Data mining reveals complex interactions of risk factors and clinical feature profiling associated with the staging of non-hepatitis B virus/non-hepatitis C virus-related hepatocellular carcinoma

AIM

  Non-hepatitis B virus/non-hepatitis C virus-related hepatocellular carcinoma (NBNC-HCC) is often detected at an advanced stage, and the pathology associated with the staging of NBNC-HCC remains unclear. Data mining is a set of statistical techniques which uncovers interactions and meaningful patterns of factors from a large data collection. The aims of this study were to reveal complex interactions of the risk factors and clinical feature profiling associated with the staging of NBNC-HCC using data mining techniques.

METHODS

  A database was created from 663 patients with NBNC-HCC at 20 institutions. The Milan criteria were used as staging of HCC. Complex associations of variables and clinical feature profiling with the Milan criteria were analyzed by graphical modeling and decision tree algorithm methods, respectively.

RESULTS

  Graphical modeling identified six factors independently associated with the Milan criteria: diagnostic year of HCC; diagnosis of liver cirrhosis; serum aspartate aminotransferase (AST); alanine aminotransferase (ALT); α-fetoprotein (AFP); and des-γ-carboxy prothrombin (DCP) levels. The decision trees were created with five variables to classify six groups of patients. Sixty-nine percent of the patients were within the Milan criteria, when patients showed an AFP level of 200 ng/mL or less, diagnosis of liver cirrhosis and an AST level of less than 93 IU/mL. On the other hand, 18% of the patients were within the Milan criteria, when patients showed an AFP level of more than 200 ng/mL and ALT level of 20 IU/mL or more.

CONCLUSION

  Data mining disclosed complex interactions of the risk factors and clinical feature profiling associated with the staging of NBNC-HCC.

Paternal mosaicism of an STXBP1 mutation in OS

Ohtahara syndrome (OS) is one of the most severe and earliest forms of epilepsy. We have recently identified that the de novo mutations of STXBP1 are important causes for OS. Here we report a paternal somatic mosaicism of an STXBP1 mutation. The affected daughter had onset of spasms at 1 month of age, and interictal electroencephalogram showed suppression-burst pattern, leading to the diagnosis of OS. She had a heterozygous c.902+5G>A mutation of STXBP1, which affects donor splicing of exon 10, resulting in 138-bp insertion of intron 10 sequences in the transcript. The mutant transcript had a premature stop codon, and was degraded by nonsense-mediated mRNA decay in lymphoblastoid cells derived from the patient. High-resolution melting analysis of clinically unaffected parental DNAs suggested that the father was somatic mosaic for the mutation, which was also suggested by sequencing. Cloning of PCR products amplified with the paternal DNA samples extracted from blood, saliva, buccal cells, and nails suggested that 5.3%, 8.7%, 11.9%, and 16.9% of alleles harbored the mutation, respectively. This is a first report of somatic mosaicism of an STXBP1 mutation, which has implications in genetic counseling of OS.

[A case of small cell lung cancer (extensive disease) with liver metastasis acquiring stable disease by hepatic arterial infusion chemotherapy]

The patient was a 58-year-old male with small cell lung cancer [T2N1M1 (HEP) ED case] who was treated systemic chemotherapy with 2 courses of CDDP+CPT-11 and 3 courses of CBDCA+PTX. After 5 courses of chemotherapy, the total response was stable disease (SD). Because the primary lesion had achieved a minor response, however, liver metastasis evidenced no change. Because of his good performance status, he was immediately treated by hepatic arterial infusion chemotherapy ( HAI) using CPT-11 to control the liver metastasis. After the HAI of weekly CPT-11 during eleven months until progression of primary lung lesion, no change in size of the liver metastasis was recognized with decreasing ProGRP (18,400 -->5,800). HAI is considered very useful for disease control without progression and for good quality of life.

Validity of FibroScan values for predicting hepatic fibrosis stage in patients with chronic HCV infection

OBJECTIVE

The aim of this study was to validate the FibroScan system compared with liver histology and serum markers for the diagnosis of hepatic fibrosis. We also tried to determine the cut-off levels and assess the feasibility of using FibroScan values to predict the fibrosis stage.

