Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Surgical resection remains the best option for potential cure and long-term survival in patients with HCC. The question of to what extent transplantation for HCC should be performed remains controversial. There appears to be a definite role for OLT in the treatment of HCC, with many series showing improved survival over resection, especially with "favorable" tumors. What remains to be determined are the best patients and the best protocol. There is little question that patients with small unifocal tumors do well after OLT. It is the patient who falls outside of these narrow guidelines that poses a problem in clinical decision making and organ allocation. The ability to determine relative risk of recurrence of HCC would perhaps allow a more equitable allocation of a scarce resource. Currently, we evaluate each patient with HCC on an individual basis, making the best decision possible based on the patient's clinical status, our most advanced current imaging studies, and known clinical prognostic factors (Table 6). Adequate staging is essential to determine suitable candidates. Advances in multimodal adjuvant therapy are needed for patients with poor prognostic factors to achieve results similar to what is seen in those who receive transplants for nonmalignant diseases. Attempts at resection should be performed for those patients presenting with Child's class A cirrhosis, because these are the patients who would tolerate a resection with acceptable morbidity and mortality. Limited resections based on segmental anatomy may be consider in "good risk" Child's class B cirrhotics, considering the current organ shortage. Child's class C and decompensated Child's class B patients without significant risk factors should be evaluated for transplantation, and preoperative chemoembolization should be considered to prevent spread while the patient is on the waiting list. These patients should be monitored with imaging studies and by AFP levels on a regular basis while they await their transplant. After transplantation, chemotherapy should be considered for those patients with moderate to high risk of recurrence, within the guidelines of an institutional or multicenter protocol. In patients with multiple poor prognostic factors, or those who are too ill to undergo resection or transplantation, palliative measures may be used. As the need for organs increases, and the wait continues to grow, it becomes increasingly difficult to justify the use of a scarce resource for patients with a known less desirable outcome. On the other hand, we must be careful not to exclude an entire group of patients from a potentially curative procedure. We now have evidence that survival after transplantation for HCC in carefully chosen patients can equal that of benign disease. We need to be selective and cautious in our choice of recipients, but not exclusive, using prior experience and the knowledge we now possess regarding a set of fairly well-delineated risk factors.
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PMID:Surgical options for hepatocellular carcinoma: resection and transplantation. 974 1

The 1-6 fucosylated -fetoprotein (AFP) present in serum of patients with hepatocellular carcinoma (HCC) has been employed for the differential clinical diagnosis of HCC from chronic liver diseases. The molecular mechanism by which this alteration occurs, however, remains largely unknown. To address this issue, we purified GDP-L-Fuc:N-acetyl-beta-D-glucosaminide 1-6 fucosyltransferase (1-6 FucT), an enzyme involved in the 1-6 fucosylation of N-glycans from porcine brain, as well as from a human gastric cancer cell line, and cloned their genes. In this study, levels of 1-6 FucT mRNA expression and the activity of this enzyme for 12 human HCC tissues were examined and compared with that in surrounding tissues and normal livers. The mean +/- SD for 1-6 FucT activity was 78 +/- 41 pmol/h/mg in normal control liver, 202 +/- 127 pmol/h/mg in adjacent uninvolved liver tissues (chronic hepatitis: 181 +/- 106 pmol/h/mg; liver cirrhosis: 233 +/- 164 pmol/h/mg), and 195 +/- 72 pmol/h/mg in HCC tissues. The mRNA expression of 1-6 FucT was also enhanced in proportion to enzymatic activity except for a few cases, suggesting that 1-6 FucT expression is increased in chronic liver diseases, especially liver cirrhosis. Transfection of 1-6 FucT gene into cultured rat hepatocytes markedly increased 1-6 FucT activity and led to an increase in lens culinaris agglutinin (LCA) binding proteins in both cell lysates and condition media. When the 1-6 FucT gene was transfected into a human HCC cell line, Hep3B, which originally showed low levels of 1-6 FucT expression, 1-6-fucosylated AFP was dramatically increased in the condition media. Collectively, these results suggest that the enhancement of 1-6 FucT expression increased the fucosylation of several proteins, including AFP, and that the level of 1-6-fucosylated AFP in patients with HCC was in part caused by up-regulation of the 1-6 FucT gene expression.
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PMID:Gene expression of alpha1-6 fucosyltransferase in human hepatoma tissues: a possible implication for increased fucosylation of alpha-fetoprotein. 975 30

