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1.
Z Gastroenterol ; 58(1): 57-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31931541

RESUMO

The rising prevalence of the metabolic syndrome has led to an increase of non-alcoholic fatty liver disease (NAFLD), and its progressive-inflammatory form called non-alcoholic steatohepatitis (NASH). In recent years, NAFLD and NASH have become major risk factors for developing liver cirrhosis and hepatocellular carcinoma (HCC). In this case, we report a 46-year-old patient with type 2 diabetes mellitus and metabolic comorbidities including obesity and arterial hypertension, who was referred because of rising liver enzymes. After clinical and diagnostic evaluation, the patient was diagnosed with NASH-associated liver cirrhosis, Child-Pugh stage B. A normal blood sugar level was difficult to achieve, and the patient presented with consistently elevated HbA1c-levels irresponsive to insulin therapy. Due to the underlying liver cirrhosis, the patient was enrolled in the HCC-surveillance program. Sonography during follow up showed a focal lesion. On magnetic resonance imaging (MRI), the diagnosis of HCC (BCLC stage A) was confirmed based on typical contrast enhancement and portal-venous wash-out. The patient was evaluated for liver transplantation with a labMELD of 17, and an intermittent therapy with TACE was initiated. Only 2 months after liver transplantation, the patient developed severe and lethal complications. Overall, this case highlights the different medical issues of patients with metabolic syndrome developing a chronic liver disease. In this patient, a rapid progression from NASH-associated liver cirrhosis to HCC was seen, and therefore highlights the importance of close surveillance to identify and treat potential risk factors early in the course of the disease.


Assuntos
Carcinoma Hepatocelular/complicações , Diabetes Mellitus Tipo 2/complicações , Neoplasias Hepáticas/complicações , Hepatopatia Gordurosa não Alcoólica/complicações , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Comorbidade , Evolução Fatal , Humanos , Hipertensão/complicações , Resistência à Insulina , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Imagem por Ressonância Magnética , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/terapia , Obesidade/complicações
2.
Pan Afr Med J ; 34: 53, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762919

RESUMO

Hepatocellular carcinoma (HCC) tumor is the most common primary hepatic cancer. Bone metastases are rare with an incidence varying from 2% to 20% during autopsy. Spinal cord compression secondary to HCC is exceptional (0.03%-1.52%). It represents a therapeutic emergency. Therefore, it must be systematically searched in case of neurological signs. We report here two new cases of spinal cord compression secondary to HCC with a review of the literature.


Assuntos
Carcinoma Hepatocelular/complicações , Neoplasias Hepáticas/complicações , Compressão da Medula Espinal/etiologia , Carcinoma Hepatocelular/patologia , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade
3.
Orv Hetil ; 160(40): 1591-1602, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31565976

RESUMO

Introduction: Liver cirrhosis (20-25%), hepatocellular carcinoma (1.5-3%), insulin resistance (30-40%) and type 2 diabetes (25-30%) are common complications in patients with chronic hepatitis C virus (HCV) infection; however, data are missing from Hungary. Aim: To determine the prevalence of diabetes and insulin resistance in Hungarian HCV patients; to evaluate treatment-induced metabolic changes in relation to diabetes/insulin resistance and virological response and to perform a sustained follow-up for hepatocellular carcinoma detection. Method: We enrolled 150 Hungarian HCV genotype 1 patients (mean age: 48.55 ± 8.55 years, male/female ratio: 45/55%) from 2007-2012. We analysed their baseline, week 12, and end of therapeutic follow-up (24 weeks after interferon-based therapy completion) laboratory data. We performed a 5-year follow-up (2012-2017). Results: The prevalence of insulin sensitivity, insulin resistance and diabetes was 37.4%, 35.3% and 27.3%, respectively. Insulin resistant and diabetic patients showed a decrease in fasting glucose from baseline to end of follow-up (5.47 ± 0.66 vs. 5.08 ± 0.60, p<0.001; 7.90 ± 2.67 vs. 7.04 ± 2.75, p = 0.006), as did both the sustained responder and non-responder groups. Treatment efficacy rate was poor in diabetic vs. insulin sensitive and insulin resistant groups (17% vs. 46% and 40%); insulin sensitivity was not a predictor of virological response. Three participants with diabetes were diagnosed with hepatocellular carcinoma during follow-up by regular ultrasound examinations. Conclusion: Hungarian HCV patients showed high prevalence of diabetes and insulin resistance, though antiviral therapy caused favourable changes in their carbohydrate metabolism. Antiviral therapy was less effective in diabetic patients. Follow-up ultrasound examinations are required for hepatocellular carcinoma in HCV patients, especially those with diabetes. Orv Hetil. 2019; 160(40): 1591-1602.