METHODS

In 44 patients with HCV infection, liver stiffness was evaluated by FibroScan, serum fibrosis markers and a liver biopsy. Associations between these indices were also analyzed.

RESULTS

FibroScan values showed a good correlation with serum levels of type IV collagen, hyaluronic acid and procollagen-III-peptide, and with the platelet count. Compared with liver histology, the FibroScan values increased proportionally with the progression of the histological fibrosis stage. Advanced fibrosis (F3 or F4) could be efficiently predicted by a FibroScan cut-off value of 15 kPa. The FibroScan sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100%, 73.9%, 77.8%, 100%, and 86.4%, respectively.

CONCLUSION

FibroScan values gave a good correlation with various markers of fibrosis and increased proportionally with the progression of the hepatic fibrosis stage. A FibroScan value of 15 kPa was found to be a significant separation limit for differentiating advanced fibrosis stages (F3 and F4) from the milder stages (F0-F2). FibroScan values are clinically useful for predicting the fibrosis stages and helpful in managing interferon therapy in patients with chronic hepatitis C.

Characteristics of gastric cancer in patients over 80-years-old

BACKGROUND/AIMS

The number of elderly gastric cancer patients undergoing surgery is rapidly increasing because of the current aging society. To determine an effective surgical treatment method, the clinicopathological characteristics of such patients should therefore be clarified.

METHODOLOGY

Between 1979 and 2005, 2010 patients with gastric cancer underwent curative surgery in our institute. Clinicopathological characteristics of 109 patients in the elderly group (> or = 80-years-old) were compared with those of 1901 patients in the young group (< 80-years-old).

RESULTS

In the elderly group, cancers of the lower third of the stomach and differentiated types, and less-invasive surgery were common. The 5-year survival rate specific to gastric cancer was not significantly different between groups, but the overall 5-year survival rate including causes other than gastric cancer was significantly different (p<0.01) at 82% in the elderly group and 67% in the young group.

CONCLUSIONS

In the medical care of elderly gastric cancer patients, it is necessary to accurately determine the specific clinicopathological characteristics, and subsequently, an effective surgical treatment method.

Second primary cancer after surgery for colorectal cancer without lymph node metastasis

BACKGROUND/AIMS

Colorectal cancer patients without lymph node metastasis usually show a favorable prognosis with low recurrence rates; however, there is an increased risk of the development of a second primary cancer. Understanding the features of a second primary cancer is important to establish an effective postoperative follow-up program for colorectal cancer without lymph node metastasis.

METHODOLOGY

The clinicopathological data on 801 patients with Dukes' A and Dukes' B colorectal cancer were examined in respect to second primary cancer.

RESULTS

In patients with Dukes' A cancer, the incidences of recurrence and second primary cancer were similar. When tumor invasion was limited within subserosa in Dukes' B patients, the incidence of a second primary cancer was almost two-thirds that of recurrence. More than half of the second primary cancers again developed from the colorectum, followed by stomach and lung.

CONCLUSIONS

When colorectal cancer patients without lymph node metastasis show tumor invasion limited within the subserosa, postoperative follow-up should monitor a balance of recurrence with a second primary cancer.

Influence of prophylactic apical node dissection of the inferior mesenteric artery on prognosis of colorectal cancer

BACKGROUND/AIMS

Middle ligation (ML) of the inferior mesenteric artery (IMA) maintains adequate blood supply to an anastomosis and has no risk of autonomic nerve injury. If apical node dissection of the IMA improves the prognosis, ML and prophylactic dissection of the apical node without division of the IMA above the colic artery may also result in an additional prognostic improvement in patients with sigmoid colon or rectal cancer.

METHODOLOGY

Four hundred and one patients with either Dukes' B or Dukes' C colorectal cancer were clinicopathologically examined. In order to evaluate the influence of the prophylactic dissection of the apical node on the prognosis, the two groups of ML with and without apical node dissection were compared.

