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– Gastric cancer (GC) is the third leading cause of cancer death in both sexes worldwide, with the highest estimated mortality rates in Eastern Asia and the lowest in Northern America. However, the availability of modern treatment has... more
– Gastric cancer (GC) is the third leading cause of cancer death in both sexes worldwide, with the highest estimated mortality rates in Eastern Asia and the lowest in Northern America. However, the availability of modern treatment has improved the survival and the prognosis is often poor due to biological characteristics of the disease. In oncology, we are living in the " Era " of target treatment and, to know biological aspects , prognostic factors and predictive response informations to therapy in GC is mandatory to apply the best strategy of treatment. The purpose of this review, according to the recently published English literature, is to summarize existing data on prognostic aspects and pre-dictive factors to response to therapy in GC and to analyze also others therapeutic approaches (surgery and radiotherapy) in locally, locally advanced and advanced GC. Moreover, the multidisciplinary approach (chemotherapy, surgery and ra-diotherapy) can improve the prognosis of GC.
Background: Hepatocellular Carcinoma (HCC) represents the fifth most common malignancy and the third cancer-related cause of death worldwide. Hepatitis B (HBV) and C (HCV) viral infections and alcohol abuse are the principal etiological... more
Background: Hepatocellular Carcinoma (HCC) represents the fifth most common malignancy and the third cancer-related cause of death worldwide. Hepatitis B (HBV) and C (HCV) viral infections and alcohol abuse are the principal etiological factors for HCC. Liver transplantation (LT) is oncologically the preferable approach to HCC, as it can remove all the intrahepatic tumor foci, and also the oncogenic cirrhotic liver. The use of mTOR inhibitors (mTORi) for immunosuppression after LT for HCC has been proposed due to rapamycin antitumor activity. We decided to review the literature to clarify the oncological role of mTORi after liver transplantation for HCC, analyzing both present condition and future perspectives. Material and Methods: A systematic literature search was performed using PubMed, EMBASE, Scopus, and the Cochrane Library Central. The search was limited to studies in humans and to those reported in the English language in the period of time between January 2005 and December 2015. Results: The literature search yielded 93 articles; after duplicates were removed, 77 titles and abstracts were reviewed. Most relevant data and papers are herein reported and discussed. Conclusions: So far, the use of mTORi is encouraging in terms of oncological outcomes for patients underwent LT for HCC, both for prevention and treatment of HCC recurrence although definitive data are still awaited.
The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. However, it should be noted that surgical approach for hepatocellular carcinomas (HCC) is not merely a technical or... more
The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. However, it should be noted that surgical approach for hepatocellular carcinomas (HCC) is not merely a technical or technological issue. Nowadays, the epidemiology of HCC is evolving due to the increasing role of non-alcoholic fatty-liver-disease, and the emerging concerns on direct-acting antivirals against hepatitis C virus in terms of HCC incidence. Therefore, a fully multidisciplinary study of the cirrhotic patient is currently more important than ever before, and the management of those patients should be reserved to tertiary referral hepatobiliary centers. In particular, minimally invasive approach to the liver showed several advantages compared to the classical open procedure, in terms of: (1) the small impact on abdominal wall; (2) the gentle manipulation on the liver; (3) the limited surgical trauma; and (4) the respect of venous shunts. Therefore, more direct indications should be outlined also in the Barcelona Clinic Liver Cancer model. We believe that treatment of HCC in cirrhotic patients should be reserved to tertiary referral hepatobiliary centers, that should offer patient-tailored approaches to the liver disease, in order to provide the best care for each case, according to the individual comorbidities, risk factors, and personal quality of life expectations.
