title: Tumor markers for early diagnosis for brain metastasis of hepatocellular carcinoma: A case series and literature review for effective loco-regional treatment.
abstract: Intrahepatic lesions of hepatocellular carcinoma (HCC) have been controlled by significant advances in treatment using loco-regional therapies, including, surgery, ablative therapy, catheter-based chemotherapy, and embolization. Consequently, the number of patients with extrahepatic metastatic lesions has increased. Their prognosis remains poor with approximately <1 y of survival from the time of diagnosis. A molecularly targeted drug, sorafenib, have been used to treat extrahepatic lesions and shown the prolonged survival time. However, the therapeutic benefit for the brain metastasis remains unclear, since it causes intratumor bleeding leading to the severe brain damage. No guidelines for the brain metastasis of HCC have been developed to date due to the shortage of the experiences and evidences. Therefore, the development of standard therapy for brain metastasis following the early diagnosis is essential by accumulating the information of clinical courses and evidences. For this purpose, we reviewed cases of HCC brain metastasis reported to date and analyzed additional 8 cases from our hospital, reviewing 592 advanced HCC cases to estimate the possible metastatic lesions in the brain. With careful review of cases and literature, we suggest that the cases with lung metastasis with increase tendency of tumor markers within recent 3-6 months have higher risks of brain metastasis. Therefore, they should be carefully followed by imaging modalities. In addition, the loco-regional treatment, including surgical resection and radiation therapy should be performed for better prognosis by preventing re-bleeding from the tumors.
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kamimura
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Abe
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kumaki
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yokoo
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Hiroteru
authors.initials: H
authors.lastname: Kamimura
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Sakai
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sakamaki
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Abe
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takamura
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kawai
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamagiwa
authors.affiliation: a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Terai
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000737:chemistry*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: AFP; Hepatocellular carcinoma; L3; brain metastasis; radiation; surgery; tumor marker