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Abstract
BACKGROUND Hepatocellular carcinoma is an aggressive disease in Asia and Africa with poor prognosis partially due to lack of disease-specific biomarkers. OBJECTIVES The aim of this study was to assess the concentrations of different cytokines and chemokines in peripheral blood of patients with hepatocellular carcinoma and identify the potential biomarkers that would help in clinical assessment. METHODS Profiling of 14 cytokines, chemokines and growth factors was performed in peripheral blood of 78 patients and 78 healthy controls using Bio-Plex Human 15-plex assay kit. RESULTS The results showed that patients had significantly higher levels of IL-1β (p=0.034), IL-6 (p=2.13e-06), IL-10 (p=0.013), IL-17A (p=0.017), IL-22 (p=0.00276), IL-25 (p=0.0005), but lower levels of IL-4 (p=0.00341) and IL-33 (p=0.00982) in peripheral blood. CONCLUSION We identified a unique eight-peripheral blood cytokines signature for hepatocellular carcinoma detection. This work will serve as the basis for further studies about the clinical value of peripheral blood cytokines in forecasting prognosis.
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Affiliation(s)
- Jing Shen
- Medical Scientific Research Center of Guangxi Medical University, Nanning, 530022, Guangxi, China
| | - Hua Wu
- Medical Scientific Research Center of Guangxi Medical University, Nanning, 530022, Guangxi, China
| | - Ning Peng
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, 530022, Guangxi Province, China
| | - Jie Cai
- Medical Scientific Research Center of Guangxi Medical University, Nanning, 530022, Guangxi, China
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2
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Kielar A, Fowler KJ, Lewis S, Yaghmai V, Miller FH, Yarmohammadi H, Kim C, Chernyak V, Yokoo T, Meyer J, Newton I, Do RK. Locoregional therapies for hepatocellular carcinoma and the new LI-RADS treatment response algorithm. Abdom Radiol (NY) 2018; 43:218-230. [PMID: 28780679 DOI: 10.1007/s00261-017-1281-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Radiologists play a central role in the assessment of patient response to locoregional therapies for hepatocellular carcinoma (HCC). The identification of viable tumor following treatment guides further management and potentially affects transplantation eligibility. Liver Imaging Reporting and Data Systems (LI-RADS) first introduced the concept of LR-treated in 2014, and a new treatment response algorithm is included in the 2017 update to assist radiologists in image interpretation of HCC after locoregional therapy. In addition to offering imaging criteria for viable and nonviable HCC, new concepts of nonevaluable tumors as well as tumors with equivocal viability are introduced. Existing guidelines provided by response evaluation criteria in solid tumors (RECIST) and modified RECIST address patient-level assessments and are routinely used in clinical trials but do not address the variable appearances following different locoregional therapies. The new LI-RADS treatment response algorithm addresses this gap and offers a comprehensive approach to assess treatment response for individual lesions after a variety of locoregional therapies, using either contrast-enhanced CT or MRI.
