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World Journal of Clinical Cases 2023年第36期11卷 8434-8439页

作者： Silvia Cocca Lorenzo Carloni Margherita Marocchi Giuseppe Grande Marcello Bianchini Antonio Colecchia Rita Conigliaro Helga Bertani Gastroenterology and Endoscopy Unit Azienda Ospedaliero Universitaria Policlinico di ModenaModena 41121Italy Department of Medical and Surgical Sciences IRCCS Azienda Ospedaliero-Universitaria di BolognaBologna 00100Italy Department of Internal Medicine Azienda Ospedaliero Universitaria Policlinico di ModenaModena 41121Italy

Liver cancer is the fifth most common tumor and the second highest death-related cancer in the ***(HCC)represents 90%of liver *** to the Barcelona Clinic Liver Cancer group,different treatment options could be offered to patients in consideration of tumor burden,liver function,pa-tient performance status and biochemical marker serum concentration such as ***-arterial chemoembolization(TACE)is the treatment of choice in patients with diagnosis of unresectable HCC not eligible for liver trans-plantation,and preserved arterial *** is known to be safe and its com-plications are generally mild such as post-TACE syndrome,a self-resolving adverse event that occurs in about 90%of patients after the ***,albeit rarely,more severe adverse events such as biloma,sepsis,hepatic failure,chemoagents induced toxicities,and post-TACE liver necrosis can occur.A prompt diagnosis of these clinical conditions is fundamental to prevent further *** a result,biliary stenosis could be a rare post-TACE necrosis complication and can be difficult to *** from untreated biliary strictures include recurring infections,jaundice,chronic cholestasis,and secon-dary biliary cirrhosis.

关键词： Hepatocarcinoma trans-arterial chemoembolization Biliary stenosis Multistenting

Hepatocellular carcinoma treated with transarterial chemoembolization: Dynamic perfusion-CT in the assessment of residual tumor

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World Journal of Gastroenterology 2010年第47期16卷 5993-6000页

作者： Davide Ippolito Pietro Andrea Bonaff ini Laura Ratti Laura Antolini Rocco Corso Ferruccio Fazio Sandro Sironi Department of Diagnostic Radiology School of Medicine University of Milano-BicoccaH S. Gerardo Department of Clinical Medicine Prevention and Biotechnology Section of Medical Statistics H S. Gerardo Department of Clinical Medicine School of Medicine University of Milano-Bicocca H S. Gerardo Department of Interventional Radiology H S. Gerardo

AIM: To asses the value of computed tomography (CT)-perfusion in the detection of residual hepatocellular carcinoma (HCC) vascularization after transarterial chemoembolization (TACE). METHODS: Thirty-two consecutive patients were pro-spectively included in this study. All patients had liver cirrhosis and a conf irmed HCC lesion which was treated with TACE. One month after treatment, perfusion measurements of treated lesions were carried out. The CTperfusion (CT-p) protocol was performed with 16 slice multidetector computed tomography which included the following parameters: 8 dynamic slices/scan per 40 scans after iv injection of 50 mL of iodinated contrast (350 mg/mL) at a flow rate of 6 mL/s. Treated lesions were evaluated using dedicated perfusion software, which generated a quantitative colour map of perfusion. The following parameters were considered: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), hepatic perfusion index (HPI), and time to peak (TTP). Perfusion parameters were described with quartile values of their distribution and statistically analyzed. RESULTS: Perfusion parameters of the treated lesions could be quantitatively assessed using CT-p analysis. The presence of residual tumor tissue was observed in 13 of the 32 patients. The values of the perfusion parameters measured within the relapse tissue were: HP (mL/100 g per minute): median = 44.4 (1stqt = 31.3, 3rdqt = 55.8); BV (mL/100 g): median = 18.7 (1stqt = 11.5, 3rdqt = 22.5); AP (mL/min): median = 39.0 (1stqt = 36.5, 3rdqt = 61.3); HPI (%): median = 34.0 (1stqt = 30.4, 3rdqt = 38.9); TTP (s): median = 17.3 (1stqt = 15.8, 3rdqt = 26.5). With the use of the univariate paired Wilcoxon signed rank test, HP, AP and HPI were shown to be significantly higher (P<0.001) in the relapse site than in the primary lesion. The BV and TTP parameters showed a tendency to be greater and lower, respectively, in the relapse site than in the primary lesion. CONCLUSION: In patients with HCC treat

