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HCC Diagnosis (hcc + diagnosis)
Selected AbstractsMultiple primary malignancies in Spanish patients with hepatocellular carcinoma: Analysis of a hospital-based tumor registryJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2009Mario Fernández-Ruiz Abstract Background and Aim:, Little is known about the etiological associations and clinical features of extrahepatic primary malignant (EHPM) neoplasms in subjects with hepatocellular carcinoma (HCC). The aim of this study was to characterize this phenomenon in a consecutive series of Spanish patients in order to define its natural history and influence on survival. Methods:, A retrospective analysis of 245 patients with HCC during the period 1999,2003 was performed. Subjects identified with a second primary malignancy elsewhere constituted the EHPM group and were compared to patients with HCC alone. Results:, Eighteen patients (7.3%) had one or two associated extrahepatic malignancies (mean age 67.7 ± 9.7 years); of these, 17 had double cancer and one patient, triple. Nine of the 19 EHPM occurred before HCC diagnosis. The associated cancers included five cases of colorectal carcinoma, four cases of head and neck carcinoma, three cases of genitourinary cancer, two cases of lymphoproliferative disorder, one lung carcinoma, one skin melanoma, one breast carcinoma, and two cancers of unknown origin. Age and sex distribution, etiology of underlying hepatopathy, and liver function tests did not differ significantly between both groups. There was no difference between the overall survival rates. Conclusions:, EHPM is not rare among Spanish patients with HCC, although no specific clinicopathological features were detected in this population. Our results suggest that the association of another primary tumor with HCC does not imply a worse prognosis. The possibility of development of EHPM should be kept in mind when deciding on therapy and follow-up of HCC. [source] Clinical manifestations and survival of hepatocellular carcinoma patients with peritoneal metastasisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2009Chien-Chu Lin Abstract Background and Aim:, Peritoneal metastasis is an uncommon manifestation of hepatocellular carcinoma (HCC). The aim of the present paper was to investigate the characteristics and survival of HCC patients with peritoneal metastases. Methods:, From January 1985 to December 2004, we retrospectively reviewed the records of 53 Taiwanese HCC patients with peritoneal metastases. Results:, Peritoneal metastases were detected at the time of HCC diagnosis (synchronously) in 10 patients and after the initial therapy for the primary tumors (metachronously) in 43 patients. The mean time for development of the metachronous peritoneal metastases was similar whether the primary cancer was treated with surgery (24 months) or transarterial chemoembolization (22.2 months). The single patient whose primary cancer was treated with supportive care alone developed peritoneal metastasis only 7.5 months after detection of the primary cancer. Surgical resection of the peritoneal metastases was possible in two-thirds of the 43 metachronous patients. The median survival for those who received surgery for these metastases was 12.5 months vs. 2.1 months for those without surgery (P = 0.0013). However, there was no difference in survival if patients were stratified to Child-Pugh grade. Conclusions:, Peritoneal metastases of HCC are rare and can occur synchronously or metachronously. Though increased long-term survival was found in patients who had surgical removal of peritoneal metastases, the main determinant of better survival is Child-Pugh grade. [source] Des-,-carboxyprothrombin, ,-fetoprotein and AFP-L3 in patients with chronic hepatitis, cirrhosis and hepatocellular carcinomaJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2008Francisco A Durazo Abstract Background and Aim:, Hepatocellular carcinoma (HCC) is a common complication in patients with chronic viral hepatitis. Detection of HCC at an early stage is critical for a favorable clinical outcome. The study aim was to: (i) compare the levels of des-,-carboxyprothrombin (DCP), ,-fetoprotein (AFP) and AFP-L3 in HCC patients and in chronic viral hepatitis patients without HCC; (ii) define the level of each tumor marker with the best sensitivity and specificity for HCC diagnosis; and (iii) to correlate the levels of these markers with respect to size and tumor burden. Methods:, Two hundred and forty patients with either hepatitis B virus (HBV) or