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Nicolosi A, Gaia S, Risso A, Rosso C, Rolle E, Abate ML, Olivero A, Armandi A, Ribaldone DG, Carucci P, Fagoonee S, Pellicano R, Saracco GM, Bugianesi E, Caviglia GP. Serum glypican-3 for the prediction of survival in patients with hepatocellular carcinoma. Minerva Gastroenterol (Torino) 2022; 68:378-386. [PMID: 36222678 DOI: 10.23736/s2724-5985.21.03006-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Glypican-3 (GPC-3) is a heparan sulfate proteoglycan overexpressed by hepatocellular carcinoma (HCC) cells. Several studies highlighted the diagnostic and prognostic value of GPC-3 expression in liver tissue, while data on the reliability of serum GPC-3 are limited and conflicting. We aimed to evaluate the prognostic value of serum GPC-3 in patients with HCC. METHODS A total of 449 patients (91 F and 358 M; median age 65 [38-86] years) with a new diagnosis of HCC and available serum samples collected at tumor diagnosis were retrospectively analyzed. All patients had cirrhosis and the main underlying etiology was viral (N.=323, 72%). Barcelona Clinic Liver Cancer (BCLC) staging system was adopted for patients' classification (BCLC 0/A, N.=293, 65% vs. B/C/D, N.=156, 35%) and treatment allocation. Response to therapy was assessed by modified Response Evaluation Criteria in Solid Tumors (mRECIST). RESULTS Median overall survival (OS) after HCC diagnosis was 30 months (95% confidence interval [CI]: 27-34). Patients with serum GPC-3>150 pg/mL showed lower overall survival (16; 95%CI: 13-24 months) compared to those with GPC-3≤150 pg/mL (36; 95%CI: 30-56 months) (Log-rank test, P<0.001). At multivariate Cox proportional-hazard regression analysis, presence of ascites (adjusted Hazard Ratio [aHR]=1.84; 95%CI: 1.23-2.74, P=0.003), BCLC stage (aHR=1.65; 95%CI: 1.39-1.97, P<0.001), mRECIST (aHR=0.33; 95%CI: 0.21-0.51, P<0.001) and GPC-3>150 pg/mL (aHR=2.02; 95%CI: 1.47-2.78, P<0.001) resulted significantly associated to overall survival. CONCLUSIONS Serum GPC-3 resulted an independent prognostic factor for patients with HCC irrespectively from tumor stage and response to therapy.
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Affiliation(s)
- Aurora Nicolosi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Silvia Gaia
- Division of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Alessandra Risso
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Rosso
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Emanuela Rolle
- Division of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Maria L Abate
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Angelo Armandi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Davide G Ribaldone
- Department of Medical Sciences, University of Turin, Turin, Italy.,Division of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Patrizia Carucci
- Division of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, Turin, Italy
| | - Rinaldo Pellicano
- Division of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giorgio M Saracco
- Department of Medical Sciences, University of Turin, Turin, Italy.,Division of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Elisabetta Bugianesi
- Department of Medical Sciences, University of Turin, Turin, Italy.,Division of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Gian P Caviglia
- Department of Medical Sciences, University of Turin, Turin, Italy -
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Rognoni C, Barcellona MR, Bargellini I, Bavetta MG, Bellò M, Brunetto M, Carucci P, Cioni R, Crocetti L, D’Amato F, D’Amico M, Deagostini S, Deandreis D, De Simone P, Doriguzzi A, Finessi M, Fonio P, Grimaldi S, Ialuna S, Lagattuta F, Masi G, Moreci A, Scalisi D, Virdone R, Tarricone R. Cost-effectiveness analysis of personalised versus standard dosimetry for selective internal radiation therapy with TheraSphere in patients with hepatocellular carcinoma. Front Oncol 2022; 12:920073. [PMID: 36106105 PMCID: PMC9464985 DOI: 10.3389/fonc.2022.920073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022] Open
Abstract
Aims To perform a cost-effectiveness analysis (CEA) comparing personalised dosimetry with standard dosimetry in the context of selective internal radiation therapy (SIRT) with TheraSphere for the management of adult patients with locally advanced hepatocellular carcinoma (HCC) from the Italian Healthcare Service perspective. Materials and methods A partition survival model was developed to project costs and the quality-adjusted life years (QALYs) over a lifetime horizon. Clinical inputs were retrieved from a published randomised controlled trial. Health resource utilisation inputs were extracted from the questionnaires administered to clinicians in three oncology centres in Italy, respectively. Cost parameters were based on Italian official tariffs. Results Over a lifetime horizon, the model estimated the average QALYs of 1.292 and 0.578, respectively, for patients undergoing personalised and standard dosimetry approaches. The estimated mean costs per patient were €23,487 and €19,877, respectively. The incremental cost-utility ratio (ICUR) of personalised versus standard dosimetry approaches was €5,056/QALY. Conclusions Personalised dosimetry may be considered a cost-effective option compared to standard dosimetry for patients undergoing SIRT for HCC in Italy. These findings provide evidence for clinicians and payers on the value of personalised dosimetry as a treatment option for patients with HCC.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
- *Correspondence: Carla Rognoni,
| | | | | | | | - Marilena Bellò
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | | | - Patrizia Carucci
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Roberto Cioni
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Fabio D’Amato
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Mario D’Amico
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Simona Deagostini
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Désirée Deandreis
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | | | - Andrea Doriguzzi
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Monica Finessi
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Paolo Fonio
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Serena Grimaldi
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Salvatore Ialuna
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Fabio Lagattuta
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Gianluca Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Antonio Moreci
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Daniele Scalisi
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Roberto Virdone
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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3
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Caviglia GP, Nicolosi A, Abate ML, Carucci P, Rosso C, Rolle E, Armandi A, Aneli S, Olivero A, Risso A, Ribaldone DG, Fermer C, Saracco GM, Gaia S, Bugianesi E. Liver Cancer-Specific Isoform of Serine Protease Inhibitor Kazal for the Detection of Hepatocellular Carcinoma: Results from a Pilot Study in Patients with Dysmetabolic Liver Disease. Curr Oncol 2022; 29:5457-5465. [PMID: 36005169 PMCID: PMC9406939 DOI: 10.3390/curroncol29080431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/10/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
Reliable non-invasive biomarkers for the surveillance of patients at risk of hepatocellular carcinoma (HCC) development represent an unmet medical need. Recently, the liver-cancer-specific isoform of serine protease inhibitor Kazal (LC-SPIK) has been proposed as a valuable biomarker for the detection of HCC in patients with chronic liver disease of viral etiology. In the present study, we assessed the diagnostic accuracy of LC-SPIK, alone or in combination with standard serologic biomarkers (i.e., alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II, PIVKA-II), for the detection of HCC among patients with dysmetabolic liver disease. A total of 120 patients with non-alcoholic fatty liver disease (NAFLD), including 62 patients with a diagnosis of HCC and 58 with cirrhosis but without tumor, were retrospectively analyzed. The serum levels of LC-SPIK were measured by enzyme-linked immunosorbent assay (ImCare Biotech, Doylestown, PA). The serum LC-SPIK values were significantly different between patients with HCC (24.3, 17.6−39.8 ng/mL) and those with cirrhosis but without tumor (11.7, 8.7−18.2 ng/mL) (p < 0.001). By receiver operating characteristic curve analysis, we observed an area under the curve (AUC) of 0.841 for the detection of HCC; the combination with PIVKA-II further increased the accuracy to AUC = 0.926 (cross-validation). The promising results observed in the present pilot study foster additional research to investigate the usefulness of LC-SPIK for the stratification of the risk of HCC development in patients with NAFLD and advanced liver disease.
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Affiliation(s)
- Gian Paolo Caviglia
- Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.N.); (M.L.A.); (C.R.); (A.A.); (A.O.); (D.G.R.); (G.M.S.); (E.B.)
- Correspondence: ; Tel.: +39-11-633-3922
| | - Aurora Nicolosi
- Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.N.); (M.L.A.); (C.R.); (A.A.); (A.O.); (D.G.R.); (G.M.S.); (E.B.)
| | - Maria Lorena Abate
- Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.N.); (M.L.A.); (C.R.); (A.A.); (A.O.); (D.G.R.); (G.M.S.); (E.B.)
| | - Patrizia Carucci
- Gastroenterology Unit, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.C.); (E.R.); (A.R.); (S.G.)
| | - Chiara Rosso
- Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.N.); (M.L.A.); (C.R.); (A.A.); (A.O.); (D.G.R.); (G.M.S.); (E.B.)
| | - Emanuela Rolle
- Gastroenterology Unit, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.C.); (E.R.); (A.R.); (S.G.)
| | - Angelo Armandi
- Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.N.); (M.L.A.); (C.R.); (A.A.); (A.O.); (D.G.R.); (G.M.S.); (E.B.)
| | - Serena Aneli
- Department of Sciences of Public Health and Pediatrics, University of Turin, 10126 Torino, Italy;
| | - Antonella Olivero
- Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.N.); (M.L.A.); (C.R.); (A.A.); (A.O.); (D.G.R.); (G.M.S.); (E.B.)
| | - Alessandra Risso
- Gastroenterology Unit, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.C.); (E.R.); (A.R.); (S.G.)
| | - Davide Giuseppe Ribaldone
- Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.N.); (M.L.A.); (C.R.); (A.A.); (A.O.); (D.G.R.); (G.M.S.); (E.B.)
- Gastroenterology Unit, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.C.); (E.R.); (A.R.); (S.G.)
| | | | - Giorgio Maria Saracco
- Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.N.); (M.L.A.); (C.R.); (A.A.); (A.O.); (D.G.R.); (G.M.S.); (E.B.)
- Gastroenterology Unit, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.C.); (E.R.); (A.R.); (S.G.)
| | - Silvia Gaia
- Gastroenterology Unit, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.C.); (E.R.); (A.R.); (S.G.)
| | - Elisabetta Bugianesi
- Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.N.); (M.L.A.); (C.R.); (A.A.); (A.O.); (D.G.R.); (G.M.S.); (E.B.)
- Gastroenterology Unit, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.C.); (E.R.); (A.R.); (S.G.)
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Ribaldone DG, Caviglia GP, Gaia S, Rolle E, Risso A, Campion D, Brunocilla PR, Saracco GM, Carucci P. Effect of COVID-19 Pandemic on Hepatocellular Carcinoma Diagnosis: Results from a Tertiary Care Center in North-West Italy. Curr Oncol 2022; 29:1422-1429. [PMID: 35323319 PMCID: PMC8946861 DOI: 10.3390/curroncol29030119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has forced us to direct most of the available resources towards its management. This has led to the neglect of all other pathologies, including cancer. The aim of this study was to verify whether the difficulty in accessing the health system has led to a reduction in new diagnoses of hepatocellular carcinoma (HCC) and whether this has already been reflected in a more advanced stage of the cancer. A single-center, retrospective study including adult patients with a new diagnosis of HCC was performed. Patients were divided into three groups: the prelockdown phase (May 2019–February 2020), the lockdown phase (March 2020–December 2020), and the postlockdown phase (January 2021–October 2021); 247 patients were included. The number of patients diagnosed with HCC distinctly diminished in the periods March 2020–December 2020 (n = 69; −35%) and January 2021–October 2021 (n = 72; −32%) as compared to the period May 2019–February 2020 (n = 106). Noteworthy was the reduced surveillance in the period January 2021–October 2021 as compared to May 2019–February 2020 (22.9% vs. 36.6%, p = 0.056). No significant changes have yet been observed in tumor characteristics (BCLC staging distribution remained unvaried, p = 0.665). In conclusion, the number of new HCC diagnoses decreased sharply in the first 2 years of the pandemic, with no worsening of the stage. A more advanced stage of the disease could be expected in the next few years in patients who have escaped diagnosis.
