Optimal management of hepatocellular carcinoma: Challenges and opportunities

Kao, Jia‐Horng

doi:10.1111/j.1440-1746.2010.06373.x

Cited by 10 publications

(7 citation statements)

References 26 publications

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“…Hepatocellular carcinoma (HCC) is a malignant liver tumor with a substantial risk of recurrence, metastasis, and death, representing the third leading cause of cancer-related mortality worldwide [1,2]. In contrast, hepatocellular adenomas (HCAs) are benign liver tumors that are generally treated with simple resection because of the risk of rupture and associated HCC, but conservative management, such as observation, may be considered for small HCAs [3,4].…”

Section: Introductionmentioning

confidence: 99%

Atypical hepatocellular adenoma–like neoplasms with β-catenin activation show cytogenetic alterations similar to well-differentiated hepatocellular carcinomas

et al. 2013

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Summary The distinction of hepatocellular adenoma from well-differentiated hepatocellular carcinoma (HCC) arising in noncirrhotic liver can be challenging, particularly when tumors histologically resembling hepatocellular adenoma occur in unusual clinical settings such as in a man or an older woman or show focal atypical morphologic features. In this study, we examine the morphologic, immunohistochemical, and cytogenetic features of hepatocellular adenoma–like neoplasms occurring in men, women 50 years or older or younger than 15 years, and/or those with focal atypia (small cell change, pseudogland formation, and/or nuclear atypia), designated atypical hepatocellular neoplasms, where the distinction of hepatocellular adenoma versus HCC could not be clearly established. Immunohistochemistry was performed for β-catenin, glutamine synthetase, and serum amyloid A in 31 hepatocellular adenomas, 20 well-differentiated HCCs, and 40 atypical hepatocellular neoplasms. Chromosomal gains/losses had previously been determined in 37 cases using comparative genomic hybridization or fluorescence in situ hybridization. β-Catenin activation was observed in 35% of atypical hepatocellular neoplasms compared with 10% of typical hepatocellular adenomas (P < .05) and 55% of well-differentiated HCCs (P = .14). Cytogenetic changes typically observed in HCC were present in all atypical hepatocellular neoplasms with β-catenin activation. β-Catenin activation in atypical hepatocellular neoplasms was also associated with atypical morphologic features. Follow-up data were limited, but adverse outcome was observed in 2 atypical hepatocellular neoplasms with β-catenin activation (1 recurrence, 1 metastasis); transition to areas of HCC was observed in 1 case. The similarity in morphologic and cytogenetic features of β-catenin–activated hepatocellular adenoma–like tumors and HCC suggests that the former tumors represent an extremely well-differentiated variant of HCC. Published by Elsevier Inc.

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Section: Introductionmentioning

confidence: 99%

Atypical hepatocellular adenoma–like neoplasms with β-catenin activation show cytogenetic alterations similar to well-differentiated hepatocellular carcinomas

et al. 2013

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“…Fewer effective options are available for those with an advanced disease [6-9]. However as noted by Lin and Kao, the guidelines differ from one another and further research is needed to develop best practice guidelines for optimal management of HCC [10]. …”

Section: Introductionmentioning

confidence: 99%

Controlling liver cancer internationally: A qualitative study of clinicians' perceptions of current public policy needs

Bridges

Gallego

Blauvelt

2011

Health Res Policy Sys

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BackgroundLiver cancer is the fifth most common cancer in men and the seventh for women. Usually because of late diagnosis, the prognosis for liver cancer remains poor, resulting in liver cancer being the third most common cause of death from cancer. While some countries have treatment guidelines, little is known or understood about the strategies needed for liver cancer control internationally.ObjectiveTo explore leading liver cancer clinician's perceptions of the current public policy needs to control liver cancer internationally.MethodsKey informant interviews were conducted with a range of liver cancer clinicians involved in policy in eleven countries. Interviews were digitally recorded, transcribed verbatim, translated (where necessary), de-identified and analyzed by two researchers using a constant comparative method.ResultsTwenty in-depth semi-structured interviews were conducted in: Australia, China, France, Germany, Italy, Japan, Spain, South Korea, Taiwan, Turkey and the United States. Nine themes were identified and cluster into three groups: 1) Promoting prevention via early risk assessment, focusing on viral hepatitis and other lifestyle factors; 2) Increasing political, public and medical community awareness; and 3) Improving funding for screening, liver cancer surveillance and treatment.ConclusionThis study is an important step towards developing an evidence-based approach to assessing preparedness for implementing comprehensive liver cancer control strategies. Evaluation mechanisms to assess countries' performance on the needs described are needed. Future research will concentrate of understanding how these needs vary across countries and the optimal strategies to improve the diagnosis and prognosis of patients with liver cancer internationally.

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“…Overall, HCCs are the third leading cause of cancer-related mortality worldwide. 5,6 Distinguishing hepatic adenomas from HCCs can be difficult because some well-differentiated HCCs show overlapping morphologic findings with hepatic adenomas. In many biopsy specimens, with their more limited tissue, this distinction can be particularly challenging.…”

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confidence: 99%

Immunostains Used to Subtype Hepatic Adenomas Do Not Distinguish Hepatic Adenomas From Hepatocellular Carcinomas

Liu

Shah

Naini

et al. 2016

American Journal of Surgical Pathology

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Immunostains are used to subtype hepatic adenomas to stratify for the risk of malignant transformation. The most common panel of immunostains used for this purpose includes liver fatty acid-binding protein (LFABP), serum amyloid A (SAA) protein, C-reactive protein (CRP), and glutamine synthetase (GS). Importantly, some pathologists use these stains in an attempt to distinguish hepatocellular carcinomas (HCC) from hepatic adenomas. However, there are limited data on the performance of these stains in HCCs. To investigate the staining characteristics of HCCs, we studied 159 HCCs (92 well-differentiated, 67 moderately differentiated, and 7 poorly differentiated) and 7 fibrolamellar carcinomas for the expression of LFABP, SAA, CRP, and GS. All of the stains were positive in at least a subset of HCCs: SAA was positive in 27 of 159 (17%), CRP in 86 of 159 (54%), and GS in 23 of 47 (49%) cases; LFABP showed loss of staining in 36 of 159 (23%) cases. Fibrolamellar carcinomas were consistently CRP positive (7 of 7 cases) and frequently showed loss of LFABP (4 of 7 cases). There was no association between expression of SAA, CRP, and GS as well as loss of LFABP expression and other clinicopathologic features. HCCs with loss of LFABP were more frequently associated with negative GS expression (11 of 14 cases, P=0.02). These data show that immunostains used to subtype hepatic adenomas are not useful for distinguishing HCCs from hepatic adenomas and should be used only after a diagnosis of hepatic adenoma has been made using other criteria.

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Optimal management of hepatocellular carcinoma: Challenges and opportunities

Abstract: See article in J. Gastroenterol. Hepatol. 2010; 25: 1426–1434.

Cited by 10 publications

References 26 publications

Atypical hepatocellular adenoma–like neoplasms with β-catenin activation show cytogenetic alterations similar to well-differentiated hepatocellular carcinomas

Atypical hepatocellular adenoma–like neoplasms with β-catenin activation show cytogenetic alterations similar to well-differentiated hepatocellular carcinomas

Controlling liver cancer internationally: A qualitative study of clinicians' perceptions of current public policy needs

Immunostains Used to Subtype Hepatic Adenomas Do Not Distinguish Hepatic Adenomas From Hepatocellular Carcinomas

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