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Affiliation(s)
- Ania Kielar
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Kathryn J Fowler
- Department of Radiology, Washington University, St. Louis, MO, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vahid Yaghmai
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Hooman Yarmohammadi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles Kim
- Department of Radiology, Duke University, Durham, NC, USA
| | - Victoria Chernyak
- Department of Radiology, Montefiore Medical Center, New York, NY, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Isabel Newton
- Department of Radiology, UC San Diego, San Diego, CA, USA
| | - Richard K Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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3
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Salman A, Simoneau E, Hassanain M, Chaudhury P, Boucher LM, Valenti D, Cabrera T, Nudo C, Metrakos P. Combined sorafenib and yttrium-90 radioembolization for the treatment of advanced hepatocellular carcinoma. ACTA ACUST UNITED AC 2016; 23:e472-e480. [PMID: 27803608 DOI: 10.3747/co.23.2827] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS In this pilot study, we assessed the safety and tolerability of combining sorafenib with 90Y radioembolization for the treatment of unresectable hepatocellular carcinoma (hcc). METHODS The study, conducted prospectively during 2009-2012, included eligible patients with unresectable hcc and a life expectancy of at least 12 weeks. Each patient received sorafenib (400 mg twice daily) for 6-8 weeks before 90Y treatment. Safety and tolerability were assessed. RESULTS Of the 40 patients enrolled, 29 completed treatment (combined therapy). In the initial cohort, the most common cause of hcc was hepatitis C (32.5%), and most patients were staged Child A (82.5%). The 29 patients who completed the study had similar baseline characteristics. Grades 1 and 2 toxicities accounted for 77.8% of all adverse events reported. The most common toxicities reported were fatigue (19.0%), alteration in liver function (7.9%), and diarrhea (6.3%). There were 12 grade 3 and 2 grade 4 toxicity events reported. One patient died of liver failure within 30 days after treatment. During the study, the sorafenib dose was reduced in 6 patients (20.7%), and sorafenib had to be interrupted in 4 patients (13.8%) and discontinued in 4 patients (13.8%). The disease control rate was 72.4% per the modified Response Evaluation Criteria in Solid Tumors, and tumour necrosis was observed in 82.8% of patients. Overall survival in patients undergoing combined therapy was 12.4 months. CONCLUSIONS Preliminary results demonstrate the safety and tolerability of combining 90Y radioembolization and sorafenib for advanced hcc. A larger prospective study is needed to determine the extent of the survival benefit.
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Affiliation(s)
- A Salman
- Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, McGill University, Montreal, QC
| | - E Simoneau
- Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, McGill University, Montreal, QC
| | - M Hassanain
- Department of Oncology, McGill University, Montreal, QC; Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - P Chaudhury
- Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, McGill University, Montreal, QC; Department of Oncology, McGill University, Montreal, QC
| | - L M Boucher
- Department of Radiology, Division of Interventional Radiology, McGill University, Montreal, QC
| | - D Valenti
- Department of Radiology, Division of Interventional Radiology, McGill University, Montreal, QC
| | - T Cabrera
- Department of Radiology, Division of Interventional Radiology, McGill University, Montreal, QC
| | - C Nudo
- Department of Medicine, Division of Hepatology, McGill University, Montreal, QC
| | - P Metrakos
- Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, McGill University, Montreal, QC; Department of Oncology, McGill University, Montreal, QC
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4
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Lorenzin D, Pravisani R, Leo CA, Bugiantella W, Soardo G, Carnelutti A, Umberto B, Risaliti A. Complete Remission of Unresectable Hepatocellular Carcinoma After Combined Sorafenib and Adjuvant Yttrium-90 Radioembolization. Cancer Biother Radiopharm 2016; 31:65-9. [DOI: 10.1089/cbr.2015.1905] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Dario Lorenzin
- General Surgery and Transplantation Unit, University Hospital “S. Maria della Misericordia,” Udine, Italy
| | - Riccardo Pravisani
- General Surgery and Transplantation Unit, University Hospital “S. Maria della Misericordia,” Udine, Italy
| | - Cosimo Alex Leo
- General Surgery and Transplantation Unit, University Hospital “S. Maria della Misericordia,” Udine, Italy
| | - Walter Bugiantella
- General Surgery, AUSL Umbria 2, Italy
- School of Biotechnologies, University of Perugia, Italy
| | - Giorgio Soardo
- General Surgery and Transplantation Unit, University Hospital “S. Maria della Misericordia,” Udine, Italy
| | - Alessia Carnelutti
- General Surgery and Transplantation Unit, University Hospital “S. Maria della Misericordia,” Udine, Italy
| | - Baccarani Umberto
- General Surgery and Transplantation Unit, University Hospital “S. Maria della Misericordia,” Udine, Italy
| | - Andrea Risaliti
- General Surgery and Transplantation Unit, University Hospital “S. Maria della Misericordia,” Udine, Italy
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5
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Abstract
The feasibility of disrupting a tumor’s vascular structure using 210Po microspheres is investigated using standard ion and photon absorbed dose methodologies. Calculated absorbed dose profiles for 210Po alpha particles are sufficient to disrupt a tumor’s arteriole structure while minimizing the dose outside the blood vessel wall. 210Po photons contribute minimal dose to healthy tissue. The requisite activity of 210Po to facilitate vascular disruption is calculated.