Liver transplant for hepatitis B virus (HBV) currently yields excellent outcomes: it allows to rescue patients with an HBV-related advanced liver disease, resulting in a demographical modification of the waiting list for liver transplant.... more
Liver transplant for hepatitis B virus (HBV) currently yields excellent outcomes: it allows to rescue patients with an HBV-related advanced liver disease, resulting in a demographical modification of the waiting list for liver transplant. In an age of patient-tailored treatments, in liver transplantation as well the aim is to offer the best suitable graft to the patient who can benefit from it, also expanding the criteria for organ acceptance and allocation. With the intent of developing strategies to increase the donor pool, we set
– OBJECTIVE: Hepatocellular Car-cinoma (HCC) represents the fifth most common malignancy and the third cancer-related cause of death worldwide. Liver transplantation (LT) is an excellent treatment for patients with small HCC associated... more
– OBJECTIVE: Hepatocellular Car-cinoma (HCC) represents the fifth most common malignancy and the third cancer-related cause of death worldwide. Liver transplantation (LT) is an excellent treatment for patients with small HCC associated with cirrhosis. The purpose of this review is to investigate the possible strategies for the treatment of HCC recurrence after LT based on current clinical evidence. MATERIALS AND METHODS: A systematic literature search was performed independently by two of the authors using PubMed, EMBASE, Scopus and the Cochrane Library Central. The search was limited to studies in humans and to those reported in the English language. RESULTS: Thanks to the introduction of strict selection criteria, LT for HCC has achieved a survival rate of 85% at five years. However, the recurrence of HCC after transplantation remains a serious problem that affects about 20% of post-transplant cases. While most recurrences occur within the first 2 years, late recurrences have been described. The prognosis of recurrence is poor despite numerous proposals of the therapeutic option. Lower levels of immu-nosuppressive therapy and use of mammalian targets of rapamycin (mTORs) is a potential preventive strategy to reduce HCC recurrence post-Lt. Surgical resection and locoregional therapies (mainly TACE and RFA) play a very important role and are associated with improved survival. Conversely, multikinase inhibitors such as Sorafenib and their association with mTOR in-hibitors play a role in cases of advanced HCC recurrence not suitable for the surgical or abla-tive approach. CONCLUSIONS: Treating HCC recurrence is a multidisciplinary workup involving hepatolo-gists, surgeons, oncologists and radiologists in order to offer a patient-tailored therapy.
We read with great interest the paper by Dr. Cao et al 1 , recently published on European Review for Medical and Pharmacological Sciences and titled ''PHACTR4 regulates proliferation, migration and invasion of human hepatocellular... more
We read with great interest the paper by Dr. Cao et al 1 , recently published on European Review for Medical and Pharmacological Sciences and titled ''PHACTR4 regulates proliferation, migration and invasion of human hepatocellular carcinoma by inhibiting IL-6/Stat3 pathway''. Authors concluded that Stat3 inhibitors have a promising role in the treatment of HCC and that should be considered for better pharmacokinetic design in the future. We congratulate the authors for their interesting work. Our comments focus on the clinical impact of their results. First of all, matching the down-regulation of PHACTR4, and the consequent modulation of target genes expression, with the histological grade of HCC may interestingly enrich such data. Currently, HCC severity and consequent therapeutic approach are stratified with the Barcelona Clinic Liver Cancer staging system (BCLC) 2 , a multidimensional platform based on patient's performance status, liver function calculated using the Child-Turcotte-Pugh (CTP) score, and tumor's dimension 3,4. However, high tumor grade, like other histological features, significantly influence the prognosis of HCC patients 5. Therefore, novel tumor-specific features may be added to the currently adopted staging systems to provide a complete evaluation 6. Moreover, it would be of great interest to clarify the role of PHACTR4 in the peri-tumoral stro-ma and its implications. As we previously reported in our study on the Hedgehog pathway, aggressive HCC cells modulate HSC viability via inhibition of Hh signaling mediated by the GPC3, in order to obtain a niche that permits tumor outgrowth and/or angiogenesis 7. In other words, we believe that the complex environment of the cirrhotic liver 8 deserves more attention for the comprehension of the underlying mechanisms of tumor genesis. In summary, studies on intracellular pathways and tumor-stroma cross-talk are needed to improve diagnosis and management of HCC, since currently adopted staging systems do not include any tumor-specific biological prognostic factor.