidence of recurrence and metastasis. An updated knowledge on the influencing factors of recurrence and treatment strategies of postoperative recurrence is important for clinicians in designing a strategy to optimize the chance of long-term survival in patients undergoing hepatic resection for HCC. METHODOLOGY: Using key words “Hepatocellular Carcinoma”, “liver cancer”, “resection”, “postoperative recurrence”, “treatment strategy”, “therapy”, “influencing factors”, “risk factors”, we performed a review of relevant English articles based on based on a Medline search before May 2012. RESULTS: Influencing factors include tumor size, venous invasion, satellite nodules, cirrhosis, alpha-foetoprotein, aspartate aminotransferase, alkaline phosphatase levels, hepatitis B virus and hepatitis C virus infection, Alpha-foetoprotein mRNA and some surgical factors. Treatment strategies include re-resection, transarterial chemoembolization, radiofrequency ablation, percutaneous ethanol injection, salvage liver transplantation, radioactive seed 125I implantation and other new treatment modalities of postoperative recurrent HCC are all used to prolong survival in patients with recurrence, and multimodality therapy of above mentioned therapies may offer additional beneﬁt. CONCLUSIONS: With advances in perioperative detection and therapeutic modalities, results of recurrence after resection of HCC will greatly improved.
BACKGROUND: Correct characterization of focal solid hepatic lesions has always been a challenge and is of great diagnostic and therapeutic relevance. The purpose of this study was to determine the added value of hepatobiliary phase images in Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for differentiating focal solid hepatic lesions. METHODS: In this retrospective trial 84 consecutive patients underwent Gd-EOB-DTPA-enhanced MR examinations. MRI was conducted for 64 patients with malignant focal hepatic lesions (34 hepatocellular carcinoma (HCC), 30 metastases) and for 20 patients with benign hepatic lesions (14 focal nodular hyperplasia (FNH), 3 adenoma, 3 hemangioma). Five radiologists independently reviewed three sets of MR images by means of a 5-point confidence scale from score 1 (definitely benign) to score 5 (definitely malignant): set 1: unenhanced images; set 2: unenhanced and Gd-EOB-DTPA-enhanced dynamic images; set 3: hepatobiliary phase images in addition to set 2. Accuracy was assessed by the alternative free-response receiver operating characteristic curve (Az) and the index of diagnostic performance was calculated. RESULTS: Diagnostic accuracy was significantly improved by the addition of Gd-EOB-DTPA-enhanced dynamic images: Az in set 1 was 0.708 and 0.833 in set 2 (P = 0.0002). The addition of hepatobiliary phase images increased the Az value to 0.941 in set 3 (set 3 vs set 2, P < 0.0001; set 3 vs set 1, P < 0.0001). The index of diagnostic performance was lowest in set 1 (45%), improved in set 2 (71%), and highest in set 3 (94%). CONCLUSIONS: Hepatobiliary phase images obtained after Gd-EOB-DTPA-enhanced dynamic MRI improve the differentiation of focal solid hepatic lesions.
Toyota N, Nakamura Y, Hieda M, et al. Diagnostic capability of gadoxetate disodium-enhanced liver MRI for diagnosis of hepatocellular carcinoma: comparison with multi-detector CT. Hiroshima J Med Sci. 2013; 62(3):55-61 [PubMed] Related Publications
The purpose of this study was to evaluate the diagnostic capability of gadoxetate disodium (Gd-EOB)-MRI for the detection of hepatocellular carcinoma (HCC) compared with multidetector CT (MDCT). Fifty patients with 57 surgically proven HCCs who underwent Gd-EOB-MRI and MDCT from March 2008 to June 2011 were evaluated. Two observers evaluated MR and CT on a lesion-by-lesion basis. We analyzed sensitivity by grading on a 5-point scale, the degree of arterial enhancement and the differences in histological grades in the diffusion-weighted images (DWI). The results showed that the sensitivity of Gd-EOB-MRI was higher than that of MDCT especially for HCCs that were 1 cm in diameter or smaller. The hepatobiliary phase was useful for the detecting of small HCC. We had few cases in which it was difficult to judge HCC in the arterial enhancement between MRI and MDCT. In the diffusion-weighted image, well differentiated HCC tended to show a low signal intensity, and poorly differentiated HCC tended to show a high signal intensity. In moderately differentiated HCC's, the mean diameter of the high signal intensity group was larger than that of the low signal intensity group (24.5 mm vs. 15.8 mm). In conclusion, Gd-EOB-MRI tended to show higher sensitivity compared to MDCT in the detection of HCC.
