http://repub.eur.nl/res/aut/20005/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/39902/ 2013-04-01T00:00:00Z Background: Hepatocellular carcinoma (HCC) may be diagnosed in the absence of cirrhosis. However, little is known about prognostic factors for the survival of HCC patients with a non-cirrhotic liver in the absence of well-established risk factors. Method: Survival rates and risk factors for survival and recurrence were analysed in all patients diagnosed between 2000 and 2010 with HCC in a non-cirrhotic liver and in the absence of well-established risk factors. Results: Ninety-four patients were analysed. Treatment with curative intent consisted of surgical resection in 43 patients (46%) and radiofrequency ablation in 4 patients (4%). In patients treated with curative intent and alive 30 days after treatment (n = 40), 1-and 5-year overall survival rates were 95 and 51%, respectively. Patients with a high preoperative α-fetoprotein (AFP) serum level, the presence of microvascular invasion in the resected specimen, a complicated postoperative course and a major resection, due to a greater tumour volume, had a significantly worse outcome and a higher recurrence rate. In multivariate analysis, a high AFP serum level at presentation was significantly associated with recurrence and a worse survival. Conclusion: HCC presenting in a non-cirrhotic liver in the absence of well-established risk factors has a poor prognosis. Increased AFP serum levels are significantly associated with clinical outcome. http://repub.eur.nl/res/pub/39738/ 2013-01-01T00:00:00Z Purpose: Early detection of hepatocellular carcinoma (HCC) is essential for improved prognosis and long-term survival. To date, screening for HCC depends on serological testing (alpha-fetoprotein, AFP) and imaging (ultrasonography), both of which are not highly sensitive. A meta-analysis was performed to discuss recent developments in biomarkers that may be effective in screening for HCC. Methods: A systematic search of PubMed, Embase, and Web of Science was performed for articles published between January 2005 and October 2010, and focusing on biomarkers for HCC in urine, serum, or saliva. Data on sensitivity and specificity of tests were extracted from each included article and displayed with a summary ROC. A meta-analysis was carried out in which the area under the curve for each biomarker was used to compare the accuracy of different tests. Results: In seven well-defined studies, three biomarkers were identified for potential use, namely, Golgi protein 73 (GP73), interleukin-6 (IL-6), and squamous cell carcinoma antigen (SCCA). Comparison with AFP showed that GP73 was superior (p = 0.006; 95 % CL -0.23, -0.12), IL-6 was similar (p = 0.66; 95 % CL -0.31, 0.25), and SCCA was inferior to AFP (p = 0.001; 95 % CL 0.12, 0.23). Conclusion: GP73 is a valuable serum marker that seems to be superior to AFP and can be useful in the diagnosis and screening of HCC. Although GP73 may improve the detection and treatment of one of the most common malignancies worldwide, additional research is required. http://repub.eur.nl/res/pub/37455/ 2012-11-01T00:00:00Z http://repub.eur.nl/res/pub/37371/ 2012-10-10T00:00:00Z Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer mortality. HCC is one of the few cancers with well-defined major risk factors. Worldwide, in 80% of the cases HCC develops in cirrhotic livers, and cirrhosis is the strongest predisposing factor. The incidence is high in Asia and parts of Africa. Geographical differences in incidence reflect variations of the main causal factors such as hepatitis B virus infection (HBV) which is common in Asia and Africa. HBV infection leads to the development of HCC through direct and indirect pathways. Being an oncogenic virus, it can cause HCC in the absence of cirrhosis, as it has the ability to integrate into the host genome affecting cellular signalling and growth control. Another unique feature of HCC is that it is a vaccine preventable disease. Implementation of a nationwide HBV vaccination programme for newborns in Taiwan has convincingly demonstrated a drop in the incidence of HCC in the years thereafter. In Japan, Europe, and the United States about 60% of the patients with HCC are attributed to chronic hepatitis C virus (HCV) infection, 20% are attributed to chronic HBV infection and about 20% are equally divided between cryptogenic and alcoholic liver disease. Hepatitis C as an infection transmitted by blood or plasma products before 1990 and is an important factor in the development of HCC in western countries. HCV causes HCC mainly through indirect pathways: chronic inflammation, cell deaths, and regeneration. In the pathogenesis the concurrent presence of the use of alcohol, the presence of diabetes and overweight play also an important role as a co-factor in HCV infection. http://repub.eur.nl/res/pub/34743/ 2012-01-01T00:00:00Z During recent years, there was a great development in the area of hepatocellular adenomas (HCA), especially regarding the pathological subtype classification, radiological imaging and management during pregnancy. This review discusses the current knowledge about diagnosis and treatment modalities of HCA and proposes a decision-making model for HCA. A Medline search of studies relevant to epidemiology, histopathology, complications, imaging and management of HCA lesions was undertaken. References from identified articles were hand-searched for further relevant articles. http://repub.eur.nl/res/pub/16593/ 2009-01-01T00:00:00Z Hepatocellular carcinoma (HCC) is the third most common cause of cancer mortality worldwide. In localised disease, orthotopic liver transplantation, surgical resection or local ablations are the mainstay of treatment. In unresectable or metastatic HCC, systemic therapy has unfortunately yielded disappointing results and therefore until recently was generally considered to be ineffective. Most patients with HCC have an underlying liver disease and many drugs may exacerbate the underlying liver disease. Recently, two randomised phase III trials with sorafenib in patients with advanced or metastatic HCC have shown a significant increase in progression free and overall survival of approximately two months, which is an absolute novum for this disease. Sorafenib is therefore now considered a viable treatment option in patients with unresectable or metastatic HCC, a good performance status and Child-Pugh A liver cirrhosis. Despite this very promising result, of major concern is the treatment-related toxicity as observed in these and other trials by sorafenib treatment. However, the important first significant survival benefit by systemic treatment has generated hope for the development of new treatment strategies which will be more efficacious, have favourable toxicity profiles and will further extend survival of this still highly lethal disease.