关键词： Computed tomography-perfusion Functional-computed tomography Hepatocellular carcinoma trans-arterial chemoembolization Tumour neo-angiogenesis

trans-arterial gene therapy for hepatocellular carcinoma in a rabbit model

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World Journal of Gastroenterology 2007年第14期13卷 2113-2117页

作者： Tao Gu Cai-Xia Li Yan Feng Qian Wang Chun-Hai Li Chuan-Fu Li Department of Radiology Qilu Hospital of Shandong University Jinan 250012 Shandong Province China

AIM： To study the effect of adenovirus （Ad）-p53 gene therapy on hepatocellular carcinoma （HCC） in a rabbit model.METHODS： VX2 tumor was grown in the liver of 24rabbits. Animals were divided into four groups： group A receiving trans-arterial gene therapy （Ad-p53） only,group B receiving combined Ad-p53 therapy and transarterial embolization （lipiodol）, group C receiving transarterial chemoembolization （lipiodol ＋ mitomycin C）,control group （D） receiving sodium chloride. Tumor volume （V1） was measured by using MRI （d 13）.Interventional procedure was applied （d 14）.Tumor volume （V2） was assessed by MRT （d 21） and the mean ratio （V2/V1） was calculated. After the second MRI,specimens of the liver were abstained and examined immunohistochemically using mutant-type p53 *** positive expression was scored.RESULTS： Compared with control group （（^-x） = 3.14± 0.64）, therapeutic groups all showed a significant decrease in the tumor growth ratio （P 〈 0.05）. A slight difference was found between group A （（^-x） =2.35 ±0.59） and group B （（^-x） = 1.75 ± 0.28）（P = 0.048）. Nostatistically significant difference was observed between group B and group C （（^-x） = 2.00 ± 0.44）. The positive expression rate of mutant-type p53 was the lowest in group B and significantly different between group A and group C （P 〈 0.05）.Compared to the control subjects, groups A and C both showed a decrease in the expression of mutant-type p53, but there was no significant difference between them.CONCLUSION： trans-arterial Ad-p53 gene therapy can reduce tumor growth of HCC in rabbit model.

关键词： Liver hepatocellular carcinoma trans-arterial chemoembolization Gene therapy

Hepatocellular carcinoma review:Current treatment,and evidence-based medicine

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World Journal of Gastroenterology 2014年第15期20卷 4115-4127页

作者： Ali Raza Gagan K Sood Department of Internal Medicine St. Luke’s Episcopal HospitalBaylor College of MedicineHoustonTX 77030United States Division of Gastroenterology and Hepatology Baylor College of MedicineSt. Luke’s Liver CenterHoustonTX 77030United States

Hepatocellular carcinoma(HCC)is the fifth most common tumor *** treatment options are available for HCC including curative resection,liver transplantation,radiofrequency ablation,trans-arterial chemoembolization,radioembolization and systemic targeted agent like *** treatment of HCC depends on the tumor stage,patient performance status and liver function reserve and requires a multidisciplinary *** the past few years with significant advances in surgical treatments and locoregional therapies,the short-term survival of HCC has improved but the recurrent disease remains a big *** pathogenesis of HCC is a multistep and complex process,wherein angiogenesis plays an important *** patients with advanced disease,sorafenib is the only approved therapy,but novel systemic molecular targeted agents and their combinations are *** article provides an overview of treatment of early and advanced stage HCC based on our extensive review of relevant literature.

关键词： Hepatocellular carcinoma trans-arterial chemoembolization Drug-eluting beads Radiofrequency ablation Liver transplantation Chemotherapy Sorafenib Radioembolization

Solitary hepatic lymphangioma mimicking liver malignancy: A case report and literature review

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World Journal of Clinical Cases 2020年第19期8卷 4633-4643页

作者： Xin Long Lei Zhang Qi Cheng Qian Chen Xiao-Ping Chen Hepatic Surgery Center Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina Endoscopic Unit Department of Gastroenterology and HepatologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