Hu QY, Jiang H, Su J, Jia YQ MicroRNAs as biomarkers for hepatocellular carcinoma: a diagnostic meta-analysis. Clin Lab. 2013; 59(9-10):1113-20 [PubMed] Related Publications
BACKGROUND: Numerous studies reported various microRNAs (miRNAs) could be novel serum biomarkers for hepatocellular carcinoma (HCC). However, the diagnostic ability of different miRNA biomarkers varies among the reports. In this paper, we made a meta-analysis about the diagnostic accuracy of miRNAs for HCC. METHODS: We systematically searched The Cochrane Central Register of Controlled Trials, MEDLINE, Pub Med, EMBASE, the Chinese Biomedical Literature Database, the China Academic Journals Full-text Database, and the Chinese Scientific Journals Database for potential studies. Studies were included if they were related to miRNAs and HCC and reported diagnostic outcomes. Diagnostic values analysis was used to summarize the overall test performance of miRNAs. RESULTS: Eight studies were included in this meta-analysis. The ranges of the diagnostic value of miRNAs for HCC were as follows: sensitivity was 0.72 - 0.98, pooled sensitivity was 0.87; specificity was 0.76 - 1.00, pooled specificity was 0.90; positive likelihood ratio was 3.52 - 97.45, pooled positive likelihood ratio was 8.70; negative likelihood ratio was 0.02 - 0.31, pooled negative likelihood ratio was 0.13; and diagnostic odds ratio was 19.06 - 2,646.00, pooled diagnostic odds ratio was 86.69. CONCLUSIONS: MiRNAs showed high accuracy in identifying HCC, and could be a useful screening tool for diagnosing HCC patients.
Li J, Shi W, Gao Y, et al. Analysis of microRNA expression profiles in human hepatitis B virus-related hepatocellular carcinoma. Clin Lab. 2013; 59(9-10):1009-15 [PubMed] Related Publications
BACKGROUND: Increasing evidence has shown that the deregulation of microRNAs (miRNAs) is closely related to the development and progression of hepatocellular carcinoma (HCC). To screen for HCC-specific miRNAs, this study investigated the differentially expressed miRNAs between HCC and matched non-tumorous tissue (NT). METHODS: This study analyzed the differential expression profiles of miRNAs in 11 pairs of HCC and matched NT from 11 hepatitis B virus (HBV) infection patients with the RT2 miRNA PCR array containing 88 human cancer-related miRNAs. The fold change value was more than two between the HCC and the matched NT, which indicated that there was deregulation of miRNAs. The down-regulated let-7a was validated in another sample set of 34 tissues with the TaqMan RT-qPCR method. RESULTS: Compared with the matched NT tissues, 9 miRNAs were up-regulated in the HCC tissues, and three were considered statistically significant (p < 0.05): miR-96, miR-183, and miR-196a, which were up-regulated 4.746-, 7.127-, and 3.498-fold, respectively. Simultaneously, 9 miRNAs were down-regulated in the HCC tissues, and two were considered statistically significant: let-7c and miR-138, which were down-regulated 3.945- and 4.790-fold, respectively. The expression levels of let-7a were 1.071 +/- 0.401, 0.926 +/- 0.477, 0.881 +/- 1.214, and 0.535 +/- 0.719 in the healthy group, chronic hepatitis B(CHB) group, NT group, and HCC group, respectively (p > 0.05). CONCLUSIONS: This study demonstrates that 18 miRNAs were deregulated in the HCC and matched NT tissues. The deregulated miRNAs suggest that further analyses with larger miRNA samples as a diagnostic marker are warranted.
Yahya RS, Ghanem OH, Foyouh AA, et al. Role of interleukin-8 and oxidative stress in patients with hepatocellular carcinoma. Clin Lab. 2013; 59(9-10):969-76 [PubMed] Related Publications
BACKGROUND: The rate of hepatocellular carcinoma (HCC) is increasing in Egypt where the major risk factor is chronic infection with hepatitis C virus (HCV). The development of effective markers for the detection of HCC could have an impact on cancer mortality and significant public health implications worldwide. The objective of this study is to investigate the role of interleukin-8, alpha-fetoprotein (AFP), oxidative stress markers, and some trace elements in Egyptian patients with hepatocellular carcinoma infected with hepatitis C virus. METHODS: This study comprised 40 patients with HCC (20 with cirrhosis and 20 without cirrhosis) and 20 patients with hepatitis C virus. They were 39 males and 21 females with ages ranging from 22 to 71 years. Twenty apparently healthy volunteers with matched age and sex were taken as control group. Serum concentration levels of IL-8 and AFP were measured using an enzyme-linked immunosorbent assay (ELISA). Antioxidants were measured using spectrophotometric analysis and trace elements by using atomic absorption spectrophotometry. RESULTS: A highly significant elevation was found in interleukin-8, alpha- fetoprotein, iron, and malondialdehyde in patients with HCC compared to control subjects. On the other hand, serum levels of reduced glutathione, catalase, superoxide dismutase, total antioxidant capacity, and zinc were significantly decreased in patients with HCC compared to control subjects. A positive correlation was found between serum level of IL-8 and each of GSH (r = -0.534 and p = 0.000), SOD (r = -0.295 and p = 0.021), CAT (r = -0.545 and p = 0.000), and Zn (r = 0.422 and p = 0.001) in all patient groups. CONCLUSIONS: The ability to measure IL-8 in serum could be useful as a marker of HCC in patients. The levels of antioxidants such as CAT, SOD, and GSH in HCC patients when compared to control groups play a vital and important role in the prevention of liver cancer. Interleukin-8, some antioxidants (MDA, GSH, CAT and SOD), and some trace elements (Fe and Zn) might be simultaneously evaluated in order to enhance the detection of HCC.