Cirrhosis of the liver can be regarded as premalignant state, since more than 80 percent of hepatocellular carcinoma (HCC) in the western world develop in a cirrhotic liver. The risk to develop this malignancy depends on the activity of the underlying cirrhosis, its etiology and the duration of the disease. Patients suffering from cirrhosis of the liver due to HBV-, HCV- or HDV-infection and patients with genetic hemochromatosis exhibit a high risk for HCC. This risk is further increased by cocarcinogens, such as alcohol, nicotine and toxins. Ultrasound and AFP-studies aim to diagnose HCC early. The sensitivity of AFP in the serum is remarkably low (about 64%). In contrast a normal AFP-concentration (< 20 ng/ml) carries a high negative prognostic value (> 90%). Patients suspected to suffer from HCC according to the results of screening procedures should be subjected to additional radiologic investigations, such as CT-arterioportography or lipiodol-angiography.
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PMID:[Cirrhosis of the liver as a precancerous condition]. 984 85

Worldwide the hepatocellular carcinoma (HCC) is one of the most common malignancies. There is a coincidence with liver cirrhosis or chronic hepatitis B/C in most cases. HCC can be suspected by ultrasound and by rise of the tumor marker (AFP). Further investigations, like biopsies, are not necessary if angiography or computed tomography in combination with patient history and elevated AFP levels are positive. The prognosis of untreated HCC is extremely poor. Live expectancy of symptomatic patients is only a couple of weeks. Radical tumor removal by liver resection or transplantation is the only treatment with curative intent. However these options are only suitable for patients with limited disease. Five year survival after curative liver resection depends on the tumor stage, ranging from 25% to 67%. The results after liver transplantation are similar for small cancer. Large, symptomatic tumors are in most cases only suitable for palliative treatment (chemoembolisation, ethanol injection, chemotherapy, immunotherapy). The strong dependence of prognosis on tumor extent underlines the importance of screening patients with elevated risk of developing an HCC. The early recognition of small tumors allows curative therapy with good results.
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PMID:[Hepatocellular carcinoma: surgical treatment]. 984 87

Two cases with spontaneous regression of a histologically confirmed hepatocellular carcinoma (HCC) are presented. This rarely seen phenomenon of a spontaneous tumor involution is discussed and compared with the current literature. The clinical symptoms were very similar to that of a liver abscess. A 56-year-old male suffered from a multicentric, highly differentiated, trabecular HCC. First symptoms were epigastric pain, septic fever and arthritis. The tumor marker AFP was constantly normal and no hepatitis could be verified. A resection of the tumor was performed. In patient 2, a 74-year-old male, a multicentric, clear cell HCC was found. The patient had completely recovered from hepatitis type B and within the liver tissue no viruses could be identified. Clinical symptoms were mainly characterized by upper abdominal pain and septic fever. AFP was excessively elevated (3850 ng/ml) but returned to normal preoperatively. In both cases, the specimen showed a subtotal necrotic HCC with insignificant amounts of vital tumor cells. Neither patient had a liver cirrhosis macroscopically, however patient 2 had local periportal fibrosis histologically. After 24 and 41 months of follow-up, respectively, both patients are in good health
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PMID:Spontaneous regression of hepatocellular carcinoma confirmed by surgical specimen: report of two cases and review of the literature. 992 45

Serum transforming growth factor beta 1 (TGF beta 1) concentration was determined in 47 patients with primary hepatic carcinoma (PHC) and 77 patients with various liver diseases and gastrointestinal tumors by means of enzyme-linked immunosorbent assay system. The result revealed that serum TGF beta 1 level of PHC patients were significantly higher (257.6 +/- 126.0 micrograms/L) than those in normal subjects (81.5 +/- 43.5 micrograms/L), in patients with hepatitis (152.4 +/- 98.4 micrograms/L), cirrhosis (191.8 +/- 96.3 micrograms/L), hepatic benign tumor (91.9 +/- 37.9 micrograms/L), metastatic liver cancer (146.4 +/- 73.7 micrograms/L) and gastrointestinal tumor (128.7 +/- 56.4 micrograms/L) (P < 0.01 or 0.05). Serum TGF beta 1 level was elevated in 34 of 47 (72.3%) PHC patients, including 5 of 7 (91.4%) small (< 5 cm) PHC patients. The sensitivity and specificity of diagnosis of TGF beta 1 in PHC were 72.3% and 77.9%, respectively. The diagnostic positivity was 78.5% in AFP-negative PHC patients. The combined assay of serum TGF beta 1 and AFP could further raise the detection rate of PHC up to 93.6%. Above results suggest that serum TGF beta 1 might be a candidate for a novel tumor marker for diagnosis and monitoring of PHC.
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PMID:[Clinical evaluation of serum transforming growth factor beta 1 assay in the diagnosis of primary hepatic carcinoma]. 1043 81

