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Nobuyoshi Fukushima,
Ryoko Kuromatsu,
Daiji Uchiyama,
Satoshi Itano,
Akio Takata,
Eiji Ando, Shuji Sumie,
Takuji Torimura,
Masafumi Uchida,
Osamu Nakashima,
Masamichi Kojiro,
Michio Sata
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ABSTRACT: We describe a 48-year-old man with nodular intrahepatic lesions accompanied by communication between the inferior vena cava and portal systems as well as absence of intrahepatic portal veins. After infection with malaria in childhood, end-to-side portacaval shunting had been performed to treat upper gastrointestinal bleeding at the age of 15 years. A biopsy specimen obtained under ultrasonographic guidance showed hyperplastic nodules suggestive of focal nodular hyperplasia. The estradiol concentration in the blood was elevated (55 pg/ml). This case suggests that portacaval shunting may be associated with hyperplastic liver nodules through hyperestrogenemia and abnormal hepatic hemodynamics.
Internal Medicine 02/2007; 46(15):1203-8. · 0.94 Impact Factor
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ABSTRACT: The prognosis of advanced hepatocellular carcinoma remains poor. The aim of this study was to compare the efficacy of hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization for treatment of advanced tumor. SUBJECTS AND METHODS. Thirty-seven patients with hepatocellular carcinoma and unresectable tumors were enrolled. In the hepatic artery infusion chemotherapy group (n = 16), cisplatin (10 mg/person, on days 1-5) and subsequent 5-fluorouracil (250 mg/person, on days 1-5) were administered for four serial courses. In the transcatheter arterial Lipiodol chemoembolization group (n = 21), an emulsion of Epirubicin (20-30 mg/person) and Lipiodol was administered every 3-4 weeks.
The tumor response rates (complete response plus partial response for all cases) of the hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization groups were 56.3% and 23.8%, respectively, showing the significantly higher rate in the former than in the latter group. The cumulative survival rates between the two groups were not significantly different; whereas in those patients whose tumors were classified as TNM stage IV or as having the maximal tumor size of greater than 5 cm, patients tended to have higher survival rates in the hepatic artery infusion chemotherapy group than in the transcatheter arterial Lipiodol chemoembolization group. Univariate analysis identified the serum aspartate aminotransferase value as solely significant. Patients' adverse reactions were successfully managed by treatment of symptoms. Adverse events, such as obstructions of the catheter or hepatic artery or infection around the catheter, rarely occurred.
Hepatic artery infusion chemotherapy had a better antitumor effect than transcatheter arterial Lipiodol chemoembolization and may be a useful therapeutic option for more advanced hepatocellular carcinoma.
American Journal of Roentgenology 12/2003; 181(5):1327-34. · 2.78 Impact Factor
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ABSTRACT: We investigated the unsettled issue of whether seropositivity for antibody to hepatitis B core antigen (anti-HBc) affects characteristics of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC).
Antibody status was determined by enzyme immunoassay in 243 patients with this cancer, and associations with clinicopathologic characteristics and outcome were analysed. Serum hepatitis B virus (HBV) DNA was determined by real-time polymerase chain reaction.
Of 235 patients with unequivocal serologic status, 142 were seropositive and 93 were seronegative. Clinicopathologic characteristics and overall cumulative survival rates were comparable between the two groups. However, seropositivity tended to predict poor outcome for patients in Child class B or C (P=0.068), those in tumour-nodes-metastasis-based stage 3 or 4 (P=0.081), those with tumours exceeding 25 mm (P=0.068), and those with a past history of clinical liver disease (P=0.088). Multivariate analysis identified serum albumin, portal vein tumour thrombosis, and tumour size as independent determinants of survival. Serum HBV DNA was below 1.7 log copies/ml in all 40 patients tested.
Overall, the clinical features of HCV-HCC were unaffected by seropositivity for anti-HBc. Seropositivity tended to worsen prognosis for subgroup with poor hepatic reserve or advanced tumours.
Liver international: official journal of the International Association for the Study of the Liver 09/2003; 23(4):227-31. · 3.82 Impact Factor
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Eiji Ando,
Masatoshi Tanaka,
Fumihiko Yamashita,
Ryoko Kuromatsu,
Akio Takada,
Kazuta Fukumori,
Yoichi Yano, Shuji Sumie,
Koji Okuda,
Ryukichi Kumashiro,
Michio Sata
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ABSTRACT: To elucidate the usefulness of monitoring Lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3) and des-gamma-carboxy prothrombin detected with a revised kit (DCP-R) as clues to the diagnosis of recurrent hepatocellular carcinoma (HCC).