Zhang YL, Wang XS, Fang W, et al. In vitro study of the cytotoxicities of two mixed-ligand oxovanadium complexes on human hepatoma cells. Pharmazie. 2013; 68(10):827-34 [PubMed] Related Publications
The cytotoxicities of two oxovanadium complexes, VOI [VO(satsc)(phen)] (satsc = salicylaldehyde thiosemicarbazone, phen = 1,10-phenanthroline) and VOII [VO(3,5-dibrsatsc)(phen)](3,5-dibrsatsc = 3,5-dibromosalicylaldehyde thiosemicarbazone), were studied by performing MTT assays on human hepatoma cell lines BEL-7402, HUH-7 and HepG2. The results showed that both the VOI and VOII complexes possess significant anti-proliferative effects. In addition, the anti-proliferative mechanism of the complexes was analyzed by cell cycle analysis and an apoptosis assay and by detecting the mitochondrial membrane potential (delta psi m). The experimental results showed that the complexes can cause a G0/G1 phase cell cycle arrest and can significantly decrease delta psi m, causing depolarization of the mitochondrial membrane. Notably, the two complexes induced apoptosis in BEL-7402 cells and displayed typical morphological apoptotic characteristics. The cytotoxicities of the VOII complex are significantly stronger than that of the VOI complex, suggesting that the cytotoxic effects of oxovanadium complexes may be associated with the electronic effects of the complexes.
Margolis NE, Shaver CM, Rosenkrantz AB Indeterminate liver and renal lesions: comparison of computed tomography and magnetic resonance imaging in providing a definitive diagnosis and impact on recommendations for additional imaging. J Comput Assist Tomogr. 2013 Nov-Dec; 37(6):882-6 [PubMed] Related Publications
PURPOSE: The purpose of this study was to compare computed tomography (CT) and magnetic resonance imaging (MRI) in terms of likelihood of providing a definitive diagnosis (DD) and a recommendation for additional imaging (RAI), when performed to evaluate indeterminate liver and renal lesions detected on ultrasound as well as in terms of impact on imaging costs. METHODS: This retrospective study was Health Insurance Portability an Accountability Act (HIPAA)-compliant and institutional review board-approved, with waiver of informed consent. We identified consecutive indeterminate liver and renal lesions detected on ultrasound that underwent contrast-enhanced CT or MRI for further characterization. Reports from follow-up studies were reviewed for whether the impression provided DD and RAI. Frequency of DD and RAI was compared between CT and MRI using the Fisher exact test. On the basis of the observed frequency of DD, anticipated imaging costs were compared in a hypothetical sample of 100 patients with indeterminate lesions between first obtaining multiphase CT for all lesions and a subsequent MRI for those lesions indeterminate on CT versus directly obtaining a multiphase MRI for all lesions. RESULTS: A total of 143 renal lesions were included, of which 77 and 66 underwent CT and MRI, respectively. Magnetic resonance imaging was significantly more likely than CT to provide DD (95.5% vs 77.9%; P = 0.003) and significantly less likely to provide RAI (1.5% vs 10.4%; P = 0.038). A total of 221 liver lesions were included, of which 76 and 145 underwent CT and MRI, respectively. Magnetic resonance imaging was significantly more likely than CT to provide DD (95.2% vs 71.1%; P < 0.001) and significantly less likely to provide RAI (0% vs 10.5%; P < 0.001). Across the entire study cohort, there were 13 instances of MRI recommended after an indeterminate CT and 1 case of CT recommended after an indeterminate MRI. A DD was provided in 8 of 9 instances in which MRI was performed after an indeterminate CT. However, anticipated imaging costs were higher when directly obtaining MRI for all indeterminate lesions, compared with initially obtaining multiphase CT, for both kidney ($64,739 vs $49,759) and liver ($64,739 vs. $56,975) lesions, respectively. CONCLUSIONS: For indeterminate liver and renal lesions detected on ultrasound, MRI is more likely to provide DD and less likely to provide RAI in comparison with CT, although these differences did not result in lower anticipated imaging costs.
