Kazuta Fukumori

Clinical features of hepatocellular carcinoma seronegative for both HBsAg and anti-HCV antibody but positive for anti-HBc antibody in Japan.

OBJECTIVE:We determined the prevalence of patients with hepatocellular carcinoma (HCC) who were positive for only anti-hepatitis B core (anti-HBc) antibody among 284 Japanese patients and compared their clinical features to those who were hepatitis B surface antigen positive [HBsAg (+)].METHODS:Serum HBsAg and anti-hepatitis C virus (anti-HCV) antibody were examined for all HCC patients. Testing for anti-HBc antibody was performed in the HBsAg(−)/anti-HCV(−) patients. The clinical factors and the survival rate were compared between the HBsAg(+) patients (HCC-B) and those positive for anti-HBc alone (HCC-PB).RESULTS:There were 19 (6.7%) HBsAg(+), 236 (83.1%) anti-HCV(+), seven (2.5%) HBsAg(+)/anti-HCV(+), and 22 (7.7%) HBsAg(−)/anti-HCV(−) among the 284 patients tested. Sixteen (72.7%) of the 22 HBsAg(−)/anti-HCV(−) patients were assigned to the HCC-PB group. The prevalence of positivity for anti-HBc alone among all 284 HCC patients was 5.6%. Significant differences between the HCC-PB and HCC-B groups were that age at diagnosis was higher in the HCC-PB group (72.1 yr) than in the HCC-B group (56.2 yr) (p < 0.001), the serum α-fetoprotein concentrations were lower in the HCC-PB group (8.2 ng/ml) than in the HCC-B group (43 ng/ml) (p = 0.0488), and a higher familial history of liver disease was observed in the HCC-B group (p = 0.0373). However, there was no significant difference in the cumulative survival rate.CONCLUSIONS:Positivity for anti-HBc alone is not rare compared to HBsAg(+), and the clinical features of positivity for anti-HBc alone are similar to those of HBsAg(+). Some differences in the clinical features between the two groups may be explained by differences in the time of first exposure to hepatitis B virus. Therefore, the natural course of acute hepatitis B may be reconsidered.

Chemotherapy for Hepatocellular Carcinoma with Portal Hypertension Due to Tumor Thrombus

A case of hepatocellular carcinoma (HCC) complicated by tumor thrombosis of the main trunk is presented. Four courses of hepatic arterial infusion therapy, via a subcutaneously implanted injection port, were performed using cisplatin (10 mg for 1 hour on days 1-5) and 5-fluorouracil (250 mg for 5 hours on days 1-5). After four courses of the chemotherapy, marked reduction in size of HCC and the tumor markers were noted. The esophageal varices and ascites were improved after the chemotherapy with a recanalization of the left branch of the portal vein. The patient was doing well with a survival period of 28 months after the chemotherapy. These encouraging results suggested that the present therapy, based on the biochemical modulation, was a useful option for advanced HCC with portal hypertension due to tumor thrombosis of the main portal vein.

Phase II Trial of Hepatic Arterial Infusion Chemotherapy Using Cisplatin and 5-Fluorouracil in Patients with Advanced Hepatocellular Carcinoma

We investigated the effect of hepatic artery infusion (HAI) chemotherapy on advanced hepatocellular carcinoma. Ten milligrams per hour of cisplatin for 1 h and subsequently 250mg/h for 5h of 5-fluorouracil were administered using a subcutaneously implanted vascular access device (an injection port) for 5 consecutive days followed by 2 days rest. One course consisted of repetition of the above dosage regimen for 4 weeks. We treated 77 patients with advanced hepatocellular carcinoma (HCC), excluding nodular-type tumors indicated for chemoembolization, percutaneous ethanol injection therapy, or hepatic resection. Vascular invasion was seen in 28 patients and distant metastasis was seen in 7 patients. Of patients with advanced HCC, 77% were at tumor stage IV. Ten patients (13%) had a complete response, 25 (32%) had a partial response, 30 (39%) exhibited no change, and 12 (16%) had progressive disease. The response rate was thus 46%. Estimated 1-year, 2-year, and 3-year survival by the Kaplan-Meier method in 77 patients was 56%, 28%, and 19%, respectively. According to a multivariate analysis, the effects of initial therapy (P > .0001) and the Child-Pugh grade (P = .0012) were significant prognostic factors. A survival benefit was noted in patients with portal vein invasion (1-year survival rate: 43%, 2- year survival rate: 24%) when compared with reported results, and HAI was considered to be the first choice for unresectable cases. Adverse reactions of patients were tolerable and included transient nausea, loss of appetite, and mild thrombocytopenia. In conclusion, HAI chemotherapy with the regimen described achieved favorable results, and is useful in treating patients with advanced HCC not indicating chemoembolization, hepatic resection, or ethanol injection therapy.

A crossover study of oral administration of UFT in chronic liver disease: comparison of continuous and intermittent schedules.

This study was aimed at evaluating the tolerance to an intermittently administered oral UFT for hepatocellular carcinoma (HCC) with chronic liver disease (CLD). Ten patients who had received curative therapy for HCC with CLD (Childs classification A or B) were randomly assigned either an intermittent schedule (IS), oral administration of UFT (130 mg/m2/b.i.d.) with 2 days rest a week, or a continuous schedule (CS), consecutive administration of UFT with the same dose. On day 12, the serum concentration of 5-fluorouracil (5-FU) was measured. After 2 weeks rest, the patients were switched to the other schedule for 10 weeks and the concentration of 5-FU was measured on day 12. The median values of the area under the curve (AUC) and maximum concentration (Cmax) of 5-FU in IS and CS were 187.7 and 263.2 ng/ml/h, 57.1 and 93.0 ng/ml, respectively. Both the AUC and Cmax for IS were significantly lower than those for CS. One IS patient had tolerable diarrhea, while three of the CS patients had intolerable nausea and one had hemorrhagic gastritis. IS seemed to be a suitable measure for CLD.