Giá trị của cắt lớp vi tính trong đánh giá mạch máu của ung thư biểu mô tế bào gan có chỉ định nút mạch hóa chất

Mục tiêu: Khảo sát giá trị của cắt lớp vi tính (CLVT) trong đánh giá mạch máu của ung thư biểu mô tế bào gan (UTBMTBG) có chỉ định nút mạch hóa chất (TACE). Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang trên 63 bệnh nhân UTBMTBG được nút mạch hóa chất (TACE) tại Bệnh viện trường Đại học Y Dược Huế từ 9/2018 đến tháng 10/2020. Mô tả đặc điểm hình ảnh mạch máu của UTBMTBG trên CLVT đối chiếu với chụp mạch xóa nền (DSA). Chẩn đoán UTBMTBG và chỉ định TACE dựa vào hướng dẫn của EASL 2018. Kết quả: Tuổi trung bình của nhóm nghiên cứu là 63,2 ± 11,3. Kích thước trung bình của UTBMTBG là 5,7 ± 3,4 cm, (1 - 14,5 cm). Đặc điểm hình ảnh mạch máu của UTBMTBG trên CLVT và DSA là: ngấm thuốc mạnh (87,3% vs. 96,8%), mạch tăng sinh (58,7% vs. 88,9%), mạch tân sinh (65,1% vs. 88,9%), thông động - tĩnh mạch (6,4% vs. 6,4%), mạch nuôi u ngoài gan (25,4% vs. 19%), biến thể giải phẫu (14,3% vs. 15,9%). CLVT và DSA có sự phù hợp thấp trong khảo sát mạch tăng sinh và mạch tân sinh nhưng có độ nhạy và độ đặc hiệu cao trong khảo sát thông động tĩnh mạch, nguồn mạch nuôi u ngoài gan và biến thể giải phẫu. Kích thước u có tương quan thuận với mạch tăng sinh và có ý nghĩa dự báo nguồn mạch nuôi u ngoài gan, mạch tăng sinh, mạch tân sinh và thông động - tĩnh mạch. Kết luận: CLVT có độ nhạy và độ đặc hiệu cao trong đánh giá thông động tĩnh mạch, nguồn mạch nuôi u ngoài gan và biến thể giải phẫu. Phân tích đầy đủ hình ảnh CLVT trước can thiệp là rất cần thiết nhằm tối ưu hóa kỹ thuật và hiệu quả điều trị. Từ khóa: Ung thư biểu mô tế bào gan, cắt lớp vi tính, chụp mạch xóa nền, nút mạch hóa chất. ABSTRACT VALUE OF COMPUTED TOMOGRAPHI IN THE EVALUATION OF VASCULAR PATTERNS OF HEPATOCELLULAR CARCINOMA Aim: To determine the additional value of computed tomography in the evaluation of vascular patterns of hepatocellular carcinoma (HCC). Materials and methods: A cross - sectional study was conducted on 63 HCC patients who underwent transarterial chemoembolization at Hue University of Medicine and Pharmacy Hospital from 9/2018 to 10/2020. Vascular patterns of HCC were documented on CT and correlated with digital subtraction angiography (DSA). Diagnosis and management of HCC were based on the practice guideline of EASL 2018. Results: The mean age was 63.2 ± 11.3 years, the average HCC diameter was 5.7 ± 3.4 cm, (range 1 - 14,5 cm). Vascular patterns of HCC at CT and DSA were hyperattenuating/tumor staining (87.3% vs. 96.8%), hypervascularity (58.7% vs. 88.9%), neovascularity (65.1% vs. 88.9%), arterioportal shunt (6.4% vs. 6.4%), extrahepatic parasitic supplies (25.4% vs. 19%), and anatomical variations (14.3% vs. 15.9%), respectively. There was a low agreement between CT and DSA on hyper and neovascularity. CT had high sensitivity and specificity in detecting arterioportal shunt, extrahepatic supply and anatomical variations. Tumor size had a positive correlation with hypervascularity and was a predictor of hyper/neovascularity, arterioportal shunt, and extrahepatic supply. Conclusion: CT had high sensitivity and specificity in detecting arterioportal shunt, extrahepatic supply and anatomical variations. Careful and comprehensive interpretation of preprocedural computed tomography and angiography is essential to optimize treatment and patient outcomes. Key words: Hepatocellular carcinoma, computed tomography, digital subtraction angiography, transarterial chemoembolization.

