Fakülteler / Faculties
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Item Pulmonary Embolism as the First Sign of Hepatocellular Carcinoma in A Patient Who Was Cured After Five Years(2023) Esendagli, Dorina; Rahatli, Samed; Hekimoglu, Koray; Bozbas, Serife Savas; AAJ-3047-2021Pulmonary embolism (PE) is a preventable cause of death associated with high morbidity and mortality rates. Cancer is a significant risk factor for PE. In this case report, we present a patient with PE who was diagnosed with hepatocellular carcinoma (HCC) one month later. The patient had an unresectable tumor in the liver that had invaded both the inferior vena cava and the right atrium. He underwent transarterial chemoembolization (TACE) and sorafenib treatment. After two years, he underwent stereotactic radiosurgery, and he was switched to regorafenib. After five years, he was cured. This case is unique in terms of long survival compared to the literature.Item Local Ablation for Hepatocellular Carcinoma(2014) Boyvat, Fatih; 24635794; F-4230-2011Surgical options for hepatocellular carcinoma must be considered first; if not, image-guided tumor ablation is recommended. The Barcelona Clinic Liver Cancer classification system is commonly used for patients with hepatocellular carcinoma. This classification system is important for image-guided tumor ablation. According to Barcelona Clinic Liver Cancer system, percutaneous tumor ablation is recommended for early stage hepatocellular carcinoma. Hepatocellular carcinoma nodules smaller than 2 cm, not subcapsular or perivascular, are ideal nodules for image-guided radiofrequency ablation. In patients with early hepatocellular carcinoma, the rate of complete response is approximately 97%, with a 68% of 5-year survival rate. Early stage hepatocellular carcinoma includes patients with preserved liver function (Child-Pugh score A or B), with solitary hepatocellular carcinoma, or up to 3 nodules less than 3 cm. it is important to the success of radiofrequency ablation to ablate all viable tumor cells and to create tumor-free margin. The best results are achieved if the tumor is less than 3 cm. If the tumor is between 3 and 5 cm, the success rate of radiofrequency ablation is decreased. Therefore, combination treatment has emerged for better results if the hepatocellular carcinoma nodule is larger than 3 cm and smaller than 5 cm. Radiofrequency ablation offers better survival than ethanol injection if the nodule larger than 2 cm. Microwave ablation can cause higher intratumoral temperatures, larger tumor ablation volumes, and faster ablation times. However, no statistically significant differences were observed between the two. A nonchemical and nonthermal image-guided ablation technique is irreversible electroporation. Irreversible electroporation causes irreversible disruption of the cell membrane integrity by changing the transmembrane potential. One advantage of this technique is complete ablation of the margin of the vessels. It can be applied to the nodules that is centrally located.Item Hepatitis B- and Hepatitis D-Virus Related Liver Transplant: Single-Center Data(2015) Ocal, Serkan; Korkmaz, Murat; Harmanci, Ozgur; Ensaroglu, Fatih; Akdur, Aydincan; Selcuk, Haldun; Moray, Gokhan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-8726-3369; 0000-0003-3719-9482; 0000-0002-9333-782X; 0000-0003-2498-7287; 0000-0002-8445-6413; 0000-0002-0643-4980; 25894142; AAJ-8097-2021; AAA-3068-2021; ABH-4817-2020; AAM-1330-2020; AAE-1041-2021; AAJ-6976-2021Objectives: Hepatitis B and D virus coinfection or superinfection lead to chronic liver disease and have poor treatment results and poor prognosis. After transplant, these patients have difficult problems. We aimed to report long-term data of liver transplant recipients who had hepatitis B and D virus-related chronic liver disease. Materials and Methods: This retrospective, longitudinal study included 25 consecutive hepatitis B surface antigen-positive patients with anti-hepatitis D virus antibodies. Patient data (age, sex, antiviral treatment, posttransplant use of hepatitis B hyperimmunoglobulin and/or nucleoside/nucleotide analogues, the presence of hepatocellular carcinoma, age at transplant, follow-up) were extracted from patient records. Results: Females comprised 32% patients. The median age was 44 years (range, 23-63 y). The serum Hepatitis B envelope antigen level was negative in all patients. At the time of transplant, 4 patients were positive for hepatitis B virus DNA and 11 patients also had hepatocellular