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Tan HY, Liu SQ, Liu YH, Dai GH, Zheng JL, Feng HG. Radiotherapy, tyrosine kinase inhibitors, immune checkpoint inhibitors combined with hepatic arterial infusion chemotherapy of RALOX versus FOLFOX for hepatocellular carcinoma with portal vein tumor thrombus: a propensity score-matching cohort study. Discov Oncol 2025; 16:717. [PMID: 40347357 PMCID: PMC12065692 DOI: 10.1007/s12672-025-02553-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Accepted: 05/02/2025] [Indexed: 05/12/2025] Open
Abstract
BACKGROUND This retrospective study aimed to evaluate the safety and effectiveness of hepatic arterial infusion chemotherapy with raltitrexed and oxaliplatin (RALOX-HAIC) combined with radiotherapy, tyrosine kinase inhibitors, and immune checkpoint inhibitors in patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). METHODS A propensity score-matching (PSM) cohort study was conducted. The tumor response, treatment-related adverse events, survival outcomes were compared. Univariate and multivariate analyses were conducted to explore the risk factors of overall survival (OS). RESULTS Twenty-one pairs of patients were evaluated after PSM. No statistical differences were found in the tumor response, objective response rate, disease control rate, PVTT response, surgical resection rate, metastasis, and mortality between the two groups before and after PSM. Compared with the FOLFOX-HAIC group, the incidences of abdominal pain and fever was lower in the RALOX-HAIC group (P = 0.028, P = 0.029). These differences still had statistical significance after PSM (P = 0.013, P = 0.014). No statistical differences were found in OS and progression-free survival (PFS) between the two groups before and after PSM (Before [OS: hazard ratio(HR) = 1.138; 95%CI 0.569-2.276, P = 0.715; PFS: HR = 0.549; 95%CI 0.195-1.548, P = 0.257; After [OS: HR = 0.998; 95%CI 0.438-2.274, P = 0.995; PFS: HR = 0.792; 95%CI 0.359-1.748, P = 0.564]). The prealbumin < 170 mg/L before therapy was an independent risk factor for OS (HR = 2.234; 95%CI 1.051-4.751; P = 0.037). CONCLUSIONS The RALOX-HAIC combined radiotherapy, TKI, and ICI may provide similar survival advantages with fewer treatment-related abdominal pain and fever compared to FOLFOX-HAIC for HCC patients with PVTT. The prealbumin < 170 mg/L before therapy is an independent risk factor for OS.
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Affiliation(s)
- Hao-Yang Tan
- Department of Hepatobiliary Surgery, the Chongqing University Jiangjin Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Shuang-Quan Liu
- Department of Hepatobiliary Surgery, the Chongqing University Jiangjin Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yan-Han Liu
- Department of Radiology, the Chongqing University Jiangjin Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Guo-Hua Dai
- Department of Hepatobiliary Surgery, the Chongqing University Jiangjin Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jiu-Ling Zheng
- Department of Hepatobiliary Surgery, the Chongqing University Jiangjin Hospital, School of Medicine, Chongqing University, Chongqing, China.
| | - Hua-Guo Feng
- Department of Hepatobiliary Surgery, the Chongqing University Jiangjin Hospital, School of Medicine, Chongqing University, Chongqing, China.
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Zhang H, Xu H, Wen N, Li B, Chen K, Wei Y. Short- and long-term outcomes following laparoscopic liver resection for hepatocellular carcinoma combined with type I/II portal vein tumor thrombus. Updates Surg 2025; 77:427-434. [PMID: 39806238 DOI: 10.1007/s13304-025-02065-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/07/2025] [Indexed: 01/16/2025]
Abstract
BACKGROUND Despite the expanding indications for laparoscopic liver resection (LLR), its role in hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remains unclear. The aim of the current study is to compare the short- and long-term outcomes following LLR and open liver resection (OLR) for HCC with PVTT. METHODS All HCC patients with PVTT registered for surgery between April 2015 and May 2022 were enrolled. Patients were divided into LLR and OLR groups, and postoperative recovery and oncological outcomes were analyzed. RESULTS Twenty-eight patients in the LLR group and one hundred seventeen patients in the OLR group were included for comparison. The blood loss was less and the postoperative hospital stay was shorter in LLR group compared to OLR group both before and after propensity score matching. The median recurrence-free survival (RFS) time did not significantly differ between the two groups (8.0 months [95% CI 3.1-13.0] vs. 7.5 months [95% CI 6.0-9.1]; P = 0.845). In stratified analysis, both the recurrence pattern and the median RFS time were comparable between the LLR group and the OLR group in type I PVTT (7.23 [95% CI 0.35-14.12] vs. 7.17 months [95% CI 3.49-10.85]; P = 0.794) and type II PVTT (8.96 [95% CI 0-19.56] vs. 7.60 months [95% CI 5.98-9.22], P = 0.651), respectively. The multivariate regression analysis showed that the tumor size ≥ 10 cm, AFP > 200 ng/ml, and HBV-DNA > 1000 copies/ml were independent risk factors for RFS. CONCLUSION LLR for HCC patients with type I/II PVTT could be safely performed with superior short-term recovery and similar long-term survival compared to OLR. Larger tumor size, higher AFP, and elevated HBV-DNA levels contribute to worse RFS.
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Affiliation(s)
- Haili Zhang
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, 37 Guo Xue Road, Wu hou District, Chengdu, 610041, China
| | - Hongwei Xu
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, 37 Guo Xue Road, Wu hou District, Chengdu, 610041, China
| | - Ningyuan Wen
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Bo Li
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, 37 Guo Xue Road, Wu hou District, Chengdu, 610041, China
| | - Kefei Chen
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, 37 Guo Xue Road, Wu hou District, Chengdu, 610041, China
| | - Yonggang Wei
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, 37 Guo Xue Road, Wu hou District, Chengdu, 610041, China.
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Ye C, Ou M, Wen Z, Xu B, Lu T, Guo Y, Sun X. Efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma with macrovascular invasion: a single-center retrospective analysis. World J Surg Oncol 2024; 22:260. [PMID: 39342303 PMCID: PMC11439314 DOI: 10.1186/s12957-024-03538-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 09/20/2024] [Indexed: 10/01/2024] Open
Abstract
Objective The influence of macrovascular invasion on the therapeutic efficacy of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) in hepatocellular carcinoma (HCC) patients has not been previously reported. This study primarily examines the therapeutic effect of ALPPS in treating HCC with macrovascular invasion. Methods 89 patients who underwent ALPPS at the First Affiliated Hospital of Guangxi Medical University from December 2016 to December 2021 were included. Patients were categorized into three groups based on macrovascular invasion status: pure HCC, HCC with portal vein tumor thrombus (PVTT), and HCC with hepatic vein tumor thrombus (HVTT). Outcome measures such as postoperative complications, liver hyperplasia rates, and survival times were compared across the groups. Results The study comprised 44 patients without macrovascular invasion and 45 cases with it, including 37 PVTT and 8 HVTT cases. Patients with PVTT or HVTT had a higher rate of complications and liver failure after the first ALPPS stage compared to those without macrovascular invasion (P = 0.018, P = 0.036). This trend was also observed in the stratified analysis of severe complications. However, no significant differences were found in these outcomes after the second ALPPS stage among the groups. The volume and rate of future liver remnant proliferation between the two stages of ALPPS were not statistically different among the groups, with median overall survival times of 42, 39, and 33 months, and progression-free survival times of 30, 24, and 14 months, respectively (P = 0.412 and P = 0.281). Conclusion ALPPS for HCC with macrovascular invasion was considered safe, feasible, and effective, as it achieved therapeutic effects comparable to those in cases without macrovascular invasion.
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Affiliation(s)
- Chunhui Ye
- The Medicine Center of Transplantation, the Second Affiliated Hospital of Guangxi Medical University, Nanning, 530000, China
- The Medical Research Center of Organ Transplantation of Guangxi province, Nanning, 530000, China
- The Key Laboratory of Organ Donation and Transplantation of Guangxi province, Nanning, 530000, China
| | - Meifang Ou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Zhang Wen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Banghao Xu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Tingting Lu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Ya Guo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Xuyong Sun
- The Medicine Center of Transplantation, the Second Affiliated Hospital of Guangxi Medical University, Nanning, 530000, China.
- The Medical Research Center of Organ Transplantation of Guangxi province, Nanning, 530000, China.
- The Key Laboratory of Organ Donation and Transplantation of Guangxi province, Nanning, 530000, China.
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Chen QF, Jiang XY, Hu Y, Chen S, Yi JZ, Zhong SX, Wang JL, Lyu N, Zhao M. Additional Hepatic Arterial Infusion Chemotherapy to Sorafenib Was Cost-Effective for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombosis. J Hepatocell Carcinoma 2024; 11:1473-1479. [PMID: 39105210 PMCID: PMC11298563 DOI: 10.2147/jhc.s470470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/14/2024] [Indexed: 08/07/2024] Open
Abstract
Purpose The combination of sorafenib and hepatic arterial infusion chemotherapy (SoHAIC) has shown to enhance overall survival rates in patients with advanced hepatocellular carcinoma and major portal vein tumor thrombosis (HCC-Vp3-4) compared to sorafenib alone. Our objective was to evaluate the cost-effectiveness of SoHAIC versus sorafenib for the treatment of HCC-Vp3-4, taking into account the viewpoint of Chinese healthcare payers. Methods This pharmacoeconomic study employed a Markov model to assess the cost-effectiveness of treating HCC-Vp3-4 with SoHAIC in comparison to sorafenib. The patient characteristics were drawn from individuals from the trial conducted between June 2017 and November 2019, with cost and health value data sourced from published literature. The primary outcome measure in this research was the incremental cost-effectiveness ratio (ICER), which indicates the additional cost per quality-adjusted life year (QALY). The willingness-to-pay (WTP) threshold per QALY was set at $30,492.00. Furthermore, 1-way sensitivity and probabilistic sensitivity analyses were carried out to validate the consistency of the results. Results In the baseline scenario, sorafenib resulted in 0.42 QALY at a cost of $10,507.89, while SoHAIC generated 1.66 QALY at a cost of $32,971.56. When comparing SoHAIC to sorafenib, the ICER was $18,237.20 per QALY, which was below the WTP threshold per QALY. Furthermore, the 1-way sensitivity analysis demonstrated that the ICER remained within the WTP threshold despite fluctuations in variables. In the probabilistic sensitivity analysis, SoHAIC had a 98.8% probability of being cost-effective at the WTP threshold, considering a wide range of parameters. Conclusion In this cost-effectiveness evaluation, SoHAIC demonstrated cost-effectiveness over sorafenib for HCC with major portal vein tumor thrombosis, as observed from the perspective of a Chinese payer.
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Affiliation(s)
- Qi-Feng Chen
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Xiong-Ying Jiang
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
- Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510210, People’s Republic of China
| | - Yue Hu
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Song Chen
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Jun-Zhe Yi
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Sui-Xing Zhong
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Jiong-Liang Wang
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Ning Lyu
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Ming Zhao
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
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Fu S, Xu Y, Mao Y, He M, Chen Z, Huang S, Li D, Lv Y, Wu J. Hepatic arterial infusion chemotherapy, lenvatinib plus programmed cell death protein-1 inhibitors: A promising treatment approach for high-burden hepatocellular carcinoma. Cancer Med 2024; 13:e7105. [PMID: 38686567 PMCID: PMC11058683 DOI: 10.1002/cam4.7105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/18/2023] [Accepted: 03/03/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Hepatic arterial infusion chemotherapy (HAIC) has demonstrated remarkable local therapeutic efficacy in treating patients with large unresectable hepatocellular carcinoma (HCC). Additionally, the combination of lenvatinib and programmed cell death protein-1 (PD-1) inhibitors has demonstrated promising antitumor effects in unresectable HCC. Therefore, we conducted a retrospective analysis to evaluate the efficacy and safety of combining HAIC with lenvatinib and PD-1 inhibitors as a first-line therapeutic approach in high-burden HCC patients. METHODS We conducted a retrospective analysis on patients diagnosed with high-burden HCC who had major portal vein tumor thrombosis (Vp3 and Vp4) or tumor occupancy exceeding 50% of the liver. These patients received a first-line treatment consisting of HAIC with a combination of 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX), along with lenvatinib and PD-1 inhibitors between November 2020 and June 2023. The primary endpoints of this study included progression-free survival (PFS) and overall survival (OS), while the secondary endpoints were objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs). RESULTS Ninety-one patients were enrolled in this study, with a median PFS of 8.8 months (95% confidence interval [CI]: 5.75-11.78) and a median OS of 14.3 months (95% CI: 11.23-17.31). According to RECIST 1.1 criteria, the ORR was 52.7%, and DCR was 95.6%. According to the mRECIST criteria, the ORR was 72.5%, and the DCR was 96.5%. Among all patients, 86 (94.5%) experienced TRAEs, and there were no instances of treatment-related deaths. CONCLUSION The combination of HAIC-FOLFOX with lenvatinib and PD-1 inhibitors as a first-line therapy has exhibited notable therapeutic efficacy and well-tolerated adverse events among patients with high-burden HCC.
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Affiliation(s)
- Shumin Fu
- Department of Oncology, The Second Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJixangxiChina
| | - Yongkang Xu
- Department of Oncology, The Second Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJixangxiChina
| | - Ye Mao
- Department of Oncology, The Second Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJixangxiChina
| | - Mengting He
- Department of Oncology, The Second Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJixangxiChina
| | - Zhimeng Chen
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJixangxiChina
| | - Shenglan Huang
- Department of Oncology, The Second Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJixangxiChina
| | - Dan Li
- Department of Oncology, The Second Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJixangxiChina
| | - Yaqin Lv
- Department of Oncology, The Second Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJixangxiChina
| | - Jianbing Wu
- Department of Oncology, The Second Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangJixangxiChina
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Ruiz E, Honles J, Fernández R, Uribe K, Cerapio JP, Cancino K, Contreras-Mancilla J, Casavilca-Zambrano S, Berrospi F, Pineau P, Bertani S. A preoperative risk score based on early recurrence for estimating outcomes after resection of hepatocellular carcinoma in the non-cirrhotic liver. HPB (Oxford) 2024; 26:691-702. [PMID: 38431511 DOI: 10.1016/j.hpb.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 01/15/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Liver resection is the mainstay treatment option for patients with hepatocellular carcinoma in the non-cirrhotic liver (NCL-HCC), but almost half of these patients will experience a recurrence within five years of surgery. Therefore, we aimed to develop a rationale-based risk evaluation tool to assist surgeons in recurrence-related treatment planning for NCL-HCC. METHODS We analyzed single-center data from 263 patients who underwent liver resection for NCL-HCC. Using machine learning modeling, we first determined an optimal cut-off point to discriminate early versus late relapses based on time to recurrence. We then constructed a risk score based on preoperative variables to forecast outcomes according to recurrence-free survival. RESULTS We computed an optimal cut-off point for early recurrence at 12 months post-surgery. We identified macroscopic vascular invasion, multifocal tumor, and spontaneous tumor rupture as predictor variables of outcomes associated with early recurrence and integrated them into a scoring system. We thus stratified, with high concordance, three groups of patients on a graduated scale of recurrence-related survival. CONCLUSION We constructed a preoperative risk score to estimate outcomes after liver resection in NCL-HCC patients. Hence, this score makes it possible to rationally stratify patients based on recurrence risk assessment for better treatment planning.
