BACKGROUND/AIMS: Screening for hepatocellular carcinoma (HCC) is a common practice in the endemic countries but its exact role has not been fully investigated. The purpose of this study was to determine whether screening can achieve early diagnosis and survival benefits. METHODS: All HCC patients diagnosed at our hospital (September 1994~April 2000) were enrolled; They were divided into two groups; a surveilled group screened with alpha-fetoprotein (AFP) and ultrasound (US) for longer than 6 months before diagnosis and a non-surveilled group. We compared the tumor size, portal vein thrombosis, and stage at initial diagnosis and survival rate between the two groups. RESULTS: A total of 247 patients were enrolled. 64 were in the surveilled group and 183 were in the non-surveilled group. The tumor size at initial diagnosis in the surveilled group was smaller than in the non-surveilled group (2.6+/-2.0 cm vs. 5.7+/-4.1 cm, p<0.05). The percentages of patients with stage I, II, III, and IV were 42.2%, 20.3%, 14.1%, 23.4% in the surveilled group and 8.7%, 19.7%, 36.6%, 35.0% in the non-surveilled group. A significantly higher proportion in the surveilled group had earlier stage compared with the non-surveilled group (p<0.05). Portal vein thrombosis in the surveilled group was noticed as significantly less than in the non-surveilled group (9.4% vs. 26.8%, p<0.05). Among Child-Pugh A patients, the cumulative survival rate in the surveilled group was significantly higher than in the non-surveilled group (1 year; 91.4% vs. 70.7%, 2 year; 71.5% vs. 59.9%, p<0.05). CONCLUSIONS: Screening with AFP and US is a useful tool for early diagnosis of HCC, especially with improved survival in Child-Pugh A patients.
Adult ; Aged ; Carcinoma, Hepatocellular/*diagnosis/mortality/therapy ; Female ; Humans ; Liver Neoplasms/*diagnosis/mortality/therapy ; Male ; Middle Aged ; Survival Rate ; alpha-Fetoproteins/analysis

OBJECTIVETo observe the long-term effects of combined transcatheter arterial chemoembolization (TACE) and radiotherapy for patients with large hepatocellular carcinoma (HCC) and to analyze the prognostic factors.

METHODSA total of 107 patients with large unresectable HCC (the largest diameter of tumor ranged from 5 to 18 cm) were treated with TACE followed by external-beam irradiation. Acute effects and survival rates were observed. The Cox proportional hazards model was used to analyze the prognostic factors.

RESULTSAn objective response was achieved in 48.6% of the cases. The cumulative survival rates at 1, 3, and 5 years were 59.4%, 28.4%, and 15.8%, respectively. The tumor number and irradiation dose were the independent prognostic factors. The cumulative survival rates of the patients with a solitary lesion (75.8%, 43.9%, and 26.8% at 1, 3, and 5 years, respectively) were significantly higher than those with multiple lesions (31.3%, and 5.0% at 1 and 3 years, respectively, P=0.0005). The survival rates of the patients received irradiation above 40 Gy (95.8%, 74.7%, and 37.4% at 1, 3, and 5 years, respectively) were significantly higher than those received 20~40 Gy (60.9%, 20.7%, and 10.3%, respectively) and those received radiation lower than 20 Gy (26.7%, 7.1%, and 7.1%, respectively, P=0.0001).

CONCLUSIONSCombined TACE with radiotherapy is a promising treatment for large unresectable HCC. The number of tumor is the most important clinical prognostic factor. Delivering the highest irradiation dose within the tolerance of the liver is the key to improve the long-term effect.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnosis ; mortality ; radiotherapy ; therapy ; Embolization, Therapeutic ; Female ; Humans ; Liver Neoplasms ; diagnosis ; mortality ; radiotherapy ; therapy ; Male ; Middle Aged ; Prognosis ; Survival Rate