The potential of spectroscopy in the diagnosis of hepatocellular carcinoma – a pilot study

Summary: None of the bio­markers studied so far in the HCC area has yielded higher sensitivity and specificity in the early-stage dia­gnosis than the liver ultrasonography examination. There is an urgent clinical need for establishing a laboratory marker for HCC that meets the requirements for high sensitivity and specificity for the screening and early dia­gnosis of at-risk patients. As a variety of pathological processes, including carcinogenesis, may cause changes in both the concentration and the structure and spatial arrangement of body bio­molecules, the spectroscopic analysis of blood-based derivatives appears to be an appropriate tool for the early detection thereof. In our research, the focus is on the identification of novel bio­markers in blood plasma, which would exhibit sufficient sensitivity and specificity to detect early and potentially curable HCC stages, and which would be potentially useful for routine screening of this disease in well-defined at-risk groups. For this purpose, we utilised a unique combination of two chiroptical methods – electronic circular dichroism (ECD) and Raman optical activity (ROA) – supplemented by non-polarised variants – infrared (IR) absorption and Raman spectroscopy. Methods: Blood plasma of 18 selected patients with liver cirrhosis, 8 of which also suffered from HCC, was analysed by a combination of ECD, ROA, IR and Raman spectroscopy. Results: The obtained spectral data were processed by a multivariate statistical evaluation using principal component analysis (PCA) and linear discriminant analysis (LDA). The visualisation of the LDA results showed the separation of the two monitored groups with only a slight overlap. Based on the spectral analysis within this preliminary study, sensitivity and specificity for the discrimination between cirrhotic individuals with and without HCC reached 88% and 90% after leave-one-out cross validation, respectively. The area under the ROC curve of 0.975 proved high reliability of the established model. Conclusion: Based on our findings, the combination of advanced spectroscopic methods for the analysis of blood plasma might be a promising tool in HCC dia­gnosis and potentially in the screening thereof. Key words: hepatocellular carcinoma – blood plasma – spectroscopy – cirrhosis

Efficacy and safety of anlotinib combined with transarterial chemoembolization versus transarterial chemoembolization alone in patients with unresectable hepatocellular carcinoma: A retrospective study.

e16611 Background: HCC is one of the most common cancer among all the malignant tumor, while the efficacy of TACE alone for unresectable HCC patients still remains unsatisfactory. With the development of targeted drug, more and more targeted drugs are applying to the treatment of HCC. Objective: The aim of the stidy is to investigate the efficacy and safety of transarterial chemoembolization (TACE) combined with Anlotinib versus TACE alone in patients with unresectable HCC. Methods: This single-center retrospective study involved 82 patients with unresectable HCC who underwent TACE alone (TA group; n=46) or TACE combined with Anlotinib (TC group; n=36) between Jan 2018 and Jan 2019. The primary outcomes were progression-free survival (PFS) and overall survival (OS), while the secondary outcomes included the objective response rate (ORR), the disease control rate (DCR) and main complications. Results: The TC group showed relatively higher PFS than the TA group (7.35months vs. 5.54 months, p=0.035). The 3-month survival rate was not statistically different between the two groups (97.2% vs. 93.5%, p=0.627), while both the 6-month survival rate and 1-year survival rate were significantly higher in the TC group than in the TA group (83.3% vs. 56.5%, p=0.016; 66.7% vs. 19.6%, p<0.01). ORR in the TA group was significantly higher than in the TC group (77.8% vs. 32.6%, p<0.01), while the two groups showed no statistical difference in DCR (94.4% vs. 82.6%, p=0.17). No treatment-related mortality or grade 4 adverse event was observed, but grade 3 adverse events occurred in two patients in the TC group (one suffered with erythra, and another suffered with hand-foot-skin reaction). Both of them disappeared after prompt treatment. Conclusions: TACE combined with Anlotinib is safe and may improve outcomes for unresectable HCC patients comparing with TACE alone. It still needs more further randomized controlled trials to clarify the potential role of Anlotinib in hepatocellular carcinoma. Key words: Hepatocellular carcinoma; Anlotinib; Transarterial chemoembolization