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Affiliation(s)
- Eloy Ruiz
- Departamento de Cirugía en Abdomen, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; International Joint Laboratory of Molecular Anthropological Oncology, INEN, IRD, Lima, Peru.
| | - Jorge Honles
- International Joint Laboratory of Molecular Anthropological Oncology, INEN, IRD, Lima, Peru; UMR 152 PHARMADEV, Université de Toulouse, IRD, Toulouse, France
| | - Ramiro Fernández
- Departamento de Cirugía en Abdomen, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; International Joint Laboratory of Molecular Anthropological Oncology, INEN, IRD, Lima, Peru
| | - Karla Uribe
- Departamento de Cirugía en Abdomen, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Juan P Cerapio
- International Joint Laboratory of Molecular Anthropological Oncology, INEN, IRD, Lima, Peru; UMR 1037 CRCT, Université de Toulouse, INSERM, Toulouse, France
| | - Karina Cancino
- International Joint Laboratory of Molecular Anthropological Oncology, INEN, IRD, Lima, Peru; UMR 152 PHARMADEV, Université de Toulouse, IRD, Toulouse, France; UMR 1037 CRCT, Université de Toulouse, INSERM, Toulouse, France
| | - Juan Contreras-Mancilla
- International Joint Laboratory of Molecular Anthropological Oncology, INEN, IRD, Lima, Peru; Laboratorio de Investigación Traslacional y Biología Computacional, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sandro Casavilca-Zambrano
- International Joint Laboratory of Molecular Anthropological Oncology, INEN, IRD, Lima, Peru; Departamento de Patología, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Facultad de Ciencias de la Salud, Universidad de Huánuco, Huánuco, Peru
| | - Francisco Berrospi
- Departamento de Cirugía en Abdomen, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Pascal Pineau
- International Joint Laboratory of Molecular Anthropological Oncology, INEN, IRD, Lima, Peru; Unité Organisation Nucléaire et Oncogenèse, INSERM, Institut Pasteur, Paris, France
| | - Stéphane Bertani
- International Joint Laboratory of Molecular Anthropological Oncology, INEN, IRD, Lima, Peru; UMR 152 PHARMADEV, Université de Toulouse, IRD, Toulouse, France.
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Chang X, Li X, Sun P, Li Z, Sun P, Ning S. HAIC Combined with lenvatinib plus PD-1 versus lenvatinib Plus PD-1 in patients with high-risk advanced HCC: a real-world study. BMC Cancer 2024; 24:480. [PMID: 38627684 PMCID: PMC11020267 DOI: 10.1186/s12885-024-12233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The treatment of hepatocellular carcinoma (HCC) patients exhibiting high-risk characteristics (Vp4, and/or bile duct invasion, and/or tumor occupancy ≥ 50%) lacks standardized approaches and yields unfavorable results. This study endeavors to evaluate the safety, efficacy, and prognostic impacts of employing hepatic arterial infusion chemotherapy (HAIC), lenvatinib, and humanized programmed death receptor-1 (PD-1) in the treatment of high-risk HCC patients. METHODS In this retrospective analysis, HCC patients with high-risk features were treated with either lenvatinib combined with PD-1 (LEN-PD1) or a combination of HAIC, lenvatinib, and PD-1 (HAIC-LEN-PD1). The study assessed the antitumor efficacy by calculating overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). Treatment-related adverse events (TRAEs) were analyzed to assess the safety profiles. RESULTS Between June 2019 and September 2022, a total of 61 patients were included in the LEN-PD1 group, while 103 patients were enrolled in the HAIC-LEN-PD1 group. The OS was 9.8 months in the LEN-PD1 group, whereas the HAIC-LEN-PD1 group exhibited a significantly longer median OS of 19.3 months (HR = 0.43, p < 0.001). Furthermore, PFS was notably extended in the HAIC-LEN-PD1 group compared to the LEN-PD1 group (9.6 months vs. 4.9 months, HR = 0.48, p < 0.001). Patients in the HAIC-LEN-PD1 group had a higher ORR and DCR according to the modified RECIST (76.7% vs. 23.0%, p < 0.001; 92.2% vs. 72.1%, p = 0.001). HAIC-LEN-HAIC group led to more adverse events than LEN-PD1 group, most of which were tolerable and controllable. CONCLUSION Lenvatinib, HAIC and PD-1 showed safe and promising anti-tumor activity compared with lenvatinib alone for HCC with high-risk features.
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Affiliation(s)
- Xu Chang
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xinge Li
- Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Peng Sun
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Zhenfeng Li
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Pengfei Sun
- Department of Hepatological Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 250117, Jinan, Shandong, China.
| | - Shangkun Ning
- Department of Interventional Therapy I, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 250117, Jinan, Shandong, China.
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Zhang L, Wang J, Li Y, Hou L, Xia J, Shen J. Implanting Iodine-125 Seed Strand Inside the Portal Vein Stent: An Improved Approach to Endovascular Brachytherapy for Treatment of Patients with Hepatocellular Carcinoma and Main Portal Vein Tumor Thrombus. J Hepatocell Carcinoma 2023; 10:2187-2196. [PMID: 38084210 PMCID: PMC10710807 DOI: 10.2147/jhc.s430686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/09/2023] [Indexed: 07/22/2024] Open
Abstract
PURPOSE To investigate the feasibility and efficacy of implanting an iodine-125 (125I) seed strand inside a portal vein stent (PVS) in the treatment of patients with hepatocellular carcinoma (HCC) and main portal vein tumor thrombus (mPVTT). PATIENTS AND METHODS Twenty-three patients who diagnosed with HCC and mPVTT and underwent endovascular implantation 125I seed strands and portal vein stenting were included in this study. Patients were divided into two groups. For patients in group A (n = 12), the 125I seed strand was placed outside the PVS, and for those in group B (n = 11), the strand was placed inside the PVS. Technical success, pain intensity during the procedure (numeric rating scale), procedure-related complications, changes in liver function, stent patency, and survival rates were recorded and analyzed. RESULTS The procedures were successful in all patients, and no serious procedure-related complications occurred in either group. Pain intensity during the procedure was significantly lower in group B than in group A (2.64 ± 1.50 vs 4.08 ± 1.78, p = 0.048), and there were no significant differences between pre- and post-procedure liver function in either group. The median duration of stent patency was 9 months (95% CI 2.21-15.79 months) in group A and 12 months (95% CI 3.63-18.37 months) in group B (p = 0.670). Median survival was 12 months (95% CI 10.30-13.70 months) in group A and 13 months (95% CI 10.03-15.97 months) in group B (p = 0.822). The cumulative stent patency and survival rates at 3, 6, and 12 months were 75%, 50%, and 41.7%, and 83.3%, 75%, and 50% in group A and 72.7%, 62.3%, and 31.2%, and 90.9%, 80.8%, and 50.5%, respectively. CONCLUSION Implantation of 125I seed strand inside the PVS is effective and feasible for treating patients with HCC and mPVTT.
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Affiliation(s)
- Liang Zhang
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jun Wang
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yang Li
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Leina Hou
- Department of Anesthesiology, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, People’s Republic of China
| | - Jianguo Xia
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jialin Shen
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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9
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Chang X, Wu H, Ning S, Li X, Xie Y, Shao W, Yu J. Hepatic Arterial Infusion Chemotherapy Combined with Lenvatinib Plus Humanized Programmed Death Receptor-1 in Patients with High-Risk Advanced Hepatocellular Carcinoma: A Real-World Study. J Hepatocell Carcinoma 2023; 10:1497-1509. [PMID: 37701565 PMCID: PMC10493101 DOI: 10.2147/jhc.s418387] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/20/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose The treatment of hepatocellular carcinoma (HCC) patients with high-risk features (Vp4, and/or tumor occupancy≥50%) has not been standardized and has poor outcomes. The present study aimed to assess the safety, efficacy, and prognostic impact of lenvatinib, hepatic arterial infusion chemotherapy (HAIC), and humanized programmed death receptor-1 (PD-1) in treating high-risk patients and to explore the biomarkers that may predict the efficacy. Methods HCC patients with high-risk features treated with lenvatinib, HAIC, and PD-1 were analyzed retrospectively. Overall survival (OS), progression-free survival (PFS), duration of response (DOR), objective response rate (ORR), and disease control rate (DCR) were calculated to evaluate the antitumor efficacy. Treatment-related adverse events (TRAEs) were analyzed to assess the safety profiles. Results Between February 2020 and July 2022, 97 patients were enrolled in this retrospective cohort study. The median follow-up time was 447 days. During analysis, 65 patients had disease progression, and 39 patients died. The median PFS and OS were 295 and 579 days, respectively. According to RECIST 1.1 and mRECIST, the ORR was 64.9% and 78.3%, respectively, and the DCR was 92.8%. The median and intrahepatic DOR was 363 and 462 days, respectively. Treatment-related grade 3 or 4 adverse events occurred in 64 (65.9%) patients, and the most common adverse events were hypertension (9.3%), thrombocytopenia (7.2%), and elevated aspartate transaminase (7.2%). Participants with low levels of serum procalcitonin (PCT) had satisfactory prognosis. Conclusion Lenvatinib, HAIC, and PD-1 were safe and showed promising antitumor activity against HCC with high-risk features. The initial levels of procalcitonin might be the predictive biomarkers for the combined treatment.
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Affiliation(s)
- Xu Chang
- Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300000, People’s Republic of China
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People’s Republic of China
| | - Huiyong Wu
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People’s Republic of China
| | - Shangkun Ning
- Department of Interventional Therapy I, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People’s Republic of China
| | - Xinge Li
- Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250117, People’s Republic of China
| | - Yinfa Xie
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People’s Republic of China
| | - Wenbo Shao
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People’s Republic of China
| | - Jinming Yu
- Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300000, People’s Republic of China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong, 250117, People’s Republic of China
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10
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Chen J, Lai L, Zhou C, Luo J, Wang H, Li M, Huang M. Safety, efficacy, and survival of drug-eluting beads-transarterial chemoembolization vs. conventional-transarterial chemoembolization in advanced HCC patients with main portal vein tumor thrombus. Cancer Imaging 2023; 23:70. [PMID: 37481660 PMCID: PMC10362718 DOI: 10.1186/s40644-023-00581-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/01/2023] [Indexed: 07/24/2023] Open
Abstract
OBJECTIVES To compare the efficacy, overall survival (OS) and safety of drug-eluting beads-TACE (DEB-TACE) and C-TACE as initial treatment in advanced hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (mPVTT). METHODS The medical records of consecutive advanced HCC patients with mPVTT who underwent initial DEB-TACE or C-TACE from September 2015 to October 2021 were retrospectively evaluated. Treatment crossover was allowed in this retrospective research. The adverse events, disease control rate (DCR), time to tumor progression (TTP) and OS of patients who underwent DEB-TACE were compared with those of patients who underwent C-TACE. RESULTS Eighty-three patients were included: 42 patients in DEB-TACE group and 41 patients in C-TACE group. DEB-TACE could be safely performed in HCC patients with mPVTT, and they gained a better DCR than those submitted to the C-TACE (76.2% vs. 53.7%, P = 0.031), which might have resulted in longer TTP (median TTP: 9.0 months vs. 3.0 months, P < 0.001). Furthermore, DEB-TACE showed significant OS benefits compared with C-TACE (median OS: 12.0 months vs. 5.0 months, P < 0.001). DEB-TACE, absence of arterioportal shunts (APS), leisons with capsular non-infiltration were found to be independent prognostic factors for better OS. Furthermore, subgroup analysis proved that patients with good DCR gained longer OS in DEB-TACE group. CONCLUSIONS DEB-TACE could be safely performed and improve the DCR of HCC patients with mPVTT, which resulting in longer TTP and OS, compared with C-TACE.
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Affiliation(s)
- Junwei Chen
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Lisha Lai
- Department of Radiology, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, 510180, China
| | - Churen Zhou
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Junyang Luo
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Haofan Wang
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Mingan Li
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
| | - Mingsheng Huang
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
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11
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Li QM, Sun QC, Jian Y, He JZ, Zhu HB, Hong C, Zeng L, Li RN, Wang JR, Li Y, Chen LY, Weng X, Liu L, Dong HZ, Xiao LS, Cui H. Efficacy and safety of different PD-1 inhibitors in combination with lenvatinib in the treatment of unresectable primary liver cancer: a multicentre retrospective study. Discov Oncol 2023; 14:105. [PMID: 37336826 DOI: 10.1007/s12672-023-00708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are safe and efficacious treatments for advanced primary liver cancer (PLC). The efficacy of different ICIs in the treatment of liver cancer remains unclear. The purpose of this study was to explore whether there is a difference in the efficacy and safety of various programmed cell death protein 1 (PD-1) inhibitors in combination with lenvatinib in the treatment of unresectable PLC. Patients with PLC treated with lenvatinib in combination with PD-1 inhibitors (camrelizumab, tislelizumab, sintilimab, or pembrolizumab) between January 2018 and December 2021 were retrospectively enrolled. Tumor response, adverse events, and grades were evaluated. Kaplan-Meier analysis and log-rank test were used to compare the overall survival and progression-free survival of patients treated with different PD-1 inhibitors. Cox regression analysis was used for univariate and multivariate analyses to identify clinical variables related to treatment efficacy. This study included a total of 176 patients who received a combination of lenvatinib and PD-1 inhibitors. Of these, 103 patients received camrelizumab, 44 received tislelizumab, 20 received sintilimab, and 9 received pembrolizumab. There was no significant difference in the pairwise comparison of camrelizumab, tislelizumab, sintilimab, and pembrolizumab using Kaplan-Meier survival analysis. Adverse events occurred in 40 (22.7%) patients (grade ≥ 3, 2.3%). The incidence of grade 3 adverse events among the four PD-1 inhibitor groups was below 5%. Camrelizumab, tislelizumab, sintilimab, and pembrolizumab are viable options for patients with unresectable PLC. These PD-1 inhibitors in combination with lenvatinib showed good safety profiles. The results guide selecting treatment for patients with unresectable PLC.
