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Rosenthal BE, Hoteit MA, Lluri G, Haeffele C, Daugherty T, Krasuski RA, Serfas JD, de Freitas RA, Porlier A, Lubert AM, Wu FM, Valente AM, Krieger EV, Buber Y, Rodriguez FH, Gaignard S, Saraf A, Hindes M, Earing MG, Lewis MJ, Rosenbaum MS, Zaidi AN, Hopkins K, Bradley EA, Cedars AM, Ko JL, Franklin WJ, Frederickson A, Ginde S, Grewal J, Nyman A, Min J, Schluger C, Rand E, Hilscher M, Rychik J, Kim YY. Characteristics and Survival Outcomes of Hepatocellular Carcinoma After the Fontan Operation. JACC. ADVANCES 2025; 4:101646. [PMID: 40080923 PMCID: PMC11953964 DOI: 10.1016/j.jacadv.2025.101646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 01/31/2025] [Accepted: 01/31/2025] [Indexed: 03/15/2025]
Abstract
BACKGROUND The Fontan operation is a surgical procedure to palliate single ventricle congenital heart disease. Hepatocellular carcinoma (HCC) is a rare complication of Fontan-associated liver disease (FALD). OBJECTIVES The authors aim to examine characteristics of individuals with Fontan circulation diagnosed with HCC and to describe tumor characteristics, treatment, and survival outcomes of these patients. METHODS This was a multicenter retrospective case-control study of adults with Fontan circulation between 2005 and 2021. HCC cases were included based on histology or imaging-based diagnosis. Controls were randomly selected in a 3:1 ratio from the center in which the case was derived. Descriptive statistics were used to compare groups and Kaplan-Meier survival analysis was performed. RESULTS There were 58 cases of HCC diagnosed at a median age of 31 (IQR: 26-38) years. Diagnosis was made at very early or early stage disease in 68%. Compared to controls, cases had higher prevalence of advanced FALD including varices, ascites, splenomegaly, and decreased platelets. Treatment with curative intent (combined heart-liver transplantation, resection, or ablation) was performed in 41%. Survival at 1 year was 78.9% and highest among those diagnosed at very early or early stage. Over half were undergoing active surveillance at diagnosis, which showed a nonsignificant trend toward higher survival (P = 0.088). CONCLUSIONS We describe the clinical characteristics, treatment, and survival in patients with FALD-HCC. Results suggest that adults with FALD-HCC diagnosed with early stage disease may have survival benefit. Our findings underscore the importance of HCC screening for early detection in individuals after the Fontan operation.
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Affiliation(s)
- Benjamin E Rosenthal
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maarouf A Hoteit
- Division of Hepatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gentian Lluri
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Christiane Haeffele
- Division of Cardiovascular Medicine, Stanford Medicine, Stanford, California, USA
| | - Tami Daugherty
- Division of Cardiovascular Medicine, Stanford Medicine, Stanford, California, USA
| | | | - John D Serfas
- Duke University Health System, Durham, North Carolina, USA
| | - R Andrew de Freitas
- Division of Pediatric Cardiology, Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Avaliese Porlier
- Division of Pediatric Cardiology, Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Adam M Lubert
- Department of Pediatrics, Cincinnati Children's Hospital Heart Institute, University of Cincinnati, Cincinnati, Ohio, USA
| | - Fred M Wu
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Anne Marie Valente
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Eric V Krieger
- University of Washington Medical Center, University of Washington School of Medicine, Seattle, Washington, USA; Seattle Children's Hospital, Seattle, Washington, USA
| | - Yonatan Buber
- University of Washington Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Fred H Rodriguez
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Scott Gaignard
