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Commander SJ, Cerullo M, Arjunji N, Leraas HJ, Thornton S, Ravindra K, Tracy ET. Improved Survival and Higher Rates of Surgical Resection Associated with Hepatocellular Carcinoma in Children as Compared to Young Adults. Int J Cancer 2022; 151:2206-2214. [PMID: 35841394 DOI: 10.1002/ijc.34215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022]
Abstract
Hepatocellular adenocarcinoma (HCC) is the second most common primary hepatic malignancy in children with a 5-year overall survival of 30%. Few studies have examined the similarities and differences between pediatric and adult HCC. This paper aims to examine the relationship between tumor characteristics, treatments, and outcomes in pediatric and adult patients with HCC. The 2019 National Cancer Database was queried for patients with HCC. Patients were stratified by age: pediatric <21 years (n = 214) and young adults 21-40 (n = 1102). Descriptive statistics and chi square were performed. The mean age at diagnosis was 15.5 years (SD 5.6) in the pediatric and 33 years (5.3) in the adult group. Children had a comparable rate of metastasis (30% vs 28%, P = 0.47) and increased fibrolamellar histology (32% vs 9%). Surgical resection was more common in children compared with adults (74% vs 62%, P < 0.001), children also had more lymph nodes examined (39% vs 19%, P < 0.001), positive lymph nodes (35% vs 17%, P = 0.02), and surgical resection when metastasis were present at diagnosis (46% vs 18%, P < 0.001). The 1, 3, and 5-year overall survival was higher for pediatric patients than adults (81%, 65%, 55%, vs 70%, 54%, 48%,) Despite higher prevalence of fibrolamellar histology, greater number of positive lymph nodes, and comparable rates of metastasis at diagnosis, children with HCC have improved overall survival compared with adults. Age did not significantly contribute to survivorship, so it is likely that the more aggressive surgical approach contributed to the improved overall survival in pediatric patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Marcelo Cerullo
- Department of General Surgery, Duke University Medical Center
| | - Neha Arjunji
- School of Medicine, Duke University Medical Center
| | - Harold J Leraas
- Division of Pediatric Surgery, Duke University Medical Center
| | | | - Kadiyala Ravindra
- Division of Abdominal Transplantation, Duke University Medical Center
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Biolato M, Galasso T, Marrone G, Miele L, Grieco A. Upper Limits of Downstaging for Hepatocellular Carcinoma in Liver Transplantation. Cancers (Basel) 2021; 13:cancers13246337. [PMID: 34944957 PMCID: PMC8699392 DOI: 10.3390/cancers13246337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Currently, most transplant centres worldwide accept patients with hepatocellular carcinoma who underwent successful downstaging. Concurrently, the effectiveness of radiological and systemic therapies used for the downstaging of hepatocellular carcinoma are increasing. It is now more frequently observed that candidates for liver transplantation have an excellent response to downstaging, even if the baseline stage was well beyond the transplantable tumour. Downstaged patients have a higher risk of dropout from the waiting list and post-transplant recurrence if not transplanted in a short time. Since an increasing number of downstaged patients affects the waitlist dynamics, the definition of upper limits of downstaging is becoming a crucial issue. In this narrative review, we summarise current evidence on the downstaging of hepatocellular carcinoma for liver transplantation, including downstaging of patients with macrovascular invasion or extrahepatic metastasis at presentation and employment of the new systemic treatments for hepatocellular carcinoma. Abstract In Europe and the United States, approximately 1100 and 1800 liver transplantations, respectively, are performed every year for hepatocellular carcinoma (HCC), compared with an annual incidence of 65,000 and 39,000 new cases, respectively. Because of organ shortages, proper patient selection is crucial, especially for those exceeding the Milan criteria. Downstaging is the reduction of the HCC burden to meet the eligibility criteria for liver transplantation. Many techniques can be used in downstaging, including ablation, chemoembolisation, radioembolisation and systemic treatments, with a reported success rate of 60–70%. In recent years, an increasing number of patient responders to downstaging procedures has been included in the waitlist, generally with a comparable five-year post-transplant survival but with a higher probability of dropout than HCC patients within the Milan criteria. While the Milan criteria are generally accepted as the endpoint of downstaging, the upper limits of tumour burden for downstaging HCC for liver transplantation are controversial. Very challenging situations involve HCC patients with large nodules, macrovascular invasion or even extrahepatic metastasis at baseline who respond to increasingly more effective downstaging procedures and who aspire to be placed on the waitlist for transplantation. This narrative review analyses the most important evidence available on cohorts subjected to “extended” downstaging, including HCC patients over the up-to-seven criteria and over the University of California San Francisco downstaging criteria. We also address surrogate markers of biological aggressiveness, such as alpha-fetoprotein and the response stability to locoregional treatments, which are very useful in selecting responders to downstaging procedures for waitlisting inclusion.
