RESUMEN
BACKGROUND/AIMS: There is more potential for misclassification of adenocarcinoma of the pancreas than for many other cancers because of the difficulty of accurate diagnosis. METHODOLOGY: We analyzed the clinicopathological features of 105 patients who were suspected of having unresectable adenocarcinoma of the pancreas on their 1st visit to our outpatient clinic. RESULTS: Ten of 105 patients (10%) had been misdiagnosed as having pancreatic carcinoma. The final diagnoses were made mainly using dynamic computed tomography (CT) and/or histologic examination. The incidence of weight loss (> or = 7% of total-body weight, within 6 months before diagnosis) in the misdiagnosed patients was significantly lower than that in pancreatic carcinoma patients (30% vs. 67%, p=0.02). Serum CA19-9 abnormality (> 100 U/ml) was observed less frequently in the misdiagnosed patients than in the patients with pancreatic carcinoma (40% vs. 77%, p=0.01). The detection of a dilated main pancreatic duct and/or pancreatic mass by imaging modalities was less frequent in the misdiagnosed patients (p<0.01). CONCLUSIONS: Dynamic CT and/or histologic examination may be essential when making a definite diagnosis of advanced pancreatic carcinoma. In addition, weight loss, serum CA19-9 abnormality, detection of a dilated main pancreatic duct and/or pancreatic mass may also be useful in making a differential diagnosis of this disease.
Asunto(s)
Adenocarcinoma/patología , Neoplasias Pancreáticas/patología , Adenocarcinoma/diagnóstico , Antígeno CA-19-9/sangre , Antígeno Carcinoembrionario/sangre , Errores Diagnósticos , Humanos , Páncreas/patología , Elastasa Pancreática/sangre , Neoplasias Pancreáticas/diagnóstico , Valor Predictivo de las Pruebas , Tomografía Computarizada por Rayos X , Pérdida de Peso/fisiologíaRESUMEN
Undifferentiated carcinoma of the liver is very rare. A 54-year-old man was admitted to our hospital for a detailed examination of multiple liver tumors. These tumors were high or low echoic on ultrasonography, but not enhanced by contrast medium in dynamic computed tomography. A fine-needle aspiration biopsy specimen of the tumor showed undifferentiated carcinoma. The serum level of neuron-specific enolase was high (357 ng/ml) and the immunohistochemical stain of the biopsy specimen was positive for synaptophysin. We diagnosed the patient as having undifferentiated carcinoma of the liver with neuroendocrine features. The patient was treated with combined systemic chemotherapy: etoposide 100 mg/m2/day for three days plus cisplatin 80 mg/m2/day on day one. He achieved a partial response, the duration of which was 7+ months. The serum neuron-specific enolase levels were decreased to the normal range after chemotherapy. Primary liver carcinoma with neuroendocrine features is extremely rare, but in a suspicious case it is important to measure the serum levels of neuroendocrine markers and make a histological confirmation, because chemotherapy may be effective for this disease.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/tratamiento farmacológico , Carcinoma/enzimología , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/enzimología , Fosfopiruvato Hidratasa/sangre , Biomarcadores de Tumor/sangre , Carcinoma/patología , Cisplatino/administración & dosificación , Etopósido/administración & dosificación , Humanos , Inmunohistoquímica , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Sinaptofisina/análisisRESUMEN
Zinostatin stimalamer (SMANCS) is a lipophilic intra-arterial chemotherapeutic agent for hepatocellular carcinoma (HCC). Thirty HCC patients underwent transcatheter arterial injection of 4 mg SMANCS-lipiodol emulsion. Their responses were evaluated by computed tomography 1 month after treatment. Complete response (CR) was defined as disappearance or 100% necrosis of all tumors. Partial response (PR) was defined as > or = 50% reduction and/or > or = 50% necrosis. We regarded the lipiodol accumulation in tumors as being necrotic. CR and PR were observed in 8 patients (27%) and 4 patients (13%), respectively, and the overall response rate (CR + PR/all patients) was 40% (12/30). Of 12 patients whose serum alpha-fetoprotein levels had been more than 200 ng/ml before treatment, 5 patients (42%) showed more than 50% reduction in this level within 1 month after treatment. Toxicity was quite acceptable, although grade 4 toxicity (WHO) was observed as liver dysfunction in 1 patient. Transarterial chemotherapy with SMANCS, which is well tolerated, appears to have moderate antitumor effect in patients with HCC.
