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| 1 | challenges of advanced hepatocellular carcinoma显示文摘Hepatocellular carcinoma(HCC) is an aggressive malignancy,resulting as the third cause of death by cancer each year. The management of patients with HCC is complex,as both the tumour stage and any underlying liver disease must be considered conjointly. Although surveillance by imaging,clinical and biochemical parameters is routinely performed,a lot of patients suffering from cirrhosis have an advanced stage HCC at the first diagnosis. Advanced stage HCC includes heterogeneous groups of patients with different clinical condition and radiological features and sorafenib is the only approved treatment according to Barcelona Clinic Liver Cancer. Since the introduction of sorafenib in clinical practice,several phase Ⅲ clinical trials have failed to demonstrate any superiority over sorafenib in the frontline setting. Locoregional therapies have also been tested as first line treatment,but their role in advanced HCC is still matter of debate. No single agent or combination therapies have been shown to impact outcomes after sorafenib failure. Therefore this review will focus on the range of experimental therapeutics for patients with advanced HCC and highlights the successes and failures of these treatments as well as areas for future development. Specifics such as dose limiting toxicity and safety profile in patients with liver dysfunction related to the underlying chronic liver disease should be considered when developing therapies in HCC. Finally,robust validated and reproducible surrogate end-points as well as predictive biomarkers should be defined in future randomized trials. | Stefano Colagrande Andrea L Inghilesi Sami Aburas Gian G Taliani Cosimo Nardi Fabio Marra | 2016 | World Journal of Gastroenterology2016，22，34： | 19 |
| 2 | Advanced hepatocellular carcinoma and sorafenib: Diagnosis, indications, clinical and radiological follow-up显示文摘Advanced stage hepatocellular carcinoma(HCC) is a category of disease defined by radiological, clinical and hepatic function parameters, comprehending a wide range of patients with different general conditions. The main therapeutic option is represented by sorafenibtreatment, a multi-kinase inhibitor with anti-proliferative and anti-angiogenic effect. Trans-arterial Radio Embolization also represents a promising new approach to intermediate/advanced HCC. Post-marketing clinical studies showed that only a portion of patients actually benefits from sorafenib treatment, and an even smaller percentage of patients treated shows partial/complete response on follow-up examinations, up against relevant costs and an incidence of drug related adverse effects. Although the treatment with sorafenib has shown a significant increase in mean overall survival in different studies, only a part of patients actually shows real benefits, while the incidence of drug related significant adverse effects and the economic costs are relatively high. Moreover, only a small percentage of patients also shows a response in terms of lesion dimensions reduction. Being able to properly differentiate patients who are responding to the therapy from non-responders as early as possible is then still difficult and could be a pivotal challenge for the future; in fact it could spare several patients a therapy often difficult to bear, directing them to other second line treatments(many of which are at the moment still under investigation). For this reason, some supplemental criteria to be added to the standard modified Response Evaluation Criteria in Solid Tumors evaluation are being searched for. In particular, finding some parameters(cellular density, perfusion grade and enhancement rate) able to predict the sensitivity of the lesions to anti-angiogenic agents could help in stratifying patients in terms of treatment responsiveness before the beginning of the therapy itself, or in the first weeks of sorafenib treatment. This would bring a strongly desirable help in clinical managements of these patients. | Stefano Colagrande Francesco Regini Gian Giacomo Taliani Cosimo Nardi Andrea Lorenzo Inghilesi | 2015 | World Journal of Hepatology2015，7，8： | 6 |
