Which system is better to predict prognosis of patients with hepatocellular carcinoma treated by transcatheter arterial chemoembolization as initial therapy? Comparison between CLIP and JIS in a Japanese population.

Background There has been no consensus as to which system, either the Cancer of the Liver Italian Program (CLIP) or the Japan Integrated Staging (JIS) system, is suitable to predict the prognosis of hepatocellular carcinoma (HCC) patients who underwent transcatheter arterial chemoembolization (TACE) as initial therapy. Purpose To retrospectively compare the usefulness of CLIP and JIS in predicting and stratifying the prognosis of HCC patients treated by TACE. Material and Methods Between 1995 and 2005, consecutive 728 patients with untreated HCC who underwent TACE in our institute were selected for this study. The survival rate and its prognostic factors were assessed by multivariate analysis. Patients were stratified according to the two systems, and their survival rates between the scores were compared. Results The mean follow-up period was 1689 days. The 1-year, 3-year, 5-year, and 10-year survival rates were 83.1%, 55.1%, 34.7%, and 12.8%, respectively. Both systems stratified the prognosis of patients well, but was slightly better in CLIP as compared to in JIS. As for multivariate factor analysis, less severe Child-Pugh classification ( P < 0.001), simple tumor morphology ( P < 0.001), absence of portal vein invasion ( P < 0.001), and lower alpha-fetoprotein (AFP) level ( P < 0.001) were suggested to be independent indicators for favorable survival rate. All of these independent factors were included in CLIP, whereas JIS lacked AFP level. Furthermore, the likelihood χ2-test value was higher, and the Akaike information criterion value was lower for CLIP than for JIS. Conclusion CLIP is more suitable than JIS for predicting prognosis of patients with HCC who would undergo TACE in a Japanese population.

Pilot Study of Hepatic Arterial Infusion Chemotherapy with Interferon-beta and 5-fluorouracil: A New Chemotherapy for Patients with Advanced Hepatocellular Carcinoma.

BACKGROUND/AIMS: The present pilot study aimed to evaluate the safety and efficacy of hepatic arterial infusion chemotherapy (HAIC) with interferon-beta (IFN-ß) and 5-fluorouracil (5-FU) in patients with advanced hepatocellular carcinoma (HCC). METHODOLOGY: We studied 10 patients with advanced HCC and who were unresponsive to previous HAIC using low-dose 5-FU and cisplatin. The median age was 67 years. Eight patients had portal vein tumor thrombosis and four patients had extrahepatic metastasis. Using a drug delivery system, patients were treated with HAIC of IFN-ß (600 MIU/body, three times/week) and 5-FU (250 mg/body, five times/week). Chemotherapy was repeated consecutively for 2 weeks every 4 weeks. RESULTS: Six (60%) patients had a decrease in tumor markers alpha-fetoprotein (APP) or des-gamma-carboxy prothrombin (DCP). The median overall survival was 108 days and the 1-year survival rate was 10.0%. Univariate analysis showed two significant prognostic factors related to long-term survival for more than 60 days: a decrease in APP or DCP 4 weeks after treatment (P = 0.035) and no extra hepatic metastasis (P = 0.035). Severe hepatic injury was not observed. CONCLUSIONS: HAIC with IFN-ß and 5-PU exerts modest antitumor effects and poses no particular safety concerns. This may be a new promising strategy for treatment of advanced HCC.

Warming effect on miriplatin-lipiodol suspension for potential use as a chemotherapeutic agent for transarterial chemoembolization of hepatocellular carcinoma: In vitro study.

