This document summarizes information on the diagnosis, staging, and management of hepatocellular carcinoma (HCC). It discusses:
- The major risk factors for HCC are hepatitis B and C infections, alcohol intake, and other conditions like obesity.
- Surveillance of high-risk patients can improve early detection and prognosis. Imaging techniques like ultrasound, CT, and MRI are used for diagnosis.
- Staging systems like BCLC incorporate tumor stage, liver function, and performance status to determine prognosis and guide treatment selection.
- For early stage HCC meeting Milan criteria, radiofrequency ablation (RFA) and surgical resection (SR) are curative options, with SR having a lower recurrence rate but
cystatin C as an early marker of cisplatin-induced AKIد.محمود نجيب
discussion presentation for master degree in Nephrology with the title of Cystatin C as an early predictor of acute kidney injury induced by cisplatin and its analogues
ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN OPTIMIZATION OF TREATMENT FOR ESOPHAGEAL CANCER PATIENTS AFTER COMPLETE ESOPHAGECTOMIES
cystatin C as an early marker of cisplatin-induced AKIد.محمود نجيب
discussion presentation for master degree in Nephrology with the title of Cystatin C as an early predictor of acute kidney injury induced by cisplatin and its analogues
ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN OPTIMIZATION OF TREATMENT FOR ESOPHAGEAL CANCER PATIENTS AFTER COMPLETE ESOPHAGECTOMIES
Kshivets O. Cardioesophageal Cancer SurgeryOleg Kshivets
ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PREDICTION OF 5-YEAR SURVIVAL OF CARDIOESOPHAGEAL CANCER PATIENTS AFTER COMPLETE LEFT THORACOABDOMINAL ESOPHAGOGASTRECTOMIES
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
5-YEAR SURVIVAL OF UPPER THIRD ESOPHAGEAL CANCER PATIENTS WAS SIGNIFICANTLY SUPERIOR IN COMPARISON WITH MIDDLE AND LOWER THIRD ESOPHAGEAL CANCER PATIENTS AFTER RADICAL SURGERY AND STRONGLY DEPENDED ON PHASE TRANSITION EARLY-INVASIVE CANCER, LYMPH NODE METASTASES, CELL RATIO FACTORS AND ADJUVANT CHEMOIMMUNORADIOTHERAPY
Artificial Intelligence, System Analysis and Simulation Modeling in Precise Prediction of 5-Year Survival of Esophageal Cancer Patients after Complete Esophagogastrectomies
5th Annual Early Age Onset Colorectal Cancer - Session VI: Palliative Care: Why Early is Best Including Guidance, Support and Resources to Patients and Caregivers During Their Treatment Journey/Continuum of Care. Epigenetics and its Future Role in the Diagnosis and Treatment of Individuals More Specifically and Accurately.
An Interactive Discussion On Key Issues Affecting Young Adult Colorectal Cancer Patients and Their Caregivers
Powered By Our Survivor Community and Their Families
Kshivets O. Cardioesophageal Cancer SurgeryOleg Kshivets
ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PREDICTION OF 5-YEAR SURVIVAL OF CARDIOESOPHAGEAL CANCER PATIENTS AFTER COMPLETE LEFT THORACOABDOMINAL ESOPHAGOGASTRECTOMIES
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
5-YEAR SURVIVAL OF UPPER THIRD ESOPHAGEAL CANCER PATIENTS WAS SIGNIFICANTLY SUPERIOR IN COMPARISON WITH MIDDLE AND LOWER THIRD ESOPHAGEAL CANCER PATIENTS AFTER RADICAL SURGERY AND STRONGLY DEPENDED ON PHASE TRANSITION EARLY-INVASIVE CANCER, LYMPH NODE METASTASES, CELL RATIO FACTORS AND ADJUVANT CHEMOIMMUNORADIOTHERAPY
Artificial Intelligence, System Analysis and Simulation Modeling in Precise Prediction of 5-Year Survival of Esophageal Cancer Patients after Complete Esophagogastrectomies
5th Annual Early Age Onset Colorectal Cancer - Session VI: Palliative Care: Why Early is Best Including Guidance, Support and Resources to Patients and Caregivers During Their Treatment Journey/Continuum of Care. Epigenetics and its Future Role in the Diagnosis and Treatment of Individuals More Specifically and Accurately.