Treatment outcomes of unresectable hepatocellular carcinoma by transarterial chemoembolisation combined with radiofrequency ablation

Background: Hepatocellular carcinoma (HCC) is one of the most common cancer and ranks third in terms of cancer related deaths. The majority of patients are not eligible for curative treatment because of local or distal progression of tumor. RFA treatment following TACE has some advantages over TACE alone. The purpose of this study was to evaluate the effectiveness and survival benefits of the TACE+RFA approach to the management of unresectable HCCs in Hue Central Hospital, Vietnam. Methods: A prospective, cohort study on 60 patients, diagnosed with unresectable HCCs and treated with TACE combined with RFA at Hue Central Hospital from 1/2016 – 1/2019. All clinical and paraclinical data and adverse effects of each treatment, tumor response rate assessed by m-RECIST criteria, survival rate and other adverse events from the first treatment were documented. Results: There were no major complications after combined therapy except for two cases (1.4%) of liver failure treated successfully with conservative therapy. Tumor control rate (CR+PR) at three months after the last treatment was 81.6%. All patients were followed-up closely after treatment and additional treatments were decided based on imaging and laboratory results. The mean follow-up time was 19.3 (4 – 30) months. The 1-year and 2-year survival rates were 71.7% and 58.3%, respectively. Conclusion: Combination therapy with TACE and RFA is an effective, safe and feasible option for patients with unresectable HCCs. Key words: Hepatocellular carcinoma (HCC), transarterial chemoembolisation (TACE), radiofrequency ablation (RFA) 1

Screening and early diagnosis of hepatocellular carcinoma

Presents the risk factors for the development of hepatocellular carcinoma, the current possibilities for screening and early diagnosis of HCC with imaging techniques, non-invasive serological markers. The categories of patients subject to HCC screening and the examination algorithm are determined. Key words: hepatocellular carcinoma, primary liver cancer, screening, early diagnosis.

Does Nonalcoholic Fatty Liver Disease Predispose Patients to Hepatocellular Carcinoma in the Absence of Cirrhosis?

Context.—Hepatocellular carcinoma (HCC) is recognized as a complication of cirrhosis related to nonalcoholic fatty liver disease (NAFLD). Diabetes and the metabolic syndrome are also associated with HCC. However, it is not clear whether NAFLD predisposes patients to HCC in the absence of cirrhosis. Objective.—To seek evidence that HCC can develop in NAFLD unaccompanied by cirrhosis. Design.—Retrospective case study was performed on cases from 2004 to 2007 at the University of Illinois at Chicago Medical Center, using the key words hepatocellular carcinoma, liver explant, and liver resection. The diagnosis of HCC was identified and confirmed by hematoxylin-eosin–stained slides in 50 cases. Cause of liver disease was determined by review of liver histology, clinical history, and laboratory data. Results.—Three patients presented with advanced HCC with features of metabolic syndrome, including an elevated body mass index. Each patient had bland steatosis on liver biopsy, without fibrosis or cirrhosis. None of the 3 patients had evidence of any cause for liver disease other than NAFLD. Conclusions.—The cases presented here suggest that NAFLD may predispose patients to HCC in the absence of cirrhosis. Further studies are needed to confirm this potentially important observation.