Assuntos
Antivirais/uso terapêutico , Glicemia/metabolismo , Carcinoma Hepatocelular/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Hepatite C Crônica/complicações , Hepatite C Crônica/terapia , Resistência à Insulina , Neoplasias Hepáticas/complicações , Adulto , Idoso , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/virologia , Humanos , Hungria/epidemiologia , Cirrose Hepática/complicações , Cirrose Hepática/epidemiologia , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência
4.
Gastroenterol. hepatol. (Ed. impr.) ; 42(8): 502-511, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183892

RESUMO

La erradicación del virus de la hepatitis C (VHC) con esquemas libres de interferón (AAD) ha modificado la evolución de la enfermedad ya que más del 95% de los pacientes con cirrosis compensada logran la respuesta virológica sostenida. Sin embargo, el impacto de la erradicación del VHC sobre el desarrollo del carcinoma hepatocelular (CHC) es controvertido. Dicha controversia podría dividirse en diversos aspectos fundamentales: el impacto del AAD en la tasa de recurrencia del CHC, la asociación temporal entre el inicio de AAD y el desarrollo de la recurrencia del CHC y finalmente la agresividad de los CHC. Es por ello que esta revisión tiene por objetivo analizar los resultados disponibles en esta población de pacientes desde una perspectiva clínica donde se valoran los riesgos/beneficios de erradicar el VHC con AAD en el contexto de pacientes con CHC en respuesta completa


Eradication of the hepatitis C virus (HCV) with interferon-free therapies (DAAs) has modified the course of the disease, as the rate of patients with compensated cirrhosis who achieve a sustained virological response exceeds 95%. However, the impact on development of hepatocellular carcinoma (HCC) is currently in dispute. This argument could be divided into different key points: the impact of DAA on rate of HCC recurrence, the temporal link between starting DAAs and HCC recurrence, and finally, the aggressive pattern of HCC. Therefore, the aim of this review is to analyse the available results in this population of patients from a clinical perspective where the risks and benefits of HCV eradication with DAA therapies are evaluated in patients with complete response of HCC


Assuntos
Humanos , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/epidemiologia , Recidiva Local de Neoplasia/complicações , Antivirais/administração & dosagem
5.
Jpn J Radiol ; 37(11): 781-792, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31522384

RESUMO

PURPOSE: To determine the treatment outcome and prognostic factors for survival in patients with hepatocellular carcinoma (HCC) and macrovascular tumor thrombosis (MTT). METHODS: Between January 2010 and December 2018, 66 patients diagnosed with HCC and MTT, who received specific treatment were included. Various clinical and imaging data, treatment methods, outcomes, prognostic factors, and overall survival were evaluated. Outcomes were compared with those of 24 patients treated with supportive care. RESULTS: Most patients with HCC and MTT showed disease progression (80.3%) and a low 5-year survival rate. The median survival time after treatment was 13 months (vs. supportive care group 3 months, p < 0.001). Main branch MTT (p = 0.036), extent of tumor thrombus > 1 segment (p = 0.039), presence of ascites (p = 0.009) and among treatment methods, systemic therapy alone (p = 0.007), and supportive care (p < 0.001) compared with combined local with systemic therapies were prognostic factors for poor survival. CONCLUSIONS: Although most patients with HCC and MTT showed disease progression, median survival time was significantly longer than that with supportive care. Main branch and > 1 segment involvement of MTT and presence of ascites were significant prognostic factors for poor survival. Combined local and systemic therapy over systemic therapy alone are recommended for patients with these advanced stage HCCs.


Assuntos
Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Trombose/diagnóstico por imagem , Idoso , Carcinoma Hepatocelular/complicações , Feminino , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida , Trombose/etiologia , Trombose/terapia
6.
J Surg Oncol ; 120(7): 1112-1118, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31486087