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Affiliation(s)
- Qi-Mei Li
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Qing-Can Sun
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yan Jian
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, 330029, China
| | - Jing-Zhe He
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Hong-Bo Zhu
- Department of Oncology, The First Affiliated Hospital of University of South China, Hengyang, 421001, China
| | - Chang Hong
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Lin Zeng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Rui-Ning Li
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jia-Ren Wang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yan Li
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Li-Ya Chen
- Department of Medical Quality Management, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xie Weng
- Integrated Hospital of Traditional Chinese Medicine, Cancer Center, Southern Medicine University, Guangzhou, 510315, China
| | - Li Liu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Nanfang Hospital, Big Data Center, Southern Medical University, Guangzhou, 510515, China
| | - Han-Zhi Dong
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, 330029, China.
| | - Lu-Shan Xiao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Hao Cui
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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12
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Ji X, Xu Z, Sun J, Li W, Duan X, Wang Q. Lenvatinib with or without stereotactic body radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis: a retrospective study. Radiat Oncol 2023; 18:101. [PMID: 37308914 DOI: 10.1186/s13014-023-02270-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/26/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with hepatocellular carcinoma (HCC) involving portal vein tumor thrombosis (PVTT) are presently lacking effective treatment options. We aimed to compare the efficacy and safety of lenvatinib with or without SBRT for HCC with PVTT. MATERIALS AND METHODS This retrospective analysis included 37 patients treated with lenvatinib in combination with SBRT and 77 patients treated with lenvatinib alone from August 2018 to August 2021. Overall survival (OS), progression-free survival (PFS), intrahepatic PFS (IHPFS) and objective remission rate (ORR) were compared between the two groups, while adverse events (AEs) was analyzed between the two groups to assess safety profiles. RESULTS Median OS, PFS and IHPFS were significantly prolonged in the combination treatment group compared with the single treatment group (median OS, 19.3 vs. 11.2 months, p < 0.001; median PFS: 10.3 vs. 5.3 months, p < 0.001; median IHPFS, 10.7 vs. 5.3 months, p < 0.001). Moreover, a higher ORR (56.8% vs. 20.8%, P < 0.001) were observed in the lenvatinib combined with SBRT group. In subgroup analyses of Vp1-2 and Vp3-4 group, median OS, PFS and IHPFS were also significantly longer in the lenvatinib combined with SBRT group than those in the lenvatinib alone group. AEs in the combined therapy group were mostly manageable and the incidence was not statistically significant compared to the monotherapy group. CONCLUSION Lenvatinib plus SBRT had a significantly better survival benefit than lenvatinib monotherapy in the treatment of HCC patients with PVTT and was well tolerated.
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Affiliation(s)
- Xiaoquan Ji
- Department of Radiation Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhe Xu
- Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
| | - Jing Sun
- Department of Radiation Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Wengang Li
- Department of Radiation Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Xuezhang Duan
- Department of Radiation Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Quan Wang
- Department of Radiation Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China.
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Chen Y, Hong H, Fang W, Zhang X, Luo H, Chen Z, Yu J, Fan W, Chi X, Peng Y. Toripalimab in combination with Anlotinib for unresectable hepatocellular carcinoma after SBRT: A prospective, single-arm, single-center clinical study. Front Oncol 2023; 13:1113389. [PMID: 37007075 PMCID: PMC10065408 DOI: 10.3389/fonc.2023.1113389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
ObjectiveExposing tumor antigens to the immune system is the key to ensuring the efficacy of immunotherapy. SBRT is the main way to reveal the specifical antigens of tumors which can enhance the immune response. We aimed to explore the clinical efficacy and safety of Toripalimab combined with Anlotinib for uHCC after SBRT.MethodsThis is a prospective, single-arm, explorative clinical study. uHCC patients with an ECOG PS score of 0–1, Child–Pugh class A or B, and BCLC stage B or C were included and treated with SBRT(8Gy*3) followed by 6-cycle combinational therapy with Toripalimab and Anlotinib. The primary endpoint was progression-free survival (PFS) and the secondary endpoints were objective response rate (ORR), disease control rate (DCR), overall survival (OS), and incidence of treatment-related adverse events (TRAEs). Continuous variables were presented as medians and ranges. Survivals were studied with the Kaplan-Meier method. Categorical data were expressed as n (percentage).ResultsBetween June 2020 and October 2022, a total of 20 patients with intermediate-advanced uHCC were enrolled. All cases had multiple intrahepatic metastases, or macrovascular invasion, or both, among whom 5 cases with lymph node or distant metastases. Until September 2022, the median follow-up time was 7.2 months (range, 1.1-27.7 months). Median survival time could not be assessed at the moment, based on iRecist, median PFS was 7.4 months (range, 1.1-27.7 months), ORR 15.0%, and DCR 50.0%. 14 patients experienced treatment-related adverse events with an incidence of 70%. The overall survival rates at 18 months and 24 months were 61.1% and 50.9%, respectively. And the progression-free survival rates were 39.3% and 19.7%.ConclusionExposure of specific antigens of HCC via SBRT may improve the efficacy of combinational therapy with Toripalimab and Anlotinib for uHCC with manageable adverse effects, which deserves further exploration.Clinical trial registrationwww.clinicaltrials.gov, identifier ChiCTR2000032533.
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Affiliation(s)
- Yongbiao Chen
- Department of Hepatobiliary Surgery, 900 Hospital of the Joint Logistics Support Force, Fuzhou, China
| | - Hanyin Hong
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Wenzheng Fang
- Department of Oncology, 900 Hospital of the Joint Logistics Support Force, Fuzhou, China
| | - Xia Zhang
- Department of Hepatobiliary Disease, 900 Hospital of the Joint Logistics Support Force, Fuzhou, China
| | - Huachun Luo
- Department of Radiology, 900 Hospital of the Joint Logistics Support Force, Fuzhou, China
| | - Zhijian Chen
- Department of Hepatobiliary Surgery, 900 Hospital of the Joint Logistics Support Force, Fuzhou, China
| | - Jianda Yu
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Weiqiang Fan
- Medical Oncology of Cangshan Hospital Area, 900 Hospital of the Joint Logistics Support Force, Fuzhou, China
| | - Xiaobin Chi
- Department of Hepatobiliary Surgery, 900 Hospital of the Joint Logistics Support Force, Fuzhou, China
- *Correspondence: Yonghai Peng, ; Xiaobin Chi,
| | - Yonghai Peng
- Medical Oncology of Cangshan Hospital Area, 900 Hospital of the Joint Logistics Support Force, Fuzhou, China
- *Correspondence: Yonghai Peng, ; Xiaobin Chi,
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14
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Zhang ZH, Hou SN, Yu JZ, Zhang W, Ma JQ, Yang MJ, Liu QX, Liu LX, Luo JJ, Qu XD, Yan ZP. Combined iodine-125 seed strand, portal vein stent, transarterial chemoembolization, lenvatinib and anti-PD-1 antibodies therapy for hepatocellular carcinoma and Vp4 portal vein tumor thrombus: A propensity-score analysis. Front Oncol 2023; 12:1086095. [PMID: 36741718 PMCID: PMC9893110 DOI: 10.3389/fonc.2022.1086095] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023] Open
Abstract
Objective To evaluate the safety and efficacy of interventional therapy (iodine-125[125I] seed strand and portal vein stent [PVS] implantation plus transarterial chemoembolization [TACE]) combined with systemic therapy (lenvatinib plus anti-PD-1 antibody) as first-line treatment for hepatocellular carcinoma (HCC) patients with Vp4 portal vein tumor thrombus (PVTT). Patients and methods From December 2018 to October 2021, 87 HCC patients with Vp4 PVTT were included in this single-center retrospective study. Forty-seven patients underwent interventional therapy combined with lenvatinib and anti-PD-1 antibody (group A), while 40 cases underwent interventional therapy combined with lenvatinib only (group B). Overall response rate (ORR), stent occlusion rates (SOR), median overall survival (OS), median progression-free survival (PFS) and median stent patency time (SPT) were compared between the 2 groups. Results The mean intended dose (r = 10 mm; z = 0; 240 days) was 64.9 ± 1.0 Gy and 64.5 ± 1.1 Gy in group A and B, respectively (p = 0.133). ORR and SOR were significantly different between group A and B (ORR, 55.3% vs 17.5%, p < 0.001; SOR, 12.8% vs 35.0%, p = 0.014). In the propensity-score matching (PSM) cohort, the median OS, median PFS and median SPT were significantly longer in group A compared with group B (32 PSM pairs; OS, 17.7 ± 1.7 vs 12.0 ± 0.8 months, p = 0.010; PFS, 17.0 ± 4.3 vs 8.0 ± 0.7 months, p < 0.001; SPT, not-reached vs 12.5 ± 1.1 months, p = 0.028). Conclusion This interventional therapy combined with lenvatinib and anti-PD-1 antibody is safe and effective for HCC patients with Vp4 PVTT.
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Affiliation(s)
- Zi-Han Zhang
- Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China,National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Si-Nan Hou
- Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China,National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jia-Ze Yu
- Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China,National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen Zhang
- Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China,National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing-Qin Ma
- Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China,National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min-Jie Yang
- Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China,National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qing-Xin Liu
- Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China,National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ling-Xiao Liu
- Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China,National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian-Jun Luo
- Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China,National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xu-Dong Qu
- Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China,National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Zhi-Ping Yan, ; Xu-Dong Qu,
| | - Zhi-Ping Yan
- Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China,National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Zhi-Ping Yan, ; Xu-Dong Qu,
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15
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Nguyen-Khac V, Brustia R, Rhaiem R, Regnault H, Sessa A, Mule S, Duvoux C, Laurent A, Leroy V, Calderaro J, Luciani A, Roudot-Thoraval F, Amaddeo G, Sommacale D. Liver resection for single large hepatocellular carcinoma: a prognostic factors study. Ann Hepatol 2022; 27:100739. [PMID: 35781089 DOI: 10.1016/j.aohep.2022.100739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Liver resection is the only curative therapeutic option for large hepatocellular carcinoma (> 5 cm), but survival is worse than in smaller tumours, mostly due to the high recurrence rate. There is currently no proper tool for stratifying relapse risk. Herein, we investigated prognostic factors before hepatectomy in patients with a single large hepatocellular carcinoma (HCC). MATERIAL AND METHODS We retrospectively identified 119 patients who underwent liver resection for a single large HCC in 2 tertiary academic French centres and collected pre- and post-operative clinical, biological and radiological features. The primary outcome was overall survival at five years. Secondary outcomes were recurrence-free survival at five years and prognostic factors for recurrence. RESULTS A total of 84% of the patients were male, and the median age was 66 years old (IQR 58-74). Thirty-nine (33%) had Child-Pugh A cirrhosis, and the mean Model for End-Stage Liver Disease (MELD) score was 6 (6-6). The aetiology of liver disease was predominantly alcohol-related (48%), followed by nonalcoholic steatohepatitis (22%), hepatitis B (18%) and hepatitis C (10%). The mean tumour size was 70 mm (55-110). The median overall survival was 72.5 months (IC 95%: 56.2-88.7), and the five-year overall survival was 55.1 ± 5.5%. The median recurrence-free survival was 26.6 months (95% CI: 16.0-37.1), and the five-year recurrence-free survival rate was 37.8 ± 5%. In multivariate analysis, preoperative prognostic factors for recurrence were baseline alpha-fetoprotein (AFP) > 7 ng/mL (p<0.001), portal veinous invasion (p=0.003) and cirrhosis (p=0.020). Using these factors, we created a simple recurrence-risk scoring system that classified three groups with distinct disease-free survival medians (p<0.001): no risk factors (65 months), 1 risk factor (36 months), and ≥2 risk factors (8.9 months). CONCLUSION Liver resection is the only curative option for large HCC, and we confirmed that survival could be acceptable in experienced centres. Recurrence is the primary issue of surgery, and we proposed a simple preoperative score to help identify patients with the most worrisome prognosis and possible candidates for combined therapy.
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Affiliation(s)
- Vincent Nguyen-Khac
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Raffaele Brustia
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Digestive and Hepatobiliary Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Rami Rhaiem
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, Robert Debré University Hospital, University Reims Champagne-Ardenne, Reims 51100, France
| | - Hélène Regnault
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France; Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France
| | - Anna Sessa
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France; Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Sebastien Mule
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Christophe Duvoux
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France; Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Alexis Laurent
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Digestive and Hepatobiliary Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Vincent Leroy
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France; Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France
| | - Julien Calderaro
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Pathology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Alain Luciani
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Francoise Roudot-Thoraval
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Giuliana Amaddeo
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France; Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France.
| | - Daniele Sommacale
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Digestive and Hepatobiliary Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France.
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Sena G, Paglione D, Gallo G, Goglia M, Osso M, Nardo B. Surgical Resection of a Recurrent Hepatocellular Carcinoma with Portal Vein Thrombosis: Is It a Good Treatment Option? A Case Report and Systematic Review of the Literature. J Clin Med 2022; 11:5287. [PMID: 36142934 PMCID: PMC9502949 DOI: 10.3390/jcm11185287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/07/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the sixth most frequent diagnosed tumor worldwide and the third leading cause of cancer related death. According to the EASL Guidelines, HCC with portal vein tumor thrombosis (PVTT) is classified as an advanced stage (BCLC stage C) and the only curative option is represented by systemic therapy. Therefore, treatment of HCC patients with PVTT remains controversial and debated. In this paper, we describe the case of a 66-year-old man with a recurrent HCC with PVTT who underwent surgical resection. A systematic review of the literature, comparing surgical resection with other choices of treatment in HCC patients with PVTT, is reported. METHODS A systematic review of the literature regarding all prospective and retrospective studies comparing the survival outcomes of HCC patients with PVTT treated with surgical resections (SRs) or other non-surgical treatments (n-SRs) has been conducted. CASE PRESENTATION A 66-year-old Caucasian man with a history of Hepatitis C Virus (HCV) related liver cirrhosis and previous hepatocellular carcinoma of the VI segment treated with percutaneous ethanol infusion (PEI) seven years before presented to our clinics. A new nodular hypoechoic lesion in the VI hepatic segment was demonstrated on follow-up ultrasound examination. A hepatospecific magnetic resonance imaging (MRI) scan confirmed also the presence of a 18 × 13 mm nodular lesion in the V hepatic segment with satellite micronodules associated with V-VIII sectoral portal branch thrombosis. The case was then discussed at the multidisciplinary team meeting, and it was decided to perform a right hepatectomy. The postoperative course was regular and uneventful, and the discharge occurred seven days after the surgery. At eight-month follow-up, there was no clinical nor radiological evidence of neoplastic recurrence, with well-preserved liver function (Child-Pugh A5). RESULTS Nine studies were included in the review. Median Overall Survaival (OS) ranged from 8.2 to 30 months for SRs patients and from 7 to 13.3 for n-SRs patients. In SR patients, one-year survival ranged from 22.7% to 100%, two-year survival from 9.8% to 100%, and three-year survival from 0% to 71%. In n-SRs patients, one-year survival ranged from 11.8% to 77.6%, two-year survival from 0% to 47.8%, and three-year survival from 0% to 20.9%. CONCLUSION The present systematic literature review and the case presented demonstrated the efficacy of surgery as a first-line treatment in well-selected HCC patients with PVTT limited or more distal to the right and left portal branches. However, further studies, particularly randomized trials, need to be conducted in future to better define the surgical indications.
