Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019204 (hepatocellular carcinoma)
 71,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During a 12-year period (1981-1992), 3,029 patients, including 220 with hepatocellular carcinoma (HCC), received their first orthotopic liver transplantation (OLTX) for various liver diseases. One-, three- and five-year survivals of these 220 patients with HCC were 68%, 46%, and 37%, respectively, and those of the 2,809 patients without HCC were 78%, 71%, and 67.0%, respectively. Among the 220 patients with HCC, the following factors were associated with a poor prognosis: multiple tumors, HCC in two lobes of the liver ("bilobar tumors"), micro- and macroscopic vascular invasion, lymph node metastasis, tumor within the surgical margin, Stage IV HCC, and male gender. Cirrhosis and detection of hepatitis B surface antigen (HBsAg) or antibody to hepatitis C virus (anti-HCV) did not influence the survival rates after OLTX in the presence of HCC. By multivariate analysis, the negative prognostic value of only vascular invasion, bilobar distribution, and lymph node metastasis reached significance. As vascular invasion of HCC was the most significant prognostic factor after OLTX, its incidence was examined according to the following three radiologic measurements of the HCC before operation: (1) size, (2) lobar distribution, and (3) number of HCC nodules. Fifty percent of the HCCs of greater than 5 cm diameter had macroscopic vascular invasion, and 1-, 3- and 5-year survivals of the patients with these HCCs were 60%, 30%, and 18%, respectively, after OLTX. Nearly 50% of the bilobar HCCs also had macroscopic vascular invasion, and 1-, 3- and 5-year survivals were 56%, 29%, and 15%, respectively, after OLTX. One-third of multiple tumors had macroscopic vascular invasion, and 1-, 3- and 5-year survivals were 64%, 38%, and 27%, respectively. However, survival after OLTX in patients with bilobar HCCs of < or = 2 cm diameter (even when these were Stage IV) was as good as in patients without HCC who had OLTX. The 5-year survival rate of the patients with unilobar, multiple HCCs without macroscopic vascular invasion, lymph node invasion and distant metastasis was 60%. These data indicate that HCCs of up to 5 cm diameter without macroscopic vascular invasion and nodal or distant metastasis can be effectively treated by OLTX.
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PMID:Survival after liver transplantation in patients with hepatocellular carcinoma. 887 33

Treatment of chronic hepatitis B and C aims to achieve viral eradication. Decreasing the number of carriers subsequently reduces the transmission of the viruses. For an individual patient, therapy is aimed at preventing cirrhosis, liver failure and hepatocarcinoma. Among potential therapies, interferon alfa offers the best results. In one study involving the treatment of children from a region of intermediate endemicity, interferon alfa accelerated the clearance of hepatitis B virus (HBV) replication. In long-term follow-up, the study did not show a significant difference between patients who were treated and those who were not in the rate of disappearance of serum HBV-DNA, normalization of alanine aminotransferase (ALT) levels or seroconversion to antibodies to hepatitis B e antigen. The most important factors in predicting a rapid decrease in HBV replication were AI T levels more than twice normal, low levels of serum HBV-DNA (less than 100 pg/mL) and inflammatory activity on liver biopsy (chronic active hepatitis). A select group of children with HBV infection has thus been shown to benefit from interferon alfa therapy. Treatment should be administered in a dosage of 6 MU/m2 three times each week for 6 months. Chronic active hepatitis, develops in approximately 30% of children with a chronic hepatitis C virus (HCV) infection. Cirrhosis due to HCV appears to be a very rare complication among children. Results of interferon alfa treatment for children with HCV are scarce. A pilot study of 12 children treated with interferon alfa in a dosage of 3 MU/m2 three times each week for 6 months showed that ALT levels normalized in approximately 90% of the patients after 15 months of follow-up. All of the patients had a decrease in the histological activity of the disease. Factors predictive of a favourable response in adults were: low levels of gamma-glutamyl transferase, young age, female sex, short duration of disease, absence of cirrhosis and low histological activity of the disease. Controlled randomized studies are needed to determine the indications for interferon alfa therapy in children infected with HCV. Available data suggest that children may have a better response than adults.
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PMID:Therapy for chronic viral hepatitis. 888 78