Because Mongolia has much higher liver disease burden than any other regions of the world, it is necessary to provide information on real-time situation of chronic liver disease in Mongolia. In this article, we reviewed studies performed in Mongolia from 2000 to 2011 on seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) among healthy individuals and patients with chronic liver diseases, and on the practice patterns for the management of liver cirrhosis and hepatocellular carcinoma (HCC). According to previous reports, the seroprevalence of HBV and HCV in general population in Mongolia is very high (11.8% and 15% for HBV and HCV, respectively). Liver cirrhosis is also highly prevalent, and mortality from liver cirrhosis remained high for the past decade (about 30 deaths per 100,000 populations per year). Among patients with cirrhosis, 40% and 39% are positive for HBsAg and anti-HCV, respectively, and 20% are positive for both. The seroprevalence is similar for HCC and more than 90% of HCC patients are positive for either HBV or HCV. The incidence of HCC in Mongolia is currently among the highest in the world. The mortality from HCC is also very high (52.2 deaths per 100,000 persons per year in 2010). Partly due to the lack of established surveillance systems, most cases of HCC are diagnosed at an advanced stage. The mortality from liver cirrhosis and HCC in Mongolia may be reduced by implementation of antiviral therapy program and control of alcohol consumption.
Carcinoma, Hepatocellular/blood/diagnosis/*epidemiology/mortality/therapy ; Hepatitis B, Chronic/epidemiology ; Hepatitis C, Chronic/epidemiology ; Humans ; Liver Cirrhosis/epidemiology ; Liver Diseases/blood/diagnosis/*epidemiology/mortality/therapy ; Liver Neoplasms/blood/diagnosis/*epidemiology/mortality/therapy ; Mongolia/epidemiology ; Prevalence ; Prognosis ; Risk Assessment ; Risk Factors ; Seroepidemiologic Studies ; Time Factors

BACKGROUND/AIMS: Spontaneous rupture of hepatocellular carcinoma (HCC) is a rare but life-threatening complication. Although the prevalence rate and mortality of HCC has been reportedly high in Korea, studies on ruptured HCC are limited. The aim of this study was to determine the clinical characteristics and prognostic factors of ruptured HCC. METHODS: Among 886 cases with HCC that had been diagnosed at Chonnam National University Hospital from January 2002 to December 2007, 62 cases (7.0%) with ruptured HCC were studied retrospectively regarding their clinical characteristics and prognostic factors. RESULTS: Transarterial embolization was performed in 56 cases (90.3%) to control bleeding, with a hemostasis success rate of 89.3%. The survival time after the rupture of HCC was 8.0+/-1.7 months (mean+/-SD), although it was longer in HCC cases that were first diagnosed in a ruptured state or ruptured with a small amount of bleeding than in those that ruptured during follow-up after diagnosis or with a large amount of bleeding, respectively. The 30-day mortality rate in patients with a ruptured HCC was 43.5%, and the early deaths were independently associated with the presence of hepatic encephalopathy (odds ratio, OR=44.7; 95% confidence interval, CI=1.9-1051.1; P=0.018), serum bilirubin >3.0 mg/dL (OR=36.7; 95% CI=1.3-1068.5; P=0.036), and the massive or diffuse type of tumor morphology (OR=53.5; 95% CI=3.0-964.2; P=0.007). CONCLUSIONS: The prognosis in patients with ruptured HCCs was poor with a 30-day mortality of 43.5%. The early deaths after the rupture of HCC were associated with elevated serum bilirubin levels, hepatic encephalopathy, and the massive or diffuse type of tumor morphology.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*diagnosis/mortality/therapy ; Clinical Chemistry Tests ; Data Interpretation, Statistical ; Female ; Humans ; Liver Neoplasms/*diagnosis/mortality/therapy ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Rupture, Spontaneous/diagnosis ; Severity of Illness Index ; Survival Rate ; Tomography, X-Ray Computed ; Treatment Outcome

