Characteristics and Outcomes of Elderly Hepatocellular Carcinoma Patients following Surgical Resection: Systematic Review and Meta-analysis
Elizabeth M GarciaSanjna Nilesh NerurkarEunice Xiang Xuan TanShaun Ye Song TanErn-Wei PeckSabrina Xin Zi QuekReadon TehMargaret TengAndrew TranEe Jin YeoMichael H. LeConnie WongRamsey CheungDaniel Q. Huang
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Abstract:
Due to ageing of the global population, hepatocellular carcinoma (HCC) is increasingly common among elderly patients, but outcomes after curative hepatic resection are unclear. Using a metanalytic approach, we aimed to estimate overall survival (OS), recurrence free survival (RFS) and complication rates in elderly HCC patients undergoing resection.We searched PubMed, Embase, and Cochrane databases from inception to Nov 10, 2020 for studies reporting outcomes in elderly (age ≥ 65 years) patients with HCC undergoing curative surgical resection. Pooled estimates were generated using a random-effects model.We screened 8,598 articles and included 42 studies (7,778 elderly patients). The mean age was 74.45 years (95% CI 72.89-76.02), 75.54% were male (95% CI 72.53-78.32) and 66.73% had cirrhosis (95% CI 43.93-83.96). The mean tumor size was 5.50 cm (95% CI 4.71-6.29) and 16.01% had multiple tumors (95% CI 10.74-23.19). The 1-year (86.02% versus 86.66%, p=0.84) and 5-year OS (51.60% versus 53.78%) between non-elderly versus elderly patients were similar. Likewise, there were no differences in the 1-year (67.32% versus 73.26%, p=0.11) and 5-year RFS (31.57% versus 30.25%, p=0.67) in non-elderly versus elderly patients. There was a higher rate of minor complications (21.95% versus 13.71%, p=0.03) among elderly patients compared with non-elderly patients, but no difference in major complications (p=0.43) Conclusion: This data shows that overall survival, recurrence and major complications after liver resection for HCC are comparable between elderly and non-elderly patients, and may inform clinical management of HCC in this population.The present studt was completed to assess the clinical utility of B protein, as a tumor marker of hepatocellular carcinoma. The association of B protein and liver cirrhosis was also evaluated because hepatocellular carcinoma is usually combined with cirrhosis. The serum levels of B protein were studied by a Latex-agglutination test. One hundred and twenty-nine patients including 23 hepatocellular carcinoma, 50 hepatocellular carcinoma combined with liver cirrhosis, 40 liver cirrhosis, and 16 chronic hepatitis were tested. The positive rates of B protein in various diseases were as follows: 30.4% (7/23) in patients with hepatocellular carcinoma; 68.6% (35/50) in patients with hepatocellular carcinoma combined with cirrhosis; 82.5% (33/40) in patients with cirrhosis; and 62.5% (10/16) in patients with chronic hepatitis. When B protein was used as a tumor marker of hepatocellular carcinoma, the sensitivity (57.5%) and specificity (25%) were very low. Furthermore, patients with hepatocellular carcinoma, usually combined with cirrhosis; which carried the highest positive rate on B protein determination. This also limited clinical utilization of B protein as a tumor marker of hepatocellular carcinoma. Moreover, there was no correlation of B protein with the serum alpha-fetoprotein level or tumor size. On the contrary, positive correlation of the B protein level with Child's staging (Tau-c value = 0.392, p = 0.008), and death during follow-up (Tau-c value = 0.456, p = 0.021), were discovered in patients with cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cirrhosis is a common diagnosis that clinicians will see throughout their career. We encountered a 36-year-old man who presented to the hospital about concerns of alcohol withdrawal. In the hospital, he was initially diagnosed with cirrhosis via imaging studies, and a subsequent magnetic resonance imaging scan uncovered hepatocellular carcinoma. This patient case underscores the importance of screening individuals with cirrhosis for hepatocellular carcinoma, even early in their diagnosis.
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We have measured the serum erythropoietin concentrations in 14 patients with liver cirrhosis and in 14 patients with a hepatocellular carcinoma. Among these patients, 2 with liver cirrhosis (14.3%) and 7 with a hepatocellular carcinoma (50.0%) were found to have raised serum erythropoietin concentrations, ranging up to 40 mU/ml. Negative correlations were found between erythropoietin and the RBC, and the Hb and Ht in the cases with liver cirrhosis. In contrast, a positive correlation which was not significant was found only between the erythropoietin and the RBC in cases involving a hepatocellular carcinoma. This has suggested that the relationship between the erythropoietin and the RBC in cases of a hepatocellular carcinoma differs from the relationship seen under the usual physiological circumstances of those with liver cirrhosis.
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Foreword. Preface. 1. The background to hepatocellular carcinoma and the liver. 2. Premalignant lesions of hepatocellular carcinoma. 3. Pathomorphologic characteristics of early-stage small hepatocellular carcinoma. 4. Morphologic evolution of hepatocellular carcinoma: from early to advanced. 5. Angioarchitecture of hepatocellular carcinoma. 6. Advanced hepatocellular carcinoma. 7. Multicentric occurrence of hepatocellular carcinoma. 8. Combined hepatocellular carcinoma and cholangiocarcinoma. 9. Nodular lesions mimicking hepatocellular carcinoma. 10. Biopsy diagnosis of tumorous lesions of the liver. 11. Chemoprevention of hepatocellular carcinoma. Index
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In a retrospective study, 42 out of 44 cases of hepatocellular carcinoma were investigated immunohistochemically for chronic hepatitis B infection. Surface antigen was found in the liver tissue of only 4 of these cases. In 41 of the patients, mildly to moderately active cirrhosis of the liver was found to be underlying the carcinoma. The age distribution and case histories showed that hepatocellular carcinoma often developed from low-complication cirrhosis of long standing and of various etiologies, and must thus be considered a late complication of cirrhosis.