Experience in liver transplantation (OLT) in Italy over a ten-year period is reported. Data were obtained using a multiple-items form collected from Italian liver transplant centres (reference centres) and other Italian institutions actively involved both in the processes of evaluation of the candidates and the follow-up of liver transplant recipients (afference centres). During this period, a total of 1046 liver transplants were performed on 954 patients, with a cumulative proportional survival of 71%. The most common indication for liver transplantation was post-hepatitic cirrhosis due to either hepatitis B virus (+/-hepatitis Delta virus) or hepatitis C virus infection. Good survival rates were observed, particularly in controversial indications, such as alcoholic cirrhosis, post-hepatitic hepatitis B virus-related cirrhosis and hepatocellular carcinoma, most likely due to proper and careful selection of the patients. Cirrhosis, secondary to an autoimmunity-based liver disease, showed the highest rate of rejection episodes. Infections, in our study population, were the most common cause of death after transplantation.
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PMID:Liver transplantation in Italy: preliminary 10-year report. The Monotematica Aisf-Olt Study Group. 889 51

Cirrhosis accounts for 60% of liver transplantations that are performed. The main causes are chronic viral hepatitis B and C, and alcoholism. However, all patients with severe cirrhosis are potential candidates for liver transplantation, regardless of the cause. Liver transplantation is indicated when the patient's life expectancy is one year or less. The main criterion for transplantation is severe liver failure (Child-Pugh's stage C). Transplantation is also proposed in patients with intractable ascites, and in patients with spontaneous encephalopathy. Isolated portal hypertension is not an indication for transplantation. Liver transplantation in hepatocellular carcinoma is still a matter of debate. The results of liver transplantation are very satisfactory with survival rates of 70% at 5 years and patient rehabilitation is usually excellent.
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PMID:[Hepatic transplantation for cirrhosis]. 913 14

Cirrhosis is a frequent and severe event in the course of chronic hepatitis C, but it is unclear why some patients develop cirrhosis after a given period whereas others do not. We studied a large cohort of patients with chronic hepatitis C to determine the role of the route of transmission of hepatitis C virus (HCV) in the onset of cirrhosis. Six thousand six hundred sixty-four patients were enrolled in a nationwide survey of chronic hepatitis C in France. We first randomly defined a representative sample of 30 hospitals with medical units managing patients with HCV infection. All patients with chronic hepatitis C were enrolled if hepatitis C was diagnosed or treated in these units in 1991, 1992, or 1993. A questionnaire was filled in from the patients' charts and covered demographic data, risk factors for HCV infection, clinical and histological data, hepatitis B virus (HBV) and human immunodeficiency virus status, and alcohol intake. Descriptive statistics were prepared, and factors potentially related to the onset of cirrhosis were identified by means of univariate analysis followed by stepwise logistic regression analysis. Among the patients enrolled, 21.4% had biopsy-proven cirrhosis. Prevalence of cirrhosis markedly varied according to the route of transmission of HCV. It was significantly more frequent in blood recipients (23.4%) than in drug users (7.0%). Although the occurrence of cirrhosis was dependent on disease duration, it remained more frequent in blood recipients than in drug users for a given duration. Apart from the route of transmission, excessive alcohol intake was also associated with a higher risk of cirrhosis (34.9% vs. 18.2%; P < .001), and so was HBV infection (24.6% vs. 21.1%; P < .05). These factors acted independently of the route of transmission. Hepatocellular carcinoma was observed in 3.6% of all patients and in 17.8% of cirrhotic patients, and its occurrence was strongly and mainly related to the presence of cirrhosis. In conclusion, cirrhosis occurred in about 20% of the HCV-infected patients in this study and was more frequent in blood recipients than in drug users, independently of disease duration. Expected changes in the epidemiology of HCV infection might modify the risk of developing cirrhosis and, thereafter, cancer.
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PMID:Epidemiological factors affecting the severity of hepatitis C virus-related liver disease: a French survey of 6,664 patients. The Study Group for the Prevalence and the Epidemiology of Hepatitis C Virus. 925 63

