Yasuhiro Sakaguchi

Long-Term Interferon Maintenance Therapy Improves Survival in Patients with HCV-Related Hepatocellular Carcinoma after Curative Radiofrequency Ablation

Objective: To assess whether low-dose, long-term maintenance interferon (IFN) therapy inhibits recurrence after complete ablation of hepatocellular carcinoma (HCC) and improves patient survival. Methods and Patients: From June 1999 through May 2006, a total of 127 HCC cases that met the requirements of both tumor diameter 3 cm or less, and number of tumors three or fewer, were curatively treated by radiofrequency ablation therapy (RFA). Among them, 43 patients received three million IU of IFN-α2b twice per week or pegylated IFN-α2a 90 µg once per week or once per 2 weeks without discontinuation (IFN maintenance group). The remaining 84 patients, whose sex, age, and platelet counts were randomly matched to those of the IFN maintenance group, did not receive IFN treatment (control group). Results: Cumulative first, second, and third recurrence rates were significantly reduced in the IFN maintenance group compared with the control group by Kaplan-Meier estimate. The 5-year survival rate was 66% for the control group and 83% for the IFN maintenance group (p = 0.004). Multivariate analysis using the Cox proportional hazards model identified IFN maintenance therapy as an independent risk factor for survival, and the risk ratio was 0.21 (95% CI: 0.05–0.73). In conclusion, low-dose, long-term maintenance IFN therapy after curative RFA therapy of HCC significantly inhibits recurrence, and consequently improves patient survival.

Percutaneous ultrasound-guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma in the hepatic dome

BackgroundNodules of hepatocellular carcinoma (HCC) located in the hepatic dome cannot be depicted on ultrasography because of pulmonary air. Therefore, percutaneous treatment is not possible in such cases. The purpose of this study was to clarify the feasibility and safety of percutaneous sonographically guided radiofrequency (RF) ablation with the concurrent use of artificial pleural effusion for HCC located in the right subphrenic region.MethodsBetween May 2001 and June 2002, 24 patients with 28 HCC nodules located directly below the diaphragm were enrolled in this study. The patient population included 17 men and 7 women (age range, 51–87 years; mean age, 66.5 years). The maximum diameter of the HCC nodules ranged from 1.0 cm to 4 cm (mean ± SD, 2.1 ± 0.8 cm).ResultsWe infused 200–1100 ml of 5% glucose solution intrathoracically to separate the lung and liver; thus, obtaining an image of the whole tumor was impossible on gray-scale sonography. Complete tumor necrosis was achieved in a single session of RF ablation in 27 (96.4%) of the 28 lesions, while two sessions of RF ablation were required for the remaining lesion (3.6%). During treatment, no dyspnea or other complications concerned with the respiratory system were observed. Clinical courses have been satisfactory without recurrences at 1–13 months after treatment (mean, 7.9 months).ConclusionsPercutaneous RF ablation with artificial pleural effusion in patients with HCC in the hepatic dome may be a safe and feasible therapy.

Low-Dose, Long-Term, Intermittent Interferon-alpha-2b Therapy after Radical Treatment by Radiofrequency Ablation Delays Clinical Recurrence in Patients with Hepatitis C Virus-Related Hepatocellular Carcinoma

Objective: To assess whether or not interferon (IFN) therapy prevents recurrence, and eventually improves the prognosis of patients with hepatocellular carcinoma (HCC) after completion of radical radiofrequency ablation (RFA) therapy. Methods: Included as the IFN group in this study were 24 patients in total, who received radical RFA therapy first, followed by medication with IFN-α2b at such a low dose of 3 MIU × 2/week for as long as possible. On the other hand, the control group comprised 33 patients in total, who received radical RFA therapy without subsequent treatment with IFN. The control group was matched to the IFN group in age, platelet counts and size of nodules. Results: Of the 24 patients treated with IFN, only one patient showed sustained virologic response. The median tumor-free period until the first recurrence after radical RFA therapy was 3.4 years in the IFN group and 1.4 years in the control group (p = 0.02). During the first 3 years after commencement of IFN administration, the cumulative recurrence rate in the IFN group was found to be lower than in the control group (p = 0.01); however, with the lapse of time over 3 years, the recurrence rate in the IFN group increased. There was no difference in the cumulative survival rates between the IFN group and the control group (p = 0.25). Conclusion: Subsequently after radical RFA therapy, long-term, low-dose, intermittent IFN therapy successfully delayed clinical recurrence of HCC.

Comparison of three current staging systems for hepatocellular carcinoma : Japan integrated staging score, new Barcelona Clinic Liver Cancer staging classification, and Tokyo score

Background and Aim:  Although various staging systems for hepatocellular carcinoma (HCC) have been developed in recent years, there is no worldwide consensus which staging system is best. The aim of the present study was to compare the performance of the currently developed three staging systems: the Japan integrated staging (JIS) score, new Barcelona Clinic Liver Cancer (BCLC) staging classification, and the Tokyo score.

Clinical characteristics of NonBNonC- HCC: Comparison with HBV and HCV related HCC.