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Affiliation(s)
- Davide Giuseppe Ribaldone
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (G.P.C.); (A.R.); (G.M.S.)
- Correspondence: (D.G.R.); (P.C.); Tel.: +39-11-633-3615 (D.G.R.); Fax: +39-11-633-3970 (D.G.R.)
| | - Gian Paolo Caviglia
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (G.P.C.); (A.R.); (G.M.S.)
| | - Silvia Gaia
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (S.G.); (E.R.); (D.C.); (P.R.B.)
| | - Emanuela Rolle
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (S.G.); (E.R.); (D.C.); (P.R.B.)
| | - Alessandra Risso
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (G.P.C.); (A.R.); (G.M.S.)
| | - Daniela Campion
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (S.G.); (E.R.); (D.C.); (P.R.B.)
| | - Paola Rita Brunocilla
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (S.G.); (E.R.); (D.C.); (P.R.B.)
| | - Giorgio Maria Saracco
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (G.P.C.); (A.R.); (G.M.S.)
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (S.G.); (E.R.); (D.C.); (P.R.B.)
| | - Patrizia Carucci
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (S.G.); (E.R.); (D.C.); (P.R.B.)
- Correspondence: (D.G.R.); (P.C.); Tel.: +39-11-633-3615 (D.G.R.); Fax: +39-11-633-3970 (D.G.R.)
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5
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Di Maira G, Foglia B, Napione L, Turato C, Maggiora M, Sutti S, Novo E, Alvaro M, Autelli R, Colombatto S, Bussolino F, Carucci P, Gaia S, Rosso C, Biasiolo A, Pontisso P, Bugianesi E, Albano E, Marra F, Parola M, Cannito S. Oncostatin M is overexpressed in
NASH
‐related hepatocellular carcinoma and promotes cancer cell invasiveness and angiogenesis. J Pathol 2022; 257:82-95. [PMID: 35064579 PMCID: PMC9315146 DOI: 10.1002/path.5871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/03/2021] [Accepted: 01/13/2022] [Indexed: 12/03/2022]
Abstract
Oncostatin M (OSM) is a pleiotropic cytokine of the interleukin (IL)‐6 family that contributes to the progression of chronic liver disease. Here we investigated the role of OSM in the development and progression of hepatocellular carcinoma (HCC) in non‐alcoholic fatty liver disease (NAFLD)/non‐alcoholic steatohepatitis (NASH). The role of OSM was investigated in (1) selected cohorts of NAFLD/NASH HCC patients, (2) liver cancer cells exposed to human recombinant OSM or stably transfected to overexpress human OSM, (3) murine HCC xenografts, and (4) a murine NASH‐related model of hepatic carcinogenesis. OSM was found to be selectively overexpressed in HCC cells of NAFLD/NASH patients, depending on tumor grade. OSM serum levels, barely detectable in patients with simple steatosis or NASH, were increased in patients with cirrhosis and more evident in those carrying HCC. In this latter group, OSM serum levels were significantly higher in the subjects with intermediate/advanced HCCs and correlated with poor survival. Cell culture experiments indicated that OSM upregulation in hepatic cancer cells contributes to HCC progression by inducing epithelial‐to‐mesenchymal transition and increased invasiveness of cancer cells as well as by inducing angiogenesis, which is of critical relevance. In murine xenografts, OSM overexpression was associated with slower tumor growth but an increased rate of lung metastases. Overexpression of OSM and its positive correlation with the angiogenic switch were also confirmed in a murine model of NAFLD/NASH‐related hepatocarcinogenesis. Consistent with this, analysis of liver specimens from human NASH‐related HCCs with vascular invasion showed that OSM was expressed by liver cancer cells invading hepatic vessels. In conclusion, OSM upregulation appears to be a specific feature of HCC arising on a NAFLD/NASH background, and it correlates with clinical parameters and disease outcome. Our data highlight a novel pro‐carcinogenic contribution for OSM in NAFLD/NASH, suggesting a role of this factor as a prognostic marker and a putative potential target for therapy. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Giovanni Di Maira
- Department of Clinical and Experimental Medicine and Center Denothe University of Firenze Italy
| | - Beatrice Foglia
- Department of Clinical and Biological Sciences, Unit of Experimental Medicine & Clinical Pathology University of Torino Italy
| | - Lucia Napione
- Laboratory of Vascular Oncology Candiolo Cancer Institute – FPO IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico)
- Department of Applied Science and Technology Politecnico di Torino Torino Italy
| | - Cristian Turato
- Department of Molecular Medicine University of Pavia Pavia Italy
| | - Marina Maggiora
- Department of Clinical and Biological Sciences, Unit of Experimental Medicine & Clinical Pathology University of Torino Italy
| | - Salvatore Sutti
- Dept. Health Sciences and Interdisciplinary Research Center for Autoimmune Diseases University Amedeo Avogadro of East Piedmont Novara Italy
| | - Erica Novo
- Department of Clinical and Biological Sciences, Unit of Experimental Medicine & Clinical Pathology University of Torino Italy
| | - Maria Alvaro
- Laboratory of Vascular Oncology Candiolo Cancer Institute – FPO IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico)
- Department of Oncology University of Torino Italy
| | - Riccardo Autelli
- Department of Clinical and Biological Sciences, Unit of Experimental Medicine & Clinical Pathology University of Torino Italy
| | | | - Federico Bussolino
- Laboratory of Vascular Oncology Candiolo Cancer Institute – FPO IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico)
- Department of Oncology University of Torino Italy
| | - Patrizia Carucci
- Division of Gastroenterology Città della Salute e della Scienza University‐Hospital 10100 Turin Italy
| | - Silvia Gaia
- Division of Gastroenterology Città della Salute e della Scienza University‐Hospital 10100 Turin Italy
| | - Chiara Rosso
- Department of Medical Sciences University of Torino Italy
| | | | | | | | - Emanuele Albano
- Dept. Health Sciences and Interdisciplinary Research Center for Autoimmune Diseases University Amedeo Avogadro of East Piedmont Novara Italy
| | - Fabio Marra
- Department of Clinical and Experimental Medicine and Center Denothe University of Firenze Italy
| | - Maurizio Parola
- Department of Clinical and Biological Sciences, Unit of Experimental Medicine & Clinical Pathology University of Torino Italy
| | - Stefania Cannito
- Department of Clinical and Biological Sciences, Unit of Experimental Medicine & Clinical Pathology University of Torino Italy
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6
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Carlevato R, Chiofalo V, Spinelli L, Giglioli F, Carucci P, Rolle E, Rizza G, Faletti R, Romagnoli R, Saracco G, Fonio P, Iorio G, Guarneri A, Ricardi U. PH-0499 SABR as a treatment option for HCC patients: efficacy and toxicity profile. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07350-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Martelletti C, Ricotti A, Gesualdo M, Carucci P, Gaia S, Rolle E, Burlone ME, Okolicsanyi S, Mattalia A, Pirisi M, Berchialla P, Tabone M. Radioembolization vs sorafenib in locally advanced hepatocellular carcinoma with portal vein tumor thrombosis: A propensity score and Bayesian analysis. J Dig Dis 2021; 22:496-502. [PMID: 34189839 DOI: 10.1111/1751-2980.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/19/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In this study we aimed to compare patient outcomes between the use of transarterial radioembolization (TARE) and sorafenib in patients with hepatocellular carcinoma (HCC) and intrahepatic portal vein tumor thrombosis (PVTT). METHODS A total of 65 patients with HCC and intrahepatic PVTT treated in five Italian hospitals between 2012 and 2018 were included in the analysis. Those with any previous treatment, extension of PVTT to the main portal tract and extrahepatic involvement were excluded. Propensity score matching analysis and Bayesian model averaging analysis were performed. RESULTS Of the 41 patients treated with TARE and 24 with sorafenib, 11 patients were downstaged to curative-intent surgery (liver transplant in three and hepatectomy in eight), including 10 treated with TARE and one with sorafenib. TARE was more effective than sorafenib in downstaging patients to surgery, achieving a mean survival of 54 months. In the 54 patients without downstaging after treatment, of whom 31 were treated with TARE and 23 with sorafenib, median survival was 20.3 and 9.1 months, respectively (P = 0.001), with different 1-, 2- and 3-year OS rates (64.5%, 42.6% and 37.3% vs 39.1%, 13.0% and 0%). Both propensity score and Bayesian model averaging confirmed an improvement in overall survival in the TARE group compared with sorafenib treatment. CONCLUSIONS TARE was more effective than sorafenib in downstaging patients with HCC to surgery, providing a significant improvement in survival. Even in patients who were not downstaged to surgery, survival appeared to be superior with TARE over sorafenib.
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Affiliation(s)
| | - Andrea Ricotti
- Medical Direction of Hospital, Mauriziano Hospital, Turin, Italy.,Department of Public Health and Pediatric, University of Torino, Turin, Italy
| | - Marcantonio Gesualdo
- Division of Gastroenterology, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Patrizia Carucci
- Division of Gastroenterology, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Silvia Gaia
- Division of Gastroenterology, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Emanuela Rolle
- Division of Gastroenterology, Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Stefano Okolicsanyi
- Division of Gastroenterology, Regional Hospital of Aosta Valley, Aosta, Italy
| | - Alberto Mattalia
- Division of Gastroenterology, Santa Croce e Carle General Hospital, Cuneo, Italy
| | - Mario Pirisi
- Internal Medicine Division, Maggiore della Carità Hospital, Novara, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Science, University of Torino, Turin, Italy
| | - Marco Tabone
- Division of Gastroenterology, Mauriziano Hospital, Turin, Italy
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Gaia S, Ciruolo M, Ribaldone DG, Rolle E, Migliore E, Mosso E, Vola S, Risso A, Fagoonee S, Saracco GM, Carucci P. Higher Efficiency of Percutaneous Microwave (MWA) Than Radiofrequency Ablation (RFA) in Achieving Complete Response in Cirrhotic Patients with Early Hepatocellular Carcinoma. Curr Oncol 2021; 28:1034-1044. [PMID: 33669107 PMCID: PMC8025753 DOI: 10.3390/curroncol28020101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Contrasting data are available in the literature regarding the superiority of percutaneous microwave ablation (MWA) or radiofrequency ablation (RFA) in very early or early (BCLA 0 or A) hepatocellular carcinoma (HCC). AIMS The primary outcome was to compare the efficacy of RFA and MWA in achieving complete response in cirrhotic patients with early and very early HCC. The secondary outcomes were to evaluate the overall survival and the recurrence rate. METHODS A retrospective, observational, single-center study was performed. Inclusion criteria were liver cirrhosis, new diagnosis of a single node of HCC measuring a maximum of 50 mm or up to three nodules with diameter up to 35 mm, treatment with RFA or MWA. Radiological response was evaluated with multiphasic contrast-enhanced Computed Tomography or Magnetic Resonance Imaging at 5-7 weeks after thermal ablation. Complete response was defined when no vital tissue was detected after treatment. RESULTS Overall, 251 HCC patients were included in this study; 81 patients were treated with MWA and 170 with RFA. The complete response rate was similar in MWA and RFA groups (out of 331 nodules, 87.5% (91/104) were treated with MWA and 84.2% (186/221) were treated with RFA, p = 0.504). Interestingly, a subanalysis demonstrated that for 21-35 mm nodules, the probability to achieve a complete response using MWA was almost 5 times higher than for RFA (OR = 4.88, 95% CI 1.37-17.31, p = 0.014). Moreover, recurrence rate in 21-35 mm nodules was higher with RFA with respect to MWA (31.9% versus 13.5%, p = 0.019). Overall survival was 80.4% (45/56) when treated with MWA and 62.2% (56/90) when treated with RFA (p = 0.027). No significant difference was observed between MWA and RFA treatment in the 15-20 mm nodules group. CONCLUSION This study showed that MWA is more efficient than RFA in achieving complete response in HCC nodules with 21 to 35 mm diameter.
