Đánh giá đáp ứng điều trị ung thư biểu mô tế bào gan sau nút mạch hóa chất (TACE) theo mRECIST

TÓM TẮT Mục tiêu: Đánh giá đáp ứng điều trị ung thư biểu mô tế bào gan (UTBMTBG) sau nút mạch hoá chất (TACE) theo tiêu chuẩn mRECIST. Phương pháp: Nghiên cứu tiến cứu.Chẩn đoán UTBMTBG theo EASL 2018. Đánh giá đáp ứng sau TACE theo thang điểm mRECIST tại các thời điểm < 3 tháng, 3 - 6 tháng, 6 - 12 tháng, > 12 tháng. Kết quả: 46 bệnh nhân (nam/nữ: 39/7), tuổi trung bình 61,5 ± 11,2 tuổi thỏa mãn tiêu chuẩn chọn bệnh. Thời gian theo dõi trung bình: 223 ngày (42 - 723 ngày). Đường kính lớn nhất trung bình của u: 62 mm (10 - 153 mm). 23,9% bệnh nhân có huyết khối tĩnh mạch cửa (HKTMC). Tỉ lệ đáp ứng hoàn toàn đối với tổn thương đích tại các thời điểm < 3 tháng, 3 - 6 tháng, 6 - 12 tháng, > 12 tháng lần lượt là 33,3%; 33,3%; 35,3% và 33,3%. Có 16,7% u tiến triển sau lần TACE thứ nhất. U thâm nhiễm, kích thước > 10cm, ở cả 2 thùy và có HKTMC là những yếu tố dự báo tái phát sau TACE. Kết luận: TACE có hiệu quả kiểm soát u ngắn hạn khi đánh giá bằng mRECIST. ABSTRACT EVALUATION OF TREATMENT RESPONSE OF HEPATOCELLULAR CARCINOMA AFTER TRANSARTERIAL CHEMOEMBOLIZATION USING mRECIST CRITERIA Nguyen Thi Thuy Linh1, Hoang Anh Dung1, Huyen Ton Nu Hong Hanh2, Ngo Dac Hong An1, Le Minh Tuan1, Dang Quang Hung2, Le Hoang Huy2, Le Trong Binh1* Purpose: To evaluate the treatment response of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) using mRECIST. Methods: Diagnosis of HCC was based on EASL 2018, and an indication of TACE was based on SIR practice guideline. Treatment responses were evaluated at < 3 - month, 3 - 6 - month, 6 - 12 - month and > 12 - month intervals. Results: Forty - sixpatients (male/female 39/7) with the mean age 61.5 ± 11.2 years were enrolled in the present study. The mean follow - up duration was 223 days (range, 42 - 723 days). The mean of maximal HCC diameter was 62mm (range, 10 - 153mm). 23.9% of patients had portal vein thrombosis (PVT). The rates of complete response of the target lesions at the < 3 - month, 3 - 6 - month, 6 - 12 - month and > 12 - month were 33.3%; 33.3%; 35.3% and 33.3%, respectively. Progression disease was seen in 16.7%. Infiltrative type, diameter > 10cm, bilobar HCC, and portal vein thrombosis were predictors for recurrence. Conclusion: TACE offered short - term therapeutic control of HCC when using mRECIST. Keywords: Hepatocellular carcinoma, transarterial chemoembolization, mRECIST.

Frequency of Decompensation in Patients with Hepatocellular Carcinoma in Child Pugh Class A Undergoing Trans Arterial Chemoembolization

Objective: To determine the frequency of decompensation in patients with hepatocellular carcinoma in Child Pugh Class A undergoing trans arterial Chemoembolization. Study Design: Descriptive case series Place &Duration: Study was conducted at gastroenterology department with collaboration of interventional radiologists Gambat Institute of Medical Science's Khairpur for six months during the time period of November 2020 to April 2021. Methodology: 218 patients of either sex with hepatocellular carcinoma presenting to Gastroenterology Department fulfilling the inclusion criteria were enrolled in the study. TACE involved injection of a chemotherapeutic agent (doxorubicin) mixed with lipoidol into selectively or super selectively catheterized branches of the arteries feeding the tumor followed by injection of gel foam particles to reinforce the effect of the treatment. Data was used to calculate incidence of decompensation in patients with hepatocellular carcinoma in Child Pugh Class A undergoing transarterial Chemoembolization. Results: The frequency of decompensation in patients with hepatocellular carcinoma in Child Pugh Class A undergoing transarterial Chemoembolization was 9.2%. Conclusion: We conclude frequency of decompensation in patients with hepatocellular carcinoma in Child Pugh Class A undergoing transarterial Chemoembolization was 9.2%. Keywords: Hepatocellular carcinoma, decompensation, chemoembolization