BACKGROUND Hepatic lymphangioma,a malformation of the liver lymphatic system,is a rare benign neoplasm and usually coexists with other visceral *** hepatic lymphangioma is much more rarely seen and could cause a clinical misinterpretation as *** SUMMARY A 50-year-old woman with a liver mass of approximately 3.5 cm was initially diagnosed with hepatocellular carcinoma given the risk factors for liver cancer that she presented with,including Schistosome japonicum infection and jaundice,and also together with imaging results,which showed the mass enhanced quickly in the arterial phase and faded fast in the venous *** patient did not have the surgery first but received three rounds of transarterial chemoembolization because of her anxiety and fears for ***,the patient underwent laparoscopic liver segment 4b resection and cholecystectomy and was discharged from the hospital only 10 d after the *** pathological examination indicated the mass as hepatic *** patient has been followed up for 30 mo without *** raise the awareness of this misdiagnosed case and to better diagnose and treat this rare disease in future,we reviewed the published literature of solitary hepatic lymphangioma for its clinical symptoms,imaging presentation,operative techniques,histology features and *** Solitary hepatic lymphangioma mimicking malignancy makes diagnosis *** surgical resection is the first choice to treat solitary hepatic lymphangioma.

关键词： Hepatic lymphangioma Hepatocellular carcinoma Laparoscopic hepatectomy trans-arterial chemoembolization Adult Case report

Evaluating the best treatment for multifocal hepatocellular carcinoma:A propensity score-matched analysis

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World Journal of Gastroenterology 2022年第29期28卷 3981-3993页

作者： Matteo Risaliti Ilenia Bartolini Claudia Campani Umberto Arena Carlotta Xodo Valentina Adotti Martina Rosi Antonio Taddei Paolo Muiesan Amedeo Amedei Giacomo Batignani Fabio Marra Department of Experimental and Clinical Medicine AOU CareggiFlorence 50134Italy

BACKGROUND Hepatocellular carcinoma(HCC)is a common tumour often diagnosed with a multifocal *** with multifocal HCC represent a heterogeneous *** trans-arterial chemoembolization(TACE)is the most frequently employed treatment for these patients,previous data suggested that liver resection(LR)could be a safe and effective *** To compare LR and TACE in patients with multifocal HCC in terms of procedurerelated morbidity and oncologic *** All patients with multifocal HCC who underwent LR or TACE as the first procedure between May 2011 and March 2021 were *** decision to perform surgery or TACE was made after a multidisciplinary team *** patients in Child-Pugh class A or B7 and stage B(according to the Barcelona Clinic Liver Cancer staging system,without severe portal hypertension,vascular invasion,or extrahepatic spread)were included in the final *** score matching was used to adjust the baseline differences between patients undergoing LR and the TACE group[number and diameter of lesions,presence of cirrhosis,alpha-fetoprotein(AFP)levels,and Model for End-Stage Liver Disease score].The Kaplan-Meier method was used to estimate overall survival(OS)and disease-free survival(DFS).The outcomes of LR and TACE were compared using the log-rank *** After matching,30 patients were eligible for the final analysis,15 in each *** rates were 42.9% and 40% for LR and TACE,respectively(P=0.876).Median OS was not different in the LR and TACE groups(53 mo vs 18 mo,P=0.312),while DFS was significantly longer with LR(19 mo vs 0 mo,P=0.0001).Subgroup analysis showed that patients in the Italian Liver Cancer(***)B2 stage,with AFP levels lower than 400 ng/mL,less than 3 lesions,and lesions bigger than 41 mm,benefited more from LR in terms of *** classified as *** B3,with AFP levels higher than 400 ng/mL and with more than 3 lesions,appeared to receive more benefi

关键词： Hepatocellular carcinoma Multifocal hepatocellular carcinoma Liver resection trans-arterial chemoembolization Guidelines Liver tumour management

Combined radiofrequency and chemoembolization *** in management of hepatocellular carcinoma

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Hepatoma Research 2015年第1期1卷 19-23页

作者： Ahmed Kamal El Dorry Eman Mahmoud Fathy Barakat Amal Tohamy Abd ElMoez Mervat Abd Fatah Mawad Nevien Fouad El-Fouly Mohamed Kamal Shaker Department of Radiology Medicine Faculty of MedicineAin Shams UniversityCairo 11566Egypt Department of Tropical Medicine Faculty of MedicineAin Shams UniversityCairo 11566Egypt Atomic Energy Authority Cairo 13759Egypt