Park MJ, Kim YK, Park HJ, et al. Scirrhous hepatocellular carcinoma on gadoxetic acid-enhanced magnetic resonance imaging and diffusion-weighted imaging: emphasis on the differentiation of intrahepatic cholangiocarcinoma. J Comput Assist Tomogr. 2013 Nov-Dec; 37(6):872-81 [PubMed] Related Publications
OBJECTIVE: The objective of this study was to determine the features of scirrhous hepatocellular carcinoma (sHCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) with an emphasis on the differentiation from intrahepatic cholangiocarcinoma (ICC). MATERIALS AND METHODS: A total of 41 patients with sHCCs and 41 patients with ICCs underwent gadoxetic acid-enhanced MRI and DWI. Images were analyzed for shape of lesions, surface retraction, enhancement pattern, proportion of arterial hyperenhancement, target appearance on the hepatobiliary phase and DWI, and presence of necrosis. RESULTS: Lobulating shape, rim enhancement, and target appearance on the hepatobiliary phase and DWI were the main features in both tumors. The proportion of arterial hyperenhancement of 20% of tumor diameter or more was the only significant MRI feature for differentiating sHCC from ICC (P ≤ 0.006 in the multivariate analysis). CONCLUSIONS: Although the features of sHCC on gadoxetic acid-enhanced MRI and DWI are similar to those of ICC, the proportion of hyperenhancement of 20% or more on the arterial phase is a helpful feature in distinguishing sHCC from ICC.
Hwang J, Kim YK, Lee WJ, et al. Unenhanced magnetic resonance portography using repetitive arterial or vein labeling method at 3.0-T. J Comput Assist Tomogr. 2013 Nov-Dec; 37(6):856-61 [PubMed] Related Publications
OBJECTIVE: The objective of this study was to determine whether unenhanced magnetic resonance (MR) angiography using repetitive arterial or vein labeling (RAVEL) is feasible to visualize effectively the intrahepatic portal vein (PV) at 3.0 T. METHODS: Forty patients underwent liver MR imaging (MRI) with unenhanced MR portography using RAVEL. Two radiologists performed a consensus review of unenhanced MR portography and portal-phase MRI with regard to anatomic type of PV, vessel conspicuity, and image quality. RESULTS: For determination of the anatomic type of PV, the 2 techniques were equivalent. There were tendencies toward increased conspicuity for right segmental PV and its branches with unenhanced MR portography and for left PV with conventional MRI, although significant differences were not found between MRIs (P > 0.05). Image quality for unenhanced MR portography was poor in 1, moderate in 8, and good in 31 patients. CONCLUSIONS: Unenhanced MR portography using RAVEL at 3.0 T is feasible and provides effective visualization of intrahepatic PV.
Choi SH, Hee Lee C, Kim BH, et al. "Nondefect" of arterial enhancing rim on hepatobiliary phase in 3.0-T gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced liver magnetic resonance imaging: distinguishing hepatic abscess from metastasis. J Comput Assist Tomogr. 2013 Nov-Dec; 37(6):849-55 [PubMed] Related Publications
OBJECTIVE: The objective of this study was to retrospectively determine the findings of Gd-EOB-DTPA (gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid)-enhanced magnetic resonance imaging (MRI) to distinguish abscess from metastasis of the liver. METHODS: Among patients who underwent Gd-EOB-DTPA MRI from March 2008 to December 2011, 32 patients with abscess or metastasis were included, and all lesions showed arterial rim enhancement. Twenty-one abscesses and 19 metastases were included. Two radiologists assessed how the arterial enhancing rim showed in hepatobiliary phase (HBP) and classified the signal intensity of the rim into defect zone, gray zone, and uptake zone. The frequency of showing nondefect, which means gray or uptake zone between both lesions, was compared using Pearson χ test. RESULTS: The rim of arterial enhancement in 3 abscesses (14.3%) and 15 metastases (78.9%) showed defect zone in HBP. Six abscesses (28.6%)and no metastases showed gray zone, and 12 abscesses (57.1%) and 4 metastases (21.1%) showed uptake zone. The frequency of nondefect in the rim of arterial enhancement on HBP was significantly higher in abscesses (85.7% of abscesses, 21.1% of metastases, P < 0.001). CONCLUSIONS: A reliable finding that distinguished abscess from metastasis was nondefect of arterial enhancing rim on HBP in Gd-EOB-DTPA MRI. This is a meaningful feature for differentiating abscess from metastasis, especially when evaluating patients with primary malignancy.
Patients with cirrhosis who experience hepatic decompensation, such as the development of ascites, SBP, variceal hemorrhage, or hepatic encephalopathy, or who develop HCC, are at a higher risk of mortality. Management should be focused on the prevention of recurrence of complications, and these patients should be referred for consideration of liver transplantation.
Salgia R, Singal AG Hepatocellular carcinoma and other liver lesions. Med Clin North Am. 2014; 98(1):103-18 [PubMed] Related Publications
Patients with cirrhosis are at greatest risk for development of hepatocellular carcinoma (HCC) and should undergo semiannual surveillance using ultrasound, with or without alpha fetoprotein. Patients with positive surveillance testing should undergo contrast-enhanced MRI or 4-phase CT for diagnostic evaluation. There are therapeutic options for most patients with any tumor stage; however, treatment decisions must be individualized after accounting for degree of liver dysfunction and patient performance status. A multidisciplinary approach to care is recommended for optimal communication and treatment delivery. The aim of this review is to provide an up-to-date summary of the diagnosis and management of HCC.