An Interactive Discussion On Key Issues Affecting Young Adult Colorectal Cancer Patients and Their Caregivers
Powered By Our Survivor Community and Their Families
Epatocarcinoma: nulla di nuovo sotto il sole - Gastrolearning®Gastrolearning
Gastrolearning II modulo/13a lezione
Epatocarcinoma: nulla di nuovo sotto il sole
Relatore: Prof. Massimo Colombo (Milano)
Discussants: Prof. F. Farinati (Padova), Prof.ssa E. Villa (Modena), Prof. A. Grieco (Roma).
Circulating Tumor Cells (CTC) and pathological Complete Response (pCR) are strong independent prognostic factors in Inflammatory Breast Cancer (IBC) in a pooled analysis of two multicentre phase II trials (BEVERLY 1 & 2) of neoadjuvant chemotherapy combined with bevacizumab
Conférence du Dr. Maximiliano GELLI (Chirurgien hépatique, AP-HP Hôpital Paul Brousse, Villejuif, France) aux Journées de Chirurgie Hépato-Biliaire, juin 2014, Paris.
Radiation Therapy: Nutritional Strategies to Improve OutcomesJeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at "Integrative Cancer Medicine: Clinical Applications of Cancer Strategies" conference April 26-29, 2013, Scottsdale AZ. Explore the mechanisms of tumor resistance to radiation therapy. Review diet, lifestyle, nutritional and botanical strategies for bolstering therapeutic efficacy. Employ selective radioprotectors to lessen injury to healthy tissues. Take into consideration the unfavorable consequences of radiotherapy, which can potentially increase the oncogenic potential of surviving tumor cells, and develop a plan for blocking these pathways. Cases will be presented from 15 yrs experience of the Nutritional Solutions team in counseling clients undergoing radiation therapy for Glioblastoma multiforme brain tumors, colorectal, head-and-neck, breast and gynecologic cancers.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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7. • The major risk factor for HCC :
– HBV chronic infection (52% of all HCC)
– Followed by chronic HCV infection and alcohol intake
• Other HCC risk factors : male, aflatoxin, obesity, type
II DM, hereditary hemochromatosis, primary biliary
cirrhosis, several hereditary metabolic conditions
Risk factors of HCC
de Lope CR, Tremosini S, Forner A, et al. J Hepatol 2012;56 Suppl:S75-87.
11. 台灣 B 型肝炎與肝癌相關之危險性
Yang HI, et al NEJM, 2002; 347:168-74. This article has been cited for 805 times till Sep. 2012
HBsAg HBeAg ALT Risk
- - Normal 1 (23/71,105 person/yr)
- - Elevated 5.4
+ - Normal 10.3
+ - Elevated 29.3
+ + Normal 61.3
+ + Elevated 109
12. REVEAL: Relationship Between Baseline HBV DNA Levels and
HCC Incidence Entire Cohort, N = 3653
14
12
10
8
6
4
2
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Year of Follow-up
Cumulative Incidence of HCC (%)
Baseline HBV DNA Level (copies/mL)
1 Million
100,000-999,999
10,000-99,999
300-9,999
<300
No. at Risk
Baseline HBV DNA Level (copies/mL)
1 Million
100,000-999,999
10,000-99,999
300-9,999
<300
627 621 611 604 593 582 571 561 550 541 528 513 499 414
349 346 342 338 333 327 321 317 310 304 302 294 288 228
643 637 633 633 627 625 622 615 609 606 597 588 586 490
1161 1155 1146 1139 1137 1131 1129 1123 1119 1113 1102 1091 1082 879
873 865 862 854 850 845 836 826 823 819 814 807 802 720
Chen CJ et al. JAMA. 2006;295:65-73. This article has been cited for 1362 times till Sep. 2012
13. Nomogram for risk of HCC
Yang HI, et al. J Clin Oncol 2010;28:2437-44
14. Serum HCV RNA and ALT levels predict
HCV outcomes
High HCV RNA levels: > 3.5 x 105 U/ML
