Low applicability of the ‘‘six-and-twelve score” in hepatocellular carcinomatreated with drug-eluting bead transarterial chemoembolization

Objective: the effectiveness of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) dependson the selection of suitable patients. The ‘‘six-and-twelve score” distinguishes three groups of ideal patients with different overall survival, based on the sum of the number and size of tumors. This may impact on clinical practice and trial design. The aim of this study was to assess the reproducibility and prognostic value of the model in western patients treated with drug-eluting beads (DEB)-TACE.Methods: an observational, retrospective, unicentric study with consecutive compensated patients treated with DEBTACE from October 2008 to October 2017. Exclusion criteria were Child-Pugh ≥ 8 and DEB-TACE used as a bridge to liver transplantation.Results: a total of 225 consecutive HCC patients were included; BCLC-0/A, n = 131 (single nodules > 5, n = 29) andBCLC-B, n = 94. Median overall survival (OS) was 27 months (95 % CI, 23.8-30.2). OS was different between BCLC-0/A and BCLC-B: 30 vs. 24 months (p = 0.03), Child-Pugh A5 vs. A6-B7: 30 vs. 27 months (p = 0.003). ‘‘Six-and-twelve score” groups discriminated OS: group 1, n = 123, 32 months (95 % CI, 27.5-63.5); group 2, n = 101, 24 months (95% CI, 19.6-28.4); and group 3, n = 1, 27 months (p = 0.024). When comparing the three scores, the ‘‘six-and-twelve score” showed the best discrimination power: C-index, 0.603; Akaike’s informationcriterion (AIC), 1.642; likelihood ratio test (LRT), 16.21.Conclusion: The ‘‘six-and-twelve score” is a prognostic tool for patients with HCC treated with DEB-TACE. However, few patients were included in the third group (score > 12) and no differences were observed with BCLC, therefore applicability is limited. (AU)

Low applicability of the ''Six-and-twelve score" in hepatocellular carcinoma treated with Drug-Eluting Beads Transarterial Chemoembolization.

OBJECTIVE: The effectiveness of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) depends on the selection of suitable patients. The ''Six-and-twelve score" distinguishes three groups of ideal patients with different overall survival, based on the sum of the number and size of tumors. This may impact on clinical practice and trial design. The aim of this study was to assess the reproducibility and prognostic value of the model in western patients treated with Drug-Eluting Beads (DEB)-TACE. METHODS: Observational, retrospective, unicentric study with consecutive compensated patients treated with DEB-TACE from October 2008 to October 2017. Exclusion criteria were Child-Pugh ≥ 8 and DEB-TACE used as a bridge to liver transplantation. RESULTS: 225 HCC consecutive patients were included; BCLC-0/A n=131 (single nodules > 5, n=29) and BCLC-B n=94. The median overall survival (OS) was 27 months (95% CI 23.8-30.2). OS was different between BCLC-0/A vs BCLC-B: 30 vs 24 months (p= 0.03), Child-Pugh A5 vs A6-B7: 30 vs 27 months (p= 0.003). ''Six-and-twelve score" groups discriminated OS: group 1, n=123, 32 months (95% CI 27.5-63.5), group 2, n=101, 24 months (95% CI 19.6-28.4) and group 3, n=1, 27 months (p=0.024). When comparing the three scores, the ''Six-and-twelve score" showed the best discrimination power: C-index 0.603, Akaike's information criterion (AIC) 1.642, likelihood ratio test (LRT) 16.21. CONCLUSION: The ''Six-and-twelve score" is a prognostic tool for patients with HCC treated with DEB-TACE. However, few patients were included in the third group (score >12) and no differences were observed with BCLC, therefore its applicability is limited. .

Impact of Alcohol Abstinence on the Risk of Hepatocellular Carcinoma in Patients With Alcohol-Related Liver Cirrhosis.

INTRODUCTION: Although alcohol cessation is the only effective treatment for alcohol-related liver disease, few data exist concerning its influence on the risk of hepatocellular carcinoma (HCC). We aimed to evaluate the effect of alcohol abstinence on the incidence of HCC in patients with alcohol-related cirrhosis. METHODS: We studied 727 patients with alcohol-related cirrhosis (247 with compensated disease and 480 with previous decompensation) who were included in a surveillance program for the early detection of HCC and prospectively followed. Baseline clinical and biological parameters and alcohol consumption during follow-up were recorded. Abstinence was defined as the absence of any alcohol use. RESULTS: During follow-up (median 54 months), 354 patients (48.7%) remained abstinent and 104 developed HCC (2.3 per 100 person-years). Factors independently associated with the risk of HCC among patients with previous decompensation were age, male gender, and aspartate aminotransferase, whereas abstinence was not linked to a reduced risk (hazard ratio 0.95; 95% confidence interval 0.59-1.52). However, among patients without previous decompensation, prothrombin activity and abstinence were independently associated with the risk of HCC. Abstinent patients had a significant decrease in the risk of developing tumor (hazard ratio 0.35; 95% confidence interval 0.13-0.94). These results did not change after applying a competing risk analysis where death and liver transplantation were considered as competing events. DISCUSSION: Alcohol abstinence reduced the risk of HCC in patients with alcohol-related cirrhosis, but only in those without a history of decompensated disease. This finding emphasizes the need for an early diagnosis of alcohol-related liver disease and for implementing strategies leading to an increase in the rate of achieving and maintaining abstinence among this population.

