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Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients

World Journal of Gastroenterology 2012年第44期18卷 6398-6408页

作者： Alessandro Cucchetti Matteo Cescon franco trevisani Antonio Daniele Pinna General Surgery and Transplant Unit Department of General Surgery and Organ TransplantationAlma Mater StudiorumUniversity of Bologna40138 BolognaItaly Department of Clinical Medicine Semeiotica MedicaS.Orsola-Malpighi HospitalAlma Mater StudiorumUniversity of BolognaVia Massarenti 940138 BolognaItaly

Hepatocellular carcinoma(HCC) is one of the most frequent neoplasms worldwide and in most cases it is associated with liver *** resection is considered the most potentially curative therapy for HCC patients when liver transplantation is not an option or is not immediately *** review is aimed at investigating the current concepts that drive the surgical choice in the treatment of HCC in cirrhotic patients;Eastern and Western perspectives are *** extensive literature review of the last two decades was performed,on topics covering various aspects of hepatic *** post-operative and long-term outcome measures adopted were firstly analyzed in an attempt to define an optimal standardization useful for research *** need to avoid the development of post-hepatectomy liver failure represents the "conditio sine qua non" of surgical choice and the role of the current tools available for the assessment of liver function reserve were *** of hepatic resection in relationship with tumor burden were compared with those of available competing strategies,namely,radiofrequency ablation for early stages,and trans-arterial chemoembolization for intermediate and advanced ***,the choice for anatomical versus non-anatomical,as well as the role of laparoscopic approach,was *** literature review suggests that partial hepatectomy for HCC should be considered in the context of multi-disciplinary evaluation of cirrhotic *** research on HCC has moved,in recent years,from surgical therapy toward non-surgical approaches and most of the literature regarding topics debated in the present review is represented by observational studies,whereas very few well-designed randomized controlled trials are currently available;thus,no robust recommendations can be derived.

关键词： Hepatocellular carcinoma Hepatic resec-tion Surgical therapy Ablation techniques Transplan-tation Survival Liver failure

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Ramucirumab as a second-line treatment for hepatocellular carcinoma: reaching out further to patients with elevated alpha-fetoprotein

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Hepatobiliary Surgery and Nutrition 2019年第5期8卷 515-518页

作者： Edoardo G.Giannini franco trevisani Gastroenterology Unit Department of Internal MedicineOspedale Policlinico San Martino IRCCS per l’OncologiaUniversity of GenoaGenoaItaly Medical Semeiotics Unit Sant’Orsola HospitalAlma Mater Studiorum University of BolognaBolognaItaly

Hepatocellular carcinoma(HCC)occurs at a rate of 3-5%per year in patients with compensated cirrhosis,and itoften represents the first disease complication and themain cause of death in these patients(1).Surveillance forHCC is recommended by all liver disease associations,as it increases patient survival mainly as a result of earlydiagnosis of the tumour,allowing most patients to conveyto curative treatments(2,3).

关键词： diagnosis treatment curative death

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Surveillance for early diagnosis of hepatocellular carcinoma: How best to do it?

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World Journal of Gastroenterology 2013年第47期19卷 8808-8821页

作者： Edoardo G Giannini Alessandro Cucchetti Virginia Erroi Francesca Garuti Federica Odaldi franco trevisani Dipartimento di Medicina Interna Unità di GastroenterologiaUniversità di GenovaIRCCS-Azienda Ospedaliera San Martino-IST16155 GenovaItaly Dipartimento di Scienze Mediche Chirurgiche Unità di Chirurgia Generale e dei Trapianti40138 BolognaItaly Dipartimento di Scienze Mediche Chirurgiche Unità di Semeiotica MedicaAlma Mater Studiorum-Università di Bologna40138 BolognaItaly

Surveillance for hepatocellular carcinoma(HCC)is considered a standard of care for patients with chronic liver disease who are at risk of developing this *** studies have shown that surveillance can improve the prognosis of patients diagnosed with HCC through an increased likelihood of application of curative or effective *** of liver ultrasonography(US)every 6 mo is the recommended surveillance program to detect early HCCs,and a positive US has to entrain a well-defined recall policy based on contrast-enhanced,dynamic radiological imaging or biopsy for the diagnosis of *** HCC fulfills the accepted criteria regarding cost-effective cancer screening and surveillance,the implementation of surveillance in clinical practice is defective and this has a negative impact on the cost-effectiveness of the *** of both physicians and patients is of paramount importance in order to improve the surveillance application and its benefits in patients at risk of *** promotion of specific educational programs for practitioners,clinicians and patients is instrumental in order to expand the correct use of surveillance in clinical practice and eventually improve HCC prognosis.

