Hepatocellular Carcinoma in Hong Kong: Clinical Study on 340 Cases

Shiu, W.; Dewar, G.; Leung, Nancy; Leung, WK; Chan, Miu Shan; Tao, Meimei; Lui, Collin M.M.; Chan, Chi-Chung; Lau, W. Y.; Metreweli, C.

doi:10.1159/000226823

Cited by 53 publications

(28 citation statements)

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“…Patients with hepatocellular carcinoma were excluded from the present study for two reasons. First, patients with inoperable hepatocellular carcinoma, in general, have a very poor prognosis with a median survival of only 8 weeks [Shui et al, 1990], and hence it would be difficult to estimate the possible impact of HBV reactivation per se in the morbidity and mortality of these patients. Second, 85% of the patients with hepatocellular carcinoma are HBsAg positive [Shui et al, 1990], and this figure would have biased the HBsAg positive rate in a general cancer population.…”

Section: Methodsmentioning

confidence: 99%

Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy: A prospective study of 626 patients with identification of risk factors

et al. 2000

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Hepatitis B virus (HBV) reactivation is a well-described complication in cancer patients who receive cytotoxic chemotherapy and may result in varying degrees of liver damage. As chemotherapy is used increasingly in cancer patients, HBV reactivation during cytotoxic treatment may become a more common problem. In lymphoma patients, the incidence of chronic HBV infection has been reported to be 26%, of whom 47% developed HBV reactivation during chemotherapy. However, corresponding data for patients with other malignancies undergoing cytotoxic chemotherapy are not known. In this prospective study, hepatitis B surface antigen (HBsAg) was determined in 626 consecutive cancer patients who received cytotoxic chemotherapy over a 12-month period. Seventy-eight patients (12%) were found to be HBsAg positive. Thirty-four (44%) developed raised alanine transaminase during their course of chemotherapy. In these 34 patients, hepatitis was attributed to HBV reactivation in 15 patients (44%), chronic active HBV infection in 1 patient (3%), hepatitis C infection in 1 patient (3%), malignant hepatic infiltration in 2 patients (6%), and the use of hepatotoxic chemotherapeutic agents in 11 patients (32%). The causes of hepatitis were unknown in 4 patients (12%). HBV reactivation was more likely to develop in patients who were male, younger age, HBeAg seropositive, and those with lymphoma. Presence of malignant hepatic infiltration, baseline pre-treatment alanine transaminase, total bilirubin, and HBV DNA levels did not correlate with the development of HBV reactivation. Of the 15 patients who developed HBV reactivation, antiviral therapy with lamivudine was available and used in 9. There was no HBV-related mortality during chemotherapy. It is concluded that in patients with chronic HBV infection under chemotherapy, HBV reactivation occurs in nearly 20% of them and accounts for 44% of hepatitis cases. The risk factors identified include male sex, younger age, HBeAg seropositive, and the diagnosis of lymphoma. In HBV endemic areas, patients with risk factors for HBV reactivation should be identified prior to receiving cytotoxic treatment and monitored closely. The potential benefit of lamivudine requires further confirmation.

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Section: Methodsmentioning

confidence: 99%

Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy: A prospective study of 626 patients with identification of risk factors

et al. 2000

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“…In Hong Kong the annual incidence rate is about 40 per 100 000 in men, and in our Joint Hepatoma Clinic we see between 5 and 15 new cases each week. The median survival is less than 3 months with very few patients surviving more than 1 year (Shiu et al, 1990). Surgical resection offers the only hope of long-term survival, but is an option for less than 10% of cases.…”

mentioning

confidence: 99%

Isoelectric focusing of alphafetoprotein in patients with hepatocellular carcinoma-frequency of specific banding patterns at non-diagnostic serum levels

Cheng²,

Yuen³

et al. 1996

Br J Cancer

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Summary Serum levels of alphafetoprotein are raised in 60-80% of patients with hepatocellular carcinoma. Although widely used as a serum marker, frequent false-positive results in patients with benign liver disease, result in poor specificity. This occurs particularly when levels of alphafetoprotein fall between 50-500 ng ml ', the so-called 'grey area'. Recent reports suggest that isoelectric focusing of alphafetoprotein demonstrates certain bands that are more specific for hepatocellular carcinoma. Our aim was to determine whether the apparent specificity of this new approach is gained at the expense of decreased sensitivity. Sera from 110 patients with a 'non-diagnostic' serum alphafetoprotein level (50 -500 ng ml-') were examined by isoelectric focusing and quantified by densitometric scanning. Ten patients with chronic liver disease and a raised serum alphafetoprotein level (50-500 ng ml-'), but with no evidence of hepatocellular carcinoma, were also studied.Isoelectric focusing revealed characteristic hepatocellular carcinoma bands (bands +II and +III) in 96% patients overall, and 100% of those with levels of total alphafetoprotein greater than 100 ng ml -'. No such bands were seen among ten subjects with cirrhosis but without hepatocellular carcinoma. Bands that are characteristic of hepatocellular carcinoma (bands + II or + III) are seen in the great majority of hepatocellular carcinoma patients; their absence makes a diagnosis of hepatocellular carcinoma extremely unlikely.

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“…The triad of abdominal pain in the right upper quadrant, weight loss, and the presence of a hepatic mass constitutes the most common mode of presentation [14][15][16].…”

Section: Clinical Presentationsmentioning

confidence: 99%