RESUMO

BACKGROUND: The clinical importance of hypovascular liver lesions in cirrhotic patients awaiting liver transplantation (LT) has not been fully investigated. The objective of this study was to characterize the clinicopathologic features and management of these tumors and to assess their impact on post-LT outcomes. METHODS: We performed a retrospective review of cirrhotic patients with lesions suspicious for hypovascular hepatocellular carcinoma (HCC) who underwent LT at a single institution from 2011- 2017. RESULTS: We identified 22 pre-LT patients with radiologic diagnosis of a lesion(s) suspicious for hypovascular HCC. There were 28 hypovascular lesions within the 22 patient cohort; 9 lesions (32%) converted to hypervascular HCC before LT and 19 lesions remained hypovascular at LT. 88% of hypovascular lesions were HCC on explant pathology. Compared to patients with hyper-vascular HCC lesions, hypovascular HCC lesions underwent less preoperative tumor ablation (58% vs 89%; P < .01). Hypovascular HCC were more likely to be well-differentiated (67% vs 11%; P < .01), but there were no differences in the microvascular invasion, tumor recurrence, or survival post-LT. CONCLUSIONS: Hypovascular HCC has similar clinical outcomes and needs for transplantation as hypervascular HCC. The high prevalence of HCC within suspicious hypovascular lesions supports a similar monitoring and locoregional therapy strategy as for hypervascular HCC.


Assuntos
Carcinoma Hepatocelular/patologia , Cirrose Hepática/fisiopatologia , Neoplasias Hepáticas/patologia , Transplante de Fígado/mortalidade , Neovascularização Patológica , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
7.
Transplant Proc ; 51(7): 2482-2485, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31405736

RESUMO

BACKGROUND: Chronic hepatitis C virus (HCV) infection is a global health problem, and the need for liver transplants is ever-growing. For optimal surgical success, risk factors must be identified and HCV viral load must be reduced to a minimum to avoid complications. In this study, we aimed to investigate the role of HCV viral load on the post-transplant biliary complications. METHOD: Between 2004 and 2018, the cases of 114 liver transplant recipients with HCV infection were retrospectively reviewed. Data collection included demographic variables, preoperative and postoperative amount of serum HCV RNA copies, preoperative diagnosis of hepatocellular carcinoma (HCC), and postoperative biliary complications in the early and late period. After missing values were excluded, the remaining 97 patients were divided into 2 groups according to preoperative HCV RNA status (Group A: HCV RNA [+] and Group B: HCV RNA [-]). RESULTS: Demographic parameters were similar among both groups. There were 67 patients in Group A and 30 patients in Group B. The overall rate of biliary complications was higher in Group A without statistical significance (20% [n = 14] vs 13% [n = 4], respectively, P = .573). Biliary stricture occurrence in the late period was also higher in Group A. In HCC (+) patients (n = 26), biliary complications were significantly higher compared to HCC (-) patients (34% vs 12%, P = .018). However, in patients with biliary complications, the rate of multiple duct anastomoses was higher with no statistical significance (45% vs 26%, respectively, P = .14). CONCLUSION: The biliary complications on patient survival has been previously established, and this is mostly evident in those patients with viral etiology and hepatocellular carcinoma. As was also suggested in our study, hepatocellular carcinoma and positive viral status should be considered as predisposing factors for postoperative biliary complications after liver transplantation. However, the rate of multiple duct anastomoses should also be taken into consideration. New standards of antiviral medications and bridge therapy for HCC may improve transplant outcomes.


Assuntos
Carcinoma Hepatocelular/complicações , Hepatite C Crônica/virologia , Neoplasias Hepáticas/complicações , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/virologia , Feminino , Hepacivirus , Hepatite C Crônica/complicações , Humanos , Incidência , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/virologia , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Carga Viral
8.
Transplant Proc ; 51(9): 3147-3149, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31371215

RESUMO

BACKGROUND: Fibrocystic liver-kidney disease is caused by a group of rare and genetically diverse disorders that are associated with kidney cysts or dysplasia and ductal plate malformation in the liver. There have been several reports of liver neoplasias arising in hepatobiliary fibrocystic diseases. However, most were cholangiocarcinoma; cases involving hepatocellular carcinoma (HCC) are rare, and all the reported cases are related with adults. CASE REPORT: A 10-year-old girl with a history of repeated gastrointestinal bleeding underwent banding and sclerotherapy multiple times and had a history of a Portosystemic shunt without any significant benefit. She was referred to us as a case of fibrocystic liver disease with decompensated liver disease for liver transplantation. The patient underwent living donor liver transplantation, and the explanted liver histopathology report is documented. The explant liver weighed 838 g and measured 21 × 13 × 8.5 cm with the attached gallbladder measuring 7 × 3 × 0.2 cm (in wall thickness). The external surface was covered with multiple white nodules ranging in size from 0.4 to 1 cm. Serial slicing revealed an ill-defined, yellow, soft lesion (4 × 2.5 × 2.5 cm) localized in the subcapsular area of the left lobe (segment 4). The rest of the cut surface was green and nodular (cirrhotic). Microscopy from largest nodule was consistent with early hepatocellular carcinoma.The rest of the liver was cirrhotic, and the morphology was consistent with fibrocystic disease of liver. CONCLUSION: We report a rare case of HCC associated with fibrocystic liver disease. When diagnosing fibrocystic liver disease without known risk factors, the presence of HCC must be considered, and vice versa. To our knowledge, this is the first reported case of HCC associated with fibrocystic liver disease in a 10-year-old child.