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Anita Saraf
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Morgan Hindes
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Matthew J Lewis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Marlon S Rosenbaum
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Ali N Zaidi
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, New York, New York, USA
| | - Kali Hopkins
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, New York, New York, USA
| | - Elisa A Bradley
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ari M Cedars
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jong L Ko
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Wayne J Franklin
- Division of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, Arizona, USA; Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Abby Frederickson
- Division of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Salil Ginde
- Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jasmine Grewal
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annique Nyman
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jungwon Min
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Charlotte Schluger
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth Rand
- Division of Hepatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Moira Hilscher
- Division of Hepatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jack Rychik
- Division of Hepatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yuli Y Kim
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Cassese G, C Giglio M, Vitale A, Lauterio A, Serenari M, Cipriani F, Ardito F, Perri P, Nicolini D, Di Gioia G, Fontana AP, Lai Q, Conci S, Fumagalli L, Iaria M, Garancini M, Molfino S, Zanello M, La Barba G, Conticchio M, Germani P, Famularo S, Romano M, Zimmitti G, De Angelis M, Troci A, Belli A, Izzo F, Crespi M, Boccia L, Abu Hilal M, Zanus G, Torzilli G, Tarchi P, Memeo R, Ercolani G, Jovine E, Baiocchi G, Romano F, Della Valle R, Chiarelli M, Ruzzenente A, Rossi M, Ferrero A, Maestri M, Vivarelli M, Grazi GL, Giuliante F, Aldrighetti L, Cescon M, De Carlis L, Cillo U, I Troisi R. Minimally invasive versus open liver resection for nonmetastatic hepatocellular carcinoma staged BCLC - B and - C: an Italian multicentric analysis. HPB (Oxford) 2025:S1365-182X(25)00028-0. [PMID: 39956728 DOI: 10.1016/j.hpb.2025.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 01/12/2025] [Accepted: 01/16/2025] [Indexed: 02/18/2025]
Abstract
BACKGROUND Recent papers report significant survival gain after liver resection in BCLC-B and -C HCC patients. The results of minimally invasive liver surgery (MILS) in such patients have not been widely investigated so far. METHODS Data regarding patients undergoing MILS or open liver resection (OLR) for HCC staged BCLC -B and -C were extracted from the HERCOLES database. An inverse probability of treatment weighting (IPTW) method was adopted to balance the confounders. The primary outcome was a composite endpoint including post-hepatectomy liver failure, severe postoperative complications and in-hospital mortality. RESULTS 627 patients were included (459 undergoing OLR and 168 receiving MILS). After IPTW, no difference was found in the composite endpoint between MILS and OLR (OR 0.86 [95%CI 0.46-1-60]; p = 0.62). MILS reduced the risk of receiving intra-operative transfusions (OR 0.28 [95%CI 0.13-0.58]; p < 0.001) and of developing postoperative ascites (OR 0.56 [95%CI 0,32-0,98]; p = 0.039), with reduced length of stay (OR 0.82 [95%CI 0.66-1.01]; p = 0.045). The survival analysis showed no differences between MILS and OLR for both OS (p = 0.13) and DFS (p = 0.491). CONCLUSION MILS was shown to be safe and feasible for selected non-metastatic HCC patients staged BCLC B and C, reducing the risk of perioperative transfusions and postoperative ascites, and shortening the length of stay.