Lee MH, et al. J Clin Oncol 2010;28:4587-93
15. Diagnostic accuracies of four thresholds of ULN of ALT
for predicting unhealthy status in male
Sensitivity (%)
(95% CI)
Specificity (%)
(95% CI)
Youden’s index AUROC
(95% CI)
Training set
Current 20.3(19.5-21.0) 96.4(95.3-97.4) 0.167 0.583(0.575-0.592)
Kang 34.8(33.9-35.7) 91.0(89.3-92.6) 0.258 0.629(0.620-0.638)
Prati 36.9(36.0-37.8) 89.4(87.6-91.1) 0.263 0.632(0.623-0.640)
Wu (this study) 65.1(64.2-66.0) 67.7(65.1-70.3) 0.328 0.664(0.656-0.673)
Validation set
Current 25.1(24.0-26.2) 96.9(95.2-98.0) 0.220 0.610(0.598-0.621)
Kang 41.7(40.4-42.9) 90.3(87.7-92.4) 0.320 0.660(0.648-0.671)
Prati 44.2(43.0-45.5) 89.2(86.6-91.5) 0.334 0.667(0.656-0.678)
Wu (this study) 74.5(73.4-75.6) 63.6(59.8-67.2) 0.381 0.690(0.679-0.701)
ULN threshold of ALT: current 40 IU/L; Kang: 31 IU/L for male and 23 IU/L for female;
Prati: 30 IU/L for male and 19 IU/L for female; Wu: 21 IU/L for male and 17 IU/L for female
Wu WC, Wu CY, Wang YJ, Su CW, et al. Aliment Pharmacol Ther 2012;36:560-568
16. 2012 EASL recommendation for HCC
surveillance
Cirrhotic patients, Child-Pugh stage A and B
Cirrhotic patients, Child-Pugh stage C awaiting liver
transplantation
Non-cirrhotic HBV carriers with active hepatitis or
family history of HCC
Non-cirrhotic patients with chronic hepatitis C and
advanced liver fibrosis F3
2012 J Hepatol 2012:56:908-43
18. Diagnostic criteria for HCC in Barcelona-
2000 EASL conference
• Cyto-histological criteria
• Non-invasive criteria (restricted to cirrhotic patients)
– Radiological criteria: two coincident imaging techniques
• Focal lesion > 2cm with arterial hypervascularization
– Combined criteria: one imaging technique associated
with AFP
• Focal lesion > 2cm with arterial hypervascularization
• AFP levels > 400 ng/mL
• Four techniques considered: US, spiral CT, MRI and
angiography
Bruix J, et al. J hepatol 2001;35:421-30
19. Diagnosis accuracy of CEUS and MRI
Diagnosis accuracy of combined CEUS and MRI
Forner A, Bruix J, et al. Hepatology 2008:47:97-104
20. Algorithm for investigation of a nodule found on ultrasound
Bruix J, Sherman M. Management of hepatocellular carcinoma. AASLD practice guideline. Hepatology 2005;42:1208-1236
Image:
CEUS
CT
MRI
21. Diagnosis accuracy of single imaging
Scan Sensitivity Specificity Positive predictive
value
Negative predictive
value
Accuracy
CEUS 53% 91% 75% 79% 78%
CT 53% 99% 95% 80% 83%
MRI 62% 100% 100% 84% 87%
Khalili K, Sherman M, et al. J Hepatol 2011;54:723-8
22. The sensitivity of HCC diagnosis by imaging is
not influenced by the cirrhotic background
Imaging Liver cirrhosis Non-cirrhotic liver P
Liver CT (typical/atypical) (n=204) 81/14 (85.3%) 86/23(78.9%) 0.239
Tumor 1-2 cm (n=38) 15/6 (71.4%) 12/5 (70.6%) 1.000
Tumor > 2cm (n=166) 66/8 (89.2%) 74/18 (80.4%) 0.123
MRI (typical/atypical) (n=80) 48/12 (80%) 13/7 (65%) 0.226
Tumor 1-2cm (n=26) 19/5 (79.2%) 2/0 (100%) 1.000
Tumor >2cm (n=54) 29/7 (80.6%) 11/7 (61.1%) 0.188
Lin MT, Chen CL, Hu TH, et al. J Gastroenterol Hepatol 2011;26;745-50
25. HCC staging
• At least 10 systems have been raised
– Okuda (Japan)
– TNM/ AJCC (US)
– BCLC (Spain)
– CLIP (Italy)
– French
– CUPI (Hong Kong)
– JIS (Japan)
– NATURE scoring system (Taiwan)
– Taipei Integrated Scoring system (Taiwan)
26. • To best assess the prognosis of HCC patients it is
recommended that the staging system take into
account tumor stage, liver function and physical
status. The impact of treatment should also be
considered when estimating life expectancy.
