Masatoshi Akamatsu

Prediction of recurrence of hepatocellular carcinoma after curative ablation using three tumor markers

Three tumor markers for hepatocellular carcinoma (HCC) are available in daily practice in Japan: alpha‐fetoprotein (AFP), des‐gamma‐carboxy prothrombin (DCP), and lens culinaris agglutinin‐reactive fraction of alpha‐fetoprotein (AFP‐L3). To elucidate the predictability of these tumor markers on HCC recurrence after curative ablation, we enrolled 416 consecutive patients with naïve HCC who had been treated by percutaneous ablation at our department from July 1997 to December 2002. Tumor marker levels were determined immediately before and 2 months after the treatment. Complete ablation was defined on CT findings as nonenhancement in the entire lesion with a safety margin. Tumor recurrence was also defined as newly developed lesions on CT that showed hyperattenuation in the arterial phase with washout in the late phase. We assessed the predictability of recurrence via tumor markers in multivariate analysis, using proportional hazard regression after adjusting for other significant factors in univariate analysis. Until the end of follow‐up, tumor recurrence was identified in 277 patients. Univariate analysis revealed the following factors to be significant for recurrence: platelet count; size and number of tumors; AFP, AFP‐L3, and DCP preablation; and AFP and AFP‐L3 postablation. Multivariate analysis indicated that AFP >100 ng/mL and AFP‐L3 >15%, both pre‐ and postablation, were significant predictors. The positivity of AFP and AFP‐L3 preablation that turned negative postablation was not significant. In conclusion, tumor markers pre‐ and post‐ablation were significant predictors for HCC recurrence and can complement imaging modalities in the evaluation of treatment efficacy. (HEPATOLOGY 2006;44:1518–1527.)

Evaluation of transcatheter arterial embolization prior to percutaneous tumor ablation in patients with hepatocellular carcinoma: a randomized controlled trial.

Abstract: Background: Transcatheter arterial embolization (TAE) may reduce the risk of hepatocellular carcinoma (HCC) recurrence when performed before percutaneous tumor ablation (PTA), either percutaneous ethanol injection therapy (PEIT) or radiofrequency ablation (RFA). We conducted a randomized, controlled trial comparing the use of TAE combined with percutaneous ethanol injection therapy (TAE/PEIT) to the use of PEIT only to assess the effects on HCC recurrence and survival. We continued the study after the introduction of RFA and compared TAE combined with RFA (TAE/RFA) with RFA only.

Congenital absence of portal vein with multiple hyperplastic nodular lesions in the liver

Congenital absence of the portal vein is an extremely rare anomaly, in which enteric blood bypasses the liver and drains into the inferior vena cava. A 16-year-old girl was referred to our hospital presenting with liver tumor. Although she had suffered from galactosemia soon after birth, the galactosemia had improved spontaneously 1 year later. Between the ages of 8 and 12 years, chronic hepatitis with a mild elevation of aspartate transaminase (AST) and alanine transaminase (ALT) was observed, but liver tumor had not been detected on computed tomography (CT) in regular medical examinations. However, at age 16, liver tumors, 10 cm in diameter, were found. Abdominal angiography indicated complete absence of the portal vein, suggesting that enteric blood was bypassing the liver and draining into the inferior vena cava. In biopsy specimens obtained under ultrasonographic guidance, liver tumors were confirmed histologically as hyperplastic nodules. In addition to this case report, the clinical features of 25 reported cases of congenital absence of the portal vein are reviewed.

Health‐related quality of life of chronic liver disease patients with and without hepatocellular carcinoma

Background and Aim:  Impaired health‐related quality of life has been reported in patients with cirrhosis and chronic hepatitis. However, only limited data are available concerning the influence of hepatocellular carcinoma.

Sustained viral response prolonged survival of patients with C-viral hepatocellular carcinoma

Abstract: Background: We conducted this retrospective study to evaluate the position of interferon therapy in the curative treatment of hepatitis C virus‐associated hepatocellular carcinoma (HCC).

Analysis of factors influencing hepatocellular carcinoma detection : efficient use of computed tomography during arterial portography and during hepatic arteriography

BackgroundThis study was performed to investigate the situations in which computed tomography (CT) combined with arterial portography and hepatic arteriography surpassed dynamic CT in the detection of hepatocellular carcinoma.MethodsComputed tomography combined with arterial portography and hepatic arteriography was performed on 137 patients with chronic hepatitis (92 men and 45 women; mean age, 66.5 years) with hepatocellular carcinoma (HCC) as revealed or suspected by dynamic CT. We analyzed the clinical factors leading to the discovery of additional HCC lesions on CT combined with arterial portography and hepatic arteriography that were undetected by dynamic CT.ResultsComputed tomography combined with arterial portography and hepatic arteriography detected additional HCC lesions that had not been revealed by dynamic CT in 33 of 137 patients. Univariate analysis revealed that in the event of HCC recurrence (vs. primary), multiple HCC lesions detected by dynamic CT (vs. single) and decreased liver function (Child’s classification B/C vs. A) significantly favored the additional detection of HCC lesions. Multivariate logistic regression indicated that recurrence was the strongest predicting factor for finding additional lesions on computed tomography combined with arterial portography and hepatic arteriography.ConclusionsComputed tomography combined with arterial portography and hepatic arteriography is capable of finding additional HCC lesions undetectable by dynamic CT, especially in advanced cases such as HCC recurrence, which may affect the choice of treatment.