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Affiliation(s)
- Gianluca Cassese
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Transplantation Service, Federico II University Hospital, Naples, Italy
| | - Mariano C Giglio
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Transplantation Service, Federico II University Hospital, Naples, Italy
| | - Alessandro Vitale
- Department of Surgical Oncological and Gastroenterological Sciences, Padua University, Padua, Italy
| | - Andrea Lauterio
- General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Matteo Serenari
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Cipriani
- Division of Hepatobiliary Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ardito
- Department of Medical and Surgical Sciences, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Pasquale Perri
- Hepatobiliary and Pancreatic Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Nicolini
- HPB Surgery and Transplantation Unit, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Giulio Di Gioia
- Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Quirino Lai
- Division of General Surgery and Organ Transplantation, AUO Policlinico Umberto I of Rome, Sapienza University of Rome, Rome, Italy
| | - Simone Conci
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Luca Fumagalli
- Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy
| | - Maurizio Iaria
- Department of Medicine and Surgery, HPB Unit, University of Parma - Parma University Hospital, Parma, Italy
| | - Mattia Garancini
- Department of General Surgery, Unit of Hepatobiliary Surgery, IRCCS San Gerardo dei Tintori, Milano-Bicocca University, Monza, Italy
| | - Sarah Molfino
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Zanello
- Alma Mater Studiorum, University of Bologna, AOU Sant'Orsola Malpighi, IRCCS at Maggiore Hospital, Bologna, Italy
| | - Giuliano La Barba
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Maria Conticchio
- Department of Hepato-Pancreatc-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Paola Germani
- Surgical Clinics, University Hospital of Trieste, Trieste, Italy
| | - Simone Famularo
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maurizio Romano
- Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit, Treviso Hospital, Italy
| | - Giuseppe Zimmitti
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Albert Troci
- Department of Surgery, L. Sacco Hospital, Milan, Italy
| | - Andrea Belli
- Istituto Nazionale Tumori, IRCCS "G. Pascale", Napoli, 80131, Italy
| | - Francesco Izzo
- Istituto Nazionale Tumori, IRCCS "G. Pascale", Napoli, 80131, Italy
| | | | - Luigi Boccia
- Department of General Surgery, Ospedale Carlo Poma, Mantua, Italy
| | - Mohamed Abu Hilal
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giacomo Zanus
- Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit, Treviso Hospital, Italy
| | - Guido Torzilli
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Paola Tarchi
- Department of Medicine and Surgery, LUM University, Casamassima, Bari, Italy
| | - Riccardo Memeo
- Department of Hepato-Pancreatc-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy; Department of Medicine and Surgery, LUM University, Casamassima, Bari, Italy
| | - Giorgio Ercolani
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Elio Jovine
- Alma Mater Studiorum, University of Bologna, AOU Sant'Orsola Malpighi, IRCCS at Maggiore Hospital, Bologna, Italy
| | - Gianluca Baiocchi
- Department of General Surgery, Unit of Hepatobiliary Surgery, IRCCS San Gerardo dei Tintori, Milano-Bicocca University, Monza, Italy
| | - Fabrizio Romano
- Department of Medicine and Surgery, HPB Unit, University of Parma - Parma University Hospital, Parma, Italy
| | | | - Marco Chiarelli
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Andrea Ruzzenente
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Massimo Rossi
- Division of General Surgery and Organ Transplantation, AUO Policlinico Umberto I of Rome, Sapienza University of Rome, Rome, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital "Umberto I," Turin, Italy
| | - Marcello Maestri
- Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Vivarelli
- HPB Surgery and Transplantation Unit, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Gian Luca Grazi
- Hepatobiliary and Pancreatic Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Felice Giuliante
- Department of Medical and Surgical Sciences, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Luca Aldrighetti
- Division of Hepatobiliary Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Cescon
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luciano De Carlis
- General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Umberto Cillo
- Department of Surgical Oncological and Gastroenterological Sciences, Padua University, Padua, Italy
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Transplantation Service, Federico II University Hospital, Naples, Italy.