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Affiliation(s)
- Marco Biolato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (M.B.); (G.M.); (L.M.)
- Institute of Internal Medicine, Catholic University of Sacred Hearth, 00168 Rome, Italy;
| | - Tiziano Galasso
- Institute of Internal Medicine, Catholic University of Sacred Hearth, 00168 Rome, Italy;
| | - Giuseppe Marrone
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (M.B.); (G.M.); (L.M.)
- Institute of Internal Medicine, Catholic University of Sacred Hearth, 00168 Rome, Italy;
| | - Luca Miele
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (M.B.); (G.M.); (L.M.)
- Institute of Internal Medicine, Catholic University of Sacred Hearth, 00168 Rome, Italy;
| | - Antonio Grieco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (M.B.); (G.M.); (L.M.)
- Institute of Internal Medicine, Catholic University of Sacred Hearth, 00168 Rome, Italy;
- Correspondence:
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Pancreaticoduodenectomy for hepatic portal lymph node metastasis after hepatic resection for hepatocellular carcinoma: A clinical case report. Int J Surg Case Rep 2021; 82:105921. [PMID: 33964712 PMCID: PMC8121700 DOI: 10.1016/j.ijscr.2021.105921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction In 2018, Hepatocellular carcinoma (HCC) was predicted to be the sixth most commonly diagnosed cancer. Extra-hepatic metastasis due to HCC is a poor prognostic factor, depending on the stage of the disease. Presentation of case We report a case of a 52-years old male who had undergone Segment 5 (S5) hepatectomy for HCC of 4.7 × 2 cm. Transcatheter arterial chemoembolization (TACE) four times postoperatively was performed based on a preoperative diagnosis of a recurrent tumour at the S1. After 2 years, the solitary tumour (7.5 × 2.5 × 3.5 cm) is located behind the right lobe of the liver and the head of the pancreas. The tumour was abnormally supplied with blood from the superior mesenteric artery (SMA) and the gastroduodenal artery (GDA). The patient was underwent pancreaticoduodenectomy (PD) to remove a large tumour. Postoperative pathology and immunohistochemical staining showed metastatic HCC. There was no tumour recurrence after 6 months. Discussion The organs in the body that liver cancer cells most often spread to are the lungs (44%), the portal vein (35%), the hepatobiliary ganglion (27%), and a small number of cases of bone, eye socket, bronchus metastases. Otherwise, recurrence of lymph nodes (LNs) after hepatectomy for HCC is very rare. Conclusions HCC can metastasize to the hepatic pedicle LN after hepatectomy and maybe confused with recurrent liver tumours in the S1. Indications for PD are feasible for solitary metastatic at peri-pancreas. Pathology incorporating immunohistochemistry can determine the origin of metastases. Recurrence of lymph nodes after hepatectomy due to HCC is very rare at only approximately 1% to 2.5%. HCC can metastasize to the hepatic pedicle lymph node after hepatectomy and is easily confused with recurrent liver tumours in the S1 Indications for pancreaticoduodenectomy are feasible for solitary metastatic at peri-pancreas
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Kurita D, Mokuno Y, Matsubara H, Kaneko H, Shamoto M, Satou A, Iyomasa S. Primary hepatic carcinosarcoma with multimodal treatment. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:423-429. [PMID: 30214092 PMCID: PMC6125652 DOI: 10.18999/nagjms.80.3.423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Hepatic carcinosarcoma (HCS) generally presents in advanced stages, demonstrates aggressive behavior, and has a poor prognosis. Other than curative primary resection, no effective treatment options exist. We present a case of resected HCS with four repeat resections for solitary lymph node recurrence followed by chemoradiotherapy with doxorubicin and ifosfamide. A 67-year-old Japanese man was admitted to our hospital for evaluation of an asymptomatic hepatic tumor. The patient underwent right hepatectomy with a presumptive preoperative diagnosis of atypical hepatocellular carcinoma. Based on histopathological and immunohistochemical findings, the tumor was diagnosed as HCS containing osteosarcoma and chondrosarcoma components. After the initial surgery, the patient underwent four additional resections for solitary lymph node HCS recurrence, and then underwent chemoradiotherapy with doxorubicin and ifosfamide for an unresectable lymph node recurrence. Chemotherapy was stopped after two cycles because of severe adverse events, although chemoradiotherapy markedly reduced the size of the lymph node recurrence and provided a progression-free survival of 12 months. Thirty-seven months after the initial surgery, the patient died of cardiac invasion of multiple mediastinal lymph node metastases. The clinical course outlined in this case report suggests that chemoradiotherapy with doxorubicin and ifosfamide for metastatic HCS may prolong survival in patients with unresectable lesions.