A total of 57 patients with HCC were enrolled in the study. They were classified into two groups: group A comprised 27 patients in whom the diagnostic clue to recurrent HCC appeared before November 1997; these patients were monitored by ultrasonography, computed tomography (CT), AFP and des-gamma-carboxy prothrombin detected with a conventional kit (DCP-C). Group B comprised 30 patients in whom the diagnostic clue to recurrent HCC was detected after November 1997; these patients were monitored by ultrasound, CT, AFP, AFP-L3 and DCP-R.
In group A, 22 and five HCC recurrences were recognized initially by imaging studies and tumour markers, respectively. In group B, 17 and 13 HCC recurrences were recognized initially by imaging studies and tumour markers, respectively. The number of patients in whom tumour markers were the first clue to the diagnosis of recurrent HCC was significantly higher in group B than in group A.
Periodic examination of AFP-L3 and DCP-R may be useful for the early detection of recurrent HCC.
European Journal of Gastroenterology & Hepatology 07/2003; 15(6):641-8. · 1.76 Impact Factor
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ABSTRACT: The prognosis of patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is extremely poor. The aim of this study was to elucidate the efficacy of hepatic arterial infusion chemotherapy (HAIC) for patients with advanced HCCs.
Forty-eight HCC patients with PVTT were treated by HAIC via a subcutaneously implanted injection port. Of these, 14 had PVTT in the second portal branch and 34 patients had PVTT in the first portal branch or in the main portal trunk. One course of chemotherapy consisted of daily cisplatin (7 mg/m(2) for 1 hour on Days 1-5) followed by 5-fluorouracil (170 mg/m(2) for 5 hours on Days 1-5). Patients were scheduled to receive four serial courses of HAIC. Responders were defined as having either a complete response (CR) or partial response (PR) and nonresponders were defined as exhibiting stable disease or progressive disease. The prognosis after HAIC and factors related to survival were analyzed.
Following HAIC, 4 and 19 patients exhibited a CR and PR, respectively (response rate = 48%). The 1, 2, 3, and 5-year cumulative survival rates of 48 patients treated with HAIC were 45%, 31%, 25%, and 11%, respectively. Median survival periods for 23 responders and 25 nonresponders were 31.6 (range, 8.3-76.9) months and 5.4 (1.9-29.0) months, respectively. Therapeutic effect (P < 0.001) and hepatic reserve capacity (P = 0.021) were identified as significant prognostic factors by univariate analysis. Multivariate analysis identified only therapeutic effect as being significantly related to survival.
HAIC using low-dose cisplatin and 5-fluorouracil may be a useful therapeutic option for patients with advanced HCC with PVTT. HCC patients with PVTT who respond to HAIC could certainly have survival benefits.
Cancer 09/2002; 95(3):588-95. · 4.77 Impact Factor
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Yoichi Yano,
Fumihiko Yamashita, Shuji Sumie,
Eiji Ando,
Kazuta Fukumori,
Masahiro Kiyama,
Takashi Oyama,
Shigetaka Kuroki,
Osamu Kato,
Hiroshi Yamamoto,
Masatoshi Tanaka,
Michio Sata
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ABSTRACT: We determined the prevalence of patients with hepatocellular carcinoma (HCC) who were positive for only anti-hepatitis B core (anti-HBc) antibody among 284 Japanese patients and compared their clinical features to those who were hepatitis B surface antigen positive [HBsAg(+)].
Serum HBsAg and anti-hepatitis C virus (anti-HCV) antibody were examined for all HCC patients. Testing for anti-HBc antibody was performed in the HBsAg(-)/anti-HCV(-) patients. The clinical factors and the survival rate were compared between the HBsAg(+) patients (HCC-B) and those positive for anti-HBc alone (HCC-PB).
