1. Liver Cancer Conference
Liver Cancer Conference
소화기 센터 회의실

2. History Case 1 2010년 Alcoholic LC
이O강 M/65
2010년 Alcoholic LC
HCC at Rt segment - > RFA #1
Recurrent HCC at S7 -> TACE #1
Recurrent HCC at S7 -> TACE #2
Recurrent HCC at S7 -> TACE #3
Recurrent HCC at S7 -> TACE #4
Liver MR : recurred HCC at S7, probably HCC at S4
토의 목적: 향후 치료 방향 논의
DM/HTN/TBc/Hepatitis(+/+/-/+), Parkinsonism , Alzheimer disease
Op Hx (+) 2005’ C-HIVD OP
Alcohol Hx (+), Smoking Hx (-) : 25갑년 .

3. Underlying liver function and performance status
Case 1
이O강 M/65
Underlying liver function and performance status
Performance status: Grade 0
LC & Stage
Child-Pugh
A (5)
MELD score
0.74
Esophageal varices -
Ascites
Encephalopathy
CBC/DC
WBC
(mm3)
4010 Hb
(g/dl)
14.8
PLT
141k PT
(sec)
12.7
INR
0.96
Chemistry
TB/DB
(mg/dL)
1.36/0.6
AST/ALT
(IU/L)
84/20
ALP/rGT
120/-
Prot/Alb
(g/dL)
7.9/4.4
BUN/Cr
23/1.1
Viral markers/ underlying liver disease
HBV / HCV
(-/-)
HBeAg / HBeAb
Virus titer
0 IU/mL
Antiviral Tx
(-)
Alcohol
Tumor markers
AFP (ng/mL)
15.50
CEA (ng/mL)
4.27
PIVKA II (mAU/mL) 88
CA19-9 -

4. Tumor Stage and Clinical Course
Case 1
조O복 F/57
Tumor Stage and Clinical Course
이O강 M/65
Alcoholic LC
HCC Rt seg
HCC S7
HCC S7
HCC S7
HCC S7
HCC S7,S4
TACE #1
( )
TACE #2
( )
TACE #3
( )
TACE #4
( )
RFA #1
( )
10년06월
11년03월
11년10월
12년10월
13년01월
13년 3월
AFP
5.48
4.63
5.13
6.50
9.55
15.5
PIVKA Ⅱ 36 4 2 - 54 88
Liver MRI ( ):
Increased size of maginal recurred HCC near the RFA-associated necrosis at S7.
Probably HCC at S4, however less than 1cm in diameter.

5. Tumor Stage and Clinical Course
Case 1
조O복 F/57
Tumor Stage and Clinical Course
이O강 M/65
B-viral LC
HCC S 6/7,8
recurrent HCC
Liver abscess
Rt.paraspinal mass
TACE #1
( )
RFA#1
( )
11년11월
12년03월
12년06월
12년09월
12년12월
13년 3월
AFP
7.73
10.02
8.28
8.18
5.84
6.63
PIVKA Ⅱ 24 20 53 -
PET ( )
No abnormal hypermetabolic lesion suggesting recurrence in liver
Hypermetabolic lesion in right paravertebral space and adjacent T12 body
: Suggestive of neurogenic tumor
R/O Metastasis
*Liver –TACE CT ( ) :
Increased size of right pleural mass or right paraspinal mass.
1. metastasis, 2. neurogenic tumor with rapid growing --> malignant lesion is more likely.
No change of fibrotic scarring after RFA at segment 8/5.
No change of FNH like nodules at segment 7 and segment 4.
Liver cirrhosis with multiple regenerating nodules and dysplastic nodules

6. Summary – 치료 방침 결정 Case 1 Tumor stage Date: BCLC Current status
이O강 M/65
Tumor stage Date:
Modified UICC (대한간암연구학회)
T 3, N 0, M 0 Stage: III
BCLC
Very early/Early/ Intermediate / Advanced
Current status
Locally advanced with Well preserved liver function
Extent of current tumor
Localized (curative)
Locally advanced (resectable)
Locally advanced (unresectable) No < 4
Diffuse or multiple (> 3)
Risk factors of recurrence / Tumor biology
Extrahepatic metastasis N
Tumor size > 5 cm, capsulation
Tumor number 2
Repeated TACE ( 1회/기간) Y
Vascular or bile duct invasion
High uptake of PET
High AFP or PIVKA II
Not normalized AFP after curative Tx
Histology (microvascular invasion) -
Histology (satellite lesion, differentiation)
Poor control of underlying liver disease
Current liver function
Normal
Well preserved (no risk of decompensation)
Compensated (risk of decompensation)
Decompensated
Terminal state

