Carcinoma, Hepatocellular ; pathology ; surgery ; Humans ; Liver Neoplasms ; pathology ; surgery ; Neoplastic Cells, Circulating ; Portal Vein

OBJECTIVETo evaluate the value of radiofrequency ablation in the treatment of small hepatocellular carcinoma (HCC).

METHODSMEDLINE (1966 - 2008), EMBASE (1966 - 2008), CBMdisc (1978 - 2008) were searched. The Cochrane Library, Evidence Base Medicine Reviews (Ovid Edition), Cancerlit (1993 - 2008) and so on, date of last search: 30 January 2008. There were no restrictions in language. Randomized controlled trials (RCTs) and non-RCTs were both included in this study, and the quality of each included study was assessed. Meta-analysis was performed by RevMan 4.2 software.

RESULTSFour prospective controlled studies and two retrospective studies met the inclusion criteria. The results of meta-analysis showed that 1-, 3-, 4-year survival rates and 1-year tumor-free survival rate had not statistically significant difference in RFA group compared with surgical resection group (P > 0.05), but surgical resection was more effective to improve 3-year tumor-free survival rate than RFA (P < 0.05).

CONCLUSIONSThe effect of RFA therapy on small HCC is similar to resection, RFA could be considered as the first-line treatment of choice for surgical candidates with small HCC in cirrhotic patients.

Carcinoma, Hepatocellular ; pathology ; surgery ; Catheter Ablation ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; pathology ; surgery ; Treatment Outcome

Combined hepatocellular-cholangiocarcinoma is a rare form of primary liver cancer showing features of both hepatocellular and biliary epithelial differentiation. We report here on a case with collision tumor, which apparently was the coincidental occurrence of both hepatocellular carcinoma and cholangiocarcinoma underlying schistosomiasis. A 39-year-old-Philippine female was transferred to our hospital for evaluation of a liver mass that was found on ultrasonography at a local hospital. HBsAg and Anti-HCV were negative and serum alpha-fetoprotein (AFP) level was normal. The tumor mass was histologically diagnosed as adenocarcinoma by sono-guided biopsy before the operation. Partial lobectomy was performed and we histologically identified the concurrent occurrence of hepatocellular carcinoma and cholangiocarcinoma, (a "collision type carcinoma").
Adenocarcinoma/diagnosis/pathology/surgery ; Adult ; Carcinoma, Hepatocellular/*diagnosis/pathology/surgery ; Cholangiocarcinoma/*diagnosis/pathology/surgery ; Female ; Humans ; Schistosomiasis/*physiopathology

OBJECTIVETo study the micrometastasis distribution in liver tissue surrounding hepatocellular carcinoma (HCC), and provide reference for appropriate surgical safety margin.

METHODSThirty-six patients with HCC but without clinical metastasis underwent hepatectomy. Their specimens showing ample surgical margin were made into giant sections. Tumor micrometastasis in liver tissue around the primary tumor were examined microscopically. In each specimen, the surrounding tissue was divided into proximal(p) and distal(d) areas. In either area, three lines of demarcation 0.5 cm, 1.0 cm, and 2.0 cm away from the margin of the primary tumor were designated as L(0.5), L(1.0) and L(2.0). Therefore, the surrounding tissue was divided into six zones - Z(p0.5), Z(p1.0), Z(p2.0) and Z(d0.5), Z(d1.0), Z(d2.0). The maximum micrometastasis spread distance (MMSD) and density (D(p0.5), D(p1.0), D(p2.0) and D(d0.5), D(d1.0), D(d2.0)) in each zone were analyzed after search for micrometastasis in the giant sections.