RESULTS

The 5-year survival rates in the groups of ML and ML with apical node dissection were 90% and 91%, respectively, in 218 Dukes' B patients. The 5-year survival rates in the groups of ML and ML with apical node dissection were 73% and 71%, respectively, in 183 Dukes' C patients. There were no significant differences between the two groups in both Dukes' B and Dukes' C patients.

CONCLUSIONS

When ML is adopted for patients with sigmoid colon or rectal cancer, additional dissection of the apical node is not needed.

[Surgical treatment for multiple colorectal metastases: efficacy of ablation therapy]

Either hepatic resection, microwave coagulonecrotic therapy (MCN), or a combination of liver resection and MCN was performed in 166 patients with liver metastases from colorectal cancer. In 53 patients who underwent liver resection, the 1-, 3-, and 5-year actual survival rates were 85.0%, 51.2%, and 42.2%, respectively. In 77 who underwent MCN, the 1-, 3-, and 5-year actual survival rates were 82.8%, 46.7%, and 36.0%, respectively. In 34 who underwent both liver resection and MCN, the 1-, 3-, and 5-year actual survival rates were 84.2%, 41.6%, and 21.1%, respectively. The survival rates among the three groups did not differ significantly. Of 166 patients with liver metastases, 44 showed multiple liver metastases (H3). Of 44 patients with multiple liver metastases, 27 underwent MCN (mean tumor diameter 27.2 mm, mean number of tumors 11.2), and the 1-, 3-, and 5-year actual survival rates were 73.1%, 31.3%, and 25.1%, respectively. Of 44 patients with multiple liver metastases, 17 underwent both liver resection and MCN (mean tumor diameter 41.9mm, mean number of tumors 8.1), and the 1-, 3-, and 5-year actual survival rates were 66.3% and 14.7%, respectively. To perform MCN more effectively in the treatment of liver metastases, surgical margins around tumors should be from 10 mm to 15 mm, and both the feeding artery and drainage vein should be coagulated before MCN.

Long-term survival following treatment with antineoplastons for colon cancer with unresectable multiple liver metastases: report of a case

We report a case of survival for nearly 8 years after treatment of unresectable multiple liver metastases from colon cancer, using microwave ablation and the nontoxic antitumor agent, the antineoplastons. A 72-year-old man diagnosed with adenocarcinoma of the ascending colon and 14 bilateral liver metastases underwent a right hemicolectomy combined with microwave ablation of six metastatic liver tumors. We also decided to give antineoplastons to inhibit metastatic tumor growth and recurrence. Antineoplaston A10 was given intravenously, followed by oral antineoplaston AS2-1. Computed tomography scans done 1 and 4 years after the initial diagnosis showed recurrent tumors in S(4) and S(7), respectively. The patient underwent a second and a third microwave ablation of the recurrent tumors, and has survived for nearly 8 years without suffering any serious adverse effects. He is currently free from cancer. This case report demonstrates the potential effectiveness of the nontoxic antitumor agent, the antineoplastons, for controlling liver metastases from colon cancer.

Retrospective study on the effects of lipiodolization before a potentially curative hepatectomy for colorectal liver metastases: long-term results of a pilot study

BACKGROUND/AIMS

Lipiodolization, a selective regional cancer chemotherapeutic modality using lipiodol plus anticancer drugs, can prolong the survival time of patients with unresectable liver cancer. A preliminary study was conducted with adjuvant lipiodolization before a potentially curative hepatectomy for patients with metachronous colorectal liver metastases. The ultimate aim of this study was to improve the long-term survival after hepatectomy.

METHODOLOGY

Twenty-one consecutive patients with colorectal hepatic metastases were included in this study. Seven patients underwent preoperative lipiodolization, while the remaining 14 patients did not receive any preoperative adjuvant therapy. The clinicopathological features and prognoses of these patients were investigated. The median follow-up period after a curative hepatectomy was 56 months.

RESULTS

The clinicopathological factors did not differ markedly between the 2 groups. However, the cumulative survival rate of the 7 patients receiving preoperative lipiodolization was significantly (P < 0.05) better than that in those not receiving any preoperative treatment.