carcinoma. Posttransplant follow-up was 59 months (range, 3-120 mo). During follow-up, 4 patients died, 4 patients were lost to follow-up, and 17 patients were alive. Posttransplant survival of patients with hepatocellular carcinoma was 50.45 months (range, 3-84 mo) and without hepatocellular carcinoma was 65.8 months (range, 4-120 mo). There were 3 patients who had acute rejection and were treated successfully with pulse doses of prednisolone. Hyperimmunoglobulin therapy was used in conjunction with oral nucleotide/nucleoside analogues for 12 months (range, 3-24 mo) and then stopped. After transplant, 4 patients had antiviral medicine changed to adefovir or entecavir because of drug resistance, and otherwise all patients remained negative for hepatitis B virus DNA during follow-up. Conclusions: Patients transplanted for hepatitis B and D virus cirrhosis, even with hepatocellular carcinoma, had favorable prognosis and good long-term results. Close follow-up of patients and effective viral suppression with suitable drugs were key factors for efficient patient care.Item Liver Transplant for Hepatocellular Carcinoma: Pathologic Point Of View(2017) Ozgun, Gonca; Reyhan, Nihan Haberal; Ozdemir, Binnaz Handan; Haberal, Mehmet; 0000-0001-9852-9911; 0000-0002-7528-3557; 0000-0002-3462-7632; 28301999; AAK-4587-2021; X-8540-2019; AAJ-8097-2021Primary liver cancer is the fifth most common cancer overall and the second most common cause of cancer mortality worldwide. Hepatocellular carcinoma accounts for up to 90% of all primary hepatic malignancies and represents a major international health problem. It is a complex and heterogeneous malignancy, frequently occurs in the setting of a chronically diseased organ, and has multiple confounding factors. Liver transplant for hepato cellular carcinoma has been established as a standard treatment in selected patients. Liver resection and locoregional therapies could be other options for treatment. Pathologic evaluation of hepatocellular carcinoma is a complicated process that includes tumor grading and evaluation of microvascular invasion. Although macrovascular invasion can be detected with imaging techniques, microvascular invasion is diagnosed pathologically. Pathologic evaluation provides additional information about the tumor biology, using immunohistochemical and molecular methods to predict patient outcomes. Hepatocellular carcinoma requires a multidisciplinary approach to determine the most appropriate treatment, as well as requires accurate timing of various treatments for optimal outcomes.Item Management of Hepatocellular Carcinoma: Prevention, Surveillance, Diagnosis, and Staging(2017) Etik, Digdem Ozer; Suna, Nurettin; Boyacioglu, Ahmet Sedat; 0000-0001-6234-7788; 0000-0002-4724-0728; 0000-0002-9370-1126; 28301996; AAI-8822-2021; AAJ-4707-2021; AAE-7637-2021More than 600 000 people die from hepatocellular carcinoma each year. Worldwide, research on the disease needs to be intensified in both the medical and pharmaceutical fields, with a focus on providing help to geographic areas where resources are limited. Treatment approaches depend on the stage of the disease at diagnosis and on access to complex treatment regimens. However, advanced disease is not curable, and treating these patients is expensive and only marginally effective for increasing quality-adjusted life-years. Although the Milan criteria are often used to determine which patients will benefit from liver transplantation, many centers have their own criteria for patient selection. According to criteria developed by Baskent University in Ankara, Turkey, patients with hepatocellular carcinoma and a cirrhotic liver but without extrahepatic disease should be candidates for liver transplant when possible, and living-donor liver transplant should be considered as an alternative rescue therapy for many of these patients. Tumor size and number should not be the sole criteria for excluding liver transplant. Although significant vascular invasion and extrahepatic dissemination definitely indicate major tumor dissemination, until sensitive tests for measuring circulating tumor cells are developed, we continue to recommend liver transplant regardless of tumor size and number. Various locoregional therapies for hepatocellular carcinoma are used before transplant to prevent tumor progression and to decrease the risk of recurrence after transplant. In turn, response to locoregional therapy to decrease tumor stage in hepatocellular carcinoma may be an indicator of tumor behavior