Hepatocellular carcinoma: iodized-oil CT TNM classification.

Valls, Carlos; Figueras, Juan; Jaurrieta, Eduardo; Sancho, C.; Domínguez, Joan; Benasco, C; Moreno, Pedro; Rafecas, A; Virgili, J.; Castellsagué, Xavier

doi:10.2214/ajr.167.2.8686630

Cited by 29 publications

(6 citation statements)

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“…Conversely, no patient was misdiagnosed as TNM stage IV on a CT basis. The use of iodized-oil CT scan has been reported to be very useful in the preoperative staging of HCC, with an agreement of 96% between radiological and pathological staging, 18 but in the present series, such agreement was not found. The possible role of adjuvant chemotherapy in this group of patients with a high risk for tumor recurrence remains unclear.…”

Section: Discussioncontrasting

confidence: 67%

Influence of tumor characteristics on the outcome of liver transplantation among patients with liver cirrhosis and hepatocellular carcinoma

Herrero¹

2001

Liver Transplantation

195

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Hepatocellular carcinoma (HCC) may recur after liver transplantation (LT), mainly in patients with multinodular and large tumors. However, factors predictive of outcome after LT in patients with small tumors remain ill defined. We investigated which factors were related to mortality or tumor recurrence among 47 liver transplant recipients with liver cirrhosis and HCC and compared them with 107 patients with liver cirrhosis without tumor who underwent LT in the same period. Patients with HCC were older (P < .001), more frequently had cirrhosis of a viral origin (P < .001), and had lower Child-Pugh scores (P < T he role of liver transplantation (LT) in the treatment of hepatocellular carcinoma (HCC) has evolved. In the early ages, LT was indicated in all cases of unresectable HCC without known extrahepatic spread. 1,2 Long-term survival was poor among patients with advanced disease because of a high incidence of tumor recurrence. 3 In the 1990s, several series showed that early HCC seldom recurred after LT and survival was similar in patients with cirrhosis with or without HCC. 2,4-6 Some prefer LT over resection in these patients. 2,[6][7][8] Several studies investigated which factors predispose to HCC recurrence after LT. Several investigators studied which factors are related to post-LT outcome. 2,5,[8][9][10][11] Llovet et al 5 did not find any factor predictive of post-LT outcome. In other series, poor differentiation, vascular invasion, greater number of tumor nodules, and greater tumor size were related to lower survival or disease-free survival rates, 2,8,9,11 but most series were based on unselected groups of patients and included a considerable proportion of patients with large nodules..The present study investigates factors associated with mortality and tumor recurrence among 47 patients with HCC who underwent LT according to well-defined selection criteria in a single center. Patients and MethodsBetween 1991 and June 2000 in our center, 160 adult patients with liver cirrhosis underwent a first LT. Forty-seven of these patients also had HCC diagnosed before LT, 6 patients had incidental HCC, and 107 patients had liver cirrhosis without HCC. Patients with incidental HCC were excluded from this retrospective study.Patients with HCC were selected for LT if they had a single nodule not exceeding 60 mm in diameter or 2 or 3 tumors, none exceeding 50 mm in diameter, assessed by computed tomographic (CT) scan. Patients in whom vascular invasion or extrahepatic spread was evident preoperatively were excluded. LT was considered the treatment of choice for all patients with HCC if they fulfilled these criteria and did not have a contraindication for LT. Patients with HCC did not have a priority for LT compared to other patients with cirrhosis. During this period, only 2 patients were excluded from the LT waiting list 6 and 7 months after their listing because of progressing HCC.As well as ultrasonography and CT scan, hepatic angiography was generally performed before LT. When HCC had been detected or suspected an...

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Section: Discussioncontrasting

confidence: 67%

Influence of tumor characteristics on the outcome of liver transplantation among patients with liver cirrhosis and hepatocellular carcinoma

Herrero¹

2001

Liver Transplantation

195

145

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“…Both of these characteristics can be correctly assessed preoperatively using chemoembolization and lipiodol computed tomography. 22 We believe that, lar invasion, although not significant, was also a poor in other studies, disease-free survival for patients with radio-prognostic factor; furthermore, it is impossible to detect pregraphic early-stage HCC has been suboptimal because of un-operatively. Survival in patients with uni-or bilobar involvederstaging of the disease preoperatively.…”

