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Portal vein thrombosis in cirrhosis: Why a well-known complication is still matter of debate

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World Journal of Gastroenterology 2019年第31期25卷 4437-4451页

作者： Mariella Faccia Maria Elena Ainora Francesca Romana Ponziani laura riccardi Matteo Garcovich Antonio Gasbarrini Maurizio Pompili Maria Assunta Zocco Department of Internal Medicine and Gastroenterology Fondazione Policlinico Universitario A.Gemelli IRCCSCatholic University

Portal vein thrombosis(PVT)represents a well-known complication during the natural course of liver cirrhosis(LC),ranging from asymptomatic cases to lifethreating conditions related to portal hypertension and hepatic *** flow stasis,complex acquired hypercoagulable disorders and exogenous factors leading to endothelial dysfunction have emerged as key factors for PVT ***,PVT occurrence remains unpredictable and many issues regarding its natural history,prognostic significance and treatment are still *** particular although spontaneous resolution or disease stability occur in most cases of PVT,factors predisposing to disease progression or recurrence after spontaneous recanalization are not clarified as ***,PVT impact on LC outcome is still debated,as PVT may represent itself a consequence of liver fibrosis and hepatic dysfunction *** and transjugular intrahepatic portosystemic shunt are considered safe and effective in this setting and are recommended in selected cases,even if the safer therapeutic option and the optimal therapy duration are still ***,their impact on mortality rates should be addressed more *** this review we present the most debated questions regarding PVT,whose answers should come from prospective cohort studies and large sample-size randomized trials.

关键词： Portal vein thrombosis Liver cirrhosis Hypercoagulability Anticoagulation Direct oral anticoagulants

Ethanol injection is highly effective for hepatocellular carcinoma smaller than 2cm

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World Journal of Gastroenterology 2011年第26期17卷 3126-3132页

作者： Maurizio Pompili Erica Nicolardi Valeria Abbate Luca Miele laura riccardi Marcello Covino Nicoletta De Matthaeis Antonio Grieco Raffaele Landolfi Gian Ludovico Rapaccini Department of Internal Medicine Università Cattolica del Sacro Cuore Department of Emergency Università Cattolica del Sacro Cuore

AIM： To analyze the long-term prognosis in a cohort of western cirrhotic patients with single hepatocellular carcinoma treated with ethanol injection.METHODS： One-hundred forty-eight patients with solitan/hepatocellular carcinoma were enrolled. The tumor diameter was lower than 2 cm in 47 patients but larger in the remaining 101 patients. The impact of some pre- treatment clinical and laboratory parameters and of tu- mor recurrence on patients＇ survival was assessed.RESULTS： Among the pre-treatment parameters, only a tumor diameter of less than 2 cm was an independent prognostic factor of survival. The occurrence of new nodules in other liver segments and the neoplastic portal invasion were linked to a poorer prognosis at univariate analysis. Patients with a single hepatocellular carcinoma smaller than 2 cm showed a better 5-year cumulative survival （73.0% vs 47.9%）（P = 0.009）, 3-year local re- currence rate （29.1% vs 51.5%）（P = 0.011）, and 5-year distant intrahepatic recurrence rate （52.g% vs 62.8%）（P = 0.054） compared to patients with a larger tumor. CONCLUSION： The 5-year survival rate of patients with single hepatocellular carcinoma 〈 2 cm undergoing ethanol injection is excellent and comparable to that achieved using radiofrequency ablation.

关键词： Hepatocellular carcinoma Cirrhosis Percutaneous ethanol injection Prognosis

Elastography as a predictor of liver cirrhosis complications after hepatitis C virus eradication in the era of direct-acting antivirals

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World Journal of Hepatology 2021年第11期13卷 1663-1676页

作者： Lucia Cerrito Maria Elena Ainora Alberto Nicoletti Matteo Garcovich laura riccardi Maurizio Pompili Antonio Gasbarrini Maria Assunta Zocco CEMAD Digestive Disease Center Fondazione Policlinico Universitario"A.Gemelli"IRCCSCatholic University of Rome(Italy)Rome 00168Italy

Chronic inflammation due to hepatitis C virus(HCV)infection leads to liver fibrosis and rearrangement of liver tissue,which is responsible for the development of portal hypertension(PH)and hepatocellular carcinoma(HCC).The advent of direct-acting antiviral drugs has revolutionized the natural history of HCV infection,providing an overall eradication rate of over 90%.Despite a significant decrease after sustained virological response(SVR),the rate of HCC and liver-related complications is not completely eliminated in patients with advanced liver *** the reasons are still unclear,cirrhosis itself has a residual risk for the development of HCC and other PH-related *** elastography is a recently developed non-invasive technique for the assessment of liver *** the achievement of SVR,liver stiffness(LS)usually decreases,as a consequence of reduced inflammation and,possibly,*** studies emphasized the application of LS assessment in the management of patients with SVR in order to define the risk for developing the complications of chronic liver disease(functional decompensation,gastrointestinal bleeding,HCC)and to optimize long-term prognostic outcomes in clinical practice.

