Management of spontaneously ruptured hepatocellular carcinomas in the radiofrequency ablation era

Background and aim: Spontaneous rupture of hepatocellular carcinoma (HCC) carries a high mortality. The use of radiofrequency ablation (RFA) in recent years has enriched the armamentarium for hemostasis of spontaneously ruptured HCCs but its results have not been documented. This study investigated the prognosis and outcome of spontaneous rupture of HCC as well as the results of using RFA for hemostasis. Patients and method: From January 1991 to December 2010, 5283 patients were diagnosed with HCC at our hospital, and 189 of them had spontaneous rupture of HCCs. They were grouped under two periods: period 1, 1991-2000, n = 70; period 2, 2001-2010, n = 119. RFA was available in period 2 only. Results: Hepatitis B virus infection was predominant in both periods. Surgical hemostasis was mainly achieved by hepatic artery ligation in period 1 and by RFA in period 2. The 30-day hospital mortality after surgical treatment was 55.6% (n = 18) in period 1 and 19.2% (n = 26) in period 2 (p = 0.012). Multivariate analysis identified 4 independent factors for better overall survival, namely, hemostasis by transarterial chemoembolization (hazard ratio 0.516, 95% confidence interval 0.354-0.751), hemostasis by RFA (hazard ratio 0.431, 95% confidence interval 0.236-0.790), having surgery as a subsequent treatment (hazard ratio 0.305, 95% confidence interval 0.186-0.498), and a serum total bilirubin level <19 umol/L (hazard ratio 1.596, 95% confidence interval 1.137-2.241). Conclusion: The use of RFA for hemostasis during laparotomy greatly reduced the hospital mortality rate when compared with conventional hepatic artery ligation. © 2014 Cheung et al.published_or_final_versio

Does hepatitis B seroconversion affect survival outcome in patients with hepatitis B related hepatocellular carcinoma?

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Tolerance of high-intensity focused ultrasound ablation in patients with hepatocellular carcinoma

BACKGROUND: High-intensity focused ultrasound (HIFU) ablation is a relatively new, noninvasive way of ablation for treating hepatocellular carcinoma (HCC). Emerging evidence has shown that it is effective for the treatment of HCC, even in patients with poor liver function. There is currently no data on the safety limit of HIFU ablation in patients with cirrhosis. However, this information is vital for the selection of appropriate patients for the procedure. We analyzed HCC patients who had undergone HIFU ablation and determined the lower limit of liver function and other patient factors with which HCC patients can tolerate this treatment modality. METHODS: Preoperative variables of 100 patients who underwent HIFU ablation for HCC were analyzed to identify the risk factors in HIFU intolerance in terms of stress-induced complications. Factors that may contribute to postablation complications were compared. RESULTS: Thirteen (13 %) patients developed a total of 18 complications. Morbidity was mainly due to skin and subcutaneous tissue injuries (n = 9). Five patients had first-degree skin burn, one had second-degree skin burn, and three had third-degree skin burn. Four complications were grade 3a in the Clavien classification and 14 were below this grade. Univariate analysis showed that age (p = 0.022) was the only independent factor in HIFU intolerance. CONCLUSIONS: HIFU ablation is generally well tolerated in HCC patients with cirrhosis. It is safe for Child-Pugh A and B patients and selected Child-Pugh C patients. With this new modality, HCC patients who were deemed unsalvageable by other surgical means in the past because of simultaneous Child-Pugh B or C disease now have a new hope.published_or_final_versio

Long Term Survival Analysis of Hepatectomy for Neuroendocrine Tumour Liver Metastases

Background. Liver is the commonest site for metastasis in patients with neuroendocrine tumour (NET). A vast majority of treatment strategies including liver directed nonsurgical therapy, liver directed surgical therapy, and nonliver directed therapy have been proposed. In this study we aim to investigate the outcome of liver resection in neuroendocrine tumour liver metastases (NELM). Method. 293 patients had hepatectomy for liver metastasis in our hospital between June 1996 and December 2010. Twelve patients were diagnosed to have NET in their final pathology and their data were reviewed. Results. The median ages of the patients were 48.5 years (range 20-71 years). Eight of the patients received major hepatectomy. Four patients received minor hepatectomy. The median operation time was 418 minutes (range 195-660 minutes). The median tumor size was 8.75 cm (range 0.9-21 cm). There was no hospital mortality. The overall one-year and three-year survivals were 91.7% and 55.6%. The one-year and three-year disease-free survivals were 33.3% and 16.7%. Conclusion. Hepatectomy is an effective and safe treatment for NELM. Reasonable outcome on long term overall survival and disease-free survival can be achieved in this group of patients with a low morbidity rate. © 2014 Tan To Cheung et al.published_or_final_versio

Survival analysis of transarterial radioembolization with yttrium-90 for hepatocellular carcinoma patients with HBV infection

Introduction: For patients with resectable hepatocellular carcinoma (HCC), hepatectomy remains one of the best treatment options to provide long-term survival. However, more than 50% of the patients have unresectable disease upon diagnosis even though there are no distant metastases. Transarterial chemoembolization (TACE) is a well-established treatment option that offers a palliative survival benefit for this group of patients. A better treatment for unresectable HCC has been sought after. There is some evidence that transarterial radioembolization (TARE) with the agent yttrium-90 produces encouraging outcomes, especially in patients with portal vein tumor thrombus. This study aims to analyze the outcomes of TARE at our center. Methods: From August 2009 to April 2013, 16 patients underwent TARE at our center. Sixteen patients with similar tumor characteristics were selected to undergo TACE alone for comparison. A retrospective analysis of the prospectively collected data of the patients was conducted. Only patients with newly diagnosed primary tumors were included in this study. Results: The median survival for patients having TARE was 19.9 versus 14.0 months in the TACE group (P=0.615). There was no difference in terms of tumor response according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) (P=0.632). The 1-, 2- and 3-year survival rates in the TARE group were 80.0%, 30.5% and 20.3% respectively. The 1-year survival in the TACE group was 58.3% (P=0.615). For patients who had major vascular invasion (eight in each group), the 1- and 2-year survival rates in the TARE group were 62.5% and 15.6% respectively, while the 1-year survival in the TACE group was 35.0% (P=0.664). Conclusions: The two groups showed similar results in terms of tumor response and overall survival benefit. TARE might provide a survival benefit for patients with major vessel invasion.published_or_final_versio