Assuntos
Carcinoma Hepatocelular/complicações , Cistos/complicações , Hepatopatias/complicações , Neoplasias Hepáticas/complicações , Adulto , Carcinoma Hepatocelular/cirurgia , Criança , Cistos/cirurgia , Feminino , Humanos , Hepatopatias/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Masculino , Fatores de Risco
9.
Biomed Res Int ; 2019: 2141859, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467872

RESUMO

Objectives: Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remains a challenge in management. Transarterial chemoembolization (TACE) has been used for patients with PVTT but efficiency was limited with a median overall survival of 4 to 6.1 months. The aim of this study is to evaluate the efficiency of TACE combined with sorafenib in HBV background HCC with PVTT. Methods: A total of 498 patients were enrolled in the study including 69 patients who received TACE combined with sorafenib and 429 patients treated with TACE alone between January 1st, 2008, and April 30st, 2014. Using the 1:2 propensity score matching, 138 well-balanced patients were enrolled. Overall survival (OS) was compared between the two groups. The Kaplan-Meier method was used to evaluate the OS, and the differences between groups were analyzed with a log-rank test. Results: TACE combined with sorafenib improved the OS of the patients compared with TACE alone (13.0 vs 6.0 months, p<0.001). After propensity score matching, the median OS of combination therapy and TACE were 13.0 and 7.0 months, respectively (p=0.001). Subgroup analysis revealed that the patients younger than 60 years old, male patients, AFP more than 400ng/ml, tumor size more than 5cm, or type III/IV PVTT had OS benefits from TACE combined with sorafenib. Conclusions: Compared with TACE therapy alone, TACE combined with sorafenib could improve OS in HBV background HCC patients with PVTT. The patients who are younger, male, or with more tumor burden may benefit more from combination therapy.


Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Sorafenibe/administração & dosagem , Trombose Venosa/tratamento farmacológico , Adulto , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/virologia , Quimioembolização Terapêutica , Terapia Combinada , Intervalo Livre de Doença , Feminino , Vírus da Hepatite B/patogenicidade , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Veia Porta/efeitos dos fármacos , Veia Porta/patologia , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/patologia , Trombose Venosa/virologia
10.
J Korean Med Sci ; 34(30): e208, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31373186

RESUMO

BACKGROUND: Performing transarterial chemoembolization (TACE) is difficult with the occurrence of thrombocytopenia in cirrhotic patients with hepatocellular carcinoma (HCC). We aimed to evaluate the long-term efficacy and safety of partial splenic embolization (PSE) combined with TACE in patients with HCC with severe thrombocytopenia related to splenomegaly. METHODS: We conducted a case-control study consisting of 18 HCC patients with severe thrombocytopenia (< 50 × 109/L) who underwent PSE concurrently with TACE (PSE group) and 72 controls who underwent TACE alone (non-PSE group). RESULTS: Mean platelet counts at 1 month and 1, 3, and 5 years after concurrent PSE and TACE significantly increased compared with baseline (all P < 0.05), whereas the platelet count did not significantly increase after TACE alone. In addition, the platelet count at several time points after treatment in the PSE group was significantly higher than that in the non-PSE group, although the baseline platelet count in the PSE group was significantly lower than that in the non-PSE group. The platelet increase after PSE significantly reduced the need for platelet transfusions (P = 0.040) and enabled the subsequent TACE procedures in time (P = 0.046). The leukocyte counts and hemoglobin concentrations after concurrent PSE and TACE were also significantly increased, without deterioration of Child-Turcotte-Pugh score and unexpected side effects. CONCLUSION: PSE combined with TACE is effective in inducing and maintaining long-term thrombocytopenia improvement which reduces the need for the platelet transfusion and helps to perform initial and serial TACE, and is well-tolerated in patients with HCC and thrombocytopenia. PSE may be a promising treatment option for HCC patients with severe thrombocytopenia associated with splenomegaly who will undergo TACE.