RESULTS72.5% (111/153) micrometastases were found in form of microscopic tumor emboli. Their spread distance could be up to 6.1 cm. In 66.7% (24/36) specimens, micrometastases were found in the surrounding tissue. In 91.7% (22/24) of them, the distal MMSD was less than 3 cm. The proximal MMSD was less than 1.5 cm in 92.3% (12/13). The comparison of micrometastasis density in the different zones were D(d0.5) > D(d1.0) > D(d 2.0); D(p0.5) > D(p1.0) > D(p2.0); D(d1.0) > D(p1.0); D(d2.0) > D(p2.0) with significant differences.

CONCLUSION(1) Micrometastases of HCC exist mainly in form of microscopic tumor emboli, (2) The longer the distance from the primary focus, the lower the micrometastasis incidence, (3) In zones more than 0.5 cm away from the primary focus, tumor micrometastasis incidence is significantly lower in the proximal zones than that in the distal zones and (4) For HCC patients without clinical metastasis, a surgical margin of 3 cm wide in the distal area and 1.5 cm wide in the proximal area may reduce the rate of postoperative recurrence.

Carcinoma, Hepatocellular ; secondary ; surgery ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; pathology ; surgery ; Neoplasm Metastasis ; Neoplasm Recurrence, Local

OBJECTIVETo evaluate the risk factors for recurrence in patients with hepatocellular carcinoma (HCC) after liver transplantation (LT).

METHODSOne hundred and fifteen small HCC patients, who met Milan criteria (single<5 cm or showing up to three nodules, each of them<3 cm without major vascular invasion or distant metastasis) and underwent LT in our hospital from January 2007 to November 2013, were enrolled in the study. The risk factors for recurrence were analyzed by Cox regression and the influence of the Milan criteria and microvascular invasion (MVI) on the disease-free survival (DFS) and recurrence of patients were assessed with survival analysis and ROC method.

RESULTSNinety-eight out of 115 small HCC patients were included for analysis, the 1-,3-, 5-year overall survival of patients was 91.8%, 80.6%, 79.6% and DFS was 87.8%, 74.5%, 73.5%, respectively. Survival analysis identified that MVI, macro-vascular invasion, exceeding the Milan criteria and pre-transplant down-staging treatment were related to tumor recurrence (P<0.05). Multivariate Cox regression analysis showed that MVI and exceeding the Milan criteria were two independent prognostic indicators for early recurrence of small HCC after LT. The 1-,3-,5-year DFS for 69 patients without MVI and 29 patients with MVI were 92.8%, 85.5%, 85.5% and 75.9%, 55.2%, 48.3%, respectively (P<0.01). The 1-,3-,5-year DFS for 84 patients meeting the Milan criteria and 14 exceeding the Milan criteria were 91.7%, 83.3%, 79.8% and 64.3%, 42.9%, 42.9%, respectively (P<0.01).

CONCLUSIONFor early HCC patients undergoing LT, the presence of MVI would predict tumor recurrence and can be an indicator for the adjuvant treatment or other salvage treatments.

Carcinoma, Hepatocellular ; pathology ; surgery ; Humans ; Liver Neoplasms ; pathology ; surgery ; Liver Transplantation ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; pathology ; Prognosis ; Risk Factors

OBJECTIVETo investigate the pathological feature of primary hepatic carcinoma and the clinical significance.

METHODSFrom August 2000 to December 2007, there were 89 patients with cirrhosis and carcinoma of liver who accepted whole liver resection. The whole liver was cut into 10 mm slices to examine the tumor size, number, distribution, capsule, satellite nodes, portal vein tumor thrombi (PVTT). The invaded adjacent tissue and lymph nodes were recorded, the distance from satellite to major tumor was measured, then histological examinations were carried out, and the final diagnosis was made by pathologists.