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Affiliation(s)
- Giuseppe Sena
- Department of Vascular Surgery, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy
| | - Daniele Paglione
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
| | - Gaetano Gallo
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Marta Goglia
- Department of General Surgery, Sant’Andrea University Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Mariasara Osso
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
| | - Bruno Nardo
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
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Awiwi MO, Elsayes KM, Mohamed YI, Altameemi L, Gjoni M, Irshad OM, Sayed Ahmed A, Kaseb AO, Salem U. The Prognostic Value of Baseline Clinical and Radiologic Imaging Features in Patients with Unresectable Hepatocellular Carcinoma Treated with Atezolizumab Plus Bevacizumab. J Hepatocell Carcinoma 2022; 9:913-927. [PMID: 36065424 PMCID: PMC9440709 DOI: 10.2147/jhc.s379428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To identify prognostic clinical and radiologic features in patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab. Patients and Methods Clinical and imaging records of patients with unresectable HCC were retrospectively reviewed, and baseline features were recorded. Patients’ records and imaging studies were used to determine the patients’ overall survival (OS) and progression-free survival (PFS). Univariate and multivariate analyses were performed to determine prognostic features. Subanalyses of treatment-naïve patients (who never received local or systemic therapy) and previously treated patients were also performed. Results Fifty-five patients were included in the final analysis, 23 (41.8%) of whom were treatment naïve. The median PFS and OS for the entire cohort were 3.0 months and 7.9 months. The 3-, 6- and 12-month OS rates were 85.5%, 79.8% and 45.7%, respectively. The 3-, 6- and 12-month PFS rates were 50.1%, 41.2% and 20.1%, respectively. On multivariate analysis, independent prognostic features for poor PFS of the entire cohort were pleural effusions (p = 0.047, HR: 6.3; CI: 1.03–38.90) and hepatic vein tumor thrombus (p = 0.005; HR: 23.37; CI: 2.63–207.67); independent prognostic features for poor OS were ascites (p = 0.008; HR: 37.37; CI: 2.53–467.64), pleural effusion (p = 0.003; HR: 110.17; CI: 5.00–2426.54), and low (<40HU) pre-contrast attenuation on CT images (p = 0.007; HR: 0.09; CI: 0.02–0.53). On subanalysis of treatment-naïve patients, the median OS and PFS were 7.4 months and 2.8 months, respectively. The 3-, 6- and 12-month PFS rates were 43.5%, 38.6% and 24.8%, respectively. Pleural effusion was the only independent poor prognostic feature (p = 0.036; HR: 206.34; CI: 1.41–30,167.58). Conclusion Independent prognostic features for survival outcomes include the presence of ascites, pleural effusions, hepatic vein tumor thrombus, and HCC with low attenuation (<40 HU) on unenhanced CT images. Although several biochemical variables were significant on univariate analysis, none were independent predictors of OS or PFS.
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Affiliation(s)
- Muhammad O Awiwi
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Correspondence: Khaled M Elsayes, 1515 Holcombe Blvd, Houston, TX, 77030, USA, Tel +1 877 632-6789, Fax +1 713 794-4535, Email
| | - Yehia I Mohamed
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lina Altameemi
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Migena Gjoni
- Department of Internal Medicine, The of Istanbul-Cerrahpasa Hospital, Istanbul, Turkey
| | | | - Ahmed Sayed Ahmed
- Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmad O Kaseb
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Usama Salem
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Yang SB, Zhang JH, Fu YF, Wang R. TACE with portal vein radioactive seeds for HCC with portal vein tumor thrombus: a meta-analysis. MINIM INVASIV THER 2022; 31:856-864. [PMID: 35238280 DOI: 10.1080/13645706.2022.2045326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To assess the efficacy and safety of transarterial chemoembolization (TACE) and portal vein radioactive seed insertion (RSI) combination in hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). MATERIAL AND METHODS The relevant databases were searched from the earliest to January 2021. The endpoints included treatment response, treatment side effects, and overall survival (OS). RESULTS Nine studies were included in this meta-analysis. The pooled total response (TR, p = 0.55) and disease control (DC, p = 0.13) rates for HCC were similar between the two treatment groups. The pooled TR (p = 0.0004) and DC (p < 0.0001) rates for PVTT were both significantly higher in the TACE with portal vein RSI group than in the TACE without portal vein RSI group. The pooled HR for OS was significantly better in the TACE with portal vein RSI group than in the TACE without portal vein RSI group (p < 0.00001). The pooled rates of fever (p = 0.97), vomiting (p = 0.64), and myelosuppression (p = 0.65) were similar between the two groups. CONCLUSION Compared to traditional TACE, TACE combined with portal vein RSI can effectively prolong the patients' OS and decrease PVTT disease progression.
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Affiliation(s)
- Song-Bo Yang
- Department of Nuclear Medicine, Southwest Hospital of The Army Medical University, Chongqing, China
| | - Jian-Hua Zhang
- Department of Interventional Radiology, Fengjie People's Hospital, Chongqing, China
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Ru Wang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
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Zheng K, Zhu X, Fu S, Cao G, Li WQ, Xu L, Chen H, Wu D, Yang R, Wang K, Liu W, Wang H, Bao Q, Liu M, Hao C, Shen L, Xing B, Wang X. Sorafenib Plus Hepatic Arterial Infusion Chemotherapy versus Sorafenib for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombosis: A Randomized Trial. Radiology 2022; 303:455-464. [PMID: 35103539 DOI: 10.1148/radiol.211545] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The prognosis of hepatocellular carcinoma (HCC) with major portal vein tumor thrombosis (PVTT) is dismal after standard treatment with sorafenib. Hepatic arterial infusion chemotherapy (HAIC) has been suggested for patients with HCC and major PVTT. Purpose To compare the efficacy and safety of sorafenib plus 3cir-OFF HAIC versus sorafenib alone for advanced HCC with major PVTT. Materials and Methods This phase II trial recruited systemic treatment-naïve patients with HCC and major PVTT (portal vein invasion grade Vp3 [first branch] and Vp4 [main trunk]) between June 2017 and November 2019. Patients were randomly assigned (1:1 ratio) to receive sorafenib (400 mg twice daily) plus 3cir-OFF HAIC (35 mg/m2 oxaliplatin [hours 0-2] followed by 600 mg/m2 5-fluorouracil [hours 2-24], days 1-3) with a standardized percutaneous port catheter system or sorafenib alone (400 mg twice daily) every 4 weeks. The primary end point was overall survival (OS). The secondary end points were objective response rate, progression-free survival (PFS), and safety. OS and PFS were assessed using the Kaplan-Meier method and log-rank test. Results The intent-to-treat population included 64 patients, with 32 in each group. The median OS was 16.3 months (95% CI: 0.0, 35.5) with sorafenib plus HAIC and 6.5 months (95% CI: 4.4, 8.6) with sorafenib alone (hazard ratio [HR] = 0.28; 95% CI: 0.15, 0.53; P < .001). A higher objective response rate (41% [n = 13] vs 3% [n = 1], P < .001) and a longer median PFS (9.0 months vs 2.5 months; HR = 0.26; 95% CI: 0.15, 0.47; P < .001) were observed in the sorafenib plus HAIC group. Grade 3 or 4 adverse events were more frequent in the sorafenib plus HAIC group, including diarrhea (n = 7 [22%] vs n = 5 [16%]), hand-foot syndrome (n = 6 [19%] vs n = 2 [6%]), and thrombocytopenia (n = 7 [22%] vs n = 0). Conclusion Sorafenib plus 3cir-OFF hepatic arterial infusion chemotherapy may be a promising treatment in patients with hepatocellular carcinoma and major portal vein tumor thrombosis because of the improved survival and an acceptable safety profile. Clinical trial registration no. NCT03009461 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Chung in this issue.
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Affiliation(s)
- Kanglian Zheng
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Xu Zhu
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Shijie Fu
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Guang Cao
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Wen-Qing Li
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Liang Xu
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Hui Chen
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Di Wu
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Renjie Yang
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Kun Wang
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Wei Liu
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Hongwei Wang
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Quan Bao
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Ming Liu
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Chunyi Hao
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Lin Shen
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Baocai Xing
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Xiaodong Wang
- From the Departments of Interventional Oncology (K.Z., X.Z., S.F., G.C., L.X., H.C., D.W., R.Y., X.W.), Cancer Epidemiology (W.Q.L.), Hepatic and Biliary Surgery (K.W., W.L., H.W., Q.B., M.L., C.H., B.X.), and Gastrointestinal Oncology (L.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
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Jia J, Sun J, Duan X, Li W. Clinical Values and Markers of Radiation-Induced Liver Disease for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus Treated With Stereotactic Body Radiotherapy. Front Oncol 2022; 11:760090. [PMID: 34970485 PMCID: PMC8712705 DOI: 10.3389/fonc.2021.760090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Information about radiation-induced liver disease (RILD) in hepatocellular carcinoma (HCC) patients preexisting hepatitis B cirrhosis with portal vein tumor thrombus (PVTT) extended to the main portal vein treated with stereotactic body radiotherapy (SBRT) is still inadequate and the predictive markers for RILD have not been cleared in these patients. The aim of the study is to identify factors that can be used to predict RILD and to evaluate the influence of RILD in these patients. Methods In our study, 59 patients were analyzed and evaluated from December 2015 to June 2019, according to the entry criteria. After treatment, 59 patients were followed up within the first month and then every 3 months. Hematology test, tumor markers, three-phasic CT scan of the lungs, and CT or MRI scan of the liver were performed at each follow up. Results Median overall survival time was 10.7 months (range, 5.8 to 14.9). RILD appeared in 17 of the 59 patients (28.8%) at the 3rd month after SBRT. In the univariate analysis, not only the CP score class (A or B) but also each different pretreatment CP score (p < 0.05) was a significant predictive factor of RILD. More RILD cases were detected with the increase of CP score. The recovery rate decreased as the baseline CP score increased (p < 0.05). It was found that the overall survival time was affected by only baseline CP score and RILD (p < 0.05). Conclusions The development of RILD has a dependency on the CP score in these patients. CP scores before treatment and RILD are significantly associated with overall survival. SBRT is an effective and safe method for patients with CP ≤ B7. For patients with CP-B8, liver function should be monitored more frequently. It is not safe enough for the SBRT treatment in CP-B9 patients.
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Affiliation(s)
- Jun Jia
- Radiation Oncology Department, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jing Sun
- Radiation Oncology Department, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xuezhang Duan
- Radiation Oncology Department, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Wengang Li
- Radiation Oncology Department, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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21
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Hong D, Zhou Y, Wan X, Su H, Shao H. Brachytherapy with Iodine-125 seeds for treatment of portal vein-branch tumor thrombus in patients with hepatocellular carcinoma. BMC Cancer 2021; 21:1020. [PMID: 34521375 PMCID: PMC8439081 DOI: 10.1186/s12885-021-08680-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 08/13/2021] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND There is currently no widely-accepted consensus for the management of hepatocellular carcinoma with portal vein tumor thrombus. We evaluate the safety and efficacy of ultrasound-guided percutaneous brachytherapy with iodine-125 seeds for the treatment of hepatocellular carcinoma with portal vein-branch tumor thrombus (PVBTT). METHODS Sixty-nine hepatocellular carcinoma patients with PVBTT were enrolled; 34 received transarterial chemoembolization (TACE) combined with iodine-125 seeds implanted in the PVBTT; 35 were treated with TACE alone. Adverse events, objective response rate, disease control rate, progression-free survival, and overall survival were compared between the two groups. Tumor responses of PVBTT and intrahepatic tumor were correlated. Multivariate and subgroup analyses were conducted for overall survival. RESULTS No grade 3 or 4 adverse events were recorded, and there was no difference in grade 1 or 2 adverse events between the two groups. Objective response rate and disease control rate for PVBTT were 58.9 and 91.2%, respectively, in the combined treatment group, which were significantly greater than the 5.7 and 54.3% rates, respectively, in the TACE-alone group (both p's ≤ 0.001). Intrahepatic tumor response was positively correlated with the PVBTT response (γ = 0.782, p < 0.01). Survival outcomes were better in the combined treatment group than in the TACE-alone group: the median progression-free survival for PVBTT was 9 months versus 3 months (HR = 0.187 [95% CI: 0.101, 0.345], p < 0.001), and the median overall survival was 11 months versus 7 months (HR = 0.448 [95% CI: 0.265, 0.758], p = 0.003). Multivariate analysis revealed that application of brachytherapy and lower grade PVBTT (Vp1 + Vp2 vs. Vp3) were protective predictors of overall survival. In stratified analysis, the benefit of overall survival was more significant in the subgroup of PVBTT Vp1 + Vp2 rather than in Vp3. CONCLUSIONS The combination of iodine-125 seed brachytherapy guided by ultrasound and TACE is a convenient, safe, and effective treatment for patients with HCC and PVBTT, conferring a better survival benefit than TACE alone.
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Affiliation(s)
- Duo Hong
- Department of Interventional Radiology, The First Hospital of China Medical University, No.155 Nanjing Road, Heping District, Shenyang, 110000 Liaoning China
| | - Yi Zhou
- Vascular Surgery and Interventional Department, Changzhou No.2 People’s Hospital, 29 Xinglong Lane, Tianning District, Changzhou, 213000 Jiangsu China
| | - Xiaoting Wan
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000 China
| | - Hongying Su
- Department of Interventional Radiology, The First Hospital of China Medical University, No.155 Nanjing Road, Heping District, Shenyang, 110000 Liaoning China
| | - Haibo Shao
- Department of Interventional Radiology, The First Hospital of China Medical University, No.155 Nanjing Road, Heping District, Shenyang, 110000 Liaoning China
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22
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Montasser IF, Ibrahim AA, Farid HM, Al Balakosy AM. De novo hepatocellular carcinoma in cirrhotic hepatitis C virus: Are directly acting antivirals beneficial? Clin Res Hepatol Gastroenterol 2021; 45:101517. [PMID: 32900667 DOI: 10.1016/j.clinre.2020.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Behavior of HCC that developed after DAAs therapy for HCV infection is still debated. In this study we aim to compare characteristics and pattern of de novo HCC in cirrhotic HCV patients who were treated and untreated with DAAs. PATIENTS AND METHODS This study included 160 cirrhotic HCV patients presented with de novo HCC during the period of December 2017 to December 2018. Patients were divided into two groups, group A included 80 patients who received DAAs and group B included 80 patients who were not exposed to DAAs. The characteristics of HCC in both groups were compared using BCLC Staging System. RESULTS The size of the largest lesion was 47mm±26 in group A and 41mm±27 in group B with statistically significant difference between both groups (p=0.03). No other significant differences existed regarding number, site, or total tumor size and most of the lesions were solid in both groups. Portal vein thrombosis and extrahepatic spread detected in 16 and 11 patients in group A, while in group B the number was 17 and 9 patients respectively (p=0.83 and 0.06). No significant differences between groups in type of intervention done, BCLC staging (p=0.4), or survival. CONCLUSION Although CHCV patients treated with DAAs had larger de novo HCC lesions than untreated patients, there was no difference in BCLC staging or in aggressive behavior between both groups.