and may determine a patient's selection for liver transplant. The delivery of healthcare services for hepatocellular carcinoma could be improved by developing centers of excellence. Concentrating medical care in this way can lead to an increased level of expertise so that resections are performed by surgeons who understand liver disease and the limitations of these and other procedures.Item Prognostic Factors and Staging Systems in Hepatocellular Carcinoma(2017) Selcuk, Haldun; 0000-0002-8445-6413; 28301998; AAJ-6976-2021There are a number of factors that should be taken into consideration when predicting the outcomes and prognosis of hepatocellular carcinoma. Four of the most important factors in determining survival are the severity of the accompanying liver disease, tumor size and number, extension of the tumor into other structures, and presence of metastases. The most common and widely accepted tumor staging systems include these 4 prognostic factors. The staging systems are (1) the tumor-node-metastasis system of the American Joint Committee on cancer, (2) the Okuda system, (3) the Barcelona Clinic Liver Cancer system, (4) the Cancer of the Liver Italian Program score; (5) the recent albumin-bilirubin grading system, and finally (6) the Hong Kong Liver Cancer staging system. The successful staging of patients with hepatocellular carcinoma is difficult because of the many contributing factors to disease. Therefore, in clinical practice, there is no ideal system that can be applicable to every patient in predicting survival. As a general rule, patient and treatment modality selection criteria should be individualized for every patient and should not use an algorithmic approach because aggressive treatments in properly selected patients with hepatocellular carcinoma offer good results. A better approach for increased treatment success is one that is multidisciplinary, that is, one that considers the different variables.Item Comparison of Mortality Rates in Patients Waiting for Liver Transplant and Patients With Colorectal Metastatic Tumors(2022) Erkent, Murathan; Aydin, H. Onur; Tezcaner, Tugan; Avci, Tevfik; Kavasoglu, Lara; Soy, Ebru H. Ayvazoglu; Yildirim, Sedat; Haberal, Mehmet; 0000-0002-3592-5092; 0000-0002-0664-5147; 0000-0002-0993-9917; 0000-0002-3462-7632; 35352633; CAA-2756-2022; AAJ-8219-2021; AAC-5566-2019; AAJ-8097-2021Objectives: We aimed to identify outcomes of liver surgery in patients with hepatocellular carcinoma and colorectal cancer, which result in primary and secondary liver tumors. Materials and Methods: Our study included 51 patients with colorectal cancer and liver metastases and 63 patients with hepatocellular carcinoma who were prepared for liver transplant due to cirrhosis who underwent hepatic resection or local ablation treatments; patients were seen between January 2011 and December 2021. Results: Most patients with colorectal cancer were men (58.8%). Mean age was 65.76 +/- 13.818 years (range, 27-88 y). Most patients had planned, elective surgery (86.3%). Neoadjuvant chemotherapy was administered to 58.8% of patients. The most common location of metastasis in the liver was in the right lobe (43.1%), and the most common surgery was low anterior resection (17 patients). During simultaneous liver surgery, 31 patients required metastasectomy and 7 patients required radiofrequency ablation plus metastasectomy. No deaths occurred in the early posttransplant period, and cumulative survival was 82.624 +/- 7.962 months. Disease-free survival was 45.2 +/- 7.495 months. Most patients with hepatocellular carcinoma were men (82.5%). Mean age was 58.73 +/- 17.428 years. Hepatocellular carcinoma lesions were mostly located in both the right and left lobes (23.8%). In the hepatocellular cancer group, 60.3% had transarterial chemoembolization and 42.9% had radiofrequency ablation. The primary surgical resection was metastasectomy (17.9%) because of multiple localized lesions. Median follow-up was 22 months (range, 1-126 mo). Overall survival was 101.898 +/- 7.169 months, with 10-year overall survival of 38%. Disease-free survival was 74.081 +/- 8.732 months, with 1-year and 5-year disease-free survival of 90.5% and 54%. Conclusions: Better survival was shown in patients with hepatocellular carcinoma than in patients with colorectal cancer. Therefore, more aggressive treatment options, as used in hepatocellular carcinoma, including liver transplant, may be options for patients with colorectal cancer.Item The Relationship Between Plexin C1 Overexpression