Association between the Interleukin-10 -1082 G/A polymorphism and risk of hepatocellular carcinoma

Background: Inconsistent results have been reported from studies investigating the relationship of the interleukin-10 (IL-10) -1082 G/A polymorphism and the susceptibility of hepatocellular carcinoma (HCC). Therefore, a thorough literature review of relatedstudies was performed in this meta-analysis to examine the association of the interleukin-10(IL-10) -1082 G/A poly- morphism with HCC susceptibility. Methods: Electronic databases were searched for literature on the relationship between interleukin-10(IL-10) -1082 G/A poly- morphism and the risk of HCC in accordance with the inclusion and exclusion criteria. The selected studies were analyzed using the Stata 12.0 software. Finally, the strength of the associations was evaluated using the odds ratio (OR) and 95% confidence intervals (95% CI). Results: A total of six case-control studies were enrolled into the current meta-analysis, which included a total of 911 patients and 1889 control subjects. Our data revealed no association between the IL-10 -1082 G/A polymorphism and the risk of HCC (GG vs AA:OR=0.84, 95%CI=0.57-1.25; AG vs AA:OR=0.85, 95%CI=0.70-1.05; Dominant model: OR=0.85, 95%CI=0.70- 1.03; and Recessive model: OR=0.92, 95%CI = 0.64-1.32). Similarly, no association was found in sub-group analysis based on ethnicity. Conclusion: The results of our study suggest no association between IL-10 -1082 G/A polymorphism and the risk of HCC. Keywords: Hepatocellular carcinoma; IL-10 polymorphism; risk analysis.

The Diagnostic Value of Hepatocyte Paraffin Antibody 1 in Differentiating Hepatocellular Carcinoma from non-hepatic Tumors

The paper presents approaches the topic of hepatocellular carcinoma (HCC) differential diagnosis with various other malignant tumors, as such differentiation can be in many cases performed only based on a thorough immunohistochemical marker designed for hepatocellular differentiation. Hepatocyte paraffin-1(Hep Par-1), is a specific antibody for hepatocellular tissue that is represented within both healthy and malignant hepatic cells. The paper evaluated the expression of Hep Par-1 on paraffin tissue acquisitions of selected cases of resecable hepatocellular carcinoma referred for curative surgery (20 cases). For the experimental part, mouse anti-human hepatocyte monoclonal antibodies, Hepatocyte Ab1,and diluted clones of OCH1E5 with the EnVision technique have been used. The results were suggestive for positive expression of Hep Par-1 in 15 of the 20 cases of HCC (75%), with various degrees secondary to the differentiation degree (which was positive in all 15 G1-G2 HCCs and negative in 5 G3-G4 HCCs); on the other hand, the study showed a non-homogenous and focal Hep Par-1 distribution malignant tissue engaging a uniform staining of the non-tumorous liver tissue surrounding the lesion. The study did not show Hep Par-1 immunostaining in non-hepatocytic tumors, excepting some focal expression on a gastric adenocarcinoma with clear patchy expression. Our research confirms that Hep Par-1 can be considered a valuable marker in the diagnosis of HCC, although not totally specific; thus, it should be used in a conjugated manner with various other markers useful in hepatocellular differentiation. Keywords: hepatocellular carcinoma, metastatic carcinoma, Hep Par-1, differential diagnosis of HCC

Hepatic resection versus TILA-TACE in the treatment of Resectable Hepatocellular Carcinoma: study protocol for a randomized controlled trial

Background: Hepatic resection and transcatheter arterial chemoembolization (TACE) are common treatments for hepatocellular carcinoma (HCC). Targeting intratumoral lactic acidosis TACE (TILA-TACE) is a new therapeutic approach developed by our team that has superior response rate and effective rate than conventional TACE (cTACE). In this randomized-controlled trial, we will compare the efficacy of hepatic resection and TILA-TACE in patients clinically diagnosed with HCC to provide reliable clinical data for the subsequent effective treatment of HCC patients. Methods: A total of 230 resectable HCC patients will be given hepatic resection or TILA-TACE using a parallel-controlled approach, and the efficacy of the treatments Page 4 of 24 will be compared. The primary endpoint is the post-treatment progression-free survival (PFS) of the patients, and the secondary endpoints are the post-treatment overall survival (OS), 1-year, 3-year and 5-year survival, and the quality of life of the patients at each corresponding stage. Discussion: The aim of this study is to compare the efficacy of hepatic resection and TILA-TACE in the treatment of resectable HCC. Trial registration: ClinicalTrials.gov,NCT03314532.Registered on 19 October 2017. Keywords: Hepatocellular carcinoma, Hepatic resection, TACE, TILA-TACE, Randomized-controlled study.

