Takanobu Yoshida

Evaluation of the prognosis for small hepatocellular carcinoma based on tumor volume doubling time. A preliminary report

The relationship of tumor volume doubling time to length of patient survival was investigated for 15 patients with small hepatocellular carcinoma smaller than 4.5 cm in diameter. The mean tumor volume doubling time of these 15 nodules was 102 ± 77 days (mean ± SD; range 41 to 305 days) before the initiation of a specific treatment for cancer. These doubling times tended to correlate with mitotic indexes of the tumors and the patients could be divided into two groups according to the therapeutic modalities used. Patients in Group A received systemic chemotherapy without response or nonspecific treatments for cancer. In this group, there was a positive correlation between tumor volume doubling time and survival length (r = 0.8812; P < 0.025). Patients in Group B either received hepatectomy after transarterial embolization or systemic chemotherapy or received hepatectomy alone. In this group, early death occurred in patients who had shorter tumor volume doubling times. Three surgically treated patients in Group B were evaluated as having survived for a significantly long period as assessed from their tumor volume doubling times. These results indicate that tumor volume doubling time is one of the determining factors of survival length in patients with hepatocellular carcinoma, and, therefore, can be used in the evaluation of therapeutic efficacy.

Bone metastasis in hepatocellular carcinoma

Bone metastasis was observed in 16.1% or in 14 of 87 male autopsy cases of hepatocellular carcinoma. The primary tumor within the liver was located in the right lobe in all but one case. There were six patients who first presented with signs attributable to bone metastasis, and lung metastasis subsequently became evident in five of them. These 6 patients lived significantly longer as compared with 8 other patients with bone metastases and 73 patients without. The possible route by which hepatocellular carcinoma cells were carried to the bone is discussed.

Clinical significance of monitoring serum levels of 5-fluorouracil by continuous infusion in patients with advanced colonic cancer.

SummarySerum concentrations of 5-fluorouracil (5-FU) given by continuous infusion to 19 patients with advanced colonic cancer were measured by an HPLC method, and steady-state concentration (SSc), area under the curve (AUC72) and total body clearance (Cl) were calculated as pharmacokinetic parameters. The serum level of 5-FU rapidly increased, reaching a plateau within 2 h after the start of administration. There were positive correlations between the dose and both SSc (r = 0.578,P <0.01) and AUC72 (r = 0.558,P <0.05). When the patients were divided into toxic and non-toxic groups according to the degree of toxicity, the values for SSc and AUC72 in the toxic group were significantly higher than those in non-toxic patients. The Cl value in the toxic group was also significantly different from that in the non-toxic group when data were calculated on a log scale. Furthermore, no differences in these parameters between effective and non-effective groups were detected when the patients were divided into two groups according to anti-neoplastic responses. These results indicate that increased serum concentration does not always provide therapeutic benefits to patients receiving continuous infusions of 5-FU.

Hepatic artery embolization for inoperable hepatocellular carcinoma; prognosis and Risk Factors

SummaryDuring a 7-year period in our hospital, 69 patients with inoperable hepatocellular carcinoma (HCC) underwent 111 courses of transcatheter hepatic artery embolization (TAE) and/or chemoinfusion with lipiodol. Patient survival was 0.5–37 months following therapy and the factors affecting prognosis were evaluated. Survival rates at 1, 2 and 3 years after TAE were 53%, 24% and 15%, respectively. Survival rates at 1, 2 and 3 years in relation to tumor size were 100%, 100% and 100% in 5 patients (tumor size <2 cm in diameter), 81%, 33% and 16% in 23 patients (2.1–5.0 cm), and 35%, 9% and 0% in 41 patients (>5.1 cm). An analysis of prognostic factors showed that the size of the main tumor significantly influenced the prognosis following TAE (P<0.01), whereas the frequency of TAE, intrahepatic metastasis and the degree of liver dysfunction showed a slight correlation (P<0.1). These results suggest that TAE has a significant potential for becoming the first choice of treatment for patients with small multiple HCCs (<2 cm), provided that neither severe hepatic dysfunction nor a tumor thrombus in the main portal vein is present.

A case of secondary hepatic amyloidosis.

アミロイドージスは臨床的に稀な疾患であり,生前診断は難かしく,従来の報告は剖検例に基くものが多かった.従って検査成績はretrospectiveなものとなり,肝に関する臨床病理は未だ十分確立されていない.最近経験した症例は,両側肺結核症で治療中の51歳の男性で,肝腫を指摘され,検査でAl-pの上昇,BSPの停滞,胃X線で圧排像があり,198Au肝スキャンで右葉全体および左葉一部に欠損様所見がみとめられ,初め肝の悪性腫瘍が疑われた.しかし腹腔鏡では肝に異常なく,両葉から採取した組織に大量のアミロイド沈着がみとめられた.アミロイド沈着による肝病変は右葉に高度で,これは肝血管像からも証明された.この肝病変の部位による差異については,生体反応としての代償性肝細胞再生部位にアミロイド変化が軽いのではないかと考えられるが,これは今後の検討が必要である.(要旨の一部は第9回日本肝臓学会東部会で発表した.)