Assuntos
Carcinoma Hepatocelular/terapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Trombocitopenia/diagnóstico , Adulto , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/mortalidade , Estudos de Casos e Controles , Quimioembolização Terapêutica , Feminino , Hemoglobinas/análise , Humanos , Contagem de Leucócitos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos , Artéria Esplênica/cirurgia , Esplenomegalia/complicações , Esplenomegalia/diagnóstico , Taxa de Sobrevida , Trombocitopenia/complicações
11.
Medicine (Baltimore) ; 98(31): e16660, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374039

RESUMO

INTRODUCTION: Primary hepatocellular carcinoma (HCC) is one of the most common malignancies, only 10% to 20% of HCC patients are surgically resectable as most of the patients are diagnosed at advanced stages at presentation. The efficiencies of transcatheter arterial chemoembolization (TACE), high-intensity focused ultrasound (HIFU), and three-dimensional conformal radiation therapy (3D-CRT) in patients with advanced HCC have been clinically confirmed. We here report a patient with HCC accompanied by venous tumor thrombus, who was treated with the combination of these 3 therapies. The patient survived for 16 months with good quality of life. PATIENT CONCERNS: The patient was a 72-year-old male with a primary multicentric HCC accompanied by tumor thrombus in the right hepatic vein. The patient had the symptoms of abdominal distention and liver pain. He refused sorafenib treatment because of personal reason. DIAGNOSIS: Primary multicentric HCC stage IIIB cT4N0M0, accompanied by tumor thrombus in the right hepatic vein; chronic viral hepatitis B; and hepatitis B virus-related decompensated liver cirrhosis. INTERVENTIONS: TACE + HIFU + 3D-CRT. OUTCOMES: The patient had an overall survival of 16 months with good quality of life. Compared with monotherapy, the combined therapy significantly prolonged patient survival time with improved clinical benefits. CONCLUSION: The combination of TACE, HIFU, and 3D-CRT is safe and effective in the treatment of advanced HCC, which provides a possible comprehensive treatment strategy for advanced HCC.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Neoplasias Hepáticas/terapia , Radioterapia Conformacional/métodos , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Terapia Combinada , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Masculino , Estadiamento de Neoplasias , Trombose Venosa/etiologia
12.
Cardiovasc Intervent Radiol ; 42(10): 1494-1499, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31363899

RESUMO

INTRODUCTION: Significant intratumoral shunts between tumor-supplying arteries and portal or liver veins are a contraindication for transarterial therapy of HCC because interventional treatment of these shunts is frequently insufficient. Sorafenib has anti-angiogenic effects and is indicated for palliative treatment of patients with HCC. Here, we report our experience with the use of sorafenib for the closure of intratumoral shunts in patients scheduled for transarterial therapy of HCC. MATERIALS AND METHODS: Three patients with HCC, aged 65, 82 and 79 years, exhibited a significant intratumoral shunting from tumor artery to portal (n = 1) or liver veins (n = 2). In all cases, intratumoral shunting had already been suspected based on pre-interventional CT angiography, and DSA confirmed the shunt. Oral sorafenib (800 mg/day) was administered for at least four weeks, only and specifically to occlude the shunt. Hereafter, patients were re-evaluated by CT and DSA. RESULTS: All patients tolerated the full prescribed dose for at least 4 weeks. In one case, therapy was prolonged with an adapted dose (400 mg/day) due to sorafenib-related hand-foot syndrome. After sorafenib treatment, CT and DSA confirmed a complete closure of intratumoral shunts for all patients. No tumor progression was observed. All three patients hereafter underwent successful transarterial treatment by TACE (n = 2) or TARE (n = 1) without complications. Progression-free survival according to mRECIST was 501, 397 and 599 days, respectively. CONCLUSION: Even short-term oral sorafenib seems to effectively close intratumoral shunts in patients with HCC and thus might enable transarterial treatment of these patients.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/irrigação sanguínea , Neoplasias Hepáticas/irrigação sanguínea , Neovascularização Patológica/tratamento farmacológico , Sorafenibe/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Quimioembolização Terapêutica , Feminino , Humanos , Infusões Intra-Arteriais , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Neovascularização Patológica/complicações , Neovascularização Patológica/diagnóstico por imagem , Estudos Retrospectivos , Sorafenibe/administração & dosagem , Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Future Oncol ; 15(22): 2603-2617, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31339048

RESUMO

Aim: Micro and macro vascular invasion (VI) are known as independent predictors of tumor recurrence and poor survival after surgical treatment of hepatocellular carcinoma (HCC). Here, we aimed to re-analyze The Cancer Genome Atlas of liver hepatocellular carcinoma datasets to identify the VI-expression signatures. Materials & methods: We filtered The Cancer Genome Atlas liver hepatocellular carcinoma (LIHC) datasets into three groups: no VI (NVI = 198); micro VI (MIVI = 89) and macro VI (MAVI = 16). We performed differential gene expression, methylation and microRNA analyses. Results & conclusion: We identified 12 differentially expressed genes and 55 differentially methylated genes in MAVI compared with no VI. The GPD1L gene appeared in all of the comparative analyses. Higher GPD1L expression was associated with VI and poor outcomes in the HCC patients.


