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[Background and Aims] The combination therapy of transarterial chemoembolization (TACE) plus sorafenib has been applied for unresectable hepatocellular carcinoma (HCC). However, its efficacy remains controversial, possibly due to the timing of the initiation of sorafenib treatment. We evaluated the efficacy of this combination therapy when sorafenib treatment was initiated soon after the patient recovered from the adverse events due to the initial TACE procedure. [Methods] This was a retrospective study at a single hospital. Twenty-three unresectable HCC cases who exceeded the up-to-seven criteria but who showed no major vascular invasion or extrahepatic metastasis were enrolled in this study. The patients were classified into two groups : Group C (n=7) received combination therapy ; Group T (n=16) received TACE as the sole therapy. The time-to-tumor progression (TTP) and overall survival (OS) of the two groups were compared. [Results] The median TTP in Groups C and T was 1,737 days and 422 days, respectively (p < 0.05). The median survival time (MST) after the initiation of each therapy in Groups C and T was 1,780 days and 371 days, respectively (p < 0.05). [Conclusion] The TTP and OS of patients with unresectable HCC who received TACE plus sorafenib (administered soon after the initial TACE procedure) were superior to those in patients who received TACE alone.

A 76-year-old man presented to another hospital with a two-day history of severe diarrhea andvomiting. A laboratory analysis revealed liver dysfunction. He was admitted to that hospital,but the laboratory data showed the exacerbation of patient’s liver dysfunction and renal dysfunction.He was therefore transferred to our hospital for multidisciplinary treatment. According topatient’s laboratory data and medical history, he was diagnosed with acute liver failure due tomushroom poisoning. This mushroom was identified as Galerina fasciculata. An investigationat the prefecture’s agricultural center revealed that the mushroom contained amatoxin.

Objective : Acoustic radiation force impulse (ARFI) technology can measure the elasticity of tissueand tumor. The aim of this study was to evaluate whether the ARFI technology can differentiatecavernous hemangioma, hepatocellular carcinoma (HCC) and metastatic liver tumors inpatients with liver dysfunction.Materials and Methods : Forty patients with liver dysfunction and liver tumors were enrolledin the study. The shear wave velocities (SWVs) in the tumors and background liver were examinedby ARFI elastography under ultrasonography (US).Results : The SWVs in livers bearing HCCs were significantly higher than those of livers bearingcavernous hemangiomas. The SWVs in HCCs and metastatic liver tumors were significantlyhigher than those in cavernous hemangiomas. The SWVs in metastatic liver tumors were significantlyhigher than those in HCCs. The SWV ratio of metastatic liver tumor/parenchyma wassignificantly higher than that of cavernous hemangioma/parenchyma and HCC/parenchyma.There was a significant correlation between the tumor sizes and the SWVs in metastaticliver tumors.Conclusions : We herein demonstrated that ARFI elastography could noninvasively provide helpfulinformation, without the need for biopsy, that could be used for the differential diagnosis amongcavernous hemangiomas, HCCs and metastatic liver tumors in patients with liver dysfunction.

Aim : To evaluate the usefulness of acoustic radiation force impulse (ARFI) in predicting hepatocellularcarcinoma (HCC) in patients with chronic hepatic disease (CHD).Methods : A total of 230 patients participated in this study. They were subsequently classifiedinto the “HCC group” and the “non-HCC group”. We measured their liver stiffness and calculatedthe mean shear wave velocity (SWV) using ARFI.Results : The mean SWV was significantly higher in the HCC group than in the non-HCCgroup. The cut-off value for the mean SWV with the best discrimination between the two groupswas 1.36 (m/s). The area under the receiver operating characteristic curve (AUROC) was0.807. The AUROCs of the aspartate-aminotransferase-to-platelet ratio and Fibrosis 4 scorewere 0.780, 0.728, respectively. The independent risk factors of HCC included the mean SWVand age. A further analysis, based on the individual causes of CHD, found that among the HCVand non-HBV and non-HCV (nBnC) cases, the mean SWV was significantly higher in the HCCgroup than in the non-HCC group.Conclusion : Measuring the SWV using ARFI was a reliable method for predicting HCC in CHDpatients, especially in HCV and nBnC patients.