• Currently, the BCLC system is the only staging
system that accomplishes these aims (level II).
AASLD 2010
Staging system
27. Selecting an optimal staging system for HCC
Hsu CY, Huo TI, et al. Cancer 2010;116:3006-14
28. The Cancer of the Liver Italian Program (CLIP) scoring system
Variable Score
Child-Pugh stage
A
B
C
0
1
2
Tumor morphology
Uninodular & extension 50%
Multinodular & extension 50%
Massive or extension > 50%
0
1
2
AFP
< 400
400
0
1
Portal vein thrombosis
No
Yes
0
1
Hepatology 1998;28:751
35. Patients in the RFA group had lower overall survival rate and higher
recurrence rate than those in the SR group
Hung HH, Chiou YY, Hsia CY, et al. Clin Gastroenterol Hepatol 2011;9:79-86
36. Comparison of demographic data between HCC patients underwent RFA or SR
Parameter RFA group (n=190) SR group (n=229) P
Patient demographics
Age (years) (mean±SD) 67.42±11.45 60.07±12.56 < 0.001
Sex (M: F) (%) 121/69 (63.7%/36.3%) 184/45 (80.3%/19.7%) < 0.001
Viral factors
HBsAg positive/negative 88/97(46.3%/51.1%) 137/81(59.8%/35.4%) 0.004
Anit-HCV positive/negative 85/101(44.7%/53.2%) 61/151(26.6%/65.9%) < 0.001
Serum biochemistry tests and liver function tests
Albumin (g/dL) (mean±SD) 3.85±0.55 4.09±0.40 < 0.001
Total bilirubin (mg/dL) (mean±SD) 0.99±0.60 0.81±0.48 0.001
ALT (U/L) (mean±SD) 71.84±56.08 59.83±49.75 0.022
AST (U/L) (mean±SD) 71.43±56.55 50.58±37.67 < 0.001
Alk-P(U/L) (mean±SD) 114.08±56.02 91.25±42.06 < 0.001
Creatinine (mg/dL) (mean±SD) 1.20±1.05 1.08±0.51 0.159
Glucose (mg/dL) (mean±SD) 117.40±57.83 105.91±40.47 0.026
ICG-15R (%) (median; 25 and 75 percentiles) 19.50;8.00-29.00 11.50;7.00-16.00 0.002
PT/ INR (mean±SD) 1.06±0.12 1.03±0.06 0.002
Platelet (/mm3) (mean±SD) 128889±62029 162078±61612 < 0.001
Tumor factors
Tumor size (cm) (median; 25 and 75 percentiles) 2.20;1.70-2.90 2.70;2.00-3.70 < 0.001
Single tumor/multinodularity (%) 152/38 (80.0%/20.0%) 181/48 (79.0%/21.0%) 0.904
AFP (ng/ml) (median; 25 and 75 percentiles) 17.86;7.30-49.87 17.88;6.59-190.25 0.043
37. Multivariate analysis to determine factors associated with
poor outcomes after curative therapy for HCC
Hazard ratio (95% confidence interval) P
Poor overall survival
Age > 65 years 1.988 (1.266-3.121) 0.003
Albumin ≦4 g/dL 1.751 (1.073-2.857) 0.025
Bilirubin > 1.6mg/dL 2.032 (1.033-3.998) 0.040
PT/INR > 1.1 2.114 (1.275-3.506) 0.004
AFP> 20 ng/mL 1.680 (1.079-2.617) 0.022
Multiple tumor 1.851 (1.139-3.007) 0.013
Recurrence
RFA/SR 1.949 (1.479-2.571) < 0.001
Platelet ≦105/mm3 1.420 (1.033-1.949) 0.031
Multiple tumor 1.798 (1.344-2.405) <0.001
