Cavo-atrial thrombectomy combined with left hemi-hepatectomy for vascular invasion from hepatocellular carcinoma on diseased liver under hypothermic cardio-circulatory arrest☆

Recent success of systemic therapeutic agents, including combination immunotherapy, could promote a change in the treatment strategy in patients with advanced hepatocellular carcinoma (HCC). Although hepatic arterial infusion chemotherapy (HAIC) is a treatment option for advanced HCC in Japan, it is not recommended by other guidelines. We discuss the clinical benefits of HAIC compared to sorafenib. The clinical benefits of HAIC are as follows: (1) even a patient with Child–Pugh B HCC (7 or 8 points) is a candidate for HAIC (2) Child–Pugh scores barely decline with the use of HAIC compared with sorafenib (3) HAIC is highly effective in patients with vascular invasion compared with sorafenib; and (4) survival in patients receiving HAIC may not be associated with skeletal muscle volume. In contrast, the disadvantages are problems related with the reservoir system. HAIC has clinical benefits in a subpopulation of patients without extrahepatic metastasis with Child–Pugh A HCC and vascular invasion (especially primary branch invasion or main portal vein invasion) or with Child–Pugh B HCC.

Download Full-text

6606 Innovation in surgical treatment of the hepatocellular carcinoma with vascular invasion

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(09)71327-8 ◽

2009 ◽

Vol 7 (2) ◽

pp. 392

Author(s):

O. Kotenko ◽

A. Grinenko ◽

A. Korshak

Keyword(s):

Hepatocellular Carcinoma ◽

Surgical Treatment ◽

Vascular Invasion

Download Full-text

Vascular Invasion and Herniation by Hepatocellular Carcinoma in Cirrhosis: A Wolf in Sheep's Clothing?

Archives of Pathology & Laboratory Medicine ◽

10.5858/2005-129-0639-viahbh ◽

2005 ◽

Vol 129 (5) ◽

pp. 639-644 ◽

Cited By ~ 4

Author(s):

Alberto Quaglia ◽

Nazanin Etessami ◽

Rosalind Sim ◽

John Difford ◽

A. P. Dhillon

Keyword(s):

Hepatocellular Carcinoma ◽

Vascular Invasion ◽

Thrombus Formation ◽

Smooth Muscle Actin ◽

Point Of View ◽

Factor Xiiia ◽

Tissue Sections ◽

Prognostic Feature ◽

Vascular Structures ◽

Hematoxylin Eosin

Abstract Context.—Vascular invasion is an important diagnostic and prognostic feature of hepatocellular carcinoma (HCC) in cirrhosis. Intravascular free-floating tumor clusters (IvCs) of HCC are found histologically in the vicinity of HCC. Thrombus formation is not seen morphologically in association with these IvCs, which are usually covered by endothelium. Objective.—Our hypothesis is that these IvCs are the result of a nondestructive form of vascular invasion by HCC, and we tried to define this aspect of microvascular invasion more accurately. Design.—Tissue sections were stained with hematoxylin-eosin, and consecutive sections were stained for fibrin (Martius scarlet blue, fibrinogen), platelets (factor XIIIa), smooth muscle actin, and endothelium (CD34). We studied cirrhotic livers removed at transplantation between 1997 and 1999. Of the livers studied, 35 of 81 consecutive cirrhotic livers contained HCC, and 17 showed microscopic vascular invasion. Five of these 17 cases showed IvCs and were subjected to the study. Main Outcome Measure.—Presence or absence of thrombus formation in association with IvC. Results.—Usually, IvCs were covered by endothelium, and no associated thrombus formation was seen. In 1 case of HCC, thrombus formation was seen focally in association with disruption of the endothelial coating. Conclusions.—We propose that the endothelial-lined trabecular structure of HCC everts, frondlike, via vascular structures within the tumor capsule into peritumoral vascular lumens without destruction of the endothelial coating. This may protect these HCC tumor projections from thrombus formation but may also act as a barrier to tumor extravasation, and this may be exploited from a therapeutic point of view.