关键词： Direct-acting antiviral agents Liver stiffness Portal hypertension Hepatocellular carcinoma

Usefulness of contrast enhanced ultrasound in monitoring therapeutic response after hepatocellular carcinoma treatment

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World Journal of Hepatology 2015年第14期7卷 1866-1874页

作者： Davide Roccarina Matteo Garcovich Maria Elena Ainora laura riccardi Maurizio Pompili Antonio Gasbarrini Maria Assunta Zocco Department of Internal Medicine Catholic University of Sacred Heart

In the last years, the development in the oncology field has been huge and rapid. In particular, the evaluation of response to anti-tumour treatments has been being object of intense research, producing significant changes. Response assessment after therapy in solid neoplasias has always used radiological imaging techniques, with tumour size reduction representing a presumed therapeutic efficacy. However, with the introduction of anti-angiogenetic drugs the evaluation of tumour size has become unsuitable because some tumours, under treatment, show only tumour perfusion changes rather than lesion shrinkage. Between different imaging techniques with contrast-enhancement, contrastenhanced ultrasound(CEUS) and, in particular, dynamic CEUS have arisen as a promising and non-invasive device for monitoring cancer treatments. Moreover, the introduction of perfusion software has even more refined the technique since it is able to provide quantitative parameters related to blood flow and blood volume that can be associated with tumour response and clinical outcome such as the progression free survival and the overall survival. Here, we give an overview of the current status of CEUS in monitoring hepatocellular carcinoma response to different kind of treatments.

关键词： Dynamic contrast-enhanced ultrasound Hepatocellular carcinoma Ablative treatment Antiangiogeneticdrugs Time-intensitive curve

Reverse time-dependent effect of alphafetoprotein and disease control on survival of patients with Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma

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World Journal of Hepatology 2017年第36期9卷 1322-1331页

作者： Francesca Romana Ponziani Irene Spinelli Emanuele Rinninella Lucia Cerrito Antonio Saviano Alfonso Wolfango Avolio Michele Basso Luca Miele laura riccardi Maria Assunta Zocco Brigida Eleonora Annicchiarico Matteo Garcovich Marco Biolato Giuseppe Marrone Anna Maria De Gaetano Roberto Iezzi Felice Giuliante Fabio Maria Vecchio Salvatore Agnes Giovanni Addolorato Massimo Siciliano Gian Lodovico Rapaccini Antonio Grieco Antonio Gasbarrini Maurizio Pompili Department of Internal Medicine Gastroenterology and Hepatology Agostino Gemelli Hospital Department of Liver Transplant Surgery Agostino Gemelli Hospital Department of Oncology Gastroenterology and Hepatology Agostino Gemelli Hospital Department of Bioimaging and Radiological Sciences Agostino Gemelli Hospital Department of Hepatobiliary Surgery Agostino Gemelli Hospital Department of Pathology Agostino Gemelli Hospital

AIM To characterize the survival of cirrhotic patients with Barcelona Clinic Liver Cancer(BCLC) stage C hepatocellular carcinoma(HCC) and to ascertain the factors predicting the achievement of disease control(DC).METHODS The cirrhotic patients with BCLC stage C HCC evaluated by the Hepatocatt multidisciplinary group were subjected to the investigation. Demographic, clinical and tumor features, along with the best tumor response and overall survival were recorded. RESULTS One hundred and ten BCLC stage C patients were included in the analysis; the median overall survival was 13.4 mo(95%CI: 10.6-17.0). Only alphafetoprotein(AFP) serum level > 200 ng/m L and DC could independently predict survival but in a time dependent manner, the former was significantly associated with increased risk of mortality within the first 6 mo of follow-up(HR = 5.073, 95%CI: 2.159-11.916, P = 0.0002), whereas the latter showed a protective effect against death after one year(HR = 0.110, 95%CI: 0.038-0.314, P < 0.0001). Only patients showing microvascular invasion and/or extrahepatic spread recorded lower chances of achieving DC(OR = 0.263, 95%CI: 0.111-0.622, P = 0.002).CONCLUSION The BCLC stage C HCC includes a wide heterogeneous group of cirrhotic patients suitable for potentially curative treatments. The reverse and time dependent effect of AFP serum level and DC on patients' survival confers them as useful predictive tools for treatment management and clinical decisions.

关键词： Hepatocellular carcinoma Cirrhosis Barcelona Clinic Liver Cancer stage C Alphafetoprotein Disease control Performance status Survival