Hepatoceliulinės karcinomos prognostinės sistemos

Jonas Pivoriūnas1, Jonas Jurgaitis2, 3, Marius Paškonis2, 3, Agnius Juška1, Janina Didžiapetrienė3, Eugenijus Stratilovas3, Narimantas Evaldas Samalavičius3, Vitalijus Sokolovas3, Gintautas Brimas2, Kęstutis Strupas21 Vilniaus universiteto Medicinos fakultetas, M. K. Čiurlionio g. 21, LT-03101 Vilnius2 Gastroenterologijos, urologijos ir abdominalinės chirurgijos klinika,Vilniaus universiteto ligoninės Santariškių klinikos, Santariškių g. 2, LT-08661 Vilnius3 Vilniaus universiteto Onkologijos institutas Santariškių g. 1, LT-08660 VilniusEl paštas: [email protected] Įvadas / tikslas Hepatoceliulinė karcinoma – tai penktas tarp dažniausių navikų pasaulyje ir trečias pagal mirštamumą. Per pastaruosius dešimtmečius sergamumas šiuo naviku didėja Jungtinėse Amerikos Valstijose ir Europoje. Lietuvoje hepatoceliulinės karcinomos atvejų taip pat daugėja. Manoma, kad kepenų navikų per kitus du dešimtmečius dar padaugės. Hepatoceliulinė karcinoma yra sunkiai įvertinama, heterogoniška liga, dėl to pasaulyje kuriamos prognostinės sistemos, kurios turi padėti gydytojui parinkti tinkamą gydymą ir įvertinti ligos prognozę. Šio straipsnio tikslas – išrinkti ir apibūdinti labiausiai pasaulyje paplitusias hepatoceliulinės karcinomos prognostines sistemas, palyginti jų taikymo rezultatus, parinkti Lietuvai tinkamiausias sistemas. Metodai Pasinaudojus „PubMed“ duomenų baze ir įvedus reikšminius žodžius hepatocellular carcinoma, prognostic scores ir staging system buvo rasti 205 straipsniai, publikuoti nuo 1984 iki 2007 metų. Atrinkti 54 straipsniai, kuriuose minimos 24-ios hepatoceliulinės karcinomos prognostinės sistemos. Rezultatai Išanalizavus sistemas buvo nuspręsta atmesti tas, kurių pritaikyti Lietuvoje nėra galimybių dėl to, kad šalyje neatliekami tyrimai. Plačiau aprašytos devynios sistemos. Išvados Išrinkę plačiausiai pasaulyje naudojamas hepatoceliulinės karcinomos prognostines sistemas ir palyginę jų taikymo rezultatus, manome, kad būtų vertinga atlikti retrospektyvųjį lyginamąjį tyrimą, kad išsiaiškintume, kokia prognostinė sistema geriausiai tinka hepatoceliuline karcinoma sergantiems Lietuvos populiacijos pacientams diferencijuoti pagal išgyvenamumą. Reikšminiai žodžiai: hepatoceliulinė karcinoma, prognostinė sistema, prognostiniai kriterijai, pacientų išgyvenamumas Prognostic scores of hepatocellular carcinoma Jonas Pivoriūnas1, Jonas Jurgaitis2, 3, Marius Paškonis2, 3, Agnius Juška1, Janina Didžiapetrienė3, Eugenijus Stratilovas3, Narimantas Evaldas Samalavičius3, Vitalijus Sokolovas3, Gintautas Brimas2, Kęstutis Strupas21 Vilnius University Faculty of Medicine, M. K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania2 Clinic of Gastroenterology, Urology and Abdominal Surgery,Vilnius University Hospital Santariškių Clinic, Santariškių str. 2, LT-08661 Vilnius, Lithuania3 Institute of Oncology, Vilnius University, Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Background / objective Hepatocellular carcinoma is the most common primary liver cancer. It is the fifth most common neoplasm and the third most common cause of cancer-related death in the world. Over the last decade the incidence of this cancer has been rising in the United States of America and in Europe as well as in Lithuania. The incidence of this cancer in the next two decades is expected to rise. Hepatocelullar carcinoma is a difficult and heterogenic disease. Therefore, prognostic scores are being created to help clinicians to choose the best treatment for the patient. The aim of this review is to select and describe the most widely used prognostic systems of hepatocellular carcinoma, to compare results of their usage, applicability and to choose the most suitable scoring systems for the further use in Lithuania. Methods The PubMed data base was used to search for the keywords: “hepatocellular carcinoma”, “prognostic scores” and “staging systems”. 205 published articles were found from the year 1984 though 2007; 54 articles with 24 prognostic systems were selected. Results Upon analysing the prognostic systems, it was decided to reject the scoring systems that are impossible to use in Lithuania because of the absence of related tests. In total, nine prognostic systems were overviewed. Conclusions A retrospective cohort study is advisable to ascertain which prognostic system of hepatocellular carcinoma is most suitable for Lithuanian population. Key words: hepatocellular carcinoma, prognostic score, prognostic factors, survival of the patient