All providers, regardless of specialty, should perform screening for HBV on high-risk persons, especially those born in endemic countries. The primary care physician can perform the initial evaluation and follow-up of patients with chronic HBV by following the algorithm in this article and consulting with specialists when appropriate. Chronically infected patients should be followed on a regular basis, preferably every 6 months, with liver function tests, and when appropriate, HBV DNA levels. Those who meet the criteria for high risk for HCC should undergo liver ultrasound every 6 months. Powerful antiviral medications are available that can suppress but not cure HBV and result in resolution of liver inflammation and fibrosis, even cirrhosis, as well as decrease the risk of developing HCC. They should be used in those patients who meet the criteria outlined in the practice guidelines of the major liver societies.
He M, Huang Z, Yan X, et al. Label-free detection of hepatocellular carcinoma markers based on photoluminescence of antibody-conjugated ZnO arrays. J Biomed Nanotechnol. 2013; 9(12):2024-33 [PubMed] Related Publications
Hepatocellular carcinoma (HCC) is a malignant disease that is prevalent all around the world, especially in Asia. The combined detection of four common HCC markers, alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and 19-9 (CA19-9), can significantly improve the accuracy of early screening and diagnosis of this disease, which is very important for its effective treatment in a curable stage. In this article, hierarchical ZnO column arrays with core-shell structure were prepared, and specific antibodies of HCC markers were successfully conjugated onto ZnO arrays via the carbodiimide chemistry. The photoluminescence (PL) intensity of antibody-ZnO increased after HCC markers were bound. In the range of 0.5-15 ng/mL for AFP or CEA (or 0.5-15 U/mL for CA125 or CA19-9), the apparent linear relations between the PL enhancements and the concentrations of HCC markers offered simple standard curve for HCC detection in serum samples, indicating that the PL-enhanced antibody-ZnO arrays could be utilized in early clinical screening. A preliminary mechanism of PL intensity enhancement can be established based on this work.
Young AL, Adair R, Culverwell A, et al. Variation in referral practice for patients with colorectal cancer liver metastases. Br J Surg. 2013; 100(12):1627-32 [PubMed] Related Publications
BACKGROUND: Half of patients with colorectal cancer develop liver metastases. There remains great variability between hospitals in rates of liver resection for colorectal cancer liver metastases (CLM). This study aimed to determine how many patients with potentially resectable CLM are not seen by specialist liver surgeons. METHODS: Patients presenting with new CLM in a cancer network consisting of a tertiary centre and seven attached hospitals were studied prospectively over 12 months. Data were collected retrospectively for patients who did not have a complete data set. Outcomes for patients referred to the liver tertiary centre were collated. The radiology of tumours deemed inoperable by the local colorectal specialist teams was reviewed by specialist liver surgeons and radiologists. RESULTS: In total, 631 patients with CLM were assessed. Prospective data were complete for 241 patients, and 64 (26.6 per cent) of these were referred to the specialist liver team for consideration of resection. No decision was documented for 16 patients (6.6 per cent). Of those not referred, 30 (18.6 per cent) were deemed unfit or refused and 131 (81.4 per cent) were thought inoperable. Referral rates varied between hospitals (13-43.6 per cent). Of 131 patients deemed fit but inoperable by the colorectal specialist teams, 38 (29.0 per cent) were deemed operable and 20 (15.3 per cent) had equivocal imaging when assessed retrospectively by liver specialists. In total, 142 of the 631 patients were referred to liver specialists for consideration of treatments, and 107 (75.4 per cent) treated with curative intent. CONCLUSION: A considerable number of patients with potentially resectable CLM are not assessed by specialist liver teams. Improved referral rates could greatly improve resection rates for CLM, which may improve outcomes for patients with colorectal cancer.
Qiu J, Wu H, Bai Y, et al. Mesohepatectomy for centrally located liver tumours. Br J Surg. 2013; 100(12):1620-6 [PubMed] Related Publications
BACKGROUND: Mesohepatectomy (MH) avoids unnecessary sacrifice of functional parenchyma compared with extended hepatectomy (EH). The aim of this study was to compare the results of MH with those of EH in the management of centrally located liver tumours (CLLTs). METHODS: All patients with CLLTs treated by liver resection between 2005 and 2011 were enrolled in this retrospective study. The decision to use MH or EH was made on an individual basis. Outcomes of the procedures were compared and a classification system for MH was devised consisting of four types, with type IV representing the most complex procedure. RESULTS: MH was performed in 292 patients and EH in 138. MH was associated with a longer duration of operation (P < 0.001), higher intraoperative transfusion rate (P < 0.001) and lower complication rates (P = 0.001) compared with EH. There were no significant differences in hepatic inflow occlusion rate (P = 0.075), blood loss (P = 0.241) and length of hospital stay (P = 0.804) between the two groups. Type IV lesions had the longest duration of operation, greatest blood loss, and highest intraoperative transfusion and morbidity rates (all P < 0.050). CONCLUSION: MH is a feasible and safe alternative to EH in selected patients with CLLTs. The proposed classification system may be useful in guiding the surgical treatment of CLLTs.