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Objective To investigate the expression and relationship of TRA1 mRNA among hepatocellular carcinoma,liver cirrhosis and normal liver tissues. Methods RT-PCR was used to detect the expression of TRA1 mRNA in 34specimens of hepatocellular carcinoma,liver cirrhosis and normal liver tissues. Results The expression rates of TRA1in hepatocellular carcinoma,liver cirrhosis and normal liver tissues were 95. 00%,84. 21% and 50. 00%,respectively,there were significant differences between hepatocellular carcinoma and normal liver tissues(P 0. 05),but no significant differences between liver cirrhosis and normal liver tissues(P 0. 05). The expression levels of TRA1 mRNA were 1. 67 ± 0. 96,1. 49 ± 0. 53,0. 57 ± 0. 27,respectively,which was significantly higher in hepatocellular carcinoma and liver cirrhosis tissues than that in normal liver tissues(P 0. 05). Conclusion TRA1 mRNA is involved in the progression of hepatocellular carcinoma and liver cirrhosis,and it may be a potential biomarker for diagnosis and target for therapy.
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Direct acting antivirals stabilize or improve liver function in the majority of patients with hepatitis C virus cirrhosis. Hepatic decompensation is the main driver of death of patients with early, successfully treated hepatocellular carcinoma superimposed to cirrhosis. Treatment with direct acting antivirals could improve the prognosis of these subjects, independently from the subsequent course of hepatocellular carcinoma, if the efficacy in obtaining viral clearance is as high as in patients without a history of hepatocellular carcinoma, and if the risk of hepatocellular carcinoma recurrence is unaffected. When dealing with hepatocellular carcinoma patients, direct acting antivirals can be indicated in two different settings: (a) subjects in which hepatocellular carcinoma has been already successfully treated ("cured" hepatocellular carcinoma), or (b) subjects whose hepatocellular carcinoma is still untreated or untreatable ("active" hepatocellular carcinoma). Although there are abundant data on "cured" hepatocellular carcinoma, evidence supporting treatment decisions in patients with "active" hepatocellular carcinoma is at best scarce and controversial, since these patients as well as patients with hepatocellular carcinoma listed for liver transplantation are usually excluded from treatment.
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Objective To evaluate the diagnostic value of diffusion weighted imaging(DWI) at 3.0 T magnetic resonance in liver cirrhosis and hepatocellular carcinoma.Methods DWI was performed in 10 healthy volunteers,21 patients with liver cirrhosis and 30 patients with hepatocellular carcinoma at 3.0T magnetic resonance. DWI and ADC values in normal liver, liver cirrhosis and hepatocellular carcinoma were analysed.The diagnostic sensitivity and specificity of ADC values in normal liver, liver cirrhosis and hepatocellular carcinoma were also analysed.Results When b value was 100 s/mm2,the ADC values of normal liver were higher than liver cirrhosis, hepatocellular carcinoma(P0.05),but there was not significance between liver cirrhosis and hepatocellular carcinoma(P0.05).When b value was 300 s/mm2,1000 s/mm2,the ADC values of three groups had significant differences(P0.01). When b value was 300 s/mm2, the diagnostic sensitivity and specificity were 82.6% and 100% in liver cirrhosis ,95.2% and 90.4% in hepatocellular carcinoma ,respectively. When b value was 1000 s/mm2, the diagnostic sensitivity and specificity of ADC values were 86.9% and 100% in liver cirrhosis,95.2% and 66.7% in hepatocellular carcinoma,respectively. Conclusion DWI at 3.0 T magnetic resonance in examination of liver could synthetically and quantitatively analyze the rule of ADC values in liver cirrhosis and hepatocellular carcinoma.
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The aim of this study was to determine the characteristics of hepatocellular carcinoma at a major health center in southern Turkey. Computed tomography was compared to the combination of ultrasonography and serum alpha-fetoprotein determination in the diagnosis of hepatocellular carcinoma.Of 226 patients with liver cirrhosis, 35 were diagnosed with hepatocellular carcinoma on first admission or during follow-up in the period between 1999 and 2002. The features investigated were, age at time of hepatocellular carcinoma diagnosis, etiology of cirrhosis, severity of cirrhosis at presentation, tumor pattern, stage of hepatocellular carcinoma, serum alpha-fetoprotein level, and dynamic computed tomography findings. Results were compared to previous findings in Turkey and elsewhere.In the hepatocellular carcinoma patients, the male:female ratio was 4:1 and the mean age at presentation was 61 years. Chronic hepatitis B virus infection (65.7%) and chronic hepatitis C virus infection (28.6%) were the most frequently identified risk factors for hepatocellular carcinoma. Forty percent of the patients had Child-Pugh A cirrhosis when they were diagnosed with hepatocellular carcinoma. Sixty-seven percent of patients had fewer than three hepatocellular carcinoma nodules in the liver at the time of diagnosis. Only three of the hepatocellular carcinoma cases were Okuda stage I. The combination of ultrasonography and serum alpha-fetoprotein >20 ng/ml identified hepatocellular carcinoma in 32 of the 35 total cases.The results indicate that hepatitis B virus infection in patients with cirrhosis is still the leading risk factor for the development of hepatocellular carcinoma. Also, early-stage hepatocellular carcinoma is rarely diagnosed in cirrhosis patients from this region of Turkey. Surveillance with computed tomography for early diagnosis of hepatocellular carcinoma seems not to be mandatory.
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