Assuntos
Carcinoma Hepatocelular/genética , Neoplasias Hepáticas/genética , Recidiva Local de Neoplasia/genética , Neovascularização Patológica/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/genética , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Metilação de DNA/genética , Intervalo Livre de Doença , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Neoplasias Hepáticas/patologia , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Invasividade Neoplásica/genética , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Neovascularização Patológica/etiologia , Neovascularização Patológica/patologia , Adulto Jovem
14.
Int J Mol Sci ; 20(13)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31269646

RESUMO

The mitochondrial DNA (mtDNA) sequences of two commonly used human cell lines, HepaRG and SJCRH30, were determined. HepaRG originates from a liver tumor obtained from a patient with hepatocarcinoma and hepatitis C while SJCRH30 originates from a rhabdomyosarcoma patient tumor. In comparison to the revised Cambridge Reference Sequence, HepaRG and SJCRH30 mtDNA each contain 14 nucleotide variations. In addition to an insertion of a cytosine at position 315 (315insC), the mtDNA sequences from both cell types share six common polymorphisms. Heteroplasmic variants were identified in both cell types and included the identification of the 315insC mtDNA variant at 42 and 75% heteroplasmy in HepaRG and SJCRH30, respectively. Additionally, a novel heteroplasmic G13633A substitution in the HepaRG ND5 gene was detected at 33%. Previously reported cancer-associated mtDNA variants T195C and T16519C were identified in SJCRH30, both at homoplasmy (100%), while HepaRG mtDNA harbors a known prostate cancer-associated T6253C substitution at near homoplasmy, 95%. Based on our sequencing analysis, HepaRG mtDNA is predicted to lie within haplogroup branch H15a1 while SJCRH30 mtDNA is predicted to localize to H27c. The catalog of polymorphisms and heteroplasmy reported here should prove useful for future investigations of mtDNA maintenance in HepaRG and SJCRH30 cell lines.


Assuntos
Carcinoma Hepatocelular/genética , DNA Mitocondrial/genética , Neoplasias Hepáticas/genética , Polimorfismo Genético , Rabdomiossarcoma/genética , Carcinoma Hepatocelular/complicações , Linhagem Celular Tumoral , Hepatite C/complicações , Hepatite C/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Neoplasias Hepáticas/complicações , Mitocôndrias/genética , Análise de Sequência de DNA
15.
Am J Case Rep ; 20: 933-936, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31256189

RESUMO

BACKGROUND Intracardiac thrombosis has been known to be associated with not only hepatocellular carcinoma but also with amyloidosis and use of a cardiac implantable electronic device. We report a case of a continuous tumor thrombus with hepatocellular carcinoma from the portal vein and hepatic vein to the right atrium via the inferior vena cava in a patient with a cardiac amyloidosis and an implanted cardiac resynchronization therapy (CRT) device. CASE REPORT A 68-year-old female first admitted to our hospital because of heart failure with an AL type primary cardiac amyloidosis. After 3 years, she underwent an implantation of a CRT device for biventricular pacing following repeated episodes of heart failure and low left ventricular ejection fraction of 34% with NYHA class III. Again, she presented with symptoms of heart failure and cardiomegaly on chest x-ray at 7 years after the CRT device implantation. The echocardiography showed a huge echogenic mass occupying the right atrium, and 64 multi-detector computed tomography showed a lobulated heterogeneously enhancing mass of hepatocellular carcinoma in the right upper lobe of her liver and a continuous tumor thrombus from the portal vein and hepatic vein to the right atrium via the inferior vena cava. CONCLUSIONS Intracardiac thrombosis and heart failure occurred in a patient with hepatocellular carcinoma and cardiac amyloidosis, who had an implanted CRT device, which resulted not only in hypercoagulability by the hepatocellular carcinoma itself and the accumulation of various risk factors, but also the progression of myocardial damage with the development of amyloidosis.