Neither hepatitis C virus genotype nor virus load affects survival of patients with hepatocellular carcinoma.

Objective Hepatitis C virus (HCV) genotype and virus load, the strongest determinants of the efficacy of interferon therapy, have been presumed to be associated with risk for hepatocellular carcinoma (HCC). This study was conducted to elucidate whether these two factors are capable of predicting the prognosis of patients with HCC. Methods A total of 371 patients with HCV infection (258 men and 113 women; median age, 66 years; range, 37–88 years) who developed HCC between January 1993 and December 1999 were enrolled. Overall survival and recurrence-free survival were analysed with the Cox proportional hazard regression according to HCV genotype (type 1 versus type 2) and virus load (above versus below 100 kIU/ml). Results Of the 371 patients, 346 received locoregional treatments (ethanol injection, microwave, radiofrequency, or surgery), and 307 achieved complete response as determined by subsequent imaging studies. The remaining 25 patients underwent arterial embolization or chemotherapy. Cox proportional hazard regression showed that neither genotype (P = 0.814) nor virus load (P = 0.958) were significant predictors for survival (P = 0.814 and 0.958, respectively) and recurrence (P = 0.505 and 0.736, respectively). Conclusions Neither genotype nor virus load of HCV affected prognosis of HCC patients.

A new method for insertion of long intestinal tube for small bowel obstruction: Nonendoscopic over-the-wire method via short nasogastric tube.

AbstractIt is often difficult to insert a long intestinal tube (LT) in patients with small bowel obstruction (SBO). We developed a novel technique for inserting an LT without endoscopy called nonendoscopic over-the-wire method via short nasogastric tube (NEWSt). We evaluated the efficacy and safety of NEWSt.We performed a retrospective study of patients who underwent LT insertion for SBO without any indications of strangulation with either NEWSt (n = 16) or endoscopy (n = 17) between November 2011 and February 2015 at our hospital. Univariate analysis was used to assess the success rate of LT placement beyond the duodenojejunal flexure, time required for the procedure, clinical outcomes, and adverse events.The success rate was 100% in both groups. Procedure time was numerically, but not statistically, shorter in the NEWSt group compared with the endoscopy group (24 ± 13 vs 30 ± 13 min; P = 0.174). There were no statistically significant differences between the 2 groups in terms of surgery rate (31% vs 12%; P = 0.225), fasting period (11.3 ± 6.3 vs 9.9 ± 4.5 days; P = 0.482), hospital stay (26.4 ± 22.1 vs 18.7 ± 7.0 days; P = 0.194), and recurrence rate (19% vs 24%; P = 1.0). No serious adverse event was observed in the NEWSt group, whereas serious aspiration pneumonia was observed in 2 patients after LT insertion in the endoscopy group.Without endoscopy, NEWSt enabled the high success rate and the short procedure time for the LT insertion. Prospective, randomized controlled trials are needed.

Percutaneous Ethanol Injection Therapy, Percutaneous Infarction Therapy, and Percutaneous Microwave Coagulation Therapy for Hepatocellular Carcinoma

Nonsurgical treatments play important roles in the treatment of hepatocellular carcinoma. At our institute, more than 90% of new patients with hepatocellular carcinoma have been treated by percutaneous ethanol injection therapy (PEIT) or other percutaneous tumor ablations. Here we describe our experience in those procedures. Between 1985 and 1997, we performed PEIT on 653 patients, and the 1-, 3-, 5-, and 10-year survival rates were 89%, 63%, 38%, and 18%. In 349 patients who had three or fewer lesions and all of whose lesions were 3 cm or less in diameter, the survival rates were 93%, 74%, 47%, and 26% at 1, 3, 5, and 10 years. In percutaneous infarction therapy (PIT), ethanol is injected into the feeding artery, as detected by color Doppler ultrasonography, to cut off the blood flow to the tumor. Successful PIT induces infarction of an area in which the lesion is located. We performed PIT on 18 patients and achieved infarction in 17 of them. PIT is especially useful for a large lesion located in a peripheral portion of the liver. Percutaneous microwave coagulation therapy (PMCT) is a therapy in which heat produced by microwave energy emitted from the inserted electrode destroys the cancer tissue. Using an introducing needle with a scale, a stopper for the electrode, and a guide needle, we performed PMCT on 108 patients. CT scan following the therapy demonstrated complete necrosis of the lesion in 94 cases. Effective mass reduction was accomplished in the remaining 14 cases in which PMCT was used only palliatively. PMCT can surely destroy a certain amount of tissue, although its necrotic area is smaller than that of PEIT. Percutaneous tumor ablation techniques seem useful for hepatocellular carcinoma treatment.