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HCC : PE-075 ; Clinical courses of primary hepatic angiosarcoma
( Yoo Jin Lee ),( Woo Jin Chung ),( Yu Jin Hah ),( Hyung Ki Lee ),( Ho Young Lee ),( Jae Seok Hwang ),( Byoung Kuk Jang ),( Kyung Sik Park ),( Kwang Bum Cho ),( Eun Soo Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background/Aim: Angiosarcoma is a rare and aggressive liver malignancy originated from endothelial cells. Due to non specific symptoms and signs, it is difficult to diagnose at the early stage, radiologic findings of hepatic angiosarcoma are non specific, and it is not easy to differentiate with hemangioma or other liver malignancy. We reviewed the clinical courses of hepatic angiosarcoma those histologically confirmed. Patients and Methods: Patients who have been diagnosed at Keimyung University Dongsan Hospital between 2001 and 2011 were enrolled. we retrospectively reviewed the pattern of disease detection, the sites of metastasis , treatment responses, and prognosis. Results: 1.8 patients were histologically confirmed as primary hepatic angiosarcoma. Mean age was 66.3 year-old (41-80 yo). 4 patients were male. All patients’ serum HBsAg and anti-HCV were negative and five patients were heavy alcoholics. 2. Only two patients (25%) were diagnosed by radiology findings, and then definitive diagnosis was made on the basis of percutaneous needle biopsy in seven (87.5%) and operation in one (12.5%). 3. At initial disgnosis, extrahepatic metastasis were detected in three patients (37.5%), and metastatic site were spleen and lung (n=1), pericardium (n=1), and bone (n=1). 4. Three patients (37.5%) received conservative treatment only, one (12.5%) under went surgical resection and four (50%) received chemotherap. Median survival time in treatment group were 427days and only 36days in conservative group (p value = 0.022). Conclusion: Only few patients of hepatic angiosarcoma can be diagnosed by radiologic findings, we have to actively consider liver biopsy to confirm. More than one third of patients already had metastatic lesion at initial diagnosis, and the clinical courses were very poor. So, we have to consider aggressive treatment for better survival.
( Yoo Jin Lee ),( Woo Jin Chung ),( Yu Jin Hah ),( Hyung Ki Lee ),( Ho Young Lee ),( Jae Seok Hwang ),( Byung Kuk Jang ),( Kyung Sik Park ),( Kwang Bum Cho ),( Eun Soo Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background/Aim: Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been undergone for control of gastric variceal bleeding. But, TIPS has some limitations as hepatic encephalopathy or shunt occlusion, etc. Balloon Occluded Retrograde Transvenous Obliteration (BRTO) also has been undergone for these patients. So, we compared the effectiveness and safety of TIPS and BRTO for control of gastric variceal bleeding. Methods: Between January 2003 and February 2012, TIPS or BRTO have been undergone for gastric variceal bleeding. All patients had patent portal veins on preprocedural computed tomography. The patient who failed BRTO underwent TIPS for rescue therapy. Data regarding technical success, rebleeding, hepatic encephalopathy and survival were analyzed by Chisquare test and Kaplan-Meier method with Log-rank test. Results: 1. Among 100 patients, 32 patients underwent TIPS and 68 underwent BRTO. Technical success was achieved in 96.9% (31/32) in TIPS group and 86.8% (59/68) in BRTO group. There was no statistical difference of age, sex distribution, and Child-Pugh class in each group. 2. Early rebleeding within 5 days after procedure were 18.8% (6/32), 4.4%(3/68) (p=0.019) and late rebleeding after 5 days were 18.8% (6/32), 1.5% (1/68) in each group (p=0.002). 3. Hepatic encephalopathy was developed or aggravated in 53.1% (17/32), 4.4%(3/68) (p<0.001). 4. After procedure, Child-Pugh class was aggravated in 50% (16/32) and 19.1% (13/68) (p=0.004). 5. The survival time were 45.4 in TIPS and 62.3 months in BRTO group (p=0.04). 6. Procedure related complications did not have statistical difference in each group. Conclusion: BRTO can more effectively control of gastric variceal bleeding with less worsening of Child-Pugh class, hepatic encephalopathy, relatively decreased rebleeding rate and longer survival period than TIPS. So, if the patients who have ceased gastric variceal bleeding in the presence of gastrorenal shunt, BRTO may be considered as initial therapeutic procedure for control of gastric variceal bleeding.