7. History Case 2 1997년 B-viral LC (전남대 병원)
김O곤 M/62
1997년 B-viral LC (전남대 병원)
Esophageal varix (Cb, F3, Ls, RC(++)) EVL #1
HCC at Rt post. seg- > TACE #1 ( )
HCC at S7(1.2.cm), S6/7(3.4.cm) -> TACE #2 ( )
Liver CT : vialbe HCC at S6/7
토의 목적: 향후 치료 방향 논의
DM/HTN/TBc/Hepatitis(-/-/-/+)
B-viral LC : Entecavir 0.5mg 복용중 (2010.6~)
Op Hx (-) :
Alcohol Hx (-) :10년전 금주 , Smoking Hx (+) ex smoker : 30갑년

8. Underlying liver function and performance status
Case 2
김O곤 M/62
Underlying liver function and performance status
Performance status: Grade 0
LC & Stage
Child-Pugh
A (5)
MELD score
7.20
Esophageal varices
EV Cb, F2, RC (-)
GV Cb, F1,RC(-)
Ascites -
Encephalopathy
CBC/DC
WBC
(mm3)
2140 Hb
(g/dl)
12.3
PLT
46k PT
(sec)
16.1
INR
1.31
Chemistry
TB/DB
(mg/dL)
0.76/-
AST/ALT
(IU/L)
29/20
ALP/rGT
89/105
Prot/Alb
(g/dL)
8.1/4.5
BUN/Cr
15/0.8
Viral markers/ underlying liver disease
HBV / HCV
(+/-)
HBeAg / HBeAb
(-/+)
Virus titer
<20 IU/mL
Antiviral Tx
Entecavir 0.5mg
Alcohol
(+)
Tumor markers
AFP (ng/mL)
2.99
CEA (ng/mL) -
PIVKA II (mAU/mL) 70
CA19-9

9. Tumor Stage and Clinical Course
Case 2
Tumor Stage and Clinical Course
김O곤 M/62
B-viral LC
Esophageal varix
EVL#1 x12
HCC
At Rt,post
HCC
At S7, S6/7
Liver CT
vialbe HCC at S6/7
TACE #1
( )
TACE #2
( )
10년06월
11년08월
12년02월
12년09월
12년12월
13년 3월
AFP
443
10.84
4.48
3.51
8.18
2.78
2.99
PIVKA Ⅱ 20 - 38 70
*Liver CT ( ) :
Lipiodol uptaken HCC at S7.
Increased size and remaining viable portion within HCC at S6/7.
Underlying liver cirrhosis with splenomegaly.
A GB stone, and both renal cysts..

10. Summary – 치료 방침 결정 Case 2 Tumor stage Date: BCLC Current status
김O곤 M/62
Tumor stage Date:
Modified UICC (대한간암연구학회)
T 3, N 0, M 0 Stage: III JIS score 2
BCLC
Very early/Early/ Intermediate / Advanced
Current status
Locally advanced with Well preserved liver function
Extent of current tumor
Localized (curative)
Locally advanced (resectable)
Locally advanced (unresectable) No < 4
Diffuse or multiple (> 3)
Risk factors of recurrence / Tumor biology
Extrahepatic metastasis N
Tumor size > 5 cm, capsulation
Tumor number 2
Repeated TACE ( 1회/기간) Y
Vascular or bile duct invasion
High uptake of PET
High AFP or PIVKA II
Not normalized AFP after curative Tx
Histology (microvascular invasion) -
Histology (satellite lesion, differentiation)
Poor control of underlying liver disease
Current liver function
Normal
Well preserved (no risk of decompensation)
Compensated (risk of decompensation)
Decompensated
Terminal state