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6
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Tan-Shalaby JL. Reproducible complete remission of advanced hepatocellular carcinoma with sorafenib in combination with clopidogrel. BMJ Case Rep 2014; 2014:bcr-2014-203962. [PMID: 25178887 DOI: 10.1136/bcr-2014-203962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We present a 57-year-old Caucasian man with hepatocellular carcinoma (HCC) twice achieving complete remission with reduced dose sorafenib. His initial diagnosis of HCC rapidly improved with sorafenib and he achieved a complete biochemical and radiographic response within 7 months. Remission lasted only 5 months but we noted that the timing of his relapse was immediately after he incidentally discontinued clopidogrel. It was restarted and within 5 months of restarting clopidogrel he once again achieved complete remission. The course of his remission was followed and temporal association of sorafenib remission with use of clopidogrel was observed.
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Affiliation(s)
- Jocelyn L Tan-Shalaby
- Section of Hematology Oncology, Veteran Affairs Medical Center, Pittsburgh, Pennsylvania, USA
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Molla N, AlMenieir N, Simoneau E, Aljiffry M, Valenti D, Metrakos P, Boucher LM, Hassanain M. The role of interventional radiology in the management of hepatocellular carcinoma. ACTA ACUST UNITED AC 2014; 21:e480-92. [PMID: 24940108 DOI: 10.3747/co.21.1829] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (hcc) is one of the most common causes of cancer-related death worldwide. Overall, liver transplantation and resection are the only available treatments with potential for cure. Various locoregional therapies are widely used to manage patients with advanced hcc or as a bridging therapy for patients with early and intermediate disease. This article reviews and evaluates the role of interventional radiology in the management of such cases by assessing various aspects of each method, such as effect on rates of survival, recurrence, tumour response, and complications. METHODS A systemic search of PubMed, medline, Ovid Medline In-Process, and the Cochrane Database of Systematic Reviews retrieved all related scientific papers for review. RESULTS Needle core biopsy is a highly sensitive, specific, and accurate method for hcc grading. Portal-vein embolization provides adequate expansion of the future liver remnant, making more patients eligible for resection. In focal or multifocal unresectable early-stage disease, radiofrequency ablation tops all other thermoablative methods. However, microwave ablation is preferred in large tumours and in patients with Child-Pugh B disease. Cryoablation is preferred in recurrent disease and in patients who are poor candidates for anesthesia. Of the various transarterial modalities-transarterial chemoembolization (tace), drug-eluting beads, and transarterial radio-embolization (tare)-tace is the method of choice in Child-Pugh A disease, and tare is the method of choice in hcc cases with portal vein thrombosis. CONCLUSIONS The existing data support the importance of a multidisciplinary approach in hcc management. Large randomized controlled studies are needed to provide clear indication guidelines for each method.
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Affiliation(s)
- N Molla
- Department of Radiology, King Saud University, Riyadh, Saudi Arabia. ; Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - N AlMenieir
- Department of Radiology, King Saud University, Riyadh, Saudi Arabia
| | - E Simoneau
- Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - M Aljiffry
- Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - D Valenti
- Department of Radiology, McGill University Health Centre, Montreal, QC
| | - P Metrakos
- Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC. ; Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - L M Boucher
- Department of Radiology, McGill University Health Centre, Montreal, QC
| | - M Hassanain
- Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC. ; Department of Surgery, King Saud University, Riyadh, Saudi Arabia
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8
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Abstract
The feasibility of disrupting a tumor's vascular structure with various radiation types and radionuclides is investigated. Calculated absorbed dose profiles for photons and (4)He ions suggest that low-energy beta-gamma and alpha emitting radionuclides can deposit sufficient absorbed dose to disrupt a tumor's vascular structure while minimizing the dose outside the blood vessel. Candidate radionuclides uniformly distributed in microspheres are theoretically investigated with respect to their vascular disruption potential and to offer an alternative to (90)Y microsphere therapy. Requisite activities of candidate low-energy beta-gamma and alpha emitting radionuclides to facilitate vascular disruption are calculated.