RESULTSThe total of 89 cases included hepatocellular carcinoma in 86 cases and cholangiocarcinoma in 3 cases; 53 cases with multiple tumors and 36 cases with solitary tumor; complete capsule only in 14 cases, no obvious margin in 11 cases, 13 cases had a major tumor in the right lobe and a small tumor in the left lobe; 8 of 25 cases with gross invaded tissue were confirmed by histological examination, 7 of 16 cases with swollen lymph nodes were infiltrated by cancer cells. There were 47 cases with PVTT (47.2%) and 39 cases with satellite nodes (43.8%). PVTT and satellite nodes increased with the increase of sizes and the numbers of the tumors. The distance from satellite node to major tumor mostly were 0.5 - 3.0 cm.

CONCLUSIONSThe whole explanted liver can completely reflect the characteristics of growth and infiltration of hepatic carcinoma. Attention must be paid to the small cancer lesions in another lobe, distal satellite nodes from major tumor, and tumor thrombi in a small branch of portal vein, which can not be found by imaging, and might influence the curative effectiveness after liver resection or transplantation.

Adult ; Carcinoma, Hepatocellular ; pathology ; surgery ; Female ; Hepatectomy ; Humans ; Liver ; pathology ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Young Adult

Bile Duct Neoplasms ; pathology ; surgery ; Carcinoma, Hepatocellular ; complications ; pathology ; surgery ; Cholestasis, Intrahepatic ; etiology ; pathology ; surgery ; Humans ; Liver Neoplasms ; complications ; pathology ; surgery ; Neoplasm Invasiveness

Humans ; Carcinoma, Hepatocellular/surgery* ; Liver Neoplasms/pathology* ; Cholangiocarcinoma/pathology* ; Bile Ducts, Intrahepatic/pathology* ; Bile Duct Neoplasms/pathology*

Surgical treatment of hepatocellular carcinoma (HCC) has made great progress in recent ten years, although the appropriate selection of treatment methods remains controversial. Surgical resection of HCC is still widely recognized as the first choice, which has been remarkably improved by effectively controlling intra-operative bleeding. However, the ischemia/reperfusion injury and long-term recurrence still proposes challenges to Pringle's maneuver. The indications of liver transplantation also expand in recent years, and many centers have used marginal donor liver and living donor liver. Remission of the shortage of donors, local ablation of small HCC, and surgical resection still lack the support of randomized controlled trials. In summary, the surgical treatment of HCC should strictly based on the indications of various therapies, which should be prudently verified by randomized controlled trials.
Carcinoma, Hepatocellular ; pathology ; surgery ; Humans ; Intraoperative Complications ; prevention & control ; Liver Neoplasms ; pathology ; surgery ; Liver Transplantation ; Randomized Controlled Trials as Topic

Along with the improvement of surgical techniques and post-transplant management, the role of liver transplantation in hepatocellular carcinoma (HCC) treatment has become increasingly important. Although HCC now is an indication of liver transplantation, the criteria of HCC candidates selection vary in different transplantation centers in China. On the contrary, the HCC candidates selection criteria in western countries are relatively strict, among which Milan criteria, University of California, San Francisco (UCSF) criteria, and Pittsburgh modified TNM criteria are widely acknowledged. However, Milan criteria and UCSF criteria only focus on tumor diameter and tumor number but ignore some important risk factors such as vascular invasion and histological differentiation. In our opinion, the biological behaviors of tumor are as important as tumor burden. A set of new candidates selection and prognostic criteria of liver transplantation in HCC patients named "Hangzhou criteria" has been established based on China's real situations and on the results of our long-term research. Hangzhou criteria expands and surpasses Milan criteria, including several important risk factors. According to Hangzhou criteria, more HCC patients are given opportunities to receive liver transplantation and achieved favorable long-term survival. Also in this article, we reviewed the peri-transplantation therapy of HCC to reduce the tumor recurrence and improve the long-term survival after transplantation for the purpose of making liver transplantation more effective and reliable for HCC treatment.
Carcinoma, Hepatocellular ; mortality ; pathology ; surgery ; China ; Humans ; Liver Neoplasms ; mortality ; pathology ; surgery ; Liver Transplantation ; Patient Selection ; Treatment Outcome