Download Full-text

Combination Therapy after TACE for Hepatocellular Carcinoma with Macroscopic Vascular Invasion: Stereotactic Body Radiotherapy versus Sorafenib

Cancers ◽

10.3390/cancers10120516 ◽

2018 ◽

Vol 10 (12) ◽

pp. 516 ◽

Cited By ~ 2

Author(s):

Lujun Shen ◽

Mian Xi ◽

Lei Zhao ◽

Xuhui Zhang ◽

Xiuchen Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Stereotactic Body Radiotherapy ◽

Vascular Invasion ◽

Progression Free Survival ◽

Sorafenib Treatment ◽

Free Survival ◽

Sorafenib Group ◽

Treatment Responses ◽

Hepatic Lesions ◽

Macroscopic Vascular Invasion

Stereotactic body radiotherapy (SBRT) has shown promising results in the control of macroscopic vascular invasion in patients with hepatocellular carcinoma (HCC); however, its efficacy in comparison to sorafenib when combined with transarterial chemoembolization (TACE) remains to be determined. Between 2009 and 2017, 77 HCC patients with macroscopic vascular invasion receiving TACE–SBRT or TACE–sorafenib combination therapies were enrolled. The best treatment responses, overall survival (OS), and progression-free survival (PFS) of the two treatment arms were compared. Of the patients enrolled, 26 patients (33.8%) received TACE–SBRT treatment, and 51 (66.2%) received TACE–sorafenib treatment. The patients in the TACE–SBRT group were more frequently classified as elder in age (p = 0.012), having recurrent disease (p = 0.026), and showing lower rates of multiple hepatic lesions (p = 0.005) than patients in TACE–sorafenib group. After propensity score matching (PSM), 26 pairs of well-matched HCC patients were selected; patients in the TACE–SBRT group showed better overall response rates in trend compared to those in the TACE–sorafenib group. The hazard ratio (HR) of OS to PFS for the TACE–SBRT approach and the TACE–sorafenib approach was 0.36 (95% CI, 0.17–0.75; p = 0.007) and 0.35 (95% CI, 0.20–0.62; p < 0.001), respectively. For HCC patients with macrovascular invasion, TACE plus SBRT could provide improved OS and PFS compared to TACE–sorafenib therapy.

Download Full-text

Serum gamma-glutamyl transferase to alanine aminotransferase ratio predict the vascular invasion and outcome in hepatitis B virus related hepatocellular carcinoma

10.21203/rs.3.rs-439544/v1 ◽

2021 ◽

Author(s):

Zhifeng Zhao ◽

Jiayun Lin ◽

Xiaochun Ni ◽

Hongjie Li ◽

Lei Zheng ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Subgroup Analysis ◽

Alanine Aminotransferase ◽

Vascular Invasion ◽

Gamma Glutamyl Transferase ◽

B Virus ◽

Glutamyl Transferase

Abstract Backgrounds: The ratio of gamma-glutamyl transferase (GGT) to alanine aminotransferase (ALT) is a predictive biomarker for hepatitis and hepatocellular carcinoma (HCC). In this study, the relationship between GGT/ALT ratio and vascular invasion was explored in hepatitis B virus (HBV)-related HCC and tumor prognosis. Methods: Totally 558 patients were involved in this study. Univariate and multivariate logistic analysis were used to evaluate GGT/ALT as the risk factor of vascular invasion. Prognostic value of GGT/ALT was investigated by univariate and multivariate Cox analysis combined with Kaplan Meier curves. In order to reduce confounding bias, subgroup analysis and propensity score matching (PSM) were performed. Results: Patients were divided into high and low GGT/ALT groups with an optimal cut-off value of 2.95 in predicting vascular invasion. In univariate and multivariate logistic regression, high GGT/ALT group was listed as the independent risk factors for vascular invasion(P=0.03), the other risk factors included age (P=0.001), α-fetoprotein (AFP) (P=0.026), tumor size (P<0.001), tumor capsule (P=0.018), pathological differentiation (P<0.001) and Barcelona Clinic Liver Cancer (BCLC) classification (P<0.001). In survival analysis, high GGT/ALT ratio was associated with decreased overall survival (OS) (HR: 1.38; 95% CI: 1.03, 1.87; P<0.0001) and disease-free survival (DFS) rates (HR: 1.32; 95% CI: 1.03, 1.87; P<0.0001). In sensitivity analysis, comparable results were furtherly confirmed by subgroup analysis. In PSM analysis, GGT/ALT was still associated with vascular invasion independently (OR, 186; 95% CI, 1.23, 3.33). Conclusion: Preoperative GGT/ALT has good predictive value for vascular invasion, tumor severity and outcome in HBV-related HCC patients.

Download Full-text