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Affiliation(s)
- Silvia Gaia
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Michela Ciruolo
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | | | - Emanuela Rolle
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), 10126 Turin, Italy;
| | - Elena Mosso
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Simone Vola
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Alessandra Risso
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Sharmila Fagoonee
- Institute for Biostructure and Bioimaging (CNR) at Molecular Biotechnology Center, 10126 Turin, Italy;
| | - Giorgio Maria Saracco
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Patrizia Carucci
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
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Gruden G, Carucci P, Barutta F, Burt D, Ferro A, Rolle E, Pinach S, Abate ML, Campra D, Durazzo M. Serum levels of anti-heat shock protein 27 antibodies in patients with chronic liver disease. Cell Stress Chaperones 2021; 26:151-157. [PMID: 32895883 PMCID: PMC7736373 DOI: 10.1007/s12192-020-01164-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 05/30/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022] Open
Abstract
Heat shock protein 27 (HSP27), an intracellular molecular chaperone, is involved in the pathogenesis of cancer by promoting both tumor cell proliferation and resistance to therapy. HSP27 is also present in the circulation and circulating HSP27 (sHSP27) can elicit an autoimmune response with production of antibodies. Levels of sHSP27 are enhanced in patients with hepatocellular carcinoma (HCC); it is, however, unknown whether changes in HSP27 antibody levels occur in patients with HCC and can be exploited as a circulating biomarker of HCC. Our aim was to assess the potential association between newly diagnosed HCC and serum anti-HSP27 antibody levels. In this cross-sectional study, anti-HSP27 antibody levels were measured in serum samples from 71 HCC patients, 80 subjects with chronic liver disease, and 38 control subjects by immunoenzymatic assay. Anti-HSP27 antibody levels did not differ significantly among groups. However, in patients with chronic active hepatitis/cirrhosis, anti-HSP27 levels were significantly higher in subjects with a positive history of alcoholism (p = 0.03). Our data do not support the hypothesis that anti-HSP27 antibody levels may help identify patients with HCC among subjects with chronic liver disease. However, our finding that alcohol-related liver disease is associated with higher anti-HSP27 levels is novel and deserves further investigations.
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Affiliation(s)
- Gabriella Gruden
- Department of Medical Science, University of Turin, Turin, Italy.
| | - Patrizia Carucci
- Department of Gastro-Hepatology, Città della Salute e della Scienza, Turin, Italy
| | - Federica Barutta
- Department of Medical Science, University of Turin, Turin, Italy
| | - Davina Burt
- Department of Medical Science, University of Turin, Turin, Italy
| | - Arianna Ferro
- Department of Medical Science, University of Turin, Turin, Italy
| | - Emanuela Rolle
- Department of Gastro-Hepatology, Città della Salute e della Scienza, Turin, Italy
| | - Silvia Pinach
- Department of Medical Science, University of Turin, Turin, Italy
| | - Maria Lorena Abate
- Department of Gastro-Hepatology, Città della Salute e della Scienza, Turin, Italy
| | - Donata Campra
- Department of Surgery, Città della Salute e della Scienza, Turin, Italy
| | - Marilena Durazzo
- Department of Medical Science, University of Turin, Turin, Italy
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Caviglia GP, Ciruolo M, Abate ML, Carucci P, Rolle E, Rosso C, Olivero A, Troshina G, Risso A, Nicolosi A, Ribaldone DG, Armandi A, Tandoi F, Saracco GM, Bugianesi E, Ciancio A, Gaia S. Alpha-Fetoprotein, Protein Induced by Vitamin K Absence or Antagonist II and Glypican-3 for the Detection and Prediction of Hepatocellular Carcinoma in Patients with Cirrhosis of Viral Etiology. Cancers (Basel) 2020; 12:cancers12113218. [PMID: 33142893 PMCID: PMC7692611 DOI: 10.3390/cancers12113218] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023] Open
Abstract
International guidelines recommend the use of ultrasound as a surveillance tool for hepatocellular carcinoma (HCC) in patients with cirrhosis, while the role of serum biomarkers is still debated. We investigated serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist II (PIVKA-II) and glypican-3 (GPC-3) diagnostic accuracy for HCC detection and prediction in patients with liver cirrhosis of viral etiology under surveillance. A total of 349 patients (200 cirrhosis and 149 HCC) were enrolled. The 200 patients with cirrhosis consisted of 114 patients still HCC-free after 36 months of follow-up and 86 patients that developed HCC after 13.8 (11.0-19.8) months. AFP, PIVKA-II and GPC-3 were measured in serum samples collected at tumor diagnosis in the 149 patients with HCC, and at the beginning of follow-up in the 200 patients with cirrhosis. The higher performance for HCC detection was observed for PIVKA-II (area under the curve (AUC) = 0.790), followed by AFP (AUC = 0.737) and GPC-3 (AUC = 0.637); the combination of AFP + PIVKA-II improved the diagnostic accuracy to AUC = 0.822. Serum PIVKA-II values, but not AFP and GPC-3, were significantly higher in the 86 cirrhotics that developed HCC compared with the 114 cirrhotics still HCC-free after 36 months of follow-up (p = 0.020). PIVKA-II ≥ 55 mAU/mL allowed to identify patients with cirrhosis at higher risk of HCC development (Log-rank test, p < 0.001; adjusted Hazard Ratio = 1.99, p = 0.001). In conclusion, the measurement of PIVKA-II in patients with cirrhosis may be useful to tailor personalized surveillance strategies.
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Affiliation(s)
- Gian Paolo Caviglia
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (M.L.A.); (C.R.); (A.O.); (G.T.); (A.N.); (D.G.R.); (A.A.); (G.M.S.); (E.B.); (A.C.)
- Correspondence: (G.P.C.); (S.G.); Tel.: +39-011-633-3532 (G.P.C.)
| | - Michela Ciruolo
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Maria Lorena Abate
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (M.L.A.); (C.R.); (A.O.); (G.T.); (A.N.); (D.G.R.); (A.A.); (G.M.S.); (E.B.); (A.C.)
| | - Patrizia Carucci
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Emanuela Rolle
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Chiara Rosso
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (M.L.A.); (C.R.); (A.O.); (G.T.); (A.N.); (D.G.R.); (A.A.); (G.M.S.); (E.B.); (A.C.)
| | - Antonella Olivero
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (M.L.A.); (C.R.); (A.O.); (G.T.); (A.N.); (D.G.R.); (A.A.); (G.M.S.); (E.B.); (A.C.)
| | - Giulia Troshina
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (M.L.A.); (C.R.); (A.O.); (G.T.); (A.N.); (D.G.R.); (A.A.); (G.M.S.); (E.B.); (A.C.)
| | - Alessandra Risso
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Aurora Nicolosi
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (M.L.A.); (C.R.); (A.O.); (G.T.); (A.N.); (D.G.R.); (A.A.); (G.M.S.); (E.B.); (A.C.)
| | - Davide Giuseppe Ribaldone
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (M.L.A.); (C.R.); (A.O.); (G.T.); (A.N.); (D.G.R.); (A.A.); (G.M.S.); (E.B.); (A.C.)
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Angelo Armandi
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (M.L.A.); (C.R.); (A.O.); (G.T.); (A.N.); (D.G.R.); (A.A.); (G.M.S.); (E.B.); (A.C.)
| | - Francesco Tandoi
- Liver Transplant Unit, General Surgery 2U, Department of Surgical Sciences, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy;
| | - Giorgio Maria Saracco
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (M.L.A.); (C.R.); (A.O.); (G.T.); (A.N.); (D.G.R.); (A.A.); (G.M.S.); (E.B.); (A.C.)
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Elisabetta Bugianesi
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (M.L.A.); (C.R.); (A.O.); (G.T.); (A.N.); (D.G.R.); (A.A.); (G.M.S.); (E.B.); (A.C.)
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Alessia Ciancio
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (M.L.A.); (C.R.); (A.O.); (G.T.); (A.N.); (D.G.R.); (A.A.); (G.M.S.); (E.B.); (A.C.)
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Silvia Gaia
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
- Correspondence: (G.P.C.); (S.G.); Tel.: +39-011-633-3532 (G.P.C.)
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Caviglia GP, Ciruolo M, Olivero A, Carucci P, Rolle E, Rosso C, Abate ML, Risso A, Ribaldone DG, Tandoi F, Saracco GM, Bugianesi E, Gaia S. Prognostic Role of Serum Cytokeratin-19 Fragment (CYFRA 21-1) in Patients with Hepatocellular Carcinoma. Cancers (Basel) 2020; 12:cancers12102776. [PMID: 32998218 PMCID: PMC7601489 DOI: 10.3390/cancers12102776] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The prognosis of hepatocellular carcinoma is mainly driven by the stage of the tumor and by the overall liver function status. However, survival rates of patients with hepatocellular carcinoma are heterogeneous. In this study, we investigated whether circulating biomarkers might allow us to stratify the survival of patients with a new diagnosis of hepatocellular carcinoma. We observed that three biomarkers (namely AFP, PIVKA-II, and CYFRA 21-1) were independent predictors of overall survival. In addition, the combined use of these biomarkers allowed us to further stratify patients with hepatocellular carcinoma, according to their survival probability. This approach might help clinicians to tailor more personalized treatment strategies. Abstract Keratin 19 (K19) is a cancer stem cell marker expressed by a subpopulation of hepatocellular carcinoma (HCC), associated with tumor aggressiveness. We evaluated the prognostic value of serum K19 fragment (CYFRA 21-1), in comparison or in combination with alpha-fetoprotein (AFP) and protein induced by vitamin-K absence or antagonist-II (PIVKA-II), in patients with HCC. A total of 160 patients (28F/132M; median age 62, range 44–86 years) with a new diagnosis of HCC and available serum samples collected at tumor diagnosis were analyzed retrospectively. Median overall survival (OS) after HCC diagnosis was 35.1, 95% CI 27.1–70.5 months. Multivariate Cox regression analysis showed that CYFRA 21-1 > 2.7 ng/mL (hazard ratio (HR) = 3.39, p < 0.001), AFP > 20 ng/mL (HR = 2.27, p = 0.007), and PIVKA-II > 200 mAU/mL (HR = 2.17, p = 0.020) were independent predictors of OS. The combination of biomarkers positivity allowed us to stratify patients with HCC into four risk categories associated with a progressively lower survival probability (log-rank test, p < 0.001). CYFRA 21-1 resulted an independent prognostic factor of patients with HCC and its combination with AFP and PIVKA-II might be useful to tailor personalized treatment strategies.
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Affiliation(s)
- Gian Paolo Caviglia
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (A.O.); (C.R.); (M.L.A.); (D.G.R.); (G.M.S.); (E.B.)
- Correspondence: (G.P.C.); (S.G.); Tel.: +39-011-633-3532 (G.P.C.)
| | - Michela Ciruolo
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Antonella Olivero
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (A.O.); (C.R.); (M.L.A.); (D.G.R.); (G.M.S.); (E.B.)
| | - Patrizia Carucci
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Emanuela Rolle
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Chiara Rosso
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (A.O.); (C.R.); (M.L.A.); (D.G.R.); (G.M.S.); (E.B.)
| | - Maria Lorena Abate
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (A.O.); (C.R.); (M.L.A.); (D.G.R.); (G.M.S.); (E.B.)
| | - Alessandra Risso
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Davide Giuseppe Ribaldone
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (A.O.); (C.R.); (M.L.A.); (D.G.R.); (G.M.S.); (E.B.)
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Francesco Tandoi
- Liver Transplant Unit, General Surgery 2U, Department of Surgical Sciences, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy;
| | - Giorgio Maria Saracco
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (A.O.); (C.R.); (M.L.A.); (D.G.R.); (G.M.S.); (E.B.)