Objective: To clarify the frequency and trends of both HBsAg and HCVAb negative hepatocellular carcinoma (NonBNonC-HCC) in all HCC, to clarify the etiology of NonBNonC-HCC, and to elucidate the clinical characteristics of NonBNonC-HCC compared with those of HBsAg-positive HCC (B-HCC) and HCVAb-positive HCC (C-HCC). Methods: A total of 2,542 patients with HCC examined at three institutions between 1991 and 2004 were categorized based on their serum viral antigen/antibody positivities, and compared between groups for the etiology, annual trend of the incidence, and clinical characteristics. Results: For the etiology, C-HCC was most prevalent, followed by B-HCC, NonBNonC-HCC, and both HBsAg and HCVAb-positive HCC (BC-HCC) in order. For survival, C-HCC had the most favorable prognosis, followed by NonBNonC-HCC, and B-HCC patients had the poorest prognosis in the three groups (C-HCC, B-HCC, and NonBNonC-HCC). In tumor-node metastasis (TNM) stages I+II, however, NonBNonC-HCC patients took the most favorable clinical course. The incidence of NonBNonC-HCC in all HCC was 5–8% from 1991 to 1998, and has increased to 10–12% since 1999. Additionally, the incidence of HBcAb-positive HCC in NonBNonC-HCC declined each year. Among NonBNonC-HCC patients, the morbidity of diabetic complications was significantly higher in HBcAb-negative patients than in HBcAb-positive patients. Conclusion: Although the incidence of NonBNonC-HCC among all HCC has an increasing trend recently, the incidence of HBcAb-positive HCC in NonBNonC-HCC has a tendency of decreasing. This fact suggest its etiology might be changing from occult HBV related HCC to unknown etiology such as nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) related HCC. The prognosis of NonBNonC-HCC was fairly good if the HCC was found in its early stage.

Review of current staging systems for hepatocellular carcinoma

Several staging systems have been developed to classify patients with hepatocellular carcinoma (HCC), however, there is no consensus on which of these is the most useful and reliable. In this review article, currently available integrated staging systems taking into account both liver function and tumor progression are presented, and their characteristics and applicability for current HCC patients, many of whom are diagnosed in the early stage of the disease and treated by curative therapy, are discussed. Based on the original andsubsequent validation studies of these staging systems, we recommend that further validation studies of staging systems for HCC should focus on the revised Barcelona Clinic Liver Cancer (BCLC) staging classification, Japan Integrated Staging (JIS) score and Tokyo score.

Hepatic angiomyolipoma: identification of an efferent vessel as a hepatic vein by contrast-enhanced harmonic sonography.

Two cases of hepatic angiomyolipoma were studied by contrast-enhanced harmonic sonography. The special tumor hemodynamics, namely the efferent blood flow of the hepatic angiomyolipoma draining into the hepatic vein, were clearly shown on harmonic imaging, and they corresponded well with those seen on angiography and computed tomography during angiography. Benign hepatic tumors were diagnosed preoperatively in both cases according to the hemodynamic findings. Hepatic angiomyolipoma was finally identified histologically. The special tumor hemodynamics might be one of the important characteristics of hepatic angiomyolipoma. Contrast-enhanced harmonic sonography is useful for the detection of special tumor hemodynamics and may facilitate the differential diagnosis from other hepatic tumors, especially malignant liver tumors.

Multiple metastases from a meningeal hemangiopericytoma associated with severe hypoglycemia.

Hemangiopericytomas are rare vascular tumors that may be associated with profound hypoglycemia. We present correlative imaging findings for a 57-year-old woman who had multiple abdominal and muscular metastases with severe hypoglycemia 11 years after resection of meningeal hemangiopericytoma. The metastases were well-defined masses containing solid and cystic components, and they were extremely hypervascular in the solid component. Those characteristics on imaging associated with hypoglycemia and the past history of meningeal hemangiopericytoma may suggest the diagnosis and be helpful in differentiating the mass from other vascular tumors. Color and power Doppler ultrasound may play a valuable role in characterizing and diagnosing metastasis from hemangiopericytoma. A delay of several years between diagnosis of the primary hemangiopericytoma and the manifestation of metastasis appears to be a special feature of hemangiopericytoma.

Hemodynamic and morphologic changes of peripheral hepatic vasculature in chronic liver disease : a preliminary study by contrast-enhanced coded phase-inversion harmonic sonography

To investigate whether observing the morphology of the peripheral hepatic vasculature and the hemodynamics of microbubble arrival time in these vessels can provide useful information for the diagnosis of liver disease, Five normal volunteers and 16 patients were studied by contrast-enhanced coded phase-inversion harmonic sonography. Vessel images of the peripheral vessels were observed in real time after intravenous injection of Levovist. The time when the microbubbles appeared in the peripheral vessels was measured. Three patterns of morphologic change of the peripheral hepatic vasculature were seen, marked, slight, and no abnormal changes. The microbubble arrival times at the peripheral vessels were all shorter in patients with cirrhosis than chronic hepatitis or normal subjects. Marked, slight, and no abnormal morphologic changes of the peripheral hepatic vasculature in patients with liver cirrhosis were found in five, one and zero of the six patients, respectively. Those patients with chronic hepatitis, were found in one, six and three of the ten patients, respectively. There was a significant difference among the different groups (P < 0.001). Evaluating the hemodynamics and morphology by contrast-enhanced coded pulse-inversion harmonic sonography may offer useful information in the diagnosis of liver disease.

Atypical focal spared area in fatty liver: evaluation by color Doppler ultrasonography.

Ultrasonography often detects focal spared areas in fatty livers. One etiology was attributed to aberrant venous drainage. On ultrasonography images the lesions usually appear wedge-shaped, irregularly shaped, or, less frequently, round. We report a rare case of an irregular, hourglass-shaped focal spared area in segment IV of the liver resulting from the coexistence of an aberrant right gastric vein and anastomoses between the aberrant vein and the portal branches as well as a portohepatic venous shunt.