关键词： Hepatocellular carcinoma Surveillance Screening Ultrasonography Cost-effectiveness

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How albumin administration for cirrhosis impacts on hospital albumin consumption and expenditure

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World Journal of Gastroenterology 2011年第30期17卷 3479-3486页

作者： Federica Mirici-Cappa Paolo Caraceni Marco Domenicali Ernesto Gelonesi Barbara Benazzi Giacomo Zaccherini franco trevisani Cristina Puggioli Mauro Bernardi Department of Clinical Medicine Alma MaterS tudiorumUniversity of Bologna40126 BolognaItaly UO Pharmacology S Orsola-Malpighi University Hospital40138 BolognaItaly

AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver ***:Although randomized trials and guidelines support albumin administration for some complications of cirrhosis,the high cost of albumin greatly limits its use in clinical *** 2003,a multidisciplinary panel at Sant'Orsola-Malpighi University Hospital(Bologna,Italy)used a literature-based consensus method to list all the acute and chronic conditions for which albumin is indicated as first-or second-line *** in hepatology included prevention of post-paracentesis circulatory dysfunction and renal failure induced by spontaneous bacterial peritonitis,and treatment of hepatorenal syndrome and refractory *** still debated,albumin administration in refractory ascites is accepted by the Italian health care *** analyzedalbumin prescription and related costs before and after implementation of the new ***:While albumin consumption and costs doubled from 1998 to 2002,they dropped 20%after 2003,and remained stable for the following 6 *** of cirrhosis,namely refractory ascites and paracentesis,represented the predominant indications,followed by major surgery,shock,enteric diseases,and *** consumption increased significantly after guideline implementation in the liver units,whereas it declined elsewhere in the ***,extra-protocol albumin prescription was estimated as<10%.CONCLUSION:Albumin administration in cirrhosis according to international guidelines does not increase total hospital albumin consumption if its use in settings without evidence of efficacy is avoided.

关键词： Human serum albumin Cost analysis Livercirrhosis Critical illness Ascites

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Serum SCCA-IgM as a predictor of hepatocellular carcinoma in patients with liver cirrhosis

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Open Journal of Gastroenterology 2012年第2期2卷 56-61页

作者： Daniela Buccione Gianluca Fatti Andrea Gallotta Elisabetta Loggi Roberto Di Donato Lilia Testa Carlo Saitta Valentina Santi Antonio Di Micoli Virginia Erroi Marta Frigerio Valentina Fazio Antonino Picciotto Alessandra Biasiolo francoise Degos Patrizia Pontisso Giovanni Raimondo franco trevisani APHP Hopital Beaujon INSERM U 773 Clichy France Dipartimento di Medicina Clinica e Sperimentale “G. Patrassi” Università di Padova Padova Italia Dipartimento di Medicina Clinica Alma Mater Studiorum-Università di Bologna Bologna Italia Dipartimento di Medicina Interna Policlinico Universitario di Messina Messina Italia Dipartimento di Medicina Interna Università di Genova Genova Italia Xeptagen S.p.A. Venezia Italia

Aberrant Squamous Cell Carcinoma Antigen (SCCA) expression is an early hepatocarcinogenetic event and circulating SCCA-IgM complexes are elevated in most HCC patients. We evaluated whether serum SCCA-IgM levels can identify HCV +ve cirrhotic patients at low HCC risk. In this retrospective study we enrolled 29 cirrhotic patients in whom serum SCCA-IgM was measured 8 - 69 months (median 31) before HCC diagnosis, and 28 cirrhotic patients who remained HCC- free, with SCCA-IgM measured 15 - 68 months (median 48) before the study end. The best discriminating value of SCCA-IgM was calculated and tested in predicting HCC diagnosis within 12, 24 and 36 months. Sensitivity analysis, considering different HCC incidence, was conducted to identify the patient subgroup with an annual cancer risk below the threshold of a cost-effective semiannual surveillance with ultrasound. Cumulative HCC incidence at 12, 24 and 36 months was 7.0%, 15.7% and 26.3%, respectively. SCCA-IgM levels were higher in HCC than in cirrhotic patients [median: 381 (95% C.I.: 50 - 5289) vs. 100 (70 - 493) AU/mL, P = 0.005]. The SCCA-IgM value ≤ 200 AU/mL accurately identified patients at low risk of HCC development in the subsequent year (sensitivity 75%, specificity 62%, positive predictive value 13% and negative predictive value 97%). Considering an annual HCC incidence ≤ 3%, patients with SCCA-IgM ≤ 200 AU/mL (60% of the whole patients) had an HCC risk below the accepted threshold of a cost-effective surveillance (1.5%). In conclusion, provided that our provocative results are confirmed in larger studies, SCCA-IgM serum measurement could permit implementation of a two step (with different costs) surveillance: an initial serological surveillance, based on the annual monitoring of this biomarker, and the conventional surveillance by semiannual US when SCCA-IgM becomes >200 AU/mL. This could improve the cost/effectiveness of surveillance of HCV infected patients at risk of HCC.

关键词： SCCA-IgM HCC Risk Assessment Surveillance Cost/Effectiveness

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