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Elisabetta Bugianesi
- Department of Medical Sciences, University of Turin, 10100 Turin, Italy; (A.O.); (C.R.); (M.L.A.); (D.G.R.); (G.M.S.); (E.B.)
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
| | - Silvia Gaia
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10100 Turin, Italy; (M.C.); (P.C.); (E.R.); (A.R.)
- Correspondence: (G.P.C.); (S.G.); Tel.: +39-011-633-3532 (G.P.C.)
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Calandri M, Ruggeri V, Carucci P, Mirabella S, Veltri A, Fonio P, Gazzera C. Thermal ablation with fusion imaging guidance of hepatocellular carcinoma without conspicuity on conventional or contrast-enhanced US: surrounding anatomical landmarks matter. Radiol Med 2019; 124:1043-1048. [PMID: 31270723 DOI: 10.1007/s11547-019-01057-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/18/2019] [Indexed: 12/15/2022]
Abstract
AIM Evaluating clinical and technical factors affecting thermal ablation of B-Mode/CEUS inconspicuous HCC nodules, relying only on fusion imaging (FI) performed under conscious sedation and using previously acquired CT or MR. MATERIALS AND METHODS Among 367 HCC nodules treated in the study period, data of 37 B-mode/CEUS undetectable HCC nodules treated with FI-guided ablation were extracted from our prospectively collected institutional database. Analyzed variables included patients' sex, age, cirrhosis etiology, Child-Pugh status, size of the lesion, liver segment, subcapsular or central liver site, type of imaging used for fusion (MR/CT), and the presence of surrounding anatomical landmarks (SAL) < 3 cm from the index lesion. RESULTS The primary efficacy was 59.4% (22/37 nodules); nine lesions (24.3%) were partially ablated (PA), six lesions (16.7%) were mistargeted (MA). Eight nodules were retreated with a CA obtained in all cases (100% CA, secondary efficacy in 30/37-81.1%). LTP was observed in 2/30 cases (6.7%). Two minor complications were registered (Clavien-Dindo, Grade1, CIRSE Classification Grade 2). SAL were related to a better ablation outcome (37.5% vs 84.6% p = 0.01). No differences were observed between CA group and PA-MA group in terms of lesion size (15.4 mm vs 14.9 mm p = 0.63), liver segment (p = 0.58), subcapsular or central liver site (8/22 36% vs 4/15 26.7% p = 0.84), and imaging (MR vs CT, p = 0.72). CONCLUSION Even in the presence of potentially critical conditions (completely B-Mode/CEUS inconspicuous nodules, spontaneous breathing, and previously acquired CT or MRI), FI-only guidance is safe and allows having good primary, secondary efficacy and LTP rates. The outcome of the procedure is heavily affected by the presence of SAL.
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Affiliation(s)
- Marco Calandri
- Radiology Unit, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (Torino), University of Torino, Turin, Italy.
| | - Valeria Ruggeri
- Department of Surgical Sciences, Radiology Institute, Città della Salute e della Scienza, Torino, University of Torino, Turin, Italy
| | - Patrizia Carucci
- Gastro-Hepatology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Stefano Mirabella
- Liver Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Andrea Veltri
- Radiology Unit, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (Torino), University of Torino, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Institute, Città della Salute e della Scienza, Torino, University of Torino, Turin, Italy
| | - Carlo Gazzera
- Department of Surgical Sciences, Radiology Institute, Città della Salute e della Scienza, Torino, University of Torino, Turin, Italy
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Guarneri A, Franco P, Romagnoli R, Trino E, Mirabella S, Molinaro L, Rizza G, Filippi AR, Carucci P, Salizzoni M, Ricardi U. Stereotactic ablative radiation therapy prior to liver transplantation in hepatocellular carcinoma. Radiol Med 2016; 121:873-881. [DOI: 10.1007/s11547-016-0670-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/12/2016] [Indexed: 12/31/2022]
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Di Costanzo G, Sacco R, de Stefano G, Montesarchio V, Cabibbo G, Zolfino T, Carucci P, Pisconti S, De Vita F, Giovanis P, Attili A, Erminero C, Fontana T, Daniele B. Safety and efficacy of sorafenib in stella study, a Multicenter, Observational, Phase IV Study In Italian Centers. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv344.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cantamessa A, Brunocilla PR, Carucci P, Bruno M, Gaia S, Brizzi RF, Spandre M, Pacchioni D, Campione A, Rizzetto M, De Angelis C. Endoscopic ultrasound-guided fine needle aspiration in the diagnosis of pelvic metastasis of hepatocellular carcinoma: case report and review of literature. J Gastrointest Cancer 2013; 44:238-40. [PMID: 23054579 DOI: 10.1007/s12029-012-9440-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Alessandro Cantamessa
- Department of Gastro-Hepatology, San Giovanni Battista Hospital, University of Turin, Corso Bramante 88, 10126 Turin, Italy
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Gruden G, Carucci P, Lolli V, Cosso L, Dellavalle E, Rolle E, Cantamessa A, Pinach S, Abate ML, Campra D, Brunello F, Bruno G, Rizzetto M, Perin PC. Serum heat shock protein 27 levels in patients with hepatocellular carcinoma. Cell Stress Chaperones 2013; 18:235-41. [PMID: 23073653 PMCID: PMC3581631 DOI: 10.1007/s12192-012-0377-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 09/27/2012] [Accepted: 09/27/2012] [Indexed: 12/11/2022] Open
Abstract
Levels of serum heat shock protein 27 (sHsp27) have been studied in numerous cancer types, but their potential relevance in patients with hepatocellular carcinoma (HCC) is undetermined. Our aim was to compare sHsp27 levels in patients with HCC and HCC-free controls. Specifically, we recruited 71 patients with HCC (80 % with early tumour), 80 patients with chronic liver disease (59 with liver cirrhosis and 21 with chronic active hepatitis) and 42 healthy subjects. sHsp27 was measured by immunoenzymatic assay. Results showed that sHsp27 levels were significantly (p < 0.001) higher in patients with HCC than in the other groups, particularly in those with hepatitis C virus (HCV)-related disease. In HCC patients, sHsp27 levels were not associated with prognostic risk factors, such as size/multiplicity of nodules and stage. In logistic regression analysis, performed in patients with liver disease, log-sHsp27 was associated with a significant age-adjusted 2.5-fold increased odds ratio of HCC and with a significant 4.4-fold higher odds ratio of HCC in the subgroup with HCV-related liver disease. In receiver operating characteristic curve analysis, sensitivity and specificity of the best sHsp27 cut-off value (456.5 pg/ml) for differentiating patients with HCC from those with HCC-free chronic liver disease were 70 and 73 %, respectively. In conclusion, sHsp27 levels are enhanced in patients with HCC and may represent a candidate biomarker of HCC.
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Affiliation(s)
- Gabriella Gruden
- Department of Medical Science, University of Turin, C/so AM Dogliotti 14, 10126 Turin, Italy.
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Brunocilla PR, Brunello F, Carucci P, Gaia S, Rolle E, Cantamessa A, Castiglione A, Ciccone G, Rizzetto M. Sorafenib in hepatocellular carcinoma: prospective study on adverse events, quality of life, and related feasibility under daily conditions. Med Oncol 2012; 30:345. [PMID: 23263829 DOI: 10.1007/s12032-012-0345-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 07/18/2012] [Indexed: 02/07/2023]
Abstract
Sorafenib is an oral multikinase inhibitor approved for the treatment of hepatocellular carcinoma (HCC). In two randomized trials, sorafenib was reported to be safe without a significant impact on quality of life (QoL). The aim of this study was to evaluate the occurrence of adverse events, QoL variations, and treatment discontinuations in HCC patients treated with sorafenib. Between November 2009 and March 2011, all patients evaluated as suitable for sorafenib treatment were enrolled. Every patient was invited to complete the Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire before starting therapy, at week 1, and at months 1 and 2. QoL scores were analyzed by the Wilcoxon matched-pairs test. Side effects were classified according to the Common Terminology Criteria for Adverse Events v.3.0. Thirty-six patients were enrolled. The cumulative incidence of therapy discontinuation for drug-related adverse events was 33 % (95 % confidence interval, 20.2-49.7). The most common adverse event was fatigue (66.7 %). The worst score decrease was detected from baseline to week 1 in physical well-being, with a median reduction of -8.3 (range -60.1 to 17.9; P = 0.0003). Treatment withdrawal from adverse events was higher than previously reported, significant QoL decrease occurred, and estimated feasibility was 66.7 %.
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Affiliation(s)
- Paola Rita Brunocilla
- Division of Gastroenterology and Hepatology, AO San Giovanni Battista, Turin, Italy.
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18
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Brunello F, Carucci P, Gaia S, Rolle E, Brunocilla PR, Castiglione A, Ciccone G, Rizzetto M. Local Tumor Progression of Hepatocellular Carcinoma After Microwave Percutaneous Ablation: A Preliminary Report. Gastroenterology Res 2012; 5:28-32. [PMID: 27785175 PMCID: PMC5051038 DOI: 10.4021/gr401w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2012] [Indexed: 01/17/2023] Open
Abstract
Background Microwaves (MW) technology is an ablative treatment alternative to radiofrequency (RF) for early stages of hepatocellular carcinoma (HCC) in cirrhotic patients not suitable for surgical resection. It is well known that HCC lesions ≥ 30 mm treated by RF show a high rate of local tumor progression because of residual of unablated neoplastic tissue. Methods Aim of this study was to describe a limited experience of MW ablation (9 cirrhotic patients with medium size HCC: 11 lesions, 31 - 50 mm in diameter) treated from June 2009 to May 2010 by one of currently marketed western MW ablation systems and followed up for 2 years. Primary end-point was the probability of local tumor progression at 24 months; secondary end-point was the safety of the procedure. Results Radiological response after a single session and re-evaluation of local tumor progression along the time were performed by contrast enhanced computed-tomography at months 1-8-12-24. Early effectiveness rate was 90.1 %. The cumulative incidence of local tumor progression at 1 and 2 years were 36.4% (95% CI 11.2 - 62.7) and 57.6% (95% CI 23.6 - 81.0). We observed a single minor complication of the procedure. Conclusions In conclusion, MW ablation system “Amica” has a high rate of primary effectiveness rate but residual of unablated neoplastic tissue induce local tumor progression in about half of the cases during the following 2 years.
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Affiliation(s)
- Franco Brunello
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Patrizia Carucci
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Silvia Gaia
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Emanuela Rolle
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Paola Rita Brunocilla
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Anna Castiglione
- Departement of Tumor Epidemiology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Giovannino Ciccone
- Departement of Tumor Epidemiology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Mario Rizzetto
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
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Bruno M, Carucci P, Repici A, Pellicano R, Mezzabotta L, Goss M, Fagoonee S, Allegranza P, Reggio D, Rizzetto M, De Angelis C. Negative predictive value of endoscopic ultrasound in patients referred for fine-needle aspiration. Panminerva Med 2011; 53:179-183. [PMID: 21775944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM Endoscopic ultrasound (EUS) is a valuable diagnostic tool in pancreatic diseases and its high negative predictive value (NPV) in excluding malignancies is universally recognized. Moreover, EUS with fine-needle aspiration (EUS-FNA) can significantly impact on diagnosis and management of many clinical conditions. However, there are circumstances in which EUS-FNA cannot or should not be performed. We evaluated the factors that prevented us from performing or induced us not to perform FNA. METHODS The study was conducted in a tertiary university hospital. A total of 211 patients suspected of having solid pancreatic malignancy on the basis of clinical presentation and computed tomography and/or magnetic resonance imaging was included. When FNA was withheld because not deemed necessary by the operator, the NPV of EUS was calculated. RESULTS In 9 patients (4.3% of the procedures), FNA was withheld because of contraindications that should have been foreseen by the referring physician. In 30 subjects, FNA was not accomplished as no lesions requiring biopsy were actually found at EUS exploration. In this group, EUS reached a NPV of 96.7% in excluding malignancy, but it reached 100% in patients without chronic pancreatitis. CONCLUSION In a cohort of patients with high pre-test probability of malignancy, the high NPV of EUS was confirmed. False negative results should be expected in patients with chronic pancreatitis and they need a strict follow-up.
