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Background/aims: It is not known whether the putative etiologic factors and clinical and pathological features of hepatocellular carcinoma differ between young adults and older patients. Therefore this study aims to evaluate whether the clinicopathological features in young patients with HCC significantly differ from those of elderly patients., Methodology: A total of 1014 consecutive patients with HCC were divided into two groups based on age. Among them, 73 patients younger than 50 years of age comprised the first group and 941 patients 50 years and older made up the second. Clinical, laboratory, and pathological characteristics were compared between the two age groups., Results: The male: female ratio and the incidence of positive hepatitis B surface antigen were significantly higher in young patients than in elderly patients. Tumor size, pathological grading of the tumor, and the severity of liver disease did not differ between the two groups. Especially in those patients demonstrating positive antibody to hepatitis C virus, alanine aminotransferase was higher in the younger, and platelet count was lower. Younger patients also had a higher ratio of alcohol consumption compared to elderly patients., Conclusions: There were age-related differences in the clinicopathological characteristics of HCC patients. Concerning hepatocarcinogenesis, male and HBsAg positive patients were at high risk in young. Of the HCV-related HCC patients, heavy drinking may accelerate the progression from chronic hepatitis to cirrhosis and HCC.

Background/aims: We investigated the clinical factors predisposing moderately or poorly differentiated hepatocellular carcinoma and analyzed which clinical and histological factors are associated with poorly differentiated hepatocellular carcinoma (HCC) recurrence., Methodology: Percutaneous fine-needle biopsy was taken from the liver tumor of 191 consecutive patients between January 1994 and September 1996. The histological degree of differentiation of hepatocellular carcinoma at the first time of initial treatment and at the time of second recurrence was classified according to the criteria of Edmondson and Steiner., Results: At the time of the first therapy, 86 patients, 81, 24, and 0 patients had liver tumors classified as Edmondson (Ed), 1, 2, 3, and 4, respectively. The prognosis of patients with Ed-3/4 HCC was worse than and the tumor sizes were larger than that of Ed-1/2 HCC patients. Of the 167 patients classified as Ed-1/2 at the time of first therapy, HCC recurred in 95 of the patients during the mean follow-up period of 3.4 years. Multivariate analysis revealed that only tumor size (P=0.035) and TACE therapy (P=0.0009) were independently significant factors in predicting future Ed-3/4 or multiple HCC recurrence., Conclusions: Tumor size and TACE therapy were clinical predisposing factors for Ed-3/4 or multiple HCC recurrences.

Background/aims: To assess clinical usefulness of three-dimensional power Doppler ultrasonography for the diagnosis of hepatocellular carcinoma., Methodology: Fifty-two hepatocellular carcinoma nodules (median 31mm in diameter, range 8 to 94), histologically proven afterwards, in 33 patients were examined by three-dimensional power Doppler ultrasonography (ATL-HDI 5000 with a 5-MHz convex transducer) for tumor vascularity. We classified tumor Doppler signals into four types; Type 1: spotty signals in the tumor, Type 2: signals surrounding the tumor, Type 3: Type 3 with visualized penetrating arteries, Type 4: Type 3 with visualized drainage vein. Types 2-4 were considered specific to hepatocellular carcinoma, and compared with findings on digital subtraction angiography., Results: Definite diagnosis of hepatocellular carcinoma was obtained in 29 of 52 nodules (56%) with three-dimensional ultrasonography (5 with Type 2, 19 with Type 3, and 5 with Type 4) while all nodules revealed tumor stain on angiography. 23 nodules showed only Type 1 signals, which were not specific to hepatocellular carcinoma. These nodules included small nodules less than 2cm in diameter, located more than 5cm from body surface, and those in the subphrenic portion of the left lobe., Conclusions: Three-dimensional power Doppler ultrasonography provides definite diagnosis of hepatocellular carcinoma in a real-time, non-invasive manner under certain conditions.

