Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer with a high mortality rate. While chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent the leading risk factors worl...Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer with a high mortality rate. While chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent the leading risk factors worldwide, the spreading of metabolic disorders, such as diabetes, obesity and non-alcoholic fatty liver disease (NAFLD) justifies the increasing attention on their oncogenic mechanisms. This review discusses about the main pathogenic mechanisms implicated in occurrence of HCC in presence of viral and metabolic diseases. Additionally, it points to the importance of clinical surveillance for those patients considered at risk of HCC and highlights the strategical role of serum markers, such as alfa-fetoprotein (αFP) and Protein Induced by Vitamin K Absence or Antagonist II (PIVKA-II), which, in association to a strictly instrumental follow-up, contribute to the early detection of hepatic nodules with a better prognosis for affected patients.展开更多
Aim:To validate a novel Japanese indication criteria for liver transplantation(LT)for hepatocellular carcinoma(HCC),i.e.,the 5-5-500 criteria(nodule size≤5 cm in diameter,nodule number≤5,and alfa-fetoprotein(AFP)va...Aim:To validate a novel Japanese indication criteria for liver transplantation(LT)for hepatocellular carcinoma(HCC),i.e.,the 5-5-500 criteria(nodule size≤5 cm in diameter,nodule number≤5,and alfa-fetoprotein(AFP)value≤500 ng/mL)and the Japanese double eligibility criteria(DEC)(patients meeting the Milan or the 5-5-500 criteria)in the University of Tokyo cohort.The usefulness of biomarkers in predicting the recurrence of HCC was also verified.Methods:The overall survival and recurrence rates of patients meeting the Milan,5-5-500,and the Japanese DEC were compared among 153 patients who underwent living donor LT(LDLT)between 1996 and 2019.A receiver-operating characteristics curve analysis was conducted to evaluate the usefulness of AFP,lens culinaris agglutinin-reactive fraction of AFP,des-gamma-carboxy prothrombin,neutrophil-lymphocyte ratio,and the platelet-lymphocyte ratio to detect recurrence.Results:The 5-year recurrence rate for all patients,those meeting the Japanese DEC,5-5-500 criteria,and the Milan criteria was 10.9%,9.2%,7.4%,and 7.6%,respectively.Compared with the conventional Milan criteria,the 5-5-500 criteria and the Japanese DEC could increase the number of eligible LDLT candidates by 6.1%and 11.4%.Among five biomarkers,the area under the curve value of AFP was the highest(0.852).Conclusion:The results suggest that the 5-5-500 criteria and the Japanese DEC are the appropriate selection criteria for patients with HCC in LDLT.Among five biomarkers investigated,AFP was most reliable to predict HCC recurrence,which justified the utilization of AFP in the 5-5-500 criteria and the Japanese DEC.展开更多
文摘Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer with a high mortality rate. While chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent the leading risk factors worldwide, the spreading of metabolic disorders, such as diabetes, obesity and non-alcoholic fatty liver disease (NAFLD) justifies the increasing attention on their oncogenic mechanisms. This review discusses about the main pathogenic mechanisms implicated in occurrence of HCC in presence of viral and metabolic diseases. Additionally, it points to the importance of clinical surveillance for those patients considered at risk of HCC and highlights the strategical role of serum markers, such as alfa-fetoprotein (αFP) and Protein Induced by Vitamin K Absence or Antagonist II (PIVKA-II), which, in association to a strictly instrumental follow-up, contribute to the early detection of hepatic nodules with a better prognosis for affected patients.
文摘Aim:To validate a novel Japanese indication criteria for liver transplantation(LT)for hepatocellular carcinoma(HCC),i.e.,the 5-5-500 criteria(nodule size≤5 cm in diameter,nodule number≤5,and alfa-fetoprotein(AFP)value≤500 ng/mL)and the Japanese double eligibility criteria(DEC)(patients meeting the Milan or the 5-5-500 criteria)in the University of Tokyo cohort.The usefulness of biomarkers in predicting the recurrence of HCC was also verified.Methods:The overall survival and recurrence rates of patients meeting the Milan,5-5-500,and the Japanese DEC were compared among 153 patients who underwent living donor LT(LDLT)between 1996 and 2019.A receiver-operating characteristics curve analysis was conducted to evaluate the usefulness of AFP,lens culinaris agglutinin-reactive fraction of AFP,des-gamma-carboxy prothrombin,neutrophil-lymphocyte ratio,and the platelet-lymphocyte ratio to detect recurrence.Results:The 5-year recurrence rate for all patients,those meeting the Japanese DEC,5-5-500 criteria,and the Milan criteria was 10.9%,9.2%,7.4%,and 7.6%,respectively.Compared with the conventional Milan criteria,the 5-5-500 criteria and the Japanese DEC could increase the number of eligible LDLT candidates by 6.1%and 11.4%.Among five biomarkers,the area under the curve value of AFP was the highest(0.852).Conclusion:The results suggest that the 5-5-500 criteria and the Japanese DEC are the appropriate selection criteria for patients with HCC in LDLT.Among five biomarkers investigated,AFP was most reliable to predict HCC recurrence,which justified the utilization of AFP in the 5-5-500 criteria and the Japanese DEC.
