Early hepatocellular carcinoma as a signaling lesion for subsequent malignancy

Abstract

Objective: Early diagnosis and treatment of cancer may contribute substantially to complete cure, but it remains unknown whether treatment of early hepatocellular carcinoma can actually result in cure. This study was performed to clarify the cancer risk of the background liver after treating early hepatocellular carcinoma. Methods: Early hepatocellular carcinoma is defined as very well-differentiated cancer containing Glisson's triad. The cumulative incidence of classical hepatocellular carcinoma, hypervascular liver cancer detected on imaging studies, after resection of early hepatocellular carcinoma positive for anti-hepatitis C antibody (early hepatocellular carcinoma group, n = 105) was compared with that in patients with chronic liver disease positive for anti-hepatitis C antibody (control group, n = 751) and propensity score-matched patients after resection of classical hepatocellular carcinoma (classical hepatocellular carcinoma group, n = 105). Results: After a median follow-up of 4.8 years (range, 0.3-15.0), the cumulative incidence of classical hepatocellular carcinoma at 5 years was 56.9% (95% confidence interval, 44.2-67.7%) in the early hepatocellular carcinoma group and 70.6% (52.5-81.8%) in the classical hepatocellular carcinoma group as compared with 4.6% (2.8-6.4%) in the control group. The risk of the development of classical hepatocellular carcinoma in the early hepatocellular carcinoma group was significantly higher than that in the control group (hazard ratio, 17.5; 95% confidence interval, 12.1-25.3; P < 0.001) and significantly lower than that in the classical hepatocellular carcinoma group (hazard ratio, 0.60; 0.41-0.89; P = 0.010). However, the cumulative incidence of second primary hepatocellular carcinoma in patients with one early hepatocellular carcinoma did not differ significantly from that in patients with two or more early hepatocellular carcinoma lesions (hazard ratio, 1.50; 0.85-2.65; P = 0.157). Conclusions: Treatment of early hepatocellular carcinoma cannot provide complete cure due to the substantial risk of developing classical hepatocellular carcinoma.

Clinical correspondence to hepatocellular carcinoma-related lesions with atypical radiological pattern

“…Furthermore, the tumors associated with HCC with atypical radiological pattern that coexisted with classical HCC were not necessarily removed, because new classical HCC lesions, which should be treated immediately, often appear prior to the malignant transformation of non-enhanced lesions or hypervascular tumors without washout due to multicentric hepatocarcinogenesis (16,17).…”

“…On the other hand, we reported previously that non-enhanced lesions and enhanced lesions without washout coexisting with HCC should be considered as risk factors for new lesions in the remnant liver, and not target lesions for treatment (16). Furthermore, it is not necessary to treat hypovascular tumors associated with HCC immediately after diagnosis due to the long lead time and the substantial risk of developing classical HCC in the remnant liver (17,18).…”

High serum serotonin as a favorable prognostic factor for patients with hepatocellular carcinoma

“…All patients were followed for postoperative recurrence as described previously [20]. Brie y, tumor marker levels, including the levels of alpha-fetoprotein and des-gamma-carboxy prothrombin (DCP), were measured, and imaging studies including computed tomography and ultrasonography were performed every three months in all patients.…”

Antitumoral and Anti-inflammatory Roles of Somatostatin and Its Analogs in Hepatocellular Carcinoma

“…Liver cancer is the fourth most frequent type of cancer and has been a rising cause of concern for the global medical community [ 1 ]. Despite significant diagnostic and therapeutical advances, hepatocellular carcinoma (HCC) still has recurrence rates of over 50%, even after aggressive treatments, such as curative resection [ 2 – 4 ]. Recent studies show that the majority of patients are at risk of recurrence, and this is attributable to intrahepatic metastasis or multicentric hepatocarcinogenesis [ 5 ].…”