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Affiliation(s)
- Iman F Montasser
- Department of Tropical Medicine, Faculty of Medicine - Ain Shams University, Cairo, Egypt.
| | - Amany A Ibrahim
- Department of Tropical Medicine, Faculty of Medicine - Ain Shams University, Cairo, Egypt.
| | - Hoda M Farid
- Department of Tropical Medicine, Faculty of Medicine - Ain Shams University, Cairo, Egypt.
| | - Amira M Al Balakosy
- Department of Tropical Medicine, Faculty of Medicine - Ain Shams University, Cairo, Egypt.
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Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma: Radiologic and Clinical Factors Predictive of Survival. AJR Am J Roentgenol 2021; 216:1566-1573. [PMID: 33852336 DOI: 10.2214/ajr.20.23213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE. The goal of this study was to evaluate radiologic and clinical factors associated with overall survival of advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy (HAIC). MATERIALS AND METHODS. This single-center retrospective study included 180 patients with advanced hepatocellular carcinoma who underwent HAIC with a 5-fluorouracil (250-500 mg/m2 for 5 hours) plus cisplatin (10-20 mg/m2 for 1-2 hours) regimen via an implantable port system. Survival curves were generated by the Kaplan-Meier method and compared by log-rank tests. Factors associated with overall survival were evaluated with Cox proportional hazard models. RESULTS. The median overall survival time was 7.6 months (95% CI, 6.1-9.1), and the objective response rate was 15%. In multivariate analysis, infiltrative tumor growth (hazard ratio [HR], 1.002; p = .03) and rimlike arterial enhancement (HR, 3.040; p < .001) were pretreatment radiologic factors associated with reduced overall survival. No early response to treatment (HR, 2.064-6.491) and higher Child-Pugh class (HR, 2.010-2.815) were strong prognostic factors of poor outcome. Treatment with three or more HAIC cycles (HR, 0.371; p = .001) and high-dose HAIC (HR, 0.447; p < .001) were favorable for increased overall survival. CONCLUSION. Infiltrative tumor growth and rimlike arterial enhancement in pre-treatment imaging studies were associated with poor prognosis, and better early radiologic response and preserved liver function reserve were strong indicators of prolonged survival. Recognizing these radiologic and clinical predictors may help optimize care of patients with hepatocellular carcinoma.
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24
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Qiu Z, Wang G, Yang G, Wang G, Jiang W, Chen Z, Zhu W, Guo H, Zhang F, Gao F. Transcriptome sequencing-based personalized analysis of hepatocellular carcinoma patients with portal vein tumor thrombus. J Gastrointest Oncol 2021; 12:795-805. [PMID: 34012667 DOI: 10.21037/jgo-21-162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background The mechanism of portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC) has been widely studied, and numerous diagnostic and prognostic biomarkers for HCC with PVTT have been identified. We aimed to evaluate the extent to which these biomarkers may aid the personalized precision therapy of HCC with PVTT. Methods Matched tissue specimens [primary HCC tumor (PT), adjacent normal (N) liver, and PVTT tissues] were acquired from 3 Chinese HCC patients who underwent surgery at Sun Yat-sen University Cancer Centre between 2019 and 2020. Ribonucleic acid (RNA) sequencing was performed on the 9 tissue samples. GFOLD (generalized fold change) algorithm was used to analyze the differently expressed genes (DEGs) between the PVTT, PT, and normal tissues from each patient. Genes with a P<0.01 and a |GFOLD value| >1 were identified as having significantly different expression. Results In total, 3,543, 32,472, and 12,901 tumorigenesis-associated genes, and 2,919, 17,679, and 14,825 metastasis-associated genes, were detected in Patient 1 (P1), Patient 2 (P2), and Patient 3 (P3), respectively. We analyzed the expression levels of genes associated with hypoxia, macrophage recruitment and cancer stem cells (CSCs). The results showed that hypoxia and CSCs may have contributed to tumorigenesis but not to metastasis in P1. We also found the hypoxia microenvironment played an important role in tumorigenesis and metastasis in P2, and CSCs may have contributed to metastasis. Additionally, we found that CSCs played critical roles in metastasis but not in tumorigenesis in P3. The results also showed that the long non-coding RNA (lncRNA) Metastasis-Associated Lung Adenocarcinoma Transcript 1 (MALAT1) was greatly overexpressed in the PTs and PVTT in all 3 patients, and Heart and Neural Crest Derivatives Expressed 2-antisense RNA 1 (HAND2-AS1) was downregulated in PVTT compared with PTs in all 3 patients. Thus, MALAT1 and HAND2-AS1 may be robust biomarkers for metastasis in HCC patients with PVTT. Conclusions Tumor-associated macrophages (TAMs)-targeted immunotherapy is a promising therapy for HCC patients with PVTT. LncRNAs MALAT1, and HAND2-AS1 may be promising targets for HCC therapy.
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Affiliation(s)
- Zhenkang Qiu
- Department of Minimally Invasive and Interventional Radiology, Sun Yat-sen University Cancer Centre and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Guobao Wang
- Department of Endoscopy, Sun Yat-sen University Cancer Centre and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Guang Yang
- Department of Minimally Invasive and Interventional Radiology, Sun Yat-sen University Cancer Centre and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Guisong Wang
- Department of Minimally Invasive and Interventional Radiology, Sun Yat-sen University Cancer Centre and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Weiwei Jiang
- Department of Minimally Invasive and Interventional Radiology, Sun Yat-sen University Cancer Centre and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Zixiong Chen
- Department of Minimally Invasive and Interventional Radiology, Sun Yat-sen University Cancer Centre and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Wenliang Zhu
- Department of Minimally Invasive and Interventional Radiology, Sun Yat-sen University Cancer Centre and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Huanqing Guo
- Department of Minimally Invasive and Interventional Radiology, Sun Yat-sen University Cancer Centre and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Fujun Zhang
- Department of Minimally Invasive and Interventional Radiology, Sun Yat-sen University Cancer Centre and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Fei Gao
- Department of Minimally Invasive and Interventional Radiology, Sun Yat-sen University Cancer Centre and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
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25
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Liu Y, Li Y, Wang X, Huang Y, Zhang Q, Shi K, Ran C, Hou J, Wang X. Fufang Banmao Capsule, a Traditional Chinese Medicinal Formulation, Enhances the Survival of Patients with Hepatocellular Carcinoma and Vp3-4 Portal Vein Tumor Thrombosis Undergoing Supportive Treatment. J Altern Complement Med 2020; 26:956-965. [PMID: 32614605 DOI: 10.1089/acm.2019.0334] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives: Fufang Banmao (FFBM) capsule, a type of Chinese medicinal formulation, has decades of history in treating hepatocellular carcinoma (HCC). This retrospective study aimed to observe the effect of FFBM capsules on the 6-month survival of patients with advanced HCC and Vp3-4 portal vein tumor thrombosis (PVTT) who received supportive therapy alone. Design: In total, 320 HCC/Vp3-4 PVTT patients underwent treatment with supportive therapy, of whom 95 took FFBM capsules and were treated with supportive therapy (FFBM group) and 225 received supportive therapy alone (control group). Comparisons of the 6-month overall survival (OS) rate of the two groups were performed. Propensity score matching (PSM) was used to match the characteristics between individuals in the two groups. A nomogram was built based on independent predictive factors for OS. Results: Cox multivariate analysis revealed that hepatic encephalopathy, aspartate transaminase (AST) and γ-glutamyl transpeptidase levels, Child-Pugh class, prothrombin time, α-fetoprotein level, largest tumor diameter, and use of FFBM capsules were independent predictive factors of OS. Variceal bleeding, alanine transaminase, AST, total bilirubin, and Barcelona Clinic for Liver Cancer stage were different at baseline in the FFBM and control groups. Analysis revealed no significant adverse effects or toxicities relevant to the medications. After PSM (1:1), 95 patient pairs were analyzed as FFBM versus control. The OS probability was remarkably higher for patients in the FFBM group than in those in the control group at 6 months (p < 0.0001). The median survival time was 4 months in the FFBM group and 2.2 months in the control group. Kaplan-Meier analysis showed significant statistical differences in the 6-month OS rates in the patients with total nomogram scores ≥84 (p < 0.0001). Conclusions: Given the satisfying survival outcomes, the results suggested that FFBM capsules should be administered to patients with HCC/Vp3-4 PVTT in the high-risk group (score ≥84). FFBM capsules have the potential for improving patient survival time in those with advanced HCC and Vp3-4 PVTT who receive supportive therapy alone, especially those in the high-risk group (score ≥84).
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Affiliation(s)
- Yao Liu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuxin Li
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaojing Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yunyi Huang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qun Zhang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ke Shi
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chongping Ran
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jie Hou
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xianbo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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26
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Li T, Liu C, He JT, Sui KD, Zhang ZB, Hong D, Su HY, Shao HB. Portal stent with endovascular brachytherapy improves the efficacy of TACE for hepatocellular carcinoma with main portal vein tumor thrombus. Hepatobiliary Pancreat Dis Int 2020; 19:187-190. [PMID: 31708399 DOI: 10.1016/j.hbpd.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/21/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Tian Li
- Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110001, China
| | - Chong Liu
- Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110001, China
| | - Jin-Tong He
- Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110001, China
| | - Kai-Da Sui
- Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110001, China
| | - Zhou-Bo Zhang
- Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110001, China
| | - Duo Hong
- Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110001, China
| | - Hong-Ying Su
- Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110001, China
| | - Hai-Bo Shao
- Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110001, China.
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27
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Nomogram for Individualized Prediction of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis on Conservative Treatment. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1473718. [PMID: 32149077 PMCID: PMC7049328 DOI: 10.1155/2020/1473718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/18/2022]
Abstract
Background Portal vein tumor thrombosis (PVTT) is one of the major predictive factors for patients with hepatocellular carcinoma (HCC). The objective of this study was to establish a prognostic nomogram for identifying individual survival outcomes in patients with HCC and PVTT on conservative treatment based on specific factors. Methods Two hundred and ten patients with HCC and PVTT on conservative treatment in Beijing Ditan Hospital between June 2008 and May 2017 were studied retrospectively as a derivation cohort. We built a nomogram based on independent risk factors for survival prediction. The concordance index (c-index) and a calibration curve were used to evaluate the predictive accuracy. During the study, 102 patients were included at the Putuo Hospital and Third People's Hospital of Changzhou as a validation cohort. Results In the derivation cohort, the independent factors for overall survival were identified by multivariate analysis, namely, aspartate aminotransferase ≥119 IU/L, gamma-glutamyl transferase ≥115 IU/L, Child–Pugh class C liver function, creatinine ≥91 μmoI/L, α-fetoprotein ≥400 ng/ml, and largest tumor diameter ≥5 cm. The nomogram had a c-index of 0.737 (95% confidence interval, 0.692–0.782) and the calibration curves fitted well. The median survival time was 4.2 months in the derivation cohort, with an MST of 5 months for BCLC C stage and 1.8 months for BCLC D stage patients. Kaplan–Meier analysis showed significant statistical differences in the 6-month overall survival rates of the primary and validation cohorts after the total scores were divided into three quartiles (low risk: 0–85; intermediate risk: 86–210; high risk: ≥211; p < 0.0001 in both cohorts). Conclusions The nomogram can be a more accurate and individualized prediction for 6-month overall survival of patients with HCC and PVTT on conservative treatment, and it is possible to consider further active interventions for patients in the low-risk group (0–85 scores) to achieve the aim of prolonging survival.
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Cao F, Shen L, Qi H, Xie L, Song Z, Chen S, Fan W. Tree-based classification system incorporating the HVTT-PVTT score for personalized management of hepatocellular carcinoma patients with macroscopic vascular invasion. Aging (Albany NY) 2019; 11:9544-9555. [PMID: 31682230 PMCID: PMC6874465 DOI: 10.18632/aging.102403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/26/2019] [Indexed: 12/24/2022]
Abstract
Purpose: To develop a decision tree algorithm-based classification system for personalized management of hepatocellular carcinoma (HCC) patients with macroscopic vascular invasion. Results: The HVTT-PVTT score could differentiate two groups of patients (< 3 and ≥ 3 points) with different survival outcomes (7.4 vs 4.6 months, P < 0.001) and surgical proportion (24.4% vs 3.6%, P < 0.001). Using the Cox regression model and classification and regression tree (CART) algorithm, patients in the training set were automatically separated into three subgroups with different prognosis (10.3 vs 6.1 vs 3.3 months). The predictive accuracy was verified in the validation group (12.3 vs 6.9 vs 5.6 months) and was better than other commonly used staging systems. Conclusions: Our study proposed a new classification system for HCC patients with macroscopic vascular invasion that could be meaningful for personalized management of these patients. Methods: A total of 869 HCC patients initially diagnosed with macroscopic vascular invasion were randomly divided into training and validation sets. A comprehensive and simplified HVTT-PVTT score was set up for subdivision of vascular invasion according to the patients’ survival outcome. Then, a decision tree algorithm-based classification system was used to establish the refined subdivision system incorporating all independent prognostic factors.
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Affiliation(s)
- Fei Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China
| | - Han Qi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China
| | - Lin Xie
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China
| | - Ze Song
- Department of Oncology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
| | - Shuanggang Chen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China
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Zhao J, Xie Y. Progress in research of hepatocellular carcinoma with tumor thrombus. Shijie Huaren Xiaohua Zazhi 2019; 27:1239-1247. [DOI: 10.11569/wcjd.v27.i20.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) with tumor thrombus is a hot and difficult issue in the study of HCC, and many key issues concerning this condition are still controversial. Clinical guidelines and treatment recommendations vary widely between the East and the West, and efficacy remains unsatisfactory. In recent years, with the progress of comprehensive tumor treatment concept and the rapid development of surgical techniques, perioperative management, interventional therapy, radiotherapy, targeted therapy, and other treatment methods, the overall survival rate of HCC with tumor thrombus has been significantly extended and encouraging efficacy has been achieved. However, the core issues on how to select individualized treatment to achieve optimal treatment and how to prevent postoperative recurrence still need to be studied and discussed. This article reviews the progress in the research of hepatic carcinoma with portal vein thrombus, inferior vena cava thrombus, or bile duct thrombus.
