- Email: [email protected]
Mutation Profile of Dendritic Cell (DC SIGN) Gene and Its Association with Hepatocellular Carcinoma Patients from Delhi
NEOPLASMS
these therapies). Barcelona Clinic staging in these 35 patients was: 0 – 1 patient, A – 9 patients, B – 3 patients, and C – 22 patients. No significant postprocedure complications were encountered. 82.86% (29) patients had complete response, 2.86% (1) patients had partial response and 5.71% (2) patients had stable disease at 1month of follow-up imaging as per mRECIST criteria. 3 patients were lost to follow up. At 1 year of follow-up imaging in 14 patients, only 3 had progression of disease. Overall only 22.86% (8) patients had progression of disease on follow up at the end of 2 years. Among patients who followed-up, mean survival was 15.19 months (range 1–108 months) in patients who underwent locoregional therapies where as mean survival in patients who received sorafenib was only 3 months. Conclusion: Locoregional therapies are safe and improve survival of patients with HCC. Corresponding author: Pratibha Sonawane. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2015.07.118
Neoplasms
HIGH SENSITIVITY C-REACTIVE PROTEIN (HS-CRP) LEVELS IN HCC PATIENTS AND ITS MODULATION DURING LOCOREGIONAL THERAPY Baibaswata Nayak, Devesh Kumar, Neeti Nadda, Shashi Paul, Shalimar, Subrat Acharya All India Institute of Medical Sciences, New Delhi, India
Background: The levels of CRP increases in blood during inflammation. It is an acute phase protein (APP) synthesized in liver and this type I APP is induced by interleukin-1 like cytokines including IL-1a, IL-1b, TNF-a and TNF-b. Beside inflammation, it remains elevated during acute phase response to local or systemic infection, immunological disturbances and cancer. Recent studies have suggested that CRP may serve as prognostic biomarker for survival outcome in hepatocellular carcinoma (HCC) patients. However, modulation of hsCRP during locoregional therapy and association of its changes with therapeutic response is not studied well. For HCC patients, palliative locoregional therapy like percutaneous ablation and transarterial chemoembolisation (TACE) remains alternative to curative treatment. But in absence of suitable biomarker, imaging techniques like DPCT or MRI are only options for assessment of treatment response. In this study, we have evaluated hsCRP at baseline levels in HCC patients S60
and its modulation during locoregional post therapy and association with therapeutic response. Methodology: The patients diagnosed as HCC are staged as per BCLC staging system. The patient receiving locoregional therapy was evaluated for therapeutic response by radiological imaging as per mRECIST criteria. Serum sample were collected at baseline and 1, 3 and 6 months post therapy. The CRP estimation was carried out by hsCRP ELISA kit and values were expressed in mg/L. Statistical significance between groups were determined by Student t test and association of CRP with therapeutic response by chi square test. Result: The mean hsCRP concentration at base line levels of HCC patient is 6.312 8.268 mg/L (n = 78) and healthy subjects are 1.676 1.401 mg/L (n = 10). The hsCRP level is <10 mg/L in majority of HCC patients (73%, n = 57) and the mean concentration is 2.174 3.014 mg/L. Increased hsCRP (>10 mg/L) is observed in 27% of HCC patients. The mean hsCRP level is 17.54 7.513 mg/L (n = 21). When HCC groups were compared with healthy subjects, hsCRP >10 mg/L group found statistically significant in unpair t test (P-value 0.0001) but not found significant hsCRP <10 mg/L (P = 0.616). During locoregional post therapy, hsCRP level increased at 1-month post therapy (mean hsCRP: 13.31 11.8 mg/L) from baseline (mean hsCRP: 6.511 7.851 mg/L, n = 47). Later it gets stabilized to mean hsCRP level 5.167 4.563 mg/L at 3-month post therapy in HCC patients. Associations of hsCRP with final therapeutic response will be analyzed by Chi square test for hsCRP group of <5 mg/L and >5 mg/L with therapeutic response as responder and non-responder. Conclusion: Tumor induced inflammation from mild to moderate was observed HCC patients. The modulation of hs-CRP may be correlated with therapeutic response. Corresponding author: Baibaswata Nayak. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2015.07.119
MUTATION PROFILE OF DENDRITIC CELL (DC SIGN) GENE AND ITS ASSOCIATION WITH HEPATOCELLULAR CARCINOMA PATIENTS FROM DELHI Manash Sarma 1,2, Minakshi Bhattacharjee 1,2, Premashis Kar 1,2, 1
Assam Down Town University, Guwahati, India, 2Maulana Azad Medical College, New Delhi, India © 2015, INASL
