ASSOCIATE EDITORS Frank A. Anania, Atlanta, GA Jorge A. Bezerra, Cincinnati, OH Raymond T. Chung, Boston, MA Eithan Galun, Jerusalem, Israel Guadalupe Garcia-Tsao, New Haven, CT Stephen A. Harrison, Fort Sam Houston, TX Brett Lindenbach, New Haven, CT Jacquelyn Maher, San Francisco, CA Wajahat Mehal, New Haven, CT Lola M. Reid, Chapel Hill, NC Mario Strazzabosco, New Haven, CT Norah Terrault, San Francisco, CA Snorri S. Thorgeirsson, Bethesda, MD Michael Trauner, Vienna, Austria

Review of recent research on hepatitis C therapy for 54th annual meeting of the American association for the study of liver diseases

Personalized treatment of patients with very early hepatocellular carcinoma.

Objective To compare the clinical effect of percutaneous radiofrequency ablation(PRFA) for hepatocellular carcinoma in elderly patients and in non-elderly patients.Methods We reviewed the clinical data of 77 HCC patients undergone PRFA from March, 2004 to August, 2007. Patients were categorized into two groups by their age: the elderly group (n=31), aged 60 and above, and the non-elderly group (n=46), younger than 60 years old. Survival time, treatment-related complications were compared between the two groups. Factors that may influence the outcome were also determined using a multivariate analysis with Cox regress model. Results Results The tumor complete elimination rate was similar (87.1% vs 82.6%, P=0.832). The 1, 2 and 3 year recurrence rates were 44.4%,59.8%,71.3% respectively in the elderly group, and were 56.4%,70.7%,78.1% respectively in the non-elderly group. There was no significant difference between the two groups (P=0.464). The 1, 2 and 3 year survival rates for the elderly group and the non-elderly group were 89.6%,63.8%,35.9% vs 78.9%,46.6%,20.1%, respectively (P=0.114). Regarding the rate of treatment-related complication, no significant difference was found between the two groups (29.0% vs 26.1%, P=0.776). Recurrence tumor, non-solitary tumor and recurrence after PRFA except tumor size and age were found to be the prognostic factors.Conclusion PRFA had the advantage of less invasiveness and the survival rate in the elderly patients was as comparable as that in the non-elderly patients. PRFA may be more suitable to elderly patients as one of the treatment modality for hepatocellular carcinoma, especially to those who with recurrence tumor.

Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma in Elderly Patients

Solitary fibrous tumor (SFT) is a rare tumor of mesenchymal origin that account for less than 2% of all soft tissue masses. Initially identified in the pleura, SFT has been identified in multiple anatomic locations and can arise anywhere in the body. The varying histologic features along with non-specific means of identification have led SFT to be associated with several different names. Over the last several decades, sustained advances through research and technology have led to more reliable methods for differentiating this distinct soft tissue tumor. Advances specifically in immunohistochemistry and molecular diagnostics have identified CD34 as the most consistent marker in SFT, however even this lacks specificity to conclusively narrow down the broad differential for exact identification. More recently the discovery of the NAB2-STAT6 fusion gene has led to more precise diagnosis of SFT. Like many other soft tissue tumors, surgical management is the mainstay of treatment for SFT with emphasis on obtaining tumor-negative margins. Radiation therapy and chemotherapy regimens have not demonstrated global effectiveness, and thus no standardized treatments have been identified. Given the rarity of SFT and current supportive evidence for therapies, management should be focused on tumor extirpation. Nonetheless, individualized therapy, determined within a multidisciplinary setting should be considered.

https://tgh.amegroups.com/article/download/4708/pdf

Solitary fibrous tumor.

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/lt.24117

Combinations of biomarkers and Milan criteria for predicting hepatocellular carcinoma recurrence after liver transplantation

BACKGROUND A number of cohort studies have compared the outcomes of liver transplantation (LT) and liver resection (LR) in hepatocellular carcinoma (HCC) patients. However, the effects of LT versus LR remain unclear. We searched electronic databases and reference lists for relevant articles published before February 2013. METHODS The primary endpoints were pooled using random-effects models to model potential heterogeneity, including overall survival (OS), disease-free survival, and recurrence rate. RESULTS We found similar 1-year OS (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.81-1.43; P=0.61) yet significantly better 3-year OS (OR, 1.47; 95% CI, 1.18-1.84; P<0.001) and 5-year OS (OR, 1.77; 95% CI, 1.45-2.16; P<0.001) after LT compared with LR with relative risk differences of 9% (P<0.001) and 14% (P<0.001), respectively. The 1-, 3-, and 5-year difference-free survival were 13%, 29%, and 39% higher (P<0.001 in all) in LT recipients than LR patients. Additionally, recurrence rate was 30% less (P<0.001) in LT than LR. Furthermore, better 5-year difference-free survival (P<0.001) and recurrence rates (P<0.05) were yielded after LT when patients from the entire HCC population were included. CONCLUSIONS When including all the 62 previous studies comparing LT and resection, LT provides increased survival and lower recurrence rates than LR for HCC patients. These results of disease-free survival and recurrence rate are similar among early HCC patients with Child-Turcotte-Pugh class A cirrhosis. However, summary ORs and risk differences cannot be interpreted as causal effects of LT versus LR.

Liver transplantation versus liver resection in the treatment of hepatocellular carcinoma: a meta-analysis of observational studies.

Hepatic arterioportal shunts (HAPS) occur due to organic or functional fistulization of blood flow between arterial hepatic vasculature and venous portal systems. It is a type of hemodynamic abnormality of the liver being observed increasingly with the use of temporal imaging modalities. HAPS occur due to other underlying hepatic abnormalities including the presence of an underlying tumor or malignancy. When a HAPS is present, the appearance of these abnormalities on imaging studies suggests an underlying abnormality, must be considered atypical even if asymptomatic, and warrants careful evaluation. Over time, and as a function of degree of fistulae, symptoms and potential life-threatening complications may arise from the HAPS. These systemic complications may include the development of portal hypertension, splenomegaly, as well as accelerated metastasis in patients with malignant tumors. This manuscript reviews common underlying conditions associated with HAPS and their radiologic interpretation.

/pdf/ct-and-mri-imaging-and-interpretation-of-hepatic-25tcwslig6.pdf

CT and MRI imaging and interpretation of hepatic arterioportal shunts.

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and the third leading cause of cancer-related death. Historically, HCC has been a problem mostly faced by patients from Asian countries due to the high prevalence of hepatitis B (HBV). Increasing global rates of HBV, hepatitis C, and obesity-related non-alcoholic steatohepatitis has caused a global increased incidence in HCC. Potentially curative therapies for HCC include liver resection, liver transplant, and radiofrequency ablation. More advanced HCC may be palliated with transarterial chemoembolization, transcatheter radioembolization, and sorafenib. Appropriate surveillance for those at risk and accurate clinical staging allows for earlier diagnosis and improved chance for cure. Hepatic resection remains the preferred primary therapy for HCC in the setting of relatively preserved liver function, while liver transplantation is the preferred curative therapy in the setting of small tumor burden with underlying liver disease. The application of locoregional therapies can also cure small lesions and maximize the utility of the limited donor pool by temporizing HCC and reserving livers for those who succumb to their underlying chronic liver disease.

Management of Hepatocellular Carcinoma (HCC)

Unplanned Intubation: When and Why Does this Deadly Complication Occur?

The positive association of Association for Academic Surgery membership with academic productivity.

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