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      • Record: found
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      Hepatobiliary Tumors: Update on Diagnosis and Management

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          Abstract

          Tumors of the liver and biliary tree, mainly hepatocellular carcinoma and cholangiocarcinoma, are the second leading cause of cancer related death worldwide and the sixth leading cause of cancer related death among men in developed countries. Recent developments in biomarkers and imaging modalities have enhanced early detection and accurate diagnosis of these highly fatal malignancies. These advances include serological testing, micro-ribonucleic acids, fluorescence in situ hybridization, contrast-enhanced ultrasound, and hepatobiliary-phase magnetic resonance imaging. In addition, there have been major developments in the surgical and nonsurgical management of these tumors, including expansion of the liver transplantation criteria, new locoregional treatments, and molecularly targeted therapies. In this article, we review various types of hepatobiliary tumors and discuss new developments in their diagnosis and management.

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          Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy.

          Hiroshi Imamura, Yutaka Matsuyama, Eiji Tanaka … (2003)
          We conducted a retrospective cohort study to investigate factors to early and late phase recurrence of hepatocellular carcinoma (HCC). The study population consisted of 249 patients including 157 with cirrhosis who underwent hepatectomy for HCC. The endpoint was time-to-recurrence. Using a Cox regression model, factors to early and late phase recurrences were investigated censoring recurrence-free patients at the 2-year time point and in patients without recurrence at 2 years. Actuarial probability of overall recurrence at 1, 3, and 5 years were 0.301, 0.623, and 0.790, respectively, with a median follow-up of 624 days. Early recurrence was observed in 123 out of 249 patients; while late recurrence was found in 61 out of 113 patients. Factors to early recurrence were as follows: non-anatomical resection, presence of microscopic vascular invasion, and serum alpha-fetoprotein level >or=32 ng/ml. Those contributing to late phase recurrence were higher grade of hepatitis activity, multiple tumors, and gross tumor classification. Variables associated with metastatic recurrence were factors to early phase recurrence; whereas those related with elevated carcinogenesis contributed to late phase recurrence, thus providing an epidemiological evidence that different mechanisms, i.e. metastasis and de novo, are involved in intrahepatic recurrence after hepatectomy for HCC.
          Article 0 comments Cited 460 times – based on 0 reviews     Review now
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            Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival.

            F Y Yao, L Ferrell, N M Bass … (2001)
            The precise staging of hepatocellular carcinoma (HCC) based on the size and number of lesions that predict recurrence after orthotopic liver transplantation (OLT) has not been clearly established. We therefore analyzed the outcome of 70 consecutive patients with cirrhosis and HCC who underwent OLT over a 12-year period at our institution. Pathologic tumor staging of the explanted liver was based on the American Tumor Study Group modified Tumor-Node-Metastases (TNM) Staging Classification. Tumor recurrence occurred in 11.4% of patients after OLT. The Kaplan-Meier survival rates at 1 and 5 years were 91.3% and 72.4%, respectively, for patients with pT1 or pT2 HCC; and 82.4% and 74.1%, respectively, for pT3 tumors (P =.87). Patients with pT4 tumors, however, had a significantly worse 1-year survival of 33.3% (P =.0001). An alpha-fetoprotein (AFP) level > 1,000 ng/mL, total tumor diameter > 8 cm, age > or = 55 years and poorly differentiated histologic grade were also significant predictors for reduced survival in univariate analysis. Only pT4 stage and total tumor diameter remained statistically significant in multivariate analysis. Patients with HCC meeting the following criteria: solitary tumor < or = 6.5 cm, or < or = 3 nodules with the largest lesion < or = 4.5 cm and total tumor diameter < or = 8 cm, had survival rates of 90% and 75.2%, at 1 and 5 years, respectively, after OLT versus a 50% 1-year survival for patients with tumors exceeding these limits (P =.0005). We conclude that the current criteria for OLT based on tumor size may be modestly expanded while still preserving excellent survival after OLT.
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              Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution.