The prevalence of hepatocellular carcinoma (HCC) has increased in recent years. However, HCC remains poorly characterized in elderly patients, and comprehensive data are limited. This study aimed to investigate the clinical characteristics, prognostic features and survival outcome of elderly HCC patients. We retrospectively analyzed 992 HCC patients treated at Dongsan Hospital from January 2003 to December 2007. The patients were divided into two age groups: < 70 yr (n = 813) and > or = 70 yr (n = 179). Elderly HCC patients, compared to younger patients, had significantly higher incidence of females (31.3% vs 18.9%, P = 0.001), hepatitis C-related disease (HCV antibody positivity 26.3% vs 9.2%, P = 0.001) and comorbid condition (53.6% vs 32.1%), but lower rates of hepatitis B-related disease (HBs antigen positivity 31.3% vs 69.4%, P = 0.001). There were no significant differences in underlying liver function, stage and survival outcomes. Factors significantly influencing the prognosis of HCC were Child-Pugh grade, number of HCC, level of alpha-fetoprotein, presence of metastasis. The survival outcome of older patients with HCC was not different from that of younger patients. There were no differences between groups in independent factors influencing the prognosis of HCC. Therefore, determining the optimal management strategy for elderly HCC patients is important to improve survival and long-term outcomes.
Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Carcinoma, Hepatocellular/etiology/*mortality/*therapy ; Chemoembolization, Therapeutic ; Female ; Hepatitis B/complications/diagnosis ; Hepatitis B Surface Antigens/blood ; Hepatitis C/complications/diagnosis ; Hepatitis C Antibodies/blood ; Humans ; Liver Neoplasms/etiology/*mortality/*therapy ; Male ; Middle Aged ; Palliative Care ; Regression Analysis ; Republic of Korea ; Retrospective Studies ; Survival Analysis ; alpha-Fetoproteins/analysis

OBJECTIVE: To compare the effectiveness of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) with surgical resection in patients with a single hepatocellular carcinoma (HCC) ranging from 2 to 5 cm. MATERIALS AND METHODS: The study participants were enrolled over a period of 29 months and were comprised of 37 patients in a combined therapy group and 47 patients in a surgical resection group. RFA was performed the day after TACE, and surgical resection was performed by open laparotomy. The two groups were compared with respect to the length of hospital stay, rates of major complication, and rates of recurrence-free and overall survival. RESULTS: Major complications occurred more frequently in the surgical resection group (14.9%) than in the combined therapy group (2.7%). However, there was no statistical significance (p = 0.059). The rates of recurrence-free survival at 1, 2, 3 and 4 years were similar between the combined therapy group (89.2%, 75.2%, 69.4% and 69.4%, respectively) and the surgical resection group (81.8%, 68.5%, 68.5% and 65%, respectively) (p = 0.7962, log-rank test). The overall survival rates at 1, 2, 3 and 4 years were also similar between groups (97.3%, 86.5%, 78.4% and 78.4%, respectively, in the combined therapy group, and 95.7%, 89.4%, 84.3% and 80.3%, respectively, in the surgical resection group) (p = 0.6321, log-rank test). CONCLUSION: When compared with surgical resection for the treatment of a single HCC ranging from 2 to 5 cm, RFA combined with TACE shows similar results in terms of recurrence-free and overall survival rates.
Carcinoma, Hepatocellular/diagnosis/mortality/*therapy ; Catheter Ablation/*methods ; Chemoembolization, Therapeutic/*methods ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/diagnosis/mortality/*therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Staging ; Republic of Korea/epidemiology ; Retrospective Studies ; Survival Rate/trends ; Treatment Outcome