Optimizing Link Assignment to Enhance Service in Probabilistic Network

We consider service enhancement in a wireless environment in which clients try to obtain service from a set of servers. Each client desires a minimum overall service success probability, which is achieved by establishing multiple independent connections with multiple servers. Given the service success probability of each potential client-server connection, our problem is to assign the connections such that the number of satisfied clients (whose overall service success probability is met) is maximized subject to server capacity constraints. In this paper, we make minor adaptations to the well-known notion of probabilistic network from the machine learning community and use it as our communication model. We then formally define the above optimization problem as the link assignment for successful service problem (LASS). While LASS can be reduced to the maximum matching problem in the deterministic case (where the success probabilities of each edge is 1), we show that in the probabilistic case it is NP-hard (and MaxSNP-hard). An equivalent integer programming formulation for LASS is obtained so that for small input size, the problem may be efficiently solved by the standard IP solver in practice. To tackle large input size, various heuristics are designed. Furthermore, in the special case where the underlying network graph is a tree (which is common in many real-life settings), we show that LASS can be solved in linear time based on a simple greedy algorithm. Experimental evaluations are performed and the results demonstrate the practicality of the algorithms and the heuristics.Department of ComputingRefereed conference pape

HDPR1, a novel inhibitor of WNT/b-catenin signaling, is down-regulated in hepatocellular carcinoma: involvement of promoter hypermethylation

Conference Theme: Chromatin, Chromosomes, and Cancer Epigenetic

Analysis of long-term survival after hepatectomy for isolated liver metastasis of gastrointestinal stromal tumour

Background: In the treatment of liver metastasis of gastrointestinal stromal tumour (GIST), the role of hepatectomy is controversial. This study tried to identify such role by investigating the immediate and long-term surgical outcomes. Methods: Data of patients who underwent hepatectomy to treat their metastatic disease were reviewed. Patients whose liver tumours were confirmed to be metastatic GISTs were included for analysis. Clinicopathological characteristics of the primary disease, time of metastasis development and modes of treatment were recorded. Immediate outcome and long-term survival after hepatectomy were analysed. Results: Ten patients were confirmed to have isolated liver metastasis of GIST. Their median age was 61 (42-74) years. All of them had normal liver function and no cirrhosis. Seven patients received major hepatectomy and three patients received minor hepatectomy. The median operation time was 319.5 (122-735)min. The median tumor size was 5.5 (1.5-15) cm. No hospital death occurred. The 1-, 3- and 5-year overall survival rates were 100, 75 and 50%, respectively and the corresponding disease-free survival rates were 70, 42 and 14%, respectively. Conclusion: Treating isolated liver metastasis of GIST with hepatectomy is effective and safe. Favourable long-term overall survival and disease-free survival can be achieved. © 2013 Royal Australasian College of Surgeons.Link_to_subscribed_fulltex

Survival analysis of hepatic resection for breast cancer metastases in Chinese women

Topic: 13.b ClinicalThis journal suppl. entitled: Abstracts - APASL 2013Conference Theme: Transforming Science to Clinical PracticeINTRODUCTION: The survival for patients with carcinoma of the breast with liver metastases remains very poor. The data on the survival outcome of this treatment modality in Chinese population is still lacking. METHOD: From Jan 2000 to Dec 2009, 557 patients received hepatectomy for liver metastases in our hospital. Total 14 patients received hepatectomy for breast cancer liver metastases (BCLM) in the University of Hong Kong. Short term outcome and long term survival were analyzed. RESULT: Nine patients (64.3%) received major hepatectomy and five patients (33.7%) received minor hepatectomy. The median blood loss was 330ml. There was no hospital mortality. The median hospital stay was 6.5 days. The median tumour size was 3cm (ranged 1.5 to 10cm). All the patients received R0 tumour resections. The median overall survival and five year survival following hepatectomy was 33 months (range 12.5 months to 134 months) and 45.1%. The median disease free survival and five year disease free survival following hepatectomy was 14 months (range 6.6 months to 75 months) and 27.7%. Univariate analysis showed that age of developing liver metastases< 41.5 year (p=0.044), triple negative receptor status on pathological examination (p= 0.047) and time to develop liver metastasis < 44.6 months from primary treatment (p=0.034) were associated with poor survival. Multivariate analysis showed that time to develop liver metastasis < 44.6 months from primary treatment was an independent significant factors for poor survival (p= 0.044 HR 0.785 CI 0.62-0.99). CONCLUSION: Liver resection for BCLM is a safe and effective method in the management of patients with cancer of the breast. Satisfactory short term and long term outcome can be achieved in Chinese populations. It should be considered more frequently as part of the multidisciplinary care of patient with breast cancer and liver metastases.Link_to_subscribed_fulltex

Long term survival analysis of hepatic resection for breast cancer metastases

Hepato-Gastroenterology has been discontinued as of 2015