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Affiliation(s)
- M Bruno
- Department of Gastroenterology and Hepatology, Molinette Hospital, Turin, Italy
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20
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Maldi E, Carucci P, Pacchioni D, Bruno M, Balbo-Mussetto A, Repici A, Rizzetto M, DE Angelis C. Endoscopic ultrasound fine-needle aspiration in the diagnosis of intrapancreatic accessory spleen. Dig Endosc 2011; 23:270. [PMID: 21699575 DOI: 10.1111/j.1443-1661.2010.01090.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Elena Maldi
- Department of Biomedical Science and Human Oncology, University of Turin, Turin, Italy
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21
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Maletta F, Pacchioni D, Carucci P, Accinelli G, Bruno M, Brizzi F, Allegranza P, Rizzetto M, Bussolati G, De Angelis C. Analysis of cyst fluid obtained by endoscopic ultrasound-guided fine-needle aspiration supporting the diagnosis of a pancreatic neuroendocrine neoplasm. Endoscopy 2011; 43 Suppl 2 UCTN:E34-5. [PMID: 21271532 DOI: 10.1055/s-0030-1256036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- F Maletta
- Department of Biomedical Science and Oncology, University of Turin, Italy
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22
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Stacchini A, Carucci P, Pacchioni D, Accinelli G, Demurtas A, Aliberti S, Bosco M, Bruno M, Balbo Mussetto A, Rizzetto M, Bussolati G, De Angelis C. Diagnosis of deep-seated lymphomas by endoscopic ultrasound-guided fine needle aspiration combined with flow cytometry. Cytopathology 2011; 23:50-6. [PMID: 21219488 DOI: 10.1111/j.1365-2303.2010.00842.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although endoscopic ultrasound combined with fine needle aspiration (EUS-FNA) is rapidly becoming the preferred diagnostic approach for the sampling and diagnosis of gastrointestinal and mediastinal malignancies, there are limited data as to its use in the diagnosis of lymphoproliferative disorders. Therefore, we carried out a retrospective evaluation of the performance of EUS-guided FNA combined with flow cytometry (FC) as a tool to improve overall sensitivity and specificity in the diagnosis of lymphoma. METHODS Of 1560 patients having EUS-guided FNA during the period of the study, a total of 56 patients were evaluated by cytology with FC after EUS-FNA. There was adequate material to perform FC analysis for all but one case. RESULTS EUS-FNA-FC gave a diagnosis of lymphoma in 11 cases and of reactive lymphadenopathy in 20. A specific histological type was defined by FC alone in eight cases. The remaining cases were diagnosed later by cytology and cell block sections: 13 carcinomas, nine granulomatous lymphadenopathies and one mediastinal extramedullary haematopoiesis. One case was considered only suspicious for lymphoma on cytology and FC but was not confirmed on molecular analysis and one had insufficient material for FC. CONCLUSIONS Our results show that a combination of EUS-FNA-FC is a feasible and highly accurate method, which may be used for the diagnosis and subtyping of deep-seated lymphoma, providing a significant improvement to cytomorphology alone both for diagnosis and treatment planning, as long as immunocytochemistry is available for non-lymphoma cases.
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Affiliation(s)
- A Stacchini
- Flow Cytometry Unit, Department of Pathology, Molinette Hospital, Turin, Italy.
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Bruno M, Bosco M, Carucci P, Pacchioni D, Repici A, Mezzabotta L, Pellicano R, Fadda M, Saracco GM, Bussolati G, Rizzetto M, De Angelis C. Preliminary experience with a new cytology brush in EUS-guided FNA. Gastrointest Endosc 2009; 70:1220-4. [PMID: 19665706 DOI: 10.1016/j.gie.2009.05.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [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: 02/02/2009] [Accepted: 05/29/2009] [Indexed: 12/10/2022]
Abstract
BACKGROUND Despite the high diagnostic yield of EUS-guided FNA, room for technical improvements remains. Recently, the EchoBrush (Cook Endoscopy, Winston-Salem, NC), a disposable cytologic brush, was introduced to the market. To date, only 1 study, limited to 10 pancreatic cyst cases, using this device has been published. OBJECTIVE To assess the diagnostic yield of the EchoBrush in a cohort of consecutive patients, irrespective of the target lesion. DESIGN Case series. SETTING Tertiary care university hospital (Molinette Hospital, Turin, Italy). PATIENTS Thirty-nine consecutive patients (12 with solid pancreatic masses, 12 with pancreatic cysts, 7 with enlarged lymph nodes, and 8 with submucosal masses) were enrolled. INTERVENTIONS The material collected with the EchoBrush and with a standard FNA needle was double-blind evaluated by 2 cytopathologists. MAIN OUTCOME MEASUREMENTS Adequacy of the sample and sensitivity and specificity of the EchoBrush method. RESULTS Adequate material for cytologic analysis was collected in 17 of 39 patients (43.6%) with a single pass of the EchoBrush. Results were better for pancreatic lesions (for solid and cystic lesions, the adequacy was 58.3% and 50%, respectively); adequacy was low (28.6% and 25%, respectively) for lymph nodes and submucosal masses. The overall sensitivity and specificity were 57.9% and 31.2%, respectively. There were no adverse events with the procedure. LIMITATION Preliminary study. CONCLUSIONS This report suggests that the EchoBrush may provide adequate cellularity to diagnose solid and cystic pancreatic lesions. More extensive studies are needed to compare the EchoBrush and standard needles.
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Affiliation(s)
- Mauro Bruno
- Department of Gastro-Hepatology, Molinette Hospital, Torino, Italy
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Bosco M, Carucci P, Pacchioni D, Bruno M, Rizzetto M, Bussolati G, De Angelis C. Endoscopic ultrasound-guided fine needle aspiration diagnosis of extramedullary hematopoiesis in mediastinum. Endoscopy 2009; 41 Suppl 2:E6-7. [PMID: 19177294 DOI: 10.1055/s-2008-1077652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M Bosco
- Department of Biomedical Science and Oncology, University of Turin, Italy
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25
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Brunello F, Veltri A, Carucci P, Pagano E, Ciccone G, Moretto P, Sacchetto P, Gandini G, Rizzetto M. Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: A randomized controlled trial. Scand J Gastroenterol 2008; 43:727-35. [PMID: 18569991 DOI: 10.1080/00365520701885481] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.8] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare percutaneous ethanol injection (PEI), the standard approach which has been used for many years to treat early non-surgical hepatocellular carcinoma (HCC) in cirrhotic patients, and radiofrequency ablation (RFA), which has become an interesting alternative. MATERIAL AND METHODS A randomized trial was carried out on 139 cirrhotic patients in Child-Pugh classes A/B with 1-3 nodes of HCC (diameter 15-30 mm), for a total of 177 lesions. Patients were randomized to receive RFA (n=70) or PEI (n=69). The primary end-point was complete response (CR) 1 year after the percutaneous ablation of all HCC nodes identified at baseline. Secondary end-points were: early (30-50 days) CR, complications, survival and costs. RESULTS In an intention-to-treat analysis, 1-year CR was achieved in 46/70 (65.7%) and in 25/69 (36.2%) patients treated by RFA and PEI, respectively (p=0.0005). For lesions >20 mm in diameter, there was a larger CR rate in the RFA group (68.1% versus 26.3%). An early CR was obtained in 67/70 (95.7%) patients treated by RFA compared with 42/64 (65.6%) patients treated by PEI (p=0.0001). Complications occurred in 10 and 12 patients treated by RFA and PEI, respectively. The overall survival rate was not significantly different in the RFA versus PEI arm (adjusted hazard ratio=0.88, 95% CI: 0.50-1.53). There was an incremental health-care cost of 8286 euro for each additional patient successfully treated by RFA. CONCLUSIONS The 1-year CR rate after percutaneous treatment of early HCC was significantly better with RFA than with PEI but did not provide a clear survival advantage in cirrhotic patients.
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Affiliation(s)
- Franco Brunello
- Divisione di Gastro-Epatologia, Ospedale San Giovanni Battista di Torino, Turin, Italy.
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De Angelis C, Pellicano R, Carucci P, Bruno M, Repici A, Goss M, Fagoonee S, Saracco G, Rizzetto M. Endoscopic ultrasonography in hepatology: focus on portal hypertension. MINERVA GASTROENTERO 2008; 54:131-139. [PMID: 18319686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Portal hypertension (PHT) is more frequently caused by cirrhosis. Increase in portal pressure induces development of collateral circulation with shunting resulting in disturbances such as gastroesophageal varices (GEV). Prevention and therapy of bleeding from GEV are mandatory. Therefore, the diagnosis of PHT represents a crucial step. Endoscopic ultrasound (EUS), with its combination of endoscopic imaging and ultrasonic capabilities, can offer an almost comprehensive evaluation of portal venous system and porto-systemic collateral circulation. The improved endoscopic view of several video-echoendoscopes has filled the gap between EUS and standard video-endoscopy in diagnosing GEV and in assessing endoscopic criteria of bleeding risk. EUS combined with Color-Doppler capabilities are able to provide hemodynamic information. Furthermore, EUS data allow to stratify patients on the basis of PHT severity and first bleeding risk, monitor the results of pharmacologic and/or endoscopic therapy, predict the response to treatment, quantify the risk of variceal recurrence and recurrent bleeding after GEV obliteration and guide or assist EGD therapy. Despite having this amount of information, there is lack of scientific evidence that EUS imaging and EUS-assisted therapy can have a clear-cut clinical impact and affect patients outcome.
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Affiliation(s)
- C De Angelis
- Department of Gastro-Epatology, San Giovanni Battista (Molinette), Hospital, Corso Bramante 88, Turin, Italy.
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27
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De Angelis C, Martini M, Repici A, Pellicano R, Goss M, Carucci P, Bruno M, Peyre S, Rissone M, Saracco G, Rizzetto M. Instruments and accessories for diagnostic endoscopic ultrasound (radial scanning and miniprobes). Minerva Med 2007; 98:253-260. [PMID: 17921935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Endoscopic ultrasound (EUS) is a relatively new technology developed in the early 80's, but introduced into the clinical practice only in the late 80's. Nowadays there is an increase in demand for EUS examinations and services, because this technique is more and more recognized as an important and integral part in the diagnostic and staging algorithm of many gastrointestinal (GI) and nongastrointestinal pathologies. Even if today the EUS panorama enrich itself with a large number of different instruments, mechanical and electronic scopes, radial and linear ones, several types of miniprobes and specialty probes, for diagnostic purposes the dedicated radial scanning instruments remain the more adopted choice while miniprobes can have applications only in niche areas, like superficial GI cancers staging, small subepithelial lesions evaluation or intraductal ultrasound and some technological advances are needed to solve the potential drawbacks of this miniaturized probes. At last the EUS equipment borrowed most of the electronic sophistication from the mainstream ultrasonography, this made the choice of an EUS instrument even more difficult and challenging, but you must consider that there is no right or wrong equipment, there is only the right instrument for that specific clinical need or situation.
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Affiliation(s)
- C De Angelis
- Department of Gastrohepatology, Molinette Hospital, Turin, Italy.