BACKGROUND/AIMS: Low-dose metronomic chemotherapy involves the frequent administration of comparatively low doses of cytotoxic agents with no extended breaks, and it may be as efficient as and less toxic than the conventional maximum tolerated dose therapy. This study evaluated the feasibility and therapeutic efficacy of metronomic chemotherapy in patients with advanced hepatocellular carcinoma (HCC) with major portal vein thrombosis (PVT). METHODS: Thirty consecutive HCC patients with major PVT with or without extrahepatic metastasis were prospectively allocated to metronomic chemotherapy consisting of epirubicin being infused through the correct hepatic artery at a dose of 30 mg/body surface area (BSA) every 4 weeks, and cisplatin (15 mg/BSA) and 5-fluorouracil (50 mg/BSA) every week for 3 weeks, with intervening 1 week breaks. The treatment response was assessed using response evaluation criteria in solid tumors (RECIST). RESULTS: In total, 116 cycles of metronomic chemotherapy were administered to the 30 patients, with a median of 3 cycles given to individual patients (range, 1-15 cycles). Six patients (20.0%) achieved a partial response and six patients (20.0%) had stable disease. The median time to disease progression and overall survival were 63 days (range, 26-631 days) and 162 days (95% confidence interval; range, 62-262 days), respectively. Overall survival was significantly associated with baseline alpha-fetoprotein level (P=0.001) and tumor response (P=0.005). The baseline alpha-fetoprotein level was significantly associated with the disease control rate (P=0.007). Adverse events were tolerable and managed successfully with conservative treatment. CONCLUSIONS: Metronomic chemotherapy may be a safe and useful palliative treatment in HCC patients with major PVT.
Administration, Metronomic ; Adult ; Aged ; Antineoplastic Agents/administration & dosage ; Carcinoma, Hepatocellular/complications/*drug therapy/mortality ; Cisplatin/administration & dosage ; Epirubicin/administration & dosage ; Female ; Fluorouracil/administration & dosage ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/complications/*drug therapy/mortality ; Male ; Middle Aged ; *Portal Vein ; Prognosis ; Tomography, X-Ray Computed ; Venous Thrombosis/complications/*diagnosis ; alpha-Fetoproteins/analysis

BACKGROUND/AIMS: Nonselective beta-blockers (NSBBs), such as propranolol, reportedly exert a pleiotropic effect in liver cirrhosis. A previous report suggested that survival was higher in patients receiving adjusted doses of NSBBs than in ligation patients. This study investigated whether low-dose NSBB medication has beneficial effects in patients with liver cirrhosis, especially in terms of overall survival. METHODS: We retrospectively studied 273 cirrhotic patients (199 males; age 53.6+/-10.2 years, mean+/-SD) who visited our institution between March 2003 and December 2007; follow-up data were collected until June 2011. Among them, 138 patients were given a low-dose NSBB (BB group: propranolol, 20-60 mg/day), and the remaining 135 patients were not given an NSBB (NBB group). Both groups were stratified randomly according to Child-Turcotte-Pugh (CTP) classification and age. RESULTS: The causes of liver cirrhosis were alcohol (n=109, 39.9%), hepatitis B virus (n=125, 45.8%), hepatitis C virus (n=20, 7.3%), and cryptogenic (n=19, 7.0%). The CTP classes were distributed as follows: A, n=116, 42.5%; B, n=126, 46.2%; and C, n=31, 11.4%. Neither the overall survival (P=0.133) nor the hepatocellular carcinoma (HCC)-free survival (P=0.910) differed significantly between the BB and NBB groups [probability of overall survival at 4 years: 75.1% (95% CI=67.7-82.5%) and 81.2% (95% CI=74.4-88.0%), respectively; P=0.236]. In addition, the delta CTP score did not differ significantly between the two groups. CONCLUSIONS: Use of low-dose NSBB medication in patients with liver cirrhosis is not indicated in terms of overall and HCC-free survival.
Adrenergic beta-Antagonists/*therapeutic use ; Adult ; Aged ; Alcohol Drinking ; Carcinoma, Hepatocellular/complications/diagnosis ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/complications/diagnosis ; Liver Cirrhosis/complications/*drug therapy/mortality ; Liver Neoplasms/complications/diagnosis ; Male ; Middle Aged ; Predictive Value of Tests ; Proportional Hazards Models ; Propranolol/*therapeutic use ; Retrospective Studies ; Severity of Illness Index

BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) has been known to greatly influence the survival rate of patients with liver cirrhosis. However, the factors that affect the survival rate in patients with SBP need to be clarified. METHODS: This study enrolled 95 liver cirrhosis patients diagnosed with SBP. The laboratory findings of their serum and ascitic fluid were examined and the characteristics of the isolated microorganisms in their peritoneal fluid were analyzed. RESULTS: The proportion of patients with culture-positive SBP was 41.1%, and 47 microorganisms were isolated from the ascitic fluid. The proportions of cultured bacteria that were Gram negative and Gram positive were 57.4% and 40.4%, respectively. The proportions of Escherichia coli, Klebsiella species, and Streptococcus species were 25.5%, 19.1%, and 19.1%, respectively. Enterococcus species represented 12.8% of the microorganisms cultured. The overall survival rates at 6, 12, and 24 months were 44.5%, 37.4%, and 32.2%, respectively. There was no relationship between the bacterial factors and the survival rate in SBP. Multivariate analysis revealed that the presence of hepatocellular carcinoma (HCC; P=0.001), higher serum bilirubin levels (> or =3 mg/dL, P=0.002), a prolonged serum prothrombin time (i.e., international normalized ratio >2.3, P<0.001), renal dysfunction (creatinine >1.3 mg/dL, P<0.001), and lower glucose levels in the ascitic fluid (<50 mg/dL, P<0.001) were independent predictive factors of overall survival rate. CONCLUSIONS: HCC, higher serum bilirubin levels, a prolonged serum prothrombin time, renal dysfunction, and lower ascitic glucose levels are associated with higher mortality rates in cirrhotic patients with SBP.
Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Ascitic Fluid/metabolism/microbiology ; Bilirubin/blood ; Carcinoma, Hepatocellular/complications/diagnosis ; Creatinine/blood ; Female ; Glucose/analysis ; Gram-Negative Bacteria/isolation & purification ; Gram-Positive Bacteria/isolation & purification ; Humans ; Liver Cirrhosis/complications/*mortality ; Liver Neoplasms/complications/diagnosis ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Peritonitis/complications/*diagnosis/drug therapy ; Prognosis ; Prothrombin Time ; Survival Rate

BACKGROUND/AIMS: Practice guidelines recommend endoscopic band ligation (EBL) and endoscopic variceal obturation (EVO) for bleeding from esophageal varices and fundal varices, respectively. However, the optimal treatment for bleeding from cardiac varices along the lesser curvature of the stomach (GOV1) remains undefined. This retrospective study compared the efficacy between EBL and EVO for bleeding from GOV1. METHODS: Patients treated by EBL or EVO via cyanoacrylate injection for bleeding from GOV1 were enrolled. Patients diagnosed with hepatocellular carcinoma or treated with endoscopic injection sclerotherapy were excluded. RESULTS: The study included 91 patients treated for bleeding from GOV1. The mean age was 56.3±10.9 years (mean±SD), and 78 of them (85.7%) were men. Overall, 51 and 40 patients were treated with EBL and EVO, respectively. A trend for a higher hemostasis rate was noted in the EVO group (100%) than in the EBL group (82.6%, P=0.078). Varices rebled in 15 patients during follow-up. The rebleeding rate was significantly higher in the EBL group than in the EVO group (P=0.004). During follow-up, 13 patients died (11 in the EBL group and 2 in the EVO group); the survival rate was marginally significant between two groups (P=0.050). The rebleeding-free survival rate was significantly higher in the EVO group than in the EBL group (P=0.001). CONCLUSIONS: Compared to EBL, EVO offered significantly lower rebleeding rates, significantly higher rebleeding-free survival rates, and a trend for higher hemostasis and survival rates. EVO appears to be the better therapeutic option for bleeding from GOV1.
Adult ; Aged ; Carcinoma, Hepatocellular/complications ; Cyanoacrylates/*therapeutic use ; Disease-Free Survival ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Hemorrhage/etiology/mortality/*therapy ; Humans ; Ligation ; Liver Cirrhosis/complications/diagnosis ; Liver Neoplasms/complications ; Male ; Middle Aged ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Sclerotherapy ; Survival Rate ; Treatment Outcome