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Affiliation(s)
- Jian Zhao
- Department of Hepatobiliary Surgery, Rocket Army Featured Medical Center, Beijing 100088, China
| | - Yu Xie
- Department of Hepatobiliary Surgery, Rocket Army Featured Medical Center, Beijing 100088, China
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Zhang Y, Wu YF, Yue ZD, Zhao HW, Wang L, Fan ZH, He FL, Wang T, Liu FQ. Iodine-125 implantation with transjugular intrahepatic portosystemic shunt for main portal vein tumor thrombus. World J Gastrointest Oncol 2019; 11:310-321. [PMID: 31040896 PMCID: PMC6475673 DOI: 10.4251/wjgo.v11.i4.310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/11/2019] [Accepted: 03/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Main portal vein tumor thrombus (MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma (HCC). Therefore, attention should be paid to the treatment of MPVTT and its complications.
AIM To evaluate the efficacy of transarterial chemoembolization/transarterial embolization (TACE/TAE)+125I seeds implantation with transjugular intrahepatic portosystemic shunt (TIPS) in treating MPVTT and its complications.
METHODS From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and 125I implantation (TIPS-125I group) or TACE/TAE + TIPS only (TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-125I.
RESULTS During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-125I group, whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively (P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%, respectively, in the TIPS-125I group, whereas those in the TIPS only group were 31.1%, 62.2%, and 82.2% (P < 0.05). The rates of stent restenosis were 12.5%, 27.5%, and 42.5%, respectively, in the TIPS-125I group, and 42.2%, 68.9%, and 84.4%, respectively, in the TIPS only group (P < 0.05). TIPS-125I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC.
CONCLUSION TACE/TAE+125I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality.
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Affiliation(s)
- Yue Zhang
- Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Yi-Fan Wu
- Department of Interventional Therapy, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Zhen-Dong Yue
- Department of Interventional Therapy, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Hong-Wei Zhao
- Department of Interventional Therapy, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Lei Wang
- Department of Interventional Therapy, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Zhen-Hua Fan
- Department of Interventional Therapy, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Fu-Liang He
- Department of Interventional Therapy, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Tao Wang
- Department of Interventional Therapy, The affiliated Yantai Yuhuangding Hospital of Qingdao University, No.20 Yuhuangding East Road, Yantai 264000, Shandong Province, China
| | - Fu-Quan Liu
- Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
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Jang TY, Huang CI, Yeh ML, Lin ZY, Chen SC, Chuang WL. The prognosis of bulky hepatocellular carcinoma with nonmajor branch portal vein tumor thrombosis. Medicine (Baltimore) 2019; 98:e15066. [PMID: 30921239 PMCID: PMC6455711 DOI: 10.1097/md.0000000000015066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/01/2019] [Accepted: 03/07/2019] [Indexed: 02/07/2023] Open
Abstract
A bulky, solitary hepatocellular carcinoma (HCC) with nonmajor branch portal vein tumor thrombosis (PVTT) was staged as T2 in the tumor-node-metastasis (TNM) system. We aimed to evaluate the prognosis of this group of patients.A total of 2643 patients with HCC in a medical center were consecutively enrolled. The stage of HCC was determined according to the 7th edition of American Joint Committee on Cancer staging system. Patients who were diagnosed as having solitary HCC larger than 5 cm with nonmajor portal vein thrombosis (VP1-VP2) and no lymphadenopathy or metastasis were included.Bulky HCC with nonmajor branch PVTT and without metastasis and lymphadenopathy was identified in 0.15% (4 out of 2643 patients) of the patients with HCC. Child-Pugh scores of the patients were A to B. Tumor sizes all were larger than 5 cm (mean: 6.8 ± 1.0 cm). All patients had nonmajor branch of PVTT. Three patients initially received trans-arterial chemoembolization (TACE) therapy, and 1 patient refused treatment because of old age. The response to TACE was poor: 2 patients rapidly progressed to main portal vein thrombosis, and their tumors enlarged within a half year. Only 1 patient's disease remained stable but progressed gradually 2 years later. The median survival time was 16.5 months. The 1- year, 2-year, and 3-year survival rate was 100%, 50%, and 0%, respectively.Solitary HCC > 5 cm with PVTT of a nonmajor branch gave dismal prognoses and required aggressive treatment such as hepatic resection or combination therapy. In our opinion, it should be staged as T3 rather than a T2 in the TNM staging system.
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Affiliation(s)
- Tyng-Yuan Jang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung
| | - Ching-I. Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zu-Yau Lin
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shinn-Cherng Chen
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Walcott-Sapp S, Naugler S, Lim JY, Wagner J, Orloff SL, Farsad K, Kolbeck KJ, Kaufman J, Maynard E, Enestvedt CK, Mayo SC, Billingsley KG. Tailored treatment of patients with hepatocellular carcinoma with portal vein invasion: experience from a multidisciplinary hepatobiliary tumor program within a NCI comprehensive cancer center. J Gastrointest Oncol 2018; 9:1074-1083. [PMID: 30603126 DOI: 10.21037/jgo.2018.08.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) with portal vein invasion (PVI) has a poor prognosis with limited treatment options. Intra-arterial brachytherapy (IAB) and transarterial chemoembolization (TACE) yield local control but risk accelerating liver dysfunction. The outcomes, survival, and safety of selective liver-directed treatment are reported. Methods Thirty-seven consecutive patients with HCC and PVI treated between 2009 and 2015 were reviewed from a prospectively collected database. Univariate analysis, Kaplan-Meier plots using the log-rank method, and multivariate analyses were performed. Statistical significance was defined as P<0.05. Overall survival was reported in months (median; 95% CI). Results Most patients (59%) had PVI identified at initial HCC diagnosis. The liver-directed therapy group (n=22) demonstrated a survival advantage versus the systemic/supportive care group (n=14) [23.6 (5.8, 30.9) vs. 6.0 (3.5, 8.8) months]. Patients indicated for liver directed therapy had unilateral liver involvement (100% vs. 43%, P<0.0001), lower median alkaline phosphatase (105.5 vs. 208.0, P=0.002), and lower mean Child-Turcotte-Pugh (CTP) score (5.9 vs. 7.2, P=0.04) and tolerated treatment without serious complications. Conclusions In HCC patients presenting with PVI, liver-directed therapy was safely performed in patients with limited venous involvement and preserved liver function. Liver-directed therapy extended survival for these patients indicated for palliative chemotherapy by traditional guidelines.
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Affiliation(s)
- Sarah Walcott-Sapp
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Scott Naugler
- Division of Gastroenterology, Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jeong Youn Lim
- Division of Biostatistics, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Jesse Wagner
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Susan L Orloff
- Abdominal Transplant Division, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Kenneth J Kolbeck
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - John Kaufman
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Erin Maynard
- Abdominal Transplant Division, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - C Kristian Enestvedt
- Abdominal Transplant Division, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Skye C Mayo
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Kevin G Billingsley
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
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Hai S, Hatano E, Okada T, Uyama N, Suzumura K, Fujimoto J. Is Noncurative Hepatic Resection Justified for Advanced Hepatocellular Carcinoma? Am Surg 2018. [DOI: 10.1177/000313481808401241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
It has been obscure whether or not noncurative hepatic resection (Hx) has a favorable impact on the clinical course in patients with advanced hepatocellular carcinoma (HCC). The aim of this study is to clarify the significance of noncurative Hx for advanced HCC. Among 666 consecutive patients undergoing Hx for HCC in our department, 79 patients underwent noncurative Hx. These patients were classified as Group A (presence of macrovascular invasion [MVI]; n = 29), Group B (residual tumors in the remnant liver; n = 37), Group C (residual tumors in the remnant liver with MVI; n = 7), or Group D (residual tumors in the remnant liver with distant metastasis [with or without MVI]; n = 6). The three-year survival rates were 49.6 per cent in Group A, 30.3 per cent in Group B, 14.3 per cent in Group C, and 0.0 per cent in Group D, respectively (Groups A and B vs Group D, P < 0.05). Moreover, the survival rate was significantly higher in patients with ≤3 tumors than in those with ≥4 tumors ( P < 0.05), when Group B was divided into subgroups according to the number of residual tumors in the remnant liver. In conclusion, noncurative Hx might be acceptable for advanced HCC with MVI or ≤3 residual tumors in the remnant liver.
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Affiliation(s)
- Seikan Hai
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Etsuro Hatano
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshihiro Okada
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Naoki Uyama
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhiro Suzumura
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Jiro Fujimoto
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Lv WF, Liu KC, Lu D, Zhou CZ, Cheng DL, Xiao JK, Zhang XM, Zhang ZF. Transarterial chemoembolization for hepatocellular carcinoma combined with portal vein tumor thrombosis. Cancer Manag Res 2018; 10:4719-4726. [PMID: 30410405 PMCID: PMC6199972 DOI: 10.2147/cmar.s166527] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objectives To explore the efficacy and influencing factors of transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) combined with portal vein tumor thrombosis (PVTT). Materials and methods The clinical data of 3,126 consecutive patients who suffered from advanced HCC and underwent TACE were retrospectively analyzed. A total of 685 patients had a combination of HCC and PVTT. Of these patients, 475 were treated with TACE (Group A) and 210 were given a supportive care (Group B). The local response and overall survival of the two groups were observed and compared, and the influencing factors were examined through Cox regression analysis. Results The median survival time and cumulative survival rate at 6, 12, and 24 months of Group A were higher than those of Group B (P=0.002). Multiple Cox regression analysis revealed that Child–Pugh classes and PVTT grades were the independent prognostic factors affecting a patient’s survival. Stratified analysis demonstrated that the survival time of patients diagnosed with grades I/II PVTT and treated with TACE was superior to that of patients provided with supportive care (P=0.001), but the survival time of patients with grades III/IV PVTT with or without TACE did not significantly differ (P=0.662). Conclusion TACE can significantly improve local response, increase cumulative survival rate, and prolong the survival duration of patients with HCC and grades I/II PVTT, whereas the efficacy of TACE for patients with grades III/IV PVTT should be further verified, although their local responses were improved. Child–Pugh classes and PVTT grades are essential factors influencing patient prognosis.
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Affiliation(s)
- Wei-Fu Lv
- Department of Interventional Radiology, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei 230001, Anhui Province, China,
| | - Kai-Cai Liu
- Department of Interventional Radiology, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei 230001, Anhui Province, China,
| | - Dong Lu
- Department of Interventional Radiology, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei 230001, Anhui Province, China,
| | - Chun-Ze Zhou
- Department of Interventional Radiology, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei 230001, Anhui Province, China,
| | - De-Lei Cheng
- Department of Interventional Radiology, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei 230001, Anhui Province, China,
| | - Jing-Kun Xiao
- Department of Interventional Radiology, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei 230001, Anhui Province, China,
| | - Xing-Ming Zhang
- Department of Interventional Radiology, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei 230001, Anhui Province, China,
| | - Zheng-Feng Zhang
- Department of Interventional Radiology, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei 230001, Anhui Province, China,
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Shui Y, Yu W, Ren X, Guo Y, Xu J, Ma T, Zhang B, Wu J, Li Q, Hu Q, Shen L, Bai X, Liang T, Wei Q. Stereotactic body radiotherapy based treatment for hepatocellular carcinoma with extensive portal vein tumor thrombosis. Radiat Oncol 2018; 13:188. [PMID: 30253783 PMCID: PMC6157064 DOI: 10.1186/s13014-018-1136-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/20/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND There is currently no worldwide consensus for the management of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). We evaluated the efficacy of stereotactic body radiotherapy (SBRT) as the initial treatment for HCC with extensive PVTT based on a relatively large number of patients. METHODS In our multidisciplinary approach for patients with hepatobiliary tumors, SBRT is recommended for unresectable HCC with PVTT or those with contraindication for transarterial chemoembolization (TACE). The aim is to shrink the tumor thrombus and preserve adequate portal venous flow, thus facilitating subsequent treatments such as TACE and tumor resection. In the present study, 70 continuous cases of HCC patients with extensive PVTT initially treated with SBRT were studied. The median follow-up period was 9.5 months (range, 1.0-21.0 months). The dynamic changes of tumor thrombosis with time after SBRT were also analyzed. RESULTS The median survival time for the whole group was 10.0 months (95% CI, 7.7-12.3 months), with a 6- and 12-month overall survival (OS) rate of 67.3%, and 40.0% respectively. Patients who received combined SBRT and TACE showed significantly longer OS than those without indication for TACE after SBRT (12.0 ± 1.6 vs. 3.0 ± 1.0 months). Patients with good response to radiation usually had better survival. SBRT was well tolerated in our patient series. CONCLUSIONS In conclusion, SBRT used as the initial treatment for HCC patients with extensive PVTT originally unsuitable for resection or TACE can achieve adequate thrombus shrinkage and portal vein flow restoration in the majority of cases. It could thus offer the patients an opportunity to undergo further treatment such as resection or TACE procedure. Such therapeutic strategy may result in survival advantage, especially for those who do receive combined modality with SBRT.
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Affiliation(s)
- Yongjie Shui
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China
| | - Wei Yu
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China.,Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University Cancer Institute, Hangzhou, 310009, People's Republic of China
| | - Xiaoqiu Ren
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China.,Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University Cancer Institute, Hangzhou, 310009, People's Republic of China
| | - Yinglu Guo
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China.,Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University Cancer Institute, Hangzhou, 310009, People's Republic of China
| | - Jing Xu
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China.,Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University Cancer Institute, Hangzhou, 310009, People's Republic of China
| | - Tao Ma
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial Key Laboratory of Pancreatic Disease, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Bicheng Zhang
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China
| | - Jianjun Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Qinghai Li
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Qiongge Hu
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China
| | - Li Shen
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China
| | - Xueli Bai
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial Key Laboratory of Pancreatic Disease, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial Key Laboratory of Pancreatic Disease, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Qichun Wei
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, People's Republic of China. .,Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University Cancer Institute, Hangzhou, 310009, People's Republic of China.
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Koga Y, Beppu T, Imai K, Kuramoto K, Miyata T, Kitano Y, Nakagawa S, Okabe H, Okabe K, Yamashita YI, Chikamoto A, Baba H. Complete remission of advanced hepatocellular carcinoma following transient chemoembolization and portal vein ligation. Surg Case Rep 2018; 4:102. [PMID: 30159613 PMCID: PMC6115322 DOI: 10.1186/s40792-018-0510-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 08/16/2018] [Indexed: 12/15/2022] Open
Abstract
Background Macroscopic diffuse-type hepatocellular carcinoma with concomitant major portal vein tumor thrombus (PVTT) and peritoneal dissemination indicates poor prognosis. Additionally, triple-positive tumor marker status is a predictor of poor outcome even after hepatectomy. Sorafenib is recommended in such patients, but it has limited therapeutic effectiveness. Case presentation A 54-year-old man was diagnosed with a liver abscess that was treated by puncture and drainage at a regional hospital. However, the diagnosis was subsequently changed to hepatocellular carcinoma with macroscopic portal vein tumor thrombus, based on the results obtained for the triple-positive tumor markers (alpha-fetoprotein, 45,928 ng/ml; protein induced by vitamin K absence or antagonist-II, 125,350 mAU/ml; and alpha-fetoprotein-L3, 38.3%). As the patient’s liver functional reserve was not adequate for curative resection, chemoembolization was performed with a hepatic arterial infusion of cisplatin (50 mg) and 5-FU (1000 mg), followed by mild embolization with cisplatin (50 mg) suspended in lipiodol (5 ml) and starch microspheres (300 mg) containing mitomycin C (4 mg). As the thrombus had progressed to the bifurcation of the right and left portal veins, the right vein was surgically ligated. Three peritoneal nodules could be identified and were removed. Three additional rounds of hepatic arterial chemotherapy/chemoembolization were performed after the initial surgery. At the 2-year evaluation, all tumor markers were observed to have normalized and diagnostic imaging showed complete remission. Conclusions Complete remission of hepatocellular carcinoma with macroscopic portal vein tumor thrombus and peritoneal dissemination was obtained with a treatment regimen that involved four rounds of hepatic arterial infusion chemotherapy and transient chemoembolization, portal vein ligation, and the removal of peritoneal dissemination. This regimen can be recommended for patients with advanced hemiliver lesions who cannot undergo curative resection.
