Risk factors and therapeutic results of early local recurrence after transcatheter arterial chemoembolization

AIM:To identify factors affecting early local recurrence after transcatheter arterial chemoembolization(TACE)and investigate treatments and outcomes for local recurrence.METHODS:Early local recurrence and no early local recurrence groups drawn from 134 patients who were initially diagnosed with hepatocellular carcinoma(HCC)and showed a complete response(CR)to TACE treatment between January 1,2006,and January 31,2012,were analyzed by univariate and multivariate analyses.Additionally,the subsequent treatment for patients with recurrence was analyzed,and in cases in which TACE had been performed,the cumulative recurrence rates were calculated using the Kaplan-Meier method and compared with those of the primary lesion.RESULTS:The 1-,2-,and 3-year survival rates were92.3%,60.2%,and 39.8%,respectively,in the earlylocal recurrence group,which were significantly lower than those in both the late local and no local recurrence groups(P<0.001).On multivariate analyses,non-compact lipiodol uptake,large tumor size,and an alpha-fetoprotein>20 ng/mL after achieving a CR were significant predictors.When TACE was performed for early and late locally recurrent lesions,a CR was observed in 15 patients(41.7%)and 11 patients(78.6%),and the cumulative recurrence rates at 6,12,and 24mo were 17.9%,43.3%,and 71.2%,respectively,which did not differ significantly from those after the first CR of 20.5%,44.0%,and 58.6%,respectively(P=0.639).CONCLUSION:Closer monitoring and active treatments must be provided to patients with risk factors for early local recurrence of HCC.

Atypical onset of bicalutamide-induced liver injury

Anti-androgen therapy is the leading treatment for advanced prostate cancer and is commonly used for neoadjuvant or adjuvant treatment. Bicalutamide is a non-steroidal anti-androgen, used during the initiation of androgen deprivation therapy along with a luteinizing hormone-releasing hormone agonist to reduce the symptoms of tumor-related flares in patients with advanced prostate cancer. As side effects, bicalutamide can cause fatigue, gynecomastia, and decreased libido through competitive androgen receptor blockade. Additionally, although not as common, drug-induced liver injury has also been reported. Herein, we report a case of hepatotoxicity secondary to bicalutamide use. Typically, bicalutamideinduced hepatotoxicity develops after a few days; however, in this case, hepatic injury occurred 5 mo after treatment initiation. Based on this rare case of delayed liver injury, we recommend careful monitoring of liver function throughout bicalutamide treatment for prostate cancer.

Risk factors for metachronous gastric carcinoma development after endoscopic resection of gastric dysplasia: Retrospective, single-center study

AIM To determine the gastric adenocarcinoma(GAC)occurrence rate and related factors,we evaluated the follow-up results of patients confirmed to have gastric dysplasia after endoscopic resection(ER).METHODS We retrospectively analyzed the medical records,endoscopic examination records,endoscopic procedure records,and histological records of 667 cases from641 patients who were followed-up for at least 12mo,from among 1273 patients who were conformed to have gastric dysplasia after Endoscopic mucosal resection(EMR)or endoscopic submucosal dissection (ESD)of gastric mucosal lesions between January 2007and August 2013 at the Chungnam National University Hospital.RESULTS The mean follow-up period was 33.8 mo,and the median follow-up period was 29 mo(range:12-87).During the follow-up period,the occurrence of metachronous GAC was 4.0%(27/667).The mean and median interval periods between the occurrence of metachronous GAC and endoscopic treatment of gastric dysplasia were 36.3 and 34 mo,respectively(range:16-71).The factors related to metachronous GAC occurrence after ER for gastric dysplasia were male sex(5.3%vs 1.0%),open-type atrophic gastritis(9.5%vs3.4%),intestinal metaplasia(6.8%vs 2.4%),and highgrade dysplasia(HGD;8.4%vs 3.2%).Among them,male sex[OR:5.05(1.18-21.68),P=0.029],intestinal metaplasia[OR:2.78(1.24-6.23),P=0.013],and HGD[OR:2.70(1.16-6.26),P=0.021]were independent related factors in multivariate analysis.Furthermore,24of 27 GAC cases(88.9%)occurred at sites other than the previous resection sites,and 3(11.1%)occurred at the same site as the previous resection site.CONCLUSION Male sex,intestinal metaplasia,and HGD were significantly related to the occurrence of metachronous GAC after ER of gastric dysplasia,and most GACs occurred at sites other than the previous resection sites.