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Affiliation(s)
- Daisuke Kurita
- Department of Surgery, Yachiyo Hospital, Anjo-shi, Japan
| | - Yasuji Mokuno
- Department of Surgery, Yachiyo Hospital, Anjo-shi, Japan
| | | | | | | | - Akira Satou
- Department of surgical pathology, Aichi Medical University, Nagakute-shi, Japan
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Surgical Resection of Metachronous Lymph Node Metastasis From Hepatocellular Carcinoma: Three Case Reports and Review of the Literature. Int Surg 2017. [DOI: 10.9738/intsurg-d-15-00114.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The prognosis for hepatocellular carcinoma (HCC) patients with lymph node (LN) metastasis is generally poor, and no consensus has yet been reached on the optimum treatment strategy. We observed 3 cases involving patients with HCC and associated metachronous LN metastasis, who benefited from surgical resection of the metastatic LNs. Each of the 3 patients had solitary LN metastasis for which selective LN resection was performed, and all had C-type cirrhosis as a background disease. There were no other uncontrolled lesions at the time of LN resection. However, additional treatments were required in cases 1 and 3 to control intrahepatic lesions that recurred following the lymphadenectomy. The overall survival in cases 1 and 3 has been >5 years, with case 1 still under observation. Case 2 also remains under follow-up at 6 months after surgery. Surgical resection could be a beneficial strategy for treatment of metachronous LN metastasis arising from HCC in some cases, particularly those involving a solitary LN metastasis with no other uncontrolled lesions.
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Aisu Y, Furuyama H, Hori T, Machimoto T, Hata T, Kadokawa Y, Kato S, Ando Y, Uchida Y, Yasukawa D, Kimura Y, Sasaki M, Takamatsu Y, Yoshimura T. Solitary Metastasis to a Distant Lymph Node in the Descending Mesocolon After Primary Resection for Hepatocellular Carcinoma: Is Surgical Resection Valid? AMERICAN JOURNAL OF CASE REPORTS 2016; 17:909-915. [PMID: 27904130 PMCID: PMC5135475 DOI: 10.12659/ajcr.900813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Patient: Female, 65 Final Diagnosis: Mesocolic lymph node metastasis of Hetpatocellular carcinoma Symptoms: None Medication: — Clinical Procedure: Partial resection of descending colon including metastatic lymph node Specialty: Surgery
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Affiliation(s)
- Yuki Aisu
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Hiroaki Furuyama
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Tomohide Hori
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Takafumi Machimoto
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Toshiyuki Hata
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Shigeru Kato
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Yasuhisa Ando
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Yuichiro Uchida
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Daiki Yasukawa
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Yusuke Kimura
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Maho Sasaki
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Yuichiro Takamatsu
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Tunehiro Yoshimura
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
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Caparelli ML, Roberts NJ, Braverman TS, Stevens RM, Broun ER, Allamaneni S. Metastatic recurrence to a solitary lymph node four years after hepatic lobectomy for primary hepatocellular carcinoma. World J Hepatol 2016; 8:994-998. [PMID: 27621765 PMCID: PMC4990763 DOI: 10.4254/wjh.v8.i23.994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/09/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023] Open
Abstract
This report describes a patient that developed recurrent metastatic hepatocellular carcinoma (HCC) to a suprapancreatic lymph node four years after being treated for primary HCC via complete left hepatectomy. Metastatic HCC was proven by pathologic confirmation. The report addresses the role of surgical resection as a treatment modality for recurrent HCC to solitary lymph nodes. The role of biological chemotherapy as adjuvant treatment is also addressed.