HCC : PE-075 ; Clinical courses of primary hepatic angiosarcoma
( Yoo Jin Lee ),( Woo Jin Chung ),( Yu Jin Hah ),( Hyung Ki Lee ),( Ho Young Lee ),( Jae Seok Hwang ),( Byoung Kuk Jang ),( Kyung Sik Park ),( Kwang Bum Cho ),( Eun Soo Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Background/Aim: Angiosarcoma is a rare and aggressive liver malignancy originated from endothelial cells. Due to non specific symptoms and signs, it is difficult to diagnose at the early stage, radiologic findings of hepatic angiosarcoma are non specific, and it is not easy to differentiate with hemangioma or other liver malignancy. We reviewed the clinical courses of hepatic angiosarcoma those histologically confirmed. Patients and Methods: Patients who have been diagnosed at Keimyung University Dongsan Hospital between 2001 and 2011 were enrolled. we retrospectively reviewed the pattern of disease detection, the sites of metastasis , treatment responses, and prognosis. Results: 1.8 patients were histologically confirmed as primary hepatic angiosarcoma. Mean age was 66.3 year-old (41-80 yo). 4 patients were male. All patients` serum HBsAg and anti-HCV were negative and five patients were heavy alcoholics. 2. Only two patients (25%) were diagnosed by radiology findings, and then definitive diagnosis was made on the basis of percutaneous needle biopsy in seven (87.5%) and operation in one (12.5%). 3. At initial disgnosis, extrahepatic metastasis were detected in three patients (37.5%), and metastatic site were spleen and lung (n=1), pericardium (n=1), and bone (n=1). 4. Three patients (37.5%) received conservative treatment only, one (12.5%) under- went surgical resection and four (50%) received chemotherap. Median survival time in treatment group were 427days and only 36days in conservative group (p value = 0.022). Conclusion: Only few patients of hepatic angiosarcoma can be diagnosed by radiologic findings, we have to actively consider liver biopsy to confirm. More than one third of patients already had metastatic lesion at initial diagnosis, and the clinical courses were very poor. So, we have to consider aggressive treatment for better survival.
( Yoo Jin Lee ),( Woo Jin Chung ),( Yu Jin Hah ),( Hyung Ki Lee ),( Ho Young Lee ),( Jae Seok Hwang ),( Byung Kuk Jang ),( Kyung Sik Park ),( Kwang Bum Cho ),( Eun Soo Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Background/Aim: Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been undergone for control of gastric variceal bleeding. But, TIPS has some limitations as hepatic encephalopathy or shunt occlusion, etc. Balloon Occluded Retrograde Transvenous Obliteration (BRTO) also has been undergone for these patients. So, we compared the effectiveness and safety of TIPS and BRTO for control of gastric variceal bleeding. Methods: Between January 2003 and February 2012, TIPS or BRTO have been undergone for gastric variceal bleeding. All patients had patent portal veins on preprocedural computed tomography. The patient who failed BRTO underwent TIPS for rescue therapy. Data regarding technical success, rebleeding, hepatic encephalopathy and survival were analyzed by Chisquare test and Kaplan-Meier method with Log-rank test. Results: 1. Among 100 patients, 32 patients underwent TIPS and 68 underwent BRTO. Technical success was achieved in 96.9% (31/32) in TIPS group and 86.8% (59/68) in BRTO group. There was no statistical difference of age, sex distribution, and Child-Pugh class in each group. 2. Early rebleeding within 5 days after procedure were 18.8% (6/32), 4.4%(3/68) (p=0.019) and late rebleeding after 5 days were 18.8% (6/32), 1.5% (1/68) in each group (p=0.002). 3. Hepatic encephalopathy was developed or aggravated in 53.1% (17/32), 4.4%(3/68) (p<0.001). 4. After procedure, Child-Pugh class was aggravated in 50% (16/32) and 19.1% (13/68) (p=0.004). 5. The survival time were 45.4 in TIPS and 62.3 months in BRTO group (p=0.04). 6. Procedure related complications did not have statistical difference in each group. Conclusion: BRTO can more effectively control of gastric variceal bleeding with less worsening of Child-Pugh class, hepatic encephalopathy, relatively decreased rebleeding rate and longer survival period than TIPS. So, if the patients who have ceased gastric variceal bleeding in the presence of gastrorenal shunt, BRTO may be considered as initial therapeutic procedure for control of gastric variceal bleeding.
( Yu Jin Lim ),( Hong Gyun Wu ),( J Hun Hah ),( Myung Whun Sung ),( Kwang Hyun Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Both radiotherapy (RT) and primary surgery are treatment options in early-stage oral cavity squamous cell carcinoma (OC-SCC). This study evaluated the impact of local treatment modalities and pathologic features on patients` survival in cT1-2N0 OC-SCC. Methods: We reviewed the 167 patients with biopsy-proven cT1-T2N0 OC-SCC patients who underwent defi nitive radiotherapy (RT) (n = 33) or surgery ± postoperative RT (PORT) (n = 134) from 1990 to 2012. Cervical lymph node dissection (LND) was performed in 75 (56%) patients, and 25 (19%) patients underwent PORT. The median radiation dose for defi nitive RT and PORT were 70 Gy (range, 50.4-71.4) and 65.4 Gy (range, 50.4-67.5), respectively. Results: The median follow-up duration was 45.3 months (range, 4.4-262.4). The 5-year rates of cause-specifi c survival (CSS) in defi nitive RT and surgery were 53.8% and 85.5% (P < 0.001), respectively. The major treatment failure after defi nitive RT was local recurrence (n = 11 in 33). Defi nitive RT resulted in worse 5-year local control rate than that of surgery (29.1% vs. 84.7%, P < 0.001), and the causes of defi nitive RT (with or without medical fragility) did not impact on local control (P = 0.235). In the patients treated with surgery alone without occult lymph node metastasis (n = 106), multivariate analyses identifi ed moderately/poorly-differentiated grade and lymphatic invasion (LI) as prognostic predictors in CSS and relapse-free survival (RFS). The presence of both higher tumor grade and LI showed worse CSS and RFS compared to other patients without any of the risk factors (P < 0.001 for both). Conclusions: Defi nitive RT in cT1-2N0 OC-SCC obtained a lower cure rate compared to primary surgery group. The subgroup analyses of the low-risk patients with surgical resection alone identifi ed a high-risk group who may benefi t from PORT.