Reactivation of tuberculosis in hepatocellular carcinoma treated with transcatheter arterial chemoembolization: A report of 3 cases

Pulmonary tuberculosis is an opportunistic infection that can be reactivated in immunocompromised conditions, for example, in malignancy or after liver transplantation. Hepatocellular carcinoma (HCC) has a high mortality rate because it is frequently diagnosed at an advanced stage. Although surgical resection is the established curative measure for HCC, it is only feasible for earlystage HCC. Transcatheter arterial chemoembolization (TACE) is the most common treatment modality for patients with unresectable HCC. However, repeated TACE sessions and, occasionally, the tumor itself can further impair the reserve hepatic function and immunity. We report 3 recent cases of HCC with reactivation of pulmonary tuberculosis after TACE.

Spectrum of final pathological diagnosis of gastric adenoma after endoscopic resection

AIM: To investigate how many discrepancies occur in patients before and after endoscopic treatment of referred adenoma and the reason for these results. METHODS: We retrospectively reviewed data from 554 cases of 534 patients who were referred from primary care centres for adenoma treatment and treated for endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) at Chungnam National University Hospital, from July 2006 to June 2009. Reendoscopy was examined in 142 cases and biopsywas performed in 108 cases prior to treatment. Three endoscopists (1, 2 and 3) performed all EMRs or ESDs and three pathologists (1, 2 and 3) diagnosed most of the cases. Transfer notes, medical records and endoscopic pictures of these cases were retrospectively reviewed and analyzed. RESULTS: Adenocarcinoma was 72 (13.0%) cases in total 554 cases after endoscopic treatment of referred adenoma. When the grade of dysplasia was high (55.0%), biopsy number was more than three (22.7%), size was no smaller than 2.0 cm (23.2%), morphologic type was depressed (35.8%) or yamada type Ⅳ (100%), and color was red (30.9%) or mixed-or-undetermined (25.0%), it had much more malignancy rate than the others (P < 0.05). All 18 cases diagnosed as adenocarcinoma in the re-endoscopic forceps biopsy were performed by endoscopist 1. There were different malignancy rates according to the pathologist (P = 0.027). CONCLUSION: High grade dysplasia is the most important factor for predicting malignancy as a final pathologic diagnosis before treating the referred gastric adenoma. This discrepancy can occur mainly through inappropriately selecting a biopsy site where cancer cells do not exist, but it also depends on the pathologist to some extent.

Usefulness of colonic tattooing using indocyanine green in patients with colorectal tumors

AIM To prove that tattooing using indocyanine green(ICG) is feasible in laparoscopic surgery for a colon tumor.METHODS From January 2012 to December 2016, all patients who underwent laparoscopic colonic surgery were retrospectively screened, and 1010 patients with colorectal neoplasms were included. Their lesions were tattooed with ICG the day before the operation. The tattooed group(TG) included 114 patients, and the non-tattooed group(NTG) was selected by propensity score matching of subjects based on age, sex, tumor staging, and operation method(n = 228). In total, 342 patients were enrolled. Between the groups, the changes in [Delta(Δ), preoperative-postoperative] the hemoglobin and albumin levels, operation time, hospital stay, oral ingestion period, transfusion, and perioperative complications were compared. RESULTS Preoperative TG had a shorter operation time(174.76 ± 51.6 min vs 192.63 ± 59.9 min, P < 0.01), hospital stay(9.55 ± 3.36 d vs 11.42 ± 8.23 d, P < 0.01), and postoperative oral ingestion period(1.58 ± 0.96 d vs 2.81 ± 1.90 d, P < 0.01). The Δ hemoglobin(0.78 ± 0.76 g/dL vs 2.2 ± 1.18 g/dL, P < 0.01) and Δ albumin(0.41 ± 0.44 g/dL vs 1.08 ± 0.39 g/dL, P < 0.01) levels were lower in the TG. On comparison of patients in the "N0" and "N1 or N2" groups, the N0 colon cancer group had a better operation time, length of hospital stay, oral ingestion period, Δ hemoglobin, and Δ albumin results than those of the N1 or N2 group. The operation methods affected the results, and laparoscopic anterior resection(LAR) showed similar results. However, for left and right hemicolectomy, both groups showed no difference in operation time or hospital stay.CONCLUSION Preoperative tattooing with ICG is useful for laparoscopic colectomy, especially in the N0 colon cancer group and LAR.