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
Corresponding author: . E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2015.07.120
patients. None of the patients were in shock. Only 1 patient had an AFP >200. 4 patients were CHILD B, one CHILD C and two CHILD A. 5 patients had MELD score >15. 5 patients were BCLC C, one BCLC B and one BCLC A. 3 patients had single lesion, others had multiple lesions. 5 patients had lesions limited to the right lobe, 1 patient had left lobe lesion, 1 patient had lesions in both the lobes. 4 patients had lesions >5 cm in size. 5 patients had portal vein thrombosis. Following angioembolisation, 1 patient died within 2 days due to sepsis and multi organ dysfunction. Rest of the patients were discharged after an average ICU stay of 4 days. Conclusion: Most patients who presented with ruptured HCC had an advanced disease. With proper clinical correlation and imaging, the diagnosis can be picked up early. Angioembolisation is a lifesaving intervention in this group of patients. http://dx.doi.org/10.1016/j.jceh.2015.07.121
EVEN HEPATOLOGIST NEED TO FOLLOW SURVEILLANCE STRATEGY FOR HCC RELIGIOUSLY! Prabhat Ranjan, Ganaraj Kulamarwa, Mayank Gupta, Narendra Bhargava, Sunil Dadhich Dr. S.N. Medical College, Jodhpur, Rajasthan, India
ANGIOEMBOLISATION IN HCC RUPTURE— A TERTIARY CARE EXPERIENCE Aby Somu PVS Memorial Hospital, Kochi, India
Background: Primary liver cancer is the fifth most common cancer worldwide and the third most common cause of cancer mortality. Rupture of hepatocellular carcinoma though rare, can present with hemoperitoneum and is a life threatening complication of HCC. Aim of the Study: To study the outcome of angioembolisation in patients with ruptured HCC. Materials and Methods: Data analysis of patients who presented with HCC rupture and hemoperitoneum in the last 6 months. Results: Total number of HCC cases were 54. Cases with rupture were 7. All the patients were males. Mean age at diagnosis was 63.6 years. All patients had CLD, 2 were diagnosed for the first time, during this admission. The etiology of HCC was alcoholic liver disease in all the patients. There was associated diabetes in 4
Background and Aims: Early diagnosis and treatment are vital especially in malignancies like HCC which are associated with high mortalities. Here we assessed the adequacy of HCC management at our centre with respect to early diagnosis, treatment and prevention. Methods: All HCC patients presenting to our hospital in the year 2014 were included. We went through their records and noted the method(s) of diagnosis, treatment modalities offered and preventive strategies employed. Patients lost to follow-up were contacted in January 2015. Results: A total of 32 patients of HCC were included. In 24 patients (75%) diagnosis was arrived based on typical imaging findings on dynamic CT/MRI without need for liver biopsy. Of all patients, 23 were in BCLC stage C, 5 in stage D and 4 in stage B at the time of diagnosis. 3 of the 4 in stage B underwent TACE. Of these 3, 1 had disease progression after 2 TACE sessions and was given Sorafenib. All 23 patients in BCLC stage C were advised Sorafenib, but only 8 could afford it. All the remaining patients including stage D patients were given supportive therapy.
Journal of Clinical and Experimental Hepatology | June/July 2015 | Vol. 5 | No. S2 | S57–S65
S61
Neoplasms
Objective: To investigate the association of mutation in Dendritic Cell-Specific Intercellular adhesion molecule-3-Grabbing Non-integrin (DC SIGN) promoter region in HCC patients and healthy control and to analyze the association of these mutation as a risk factor for HCC development from India. Methods: A total of 40 cases of HCC and 40 healthy controls without any underlying liver diseases were included in the study. Total 5 ml of peripheral blood samples were collected and genomic DNA was isolated followed by PCR amplification and direct sequencing (Macrogen, Korea). Mutations were analyzed comparing these sequences with those published sequences from database. Results: A total of 8-point mutation was observed in the HCC cases. The nature of mutation observed was deletion, transition and Transversion. All mutations were located in the 19th chromosome at 9 different loci (51079, 51493, 51561, 51124, 51125, 51127, 51169, 51170 and 51172). Conclusion: Point mutation detected in the HCC cases can be used as diagnostic marker once the findings of the current study are established by further study at the proteomic levels.