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Cai Q, Pang C, Wang Z, Li J, Dai Y, Fan FY, Wang ZQ, Hu X, Li L, Chen XW, Ji R, Mei Q, Zhang C, Liang P, Yu X, Liu FY, Cheng Z, Yu J. Relationship between postablation fever and prognosis in initial hepatocellular carcinoma: a 15-year multicenter, retrospective cohort study. Int J Surg 2025; 111:962-971. [PMID: 39291970 PMCID: PMC11745605 DOI: 10.1097/js9.0000000000002066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 08/25/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Fever is a common side effect following thermal ablation in patients with hepatocellular carcinoma (HCC), yet its impact on prognosis remains unclear. MATERIALS AND METHODS This retrospective study included initial HCC patients who underwent US-guided percutaneous microwave ablation at 13 hospitals between January 2006 and February 2021. All patients were categorized into afebrile, transient low-grade fever (TLF), and prolonged or high-grade fever (PHF) groups. Primary outcomes included very early recurrence (VER) and early recurrence (ER), secondary outcomes were disease-free survival (DFS) and overall survival (OS). Fever cut-offs for VER/ER were established using restrictive cubic splines and an adjusted Cox model. Survival analyses used the Kaplan-Meier method. RESULTS A total of 1458 initial HCC patients (mean age, 59±11[SD]; 1146 men). Compared to afebrile individuals, patients with TLF (temperatures ranging 37.0-38.8°C for 1-2 days), showed independent protective effects against VER (HR, 0.73; 95% CI: 0.57-0.95; P =0.02) and ER (HR, 0.66; 95% CI: 0.54-0.81; P <0.001), however, PHF showed no differences in VER (HR, 0.99; 95% CI: 0.76-1.30; P =0.96) and ER (HR, 0.86; 95% CI: 0.69-1.07; P =0.17). With a median follow-up of 47 months (IQR: 26-79), the median DFS for TLF patients was 40 months, superior to afebrile (30 months, P =0.019) and PHF patients (33 months, P =0.049). The 5-year OS rate for TLF patients was 73.2%, higher than afebrile (69.3%, P =0.02) and PHF patients (66.7%, P =0.03). No significant difference was found in DFS and OS between afebrile and PHF patients ( P =0.90 and 0.71). Notably, TLF patients exhibited the highest lymphocyte counts increasing median 7 days after ablation ( P <0.001 vs. afebrile and P =0.01 vs. PHF). CONCLUSION Transient low-grade fever following percutaneous microwave ablation in hepatocellular carcinoma patients demonstrated protection against early recurrence, possibly attributed to the short-term activation of lymphocytes.
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Affiliation(s)
- Qian Cai
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Chuan Pang
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Zhen Wang
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Jianming Li
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Yuqing Dai
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Fang-ying Fan
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Zhong-qi Wang
- Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital and Chinese PLA Medical College, Beijing, People’s Republic of China
| | - Xin Hu
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Lijuan Li
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Xu-wei Chen
- Department of Breast and Thyroid Surgery, Qingdao Women and Children’s Hospital, Qingdao University, Qingdao, People’s Republic of China
| | - Ran Ji
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Qian Mei
- Department of Bio-Therapeutic, The First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Chao Zhang
- Senior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Ping Liang
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Xiaoling Yu
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Fang-yi Liu
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Zhigang Cheng
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Jie Yu
- Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
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Jiang J, Bouquet E, Kweon Y, Elsaid MI, Diaz DA, Conteh L, Sobotka LA. Neighborhood opportunity is associated with completion of hepatocellular carcinoma surveillance prior to the diagnosis of hepatocellular carcinoma in patients with cirrhosis. Clin Res Hepatol Gastroenterol 2024; 48:102485. [PMID: 39489339 DOI: 10.1016/j.clinre.2024.102485] [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: 07/16/2024] [Revised: 10/09/2024] [Accepted: 10/19/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND The Ohio Opportunity Index (OOI) is a multidimensional metric used to quantify neighborhood-level resources to access a wide array of factors that influence health. This study examined the relationship between neighborhood opportunity and completion of guideline-concordant hepatocellular carcinoma (HCC) screening in patients with cirrhosis. METHODS This retrospective study included patients with cirrhosis and HCC who received care at The Ohio State University Wexner Medical Center between 1/1/2015 and 12/31/2021. High opportunity was defined as a score greater than the third quartile of the study cohort. Modified Poisson regression models with robust variance examined the association, on the prevalence ratio (aPR) scale, between guideline-concordant HCC screening and high neighborhood opportunity status. RESULTS This study included 157 cirrhosis patients newly diagnosed with HCC. Only 25.5 % of the patients completed HCC surveillance within 6 months prior to diagnosis. The OOI was a significant predictor of adherence in all models. For every ten-percentile increase in OOI score, there was a consistent increase in the prevalence ratio (PR) of pre-diagnosis HCC surveillance (PR=1.37, 95 % CI 1.10-1.71). This effect remained significant after controlling for sociodemographic, clinical, and cirrhosis-related variables (adjusted PR=1.38, 95 % CI 1.02-1.85. Compared to those with high OOI (i.e.,≥Q3), patients in the lowest opportunity quartile had a 64 % lower prevalence of HCC screening (PR=0.36, 95 % CI 0.26-0.50). CONCLUSION Neighborhood opportunity status has a dose-dependent effect on HCC surveillance adherence in patients with cirrhosis. Future studies should identify neighborhood-level interventions to reduce socioeconomic disparities in HCC diagnosis and outcomes.