McDonald RJ, McDonald JS, Kallmes DF, Carter RE Behind the numbers: propensity score analysis-a primer for the diagnostic radiologist. Radiology. 2013; 269(3):640-5 [PubMed] Related Publications
Researchers frequently use observational studies to compare outcomes of patients who undergo different treatments. However, as patients in these observational studies are not randomly assigned to a particular treatment group, unknown confounding variables may be present. Specifically, there may be major differences in numerous clinical variables between the treatment groups that may affect the outcomes being examined. Propensity score adjustment is an increasingly popular statistical method used to simultaneously balance these clinical variables and control for this confounder bias. Propensity score analysis can minimize the limitations of retrospective or prospective observational studies by simulating the randomization process of randomized controlled trials. In this review, an introduction to propensity score adjustment is provided by using the Takuma et al study published in this issue of Radiology as an example.
Sanuki N, Takeda A, Mizuno T, et al. Tumor response on CT following hypofractionated stereotactic ablative body radiotherapy for small hypervascular hepatocellular carcinoma with cirrhosis. AJR Am J Roentgenol. 2013; 201(6):W812-20 [PubMed] Related Publications
OBJECTIVE: The purpose of this study is to evaluate the CT appearances of tumor responses following hypofractionated stereotactic ablative body radiotherapy for small hypervascular hepatocellular carcinomas (HCCs) and to assess the relationship between tumor responses and local control. MATERIALS AND METHODS: Among 277 HCC tumors treated with stereotactic ablative body radiotherapy (35 or 40 Gy per five fractions), we selected enhanced lesions on arterial phase CT performed before stereotactic ablative body radiotherapy. Radiographic findings after stereotactic ablative body radiotherapy were evaluated during a 2-year follow-up period with the modified Response Evaluation Criteria in Solid Tumors. Local control and survival rates were calculated with the Kaplan-Meier method. RESULTS: Forty-two tumors with a median size of 2.1 cm (range, 1.0-3.8 cm) were selected with a median follow-up of 23.3 months (range, 9-56 months). Local recurrence was observed in two tumors after achieving a complete response (CR). The 2-year local control rate was 97%, and the overall survival rate was 81%. CR increased from 10 (24%) to 28 (67%) to 30 (71%) tumors at 3, 6, and 12 months after stereotactic ablative body radiotherapy. Overall CR at maximum follow-up was 39 tumors (93%), yet three enhanced tumors persisted for more than 2 years. The median time to achieve CR was 5.9 months (range, 1.2-34.2 months). CONCLUSION: The CR rate in hypervascular HCCs after hypofractionated stereotactic ablative body radiotherapy increased during the 2-year follow-up period. Cautious and continuous observation until tumor regrowth is considered relevant to evaluate a true effect of this treatment. Further studies for the optimal evaluation of treatment outcome after stereotactic ablative body radiotherapy are warranted.
Sandrasegaran K, Tahir B, Nutakki K, et al. Usefulness of conventional MRI sequences and diffusion-weighted imaging in differentiating malignant from benign portal vein thrombus in cirrhotic patients. AJR Am J Roentgenol. 2013; 201(6):1211-9 [PubMed] Related Publications
OBJECTIVE: The objective of our study was to determine the value of diffusion-weighted imaging (DWI) and conventional MRI (non-DWI sequences) in differentiating benign portal vein thrombus (PVT) from malignant PVT in cirrhotic patients. MATERIALS AND METHODS: A retrospective search of the department of radiology's MRI database of examinations performed from October 2006 through December 2010 for "portal vein thrombosis" and "cirrhosis" and "hepatocellular cancer" was performed. Patients who underwent diagnostic DWI and had thrombus shown to be rapidly (< 3 months) increasing in size despite anticoagulation therapy were considered to have malignant PVT (n = 16 cases) and patients with MRI findings showing stability or reduction in the extent of thrombus over a 12-month follow-up were considered to have benign PVT (n = 20 cases). Two blinded and independent reviewers analyzed the DW images and conventional MR images. RESULTS: There was no difference in the distribution of patients by age (p = 0.25) or sex (p = 0.68) between the benign and malignant PVT groups. On multivariate analysis, the only parameter to predict the type of PVT was the size of HCC (p = 0.05); other parameters were excluded from the model. There was substantial overlap in apparent diffusion coefficient (ADC) values and PVT/liver ADC ratios of benign PVT and malignant PVT. The presence of at least two of the three following MRI findings had a sensitivity of 100% and specificity of 90% for the diagnosis of malignant PVT: distance from tumor to PVT of less than 2 cm, HCC size of greater than 5 cm, and arterial enhancement of PVT. CONCLUSION: Signal-intensity characteristics on DWI and measured ADC values do not reliably differentiate benign PVT from malignant PVT. On the other hand, careful assessment of conventional MRI findings may allow this distinction, thus obviating biopsy.
