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Gastrinoma and Zollinger Ellison syndrome:A roadmap for the management between new and old therapies

World Journal of Gastroenterology 2021年第35期27卷 5890-5907页

作者： Roberta Elisa Rossi Alessandra Elvevi davide citterio Jorgelina Coppa Pietro Invernizzi Vincenzo Mazzaferro Sara Massironi HPB Surgery Hepatology and Liver TransplantationENETS Center of ExcellenceFondazione IRCCS Istituto Nazionale Tumori(INTNational Cancer Institute)Milan 20133Italy Department of Pathophysiology and Transplantation University of MilanMilan 20122Italy Division of Gastroenterology and Center for Autoimmune Liver Diseases Department of Medicine and SurgeryUniversity of Milano-BicoccaMonza 20900Italy European Reference Network on Hepatological Diseases(ERN RARE-LIVER) San Gerardo HospitalMonza 20033Italy Department of Oncology and Hemato-Oncology University of MilanMilan 20122Italy

Zollinger-Ellison syndrome(ZES)associated with pancreatic or duodenal gastrinoma is characterized by gastric acid hypersecretion,which typically leads to gastroesophageal reflux disease,recurrent peptic ulcers,and chronic *** symptoms of ZES are nonspecific and overlap with other gastrointestinal disorders,the diagnosis is often delayed with an average time between the onset of symptoms and final diagnosis longer than 5 *** critical step for the diagnosis of ZES is represented by the initial clinical *** is the hallmark of ZES;however,hypergastrinemia might recognize several causes,which should be ruled out in order to make a final *** levels>1000 pg/mL and a gastric pH below 2 are considered to be diagnostic for gastrinoma;some specific tests,including esophageal pH-recording and secretin test,might be useful in selected cases,although they are not widely *** ultrasound is very useful for the diagnosis and the local staging of the primary tumor in patients with ZES,particularly in the setting of multiple endocrine neoplasia type *** controversies about the management of these tumors also *** the localized stage,the combination of proton pump inhibitory therapy,which usually resolves symptoms,and surgery,whenever feasible,with curative intent represents the hallmark of gastrinoma *** high expression of somatostatin receptors in gastrinomas makes them highly responsive to somatostatin analogs,supporting their use as anti-proliferative agents in patients not amenable to surgical *** medical options for advanced disease are super-imposable to other neuroendocrine neoplasms,and studies specifically focused on gastrinomas only are scant and often limited to case reports or small retrospective *** multidisciplinary approach remains the cornerstone for the proper management of this composite ***,we reviewed available literature about gastrinoma-associated ZES wit

关键词： Gastrinoma Zollinger-Ellison syndrome Neuroendocrine neoplasms Pancreatic neuroendocrine neoplasm Duodenal neuroendocrine neoplasm Diagnosis Therapy

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Therapeutic strategies for post-transplant recurrence of hepatocellular carcinoma

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World Journal of Gastroenterology 2022年第34期28卷 4929-4942页

作者： Carlo Sposito davide citterio Matteo Virdis Carlo Battiston Michele Droz Dit Busset Maria Flores Vincenzo Mazzaferro HPB Surgery Hepatology and Liver TransplantationFondazione IRCCS Istituto Nazionale Tumori di MilanoMilan 20133Italy Department of Oncology and Hemato-Oncology University of MilanMilan 20100Italy

Despite stringent selection criteria,hepatocellular carcinoma recurrence after liver transplantation(LT)still occurs in up to 20%of cases,mostly within the first 2–3 *** adjuvant treatments to prevent such an occurrence have been developed so ***,a balanced use of immunosuppression with minimal dose of calcineurin inhibitors and possible addition of mammalian target of rapamycin inhibitors is strongly ***,several pre-and posttransplant predictors of recurrence have been identified and may help determine the frequency and duration of post-transplant *** recurrence occurs,the outcomes are poor with a median survival of 12 mo according to most retrospective *** factor that most impacts survival after recurrence is timing(within 1–2 years from LT according to different authors).Several therapeutic options may be chosen in case of recurrence,according to timing and disease *** treatment seems to provide a survival benefit,especially in case of late recurrence,while the benefit of locoregional treatments has been suggested only in small retrospective *** systemic treatment is indicated,sorafenib has been proved safe and effective,while only few data are available for lenvatinib and regorafenib in second *** use of immune checkpoint inhibitors is controversial in this setting,given the safety warnings for the risk of acute rejection.

关键词： Liver transplantation Hepatocellular carcinoma Immunosuppression Recurrence Surgical treatment Locoregional treatment Systemic treatment

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Competing risk analysis on outcome after hepatic resection of hepatocellular carcinoma in cirrhotic patients

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World Journal of Gastroenterology 2017年第8期23卷 1469-1476页

作者： Alessandro Cucchetti Carlo Sposito Antonio Daniele Pinna davide citterio Matteo CesconMarco Bongini Giorgio Ercolani Christian Cotsoglou Lorenzo Maroni Vincenzo Mazzaferro Department of Medical and Surgical Sciences DIMECS.Orsola-Malpighi HospitalAlma Mater StudiorumUniversity of Bologna Gastrointestinal Surgery and Liver Transplantation Fondazione IRCCS Istituto Nazionale Tumori(National Cancer Institute

To investigate death for liver failure and for tumor recurrence as competing events after hepatectomy of hepatocellular *** from 864 cirrhotic Child-Pugh class A consecutive patients, submitted to curative hepatectomy (1997-2013) at two tertiary referral hospitals, were used for competing-risk analysis through the Fine and Gray method, aimed at assessing in which circumstances the oncological benefit from tumour removal is greater than the risk of dying from hepatic decompensation. To accomplish this task, the average risk of these two competing events, over 5 years of follow-up, was calculated through the integral of each cumulative incidence function, and represented the main comparison *** a median follow-up of 5.6 years, death was attributable to tumor recurrence in 63.5%, and to liver failure in 21.2% of cases. In the first 16 mo, the risk of dying due to liver failure exceeded that of dying due to tumor relapse. Tumor stage only affects death from recurrence; whereas hepatitis C infection, Model for End-stage Liver Disease score, extent of hepatectomy and portal hypertension influence death from liver failure (P < 0.05 in all cases). The combination of these clinical and tumoral features identifies those patients in whom the risk of dying from liver failure did not exceed the tumour-related mortality, representing optimal surgical candidates. It also identifies those clinical circumstances where the oncological benefit would be borderline or even where the surgery would be *** knowledge of these competing events can be used to weigh the risks and benefits of hepatic resection in each clinical circumstance, separating optimal from non-optimal surgical candidates.

关键词： Hepatocellular carcinoma Liver failure Hepatic resection Survival Competing risk Tumour recurrence

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