CONCLUSIONS

Based on the above encouraging findings, we therefore propose that a prospective randomized trial should be carried out to confirm the beneficial effects of our adjuvant chemotherapeutic modality on patient survival following a curative hepatectomy for the patients with colorectal liver metastases.

Intraoperative localization of right-sided small colonic lesions: a novel use of the cholangioscope

BACKGROUND/AIM

We describe a novel use of the cholangioscope to help in the intraoperative localization of small colonic malignancies on the right side of the colon.

METHODS

A small incision was made at the base of the appendix and a cholangioscope was inserted into the ascending colon through the incised hole of the appendix.

RESULTS

The site of the lesion was precisely determined by palpating the distal end of the cholangioscope while observing the area right under it.

CONCLUSION

Our procedure therefore appears to be worthy of consideration in patients with small colonic lesions on the right side of the colon in whom preoperative endoscopic marking techniques might otherwise be required.

A resected case of combined hepatocellular carcinoma and cholangiocarcinoma associated with cystic formation

Combined hepatocellular carcinoma and cholangiocarcinoma is a rare tumor. In addition, both hepatocellular carcinoma and cholangiocarcinoma are rarely associated with cystic lesions. We herein present a 62-year-old Japanese woman with combined hepatocellular carcinoma and cholangiocarcinoma which was associated with a rapidly enlarging cystic lesion. Both abdominal ultrasonography and computed tomography revealed a cyst with a solid portion in the left hepatic lobe. A partial hepatectomy was performed on the basis of a tentative diagnosis of a cystadenocarcinoma of the liver, while the diagnosis based on immunohistochemical studies was combined hepatocellular carcinoma and cholangiocarcinoma with cystic formation. The patient died of tumor recurrence, such as intrahepatic metastases and extensive lymph node metastases, 6 months after the operation. The prognosis of this entity, which has never been reported in the English medical literature and is difficult to preoperatively differentiate from hepatic cystadenocarcinoma, therefore seems to be extremely poor.

Rare occurrence of colorectal cancer metastasis in livers infected with hepatitis B or C virus

BACKGROUND

The rarity of the occurrence of metastatic malignancy in injured liver has been noted by many observers. However, since the clinicopathological features of primary carcinoma and the etiology of liver disease of these patients vary greatly, this phenomenon may not be universal.

METHODS

We evaluated the relationship between either hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and the incidence of colorectal liver metastasis in 438 patients undergoing surgical treatment for advanced colorectal carcinoma.

RESULTS

The liver function of the patients in the infection group (n = 37) was significantly worse than that of those in the noninfection group (n = 401). The incidences of tumor recurrence in the lung or peritoneum were comparable between the two groups. However, the percentage of patients with liver metastases in the infection group (3 of 37, 8.1%) was significantly lower (P <0.05) than that of those in the noninfection group (85 of 401, 21.2%). The patients in the infection group tended to survive longer than the patients in the noninfection group.

CONCLUSIONS

We herein report an initial finding that colorectal carcinoma rarely metastasizes to livers infected with HBV or HCV.

CD4+ hepatic cancer-specific cytotoxic T lymphocytes in patients with hepatocellular carcinoma

We investigated T cell immunity against hepatocellular carcinoma (HCC), and showed that both peripheral blood mononuclear cells and tumor-infiltrating lymphocytes incubated with interleukin-2 alone displayed HLA-nonrestricted but hepatic cancer-specific cytotoxicity in a majority of patients with HCC. Namely, they lysed both HCC and cholangiocellular carcinomas in an HLA-nonrestricted manner, but they did not lyse any tumors with the other histological types tested, normal hepatocytes, or the cells transfected with hepatitis C virus or MUC1 gene. These CTL lines and clones were phenotypically CD3+CD4+CD8-. These unique CTL could play important roles in T cell immunity against HCC.