these therapies). Barcelona Clinic staging in these 35 patients was: 0 – 1 patient, A – 9 patients, B – 3 patients, and C – 22 patients. No significant postprocedure complications were encountered. 82.86% (29) patients had complete response, 2.86% (1) patients had partial response and 5.71% (2) patients had stable disease at 1month of follow-up imaging as per mRECIST criteria. 3 patients were lost to follow up. At 1 year of follow-up imaging in 14 patients, only 3 had progression of disease. Overall only 22.86% (8) patients had progression of disease on follow up at the end of 2 years. Among patients who followed-up, mean survival was 15.19 months (range 1–108 months) in patients who underwent locoregional therapies where as mean survival in patients who received sorafenib was only 3 months. Conclusion: Locoregional therapies are safe and improve survival of patients with HCC. Corresponding author: Pratibha Sonawane. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2015.07.118
Neoplasms
HIGH SENSITIVITY C-REACTIVE PROTEIN (HS-CRP) LEVELS IN HCC PATIENTS AND ITS MODULATION DURING LOCOREGIONAL THERAPY Baibaswata Nayak, Devesh Kumar, Neeti Nadda, Shashi Paul, Shalimar, Subrat Acharya All India Institute of Medical Sciences, New Delhi, India
Background: The levels of CRP increases in blood during inflammation. It is an acute phase protein (APP) synthesized in liver and this type I APP is induced by interleukin-1 like cytokines including IL-1a, IL-1b, TNF-a and TNF-b. Beside inflammation, it remains elevated during acute phase response to local or systemic infection, immunological disturbances and cancer. Recent studies have suggested that CRP may serve as prognostic biomarker for survival outcome in hepatocellular carcinoma (HCC) patients. However, modulation of hsCRP during locoregional therapy and association of its changes with therapeutic response is not studied well. For HCC patients, palliative locoregional therapy like percutaneous ablation and transarterial chemoembolisation (TACE) remains alternative to curative treatment. But in absence of suitable biomarker, imaging techniques like DPCT or MRI are only options for assessment of treatment response. In this study, we have evaluated hsCRP at baseline levels in HCC patients S60
and its modulation during locoregional post therapy and association with therapeutic response. Methodology: The patients diagnosed as HCC are staged as per BCLC staging system. The patient receiving locoregional therapy was evaluated for therapeutic response by radiological imaging as per mRECIST criteria. Serum sample were collected at baseline and 1, 3 and 6 months post therapy. The CRP estimation was carried out by hsCRP ELISA kit and values were expressed in mg/L. Statistical significance between groups were determined by Student t test and association of CRP with therapeutic response by chi square test. Result: The mean hsCRP concentration at base line levels of HCC patient is 6.312 8.268 mg/L (n = 78) and healthy subjects are 1.676 1.401 mg/L (n = 10). The hsCRP level is <10 mg/L in majority of HCC patients (73%, n = 57) and the mean concentration is 2.174 3.014 mg/L. Increased hsCRP (>10 mg/L) is observed in 27% of HCC patients. The mean hsCRP level is 17.54 7.513 mg/L (n = 21). When HCC groups were compared with healthy subjects, hsCRP >10 mg/L group found statistically significant in unpair t test (P-value 0.0001) but not found significant hsCRP <10 mg/L (P = 0.616). During locoregional post therapy, hsCRP level increased at 1-month post therapy (mean hsCRP: 13.31 11.8 mg/L) from baseline (mean hsCRP: 6.511 7.851 mg/L, n = 47). Later it gets stabilized to mean hsCRP level 5.167 4.563 mg/L at 3-month post therapy in HCC patients. Associations of hsCRP with final therapeutic response will be analyzed by Chi square test for hsCRP group of <5 mg/L and >5 mg/L with therapeutic response as responder and non-responder. Conclusion: Tumor induced inflammation from mild to moderate was observed HCC patients. The modulation of hs-CRP may be correlated with therapeutic response. Corresponding author: Baibaswata Nayak. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2015.07.119
MUTATION PROFILE OF DENDRITIC CELL (DC SIGN) GENE AND ITS ASSOCIATION WITH HEPATOCELLULAR CARCINOMA PATIENTS FROM DELHI Manash Sarma 1,2, Minakshi Bhattacharjee 1,2, Premashis Kar 1,2, 1
Assam Down Town University, Guwahati, India, 2Maulana Azad Medical College, New Delhi, India © 2015, INASL
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