Aim:Hepatocellular carcinoma(HCC)is one of the most common cancers in the *** left untreated,liver cancer has a poor prognosis with more than 90%of patients dying of the disease within 5 years of *** aim of this study is to assess the value of combined radiofrequency ablation(RFA),followed by trans-arterial chemoembolization(TACE)in the management of ***:Fifty HCC patients with chronic liver disease were categorized into two groups according to the modality of locoregional treatment:25 HCC patients treated with RFA followed by TACE within 5 days and 25 HCC patients treated with TACE ***:Complete response was achieved in 100%and 84%of the HCC patients after 1 month from combined RFA-TACE therapy and TACE only *** rate of objective response after 7 months was 84%and 44%in the RFA-TACE and TACE groups *** year disease free survival rate was 56%and 24%in RFA-TACE and TACE groups respectively,and overall survival rate was 88%in the RFA-TACE group and 80%in the TACE only ***:Combined RFA-TACE appears to be an effective modality and superior to TACE only for the treatment of HCC.

关键词： Hepatocellular carcinoma radiofrequency trans-arterial chemoembolization

Predictive factors for hepatocellular carcinoma recurrence after curative treatments

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Hepatoma Research 2020年第6期6卷 58-76页

作者： Giovanni Marasco Federico Ravaioli Amanda Vestito Benedetta Rossini Elton Dajti LuigiColecchia Kamela Gjini Matteo Renzulli Rita Golfieri Davide Festi Antonio Colecchia Department of Medical and Surgical Sciences(DIMEC) University of BolognaBologna 40138Italy Radiology Unit Sant’Orsola Malpighi HospitalBologna 40138Italy Unit of Gastroenterology Borgo Trento University Hospital of VeronaVerona 37126Italy

Hepatocellular carcinoma(HCC)is the fifth most common neoplasm *** of HCC after resection or loco-regional therapies represents an important clinical issue as it affects up to 70%of *** can be divided into early or late,if it occurs within or after 24 months after treatment,*** the predictive factors for early recurrence are mainly related to tumour biology(local invasion and intrahepatic metastases),late recurrences are mainly related to de novo tumour ***,it is important to recognize these factors prior to any treatment in each patient,in order to optimize the treatment strategy and follow-up after *** aim of this review is to summarize the current evidence available regarding predictive factors for the recurrence of HCC,according to the different therapeutic strategies *** particular,we will discuss the role of new ultrasound-based techniques and biological features,such as tumor-related and circulating biomarkers,in predicting HCC *** advances in imaging-related parameters in computed-tomography scans and magnetic resonance imaging will also be discussed.

关键词： Liver resection trans-arterial chemoembolization radiofrequency ablation liver stiffness measurement indocyanine green retention test

Management of hepatocellular carcinoma: Enlightening the gray zones

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World Journal of Hepatology 2013年第6期5卷 302-310页

作者： Andrea Mancuso Epatologia e Gastroenterologia Ospedale Niguarda Cà Granda20162 Milano Italy Medicina Interna 1 Azienda di Rilievo Nazionale ad Alta Specializzazione Ospedale Civico90127 Palermo Italy

Management of hepatocellular carcinoma (HCC) has been continuously evolving during recent years. HCC is a worldwide clinical and social issue and typically a complicates cirrhosis. The incidence of HCC is increasing, not only in the general population of patients with cirrhosis, but particularly in some subgroups of patients, like those with human immunodeficiency virus infection or thalassemia. Since a 3% annual HCC incidence has been estimated in cirrhosis, a biannual screening is generally suggested. The diagnostic criteria of HCC has recently had a dramatic evolution during recent years. HCC diagnosis is now made only on radiological criteria in the majority of the cases. In the context of cirrhosis, the universally accepted criteria for HCC diagnosis is contrast enhancement in arterial phase and washout in venous/late phase at imaging, the so called "typical pattern". However, recently up- dated guidelines slightly differ in diagnostic criteria. Apart from liver transplantation, the only cure of both HCC and underlying liver cirrhosis, all the other treatments have to match with higher rate of HCC recurrence. The latter can be classified into curative (resection and percutaneous ablation) and palliative treatments. The aim of this paper was to review the currentknowledge on management of HCC and to enlighten the areas of uncertainty.

关键词： Hepatocellular carcinoma Management trans-arterial chemoembolization Orthotopic liver transplantation Surgery Management