and Survival in Hepatocellular Carcinoma: a Turkish Oncology Group (TOG) Study(2022) Nazim Turhal, Serdar; Dogan, Mutlu; Esendagli, Guldal; Artac, Mehmet; Korkmaz, Levent; Coskun, Hasan Senol; Goker, Erdem; PerranYumuk, Fulden; Bilgetekin, Irem; Kose, Fatih; Uncu, Dogan; Kavgaci, Halil; Akyol, Gulen; Ozet, Ahmet; Yagci, Tamer; https://orcid.org/0000-0002-0156-5973; 33656690; G-4827-2016Purpose Plexin C1 is a transmembrane receptor and plexin C1 overexpression might have role in carcinogenesis. Hepatocellular carcinoma (HCC) has poor prognosis because of its aggressive behavior and limited treatment options, especially in advanced stage. We recently documented that Plexin C1 was overexpressed in HCC. We aimed to evaluate the prognostic significance of Plexin C1 overexpression in HCC in the present study. Methods Plexin C1 overexpression was evaluated immunohistochemically on paraffin-embedded blocks of the HCC patients. Plexin C1 immunohistochemical staining was scored. Plexin C1 overexpression staining intensity and prevalence were used for plexin scale staining evaluation and plexin scores were estimated according this staining scale. Plexin C1 score and its association with survival and clinicopathological features was assessed. Results Sixty-seven HCC patients with adequate tissue for pathological evaluation were included. Median age was 63 years with male predominance (male to female ratio was 4.75 (n 57/12). Well-differentiated HCC (53.7%) patients had higher plexin C1 overexpression (p < 0.05). Median OS was 22.1 months. Patients with lower plexin C1 score (< 12) had shorter OS (17.5 vs 30.1 months, p = 0.036). Neutrophil count, GGT, and PNR (platelet/neutrophil ratio) had prognostic significance (p = 0.047, p = 0.018, and p = 0.045). Conclusion Plexin C1 overexpression is inversely correlated with grade in HCC. The patients with lower rate of Plexin C1 overexpression have worse survival outcome. It might be a prognostic factor in HCC.Item Characteristics of Newly Diagnosed Hepatocellular Carcinoma Patients Across Turkey: Prospective Multicenter Observational 3K Registry Study(2021) Ozyilkan, Ozgur; 34876392Aims: To evaluate patient profile for epidemiological and clinicopathological characteristics and potential risk/prognostic factors in newly diagnosed hepatocellular carcinoma (HCC) patients across Turkey. Methods: A total of 547 patients (mean (SD) age 62.6 (10.3) years, 81.9% were males) were included in this registry study. Data on patient characteristics, etiologies of HCC, laboratory values, and tumor characteristics and stages were recorded at study enrollment. Results: HBV infection (68.2%) was the leading etiology, followed by HCV infection (17.2%), HDV infection (5.5%), alcohol (6.4%), and NAFLD (3.5%), as the major etiologies. Considering that 51.6% of the patients had >5 cm HCC, 44% were Child-Pugh B/C and 57% were BCLC B-D, it appears that a significant group of HCC patients were diagnosed at advanced stages. Of 540 patients, 271 (50.2%) were referred or applied with the diagnosis of HCC. Patients with HCC at presentation had larger tumor size (median (min-max) 6.6 (0-30) vs. 4.8 (0-90) cm, P<.001) and more advanced BCLC stage (Stage C-D in 40.8% vs. 26.4%, respectively, P=.005), compared to patients who were diagnosed during follow-up. Conclusions: Our findings revealed that HBV infection was the leading etiology and a moderate-to-advanced disease was evident in more than half of patients at the time of diagnosis. HCC patients diagnosed at follow-up had smaller tumor size and earlier BCLC stage.Item Comparative Findings Between Ga-68-PSMA and F-18-FDG PET/CT for Hepatocellular Carcinoma(2020) Erhamamci, Seval; Aslan, Nesrin; 0000-0001-5016-4650; 33094578We have reported here the case of a 69-year-old man who presented with spinal cord compression due to bone metastases as the first manifestation of hepatocellular carcinoma (HCC). For the initial staging, the patient underwent F-18-fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) imaging, which demonstrated mild F-18-FDG uptake in the multiple expansile osteolytic bone lesions, but no remarkable atypical F-18-FDG uptake in the liver lesion on low-doses CT. An additional PET/CT scan was performed to evaluate the prostate-specific membrane antigen (PSMA) expression, which has recently been reported to be a potential biological marker in a variety of tumors including HCC. High PSMA uptake was recorded in both the metastatic bone lesions and the primary liver lesion/tumor by the Ga-68-PSMA PET/CT.