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Xu L, Xue F, Wang B, Yan D, Ding W, Yin J, Yi C, Wang W. Hoarseness due to lymph node metastasis of hepatocellular carcinoma: A case report. Oncol Lett 2016; 12:918-920. [PMID: 27446370 PMCID: PMC4950166 DOI: 10.3892/ol.2016.4687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/13/2016] [Indexed: 12/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) metastases in the mediastinum are rare, particularly under the arch of the aorta. The present study describes the case of a 30-year-old male patient who presented with back pain and hoarseness for 2 months due to lymph node metastasis of HCC. The patient had undergone right hepatic lobectomy for HCC 2 years prior and received transarterial chemoembolization 4 times following resection. A computed tomography scan revealed enlarged lymph nodes under the arch of the aorta that appeared to have invaded the left recurrent laryngeal nerve, causing the hoarseness. Percutaneous aspiration biopsy of the enlarged, right supraclavicular lymph node identified malignant cells consistent with HCC. Radiation administered as a therapy to treat for the metastatic lymph nodes did not diminish the tumor but relieved the symptoms.
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Affiliation(s)
- Lin Xu
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - Feng Xue
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - Boqing Wang
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - Dong Yan
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - Wei Ding
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - Jiwei Yin
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - Chao Yi
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - Wei Wang
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
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Hepatectomy Versus Hepatectomy With Lymphadenectomy in Hepatocellular Carcinoma: A Prospective, Randomized Controlled Clinical Trial. J Clin Gastroenterol 2015; 49:520-8. [PMID: 25564411 DOI: 10.1097/mcg.0000000000000277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
GOALS AND BACKGROUND The role of preventive lymphadenectomy has not yet been determined for hepatocellular carcinoma (HCC) patients. We designed a study to evaluate the effect of hepatectomy combined with preventive lymphadenectomy on HCC patients. STUDY Patients were randomly divided into group A (treated with hepatectomy alone) and group B (underwent hepatectomy combined with lymphadenectomy). The postoperative complications and oncologic prognoses were analyzed. RESULTS Of the 85 patients enrolled into this study, 79 cases (38 in group A and 41 in group B) were pathologically confirmed to have HCC and received curative resection. One hundred and sixteen lymph nodes were dissected and evaluated as negative by the pathologist. The 12-, 36-, and 60-month disease-free survival rates of group A were 81.6%, 68.4%, and 63.2%, respectively, whereas they were 78.0%, 65.9%, and 63.4%, respectively, for group B. The 12-, 36-, and 60-month overall survival rates in group A were 94.7%, 78.9%, and 65.8%, respectively, whereas they were 87.8%, 78.0%, and 70.7%, respectively, in group B. The differences in the disease-free survival and overall survival between the 2 groups were not statistically significant according to the log-rank test (P=0.811 and P=0.881, respectively). The difference in the surgical complication rate between groups A and B was not statistically significant (47.4% vs. 36.6%, P=0.332). CONCLUSIONS Although hepatectomy combined with regional lymphadenectomy is a safe procedure, preventive lymphadenectomy may not decrease the rate of tumor recurrence nor improve the prognosis in early-stage HCC patients.
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