| 3 | Doege-Potter syndrome by malignant solitary fibrous tumor of the liver: A case report and review of literature显示文摘BACKGROUND Solitary fibrous tumor of the liver (SFTL) is a rare occurrence with a low number of cases reported in literature. SFTL is usually benign but, 10%-20% cases are reported to be malignant with a tendency to metastasize. The majority of malignant SFTL cases are associated with a paraneoplastic hypoglycaemia defined as Doege-Potter syndrome. Surgery is the best therapeutic treatment, however, long- life follow-up is recommended. CASE SUMMARY A 74-year-old man, was admitted to the emergency department after a syncopal episode with detection of hypoglycaemia resistant to medical treatment. The computed tomography revealed a solid mass measuring 15 cm of the left liver. An open left hepatectomy was performed with complete resection of tumor. Histopathological analyses confirmed a malignant SFTL. CONCLUSION Large series with long-term follow-up have not been published neither have clinical trials been undertaken. Consequently, the methodical long-term followup of surgically treated SFTLs is strongly recommended. | Delvecchio Antonella Duda Loren Conticchio Maria Fiore Felicia Lafranceschina Stefano Riccelli Umberto Cristofano Antonella Pascazio Bianca Colagrande Anna Resta Leonardo Memeo Riccardo | 2019 | World Journal of Gastrointestinal Surgery2019，11，8： | 5 |
| 4 | Imaging of the chemotherapy-induced hepatic damage:Yellow liver,blue liver,and pseudocirrhosis显示文摘The liver is the major drug-metabolizing and drug-detoxifying organ.Many drugs can cause liver damage through various mechanisms;however,the liver response to injury includes a relatively narrow spectrum of alterations that,regardless of the cause,are represented by phlogosis,oxidative stress and necrosis.The combination of these alterations mainly results in three radiological findings:vascular alterations,structural changes and metabolic function reduction.Chemotherapy has changed in recent decades in terms of the drugs,protocols and duration,allowing patients a longer life expectancy.As a consequence,we are currently observing an increase in chemotherapy-associated liver injury patterns once considered unusual.Recognizing this form of damage in an early stage is crucial for reconsidering the therapy regimen and thus avoiding severe complications.In this frontier article,we analyze the role of imaging in detecting some of these pathological patterns,such as pseudocirrhosis,“yellow liver”due to chemotherapy-associated steatosis-steatohepatitis,and“blue liver”,including sinusoidal obstruction syndrome,veno-occlusive disease and peliosis. | Linda Calistri Vieri Rastrelli Cosimo Nardi Davide Maraghelli Sofia Vidali Michele Pietragalla Stefano Colagrande | 2021 | World Journal of Gastroenterology2021，27，46： | 2 |
| 5 | Pancreatic fistula:A proposed percutaneous procedure显示文摘AIM:To propose a percutaneous treatment for otherwise intractable pancreatic fistula (PF).METHODS:From 2005 to 2011,12 patients (9 men and 3 women,mean age 59 years,median 63 years,range 33-78 years) underwent radiological treatment for high-output PF associated with peripancreatic fluid collection.The percutaneous procedures were performed after at least 4 wk of unsuccessful conservative treatments.We chose either a one or two step procedure,depending on the size and characteristics of the fistula and the fluid collection (with an arbitrary cut-off of 2 cm).Initially,2 to 6 pigtail drainages of variable size from 8.3 (8.3-Pig Duan Cook,Bloomington,Indiana,United States) to 14 Fr (Flexima,Boston Scientific,Natick,United States) were positioned inside the collection using a transgastric approach.In a second procedure,after 7-10 d,two or more endoprostheses (cystogastrostomic 8 Fr double-pigtail,Cook,Bloomington,Indiana,United States in 10 patients;covered Niti-S stent,TaeWoong Medical Co,Seoul,South Korea in 2 patients) were placed between the collection and the gastric lumen.In all cases the metal or plastic pros-theses were removed within one year after positioning.RESULTS:Four out of 12 high-output fistulas fistulas were external while 8/12 were internal.The origin of the fistulous tract was visualised by computer tomography (CT) imaging studies:in 11 patients it was at the body,and in 1 patient at the tail of the pancreas.Single or multiple drainages were positioned under CT guidance.The catheters were left in place for a varying period (0 to 40 d-median 10 and 25 th-75 th