hepatitis C virus (HCV) infection were studied. These included 144 with HCC, 47 with chronic hepatitis (fibrosis stage I,III on liver biopsy) and 49 with cirrhosis. Results:, Levels of DCP, AFP and AFP L-3 were significantly higher in patients with HCC than in those without HCC (P , 0.0001). Receiver,operating curves (ROC) indicated that the cut-off value with the best sensitivity and specificity for each test was ,84 mAU/mL for DCP, ,25 ng/mL for AFP and ,10% for AFP-L3. The sensitivity, specificity and positive predictive value (PPV) for DCP was 87%, 85% and 86.8%, for AFP 69%, 87% and 69.8%, and for AFP-L3 56%, 90% and 56.1%, respectively. DCP levels were below the ROC cut-off in all patients without HCC. In patients with single lesions, there was a direct correlation of DCP to tumor size. High levels of AFP correlated with diffuse type of HCC. All three markers were significantly elevated in the presence of metastatic HCC. No advantage was observed by combining two or three markers for HCC diagnosis. Conclusion:, DCP had the highest sensitivity and PPV for HCC diagnosis, had a direct correlation with tumor size, and was not elevated in any patients without HCC. DCP should be used as the main serum test for HCC detection. [source] A serum metabolomic investigation on hepatocellular carcinoma patients by chemical derivatization followed by gas chromatography/mass spectrometryRAPID COMMUNICATIONS IN MASS SPECTROMETRY, Issue 19 2008Ruyi Xue The purpose of this study was to investigate the serum metabolic difference between hepatocellular carcinoma (HCC, n,=,20) male patients and normal male subjects (n,=,20). Serum metabolome was detected through chemical derivatization followed by gas chromatography/mass spectrometry (GC/MS). The acquired GC/MS data was analyzed by stepwise discriminant analysis (SDA) and support vector machine (SVM). The metabolites including butanoic acid, ethanimidic acid, glycerol, L-isoleucine, L-valine, aminomalonic acid, D-erythrose, hexadecanoic acid, octadecanoic acid, and 9,12-octadecadienoic acid in combination with each other gave the strongest segregation between the two groups. By applying these variables, our method provided a diagnostic model that could well discriminate between HCC patients and normal subjects. More importantly, the error count estimate for each group was 0%. The total classifying accuracy of the discriminant function tested by SVM 20-fold cross validation was 75%. This technique is different from traditional ones and appears to be a useful tool in the area of HCC diagnosis. Copyright © 2008 John Wiley & Sons, Ltd. [source] Transarterial Chemoinfusion for Hepatocellular Carcinoma as Downstaging Therapy and a Bridge toward Liver TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2009W. De Luna Favorable outcomes after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) are well described for patients who fall within defined tumor criteria. The effectiveness of tumor therapies to maintain tumor characteristics within these criteria or to downstage more advanced tumors to fall within these criteria is not well understood. The aim of this study was to examine the response to transcatheter arterial chemoinfusion (TACI) in HCC patients awaiting LT and its efficacy for downstaging or bridging to transplantation. We performed a retrospective study of 248 consecutive TACI cases in 122 HCC patients at a single U.S. medical center. Patients were divided into two groups: those who met the Milan criteria on initial HCC diagnosis (n = 95) and those with more advanced disease (n = 27). With TACI treatment, 87% of the Milan criteria group remained within the Milan criteria and 63% of patients with more advanced disease were successfully downstaged to fall within the Milan criteria. In conclusion, TACI appears to be an effective treatment as a bridge to LT for nearly 90% patients presenting within the Milan criteria and an effective downstaging modality for over half of those whose tumor burden was initially beyond the Milan criteria. [source] Ethnicity affects the diagnostic validity of alpha-fetoprotein in hepatocellular carcinomaASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 2-3 2005Amal GAD Abstract Introduction: Hepatocellular carcinoma (HCC) is the fourth most common cancer worldwide with a high morbidity and mortality. Alpha-fetoprotein (AFP) is considered the main tumor marker for HCC diagnosis, but the variation in its diagnostic validity among studies justifies further investigation of the underlying contributing factors. Ethnic difference