Asunto(s)
Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/tratamiento farmacológico , Neoplasias Hepáticas/tratamiento farmacológico , Anhídridos Maleicos/uso terapéutico , Poliestirenos/uso terapéutico , Cinostatina/análogos & derivados , Adolescente , Adulto , Anciano , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Femenino , Humanos , Infusiones Intraarteriales , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Anhídridos Maleicos/administración & dosificación , Anhídridos Maleicos/efectos adversos , Persona de Mediana Edad , Poliestirenos/administración & dosificación , Poliestirenos/efectos adversos , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Cinostatina/administración & dosificación , Cinostatina/efectos adversos , Cinostatina/uso terapéuticoRESUMEN
The aim of the study was to determine whether past exposure to hepatitis B virus (HBV) influences the risk of the development of hepatocellular carcinoma (HCC) in Japanese patients with chronic liver disease (CLD). We conducted a hospital-based case-control study of 141 HCC patients with CLD and 151 controls with CLD but without HCC. Past exposure to HBV was assessed by antibody to hepatitis B core antigen (anti-HBc) positivity. Ninety-two patients (65%) with HCC were anti-HBc positive compared with 65 patients (43%) with CLD alone (P < 0.01). A multivariate analysis using logistic regression modelling revealed that anti-HBc positivity significantly increased the risk of the development of HCC [odds ratio (OR) 2.0, P = 0.01]. In the anti-HBc-positive patients, a significantly increased risk of HCC was seen among the patients positive for anti-HBc alone (OR, 2.6; P < 0.01). However, a significant OR was not obtained among the patients with a transient HBV infection implied by positivity for both antibody to hepatitis B surface antigen and anti-HBc (OR, 1.5; P = 0.48). These results indicate that past exposure to HBV is a risk factor for HCC in Japanese CLD patients, especially when they have no serological evidence of immunity to HBV.
Asunto(s)
Carcinoma Hepatocelular/etiología , Hepatitis B/complicaciones , Neoplasias Hepáticas/etiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Anticuerpos contra la Hepatitis B/análisis , Antígenos de Superficie de la Hepatitis B/análisis , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
BACKGROUND: Percutaneous ethanol injection (PEI) therapy currently is widely used for small hepatocellular carcinoma (HCC). However, only limited information is available regarding needle tract implantation after PEI treatment. METHODS: Records of HCC patients who underwent PEI between March 1990 and April 1997 at the National Cancer Center Hospital (n = 177) were reviewed to clarify the incidence, risk factors, and outcome of needle tract implantation of HCC. RESULTS: PEI was performed for 348 HCC patients with a median tumor size of 20 mm. Needle tract implantation was found in 4 patients (10, 13, 15, and 46 months, respectively, after PEI). The size of the PEI-treated HCC tumors in these patients was 20, 27, 28, and 30 mm, respectively, in greatest dimension. All tumors were enhanced in the early phase on dynamic computed tomography (CT), and were found to have moderate tumor cell differentiation on biopsied specimens. Of the four implanted tumors, three were resected and the remaining tumor was treated with extrabeam radiotherapy. At last follow-up, 2 of the 4 patients had died (1 of variceal bleeding 60 months after PEI and the other from cancer 61 months after PEI) and 2 were still alive (14 and 20 months, respectively, after PEI) with no evidence of active tumor. CONCLUSIONS: Needle tract implantation after PEI is not unusual, especially when HCC tumors are > or =2 cm in greatest dimension, enhanced in the early phase on dynamic CT, and/or moderately differentiated on biopsied specimens.
Asunto(s)
Carcinoma Hepatocelular/tratamiento farmacológico , Carcinoma Hepatocelular/patología , Etanol/administración & dosificación , Inyecciones Intralesiones/efectos adversos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/patología , Agujas/efectos adversos , Administración Cutánea , Anciano , Biopsia , Etanol/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , Resultado del TratamientoRESUMEN
Chemotherapy is of limited value in the treatment of hepatocellular carcinoma (HCC), since there are no established chemotherapeutic regimens proven to be effective. The aim of the present study was to determine predictive factors for tumor response to systemic chemotherapy in HCC patients. The relationship between patients' characteristics and tumor response was examined in 147 previously untreated HCC patients receiving systemic chemotherapy. Ten patients showed partial response (PR) and none showed complete response (CR). The response rate for all single anticancer agents was less than 10% and the overall response rate was 6.8%. The response rate in patients with unilateral HCC was significantly higher than in those with bilateral HCC. However, there were no responders among patients with a performance status of 2-3, ascites, a tumor occupying more than 50% of the entire liver, tumor thrombus in the main portal trunk or a serum bilirubin level of more than 2.0 mg/dl. There was a close relationship between patients' characteristics and tumor response. It is concluded that patients with fairly advanced HCC and/or poor hepatic reserve should not be given systemic chemotherapy.
Asunto(s)
Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/tratamiento farmacológico , Neoplasias Hepáticas/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma Hepatocelular/patología , Esquema de Medicación , Femenino , Humanos , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , alfa-Fetoproteínas/análisisRESUMEN
BACKGROUND/AIMS: There is no effective treatment for hepatocellular carcinoma (HCC) with extrahepatic metastases. This study investigated the survival and causes of death in HCC patients with extrahepatic metastases. MATERIALS AND METHODS: We retrospectively analyzed 34 HCC patients with extrahepatic metastases who received systemic chemotherapy without other anticancer treatment except prior hepatectomy. We classified causes of death as cancer death and death from other causes, and subclassified cancer deaths into hepatic cause, extrahepatic cause and cachectic cause. Each cause of death was analyzed in the two subgroups comprised of 10 patients with bone metastases alone and 22 patients with metastatic lesions in sites other than bone. RESULTS: Thirty-two of the 34 patients had died at the time of analysis. The median survival time and the 1-year survival rate were 4.6 mo and 20.3%, respectively. Incidence of hepatic cause, extrahepatic cause, cachectic cause and death from other causes were 21 (66%), 7 (22%), 2 (6%) and 2 (6%), respectively. In the subgroup of 10 patients with bone metastases alone, nine (90%) died from hepatic causes, but none died from extrahepatic causes. In the group of 22 patients with metastatic lesions in sites other than bone, 7 (32%) patients died from extrahepatic causes. CONCLUSION: The causes of death in HCC patients with extrahepatic metastases depended on metastatic site at the time of diagnosis. The results of this study may be useful in the design and analysis of future clinical trials of the HCC therapy.