AIM: To elucidate whether warming may reduce the viscosity of miriplatin-lipiodol suspension (MPT/LPD) and also the injection pressure through microcatheters, for potential use as a chemotherapeutic agent of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). METHODS: Viscosity of MPT/LPD prepared at on-label dose was measured in vitro at 25°C, 30°C, 40°C, 50°C and 60°C using capillary tube method. Reproducibility of viscosity change was also tested. Injection pressure through two different commercially available microcatheters was measured using a rheometer. Data sampling was performed at least twice for each measurement. RESULTS: Viscosity of MPT/LPD was significantly reduced as the temperature was elevated (R(2) = 0.9586, P < 0.0001, Pearson's correlation); at 40°C, it was almost half of that at room temperature (25°C). Repeated warming and cooling down of MPT/LPD revealed good reproducibility of viscosity change. Injection pressure through either microcatheter showed significant reduction when MPT/LPD was warmed (P < 0.05, Spearman's rank correlation coefficient). CONCLUSION: The viscosity and injection pressure through microcatheters of MPT/LPD was confirmed to reduce significantly as the temperature is elevated. MPT/LPD warmed to 40°C has half viscosity as that at room temperature and is considered suitable for clinical use. Warming MPT/LPD may have potential to facilitate the procedure of TACE for HCC.

Pseudolesion of the liver on gadoxetate disodium-enhanced MR images obtained after transarterial chemoembolization for hepatocellular carcinoma: clinicoradiologic correlation.

OBJECTIVE: The purpose of this study was to elucidate the clinicoradiologic characteristics of pseudolesions of the liver in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) as observed on gadoxetate disodium-enhanced MR images. A particular interest was correlation between the pseudolesion characteristics and TACE-MRI interval, during which sequential changes in pseudolesions may be revealed after TACE. MATERIALS AND METHODS: Forty-eight patients with HCC who underwent gadoxetate disodium-enhanced MRI after TACE were retrospectively recruited. Pseudolesions were defined as areas of decreased signal intensity in treated areas on hepatocellular phase images that were confirmed to be nontumorous areas at follow-up. The prevalence and MRI features of pseudolesions were correlated with various clinical parameters, including TACE-MRI interval. RESULTS: Pseudolesions were found in 14 patients (29%). Within 1 month of TACE, the prevalence of pseudolesions was 83%. All of the pseudolesions had arterial enhancement, mimicking residual HCC. After 1 month, the prevalence of pseudolesions decreased, and these pseudolesions tended to exhibit no abnormality in any sequence other than the hepatocellular phase. Results of multivariate analysis suggested that size of HCC (p < 0.0001), duration of postembolization syndrome (p = 0.012), and TACE-MRI interval (p = 0.038) are independent indicators of the presence of pseudolesions. CONCLUSION: The prevalence and appearance of pseudolesions differ at different intervals from TACE. Radiologists need to recognize the clinicoradiologic characteristics to differentiate pseudolesions from true residual or recurrent HCC.

Papillary renal cell carcinoma with extensive paraaortic nodal metastasis mimicking malignant lymphoma.

A 52-year-old woman with abdominal distension underwent computed tomography (CT) that demonstrated extensive paraaortic lymphadenopathy and a right renal mass. Compared to the renal cortex, the lesions exhibited low signal intensity on T(1)- and T(2)-weighted images and high intensity on diffusion-weighted magnetic resonance (MR) images. We suspected malignant lymphoma and performed excisional biopsy, which revealed metastatic papillary renal cell carcinoma. Retrospectively, significantly reduced signal on in-phase chemical shift MR images compared to out-of-phase images suggested the presence of intratumoral hemosiderin, a characteristic finding of this entity.

Pseudolesion of the liver observed on gadoxetate disodium-enhanced magnetic resonance imaging obtained shortly after transarterial chemoembolization for hepatocellular carcinoma.

The purpose of this report was to describe pseudolesions of the liver that mimicked residual hypervascular hepatocellular carcinoma (HCC), as observed on gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI) obtained shortly after transarterial chemoembolization (TACE). Between June 2008 and December 2008, three patients underwent MRI within 12 days after TACE to rule out remaining viable cancerous tissue or to assess the treatment effect. In all three patients, nontumorous liver tissue adjacent to the treated HCC exhibited focal arterial enhancement on dynamic phase and subsequent diminished uptake of gadoxetate disodium on hepatocellular phase images, which mimicked residual HCC. All three patients had mild postembolization syndrome at the time of EOB-MRI and showed no evidence of residual or recurrent tumors on follow-up. The findings of these areas may represent transient focal hyperemia and damage to the liver cell function caused by TACE. Radiologists should be aware that EOB-MRI obtained shortly after TACE may show pseudolesions around the treated tumors and should not mistake them for residual or recurrent tumors.