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Background. Concanavalin A (Con A) affinity electrophoresis of serum [alpha]-fetoprotein (AFP) can distinguish hepatocellular carcinoma (HCC) from other malignancies when the serum AFP concentration is elevated. However, Con A has not been able to distinguish HCC from benign chronic liver disease such as cirrhosis or chronic hepatitis. Methods. The Con A affinity electrophoresis of serum AFP was analyzed in patients with a serum AFP concentration greater than 50 ng/mL by antibody affinity electrophoresis and Western blotting in an attempt to distinguish hepatocellular carcinoma from benign chronic liver disease. Before the assay, the serum AFP concentrations were adjusted between 100 ng/ml and 300 ng/ml by concentrating or diluting the samples. Results. Of 180 patients with HCC,44 (24%) had a single band and 91 (51%),35 (19%), and 10 (6%) had 2,3, and 4 bands, respectively. Al135 patients with chronic hepatitis had a single band. All but 1 of 72 patients with cirrhosis had a single band. Multiple AFP bands on Con A affinity electrophoresis appear to be diagnostic of HCC. This method has a sensitivity of 76%, a specificity of 99%, a positive predictive value of 99%, and a negative predictive value of 71% for detecting HCC. The number of AFP bands correlated with serum AFP concentration and tumor size in patients with HCC. Conclusions. This assay is useful for distinguishing HCC from benign chronic liver diseases. Cancer 1995; 76: 1139-44

Background Des-gamma-carboxyprothrombin (DCP) is a useful tumor marker for hepatocellular carcinoma (HCC). The present method for measurement of DCP concentration, however, does not have adequate sensitivity to detect small HCCs. Methods. The serum DCP concentration was investigated by the avidin-biotin complex (ABC) method in patients with an HCC smaller than 20 mm in maximum dimension. A serum DCP concentration greater than 4.0 arbitrary units per liter using the ABC method was considered abnormal. Results. Of 115 patients with small HCC, 45 (39.1%) had an abnormal DCP concentration. Ten of 141 patients with chronic hepatitis (7.1%), 18 of 115 (15.7%) with cirrhosis, and 0 of 30 normal control patients had abnormal DCP concentrations. This method yielded a sensitivity of 39.1%, a specificity of 89.1%, a positive predictive value of 61.6%, and a negative predictive value of 76.5% for detection of small HCC. The detectability of HCC increased to 56.5% when alpha-fetoprotein (AFP) was was measured (> 40 ng/ml). Abnormal DCP concentrations were seen in 8 of 34 (23.5%), 24 of 42 (57.1%), and 5 of 7 (71.4%) patients with Edmondson's Grade I, II, and III tumors, respectively. There was a significant relationship between DCP concentrations and histologic grade (P = 0.0017), but there was no association between DCP concentration and other patient characteristics. Elevation of serum AFP concentrations in patients with hepatitis B surface antigen positivity, however, was more frequent than that in patients who were antihepatitis C virus (HCV) positive. Therefore, the measurement of serum DCP concentrations may be more useful than that of serum AFP concentrations in patients with anti-HCV positivity. Conclusions. The measurement of serum DCP concentrations by the ABC method is a useful diagnostic tool for the monitoring of small HCC. Cancer 1994;74: 2918-23.

Methods. Eighty-three patients with hepatocellular carcinoma (HCC) were treated with curative surgical resection during the past 8 years. Results. No operative deaths occurred. The cumulative recurrence rates after resection at the ends of years 1, 2, and 3 were 37.0%, 57.1%, and 71.6%, respectively. After adjusting the imbalance in clinical factors among patients by using a Cox proportional-hazards model, it was shown that multiplicity, histologic classification, and absence of antibody to hepatitis C virus were associated significantly with recurrence after resection. The size of the tumor did not affect the incidence of recurrence. Thirty-eight of 41 patients with intrahepatic tumor recurrence had undergone at least one of the following three therapies against HCC: surgical reresection, percutaneous ethanol injection (PEI), and transcatheter arterial embolization (TAE). The most significant factor affecting the survival time of patients with tumor recurrence was the total number of tumor nodules at the time of recurrence. Although surgery and PEI were thought to be more effective treatments than TAE in prolonging life, multivariate analysis showed that they were not significant factors of survival time because choices in the method of treatment were correlated closely with the number of cancer nodules. A 65.3% 5-year survival rate from the time of first surgery was accomplished through vigorous therapy when tumors recurred. Conclusion. In conclusion, despite the high recurrence rate after resection of HCC, the use of multiple therapies can achieve increased survival rates. Cancer 1993; 71:19-25.

Hepatocellular carcinoma is a form of liver cancer; it is more common in Asian nations than it is in the United States, and is often associated with liver cirrhosis. When the cancer exists as only one cluster of cancerous cells, surgery may be a practical treatment. However, in many cases, there are already many clusters of cancer cells sprinkled throughout the liver by the time that the disease is first discovered. In more than 80 percent of all cases, surgery is thus impractical. An alternative form of treatment may be transcatheter arterial embolization. In this technique, tiny gelatin sponge particles are injected into an artery of the liver; these particles then clog smaller arteries, temporarily occluding the flow of blood. In some cases, significant cell death in the starved tumor masses is the result. Often, however, a single such treatment fails to produce the desired effect. Some specialists have suggested that the procedure may be repeated. A study was conducted in which the transcatheter arterial embolization was repeated again and again if an acceptable response was not obtained. This study, conducted on 142 patients with hepatocellular carcinoma, found that many patients who did not achieve complete necrosis (death of cells) within their tumor on the first treatment did so on subsequent treatments. Only 12 percent of patients achieved complete necrosis on first treatment, but 27.5 percent achieved complete necrosis with repeated treatment. Some patients received as many as 15 treatments. The survival rates for the patients in this study were 76.5, 54.5, and 41.1 percent at the end of one, two, and three years, respectively. Statistical analysis revealed that successful complete necrosis was an important determinant of survival. Analysis also revealed, however, that patients with larger cancers, patients with cirrhosis, and patients whose cancer had invaded the portal vein had worse survival rates. It should be mentioned, however, that while transcatheter arterial embolization may result in increased survival, the technique should be considered as a palliative, and that the treatment cannot be expected to result in long-term survival or cure. (Consumer Summary produced by Reliance Medical Information, Inc.)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2010.05.013 Byline: Yusuke Kawamura, Yasuji Arase, Kenji Ikeda, Miharu Hirakawa, Tetsuya Hosaka, Masahiro Kobayashi, Satoshi Saitoh, Hiromi Yatsuji, Hitomi Sezaki, Norio Akuta, Fumitaka Suzuki, Yoshiyuki Suzuki, Hiromitsu Kumada Keywords: Diabetes; Hepatocellular carcinoma; Interferon; Sustained virologic response Abstract: This retrospective cohort study assessed the impact of diabetes mellitus on hepatocarcinogenesis and determined the predictors of hepatocarcinogenesis in noncirrhotic, interferon-treated patients with hepatitis C virus infection. Author Affiliation: Department of Hepatology, Toranomon Hospital, Tokyo, Japan Article Note: (footnote) Funding: Okinaka Memorial Institute for Medical Research and Japanese Ministry of Health, Labour and Welfare., Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript., Authorship: All authors had access to the data and played a role in writing this manuscript.