The differential diagnostic utility of AFP, CEA, CA19.9 and TPA was evaluated in liver tumors. They were determined in the sera of 61 patients with primary hepatocellular carcinoma (HCC), 18 with secondary liver metastasis, 61 of benign liver cirrhosis in comparison to 20 normal healthy control subjects. The association of either HBV or HCV infection and HCC was also studied through the assay of HbSAg, HbSAb, and HCV-Ab. The optimal cut-off values were determined using the diagnostic accuracy measurements and the receiver operating characteristic (ROC) curves. AFP at an optimal cut-off value of 100 ng/ml and TPA at 160 U/L showed the highest sensitivity and specificity in detecting liver metastasis (100% and 87% for AFP; 100% and 54% for TPA respectively). The obtained data indicated that the combined assay of AFP and TPA resulted in a better discrimination of HCC among patients with hepatic focal lesions. HCV-Ab was detected in a higher ratio of HCC patients (83.6%) compared to HbsAg (68.9%), and both were detected in (34%) of HCC patients. This high incidence of HCV-Ab may suggest the implication of HCV in the molecular events leading to hepatic carcinogenesis.
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PMID:Differential tumor markers and hepatitis markers profile in liver tumors. 1047 Jan 81

The patient was a 74-year-old man. He had received medical treatment for liver cirrhosis (C types) and elevated AFP. Abdominal ultrasonography (US) revealed a 150 mm size tumor in the right lobe of the liver. After admission, anemia progressed rapidly, and we recognized bloody ascites by abdominal punction. Thus, diagnosis was a tumor rupture. Emergency angiography was performed. Farmorubicin and Lipiodol were injected, and complete TAE was added. After two TAE treatments CT-scan showed a remarkable decrement of the tumor and hypertrophy of the left lobe in the liver. Right lobectomy of the liver was then done because reserve function of the liver was good. Cancer cells changed into hyaline body and mecrotic focus. In the pathological examination of the extirpated sample, no viable tumor cells were detected.
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PMID:[A case report: disappearance of cancer cells confirmed by surgical resection after transcatheter hepatic artery embolization (TAE) for ruptured hepatocellular carcinoma]. 1056 Apr 22

90K/MAC-2BP glycoprotein is a serum tumour marker, member of the scavenger receptor cysteine rich (SRCR) protein superfamily, involved in different immunological mechanisms. In the present study, we determined 90K serum levels by a sandwich enzyme immunoassay using the same monoclonal antibody in 11 chronic active hepatitis (CAH), 48 liver cirrhosis and 36 hepatocellular carcinoma (HCC). In comparison, the same samples were also tested for AFP. According to a cut-off point of 14 micrograms/mL for the 90K, established as 100% of specificity in 50 controls, we observed increasing positivities from CAH to cirrhosis and then to HCC (27%, 50% and 78%, respectively). In cirrhotic patients 90K levels were associated with the presence of anti-HCV antibodies, but not with the degree of liver compromise. Finally, 90K sensitivity was higher than AIFP in all groups of hepatic patients. However, further investigations are needed before proposing 90K as a clinical useful tumour marker in the progression from cirrhosis to HCC.
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PMID:Serum 90K/MAC-2BP glycoprotein levels in hepatocellular carcinoma and cirrhosis. 1062 37

Hepatocellular carcinoma (HCC) is the most common cancer in Thailand. Hepatic resection has been accepted as the only chance for cure. However; very limited information about the operative treatment and survival of HCC in Thailand has been documented. The author reviewed the experiences of surgical treatment of HCC at the National Cancer Institute, Bangkok and reports herein the long term outcome. From January 1986 to January 1996 a total of 884 primary liver cancers admitted in our institute were reviewed. 112 consecutive hepatic resections were performed by the author. 67 of 112 patients were HCC of which clinical features, survival rate and recurrence were studied. Liver cirrhosis was associated in 49 patients (73.1%). HBsAg was positive in 58 patients (86.6%). Preoperative AFP level was more than 400 ng/ml in 35 patients. The resectability for HCC was 11.0 per cent. In 50 of 67 hepatic resection, major hepatic resection were carried out. Postoperative major complications were found in 14 patients (20.9%). Postoperative mortality rate of 5 patients was 7.5 per cent. Survival curve was calculated by Kaplan-Meier with the overall survival rate at 1, 2, 3, 4, 5 years was 63.2 per cent, 28.6 per cent, 21.1 per cent, 14.5 per cent and 11.5 per cent respectively. 1, 3, 5 years survival rate for a tumor less than 5 cm was 91.0 per cent, 57.0 per cent, 49.4 per cent, tumor size of 5-10 cm was 57.5 per cent, 16.0 per cent, 9.0 per cent and tumor size more than 10 cm was 52.2 per cent, 0 per cent, 0 per cent. A significant difference in survival rate was observed by size. Postoperative recurrences were observed in 45 patients (67.2%) and 82.8 per cent of the patients had intrahepatic recurrence within 2 years. Hepatic resection is an appropriate treatment for a tumor less than 10 cm. However, a tumor larger than 10 cm should be considered for multimodality approaches. Intrahepatic recurrence is high and similar to the reports from the Orient. Close follow-up with prompt treatment for recurrence is the important factor to obtain better results.
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PMID:Resection of hepatocellular carcinoma: personal experience with 67 patients and long-term results. 1065 39


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