Sixty-four consecutive subjects with hepatocellular carcinoma were prospectively studied in the department of Hepatology, IPGMR, Dhaka. Their mean age was 50.11 years. Fifty-two were male and 12 female. Cirrhosis was present in 12 (18.75%) subjects. Thirty subjects (46.88%) had HBsAg in their sera. Seven (58.33% of females) patients gave history of use of oral contraceptives. Cirrhosis, HBV infection, male sex, middle age, and probably the use of oral contraceptives in females appeared to be important risk factors for development of HCC in Bangladesh. Majority of patients presented with upper abdominal pain, weight loss and anorexia. Hepatomegaly was invariably present. Alpha fetoprotein was significantly higher in cirrhotic HCC patients than in non-cirrhotic ones. Median survival was two months. None of the clinical or laboratory features predicted the prognosis.
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PMID:Etiology and clinical profile of hepatocellular carcinoma in Bangladesh. 936 73

Iron overload has been shown to impair the immune response of the liver, and induce hepatic fibrosis and cirrhosis. Opinions differ concerning the relative risk of developing hepatocellular carcinoma (HCC) in siderotic patients as compared with patients with hepatic fibrosis and cirrhosis and the possible mechanism of liver carcinogenesis in genetic hemochromatosis is still unknown. The purpose of this study is to assess hepatic iron overload, fibrosis and cirrhosis in liver tissue adjacent to hepatocellular carcinoma and in liver tissue of controls in population at risk for hepatocellular carcinoma. Liver tissue was available for examination in 147 biopsies with HCC collected in South Africa. As controls we used liver samples from 211 age and sex matched Africans who died in accidents. Tissue samples were processed routinely, stained with H and E, Sweet's reticulin, Masson's trichrome for fibrous tissue, Prussian blue for iron stain and immunohistochemically for HBsAg. Iron content was assessed with the method described by Brissot. Iron overload was detected in 42.1% of cancerous livers and in 43.7% of livers from controls. The presence of siderosis and iron content gradually increased with the age of studied similarly in cases and in controls. Cirrhosis was present in 32% of cancerous livers and was associated with iron overload in 13%. No cirrhosis and 6% of mild periportal fibrosis not related with siderosis was observed in controls. HBsAg was stainable in 80% of cancerous livers of patients below 25 years of age and in 40% of patients over 35 years. HBsAg in controls was positive in 9%. No relationship of HBsAg and amount of stainable iron in cancerous and livers of controls was found. In conclusion, African siderosis can not play important role in the etiopathogenesis of HCC.
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PMID:Hepatic siderosis, fibrosis and cirrhosis: the association with hepatocellular carcinoma in high-risk population. 942

Cirrhosis and hepatocellular carcinoma occur as long-term complications of chronic hepatitis B virus (HBV) infection. Antiviral therapy is potentially a successful approach for the treatment of patients with HBV infection, which includes the nucleoside analog, lamivudine [(-)2'-deoxy-3'-thiacytidine, 3TC]. Although resistance to lamivudine therapy has been reported in several HBV-infected patients, the pattern of resistance-associated mutations in HBV has not been fully characterized. We report a DNA sequence database that includes a 500-base pair region of the HBV polymerase gene from 20 patients with clinical manifestations of lamivudine resistance. Analysis of the database reveals two patterns of amino acid substitutions in the tyrosine, methionine, aspartate, aspartate (YMDD) nucleotide-binding locus of the HBV polymerase. HBV DNA from the sera of patients in Group I exhibits a substitution of valine for methionine at residue 552, accompanied by a substitution of methionine for leucine at residue 528. Patients in Group II had only an isoleucine-for-methionine substitution at position 552. Reconstruction of these mutations in an HBV replication-competent plasmid was performed in a transient transfection cell assay to determine the function/relevance of these mutations to lamivudine resistance. Both Group I and Group II mutations resulted in a substantial decrease in sensitivity to lamivudine treatment (> 10,000-fold shift in IC50 over wild-type [wt] IC50), strongly indicating that these mutations were involved in resistance to lamivudine. A hypothetical model of the HBV reverse transcriptase has been generated for further study of the role of these mutations in lamivudine resistance.
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PMID:Identification and characterization of mutations in hepatitis B virus resistant to lamivudine. Lamivudine Clinical Investigation Group. 962 Mar 41