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Pellicano R, Repici A, Goss M, Carucci P, Rocca R, Bruno M, Peyre S, Saracco G, Fagoonee S, Rizzetto M, De Angelis C. Role of endoscopic ultrasound in biliary and unexplained pancreatitis. Minerva Med 2007; 98:361-365. [PMID: 17921951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In the Western world, gallstone disease accounts for approximately half of the cases of acute pancreatitis. The benefit of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) has been clearly proven for this disease. On the basis of history, laboratory, and noninvasive imaging studies, about 10-30% of patients with acute pancreatitis have no apparent aetiology. This is critical because it limits the optimal therapeutic management and the prevention of recurrence. Endoscopic ultrasound (EUS) has emerged as an important procedure to clarify the aetiology of acute pancreatitis. After extensive investigation that included EUS, 8-20% of episodes remained idiopathic. Moreover, EUS carried minimal risk when compared to ERCP. The present short review attempts to update on the indications for the employment of EUS in the diagnosis of biliary stones as well as in the clarification of aetiology in the case of unexplained pancreatitis.
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Affiliation(s)
- R Pellicano
- Unit of Gastro-Hepatology, San Giovanni Battista Hospital, Turin, Italy
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29
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Rocca R, De Angelis C, Daperno M, Carucci P, Ravarino N, Bruno M, Crocellà L, Lavagna A, Fracchia M, Pacchioni D, Masoero G, Rigazio C, Ercole E, Sostegni R, Motta M, Bussolati G, Torchio B, Rizzetto M, Pera A. Endoscopic ultrasound-fine needle aspiration (EUS-FNA) for pancreatic lesions: effectiveness in clinical practice. Dig Liver Dis 2007; 39:768-74. [PMID: 17606420 DOI: 10.1016/j.dld.2007.04.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 04/02/2007] [Accepted: 04/20/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diagnosis of pancreatic masses is often difficult. Endoscopic ultrasound-fine needle aspiration has been proposed as the best single-step strategy. AIMS To prospectively evaluate feasibility, effectiveness and safety of endoscopic ultrasound-fine needle aspiration of pancreatic masses in a consecutive study of unselected patients. METHODS Two hundred ninety-three patients were enrolled in two referral Hospitals in Northern Italy. All patients were referred either due to the presence of imaging test abnormalities (suspected or evident masses, or features indirectly suggesting the presence of a mass) or due to clinical or biochemical findings suggesting pancreatic cancer in the absence of positive imaging. All patients underwent linear array endoscopic ultrasound and, when indicated, fine needle aspiration. All procedures were recorded prospectively. The final diagnosis was established at the end of follow-up or when the patients underwent surgery or died. RESULTS Fine needle aspiration was indicated in 246 of 293 cases (84%), considered technically feasible in 232 of 246 cases (94%) and gave adequate samples for histopathological diagnosis in 204 of 232 cases (88%). Endoscopic ultrasound sensitivity, specificity and accuracy were 79, 60 and 72%, respectively; the corresponding figures for endoscopic ultrasound-fine needle aspiration were 80, 86 and 82%. There was good agreement with final diagnosis for endoscopic ultrasound-fine needle aspiration (kappa 0.673, 95%CI 0.592-0.753), greater than that for endoscopic ultrasound alone (kappa 0.515, 95%CI 0.425-0.605). There was one case of intracystic haemorrhage and one case of transient hyperthermia (0.3%). CONCLUSIONS Endoscopic ultrasound-fine needle aspiration of pancreatic masses seems to be feasible, effective and safe in this consecutive study of patients.
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Affiliation(s)
- R Rocca
- Gastroenterology Division, A.S.O. Ordine Mauriziano, Largo Turati 62, 10128 Torino, Italy.
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30
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Saracco G, Giordanino C, Roberto N, Ezio D, Luca T, Caronna S, Carucci P, De Bernardi Venon W, Barletti C, Bruno M, De Angelis C, Musso A, Repici A, Suriani R, Rizzetto M. Fatal multiple systemic embolisms after injection of cyanoacrylate in bleeding gastric varices of a patient who was noncirrhotic but with idiopathic portal hypertension. Gastrointest Endosc 2007; 65:345-7. [PMID: 17141231 DOI: 10.1016/j.gie.2006.07.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 07/10/2006] [Indexed: 12/14/2022]
Affiliation(s)
- Giorgio Saracco
- Department of Gastroenterology, Molinette Hospital, Torino, Itlay
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De Angelis C, Repici A, Carucci P, Bruno M, Goss M, Mezzabotta L, Pellicano R, Saracco G, Rizzetto M. Pancreatic cancer imaging: the new role of endoscopic ultrasound. JOP 2007; 8:85-97. [PMID: 17228140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Pancreatic cancer is the most deadly of all gastrointestinal malignancies and has a very poor prognosis. Unfortunately, most patients present late in the course of their disease and, at the time of diagnosis, only 10 to 25% of patients will be eligible for potentially curative resection. Efforts must be oriented towards an early diagnosis and towards reliably identifying patients who can really benefit from major surgery. A suspected pancreatic tumor can be a difficult challenge for the clinician. In the last ten years, we have witnessed notable technological improvements in radiological and nuclear imaging. Taking this into account, we will try to delineate the new role of endoscopic ultrasound (EUS) in pancreatic tumor imaging and to place EUS in a shareable diagnostic and staging algorithm. To date, the most accurate imaging techniques for pancreatic neoplasms remain contrast-enhanced computed tomography and EUS. EUS has the highest accuracy in detecting small lesions, in assessing tumor size and lymph node involvement, but helical CT must still be the first choice in patients with a suspected pancreatic tumor. However, after this first step, there is a place for EUS as a second diagnostic level in several cases: negative results on CT scan and persistent strong clinical suspicion of pancreatic cancer, doubtful results on CT scans or the need for cytohistological confirmation. In the near future, there will be great opportunities for the development of diagnostic and therapeutic EUS and pancreatic cancer could be the best testing ground.
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Affiliation(s)
- Claudio De Angelis
- Gastrohepatology Department, San Giovanni Battista Hospital, University of Turin. Turin, Italy.
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Buscarini E, De Angelis C, Arcidiacono PG, Rocca R, Lupinacci G, Manta R, Carucci P, Repici A, Carrara S, Vallisa D, Buscarini L, Cosentino F, Pera A, Rizzetto M, Testoni PA, Zambelli A. Multicentre retrospective study on endoscopic ultrasound complications. Dig Liver Dis 2006; 38:762-7. [PMID: 16843076 DOI: 10.1016/j.dld.2006.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 06/07/2006] [Accepted: 06/08/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic ultrasonography, both conventional and interventional, has been used increasingly during the past 20 years and is deemed a safe technique. Its complication rate, however, has been studied to only a limited extent. This multicentre investigation sought to establish the complication rate for a large number of endoscopic ultrasonography procedures. METHODS By means of a questionnaire, we collected data from six centres on the number of endoscopic ultrasonography examinations performed and divided them into conventional and interventional examinations of the upper and lower gastrointestinal tract. Information was obtained on technical modalities such as instruments and sedation and, for interventional endoscopic ultrasonography, indications, pre-procedural exams and technical details (needle calibre, number of passes) had to be specified. Complications were classified as mild, moderate, severe or fatal and their onset as immediate, early or late. Variables that entered into the analysis of complication rate included type of endoscopic ultrasonography instrument used, type and site of lesion biopsied, number of needle passes and operator experience. RESULTS Eleven thousand five hundred thirty nine endoscopic ultrasonographic procedures were reported, of which 10,731 were conventional and 808 interventional. No deaths occurred; there were 14 (0.12%) complications, 5 (0.046%) of them following conventional endoscopic ultrasonography and 9 (1.11%) after interventional endoscopic ultrasonography. Seven complications were mild, four moderate and three severe. CONCLUSIONS Both conventional and interventional endoscopic ultrasonography were confirmed to be acceptably safe techniques.
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Affiliation(s)
- E Buscarini
- Gastroenterology Department, Ospedale Maggiore, Via Macallè 1, 26013 Crema, Italy.
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Carucci P, Leone N, Repici A, De Paolis P, Garabello D, Galliano D, Curri F, Rizzetto M, De Angelis C. Emergency catheter probe endoscopic sonography (CP-EUS): an effective procedure in the assessment of a bleeding gangliocytic paraganglioma. Dig Liver Dis 2006; 38:134-7. [PMID: 16389000 DOI: 10.1016/j.dld.2005.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Accepted: 04/19/2005] [Indexed: 12/11/2022]
Abstract
Catheter probe endoscopic sonography is a relatively rapid and safe procedure, carried out during standard endoscopy, capable of distinguishing solid from cystic lesions and vascular from avascular masses. Herein we discuss the role of catheter probe endoscopic sonography in the emergency assessment of a patient with recent and severe bleeding from an ulcerated polyp, arising from the papilla. During the endoscopy, catheter probe endoscopic sonography showed the solid and submucosal nature of the lesion, suggesting its localised and benign nature and, most importantly, demonstrating the high risk of rebleeding from vascular structures communicating with the ulcer. Because of this finding three metallic endoclips were positioned. The lesion was not removed endoscopically because of its difficult position and the high risk of haemorrhage. The mass, removed through a duodenotomy, was shown to be a gangliocytic paraganglioma, an uncommon tumour, frequently resulting in surgery because of abdominal pain and gastrointestinal bleeding.
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Affiliation(s)
- P Carucci
- Department of Gastroenterology, Molinette Hospital, corso Bramante 88, Turin 10126, Italy.
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Leone N, Saettone S, De Paolis P, Carucci P, Brunello F, De Angelis C, Menozzi G, Rizzetto M. Ectopic livers and related pathology: report of three cases of benign lesions. Dig Dis Sci 2005; 50:1818-22. [PMID: 16187180 DOI: 10.1007/s10620-005-2944-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Accepted: 11/09/2004] [Indexed: 02/07/2023]
Affiliation(s)
- Nicola Leone
- Department of Gastroenterology, Molinette Hospital, Turin, Italy.
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Ciancio A, Manzini P, Castagno F, D'Antico S, Reynaudo P, Coucourde L, Ciccone G, Del Piano M, Ballarè M, Peyre S, Rizzi R, Barletti C, Bruno M, Caronna S, Carucci P, Venon WDB, De Angelis C, Morgando A, Musso A, Repici A, Rizzetto M, Saracco G. Digestive endoscopy is not a major risk factor for transmitting hepatitis C virus. Ann Intern Med 2005; 142:903-9. [PMID: 15941697 DOI: 10.7326/0003-4819-142-11-200506070-00008] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The potential role of digestive endoscopy as a mode for transmission of hepatitis C virus (HCV) is controversial. OBJECTIVE To evaluate the role of digestive endoscopy in transmitting HCV by comparing the incidence of HCV infection in a cohort of patients undergoing endoscopy and in a cohort of blood donors. DESIGN Prospective cohort study. SETTING 3 endoscopic units and 2 blood banks in northwestern Italy. PATIENTS The potentially exposed cohort consisted of 9188 outpatients consecutively recruited from 3 endoscopic units. Of 9008 patients negative for antibody to HCV (anti-HCV), 8260 (92%) were retested for anti-HCV 6 months after endoscopy. The unexposed cohort consisted of 51,230 healthy, anti-HCV-negative persons who donated blood at 2 blood banks in the same area and during the same time period; 38,280 of them (75%) were tested again for anti-HCV 6 to 48 months after the first blood donation (95,317 person-years of observation). MEASUREMENTS Differences in the anti-HCV seroconversion rate between the exposed cohort (patients undergoing endoscopy) and the unexposed cohort (blood donors). Seroconversion was evaluated by a third-generation enzyme immunoassay for anti-HCV; persons positive for anti-HCV were tested for HCV RNA by polymerase chain reaction. RESULTS All 8260 persons undergoing endoscopy remained negative for anti-HCV 6 months after the procedure (risk per 1000 persons, 0 [95% CI, 0 to 0.465]); in particular, none of the 912 patients who underwent endoscopy with the same instrument previously used on HCV carriers showed anti-HCV seroconversion (risk per 1000 persons, 0 [CI, 0 to 4.195]). Four blood donors became positive for anti-HCV and HCV RNA (mean follow-up, 2.49 years; 0.042 case per 1000 person-years [CI, 0.011 to 0.107 case per 1000 person-years]); each had undergone minor surgery before the second test. LIMITATIONS In the endoscopy cohort, 8.3% of patients were lost to follow-up. CONCLUSIONS These findings support the hypothesis that properly performed digestive endoscopy is not a major risk factor for the transmission of HCV.