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9
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Brochard C, Hamy A, Michalak S, Aubé C, Picquet J, Nebout N, Caroli-Bosc FX, Oberti F, Calès P, Boursier J. Metastatic hepatocellular carcinoma: when surgery and successive palliative treatments lead to remission. Clin Res Hepatol Gastroenterol 2014; 38:e19-22. [PMID: 23608740 DOI: 10.1016/j.clinre.2013.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 02/04/2013] [Accepted: 02/19/2013] [Indexed: 02/04/2023]
Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of death by cancer worldwide. The prognosis of patients with metastatic HCC remains limited, with an expected median survival lower than 50% at 1 year. Here, we report the case of a 63-year-old man who suffered from a small HCC in the liver and a large unique metastasis in the right adrenal gland. A surgical resection of both lesions was performed. Seven months later, HCC recurred with an isolated right renal metastatic lymphadenopathy and a high alpha-fetoprotein level. HCC was brought under control by sorafenib; the alpha-fetoprotein level was greatly reduced but remained moderately elevated and stable over 2 years after the onset of chemotherapy. Additional external radiotherapy on the metastatic lymphadenopathy led to a normalization of the alpha-fetoprotein level and discontinuation of sorafenib treatment. One year after the end of radiotherapy, a second isolated metastasis occurred in the right lung. This tumor was surgically removed. Twenty-one months after this second surgical procedure, i.e., more than 5.5 years after the initial diagnosis of metastatic HCC, the patient was asymptomatic and tumor free.
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Affiliation(s)
- Charlène Brochard
- Department of Hepato-Gastroenterology, University Hospital, Angers, France
| | - Antoine Hamy
- Department of Visceral Surgery, University Hospital, Angers, France
| | - Sophie Michalak
- Department of Pathology, University Hospital, Angers, France
| | - Christophe Aubé
- Department of Radiology, University Hospital, Angers, France
| | - Jean Picquet
- Department of Vascular and Thoracic Surgery, University Hospital, Angers, France
| | - Nathalie Nebout
- Department of Radiotherapy, Centre Paul-Papin, Angers, France
| | | | - Frédéric Oberti
- Department of Hepato-Gastroenterology, University Hospital, Angers, France
| | - Paul Calès
- Department of Hepato-Gastroenterology, University Hospital, Angers, France
| | - Jérôme Boursier
- Department of Hepato-Gastroenterology, University Hospital, Angers, France.
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Matsuda Y, Ichida T, Fukumoto M. Hepatocellular carcinoma and liver transplantation: clinical perspective on molecular targeted strategies. Med Mol Morphol 2011; 44:117-24. [PMID: 21922382 DOI: 10.1007/s00795-011-0547-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 04/20/2011] [Indexed: 12/11/2022]
Abstract
Hepatocellular carcinoma (HCC) has an aggressive clinical course with frequent recurrence and metastasis. Orthotopic liver transplantation has been the only curative tool for unresectable HCC; therefore, recent advances in molecular targeted therapy may improve the prognosis of HCC. The multiple kinase inhibitor sorafenib and the macrolide antibiotic rapamycin are currently the most promising agents for treating unresectable HCC. A large population-based clinical trial revealed that sorafenib significantly prolonged the overall survival of HCC patients. However, subsequent clinical studies showed that sorafenib rarely reduced tumor volume and inadequately prolonged survival of patients with severe liver damage. To improve its therapeutic effect, the development of a predictive biomarker and a sorafenib-based combination is awaited. Another molecular targeting agent, rapamycin, has now been considered as a putative agent for preventing tumor recurrence in post-liver transplantation HCC patients, because it not only has immunosuppressive activity but also exerts an anti-tumor effect. In the near future, a combination of molecular targeting agents, such as sorafenib and rapamycin, may become a standard protocol for treating unresectable HCC. For specifying cases with more effective and less harmful modalities, further investigation in clinical and basic research to identify unexpected effects are needed.
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Affiliation(s)
- Yasunobu Matsuda
- Department of Medical Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-dori, Niigata 951-8518, Japan.
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