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Affiliation(s)
- Yuki Koga
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan.,Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan.,Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kunitaka Kuramoto
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan.,Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tatsunori Miyata
- Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuki Kitano
- Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kazutoshi Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Akira Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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Zhu LZ, Xu S, Qian HL. Transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed for hepatocellular carcinoma with major portal vein tumor thrombus. World J Gastroenterol 2018; 24:2501-2507. [PMID: 29930471 PMCID: PMC6010942 DOI: 10.3748/wjg.v24.i23.2501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/09/2018] [Accepted: 03/29/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the efficacy and safety of transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed in hepatocellular carcinoma (HCC) with major portal vein tumor thrombus (MPVTT).
METHODS Eighty-six patients with MPVTT accepted routine embolization. The catheter was kept in the hepatic artery and oxaliplatin (50 mg in 250 mL of glucose) was infused by pump for 4 h, followed by raltitrexed (2 mg in 100 mL of 0.9% saline) infusion by pump for the next 1 h. The efficacy and safety were evaluated after the transarterial chemoembolization (TACE).
RESULTS Full or partial embolization was achieved in 86 cases, where all the cases received low dose continuous hepatic arterial infusion chemotherapy. Complete responses (CRs), partial responses (PRs), stable disease (SD), and disease progression (PD) for intrahepatic disease were observed in 0, 45, 20, and 21 patients, respectively. The 1-, 2-and 3-year overall survival rates of the 86 patients were 40.7%, 22.1%, and 8.1% respectively, and the median survival time was 8.7 mo. Complication was limited.
CONCLUSION TACE with low dose continuous hepatic arterial infusion of oxaliplatin and raltitrexed could be an option in MPVTT patient; it was shown to be effective in patients with advanced HCC with MPVTT with less toxicity.
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Affiliation(s)
- Lin-Zhong Zhu
- Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100142, China
| | - Song Xu
- Department of Radiology, Yunnan Second People’s Hospital, Kunming 650021, Yunnan Province, China
| | - Hai-Long Qian
- Interventional Therapy, Baotou Cancer Hospital, Baotou 014030, Inner Mongolia, China
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Guo H, Wu T, Lu Q, Li M, Guo JY, Shen Y, Wu Z, Nan KJ, Lv Y, Zhang XF. Surgical resection improves long-term survival of patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages. Cancer Manag Res 2018; 10:361-369. [PMID: 29503583 PMCID: PMC5827460 DOI: 10.2147/cmar.s152707] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives Surgical resection remains a controversial treatment for hepatocellular carcinoma (HCC) within different Barcelona Clinic Liver Cancer (BCLC) stages. The objective of this study was to evaluate the long-term outcome of patients undergoing surgical resection (SR) compared to non-surgical treatments across different BCLC stages. Patients and methods One thousand four hundred forty-three HCC patients within BCLC 0, A, B and C stages were identified. Overall survival was compared by log-rank test among patients within different BCLC stages and among patients receiving different treatments (SR vs locoregional therapy [LRT] vs best supportive care). Propensity score matching analysis was introduced to mitigate the confounding biases between the groups. Results The median survival time of the patients diminished from early, intermediate to advanced BCLC stages (BCLC 0-A 43 [range 0-100] months vs BCLC B 32 [range 0-100] months vs BCLC C 27 [range 0-90] months, all p<0.05). Patients undergoing SR presented with better liver function and more favorable tumor status and, consequently, displayed significant better overall survival than patients receiving LRT or best supportive care at different BCLC stages. In adjusted cohort after propensity score matching, patients who were surgically treated consistently had more favorable outcome than those who were non-curatively treated across different BCLC stages (median survival [range]: BCLC stage B: resection 45 [0-100] months vs LRT 36 [0-81] months, p=0.002; BCLC stage C: resection 39 [3-77] months vs LRT 27 [0-54] months, p=0.003). Conclusion Surgical resection should be considered as a radical treatment for selected HCC patients regardless of the BCLC stages when appropriate.
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Affiliation(s)
- Hui Guo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tao Wu
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qiang Lu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Miaojing Li
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing-Yue Guo
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuan Shen
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ke-Jun Nan
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Walcott-Sapp S, Billingsley KG. Preoperative optimization for major hepatic resection. Langenbecks Arch Surg 2017; 403:23-35. [PMID: 29150719 DOI: 10.1007/s00423-017-1638-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/06/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Major hepatic resections are performed for primary hepatobiliary malignancies, metastatic disease, and benign lesions. Patients with chronic liver disease, including cirrhosis and steatosis, are at an elevated risk of malnutrition and impaired strength and exercise capacity, deficits which cause increased risk of postoperative complications and mortality. The aims of this report are to discuss the pathophysiology of changes in nutrition, exercise capacity, and muscle strength in patient populations likely to require major hepatectomy, and review recommendations for preoperative evaluation and optimization. METHODS Nutritional and functional impairment in preoperative hepatectomy patients, especially those with underlying liver disease, have a complex and multifactorial physiologic basis that is not completely understood. RESULTS Recognition of malnutrition and compromised strength and exercise tolerance preoperatively can be difficult, but is critical in providing the opportunity to intervene prior to major hepatic resection and potentially improve postoperative outcomes. There is promising data on a variety of nutritional strategies to ensure adequate intake of calories, proteins, vitamins, and minerals in patients with cirrhosis and reduce liver size and degree of fatty infiltration in patients with hepatic steatosis. Emerging evidence supports structured exercise programs to improve exercise tolerance and counteract muscle wasting. CONCLUSIONS The importance of nutrition and functional status in patients indicated for major liver resection is apparent, and emerging evidence supports structured preoperative preparation programs involving nutritional intervention and exercise training. Further research is needed in this field to develop optimal protocols to evaluate and treat this heterogeneous cohort of patients.
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Affiliation(s)
- Sarah Walcott-Sapp
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code: L223, Portland, OR, 97239, USA.
| | - Kevin G Billingsley
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code: L223, Portland, OR, 97239, USA
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Li L, Chen J, Xu W, Ding X, Wang X, Liang J. Clinical characteristics of hepatocellular carcinoma patients with normal serum alpha-fetoprotein level: A study of 112 consecutive cases. Asia Pac J Clin Oncol 2017; 14:e336-e340. [PMID: 29071776 DOI: 10.1111/ajco.12816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/20/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Serum alpha-fetoprotein (AFP) level is normal in 30-40% of hepatocellular carcinoma (HCC) patients, and knowledge on its characteristics and clinical outcome is limited. The purpose of this observational study was to determine the clinical presentation, biological behavior and outcome of HCC patients with normal AFP level. METHODS Data of 112 consecutive HCC patients with normal AFP level were analyzed retrospectively. Statistical analysis including survival and factors associated with serum AFP level were performed by Kaplan-Meier method and t-test, respectively. RESULTS Hepatitis B virus infection exited in 83.0% of all 112 HCC patients with normal AFP level. During a mean 52 ± 20 months (range 5-85 months) follow-up, the 1-, 2-, 3-year overall survival (OS) rate was 97.2%, 85.3% and 81.7%, respectively. The OS rates at 3 years stratified by stages at diagnosis were 100%, 96.2%, 85.7%, 11.1% and 0%, respectively for Barcelona Clinic Liver Cancer (BCLC) stage 0-D diseases. Significant difference in OS was observed among patients with BCLC stage 0-D diseases, P < 0.05. Using 8.78 ng/mL as the cut off value, serum AFP level elevated beyond normal figure during follow-up (AFP conversion) in 16 patients, which related with deterioration of liver function, quantitative changes of T helper cell subsets, rapid tumor progression and shorter survival. Patients with sustained normal AFP level had better survival than patients with AFP conversion, P < 0.05. There was significant difference between the time of diagnosis with HCC to serum AFP level elevation and the time of AFP elevation to death, P < 0.05. CONCLUSION Prognosis of HCC patients with normal AFP level was relatively optimal. Serum AFP level elevation during follow-up was significantly associated with clinical outcome in terms of OS.
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Affiliation(s)
- Li Li
- Department of Oncology, Peking University International Hospital, Beijing, China
| | - Jinglong Chen
- Department of Oncology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Weiran Xu
- Department of Oncology, Peking University International Hospital, Beijing, China
| | - Xiaosheng Ding
- Department of Oncology, Peking University International Hospital, Beijing, China
| | - Xiangyi Wang
- Department of Oncology, Peking University International Hospital, Beijing, China
| | - Jun Liang
- Department of Oncology, Peking University International Hospital, Beijing, China
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Lee SW, Lee HL, Han NI, Kwon JH, Nam SW, Jang JW, Bae SH, Choi JY, Yoon SK. Transarterial infusion of epirubicin and cisplatin combined with systemic infusion of 5-fluorouracil versus transarterial chemoembolization using doxorubicin for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a retrospective analysis. Ther Adv Med Oncol 2017; 9:615-626. [PMID: 28974984 PMCID: PMC5613859 DOI: 10.1177/1758834017728018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 07/03/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND More than one-third of hepatocellular carcinoma (HCC) patients are diagnosed at advanced stage with portal vein tumor thrombosis (PVTT) or extrahepatic metastasis. However, the outcomes of current therapeutic approaches are unsatisfactory. As a novel therapeutic strategy for unresectable HCC with PVTT, we analyzed the outcomes of transarterial infusion of epirubicin and cisplatin combined with systemic infusion of 5-fluorouracil (TAC-ECF) and compared its therapeutic effects and toxicity with transarterial chemoembolization (TACE) using doxorubicin (DOX). METHODS A total of 540 consecutive HCC patients who received TACE at the Catholic Medical Center between January 2007 and November 2013 were enrolled. Of these patients, we retrospectively analyzed 129 Barcelona clinic liver cancer stage C HCC patients with PVTT who received either TAC-ECF or TACE using DOX. RESULTS The objective tumor response rate was higher in the TAC-ECF group, with 31.3% objective response rate after TAC-ECF compared to 10% after DOX treatment (p = 0.004). Median follow-up period was 7 months (range, 1-57 months). The overall survival rate was also significantly higher in the TAC-ECF group compared to the DOX group (median 9.3 versus 4.6 months, p < 0.0001). Multivariate analysis revealed that TAC-ECF and extrahepatic metastasis were independent predictive factors for overall survival (p < 0.0001 and p = 0.002 respectively). No serious adverse effects developed in both groups. CONCLUSIONS TAC-ECF therapy was tolerable and showed higher overall survival rate and tumor response compared to the conventional TACE DOX in advanced stage HCC patients with PVTT. Therefore, TAC-ECF may be considered as an effective treatment option for patients with unresectable HCC.
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Affiliation(s)
- Sung Won Lee
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Lim Lee
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nam Ik Han
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hyun Kwon
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soon Woo Nam
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Won Jang
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si Hyun Bae
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Young Choi
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Kew Yoon
- Division of Hepatology, Department of Internal Medicine, Seoul St. Mary’s hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
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Yu TZ, Zhang W, Liu QX, Li WH, Ma JQ, Zhang ZH, Yang MJ, Wang JH, Chen B, Zeng SC, Luo JJ, Liu LX, Yan ZP. Endovascular brachytherapy combined with portal vein stenting and transarterial chemoembolization improves overall survival of hepatocellular carcinoma patients with main portal vein tumor thrombus. Oncotarget 2017; 8:12108-12119. [PMID: 28076848 PMCID: PMC5355329 DOI: 10.18632/oncotarget.14520] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/27/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus have a median survival time of only about 4 months. We therefore compared the safety and efficacy of endovascular brachytherapy (EVBT) and sequential three-dimensional conformal radiotherapy (3-DCRT). From a cohort of 176 patients, we treated 123 with EVBT using iodine-125 seed strands (group A) and the remaining 53 with sequential 3-DCRT (group B). Overall survival, progression free survival and stent patency characteristics were compared between the two groups. Our analysis demonstrated a median survival of 11.7 ± 1.2 months in group A versus 9.5 ± 1.8 months in group B (p = 0.002). The median progression free survival was 5.3 ± 0.7 months in groupA versus 4.4 ± 0.4 months in group B (p = 0.010). The median stent patency period was 10.3 ± 1.1 months in group A versus 8.7 ± 0.7 months in group B (p = 0.003). Therefore, as compared to sequential 3-DCRT, EVBT combined with portal vein stenting and TACE improved overall survival of HCC patients with main portal vein tumor thrombus.
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Affiliation(s)
- Tian-Zhu Yu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qing-Xin Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wen-Hui Li
- Department of Interventional Radiology, Yancheng Third People's Hospital, Southeast University, Yancheng, China
| | - Jing-Qin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Zi-Han Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Min-Jie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Jian-Hua Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Bing Chen
- Department of Radiotherapy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shao-Chong Zeng
- Department of Radiotherapy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian-Jun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Ling-Xiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Zhi-Ping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
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Yin J, Bo WT, Sun J, Xiang X, Lang JY, Zhong JH, Li LQ. New Evidence and Perspectives on the Management of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus. J Clin Transl Hepatol 2017; 5:169-176. [PMID: 28660155 PMCID: PMC5472938 DOI: 10.14218/jcth.2016.00071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/02/2017] [Accepted: 03/04/2017] [Indexed: 02/06/2023] Open
Abstract
Portal vein tumor thrombosis (PVTT) is an intractable condition but common phenomenon in hepatocellular carcinoma (HCC). HCC patients with PVTT may have worse liver function, a higher chance of comorbidity related to portal hypertension, lower tolerance to treatment and poorer prognoses. In Western guidelines, patients are offered palliative treatment with sorafenib or other systemic agents because HCC with PVTT is grouped together with metastatic HCC during the planning of its management. In recent years, various treatment options have become available for patients with HCC and PVTT. Therapy has also shifted toward evidence-based treatment. However, policies for the management of HCC with PVTT have not been established. This comprehensive literature review aims to present current and available management options for patients with HCC and PVTT. Evidence is mainly based on studies published after 2010.