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Affiliation(s)
- Alessia Ciancio
- Ospedale Molinette, Banca del Sangue e del Plasma della città di Torino, Torino, Italy.
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Leone N, De Paolis P, Carrera M, Carucci P, Musso A, David E, Brunello F, Fronda GR, Rizzetto M. Ectopic liver and hepatocarcinogenesis: report of three cases with four years' follow-up. Eur J Gastroenterol Hepatol 2004; 16:731-5. [PMID: 15256973 DOI: 10.1097/01.meg.0000131044.05434.f7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) may arise in ectopic livers, which are autonomous islands of normal liver parenchyma located in the abdomen or thorax. The majority of HCCs in ectopic livers are reported in oriental patients. We describe here three new cases of HCC in Caucasian patients. The clinical presentation varied from dull epigastric pain in one patient, to abrupt onset with signs and symptoms of acute abdomen caused by intra-abdominal bleeding in another patient, to an unexplained progressive increase of alpha-fetoprotein serum levels in a third patient. None had risk factors for HCC or liver disease. One of the patients developed HCC at age 34 years; she is the youngest patient ever described to develop HCC in ectopic liver. Our data further strengthen the hypothesis that ectopic livers are particularly predisposed to developing HCC. The patients were followed up for 4 years after surgery: two remain free of disease, suggesting that the unique localisation and growth pattern may render these tumours particularly susceptible to curative resection.
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Affiliation(s)
- Nicola Leone
- Department of Gastroenterology, Division of B Surgery and First Service of Human Pathology, Molinette Hospital, Turin, Italy.
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Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P, Musso A, De Paolis P, Capussotti L, Salizzoni M, Rizzetto M. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology 2002; 123:134-40. [PMID: 12105842 DOI: 10.1053/gast.2002.34168] [Citation(s) in RCA: 995] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Nonalcoholic steatohepatitis (NASH) may progress to cirrhosis; whether NASH plays also a role in the development of hepatocellular carcinoma (HCC) is unknown. METHODS Among 641 cirrhosis-associated HCCs, we retrospectively identified 44 patients with cryptogenic cirrhosis (CC). Of these, 23 were actively followed up and were compared in a case-control study with viral- and alcohol-associated HCC. Family and personal history of diabetes, hypertension, coronary heart disease, dyslipidemia, obesity, and biochemical data were compared between groups. Iron status and presence of mutations in the HFE gene of familiar hemochromatosis were also determined. RESULTS Family history was not different in relation to etiology. The prevalence of obesity and diabetes was significantly higher in patients with CC. Although liver function was similar, CC patients had higher glucose, cholesterol, and triglyceride plasma levels, increased parameters of insulin resistance, and lower aminotransferase levels. Iron status and prevalence of mutations in the HFE gene did not differ. Logistic regression analysis identified in sequence hypertriglyceridemia, diabetes, and normal aminotransferases as independent factors associated with HCC arising in CC. CONCLUSIONS Features suggestive of NASH are more frequently observed in HCC arising in patients with CC than in age- and sex-matched HCC patients of well-defined viral or alcoholic etiology. HCC may represent a late complication of NASH-related cirrhosis.
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Affiliation(s)
- Elisabetta Bugianesi
- Department of Gastroenterology, Ospedale S. Giovanni Battista, University of Turin, Turin, Italy.
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Ciancio A, Marchet A, Saracco G, Carucci P, Lavezzo B, Leotta D, Capellero B, Nobili M, Smedile A, Rizzetto M. Spectral electroencephalogram analysis in hepatic encephalopathy and liver transplantation. Liver Transpl 2002; 8:630-5. [PMID: 12089718 DOI: 10.1053/jlts.2002.33971] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study is to evaluate the role of spectral electroencephalogram (EEG) analysis ((S)EEG) in quantitating brain dysfunction in cirrhotic patients, showing conditions of minimal hepatic encephalopathy (HE), and determining the impact of orthotopic liver transplantation (OLT) on its correction. (S)EEG was compared with visual EEG ((V)EEG) in 44 cirrhotic patients waiting for OLT and 44 healthy controls. Eighteen patients had overt HE, and 26 patients had no apparent HE. Twenty-one transplant recipients were reexamined 6 months after OLT. Computerized (S)EEG was performed by mean dominant frequency (MDF) and the occipital alpha-theta ratio, expressed as its logarithmic transformation (LogR). All patients underwent psychometric assessment. MDF and LogR correlated significantly with Child-Pugh score (P <.05) and the presence of HE (P <.0001). (S)EEG and (V)EEG determined minimal HE in 8 (31%) and 6 (23%) of 26 patients without overt HE, respectively. (S)EEG did not correlate with age, sex, cause of liver disease, portal hypertension, or psychometric test results. MDF and LogR improved in many transplant recipients. LogR was significantly lower in OLT candidates who died before OLT compared with OLT survivors. In conclusion, (S)EEG provides reliable quantitative information to evaluate the degree of HE and appears more sensitive than (V)EEG to discriminate a subclinical stage of HE. The improvement in (S)EEG results observed in transplant recipients confirms the reversibility of bioelectric brain dysfunction with restoration of liver functions.
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Affiliation(s)
- Alessia Ciancio
- Department of Gastroenterology, University of Torino and San Giovanni Battista Hospital, Turin, Italy
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39
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Repici A, Ferrari A, De Angelis C, Caronna S, Barletti C, Paganin S, Musso A, Carucci P, Debernardi-Venon W, Rizzetto M, Saracco G. Adrenaline plus cyanoacrylate injection for treatment of bleeding peptic ulcers after failure of conventional endoscopic haemostasis. Dig Liver Dis 2002; 34:349-55. [PMID: 12118953 DOI: 10.1016/s1590-8658(02)80129-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic therapy is a safe and effective method for treating non-variceal upper gastrointestinal bleeding. However failure of therapy, in terms of continuing bleeding or rebleeding, is seen in up to 20%. Cyanoacrylate is a tissue glue used for variceal bleeding that has occasionally been reported as an alternative haemostatic technique in non-variceal haemorrhage. AIM To retrospectively describe personal experience using cyanoacrylate injection in the management of bleeding ulcers after failure of first-line endoscopic modalities. PATIENTS AND METHODS Between January 1995 and March 1998, 18 [12 M/6 F, mean age 68.1 years) out of 176 patients, referred to our Unit for non-variceal upper gastrointestinal bleeding, were treated with intralesional injection of adrenaline plus undiluted cyanoacrylate. Persistent bleeding after endoscopic haemostasis or early rebleeding were the indications for cyanoacrylate treatment. RESULTS Definitive haemostasis was achieved in 17 out of 18 patients treated with cyanoacrylate. One patient needed surgery. No early or late rebleeding occurred during the follow-up. No complications or instrument lesions related to cyanoacrylate were recorded. CONCLUSIONS In our retrospective series, cyanoacrylate plus adrenaline injection was found to be a potentially safe and effective alternative to endoscopic haemostasis when conventional treatment modalities fail in controlling bleeding from gastroduodenal ulcers.
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Affiliation(s)
- A Repici
- Department of Gastroenterology, Endoscopy Unit, Molinette Hospital, Turin, Italy.
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Brunello F, Leone N, Delsedime L, Gaido M, Carucci P, Rizzetto M. Focal intrahepatic storage of oligomannosides mimicking a primitive liver neoplasm. J Hepatol 2001; 35:827. [PMID: 11738114 DOI: 10.1016/s0168-8278(01)00227-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- F Brunello
- Department of Gastroenterology, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy
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Repici A, Reggio D, De Angelis C, Barletti C, Marchesa P, Musso A, Carucci P, Debernardi W, Falco M, Rizzetto M, Saracco G. Covered metal stents for management of inoperable malignant colorectal strictures. Gastrointest Endosc 2000; 52:735-40. [PMID: 11115905 DOI: 10.1067/mge.2000.109803] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Metal stents have been reported as an effective alternative to surgery for the palliation of patients with colorectal neoplastic obstruction. Because most of the published series describe the use of uncovered stents, the purpose of our study was to prospectively evaluate the effectiveness, feasibility, safety, and outcome of covered stents for the palliative treatment of malignant colorectal strictures. METHODS Sixteen patients with advanced distal colorectal cancer underwent placement of 10 and 12 cm long, 23 mm diameter covered stents under fluoroscopic and endoscopic control. Clinical and endoscopic follow-up was scheduled at 3- to 6-week intervals. RESULTS Stent insertion was successful in 15 of 16 patients (93%). Perforation occurred in one patient during stent placement requiring colostomy. Relief of bowel obstruction was documented in all successfully treated patients. The median follow-up was 21 weeks (range 1 to 46). No recurrence of obstruction was observed during the follow-up period. Stent migration occurred in 2 patients, 7 and 21 days after stent placement. CONCLUSIONS Covered stents may provide safe and effective palliation of patients with malignant rectosigmoid strictures. Prolonged luminal patency and sealing of fistulous tracts are potential advantages of covered versus uncovered stents in the palliative treatment of colorectal malignancies. ¿
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Affiliation(s)
- A Repici
- Department of Gastroenterology, Molinette Hospital, Torino, Italy
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42
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Marinos G, Rossol S, Carucci P, Wong PY, Donaldson P, Hussain MJ, Vergani D, Portmann BC, Williams R, Naoumov NV. Immunopathogenesis of hepatitis B virus recurrence after liver transplantation. Transplantation 2000; 69:559-68. [PMID: 10708112 DOI: 10.1097/00007890-200002270-00017] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Hepatitis B virus (HBV) recurrence after orthotopic liver transplantation is associated with inflammatory graft changes, despite immunosuppression and donor/recipient HLA mismatch. We investigated whether immune mechanisms are involved in the pathogenesis of hepatitis B after liver transplantation. METHODS The virus-specific T helper (Th) cell response, activation of Th1/Th2 subpopulations, donor/recipient HLA, and expression of tumor necrosis factor (TNF)-alpha/TNF receptors were determined in 28 patients who underwent transplantation for HBV-related cirrhosis (17 with HBV recurrence and 11 without recurrence) in comparison to 30 nontransplant patients with chronic hepatitis B. RESULTS Orthotopic liver transplantation recipients with HBV recurrence showed significant hepatitis B core antigen-specific T-cell proliferation, comparable to nontransplant patients, which was not present in transplant recipients without recurrence. In addition, hepatic and serum interleukin (IL)-2, interferon-gamma, and TNF-alpha were enhanced, without changes in IL-4 and IL-10. Phenotypically, hepatic infiltrates in allografts with HBV recurrence were comprised of CD4+ lymphocytes and macrophages with a correlation between interferon-gamma- and TNF-alpha-producing cells and the degree of necroinflammatory activity. There was a marked up-regulation of both TNF-alpha receptors, significantly greater than in nontransplant patients. CONCLUSIONS These findings suggest that despite immunosuppression, HLA class I-independent immune mechanisms have a significant pathogenic role in liver damage associated with HBV recurrence after liver transplantation.