Asunto(s)
Carcinoma Hepatocelular/mortalidad , Neoplasias Hepáticas/mortalidad , Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/tratamiento farmacológico , Carcinoma Hepatocelular/secundario , Causas de Muerte , Femenino , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios RetrospectivosRESUMEN
Pancreatic cancer shows high mortality and has a poor prognosis. Although the rate of response to all chemotherapeutic regimens is low, some patients have shown improvement of their symptoms after chemotherapy and/or radiotherapy without obvious tumor regression. We assessed the clinical benefit of systemic combined chemotherapy with 5-fluorouracil and cisplatin (FP therapy) in 21 patients with advanced cancer of the pancreas. The clinical response to FP therapy was evaluated using two parameters: pain (intensity of pain and consumption of morphine) and performance status. A patient was considered to be a clinical responder if one of two parameters was positive and the other was positive or stable. Four patients (19%) responded. Two of the responders achieved partial response according to the objective tumor response, and the remaining two showed no change. The survival period in responders was significant longer than in the other patients. The clinical response may be one parameter for evaluating the results of treatment for pancreatic cancer, and the longer survival period of the clinical responders in this study supports this notion.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Pancreáticas/tratamiento farmacológico , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/mortalidad , Adenocarcinoma/fisiopatología , Adolescente , Adulto , Anciano , Cisplatino/administración & dosificación , Femenino , Fluorouracilo/administración & dosificación , Humanos , Estado de Ejecución de Karnofsky , Masculino , Persona de Mediana Edad , Dolor/fisiopatología , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/fisiopatología , Inducción de Remisión , Tasa de SupervivenciaRESUMEN
BACKGROUND/AIMS: The characteristics of patients with multicentric hepatocellular carcinoma (HCC) differ from those of patients with intrahepatic metastatic HCC. However, there are few reports regarding the long-term results in patients with HCC of multicentric occurrence. The purpose of this study was to clarify the prognosis of a group of patients with multicentric HCCs. MATERIALS AND METHODS: We evaluated the outcome in 28 patients with multiple hepatocellular carcinoma (HCC) suggestive of multicentric occurrence, all of whom underwent hepatic resection. The disease-free survival, recurrence pattern and survival were analyzed in the two subgroups of 12 patients with single advanced HCC (AdHCC) nodule and an early HCC (eHCC) or early advanced HCC (eAdHCC) nodule [Group A] and 16 patients with two AdHCC lesions [Group B]. These data were also compared with those of 58 patients with solitary AdHCC [Group C]. RESULTS: Both the disease-free survival and survival periods for Groups A and C were significantly longer than those for Group B, while no significant difference was seen between Group A and C. No significant differences among the three groups were recognized in the incidence of various types of recurrence pattern. CONCLUSIONS: The long-term results in patients with multicentric HCC apparently vary depending on the pathological condition at the time of operation. Among patients with multicentric HCC, those with AdHCC combined with an eHCC or eAdHCC are likely to show improved prognosis as a result of hepatic resection.
Asunto(s)
Carcinoma Hepatocelular/mortalidad , Neoplasias Hepáticas/mortalidad , Hígado/patología , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Estudios de Casos y Controles , Supervivencia sin Enfermedad , Femenino , Hepatectomía , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , PronósticoRESUMEN
BACKGROUND/AIMS: Intrahepatic recurrence frequently occurs in patients with hepatocellular carcinoma (HCC) even after successful percutaneous ethanol injection (PEI). This study investigated factors predicting recurrence after PEI for solitary HCC. MATERIALS AND METHODS: The subjects were 31 patients with solitary HCC (10-29 mm) who received successful PEI. We investigated the relationship of pretreatment clinicopathological variables to recurrence-free survival including: age, gender, alcohol abuse, tumor size, tumor staining, tumor differentiation, serum alpha-fetoprotein (AFP) level, associated liver disease, and Child-Pugh classification. Differences in recurrence-free survival among subgroups classified by each factor were evaluated using log-rank tests. RESULTS: Median recurrence-free survival time, 1 and 2 years recurrence-free survival rates of all 31 patients were 1.57 years, 72.2% and 45.4%, respectively. Among the 9 variables evaluated, serum AFP level of 20 ng/ml or less (p < 0.005) and absence of cirrhosis (p = 0.025) were factors favoring longer recurrence-free survival significantly. CONCLUSION: These results indicate that HCC patients with higher serum AFP level or coexistent cirrhosis should be followed more closely even after successful PEI.