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Affiliation(s)
- Jun Yin
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wen-Tao Bo
- Department of Hepatobiliary Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jian Sun
- Department of Medical Affairs, ZiBo Hospital of Integrated Traditional Chinese and Western Medicine, Zibo, China
| | - Xiao Xiang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Jin-Yi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jian-Hong Zhong
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
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Moriguchi M, Furuta M, Itoh Y. A Review of Non-operative Treatments for Hepatocellular Carcinoma with Advanced Portal Vein Tumor Thrombus. J Clin Transl Hepatol 2017; 5:177-183. [PMID: 28660156 PMCID: PMC5472939 DOI: 10.14218/jcth.2016.00075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/21/2017] [Accepted: 02/25/2017] [Indexed: 12/12/2022] Open
Abstract
Portal vein tumor thrombus (PVTT) frequently occurs with the progression of hepatocellular carcinoma (HCC) and is an important factor in determining the prognosis of HCC. In many cases of HCC with advanced PVTT, treatment is difficult because the tumor has considerable extension into the liver, and portal hypertension is a frequent complication. The standard therapy for unresectable HCC with advanced PVTT is sorafenib therapy in patients with good hepatic function. However, the outcomes of sorafenib therapy are not completely satisfactory, making the development of another therapy an urgent task. Therefore, this review aims to summarize non-operative treatments for HCC with advanced PVTT and discuss future perspectives based on those therapies, including therapies still being developed.
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Affiliation(s)
- Michihisa Moriguchi
- *Correspondence to: Michihisa Moriguchi, Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokouji, Kamigyo-ku, Kyoto 602-8566, Japan. Tel: +81-75-251-5519, Fax: +81-75-0251-0710, E-mail:
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45
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Jiang JF, Lao YC, Yuan BH, Yin J, Liu X, Chen L, Zhong JH. Treatment of hepatocellular carcinoma with portal vein tumor thrombus: advances and challenges. Oncotarget 2017; 8:33911-33921. [PMID: 28430610 PMCID: PMC5464922 DOI: 10.18632/oncotarget.15411] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/02/2017] [Indexed: 02/06/2023] Open
Abstract
Portal vein tumor thrombus is a frequent, challenging complication in hepatocellular carcinoma. Hepatocellular carcinoma patients with portal vein tumor thrombus may show worse liver function, less treatment tolerance and worse prognosis than patients without portal vein tumor thrombus, and they may be at higher risk of comorbidity related to portal hypertension. Western and some Asian guidelines stratify hepatocellular carcinoma with portal vein tumor thrombus together with metastatic hepatocellular carcinoma and therefore recommend only palliative treatment with sorafenib or other systemic agents. In recent years, more treatment options have become available for hepatocellular carcinoma patients with portal vein tumor thrombus, and an evidence-based approach to optimizing disease management and treatment has become more widespread. Nevertheless, consensus policies for managing hepatocellular carcinoma with portal vein tumor thrombus have not been established. This comprehensive literature review, drawing primarily on studies published after 2010, examines currently available management options for patients with hepatocellular carcinoma and portal vein tumor thrombus.
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Affiliation(s)
- Jin-Fang Jiang
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Yong-Cong Lao
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Bao-Hong Yuan
- Department of General Surgery, Yan’An Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Jun Yin
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xin Liu
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Long Chen
- Department of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Jian-Hong Zhong
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
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Jun CH, Yoon JH, Cho E, Shin SS, Cho SB, Kim HJ, Park CH, Kim HS, Choi SK, Rew JS. Barcelona clinic liver cancer-stage C hepatocellular carcinoma: A novel approach to subclassification and treatment. Medicine (Baltimore) 2017; 96:e6745. [PMID: 28445298 PMCID: PMC5413263 DOI: 10.1097/md.0000000000006745] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Barcelona clinic liver cancer-stage C (BCLC-C) encompasses a broad spectrum of tumor burdens, liver function statuses, patient prognoses, and treatment strategies. Currently, sorafenib is the only recommended treatment for patients with BCLC-C and outcomes remain suboptimal. The aims of this study were to assess the heterogeneity of BCLC-C hepatocellular carcinoma (HCC) cases, propose a novel subclassification for these cases, and suggest optimal treatment strategies other than sorafenib.We retrospectively analyzed 196 consecutive BCLC-C HCC patients who were diagnosed and treated between January 2008 and December 2015.All 196 patients were classified according to the modified Union for International Cancer Control (Stage I, 0.0%; Stage II, 8.2%; Stage III, 64.3%; Stage IVA, 21.9%; and Stage IVB, 5.6%) and American Joint Committee on Cancer TNM staging systems (Stage I, 0.0%; Stage II, 16.3%; Stage IIIA, 27.6%; Stage IIIB, 49.5%; Stage IIIC, 1.5%; Stage IVA, 1.0%; and Stage IVB, 4.1%). First-line treatment modalities included surgical resection (8.7%), transarterial chemoembolization (49.5%), hepatic arterial infusion therapy (5.6%), sorafenib therapy (9.2%), radiotherapy (9.2%), and best supportive care (10.7%). In univariate analysis, Child-Pugh score, tumor size, distant metastasis, multinodular or infiltrative/diffuse type of HCC, main portal vein invasion, hepatic vein invasion, and bile duct invasion were significantly associated with survival (P < .001). Tumor size, distant metastasis, HCC type, and bile duct invasion remained significantly associated with 1-, 3-, and 5-year survival rates in multivariate Cox regression analyses. Using these 4 characteristics, a novel subclassification of BCLC-C was developed and applied to the patient cohort. The subclassification included 5 substages (stages C0-C4), as defined based on the number of characteristics that were present in each HCC case (0-4). The subclassification showed significant associations with survival, with median survival times of 3026 days, 605 days, 224 days, 126 days, and 82 days for patients with Stage C0, C1, C2, C3, and C4 disease, respectively (P < .001). Additionally, diverse survival rates were observed when different treatment modalities were selected for cases within each substage.The proposed BCLC-C subclassification of HCC patients is effective in providing better prognostic subclassifications and more appropriate treatment strategies.
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Affiliation(s)
| | | | | | | | | | - Hee Joon Kim
- Department of Surgery, Chonnam National University Hospital, Gwangju, South Korea
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Waked I, Berhane S, Toyoda H, Chan SL, Stern N, Palmer D, Tada T, Yeo W, Mo F, Bettinger D, Kirstein MM, Iñarrairaegui M, Gomaa A, Vogel A, Meyer T, Sangro B, Lai P, Kumada T, Johnson PJ. Transarterial chemo-embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion. Br J Cancer 2017; 116:448-454. [PMID: 28125820 PMCID: PMC5318968 DOI: 10.1038/bjc.2016.423] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/17/2016] [Accepted: 11/28/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Transarterial chemo-embolisation (TACE) is recommended for patients with BCLC intermediate stage hepatocellular carcinoma (stage B), particularly in patients with good underlying liver function and minimal symptoms. The hepatoma arterial embolisation prognostic (HAP) score combines measures of liver function and tumour-related factors to offer a simple prognostic scoring system. The Albumin-Bilirubin (ALBI) grade permits assessment of the impact of liver function on survival. We aimed to investigate these two models and vascular invasion (VI). METHODS In an international cohort of 3030 patients undergoing TACE, we examined the impact of liver function as assessed by the ALBI score, the HAP score and VI on survival. RESULTS Classification according to ALBI grade resulted in non-overlapping survival curves in the overall data set and all regional cohorts. The HAP score was also validated. Tumour number, aetiology and VI were identified as additional independent prognostic risk factors not currently included in the HAP score. Survival was particularly poor for patients with VI. CONCLUSIONS The ALBI grade categorised patients receiving TACE into three clear prognostic groups, thereby emphasising the importance of underlying liver function in the outcome of TACE. The HAP score has been validated internationally and the serious adverse impact of VI is clearly shown.
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Affiliation(s)
- Imam Waked
- Department of Hepatology, National Liver Institute, Menoufeya University, Menoufia Governorate, Egypt
| | - Sarah Berhane
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, The Sherrington Building, Ashton Street, Liverpool L69 3GA, UK
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan
| | - Stephen L Chan
- Department of Anatomical & Cellular Pathology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China
| | - Nicholas Stern
- Digestive Diseases Unit, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Liverpool, UK
| | - Daniel Palmer
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, The Sherrington Building, Ashton Street, Liverpool L69 3GA, UK
| | - Toshifumi Tada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan
| | - Winnie Yeo
- State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China
| | - Frankie Mo
- State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China
| | - Dominik Bettinger
- Department of Internal Medicine II, University Hospital Freiburg, Hugstetter Street 55, Freiburg D-79106, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl Neuberg Street 1, Hannover 30625, Germany
| | - Mercedes Iñarrairaegui
- Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra; and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Asmaa Gomaa
- Department of Hepatology, National Liver Institute, Menoufeya University, Menoufia Governorate, Egypt
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl Neuberg Street 1, Hannover 30625, Germany
| | - Tim Meyer
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra; and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Paul Lai
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Takashi Kumada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan
| | - Philip J Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, The Sherrington Building, Ashton Street, Liverpool L69 3GA, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral CH63 4JY, UK
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Tarantino L, Busto G, Nasto A, Fristachi R, Cacace L, Talamo M, Accardo C, Bortone S, Gallo P, Tarantino P, Nasto RA, Di Minno MND, Ambrosino P. Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis: A feasibility study. World J Gastroenterol 2017; 23:906-918. [PMID: 28223736 PMCID: PMC5296208 DOI: 10.3748/wjg.v23.i5.906] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/14/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4- portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feasibility, safety and efficacy of this new non thermal ablative technique in those patients.
METHODS Six patients (5 males and 1 female), aged 61-85 years (mean age, 70 years), four in Child-Pugh A and two in Child-Pugh B class, entered our study series. All patients were studied with three-phase computed tomography (CT), contrast enhanced ultrasound (CEUS) and ultrasound-guided percutaneous biopsy of the thrombus before ECT. All patients underwent ECT treatment (Cliniporator Vitae®, IGEA SpA, Carpi, Modena, Italy) of Vp3-Vp4 PVTT in a single session. At the end of the procedure a post-treatment biopsy of the thrombus was performed. Scheduled follow-up in all patients entailed: CEUS within 24 h after treatment; triphasic contrast-enhanced CT and CEUS at 3 mo after treatment and every six months thereafter.
RESULTS Post-treatment CEUS showed complete absence of enhancement of the treated thrombus in all cases. Post-treatment biopsy showed apoptosis and necrosis of tumor cells in all cases. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patients, the follow-up CT and CEUS demonstrated complete patency of the treated portal vein. Other 3 patients showed a persistent avascular non-tumoral shrinked thrombus at CEUS and CT during follow-up. No local recurrence was observed at follow-up CT and CEUS in 5/6 patients. One patient was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after ECT.
CONCLUSION In patients with cirrhosis, ECT seems effective and safe for curative treatment of Vp3-Vp4 PVTT from HCC.
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Hasimu A, Gu JP, Ji WZ, Zhang HX, Zhu DW, Ren WX. Comparative Study of Percutaneous Transhepatic Biliary Stent Placement with or without Iodine-125 Seeds for Treating Patients with Malignant Biliary Obstruction. J Vasc Interv Radiol 2017; 28:583-593. [PMID: 28162906 DOI: 10.1016/j.jvir.2016.11.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/03/2016] [Accepted: 11/11/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To prospectively evaluate safety and efficacy of biliary stent placement with iodine-125 (125I) seeds in patients with malignant obstructive jaundice (MOJ). MATERIALS AND METHODS From July 2011 to June 2014, 55 patients were enrolled (group A, 11 men and 17 women, mean age 70.93 y ± 8.58; group B, 14 men and 13 women, mean age 70.26 y ± 9.71). All patients were randomly assigned to placement of a biliary stent with 125I seeds (group A) or biliary stent only (group B). After stent placement, outcomes were measured regarding relief of MOJ. Clinical success rate, survival time, and safety were recorded. P < .05 was considered to indicate significant difference. RESULTS Stents were successfully placed in all 55 patients. MOJ was relieved in all patients, and there were no significant differences in complications related to stent insertion between the 2 groups. Mean and median stent patency were 191 days ± 19.8 (95% confidence interval [CI], 152-230 d) and 179 days ± 191.4 (95% CI, 87-267 d) in group A and 88.3 days ± 16.3 (95% CI, 61-114 d) and 77 days ± 88.2 (95% CI, 65-86 d) in group B (P < .001, log-rank test). Mean and median survival time were 222.6 days ± 21.0 (95% CI, 181-263 d) and 241 days ± 18.2 (95% CI, 179-270 d) in group A and 139.1 days ± 14.5 (95% CI, 110-167 d) and 142 days ± 16.3 (95% CI, 83-177 d) in group B (P < .001, log-rank test). CONCLUSIONS 125I seeds combined with biliary stent placement could significantly improve stent patency. The procedure seems to be safe and to extend survival compared with self-expandable biliary stent placement.
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Affiliation(s)
- Asihaer Hasimu
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Jun-Peng Gu
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Wei-Zheng Ji
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Hai-Xiao Zhang
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Di-Wen Zhu
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Wei-Xin Ren
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China.
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Prognostic Value of FDG Uptake of Portal Vein Tumor Thrombosis in Patients With Locally Advanced Hepatocellular Carcinoma. Clin Nucl Med 2017; 42:e35-e40. [PMID: 27775940 DOI: 10.1097/rlu.0000000000001422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to evaluate the prognostic value of F-FDG uptake of portal vein tumor thrombosis (PVTT) for predicting progression-free survival (PFS) and overall survival (OS) in patients with locally advanced hepatocellular carcinoma (HCC). METHODS The study retrospectively included 166 HCC patients with PVTT and no extrahepatic metastases who underwent staging FDG PET/CT. Tumor-to-liver uptake ratio (TLR) and PVTT-to-liver uptake ratio (PLR) were measured for each patient, and the prognostic values of clinical factors, TLR, and PLR were assessed. Furthermore, patients were classified into 2 subgroups according to TLR, and the prognostic value of PLR was evaluated in each subgroup. RESULTS Median PFS and OS were 6.2 and 10.1 months, respectively. On multivariate analysis, tumor size (P = 0.006) and PLR (P = 0.03) were independent prognostic factors for PFS, whereas Child-Pugh class (P = 0.02) and PLR (P = 0.02) were independent prognostic factors for OS. Tumor-to-liver uptake ratio was a significant prognostic factor for PFS and OS on univariate analysis but failed to show significance on multivariate analysis. In both patient subgroups with low and high TLR, PLR remained a significant prognostic factor for predicting OS (P = 0.04 for all). CONCLUSIONS FDG uptake of PVTT, but not FDG uptake of HCC, is an independent prognostic factor for PFS and OS in HCC patients with PVTT and no extrahepatic metastasis. Given the prognostic significance, it is strongly encouraged to use FDG uptake of PVTT in further risk stratification for HCC patients with PVTT.
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