The Liver Meeting

The 2015, 66th Annual Meeting of the American Association for the Study of Liver Diseases was attended by 9,500 hepatologists and hepatology health professionals from across the nation and around the world.

Some presenters are active cholangiocarcinoma medical advisors and some will present at our upcoming annual conference as well. Others knew of our organization whereas some (predominantly non US physicians and researchers) were not aware of the Cholangiocarcinoma Foundation. Note that Saudi Arabia’s attendance was comprised of 125 attendees; many others came from Poland, China, and Japan, the UK, US and other countries.

Melinda and I were busy interacting, explaining and sharing thoughts and knowledge with hundreds of physicians and researchers. We had not anticipated the demand for our material i.e. the biliary book, pamphlets, pens and wristbands etc. and contemplated requesting an additional shipment. But, given the fact that this was a three day conference only, we promised shipments to offices and/or institutions to wherever in the world it may be. Physicians from foreign countries insisted on translating our material in their respective languages. We gratefully accepted their offer with hope that patients, wherever they reside, have access to information pertaining to the disease of cholangiocarcinoma.

Rate of occurrence and treatment options were discussed. Melinda spoke of her success with adoptive cell therapy and the immune system to knock out cancer. We all are aware of the publicity surrounding her; but we had not anticipated the request of personal photographs with Melinda. It was heartwarming to see the joy on the faces of physicians and researchers alike. Melinda was a trooper and never hesitated to smile for a photo shoot.

We learned that researchers are gaining a better understanding of cancer cell behavior and cell interaction.

“There are different cellular mechanisms involved in hepatocelluar cancer than in intrahepatic cholangiocarcinoma, but all are related and play similar roles in tumor development”, said Dr. Mark Niven. Researchers are focusing on the interplay between tumor cells and fibroblasts, white blood cells, and connective tissues and blood vessels.
(Fribroblasts are cells in connective tissue that produces collagen and other fibers and are associcated with cancer cells at all stages of cancer progression.

We heard of the growing genetic evidence pointing to a variety of genes that can be either downregulated (decreased) or upregulated (increased.)

In pancreatic cancer, for example, tumor cells make up only 10% of the tumor mass, the remaining cells are a mix of fibroblasts, collagen and other cell types.

A variety of factors in the extracellular environment of tumor cells encourages growth and migration to other tissues. Researcher are trying to understand why, under the wrong circumstances, tumor cells and the microenvironment cause tumor growth and metastases.

“Extracellular vesicles offer new insight in liver disease, diagnoses and treatment” was the title of a workshop led by Drs. Selaru and Patel. .

When a cell needs to move a molecule many times, it uses “vesicles”, cells that are the basic building blocks of all living things said Dr’s Tushar Patel and Florin Selaru, “If we understand how they work in the human body, it may be able to us them as a delivery system for compounds to specific tissues at a specific time.” This understanding could offer dramatic therapeutic advantages.

Liver recipient may benefit from this news.
Immunosuppression can be stopped for a subset of liver transplant recipients. Clinical evidence suggests that it may be possible to halt the administration of these drugs. This understanding is confirmed by clinical research studies. “There is a growing appreciation that long term outcomes of liver transplantations are severely compromised by the toxicity of immunosuppressants” said Dr. Sandy Feng. Other studies may demonstrate that even more liver recipients will benefit from these findings.

It doesn’t surprise us to hear that there is a need for improved liver literacy in the US population. Researchers surveyed 511 people and found that concern and awareness about liver disease ranks very low, especially in comparison to other major diseases.

• A majority of respondents do not think they are at risk for liver disease; they do not think about or discuss it with friends, family, or their physician.
• Nearly half of the respondents assume a person can survive without a liver.
• Most participants were unaware that liver function testing is part of routine bloodwork, and few discussed liver test results with their physician.
• These findings do not reflect general lack of health awareness or knowledge: 91% of participants were aware of tests and values for blood pressure (91%), blood sugar (81%), cholesterol (79%), and body mass index (BMI; 69%), and respondents were much more likely to discuss these with their physician.
• Respondents were more likely to think or worry about other diseases (weight, heart, breast, mental, prostate, colon and kidney) than liver.
• Additionally, respondents reported more stigma associated with liver cirrhosis than with kidney disease, heart disease, cancer (colon, breast, prostate, or lung), diabetes, or reproductive health problems.

A study aimed to determine patient outcome after recurrence of intrahepatic cholangiocarcinoma following resection. . It was concluded that active, local treatment may improve survival and possibly, lead to a cure in patients with localized recurrence of ICC.
This retrospective study involved 128 patients who underwent hepatic resection between April 2001 and April 2013. Recurrence occurred in 78 patients.

Results:
• For the total patient population, the overall survival (OS) rates at 1, 3, and 5 years were 72%, 51%, and 41%, respectively.
• Demographics for the 78 patients who experienced recurrence were 54 men and 21 women with a median age of 63 years.
• The median time from resection to recurrence was 7 months (range, 0~54 months).
• And median survival after recurrence was 9 months (range, 0~108 months).
• After recurrence, OS at 1, 3, and 5 years were 47%, 22%, and 13%.
• Researchers analyzed several clinicopathologic factors of survival for recurred ICC patients.
• Following univariate analysis, 12 factors were significant: sex, recurrent sites, disease-free survival (DFS), cell differentiation, lymphatic invasion, perineural invasion, PV invasion, BD invasion, LN metastasis high CA 19-9, high CA 19-9 at recurrence, whether adjuvant treatment (tx) for recurrence.
• Only two factors were independently significant following multivariate analysis: DFS and whether tx for recurrence.
• Surgery, transarterial chemoembolization (TACE), and radiofrequency ablation (RFA) applied to treat the localized recurrence seemed to show better survival than chemotherapy, radiation therapy, or continuous renal replacement therapy (CCRT).
• A total of 10 patients survived ≥ 3 years after recurrence; eight patients received treatment for localized or intrahepatic recurrence.

Hugs,
Marion