Assuntos
Amiloidose/complicações , Carcinoma Hepatocelular/complicações , Cardiopatias/complicações , Insuficiência Cardíaca/complicações , Neoplasias Hepáticas/complicações , Trombose/complicações , Idoso , Amiloidose/cirurgia , Dispositivos de Terapia de Ressincronização Cardíaca , Ecocardiografia , Feminino , Cardiopatias/cirurgia , Insuficiência Cardíaca/cirurgia , Humanos , Fatores de Risco , Trombofilia , Trombose/cirurgia , Tomografia Computadorizada por Raios X
16.
Nat Commun ; 10(1): 3391, 2019 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-31358770

RESUMO

Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome that elevates the risk of hepatocellular carcinoma (HCC). Although alteration of lipid metabolism has been increasingly recognized as a hallmark of cancer cells, the deregulated metabolic modulation of HCC cells in the NAFLD progression remains obscure. Here, we discovers an endoplasmic reticulum-residential protein, Nogo-B, as a highly expressed metabolic modulator in both murine and human NAFLD-associated HCCs, which accelerates high-fat, high-carbohydrate diet-induced metabolic dysfunction and tumorigenicity. Mechanistically, CD36-mediated oxLDL uptake triggers CEBPß expression to directly upregulate Nogo-B, which interacts with ATG5 to promote lipophagy leading to lysophosphatidic acid-enhanced YAP oncogenic activity. This CD36-Nogo-B-YAP pathway consequently reprograms oxLDL metabolism and induces carcinogenetic signaling for NAFLD-associated HCCs. Targeting the Nogo-B pathway may represent a therapeutic strategy for HCC arising from the metabolic syndrome.


Assuntos
Autofagia , Carcinoma Hepatocelular/metabolismo , Lipoproteínas LDL/metabolismo , Neoplasias Hepáticas/metabolismo , Proteínas Nogo/metabolismo , Hepatopatia Gordurosa não Alcoólica/metabolismo , Animais , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/genética , Linhagem Celular Tumoral , Dieta Hiperlipídica/efeitos adversos , Retículo Endoplasmático/metabolismo , Feminino , Perfilação da Expressão Gênica/métodos , Células Hep G2 , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/genética , Síndrome Metabólica/etiologia , Síndrome Metabólica/genética , Síndrome Metabólica/metabolismo , Camundongos Endogâmicos C57BL , Camundongos Nus , Proteínas Nogo/genética , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/genética , Transdução de Sinais/genética , Transplante Heterólogo
17.
Med. intensiva (Madr., Ed. impr.) ; 43(5): 261-269, jun.-jul. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183238

RESUMO

Objetivos: Identificar predictores pretrasplante de mortalidad precoz (90 días postrasplante) y evaluar su capacidad discriminante en receptores adultos de trasplante hepático (RTH). Diseño: Estudio observacional, retrospectivo, de casos y controles anidados sobre una cohorte consecutiva de RTH. Ámbito: Hospital Universitario. Pacientes: Desde enero de 2003 a diciembre de 2016, todos los receptores adultos de trasplante hepático fueron elegibles para inclusión. Fueron excluidos los RTH por fallo hepático agudo, disfunción de un injerto previo, trasplante simultáneo de órganos, de donantes en asistolia, y aquellos que precisaron retrasplante durante el periodo de estudio. Para el análisis se incluyeron 471 pacientes. Principales variables de interés: Las características pretrasplante fueron las variables de interés. Los RTH fueron agrupados de acuerdo con la variable dependiente (mortalidad precoz). Los predictores se obtuvieron mediante análisis multivariante de regresión logística. La capacidad discriminante de los modelos obtenidos se evaluó mediante comparación de curvas ROC. Resultados: Se identificaron como predictores independientes de mortalidad precoz: la puntuación MELD-Na (OR=1,069; IC95%=1,014-1,127), la edad mayor de 60 años (OR=2,479; IC95%= 1,226-5,015), y la estatura del RTH inferior a 163cm (OR=4,092; IC95%=2,115-7,917), considerándose el motivo del trasplante (carcinoma hepatocelular o cirrosis descompensada) como variable de confusión. Conclusiones: En los RTH por cirrosis descompensada, la puntuación MELD-Na, la edad mayor de 60 años y la estatura del receptor inferior a 163cm son predictores independientes de mortalidad precoz. Esos predictores producen un modelo que clasifica a los pacientes significativamente mejor que el MELD-Na en relación con la mortalidad precoz