Hepatectomy versus TILA-TACE in the treatment of Resectable Hepatocellular Carcinoma: study protocol for a randomized controlled trial

Abstract Background: Hepatectomy and transcatheter arterial chemoembolization (TACE) are common treatments for hepatocellular carcinoma (HCC). Targeting intratumoral lactic acidosis TACE (TILA-TACE) is a new therapeutic approach developed by our team that has superior response rate and effective rate than conventional TACE (cTACE). In this randomized-controlled trial, we will compare the efficacy of hepatectomy and TILA-TACE in patients clinically diagnosed with HCC to provide reliable clinical data for the subsequent effective treatment of HCC patients. Methods: A total of 230 resectable HCC patients will be given hepatectomy or TILA-TACE using a parallel-controlled approach, and the efficacy of the treatments Page 4 of 24 will be compared. The primary endpoint is the post-treatment progression-free survival (PFS) of the patients, and the secondary endpoints are the post-treatment overall survival (OS), 1-year, 3-year and 5-year survival, and the quality of life of the patients at each corresponding stage. Discussion: The aim of this study is to compare the efficacy of hepatectomy and TILA-TACE in the treatment of resectable HCC. Trial registration: ClinicalTrials.gov,NCT03314532.Registered on 19 October 2017. Keywords: Hepatocellular carcinoma, Hepatectomy, TACE, TILA-TACE, Randomized-controlled study.

Hepatocellular carcinoma in patients with autoimmune hepatitis – a systematic review of the literature published between 1989-2016

Background and aims. Liver cancer is one of the most common cause of deaths from cancer. Hepatocellular carcinoma (HCC) was reported at a frequency of 7% of patients with autoimmune hepatitis (AIH) - related cirrhosis in 1988. We aimed to provide a systematic literature review on the frequency of HCC in patients with AIH, after the discovery of hepatitis C virus (HCV), in order to avoid any possible confounding etiology. Methods. A literature search of the PubMed database between 1989-2016 was performed, using the relevant keywords “hepatocellular carcinoma” and “autoimmune hepatitis”. We followed the PRISMA statement guidelines during the preparation of this review. Results. Eleven studies (n=8,460 patients with AIH) were retained for the final analysis. HCC was diagnosed in 0-12.3% of the AIH patients included in these studies. The overall occurrence of HCC in patients with AIH was estimated in two studies, at 5.1% and 6.2%, respectively. In patients with AIH and cirrhosis, the percentage of HCC varied between 0.2%-12.3%. The proportion of HCC in patients with AIH without cirrhosis was estimated at 1.03%. The percentage of cirrhosis in AIH patients varied from 18.7% to 83.3% in Japan, and from 12% to 50.2% in the other areas. The mean follow-up of the patients with AIH was of 10 years. Conclusions. The development of HCC in patients with AIH appeared to be similar before and after the discovery of HCV, and it was mainly associated to cirrhosis. The number of patients developing cirrhosis in relation with AIH was impressive. The long evolution of AIH to cirrhosis and, eventually, to HCC, has been be suggested.

Hepatocellular Carcinoma: Novel Molecular Targets in Carcinogenesis for Future Therapies

Background. Hepatocellular carcinoma is one of the most common and lethal malignant tumors worldwide. Over the past 15 years, the incidence of HCC has more than doubled. Due to late diagnosis and/or advanced underlying liver cirrhosis, only limited treatment options with marginal clinical benefit are available in up to 70% of patients. During the last decades, no effective conventional cytotoxic systemic therapy was available contributing to the dismal prognosis in patients with HCC. A better knowledge of molecular hepatocarcinogenesis provides today the opportunity for targeted therapy. Materials and Methods. A search of the literature was made using cancer literature, the PubMed, Scopus, and Web of Science (WOS) database for the following keywords: “hepatocellular carcinoma,” “molecular hepatocarcinogenesis,” “targeted therapy,” and “immunotherapy.” Discussion and Conclusion. Treatment decisions are complex and dependent upon tumor staging, presence of portal hypertension, and the underlying degree of liver dysfunction. The knowledge of molecular hepatocarcinogenesis broadened the horizon for patients with advanced HCC. During the last years, several molecular targeted agents have been evaluated in clinical trials in advanced HCC. In the future, new therapeutic options will be represented by a blend of immunotherapy-like vaccines and T-cell modulators, supplemented by molecularly targeted inhibitors of tumor signaling pathways.