The development of early ascites is associated with shorter overall survival in patients with hepatocellular carcinoma treated with drug-eluting embolic chemoembolization.

BACKGROUND: A single-centre cohort study was performed to identify the independent factors associated with the overall survival (OS) of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization with drug-eluting beads (DEB-TACE). METHODS: A total of 216 HCC patients who underwent DEB-TACE from October 2008 to October 2015 at a tertiary hospital were consecutively recruited. The analysis of prognostic factors associated with overall survival after DEB-TACE, stressing the role of post-TACE events, was performed. RESULTS: The objective response (OR) rate (Modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria) to the first DEB-TACE (DEB-TACE-1) was 70.3%; the median OS from DEB-TACE-1 was 27 months (95% confidence interval (CI), 24-30). In the multivariate analysis, tumor size, AFP < 100 ng/mL and serum alkaline phosphatase were independent factors for survival following DEB-TACE-1. The most important clinical event associated with poor survival was the development of early ascites after DEB-TACE-1 (median OS, 17 months), which was closely related to the history of ascites, albumin and hemoglobin but not to tumour load or to response to therapy. CONCLUSIONS: Early ascites post-DEB-TACE is associated with the survival of patients despite adequate liver function and the use of a supra-selective technical approach. History of ascites, albumin and hemoglobin are major determinants of the development of early ascites post-DEB-TACE.

Bone metastases as initial presentation of hepatocellular carcinoma.

Extra-hepatic spread is present in 5% to 15% of patients with hepatocellular carcinoma (HCC) at the time of diagnosis. The most frequent sites are lung and regional lymph nodes. Here, we report 3 cases of unsuspected HCC with symptoms due to bone lesions as initial presentation. Morphological characteristics and immunohistochemistry from the examined bone were the key data for diagnosis. None of the patients had an already known chronic liver disease. Differential diagnoses with HCC upon ectopic liver disease or hepatoid adenocarcinoma were shown. Therapy with the orally active multikinase inhibitor sorafenib plus symptomatic treatment was indicated.

Tomografía computarizada cardiaca: Nuevas aplicaciones de una técnica en evolución / Cardiac computed tomography: New applications of an evolving technique

En los últimos años hemos sido testigos del continuo desarrollo de las técnicas de imagen en cardiología. Entre ellas, la tomografía computarizada cardiaca, técnica emergente y en continua evolución. Con la posibilidad actual de realizar estudios con muy baja radiación se han ampliado sus indicaciones más allá de la coronariografía no invasiva. En el presente trabajo de revisión repasamos las novedades técnicas de la tomografía computarizada cardiaca así como sus nuevas aplicaciones.

During the last years we have witnessed an increasing development of imaging techniques applied in Cardiology. Among them, cardiac computed tomography is an emerging and evolving technique. With the current possibility of very low radiation studies, the applications have expanded and go further coronariography In the present article we review the technical developments of cardiac computed tomography and its new applications.

[Cardiac computed tomography: new applications of an evolving technique]. / Tomografía computarizada cardiaca: Nuevas aplicaciones de una técnica en evolución.

During the last years we have witnessed an increasing development of imaging techniques applied in Cardiology. Among them, cardiac computed tomography is an emerging and evolving technique. With the current possibility of very low radiation studies, the applications have expanded and go further coronariography In the present article we review the technical developments of cardiac computed tomography and its new applications.

Imagen de carcinomatosis peritoneal secundaria a rotura de carcinoma hepatocelular originado sobre hígado sano / Peritoneal carcinomatosis secondary to spread of hepatocellular carcinoma originated upon a healthy liver

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An unsuspected clinical condition: Appendicitis of appendicular residual, three cases report.

INTRODUCTION: Stump appendicitis is a rare complication of appendectomy unusually included in the differential diagnosis. This is found in appendectomized patients with similar symptoms to those of a previous appendicitis. PRESENTATION OF CASE: We present three cases, two women and a man of 67, 30 and 24 years old, respectively. They underwent surgery at our centre and their appendectomies presented technical difficulties: problems when identifying the appendicular base or the complete appendicular structure. In the first case, diagnosis and therapy were performed with laparoscopy. The second case was diagnosed by an abdominal ultrasound (US) which revealed a tubular structure with thickened walls. An abscess was observed in the computed tomography (CT) scan for the third case and a laparotomy revealed the retained appendix. DISCUSSION: Although there are several factors that can contribute to this rare pathology, the main cause of stump appendicitis is the persistence of a large appendicular remnant. CT and US are very useful diagnosis tools. Treatment consists to a completion appendectomy of the stump which can be carried out by an open or a laparoscopic approach. CONCLUSION: In this rare pathology a prior history of appendicectomy can delay the diagnosis and increase its associated morbidity and even mortality. In patients with abdominal pain in the right lower quadrant and previous appendectomy, it is important to include this pathology in the differential diagnosis, in order to not delay the treatment and thus avoid complications.