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The etiology and prognosis differed in patients with fulminant hepatitis and LOHF depending on the disease types in Japan, and liver transplantation improved the prognosis of the patients irrespective of the disease type and etiology.

To assess whether ultrasound-guided percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small hepatocellular carcinoma (HCC), 60 patients with one to four HCCs smaller than 3 cm were entered onto a randomized controlled trial. Thirty-one and 29 patients, respectively, were treated by percutaneous acetic acid injection using 50% acetic acid or by percutaneous ethanol injection using absolute ethanol. There were no significant differences in age, sex ratio, Child-Pugh class, size of tumors, or number of tumors between the two groups. When there was no evidence of viable HCC from biopsy, plain and helical dynamic computed tomography, or angiography, the treatment was considered successful and was discontinued. All original tumors were treated successfully by either therapy. However, 8% of 38 tumors treated with percutaneous acetic acid injection and 37% of 35 tumors treated with percutaneous ethanol injection developed a local recurrence (P F .001) during the follow-up periods of 29 ؎ 8 months and 23 ؎ 10 months, respectively. The 1-and 2-year survival rates were 100% and 92% in percutaneous acetic acid injection and 83% and 63% in percutaneous ethanol injection (P ‫؍‬ .0017). A multivariate analysis of prognostic factors revealed that treatment was an independent predictor of survival. The risk ratio of percutaneous acetic acid injection versus percutaneous ethanol injection was 0.120 (range, 0.027-0.528; P ‫؍‬ .0050). In conclusion, percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small HCC. (HEPATOLOGY 1998;27:67-72.)Hepatocelluar carcinoma (HCC) is one of the major malignancies with poor prognosis in eastern Asia, especially China, Japan, Taiwan, Singapore, and Korea, as well as Sub-Saharan Africa 1 ; the estimated incidence is approximately 1,250,000 deaths per year worldwide. 2 The early detection strategies for HCC have increased the number of small resectable HCCs in regions where they are endemic. [3][4][5] The survival rates reported after resection have improved in the last decade, mainly because of the increasingly smaller sizes of resected tumors. 4-9 Some surgical teams have thus achieved a 50% 5-year rate of survival in patients with small, asymptomatic HCCs. 5,6 However, resection is possible in a small proportion of patients because of the underlying advanced cirrhosis. Orthotopic liver transplantation is also an effective treatment for small, unresectable HCCs, but potential recipients far outnumber donors.Such difficulty in the management of HCC prompted the development of other potentially curative therapeutic modalities such as transcatheter hepatic arterial embolization (TAE) 13,14 and ultrasound (US)-guided percutaneous injection of materials that will kill cancer cells. [15][16][17][18][19][20][21][22] The latter is indicated for both hypervascular and hypovascular HCCs, whereas TAE is only for hypervascular HCCs; small HCCs are frequently hypovascular. Percutaneous ethanol injection (PEI) is...

Pancreatic stellate cells (PSC), which are implicated in desmoplasia in pancreatic cancer, enhance the malignancy of cancer cells and confer resistance to established treatments. We investigated whether the antifibrotic agent pirfenidone can suppress desmoplasia and exert antitumor effects against pancreatic cancer. Primary PSCs were established from pancreatic cancer tissue obtained during surgery. In vitro, pirfenidone inhibited the proliferation, invasiveness, and migration of PSCs in a dose-dependent manner. Although supernatants of untreated PSCs increased the proliferation, invasiveness, and migration of pancreatic cancer cells (PCC), supernatants of pirfenidone-treated PSCs decreased these effects. Exposure to PCC supernatant increased the production of platelet-derived growth factor-A, hepatic growth factor, collagen type I, fibronectin, and periostin in PSCs, which was significantly reduced by pirfenidone. Mice were subcutaneously implanted with PCCs (SUIT-2 cells) and PSCs into the right flank and PCCs alone into the left flank. Oral administration of pirfenidone to these mice significantly reduced tumor growth of co-implanted PCCs and PSCs, but not of PCCs alone. Pirfenidone also decreased the proliferation of PSCs and the deposition of collagen type I and periostin in tumors. In mice with orthotopic tumors consisting of PCCs co-implanted with PSCs, pirfenidone suppressed tumor growth, reduced the number of peritoneal disseminated nodules, and reduced the incidence of liver metastasis. Pirfenidone in combination with gemcitabine more effectively suppressed orthotopic tumor growth compared with pirfenidone or gemcitabine alone. In conclusion, our findings indicate that pirfenidone is a promising antitumor agent for pancreatic cancer, owing to its suppression of desmoplasia through regulating PSCs. Cancer Res; 73(7); 2345-56. Ó2013 AACR.

The serum ATX activity and plasma LPA level are increased in chronic hepatitis C in association with liver fibrosis. Our study may provide the first evidence showing a significant increase of both ATX and LPA in the blood under a specific disease.

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