A number of diseases alter the normal pathophysiology of the portohepatic vascular system. The impact of these changes depends on the severity of the disease and the involvement of the entrahepatic vasculature. Cirrhosis of the liver is not a vascular disease but the effects on the liver architecture result in severe disease often accompanied by hepatic vascular changes. Alcohol abuse and viral infections are the most common causes of cirrhosis. Portal hypertension (PHT) is one of the most frequently seen sequelae of liver cirrhosis. It results in the formation of porto-systemic collateral channels which may lead to varices and hemorrhage. Primary liver cancer is also strongly associated with liver cirrhosis. Hepatocellular carcinoma (HCC) is the most common liver cancer seen in patients with cirrhosis. There are four types of HCC based on its growth patterns: infiltrative, expansive, mixed and diffuse. Raised plasma levels of alpha-fetoprotein are a characteristic of HCC. However, this marker is unreliable in patients with smaller tumors. Ultrasound is an inexpensive, non-invasive and safe diagnostic technique used to detect portal vein changes in PHT and to identify HCC lesions in the liver. Grey scale ultrasound reveals the portal vein changes and the portal-systemic collaterals which typify PHT. The technique is most useful for diagnosis or confirmation of moderate to severe disease. HCC nodules have characteristic ultrasound patterns which help in differential diagnosis. Doppler ultrasound provides functional as well as anatomical information about blood flow in the liver and is especially useful in detecting HCC and the abnormal blood vessel architecture which surrounds a tumor. However, despite their usefulness, both imaging techniques have limitations which may be improved by the use of echo-enhancing agents. Levovist(R) is a galactose-based microbubble echo-enhancing agent which has an excellent safety profile and utility in enhancing ultrasound images of the liver. It markedly improves diagnostic confidence and reduces the percentage of non-diagnostic ultrasound scans in patients with abnormal liver pathologies. The use of echo-enhanced ultrasound to diagnose liver disease may obviate the need for more expensive and invasive diagnostic procedures.
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PMID:Portohepatic vascular pathology and liver disease: diagnosis and monitoring. 967 32

The files of 122 patients hospitalized for hepatocellular carcinoma (HCC) were reviewed retrospectively to study survival as a function of treatment and different peri-therapeutic factors. Cirrhosis was certain or probable in 69 cases. Laparotomy was performed 77 times (13 exploratory, 64 excisions). Chemoembolization with Adriamycine was performed 18 times. Median survival was 11.6 months. The factors influencing survival in monovariate analysis were the Child-Pugh stage (p < 0.0001), the Okuda stage (p < 0.0001), ascites (p < 0.001), a post-operative complication (p < 0.0001), gamma-glutamyltransferase level (p < 0.0037), tumor site (p < 0.004), albuminemia (p < 0.008), alkaline phosphatase concentration (p < 0.0087), number of tumors (p < 0.01), portal thrombosis (p < 0.01) and alpha-foetoprotein level (p < 0.01). In multivariate study, the Okuda stage (p < 0.001), age (p < 0.001) and portal thrombosis (p < 0.037) remained significant. The Okuda 1 group was also considered in multivariate study, in which case only patient age and the possibility of therapeutic excision were significant factors. In our opinion, the Okuda classification, which is easy to establish, should be adopted for pretherapeutic evaluation of patients with hepatocellular carcinoma.
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PMID:[Uni- and multivariate analysis of predictive survival factors in hepatocellular carcinoma. A study of a series of 122 patients]. 968 58


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