38. After propensity score matching, RFA was not inferior to SR in overall
survival, but SR had lower incidence of developing recurrence than RFA
A B
39. There was no statistical significance between RFA and SR in
overall survival and recurrence for BCLC stage 0 HCC patients
A B
40. Survival of patients with HCC within Milan criteria
Lee YH, Hsu CY, Huo TI, et al. Aliment Pharmacol Ther 2012;36:551-59
41. Conclusions
• Patients with small HCCs (5 cm) have a higher rate
of tumor recurrence following RFA than surgery,
but overall survival rates are comparable between
therapies.
• RFA is as effective as surgery in patients BCLC stage
0 HCC.
46. Viral etiology does not impact on the outcome of
small HCC patients who undergo RFA
Overall Survival
Disease-free Survival
Propensity score matching analysis
Chen PH, Kao WY, Chiou YY, et al. Ann Hepatol (in press)
48. Minimal fibrosis
Advanced fibrosisP=0.018
P=0.018
Minimal fibrosis
Advanced fibrosis
Survival 1 yr 3yr 5yr 10yr
Mininal 100% 92.9% 92.9% 78.6%
Advanced 91.9% 71.0% 59.7% 29.2%
Recurrence 1 yr 3yr 5yr 10yr
Mininal 7.1% 21.4% 21.4% 28.6%
Advanced 24.4% 49.6% 60.3% 72.6%
Hung HH, Su CW, Chau GY, Huo TI, Wu JC, et al.
Hepatol Int 2010;4:691-699
The degree of liver fibrosis is critical in determining post-surgery
outcomes for patients with small HCC
49. APRI could predict prognosis of HCC
patients undergoing resection
APRI could serve as a feasible marker for predicting the
prognosis of patients with small HCC undergoing resection surgery
Hung HH, Su CW, Chau GY, Huo TI, Wu JC, et al. Hepatol Int 2010;4:691-699
51. Patients with splenomegaly had poorer overall
survival rate than those with normal splenic volume
Wu WC, Chiou YY, Hung HH. J Clin Gastroenterol 2012; 46;789-95
56. Resection is superior to TACE in patients
with HCC beyond Milan criteria
Hsu CY, Huo TI, et al. Ann Surg Oncol 2012;19:842-9
Propensity score matching analysis
57. Resection is superior to TACE in patients
with HCC beyond Milan criteria
Chang WC, Kao WY, Chau GY, et al. Surgery (in press)
Variable HR 95%CI p
Overall survival
Albumin 4 / > 4 g/dL 1.570 1.225-2.012 <0.001
ICGR-15 >10%/ 10% 1.290 1.009-1.650 0.042
Creatinine > 1.2 / 1.2 mg/dL 1.462 1.029-2.077 0.034
Multiple tumor (yes/no) 1.517 1.154-1.994 0.003
Edmondson stage III or IV / I or II 1.485 1.164-1.895 0.001
Macroscopic vascular invasion (yes) 1.585 1.217-2.064 0.001
58. The impact of poor respond to TACE on
overall survival
Tsai YJ, Hsu CY, Huo TI, et al. Hepatol Int 2011;5:975-84
59. Liver failure after TACE
Hsin IF, Hsu CY, Huo TI, et al. J Clin Gastroenterol 2011;45:556-62