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Affiliation(s)
- Joanna Jiang
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erin Bouquet
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yesung Kweon
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Mohamed I Elsaid
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA; Division of Medical Oncology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Dayssy A Diaz
- Department of Radiation Oncology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Lanla Conteh
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lindsay A Sobotka
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Dawood ZS, Brown ZJ, Alaimo L, Lima HA, Shaikh C, Katayama ES, Munir MM, Moazzam Z, Endo Y, Woldesenbet S, Pawlik TM. Comparison of tumor response and outcomes of patients with hepatocellular carcinoma after multimodal treatment including immune checkpoint inhibitors - a systematic review and meta-analysis. HPB (Oxford) 2024; 26:618-629. [PMID: 38369433 DOI: 10.1016/j.hpb.2024.02.003] [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: 07/20/2023] [Revised: 01/13/2024] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The efficacy of immune checkpoint inhibitors (ICIs) combined with tyrosine kinase inhibitors (TKIs), trans-arterial chemoembolization (TACE), and radiotherapy to treat hepatocellular carcinoma (HCC) has not been well-defined. We performed a meta-analysis to characterize tumor response and survival associated with multimodal treatment of HCC. METHODS PubMed, Embase, Medline, Scopus, and CINAHL databases were searched (1990-2022). Random-effect meta-analysis was conducted to compare efficacy of treatment modalities. Odds ratios (OR) and standardized mean difference (SMD) were reported. RESULTS Thirty studies (4170 patients) met inclusion criteria. Triple therapy regimen (ICI + TKI + TACE) had the highest overall disease control rate (DCR) (87%, 95% CI 83-91), while ICI + radiotherapy had the highest objective response rate (ORR) (72%, 95% CI 54%-89%). Triple therapy had a higher DCR than ICI + TACE (OR 4.49, 95% CI 2.09-9.63), ICI + TKI (OR 3.08, 95% CI 1.63-5.82), and TKI + TACE (OR 2.90, 95% CI 1.61-5.20). Triple therapy demonstrated improved overall survival versus ICI + TKI (SMD 0.72, 95% CI 0.37-1.07) and TKI + TACE (SMD 1.13, 95% CI 0.70-1.48) (both p < 0.05). Triple therapy had a greater incidence of adverse events (AEs) compared with ICI + TKI (OR 0.59, 95% CI 0.29-0.91; p = 0.02), but no difference in AEs versus ICI + TACE or TKI + TACE (both p > 0.05). CONCLUSION The combination of ICIs, TKIs and TACE demonstrated superior tumor response and survival and should be considered for select patients with advanced HCC.
