Complete response with sorafenib and transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma

Patients with advanced hepatocellular carcinoma(HCC) showing portal vein tumor thrombosis(PVTT) have an extremely poor prognosis. According to treatment guidelines, the only option for HCC patients with PVTT is sorafenib chemotherapy. However, in Asia, various treatments have been attempted and possible prolongation of overall survival has been repeatedly reported. We herein report the first case of a patient with an initially unresectable advanced HCC with PVTT who underwent curative hepatectomy after sorafenib and transcatheter arterial chemoembolization(TACE) showing complete histological response. Two months after induction with sorafenib, a significant decrease in serum alpha-fetoprotein level was observed and computed tomography imaging showed a significant decrease in tumor size. Because of remaining PVTT, TACE and curative resection were performed. The combination of sorafenib and TACE may be an effective treatment for HCC patients with PVTT.

Impaired liver function attenuates liver regeneration and hypertrophy after portal vein embolization

AIM To clarify the clinical factors associated with liver regeneration after major hepatectomy and the hypertrophic rate after portal vein embolization(PVE).METHODS A total of 63 patients who underwent major hepatectomy and 13 patients who underwent PVE in a tertiary care hospital between January 2012 and August 2015 were included in the analysis.We calculated the remnant liver volume following hepatectomy using contrast-enhanced computed tomography(CT) performed before and approximately 3-6 mo after hepatectomy.Furthermore,we calculated the liver volume using CT performed 2-4 wk after PVE.Preoperative patient characteristics and laboratory data were analyzed to identify factors affecting postoperative liver regeneration or hypertrophy rate following PVE.RESULTS The remnant liver volume/total liver volume ratio negatively correlated with the liver regeneration rate after hepatectomy(ρ =-0.850,P < 0.001).The regeneration rate was significantly lower in patients with an indocyanine green retention rate at 15 min(ICG-R15) of ≥ 20% in the right hepatectomy group but not in the left hepatectomy group.The hypertrophic rate after PVE positively correlated with the regeneration rate after hepatectomy(ρ = 0.648,P = 0.017).In addition,the hypertrophic rate after PVE was significantly lower in patients with an ICG-R15 ≥ 20% and a serum total bilirubin ≥ 1.5 mg/d L.CONCLUSION The regeneration rate after major hepatectomy correlated with hypertrophic rate after PVE.Both of them were attenuated in the presence of impaired liver function.

Classification of hepatic venous tumor thrombus in hepatocellular carcinoma: should it describe tumor status or predict patient survival?

Tumor thrombus in the hepatic veins or inferior vena cava(HVTT/IVCTT)is the second most common of the three types of vascular invasion by hepatocellular carcinoma(HCC).According to the most recent nationwide survey in Japan,vascular invasion of the portal vein(PVTT)is present 13.2%of newly diagnosed HCCs,followed by HVTT/IVCTT(6.2%)and bile duct tumor thrombus(BDTT,3.4%)based on imaging findings(1).