              Michelle L DeOliveira, Steven C. Cunningham, John L. Cameron … (2007)
              To assess long-term survival and prognostic factors in a large series of patients with bile duct cancer. The incidence of bile duct cancer is low but increasing. Determinants of survival vary in the literature, due to a lack of sufficient numbers of patients in most series. We studied 564 consecutive patients with bile duct cancer operated upon between 1973 and 2004. Patients were divided into intrahepatic, perihilar, and distal groups. Principle outcome measures were complications, 30-day mortality, and survival. Of the 564 patients, 44 (8%) had intrahepatic, 281 (50%) had perihilar, and 239 (42%) had distal tumors. Approximately half (294, 52%) were treated before 1995, while 270 (48%) were treated thereafter. The perioperative mortality rate was 4%. In log-rank analyses, survival was higher in the later time period (P = 0.002), in patients with intrahepatic disease (P = 0.001), with negative resection margins (P < 0.001), with well/moderately differentiated tumors (P < 0.001), and those with negative lymph nodal status (P < 0.001). In multivariate analysis, negative margins (P < 0.001), tumor differentiation (P < 0.001), and negative nodal status (P < 0.001), but not tumor diameter, were significant independent prognostic factors. In R0-resected patients, lymph node status (P < 0.001), but not tumor diameter, histology, or differentiation, further predicted survival. The median survivals for R0-resected intrahepatic, perihilar, and distal tumors were 80, 30, and 25 months, respectively, and the 5-year survivals were 63%, 30%, and 27%, respectively. R0 resection remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Transl Hepatol
                Journal ID (iso-abbrev): J Clin Transl Hepatol
                Journal ID (publisher-id): JCTH
                Title: Journal of Clinical and Translational Hepatology
                Publisher: XIA & HE Publishing Ltd
                ISSN (Print): 2225-0719
                ISSN (Electronic): 2310-8819
                Publication date (Electronic): 15 September 2015
                Publication date (Print): 28 September 2015
                Volume: 3
                Issue: 3
                Pages: 169-181
                Affiliations
                [1 ]Department of internal medicine, Albany medical center, Albany, NY, USA
                [2 ]Department of radiology, Albany medical center, Albany, NY, USA
                [3 ]Department of pathology, Albany medical center, Albany, NY, USA
                [4 ]Department of internal medicine, Division of gastroenterology, Albany medical center, Albany, NY, USA
                Author notes
                [* ] Correspondence to: Micheal Tadros, Department of Medicine, Division of Gastroenterology, Albany Medical Center, 47 New Scotland Avenue, MC 48, Albany, NY 12208, USA. Tel: +1-518-262-5276, Fax: +1-518-262-6470, E-mail: tradrosm1@ 123456mail.amc.edu

                Conflict of interest: None

                Author contributions: Drafting and revising the manuscript (GK, HA), providing radiology images (GB, MS), providing pathology images and editing the manuscript (HJL), conceiving this work, giving critical comments and revising the manuscript (MT).

                Article
                Publisher ID: JCTH-3-3-012
                DOI: 10.14218/JCTH.2015.00012
                PMC ID: 4663198
                PubMed ID: 26623263
                SO-VID: 0c0d4f9f-0ecf-4d15-b888-eb00d11ebbcb
                Copyright © © 2015 The Second Affiliated Hospital of Chongqing Medical University. Published by XIA & HE Publishing Ltd. All rights reserved.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 20 April 2015
                Date revision received : 22 May 2015
                Date accepted : 26 May 2015
                Categories
                Subject: Review Article

                Keywords: hepatobiliary tumors,hepatocellular carcinoma,cholangiocarcinoma,liver cancer,diagnosis,treatment,management
                Data availability:
                Keywords: hepatobiliary tumors, hepatocellular carcinoma, cholangiocarcinoma, liver cancer, diagnosis, treatment, management

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