11. History Case 3 10년 전 hepatitis B virus carrier 진단
천O현 M/46
10년 전 hepatitis B virus carrier 진단
Liver CT malignant mass of S4 liver with both IHD dilatation.
PET CT : Malignant tumor in liver, S4. No distant metastatic lesion
Liver MR : Malignant hepatic mass in segment 4 with tumor thrombosis.
tumor growing within the both IHD and CHD.
Sono guided bx : Hepatocellular carcinoma
ERCP : EST, Stent insertion, both IHD
TACE #1 at Lt lobe
, 20 PDT 시행
GB & biliary CT, Liver MR
:Aggravation of bile duct invasion of malignant hepatic tumor.
토의 목적: 향후 치료 방향 토의
DM/HTN/TBc/Hepatitis(-/-/-/+)
HBV carrier
Op Hx (-)
Alcohol Hx (+) 소주 1~2병 /주 2회 Smoking Hx (+) 10년전 금연. 20갑년

12. Underlying liver function and performance status
Case 3
천O현 M/46
천O현 M/46
Underlying liver function and performance status
Performance status: Grade 0
Viral markers
Anti-HCV Ab
(-)
HBsAg/HBeAg /anti –HBe Ab
+/-/+
Anti-HBs Ab/Anti-HBcAb
HBV Rt-PCR titer
(-)/(+)
149 IU/mL
867copies/mL
Anti-HIV Ab
CBC/DC
WBC
(mm3)
4100 Hb
(g/dl)
10.3
PLT
377k PT
(sec)
13.6
INR
1.05
Chemistry
TB/DB
(mg/dL)
0.98/0.77
AST/ALT
(IU/L)
73/58
ALP/rGT
568/481
Amylase 77
Lipase 48
CRP
12.04
Prot/Alb
(g/dL)
6.3/3.1
BUN/Cr
5/0.6
Tumor markers
CEA (ng/mL)
2.19
AFP (U/mL)
<
CA 19-9 (U/mL)
<- 1750
Biopsy (Sono guided . 1/24)
Hepatocellular carcinoma
Hep-par1 (+), CK7 (-), CK20 (-)
Masson's Trichrome (+), Reticulum (+)

16. Hep-par1 (+)
Immunohistochemical finding: Hep-par1 (+), CK7 (-), CK20 (-)

17. CK7 (-)
CK 7

18. CK20 (-)
CK 20

19. Tumor Stage and Clinical Course
Case 3
천O현 M/46
천O현 M/46
Tumor Stage and Clinical Course
Liver CT
GB & Bile duct
sono
PET CT
Liver MR
Sono guided Bx
: HCC
ERCP
: Both IHD
Stent insertion
TACE #1
Cholangitis
PTBD
(13.4.1)
Liver MR
PDT
PET ( )
c/w Malignant tumor in liver, S4. (max SUV : 6.9)
No abnormal hypermetabolic lesion suggesting distant metastasis.
Liver MRI ( ):
Aggravation of bile duct invasion of malignant hepatic tumor.
- biliary stent insertion in both IHD and CHD with nearly total obstruction of left IHD stent due to tumor ingrowth.
Mild aggravation of LNs metastases.

20. Summary – 치료 방침 결정 Case 3 Tumor stage Date: BCLC Current status
천O현 M/46
Tumor stage Date:
Modified UICC (대한간암연구학회)
T 4, N 1, M 0 Stage: IVA
BCLC
Very early/Early/ Intermediate / Advanced
Current status
advanced with high-risk for recurrence
Extent of current tumor
Localized (curative)
Locally advanced (resectable)
Locally advanced (unresectable) No < 4
Diffuse or multiple (> 3)
Risk factors of recurrence / Tumor biology
Extrahepatic metastasis N
Tumor size > 5 cm, capsulation Y
Tumor number
>3
Repeated TACE ( 회/기간)
Vascular or bile duct invasion
High uptake of PET
High AFP or PIVKA II
Not normalized AFP after curative Tx
Histology (microvascular invasion)
Histology (satellite lesion, differentiation)
Poor control of underlying liver disease
Current liver function
Normal
Well preserved (no risk of decompensation)
Compensated (risk of decompensation)
Decompensated
Terminal state