A prospective randomized trial of the preventive effect of pre-operative transcatheter arterial embolization against recurrence of hepatocellular carcinoma

To clarify whether pre-operative transcatheter arterial embolization (TAE) improves survival after hepatectomy, a prospective randomized comparative study was done. Of a total of 115 registered patients having solitary hepatocellular carcinoma (HCC) 2 to 5 cm in diameter, 18 (15.7%) were excluded after randomization. As a result, 97 patients were chosen as subjects and divided into two groups: hepatectomy with (group A: n=50) and without (group B: n=47) pre-operative TAE. The period of observation of the patients who survived the surgery was between 4.0 and 6.6 years. The randomization appeared to have provided well-balanced groups of patients and the clinico-pathological characteristics of the two groups were quite similar. The necrotic part of the cancerous lesions, as confirmed by operative specimens, amounted to 74.8+/-33.4% (mean +/-SD) in group A and 6.8+/-7.2% in group B (P<0.01). However, the cancer-free survival rates after hepatectomy in both groups showed little difference (39.1+/-7.0 (%+/-SE) and 31.1+/-0.1, respectively). We speculate that TAE is not effective against such HCC accessory lesions as minute intrahepatic metastasis and tumor thrombus and that pre-operative TAE does not improve post-operative survival.

Evaluation of surgical risk in preoperative biliary drainage patients by blood chemistry laboratory data--with special reference to rate of reduction of serum bilirubin levels

BACKGROUND/AIM

In Japan, it is generally accepted that biliary decompression should be performed before surgical operations on patients with obstructive jaundice. However, even when adequate decompression and effective reduction of serum bilirubin levels are achieved before surgical operations, it is not uncommon for unforeseen postoperative complications to occur. In this study, we analyzed the effectiveness of biliary drainage prior to pancreatoduodenectomy in patients with malignant obstruction of the papilla of Vater clinically manifested by obstructive jaundice.

PATIENTS AND METHODS

We retrospectively examined the serial blood chemistry laboratory data of 44 patients with periampullary carcinoma who had preoperative obstructive jaundice and underwent pancreatoduodenectomy during the last 10 years. We divided the cases into three groups according to the rate of decrease in serum bilirubin levels, "b": group I, b <-0.09; group II, -0.09<b<-0.05; and group III, -0.05<b. There were no significant differences between the three groups in regard to sex, location of tumor and method of biliary decompression, however, there was significantly higher morbidity rate in group III.

RESULTS

The level of biliary enzymes (gamma-GTP, ALP) tended to be higher in group I and lower in group III. Although TB and DB decreased to below 5 mg/dl before pancreatoduodenectomy in all three groups, transaminase levels instead rose in group III just before pancreatoduodenectomy.

CONCLUSION

This suggested that liver damage continued to progress after biliary decompression when the reduction rate was low, and thus we should carefully monitor such patients for postoperative complications.

A patient with hepatocellular carcinoma who underwent resection of the primary lesion 10 years ago and resection of a giant adrenal metastasis 8 and a half years later

A 56-year-old male consulted us because of a palpable mass and pain of the left flank 8 and a half years after resection of hepatocellular carcinoma of the left lobe about 3 cm in diameter. Ultrasound examination of the abdomen demonstrated a tumor about 10 cm in diameter showing a mosaic of hyperechoic and hypoechoic areas on the upper pole of the left kidney. By angiography, the tumor was found to be supplied mainly by the inferior adrenal artery. PIVKA-II was increased. Adrenal metastasis of hepatocellular carcinoma was suspected, and adrenalectomy was carried out. No intrahepatic metastasis was noted. The tumor was histopathologically identified as a pseudo-glandular type of moderately differentiated hepatocellular carcinoma with a trabecular pattern similar to the primary lesion. In this patient, a resectable giant metastasis was observed only in the left adrenal gland and no intrahepatic metastasis was demonstrated 8 and a half years after resection of hepatocellular carcinoma. The patient has survived 10 years after the first operation. This case is considered to be important for evaluation of the treatment for distant metastasis of hepatocellular carcinoma.