Bi X, Jin Y, Gao X, et al. Investigation of Pokemon-regulated proteins in hepatocellular carcinoma using mass spectrometry-based multiplex quantitative proteomics. Eur J Mass Spectrom (Chichester, Eng). 2013; 19(2):111-21 [PubMed] Related Publications
Pokemon is a transcription regulator involved in embryonic development, cellular differentiation and oncogenesis. It is aberrantly overexpressed in multiple human cancers including Hepatocellular carcinoma (HCC) and is considered as a promising biomarker for HCC. In this work, the isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative proteomics strategy was used to investigate the proteomic profile associated with Pokemon in human HCC cell line QGY7703 and human hepatocyte line HL7702. Samples were labeled with four-plex iTRAQ reagents followed by two-dimensional liquid chromatography coupled with tandem mass spectrometry analysis. A total of 24 differentially expressed proteins were selected as significant. Nine proteins were potentially up-regulated by Pokemon while 15 proteins were potentially down-regulated and many proteins were previously identified as potential biomarkers for HCC. Gene ontology (GO) term enrichment revealed that the listed proteins were mainly involved in DNA metabolism and biosynthesis process. The changes of glucose-6-phosphate 1-dehydrogenase (G6PD, up-regulated) and ribonucleoside-diphosphate reductase large sub-unit (RIM1, down-regulated) were validated by Western blotting analysis and denoted as Pokemon's function of oncogenesis. We also found that Pokemon potentially repressed the expression of highly clustered proteins (MCM3, MCM5, MCM6, MCM7) which played key roles in promoting DNA replication. Altogether, our results may help better understand the role of Pokemon in HCC and promote the clinical applications.
Wang B, Xia CY, Lau WY, et al. Determination of clonal origin of recurrent hepatocellular carcinoma for personalized therapy and outcomes evaluation: a new strategy for hepatic surgery. J Am Coll Surg. 2013; 217(6):1054-62 [PubMed] Related Publications
BACKGROUND: Recurrent hepatocellular carcinoma (RHCC) after curative resection is a major challenge for hepatic surgeons. A better understanding of the clonal origin of RHCC will help clinicians design personalized therapy and assess postoperative outcomes. The current study was performed to determine the clonal origin of RHCC and its clinical significance. STUDY DESIGN: Fifteen high-frequency of loss of heterozygosity of DNA microsatellites were determined on 100 tumor nodules in 60 matched pairs of RHCC from 40 patients who underwent liver re-resections. The relationships among the origin of clonal patterns of RHCC and the surgicopathologic features and clinical outcomes were analyzed. RESULTS: Of 60 pairs of RHCC, there were 2 clonal patterns with 6 subclonal types. Pattern I was multicentric occurrence (MO type) in 14 pairs (23.3%) and pattern II was intrahepatic metastasis (IM type) in 46 pairs (76.7%). The clinicopathologic features, including recurrence time, tumor size, vascular invasion, histological grading, and associated chronic liver diseases in patients with the MO type of RHCC were significantly different from those with the IM type of RHCC (p < 0.05 to 0.001). Compared with patients in the IM group, patients in the MO group had significantly better overall survival (130.8 ± 8.5 months vs 80.8 ± 8.5 months; p < 0.05) and recurrence-free survival (33.8 ± 4.5 months vs 14.2 ± 2.5 months; p < 0.001). CONCLUSIONS: The MO-type RHCC was closely associated with better postoperative outcomes when compared with the IM-type RHCC. Generally, we recommend liver re-resection for MO-type RHCC, and interventional therapy for IM-type RHCC. Microdissection-based microsatellite loss of heterozygosity protocol has advantages in assessing the clonal origin, modes of personalized treatment, and clinical outcomes of RHCC.