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Affiliation(s)
- Zaiba S Dawood
- Medical College, The Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Zachary J Brown
- Department of Surgery, New York University Long Island School of Medicine, Mineola, NY, USA
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Chanza Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Erryk S Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad M Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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6
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Sogbe M, Bilbao I, Marchese FP, Zazpe J, De Vito A, Pozuelo M, D’Avola D, Iñarrairaegui M, Berasain C, Arechederra M, Argemi J, Sangro B. Prognostic value of ultra-low-pass whole-genome sequencing of circulating tumor DNA in hepatocellular carcinoma under systemic treatment. Clin Mol Hepatol 2024; 30:177-190. [PMID: 38163441 PMCID: PMC11016491 DOI: 10.3350/cmh.2023.0426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND/AIMS New prognostic markers are needed to identify patients with hepatocellular carcinoma (HCC) who carry a worse prognosis. Ultra-low-pass whole-genome sequencing (ULP-WGS) (≤0.5× coverage) of cell-free DNA (cfDNA) has emerged as a low-cost promising tool to assess both circulating tumor DNA (ctDNA) fraction and large structural genomic alterations. Here, we studied the performance of ULP-WGS of plasma cfDNA to infer prognosis in patients with HCC. METHODS Plasma samples were obtained from patients with HCC prior to surgery, locoregional or systemic therapy, and were analyzed by ULP-WGS of cfDNA to an average genome-wide fold coverage of 0.3x. ctDNA and copy number alterations (CNA) were estimated using the software package ichorCNA. RESULTS Samples were obtained from 73 HCC patients at different BCLC stages (BCLC 0/A: n=37, 50.7%; BCLC B/C: n=36, 49.3%). ctDNA was detected in 18 out of 31 patients who received systemic treatment. Patients with detectable ctDNA showed significantly worse overall survival (median, 13.96 months vs not reached). ctDNA remained an independent predictor of prognosis after adjustment by clinical-pathologic features and type of systemic treatment (hazard ratio 7.69; 95%, CI 2.09-28.27). Among ctDNA-positive patients under systemic treatments, the loss of large genomic regions in 5q and 16q arms was associated with worse prognosis after multivariate analysis. CONCLUSION ULP-WGS of cfDNA provides clinically relevant information about the tumor biology. The presence of ctDNA and the loss of 5q and 16q arms in ctDNA-positive patients are independent predictors of worse prognosis in patients with advanced HCC receiving systemic therapy.
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Affiliation(s)
- Miguel Sogbe
- Clinica Universidad de Navarra, Liver Unit, Pamplona, Spain
| | - Idoia Bilbao
- Clinica Universidad de Navarra, Liver Unit, Pamplona, Spain
| | - Francesco P. Marchese
- University of Navarra, Center for Applied Medical Research (CIMA), Computational Biology and Translational Genomics Program, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Jon Zazpe
- University of Navarra, Center for Applied Medical Research (CIMA), Computational Biology and Translational Genomics Program, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Annarosaria De Vito
- University of Navarra, Center for Applied Medical Research (CIMA), Computational Biology and Translational Genomics Program, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Marta Pozuelo
- University of Navarra, Center for Applied Medical Research (CIMA), Computational Biology and Translational Genomics Program, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Delia D’Avola
- Clinica Universidad de Navarra, Internal Medicine Department, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Mercedes Iñarrairaegui
- Clinica Universidad de Navarra, Liver Unit, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Carmen Berasain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
- University of Navarra, Center for Applied Medical Research (CIMA), Hepatology Laboratory, Solid Tumors Program, Pamplona, Spain
| | - Maria Arechederra
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
- University of Navarra, Center for Applied Medical Research (CIMA), Hepatology Laboratory, Solid Tumors Program, Pamplona, Spain
| | - Josepmaria Argemi
- Clinica Universidad de Navarra, Liver Unit, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
- University of Navarra, Center for Applied Medical Research (CIMA), Hepatology Laboratory, Solid Tumors Program, Pamplona, Spain
| | - Bruno Sangro
- Clinica Universidad de Navarra, Liver Unit, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Clinica Universidad de Navarra, Liver Unit, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
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7
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Stefanini B, Ielasi L, Pallotta DP, Penazza S, Marseglia M, Piscaglia F. Intermediate-stage hepatocellular carcinoma: refining substaging or shifting paradigm? JOURNAL OF LIVER CANCER 2024; 24:23-32. [PMID: 38468499 PMCID: PMC10990660 DOI: 10.17998/jlc.2024.02.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024]
Abstract
This review explores the evolution of cancer staging, focusing on intermediate hepatocellular carcinoma (HCC), and the challenges faced by physicians. The Barcelona Clinic Liver Cancer (BCLC) staging system, introduced in 1999, was designed to address the limitations associated with providing accurate prognostic information for HCC and allocating specific treatments, to avoid overtreatment. However, criticism has emerged, particularly regarding the intermediate stage of HCC (BCLC-B) and its heterogeneous patient population. To overcome this limitation, various subclassification systems, such as the Bolondi and Kinki criteria, have been proposed. These systems are aimed at refining categorizations within the intermediate stage and have demonstrated varying degrees of success in predicting outcomes through external validation. This study discusses the shift in treatment paradigms, emphasizing the need for a more personalized approach rather than strictly adhering to cancer stages, without dismissing the relevance of staging systems. It assesses the available treatment options for intermediate-stage HCC, highlighting the importance of considering surgical and nonsurgical options alongside transarterial chemoembolization for optimal outcomes. In conclusion, the text advocates for a paradigm shift in staging systems prioritizing treatment suitability over cancer stage. This reflects the evolving landscape of HCC management, where a multidisciplinary approach is crucial for tailoring treatments to individual patients, ultimately aiming to improve overall survival.