Section: Pt4 (24%) Seven Patients Were Retransplanted In Thementioning

confidence: 65%

Survival after liver transplantation in cirrhotic patients with and without hepatocellular carcinoma: A comparative study

et al. 1997

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lected HCC are similar to the results in cirrhotic patients Cumulative recurrence after surgical resection for hewithout tumor. (HEPATOLOGY 1997;25:1485-1489.) patocellular carcinoma (HCC) is very high. Several retrospective analyses have shown that liver transplantation was more effective than resection for patients with Hepatocellular carcinoma (HCC) usually occurs with the HCC at early tumor stages. Consequently, in January presence of cirrhosis and is considered to have a poor progno-1990, we decided to prospectively indicate orthotopic sis.1 To the present, surgical resection has been the treatment liver transplantation (OLT) as the first surgical treat-of choice whenever feasible.2 However, the resection rate rement for small, localized HCC in cirrhotic patients with-mains low in cirrhotic patients. 3,4 In the last few years, some out nodal involvement independently of the degree of groups have reported disappointing long-term results after liver function. The aim of this prospective cohort study resection of small tumors in cirrhotic patients. The 5-year was to analyze prognosis, recurrence rate, and survival recurrence rate is very high, 74% among 386 patients acafter liver transplantation in patients in whom the main cording to Makuuchi, 5 and 100% in Belghiti's series. 6 Other indication was HCC with cirrhosis. Thirty-eight patients authors have accepted orthotopic liver transplantation (OLT) in whom the main indication for liver transplantation as a treatment indication in patients with advanced tumors was HCC and hepatic cirrhosis were compared with 136 or with associated end-stage liver disease.7-11 Moreover, sevtransplantations because of cirrhosis without tumor, eral retrospective analyses have recently shown that OLT performed in our unit from January 1990 to December was more effective than liver resection for patients with HCC 1995. HCC arising in noncirrhotic livers and those inci-at early tumor stages. 7,8,10,11 However unfavorable results dently discovered after OLT were excluded from the compared with benign disease and a shortage of donor organs study. Chemoembolization using doxorubicin, lipiodol, have led to a restricted indication of liver transplantation for and Gelfoam was performed before OLT in 31 patients HCC.12-14 On the other hand, the absence of recurrence after with good liver function. There were no differences in transplantation for incidental HCC prompted us to look for gender, but HCC patients were older (57 { 7 vs. 50 { 10 favorable preoperative staging criteria for small HCC in ciryears [P õ .001]). Liver function was better in HCC rhosis with regard to OLT, 15 but there is no general agree-(Child-Pugh score: 6.9 { 2 vs. 8.6 { 1.8; P õ .001), and ment as to the selection of ideal candidates for OLT. [7][8][9][10][11][12]16 hepatitis C virus antibody was positive in 31 (82%) vs. 51The 5-year survival rate after liver resection for HCC is (37%) (P õ .007). Seven tumors had bilobar involvement very poor, ranging from 12% to 50% in both eastern and (18%). Capsule was presen...

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“…Lencioni et al [4] reported that iodizedoil CT findings enabled a confident diagnosis of intrahepatic metastatic nodules of HCC, describing small, rounded, circumscribed areas of iodized-oil retention obtained 3-4 weeks after intra-arterial injection that corresponded to true cancerous lesions in most instances. Although iodized-oil CT is the best modality for the detection of small HCC nodules, recent studies based on pathologic examination of explanted livers have shown low sensitivity in detecting HCC [5], especially in the detection of small HCC or satellite nodules, the detection rate being 44-52% [6,13]. This may be partly explained in cases with well-differentiated hypovascular HCC [14], in which there are not enough tumor vessels, because the factors responsible for retention of iodized oil are thought to be high vascularity of a tumor, inability of tumor vessel to contract, increased permeability of vascular wall, and sluggish blood flow [15].…”

Section: Discussionmentioning

confidence: 99%

Iodized oil retention due to postbiopsy arterioportal shunt: a false positive lesion in the investigation of hepatocellular carcinoma

Lim

Lee

et al. 1999

Abdominal Imaging

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Hepatocellular carcinoma: iodized-oil CT TNM classification.

Cited by 29 publications

References 29 publications

Influence of tumor characteristics on the outcome of liver transplantation among patients with liver cirrhosis and hepatocellular carcinoma

Influence of tumor characteristics on the outcome of liver transplantation among patients with liver cirrhosis and hepatocellular carcinoma

Survival after liver transplantation in cirrhotic patients with and without hepatocellular carcinoma: A comparative study

Iodized oil retention due to postbiopsy arterioportal shunt: a false positive lesion in the investigation of hepatocellular carcinoma

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