Corresponding author: . E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2015.07.120
patients. None of the patients were in shock. Only 1 patient had an AFP >200. 4 patients were CHILD B, one CHILD C and two CHILD A. 5 patients had MELD score >15. 5 patients were BCLC C, one BCLC B and one BCLC A. 3 patients had single lesion, others had multiple lesions. 5 patients had lesions limited to the right lobe, 1 patient had left lobe lesion, 1 patient had lesions in both the lobes. 4 patients had lesions >5 cm in size. 5 patients had portal vein thrombosis. Following angioembolisation, 1 patient died within 2 days due to sepsis and multi organ dysfunction. Rest of the patients were discharged after an average ICU stay of 4 days. Conclusion: Most patients who presented with ruptured HCC had an advanced disease. With proper clinical correlation and imaging, the diagnosis can be picked up early. Angioembolisation is a lifesaving intervention in this group of patients. http://dx.doi.org/10.1016/j.jceh.2015.07.121
EVEN HEPATOLOGIST NEED TO FOLLOW SURVEILLANCE STRATEGY FOR HCC RELIGIOUSLY! Prabhat Ranjan, Ganaraj Kulamarwa, Mayank Gupta, Narendra Bhargava, Sunil Dadhich Dr. S.N. Medical College, Jodhpur, Rajasthan, India
ANGIOEMBOLISATION IN HCC RUPTURE— A TERTIARY CARE EXPERIENCE Aby Somu PVS Memorial Hospital, Kochi, India
Background: Primary liver cancer is the fifth most common cancer worldwide and the third most common cause of cancer mortality. Rupture of hepatocellular carcinoma though rare, can present with hemoperitoneum and is a life threatening complication of HCC. Aim of the Study: To study the outcome of angioembolisation in patients with ruptured HCC. Materials and Methods: Data analysis of patients who presented with HCC rupture and hemoperitoneum in the last 6 months. Results: Total number of HCC cases were 54. Cases with rupture were 7. All the patients were males. Mean age at diagnosis was 63.6 years. All patients had CLD, 2 were diagnosed for the first time, during this admission. The etiology of HCC was alcoholic liver disease in all the patients. There was associated diabetes in 4
Background and Aims: Early diagnosis and treatment are vital especially in malignancies like HCC which are associated with high mortalities. Here we assessed the adequacy of HCC management at our centre with respect to early diagnosis, treatment and prevention. Methods: All HCC patients presenting to our hospital in the year 2014 were included. We went through their records and noted the method(s) of diagnosis, treatment modalities offered and preventive strategies employed. Patients lost to follow-up were contacted in January 2015. Results: A total of 32 patients of HCC were included. In 24 patients (75%) diagnosis was arrived based on typical imaging findings on dynamic CT/MRI without need for liver biopsy. Of all patients, 23 were in BCLC stage C, 5 in stage D and 4 in stage B at the time of diagnosis. 3 of the 4 in stage B underwent TACE. Of these 3, 1 had disease progression after 2 TACE sessions and was given Sorafenib. All 23 patients in BCLC stage C were advised Sorafenib, but only 8 could afford it. All the remaining patients including stage D patients were given supportive therapy.
Journal of Clinical and Experimental Hepatology | June/July 2015 | Vol. 5 | No. S2 | S57–S65
S61
Neoplasms
Objective: To investigate the association of mutation in Dendritic Cell-Specific Intercellular adhesion molecule-3-Grabbing Non-integrin (DC SIGN) promoter region in HCC patients and healthy control and to analyze the association of these mutation as a risk factor for HCC development from India. Methods: A total of 40 cases of HCC and 40 healthy controls without any underlying liver diseases were included in the study. Total 5 ml of peripheral blood samples were collected and genomic DNA was isolated followed by PCR amplification and direct sequencing (Macrogen, Korea). Mutations were analyzed comparing these sequences with those published sequences from database. Results: A total of 8-point mutation was observed in the HCC cases. The nature of mutation observed was deletion, transition and Transversion. All mutations were located in the 19th chromosome at 9 different loci (51079, 51493, 51561, 51124, 51125, 51127, 51169, 51170 and 51172). Conclusion: Point mutation detected in the HCC cases can be used as diagnostic marker once the findings of the current study are established by further study at the proteomic levels.