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Affiliation(s)
- G Marinos
- Institute of Liver Studies, Department of Immunology, King's College School of Medicine and Dentistry, London, England
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Cramp ME, Rossol S, Chokshi S, Carucci P, Williams R, Naoumov NV. Hepatitis C virus-specific T-cell reactivity during interferon and ribavirin treatment in chronic hepatitis C. Gastroenterology 2000; 118:346-55. [PMID: 10648463 DOI: 10.1016/s0016-5085(00)70217-4] [Citation(s) in RCA: 253] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The role of virus-specific T-helper lymphocyte reactivity in determining the therapeutic response in chronic hepatitis C virus (HCV) infection is not fully understood. METHODS We studied CD4(+) T lymphocyte proliferation together with interferon (IFN)-gamma and interleukin (IL)-10 production from peripheral blood mononuclear cells in response to 4 HCV antigens (core, NS3, NS4, and NS5) in 25 patients with chronic hepatitis C undergoing antiviral therapy with IFN alone or in combination with ribavirin, prospectively, before, during, and after treatment. RESULTS HCV-specific T-cell reactivity was uncommon at baseline but increased markedly during antiviral therapy, peaking around treatment weeks 4-8. Resolution of hepatitis C viremia was significantly more likely in patients who developed HCV-specific T-cell proliferation with increased IFN-gamma production. The main difference in T-cell reactivity of patients treated with IFN plus ribavirin was a significantly lower production of IL-10, whereas lymphocyte proliferation was similar to that in patients receiving IFN monotherapy. CONCLUSIONS Treatment-induced control of hepatitis C viremia is associated with the development of HCV-specific T-cell responses with enhanced IFN-gamma and low IL-10 production. The greater efficacy of combination therapy with IFN-alpha plus ribavirin may be related to its ability to suppress HCV-specific IL-10 production.
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Affiliation(s)
- M E Cramp
- Institute of Liver Studies, King's College Hospital, London, England
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De Angelis C, Carucci P, Repici A, Rizzetto M. Endosonography in decision making and management of gastrointestinal endocrine tumors. Eur J Ultrasound 1999; 10:139-50. [PMID: 10586018 DOI: 10.1016/s0929-8266(99)00054-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE gastroenteropancreatic (GEP) neuroendocrine tumors, suspected on clinical basis, are often difficult to localize. We report our experience with endoscopic ultrasonography (EUS) in the preoperative localization of pancreatic endocrine tumors (PETs), compared to other imaging modalities, and in staging and following up carcinoid tumors (CTs) of the gastrointestinal (GI) wall. METHODS 50 patients (20 males; mean age 54 years), 39 with suspected PETs and 11 with GI CTs underwent EUS (Olympus GF-UM2 or GF-UM3). EUS data could be compared with resected specimens in 25 out of the 39 PETs and five out of the 11 CTs. RESULTS in the PETs group 42 tumors (35<20 mm) were removed: 23 in the pancreas, eight in the duodenum, and 11 in the lymph nodes. EUS correctly localized 20 out of the 23 (87%) pancreatic tumors, included 11 out of the 12 (91.6%) insulinomas, three out of the eight (37.5%) duodenal gastrinomas, and ten out of the 11 (90.9%) metastatic lymph nodes. Furthermore EUS accurately evaluated the depth of parietal invasion of CTs in three out of four patients (75%) (two after and one prior to endoscopic resection). In three patients EUS was confirmed as normal on resected specimens (two pancreas and one stomach). In the PETs group, a correct localization was obtained by ultrasonography (US) only in 17.4% of cases, by computed tomography (CT) in 30.4%, by magnetic resonance imaging (MRI) in 25%, by angiography in 26.6%, and by somatostatin receptor scintigraphy in 15.4%. CONCLUSION EUS must be considered the first-intention method in localizing PETs and is helpful in decision making and management of GEP endocrine tumors.
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Affiliation(s)
- C De Angelis
- Department of Gastroenterology, Azienda Ospedaliera S. Giovanni Battista, Molinette Corso Bramente 88, Turin, Italy
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45
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Cramp ME, Carucci P, Rossol S, Chokshi S, Maertens G, Williams R, Naoumov NV. Hepatitis C virus (HCV) specific immune responses in anti-HCV positive patients without hepatitis C viraemia. Gut 1999; 44:424-9. [PMID: 10026332 PMCID: PMC1727419 DOI: 10.1136/gut.44.3.424] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS Most patients infected with hepatitis C virus (HCV) develop chronic infection and persistent viraemia. The immune mechanisms responsible for resolution of viraemia remain poorly understood. HCV specific humoral and cellular immune responses in patients with and without viraemia were investigated. METHODS In vitro T helper (TH) lymphocyte responses to structural and non-structural HCV proteins were determined by means of proliferative response and cytokine production in 35 anti-HCV positive/HCV RNA negative patients and in 31 patients with chronic HCV infection and persistent viraemia. Humoral responses were determined by measuring HCV specific antibody quantity and specificity. RESULTS A TH response to two or more HCV proteins was present in 18 of 35 patients with serological viral clearance compared with just one of 31 viraemic patients (p = 0.00001). HCV specific interferon-gamma production was increased only in the former group. In contrast, the antibody levels were significantly lower and directed at fewer HCV antigens in patients with undetectable HCV RNA. CONCLUSIONS Patients without viraemia after HCV infection frequently have strong TH lymphocyte responses of the TH1 type to multiple HCV antigens many years after the onset of infection, whereas antibody responses are less marked. These results suggest that control of HCV replication may depend on effective TH lymphocyte activation.
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Affiliation(s)
- M E Cramp
- Institute of Liver Studies, King's College School of Medicine and Dentistry, London SE5, UK
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Abstract
BACKGROUND/AIMS Hepatitis C virus (HCV) infection becomes chronic in most cases, with only 10-20% of those infected not developing persistent viraemia. The immune response to HCV may be an important determinant of disease resolution and can be influenced by a number of host factors. The aim of this study was to assess the role of host HLA class II type in influencing viral clearance or susceptibility to chronic HCV infection. METHODS We have compared the distribution of HLA DRB1, DQA1 and DQB1 alleles in 49 patients with spontaneous clearance of HCV infection (HCV antibody positive but persistently HCV RNA negative), with 55 chronically infected patients and 134 racially matched controls. RESULTS Three alleles were found significantly more frequently in patients with spontaneous viral clearance compared to those with chronic infection-DRB1*04 (pc=0.0022, odds ratio OR=4.52), DQA1*03 (pc=0.0012, OR=4.69) and DQB1*0301 (pc=0.0078, OR=5.09). DQB1*0302 was found at reduced frequency in all HCV-antibody-positive patients compared to controls (pc=0.0063). CONCLUSIONS DRB1*04, DQA1*03 and DQB1*0301 are associated with spontaneous clearance of HCV viraemia, with the primary association likely to be with DQB1*0301 and the associations with DRB1*04 and DQA1*03 being due to linkage. In addition, DQB1*0302 is associated with protection from HCV infection. These findings suggest that host HLA class II genotype is an important factor in determining the outcome of infection with hepatitis C virus.
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Affiliation(s)
- M E Cramp
- Institute of Liver Studies, King's College Hospital, London, UK
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47
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Rossol S, Marinos G, Carucci P, Singer MV, Williams R, Naoumov NV. Interleukin-12 induction of Th1 cytokines is important for viral clearance in chronic hepatitis B. J Clin Invest 1997; 99:3025-33. [PMID: 9185527 PMCID: PMC508155 DOI: 10.1172/jci119498] [Citation(s) in RCA: 174] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Interleukin-12, a cytokine with an important role against intracellular pathogens, promotes Th1 cell development, cellmediated cytotoxicity, and interferon-gamma production. We investigated the immunoregulatory role of IL-12 in 72 chronic hepatitis B virus (HBV) carriers, 33 of whom were monitored longitudinally during interferon-alpha treatment. Serum levels of IL-12 heterodimer, IL-12 p40 subunit, IL-4, and Th1 cytokines were determined by specific ELISAs, and hepatitis B core antigen-specific T cell response by a proliferation assay. Chronic HBV carriers had higher serum levels of IL-12 and IL-12 p40 in comparison with controls (P < 0.01), suggesting that IL-12 production is not impaired. The longitudinal analysis revealed a further substantial increase (> 2.5x baseline level) of bioactive IL-12 and Th1 cytokines in patients who cleared HBV and seroconverted to anti- hepatitis B e, unlike the 23 nonresponders with persistent HBV replication (P < 0.01). The IL-12 peak followed the peak of hepatocytolysis by 9.8+/-2.8 wk and occurred either before or simultaneously with hepatitis B e seroconversion. Hepatitis B core antigen-specific T cell proliferation closely correlated with hepatocytolysis and increased significantly in all patients (8 responders and 15 nonresponders) who developed hepatitis flare, irrespective of the virological outcome. These results provide in vivo evidence that IL-12 may have an important role for viral clearance in chronic HBV infection.
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Affiliation(s)
- S Rossol
- Institute of Liver Studies, King's College School of Medicine & Dentistry, London SE5 9PJ, UK
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48
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Debernardi Venon W, Brunello F, Gubetta L, Lavezzo B, Gastaldi P, Pasquero P, Carucci P, Ciancio A, Marzano A, Salizzoni M, Rizzetto M. Epithelioid haemangioendothelioma of the liver: report of a case submitted to orthotopic liver transplantation. Ital J Gastroenterol 1996; 28:28-30. [PMID: 8743071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A case of hepatic epithelioid haemangio-endothelioma is described in a 42-year-old female who presented with abdominal pain and hepatomegaly. The radiographic finding showed multiple hepatic lesions in both lobes. Diagnosis was based on the liver biopsy. The tumour cells were immunoreactive with factor VIII related antigen and vimentine. A liver transplantation was performed. Although at the time of diagnosis there was no clinical evidence of metastasis, the intra-operatorive examination revealed multiple mesenteric and pulmonary neoplastic nodules. The patient is alive and well seven months after liver transplantation.
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49
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Saracco G, Rosina F, Abate ML, Carucci P, Solinas A, Chiandussi L, Bonino F, Verme G, Rizzetto M. Long-term response to interferon-alfa 2b re-treatment in chronic hepatitis C. J Hepatol 1994; 21:278-9. [PMID: 7989724 DOI: 10.1016/s0168-8278(05)80411-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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50
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Bruno A, Carucci P, Cassader M, Cavallo-Perin P, Gruden G, Olivetti C, Pagano G. Serum glucose, insulin and C-peptide response to oral glucose after intravenous administration of hydrocortisone and methylprednisolone in man. Eur J Clin Pharmacol 1994; 46:411-5. [PMID: 7957534 DOI: 10.1007/bf00191902] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Glucocorticoid-induced glucose intolerance and insulin resistance are dependent on the type of steroid, its dose and route of administration. Although the intravenous (i.v.) route is used mainly, the effects of different steroids have so far been compared using the oral route. The present study was therefore planned to compare the effects on glucose metabolism of hydrocortisone (HC) and methylprednisolone (MP) administered i.v. at equivalent antiinflammatory doses in healthy subjects. Eighteen healthy volunteers with normal glucose tolerance, divided into three groups (A,B,C) matched for age, sex and body mass index were subjected to oral glucose tolerance tests (oGTT) 12 h after HC or MP i.v. injection. The two tests were performed at a 1-month interval and in random sequence. Group A received low doses (HC 100 mg, MP 20 mg), group B intermediate doses (HC 200 mg, MP 40 mg) and group C high doses (HC 400 mg, MP 80 mg). Serum glucose, insulin and C-peptide were measured during both fasting and oGTT. Serum glucose values were not significantly different after HC or MP, during both fasting and oGTT. However, there was a positive correlation between fasting serum glucose or the area under the glucose curve and the dose.kg-1 body weight of HC (r = 0.748; r = 0.462) and MP (r = 0.708; r = 0.736). Serum insulin values were significantly higher after MP than after HC when fasting (A: 115 vs 223; B: 95 vs 215, C: 158 vs 268 pmol.l-1) and as area under the oGTT curve (A: 57.8 vs 87; B: 48.5 vs 92.1; C:57.8 vs 94.5 pmol.l-1 x 2 h).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Bruno
- Istituto di Medicina Interna, Università di Torino, Turin, Italy
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