Aims: To identify pretransplant predictors of early mortality (90 days after transplantation) and evaluate their discriminating capacity in adult liver transplant recipients (LTR). Design: An observational, retrospective, nested cases-controls study from a consecutive cohort of LTRs was carried out. Setting: University hospital. Patients: All consecutive LTR between January 2003 and December 2016 were eligible for inclusion. Patients with acute liver failure, previous graft dysfunction, simultaneous multiple organ transplantation, non-heart beating donors, and those needing urgent retransplantation during the study period were excluded. The analysis comprised 471 patients. Main variables of interest: Pretransplant characteristics were the main variables of interest. The LTR were grouped according to the dependent variable (early mortality). Multivariate logistic regression analysis was conducted to identify predictors of early mortality. The discriminating capacity of the models obtained was evaluated by comparing ROC curves (models versus MELD-Na). Results: The MELD-Na score (OR = 1.069, 95% CI = 1.014-1.127), age > 60 years (OR = 2.479, 95% CI = 1.226-5.015), and LTR height < 163cm (OR = 4.092, 95% CI = 2.115-7.917) were identified as independent predictors of early mortality. The cause of transplantation (hepatocellular carcinoma or decompensated cirrhosis) was identified as a confounding factor. Conclusions: In LTR due to decompensated cirrhosis, the MELD-Na score, age > 60 years, and height < 163cm are independent predictors of early mortality. These factors provide a better classification model than the MELD-Na score for early post-transplant mortality


Assuntos
Humanos , Adulto , Transplante de Fígado/mortalidade , Condicionamento Pré-Transplante , Fígado/patologia , Estudos Retrospectivos , Estudos de Casos e Controles , Modelos Logísticos , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/complicações , Análise Multivariada
19.
Medicine (Baltimore) ; 98(23): e15540, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169667

RESUMO

The aim of this study was to investigate the features, treatment, and prognosis of early versus late recurrence of centrally located hepatocellular carcinoma (CL-HCC) after mesohepatectomy (MH).Three hundred forty eight patients with CL-HCC undergoing MH were included. Data on clinicopathological characteristics, initial surgical details, timing and sites of tumor recurrence, management after recurrence, and long-term outcomes were analyzed.The optimal cutoff value to differentiate early (71 patients, 64.5%) versus late (39, 35.5%) recurrence was defined as 12 months. Patients with early recurrence (ER) had higher alpha fetoprotein (AFP) level (P < .001), more advanced tumor stage (P = .024), and higher incidence of microvascular invasion (MVI, P = .001). Patients with ER had higher incidence of local tumor recurrence (P = .027) and higher average number of recurrent nodules (P = .016) than patients with LR. Patients after ER showed a better overall survival (from date of diagnosis of recurrence) than after late recurrence (LR). Patients with ER had less chances of curative treatment (14.1% vs 41.0%, P = .004) after tumor recurrence than patients with LR. Multivariable analyses revealed that liver cirrhosis (P < .001) and tumor differentiation (P < .001) were associated with an increased likelihood of LR, while multiple tumor number (P = .005), type IV classification (P = .012), and MVI (P < .001) were independent risk factors related to ER.ER and LR after MH for CL-HCC were associated with different risk predictors and prognosis. Data on the timing of recurrence may inform decisions about postoperative adjuvant treatment, as well as help to predict long-term survival for these patients.


Assuntos
Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Recidiva Local de Neoplasia/etiologia , Complicações Pós-Operatórias/etiologia , Fatores de Tempo , Adulto , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/cirurgia , Feminino , Hepatectomia/métodos , Humanos , Incidência , Cirrose Hepática/etiologia , Cirrose Hepática/patologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
20.
Gan To Kagaku Ryoho ; 46(4): 799-801, 2019 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-31164540

RESUMO

The patient was a 72-year-oldwoman. She had been diagnosed with idiopathic thrombocytopenic purpura(ITP), hepatitis B, and diabetes mellitus. She was admitted to our hospital because of anemia andvomiting of blood vomiting and was diagnosed with hepatocellular carcinoma at S6. A splenectomy was performed, with a temporary improvement of her platelet count. We tried to control the platelet count with medication and performed transcatheter arterial embolization(TACE)3 times. However, the tumor size decreased only slightly anda new tumor was observed on S2. Therefore, we increased the patient's platelet count to 109×10 4/mL and performed a partial hepatectomy of 4 lesions. The postoperative complications included intraabdominal abscess, but there was no bleeding and the patient was discharged on POD 114. Platelet count is often difficult to maintain in patients diagnosed with ITP. We report our experiences and also provide a discussion of a case of operated hepatocellular carcinoma complicated with refractory ITP.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Púrpura Trombocitopênica Idiopática , Idoso , Carcinoma Hepatocelular/complicações , Feminino , Humanos , Neoplasias Hepáticas/complicações , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/cirurgia , Esplenectomia
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