There were 19 (6.7%) HBsAg(+), 236 (83.1%) anti-HCV(+), seven (2.5%) HBsAg(+)/anti-HCV(+), and 22 (7.7%) HBsAg(-)/anti-HCV(-) among the 284 patients tested. Sixteen (72.7%) of the 22 HBsAg(-)/anti-HCV(-) patients were assigned to the HCC-PB group. The prevalence of positivity for anti-HBc alone among all 284 HCC patients was 5.6%. Significant differences between the HCC-PB and HCC-B groups were that age at diagnosis was higher in the HCC-PB group (72.1 yr) than in the HCC-B group (56.2 yr) (p < 0.001), the serum alpha-fetoprotein concentrations were lower in the HCC-PB group (8.2 ng/ml) than in the HCC-B group (43 ng/ml) (p = 0.0488), and a higher familial history of liver disease was observed in the HCC-B group (p = 0.0373). However, there was no significant difference in the cumulative survival rate.
Positivity for anti-HBc alone is not rare compared to HBsAg(+), and the clinical features of positivity for anti-HBc alone are similar to those of HBsAg(+). Some differences in the clinical features between the two groups may be explained by differences in the time of first exposure to hepatitis B virus. Therefore, the natural course of acute hepatitis B may be reconsidered.
The American Journal of Gastroenterology 02/2002; 97(1):156-61. · 7.28 Impact Factor
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Eiji Ando,
Ryoko Kuromatsu,
Masatoshi Tanaka,
Akio Takada,
Nobuyoshi Fukushima, Shuji Sumie,
Sakae Nagaoka,
Jyunji Akiyoshi,
Kinya Inoue,
Takuji Torimura,
Ryukichi Kumashiro,
Takato Ueno,
Michio Sata
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ABSTRACT: Surveillance of cirrhotic patients enables early detection of hepatocellular carcinoma (HCC) and possibly prolongs survival. The aim of this study was to explore whether early-stage HCC can be detected earlier at a specialized department of liver disease than in other institutions.
The study subjects were 574 patients with HCC. Patients were subdivided into 3 groups according to the manner of HCC detection: group A, HCC was detected in 91 patients during periodic examination at Kurume University School of Medicine; group B, HCC was detected in 301 patients during periodic examination at other institutions; group C, HCC was detected incidentally or because of symptoms in 182 patients.
The HCC detected in group A was significantly of smaller size (20.4 mm) compared with groups B (27.1 mm, P<0.0001) and C (57.8 mm, P<0.0001). The frequency of receiving treatment (surgery or local ablation therapy) was significantly higher in group A (73%) than in groups B (52%, P=0.002) and C (26%, P<0.0001). The 5-year survival rates were 52% for group A, 40% for group B, and 23% for group C, respectively. The survival of group A was significantly better than that of groups B (P=0.0157) and C (P<0.0001).
Surveillance for HCC at specialized Department of Liver Disease can detect early-stage HCC, resulting in a higher chance of receiving promising treatment.
Journal of Clinical Gastroenterology 40(10):942-8. · 3.16 Impact Factor
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ABSTRACT: The prognosis for advanced hepatocellular carcinoma (HCC) remains unsatisfactory. Transarterial chemoembolization (TACE) and/or hepatic arterial infusion chemotherapy (HAIC) have been reported to be useful options. However, there are few reports of salvage therapies for patients without a curative response to initial chemotherapy. The aim of this study was to elucidate the efficacy of additional TACE as salvage therapy in cases of advanced HCC which failed to respond to HAIC. Of 43 patients with advanced HCC who did not show a complete response (CR) to HAIC, 12 were treated with additional TACE as salvage therapy (Group A). The rest were enrolled as disease control subjects (Group B). Response rates and prognosis were compared. For HAIC, cisplatin (10 mg/body on days 1-5) was administered. Subsequent treatment was the infusion of 5-fluorouracil (250 mg/body on days 1-5), which was scheduled for 4 serial courses. For TACE, carboplatin (150 mg/body) or epirubicin (30 mg/body) was administered mixed with 3 ml of ethiodized oil every 4 weeks. A CR or PR, ST and PD were observed in 6, 3, and 3 patients in Group A and 13, 18 and 0 patients in Group B, respectively. The difference in response between the two groups was significant (P=0.0074). The 1-, 2- and 3-year survival rates were 83.3, 75.0 and 44.4% in Group A and 83.9, 41.5 and 11.3% in Group B, respectively. Patients in Group A had a better prognosis than did those in Group B (P=0.018). Median survival was 31.9 months (5.8-41.1) in Group A and 16.2 months (3.3-53.2) in Group B. Consequently, TACE as salvage therapy after HAIC may improve the prognosis for patients with advanced HCC.
Molecular Medicine Reports 1(4):521-4. · 0.42 Impact Factor