[Microwave coagulo-necrotic therapy for hepatocellular carcinoma]

We performed microwave coagulo-necrotic therapy (MCN), a new surgical treatment for hepatocellular carcinoma (HCC) under laparotomy on 41 cases and under laparoscopy on 5 cases for a total of 46 cases (70 cancer nodules). The indications for MCN include: 1) cases in which an early recurrence is judged as likely to occur. For example, multinodular cases, or intrahepatic metastasis (im1-3) 25 cases (54.3%), 9 cases (19.6%) in which multiple adenomatous hyperplasia was detected, VP2 1 case (2.2%). 2) 7 cases (15.2%) in which if hepatectomy is conducted, there is a high risk of postoperative liver failure, or cases in which it is judged postoperative management will be very difficult. In only 4 cases was it because the patients requested laparoscopic MCN (lapa. MCN). Also, the tumor size was less than 15 mm in 4 cases, 16 to 20 mm in 6 cases, 21-30 mm in 21 cases, 31-50 mm in 6 cases, and larger than 51 mm in 9 cases (maximum 90 x 65 mm). Only 1 case who died on the 17th postoperative day due to sudden ventricular arrhythmia, and 3 cases who died cancer death at 1 year 6 months, 2 year 2 months, and 4 years 1 months after the operation for a total of 4 cases, so that 42 patients have survived 4 years and 3 months as of this writing. Thus MCN was in no way inferior to hepatectomy.

[Investigation of microwave coagulo-necrotic therapy for 21 patients with small hepatocellular carcinoma less than 5 cm in diameter]

Microwave coagulo-necrotic therapy (MCN) was performed in 21 patients with small hepatocellular carcinoma less than 5cm in diameter and this therapeutic method was determined to be effective from the following results. 1) A marked low density area was seen in the region receiving the therapy and no enhanced findings were observed by enhanced CT one month postoperatively. 2) Recurrence appeared in 5 patients (23.8%) and only one patient died 1 year and 6 months after the operation. However, the other 20 patients survived for a maximum of 3 years and 2 months postoperatively. 3) The levels of total bilirubin and GOT in these patients were similar to those of patients who underwent hepatectomy. However, the levels of prothrombin time and hepaplatin test in patients with MCN changed less than in those who received hepatectomy. 4) Tendency of the renal failure was seen in 2 patients, and the other 19 patients did not have any complication postoperatively.

[A device for hepatic arterial catheterization using saphenous vein graft]

We performed regional arterial infusion chemotherapy for hepatocellular carcinoma by retaining a hepatic arterial reservoir. The catheters were placed via gastroduodenal artery and positioned at the junction with common hepatic artery during operation. But we encountered many complications and did not perform regional arterial infusion chemotherapy. This time we cannulated through the saphenous vein graft by which hepatic perfusion was maintained by the superior mesenteric artery; we did not cannulate through the common femoral artery using a subcutaneously implanted reservoir. Venous arterial anastomosis is performed with interrupted (7-0 Prolene) vascular suture. Postoperative angiography by the reservoir showed total hepatic perfusion. There have been no instances of hemorrhage, thrombosis, or catheter dislodgement with this technique. Duration of follow-up varied from 2 to 7 months.

A new technique of hepatectomy using an occlusion balloon catheter for the hepatic vein

To minimize intraoperative bleeding and allow more accurate resection, we have devised a new technique for hepatectomy. In addition to occlusion of the afferent vessels, we occlude the hepatic vein at the hepatocaval junction using a balloon catheter inserted transhepatically under intraoperative ultrasonic guidance. We have performed eight hepatectomies using this method. A sequence of 15 minutes of vascular occlusion followed by 5 minutes reperfusion was repeated throughout the operation, and the total ischemic time ranged from 45 to 90 minutes. This method greatly decreased intraoperative bleeding without causing significant elevation of the postoperative transaminase or lactic dehydrogenase levels when compared with occlusion of only the afferent vessels or nonischemic resection using a microwave tissue coagulator in patients undergoing equivalent resections. Also, the postoperative prothrombin time recovered to a significantly higher level, and there were no fatal postoperative complications using this method. Our method is useful for systematic hepatic resection along the hepatic vein or for resection of tumor sited at the confluence of the hepatic vein.