Background/aims: Hepatocellular carcinoma with portal venous invasion has a very poor prognosis. The aim of this study is to clarify the factors contributing to the survival of hepatocellular carcinoma patients with portal venous invasion., Methodology: Out of 952 patients with hepatocellular carcinoma admitted to Tokyo University hospital and its affiliated hospitals from 1987 to 1999, 53 patients developed portal venous invasion until December 2000. The main portal vein was invaded in 33 patients, and the first branch was invaded in the 20 patients. The factors contributing to the prognosis of hepatocellular carcinoma patients with portal venous invasion were determined by univariate and multivariate analyses using 19 clinicopathological parameters., Results: Overall survival rates of the 53 patients at 6 months, and 1 and 2 years were 40%, 18%, and 12%, respectively. Univariate analysis indicated that the serum albumin level, Child classification, number of tumor foci, portal venous invasion-targeted irradiation, and percutaneous tumor ablation of the parenchymal main tumor were significant. Multivariate analysis showed that percutaneous tumor ablation (P = 0.033; risk ratio = 0.28) was the most important factor contributing to a favorable prognosis followed by number of tumor foci (P = 0.048; risk ratio = 0.41)., Conclusions: This study showed the significance of treatment for the parenchymal main tumor in addition to portal venous invasion in patients with hepatocellular carcinoma involving portal venous invasion. Therefore, the efficacy of combined therapy using portal venous invasion-targeted irradiation and percutaneous tumor ablation for the parenchymal main tumor on survival of hepatocellular carcinoma patients with portal venous invasion is suggested.

Background/aims: The aim of this study is to clarify the clinical features of hepatocellular carcinoma that are negative for both hepatitis B surface antigen and anti-hepatitis C antibody., Methodology: Patients were classified according to viral markers: 45 patients (82%) had hepatitis B (B-HCC), 467 patients (82%) had hepatitis C (C-HCC), and 53 patients (9%) had neither hepatitis B nor hepatitis C (NBNC-HCC). Differences in clinical parameters among these three groups were analyzed., Results: Patients with NBNC-HCC were older than B-HCC and C-HCC patients. The incidence of alcoholism in NBNC-HCC patients was higher than in C-HCC patients. Patients with NBNC-HCC had similar rates of positive antibody to hepatitis B core antigen as did patients with C-HCC. NBNC-HCC patients were further classified according to median age. The younger group showed a greater tendency towards alcoholism than did the aged group. Liver functioning in the younger group was worse than in the older group. The older group had larger tumors than the younger group., Conclusions: The livers of younger NBNC-HCC patients were more cirrhotic, possibly because of alcoholism. Older NBNC-HCC patients presented with larger tumors, possibly because they did not receive regular medical check-ups due to their relatively preserved liver function.

Background/aims: This study aimed to clarify the relation of hepatic volumetry to adverse events after percutaneous transhepatic ablation for hepatocellular carcinoma., Methodology: One hundred and forty-nine patients with hepatocellular carcinoma who underwent percutaneous ablation sessions with complete ablation of cancer nodules, underwent volume measurement of the entire liver, tumor, and ablated area using computed tomography. The parenchymal ablation rate was calculated: (ablated volume-tumor volume)/(entire liver volume-tumor volume) x 100 (%). Other clinical parameters were also analyzed to determine their relationship to adverse events., Results: The median adjusted liver volume was 591 mL/body surface area (m2) (range: 300 to 1197 mL/m2). The median parenchymal ablation rate was 2.3% (range: 0.2% to 20.2%). Adverse events were observed in 17 patients after percutaneous ablation: liver abscess in 3, hepatic infarction in 3, portal vein thrombus in 3, hemobilia in 1, pleural effusion and/or ascites in 6, and gastric ulcer in 1. Multivariate analysis showed that Child B or C (P = 0.0009), adjusted liver volume < 600 mL/m2 (P = 0.0004), and parenchymal ablation rate > 5% (P = 0.0320) were independent risk factors for adverse events., Conclusions: Measurement of liver volume and parenchymal ablation rate are useful to predict the presence of percutaneous ablation-related adverse events.