Zimmitti G, Vauthey JN, Shindoh J, et al. Systematic use of an intraoperative air leak test at the time of major liver resection reduces the rate of postoperative biliary complications. J Am Coll Surg. 2013; 217(6):1028-37 [PubMed] Article available free on PMC after 01/12/2014 Related Publications
BACKGROUND: After hepatectomy, bile leaks remain a major cause of morbidity, cost, and disability. This study was designed to determine if a novel intraoperative air leak test (ALT) would reduce the incidence of post-hepatectomy biliary complications. STUDY DESIGN: Rates of postoperative biliary complications were compared among 103 patients who underwent ALT and 120 matched patients operated on before ALT was used. All study patients underwent major hepatectomy without bile duct resection at 3 high-volume hepatobiliary centers between 2008 and 2012. The ALT was performed by placement of a transcystic cholangiogram catheter to inject air into the biliary tree, the upper abdomen was filled with saline, and the distal common bile duct was manually occluded. Uncontrolled bile ducts were identified by localization of air bubbles at the transection surface and were directly repaired. RESULTS: The 2 groups were similar in diagnosis, chemotherapy use, tumor number and size, resection extent, surgery duration, and blood loss (all, p > 0.05). Single or multiple uncontrolled bile ducts were intraoperatively detected and repaired in 62.1% of ALT vs 8.3% of non-ALT patients (p < 0.001). This resulted in a lower rate of postoperative bile leaks in ALT (1.9%) vs non-ALT patients (10.8%; p = 0.008). Independent risk factors for postoperative bile leaks included extended hepatectomy (p = 0.031), caudate resection (p = 0.02), and not performing ALT (p = 0.002) (odds ratio = 3.8; 95% CI, 1.3-11.8; odds ratio = 4.0; 95% CI, 1.1-14.3; and odds ratio = 11.8; 95% CI, 2.4-58.8, respectively). CONCLUSIONS: The ALT is an easily reproducible test that is highly effective for intraoperative detection and repair of open bile ducts, reducing the rate of postoperative bile leaks.
Shindoh J, Tzeng CW, Aloia TA, et al. Portal vein embolization improves rate of resection of extensive colorectal liver metastases without worsening survival. Br J Surg. 2013; 100(13):1777-83 [PubMed] Related Publications
BACKGROUND: Most patients requiring an extended right hepatectomy (ERH) have an inadequate standardized future liver remnant (sFLR) and need preoperative portal vein embolization (PVE). However, the clinical and oncological impact of PVE in such patients remains unclear. METHODS: All consecutive patients presenting at the M. D. Anderson Cancer Center with colorectal liver metastases (CLM) requiring ERH at presentation from 1995 to 2012 were studied. Surgical and oncological outcomes were compared between patients with adequate and inadequate sFLRs at presentation. RESULTS: Of the 265 patients requiring ERH, 126 (47·5 per cent) had an adequate sFLR at presentation, of whom 123 underwent a curative resection. Of the 139 patients (52·5 per cent) who had an inadequate sFLR and underwent PVE, 87 (62·6 per cent) had a curative resection. Thus, the curative resection rate was increased from 46·4 per cent (123 of 265) at baseline to 79·2 per cent (210 of 265) following PVE. Among patients who underwent ERH, major complication and 90-day mortality rates were similar in the no-PVE and PVE groups (22·0 and 4·1 per cent versus 31 and 7 per cent respectively); overall and disease-free survival rates were also similar in these two groups. Of patients with an inadequate sFLR at presentation, those who underwent ERH had a significantly better median overall survival (50·2 months) than patients who had non-curative surgery (21·3 months) or did not undergo surgery (24·7 months) (P = 0·002). CONCLUSION: PVE enabled curative resection in two-thirds of patients with CLM who had an inadequate sFLR and were unable to tolerate ERH at presentation. Patients who underwent curative resection after PVE had overall and disease-free survival rates equivalent to those of patients who did not need PVE.
Azoulay D, Pascal G, Salloum C, et al. Vascular reconstruction combined with liver resection for malignant tumours. Br J Surg. 2013; 100(13):1764-75 [PubMed] Related Publications
BACKGROUND: The resectability criteria for malignant liver tumours have expanded during the past two decades. The use of vascular reconstruction after hepatectomy has been integral in this process. However, the majority of reports are anecdotal. This is a retrospective analysis of the techniques, morbidity, mortality and risk factors of liver resections with vascular reconstruction based on a large series from a single centre. METHODS: Patients who underwent hepatic resection combined with vascular resection and reconstruction between 1997 and 2009 were included in this study. Indications for surgery, morbidity and 90-day mortality are reported along with factors predictive of operative mortality. RESULTS: Eighty-four patients had liver resection with 97 vascular resections and reconstruction. There were 44 men and 40 women with a mean(s.d.) age of 56·9(12·1) years. Mean(s.d.) follow-up was 37·3(34·1) months. All patients had primary or metastatic liver tumours. The perioperative morbidity rate was 62 per cent (52 patients) and the operative mortality rate 14 per cent (12). Predictors of operative mortality were: bilirubin level exceeding 34 µmol/ml (P = 0·023), indocyanine green retention rate at 15 min over 10 per cent (P = 0·031), duration of ischaemia (P = 0·011), amount of blood transfused (P = 0·025) and combined major extrahepatic procedure (P = 0·042). Actuarial 3- and 5-year survival rates were 44 and 26 per cent respectively. CONCLUSION: Liver resection with combined vascular resection and reconstruction can be performed in selected patients with acceptable morbidity and mortality. The lack of therapeutic alternatives and the poor outcome of non-operative management seem to justify this approach. The identification of risk factors should help improve patient selection and postoperative outcome as well as facilitate objective risk communication with surgical candidates.