Accelerated growth rates of recurrent hepatocellular carcinoma after liver transplantation

The growth rates of recurrent hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLTX) were estimated by calculating the tumor doubling time (TDT) in 20 patients. The mean TDT, calculated by multiple measurement of tumor size, was 44.3 +/- 11.3 days (mean +/- standard error) in 12 patients with pulmonary metastasis (range, 10 to 161 days) and 37.6 +/- 8.9 days (range, 7 to 65 days) in 5 patients with liver allograft recurrence. The TDT as estimated by serum alpha-fetoprotein (AFP) levels in 6 patients was 37.3 +/- 10.0 days (range, 12 to 84 days). The mean TDT obtained from 5 control subjects with HCC who were treated with liver resection (without immunosuppression) was 273.8 +/- 79.1 days (range, 82 to 560 days). The disease-free period and survival time after OLTX both correlated well with the TDT (r = 0.546 and r = 0.701, respectively). The patients with fibrolamellar HCC had a greater TDT and a longer survival time than those with nonfibrolamellar HCC. Despite a wide range of TDT in patients who received transplants, their recurrent HCC tumors grew significantly faster than those of patients with the same disease who did not receive transplants. The factors involved in this accelerated growth rate may include the use of immunosuppressive drugs and the consequent suppression of host immunity against the growth of micrometastasis.

Accelerated growth rates of recurrent hepatocellular carcinoma after liver transplantation

The growth rates of recurrent hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLTX) were estimated by calculating the tumor doubling time (TDT) in 20 patients. The mean TDT, calculated by multiple measurement of tumor size, was 44.3 +/- 11.3 days (mean +/- standard error) in 12 patients with pulmonary metastasis (range, 10 to 161 days) and 37.6 +/- 8.9 days (range, 7 to 65 days) in 5 patients with liver allograft recurrence. The TDT as estimated by serum alpha-fetoprotein (AFP) levels in 6 patients was 37.3 +/- 10.0 days (range, 12 to 84 days). The mean TDT obtained from 5 control subjects with HCC who were treated with liver resection (without immunosuppression) was 273.8 +/- 79.1 days (range, 82 to 560 days). The disease-free period and survival time after OLTX both correlated well with the TDT (r = 0.546 and r = 0.701, respectively). The patients with fibrolamellar HCC had a greater TDT and a longer survival time than those with nonfibrolamellar HCC. Despite a wide range of TDT in patients who received transplants, their recurrent HCC tumors grew significantly faster than those of patients with the same disease who did not receive transplants. The factors involved in this accelerated growth rate may include the use of immunosuppressive drugs and the consequent suppression of host immunity against the growth of micrometastasis.

[An assessment of therapeutic effects by transcatheter arterial embolization (TAE) with degradable starch microspheres (DSM) for hepatic malignant tumors]

Transcatheter arterial embolization (TAE) by using degradable starch microspheres (DSM) as embolic material, 40 microns in diameter and degraded by serum amylase within one hour, was carried out for thirteen cases with hepatic malignancies including eleven cases with hepatocellular carcinoma (HCC), one case with cholangiocarcinoma and one case with metastatic liver cancer. DSM were mixed with anticancer agents and administered through the catheter, which was introduced by Seldinger's method, via the hepatic artery immediately after hepatic angiography in ten cases and through subcutaneously implanted drug delivery system (Port-A-Cath) in three cases. The dose of DSM was 900 mg/body and adriamycin 30-40 mg/m2 or 12-14 mg/m2 were used. The former was administered through the catheter immediately after angiography and the latter through Port-A-Cath for HCC and cholangiocarcinoma. A same dose of DSM and mitomycin C 15-16 mg/m2 was administered for metastatic liver cancer through the catheter immediately after angiography. The administration was repeated weekly in three cases in which Port-A-Cath was implanted, and at five weeks' interval through the catheter immediately after hepatic angiography in the other ten cases. Therapeutic effects were assessed and pharmacokinetics of adriamycin were studied. Results were as follows; 1) Partial response (PR) was obtained in five cases out of eleven cases with HCC (45.5%) and there were three cases with minor response (MR) in the other six cases. Totally, decrease of tumor size was demonstrated in eight cases out of eleven cases (72.7%). 2) In nine cases in which AFP was positive, the titer of AFP was decreased in seven cases (77.8%). 3) No change (NC) was obtained in cholangiocarcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)