percentile 0-14).In one case external transgastric drainages were left in place for a prolonged time (40 d) due to the presence of vancomycin-resistant bacteria (Staphylococcus) and fluconazole-resistant fungi (Candida) in the drained fluid.In this latter case systemic and local antibiotic therapy was administered.In both single and two-step techniques,when infection was present,we carried out additional washing with antibiotics to improve the likelihood of the procedure's success.In all cases the endoprostheses were left in situ for a few weeks and endoscopically removed after remission of collections,as ascertained by CT scan.Procedural success rate was 100% as the resolution of external PF was achieved in all cases.There were no peri-procedural complications in any of the patients.The minimum follow-up was 18 mo.In two cases the procedure was repeated after 1 year,due to the onset of new fluid collections and the development of pseudocysts.Indeed,this type of endoprosthesis is routinely employed for the treatment of pseudocysts.Endoscopy was adopted both for control of the positioning of the endoprosthesis in the stomach,and for its removal after resolution of the fistula and fluid collection.The resolution of the external fistula was assessed clinically and CT scan was employed to demonstrate the resolution of peripancreatic collections for both the internal and external fistulae.CONCLUSION:The percutaneous placement of cistogastrostomic endoprostheses can be used for the treatment of PF that cannot be treated with other procedures. | Silvia Pradella Ernesto Mazza Francesco Mondaini Stefano Colagrande | 2013 | World Journal of Hepatology2013，5，1： | 1 |
| 6 | Fibrosis in chronic liver diseases: diagnosis and management显示文摘 | Massimo Pinzani Krista Rombouts Stefano Colagrande | 2004 | Journal of Hepatology2004，，1： | 1 |
| 7 | Predictors of survival in patients with established cirrhosis and hepatocellular carcinoma treated with sorafenib显示文摘AIM:To investigate in greater detail the efficacy and safety of sorafenib for the treatment of hepatocellular carcinoma(HCC)in patients with established cirrhosis.METHODS:From October 2009 to July 2012 patients with an established diagnosis of cirrhosis and HCC treated with sorafenib were consecutively enrolled.According to the Barcelona Clinic Liver Cancer(BCLC)classification,patients were in the advanced stage(BCLC-C)or in the intermediate stage(BCLC-B)but unfit or unresponsive to other therapeutic strategies.Treatment was evaluated performing a 4-phase computed tomography or magnetic resonance imaging scan every 2-3 mo,and analyzed according to the modified Response Evaluation Criteria in Solid Tumors.Sorafenib was administered at 800 mg/d,until radiological progression or occurrence of unacceptable adverse events(AEs).Univariate and multivariate analyses identified predictors of 16-wk clinical benefit and overall survival.RESULTS:Forty-four patients were enrolled,15 had intermediate HCC and 14 a Child-Pugh score of B7.AEs caused treatment interruption in 19 patients(43%),and median treatment duration was shorter in this subset(5 wk vs 19 wk,P<0.001)and in the BCLC-C subgroup(13 wk vs 40 wk,P=0.015).No significant differences in the reason for treatment interruption or in treatment duration were found comparing patients in Child-Pugh class A vs B or in patients older or younger than 70 years.After 16 wk of treatment,18 patients(41%)had stable disease or partial response.Patients with viral infection or BCLC-C were at higher risk of disease progression.ECOG,extrahepatic spread,macrovascular invasion,alpha-fetoprotein or alkaline phosphatase levels at admission were independent predictors of overall survival.CONCLUSION:In patients with cirrhosis and HCC treated with sorafenib,AEs are a common cause of early treatment withdrawal.Vascular invasion and extrahepatic spread condition early response to treatment and survival.Baseline biochemical parameters may be helpful to identify patients at higher risk of shorter overall survival. | Andrea L Inghilesi Donatella Gallori Lorenzo Antonuzzo Paolo Forte Daniela Tomcikova Umberto Arena Stefano Colagrande Silvia Pradella Bernardo Fani Elena Gianni Luca Boni Giacomo Laffi Francesco Di Costanzo Fabio Marra | 2014 | World Journal of Gastroenterology2014，20，3： | 1 |
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