could be one of the factors that has not been well studied. We aimed at investigating the ethnic difference in AFP validity between Egyptian (representing Arabic North African) and Japanese (representing Asian) for HCC diagnosis. Methods: Four cohorts with chronic liver diseases (CLD) were studied: 171 Egyptian (65 HCC/106 non-HCC), and 173 Japanese (45 HCC/128 non-HCC). Laboratory tests including serum AFP, protein-induced vitamin K deficiency or absence (PIVKA-II), alanine aminotransferase (ALT), total bilirubin, platelet count, HBsAg, anti-HCV, and HCV core antigen were conducted using standard commercially available assays. Results: A significantly higher sensitivity of AFP in Egyptian in comparison with Japanese for HCC diagnosis (99 vs 67%, P < 0.001) was observed using an AFP cut-off point of 10 ng/mL, with a comparable specificity, (75,vs, 82%), While, a, sensitivity, of, 98, versus, 56%,,P < 0.001, and, a, specificity, of, 83, versus, 89% was found for AFP cut-off point of 20 ng/mL, respectively. The area under the receiver operating characteristic curve (ROC) was found to be 0.98 (95%CI = 0.969,0.997) for Egyptian and 0.77 (95%CI = 0.686,0.864) for Japanese. The highest sensitivity for the former group occurred at AFP = 20.5 ng/mL and at AFP = 10.2 ng/mL for the latter. Univariate analysis showed no effect for age, sex, underlying liver disease, cirrhosis, Child's class or tumor characteristics (size, pathological grade) on AFP sensitivity, while race significantly contributed to the higher sensitivity among Egyptians in comparison with the Japanese. Using ROC analysis, the AFP cut-off point for HCC detection in each subgroup of patients with and without each of the risk factors of interest was determined and the subgroups were again subclassified according to AFP positivity (< or , the decided cut-off point for each group). Logistic regression analysis of those factors combined showed that Egyptian ethnicity with an AFP level >20.5 ng/mL (P = 0.007), older age (>50 years) with an AFP level >26 ng/mL (P = 0.010), and cirrhosis with an AFP level >10.5 ng/mL (P = 0.014) were the independent risk factors for HCC. Conclusion: There is an ethnic variation in AFP validity between Egyptian and Japanese patients with a significantly lower sensitivity in the latter. Alpha-fetoprotein should not be the only marker used for screening HCC among Asian Japanese and younger age groups (<50 years) with CLD. In addition, an AFP cut-off point of 20 ng/mL is recommended when screening patients of Asian origin for HCC. [source] Association of diabetes duration and diabetes treatment with the risk of hepatocellular carcinomaCANCER, Issue 8 2010Manal M. Hassan MD Abstract BACKGROUND: Despite the observed association between diabetes mellitus and hepatocellular carcinoma (HCC), little is known about the effect of diabetes duration before HCC diagnosis and whether some diabetes medications reduced the risk of HCC development. This objective of the current study was to determine the association between HCC risk and diabetes duration and type of diabetes treatment. METHODS: A total of 420 patients with HCC and 1104 healthy controls were enrolled in an ongoing hospital-based case-control study. Multivariate logistic regression models were used to adjust for HCC risk factors. RESULTS: The prevalence of diabetes mellitus was 33.3% in patients with HCC and 10.4% in the control group, yielding an adjusted odds ratio (AOR) of 4.2 (95% confidence interval [95% CI], 3.0-5.9). In 87% of cases, diabetes was present before the diagnosis of HCC, yielding an AOR of 4.4 (95% CI, 3.0-6.3). Compared with patients with a diabetes duration of 2 to 5 years, the estimated AORs for those with a diabetes duration of 6 to 10 years and those with a diabetes duration >10 years were 1.8 (95% CI, 0.8-4.1) and 2.2 (95% CI, 1.2-4.8), respectively. With respect to diabetes treatment, the AORs were 0.3 (95% CI, 0.2-0.6), 0.3 (95% CI, 0.1-0.7), 7.1 (95% CI, 2.9-16.9), 1.9 (95% CI, 0.8-4.6), and 7.8 (95% CI, 1.5-40.0) for those treated with biguanides, thiazolidinediones, sulfonylureas, insulin, and dietary control, respectively. CONCLUSIONS: Diabetes appears to increase the risk of HCC, and such risk is correlated with a long duration of diabetes. Relying on dietary control and treatment with sulfonylureas or insulin were found to confer the highest magnitude of HCC risk, whereas treatment with biguanides or thiazolidinediones was associated with a 70% HCC risk reduction among diabetics. Cancer 2010. © 2010 American Cancer Society. [source] | ||||||||||