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Affiliation(s)
- Bernardo Stefanini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luca Ielasi
- Department of Internal Medicine, Ospedale degli Infermi, Faenza, Italy
| | - Dante Pio Pallotta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Sofia Penazza
- Divison of Hepatobiliary and Immunoallergic Diseases, Department of Internal Medicine, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - Mariarosaria Marseglia
- Divison of Hepatobiliary and Immunoallergic Diseases, Department of Internal Medicine, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Divison of Hepatobiliary and Immunoallergic Diseases, Department of Internal Medicine, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
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8
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Wang K, Xiang YJ, Yu HM, Cheng YQ, Liu ZH, Zhong JY, Feng S, Ni QZ, Zhu HF, Pan WW, Li JJ, Liang C, Zhou HK, Meng Y, Lau WY, Cheng SQ. Intensity-modulated radiotherapy combined with systemic atezolizumab and bevacizumab in treatment of hepatocellular carcinoma with extrahepatic portal vein tumor thrombus: A preliminary multicenter single-arm prospective study. Front Immunol 2023; 14:1107542. [PMID: 36875125 PMCID: PMC9978499 DOI: 10.3389/fimmu.2023.1107542] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
Background and aims The efficacy and safety of systemic atezolizumab and bevacizumab (atezo/bev) in treatment of patients with unresectable hepatocellular carcinoma (HCC) have been demonstrated. However, the efficacy of this treatment in patients with HCC and extrahepatic portal vein tumor thrombus (ePVTT) is not satisfactory. This study aimed to study the efficacy and safety of combining intensity-modulated radiotherapy (IMRT) with systemic atezo/bev in treatment of these patients. Methods This multicenter prospective study included patients with ePVTT treated with IMRT combined with atezo/bev from March to September 2021 in three centers in China. The outcomes of this study included objective response rate (ORR), overall survival (OS), progression-free survival (PFS), time to progression (TTP), and association between response and tumor mutational burden (TMB). Treatment-related adverse events (TRAEs) were analyzed to assess safety. Results Of 30 patients in this study, the median follow-up was 7.4 months. Based on the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, the ORR was 76.6%, the median OS for the entire cohort was 9.8 months, the median PFS was 8.0 months, and the median TTP was not reached. This study failed to establish a significant correlation between TMB with any of the following outcomes, including ORR, OS, PFS or TTP. The most common TRAEs at all levels were neutropenia (46.7%), and the most common grade 3/4 TRAE was hypertension (16.7%). There was no treatment-related deaths. Conclusions IMRT combined with atezo/bev showed encouraging treatment efficacy with an acceptable safety profile, making this treatment to be a promising option for HCC patients with ePVTT. Further studies are required to support the findings of this preliminary study. Clinical trial registration http://www.chictr.org.cn, Identifier ChiCTR2200061793.
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Affiliation(s)
- Kang Wang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Yan-Jun Xiang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Hong-Ming Yu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Yu-Qiang Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Zong-Han Liu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Jing-Ya Zhong
- Department of Cell Biology, College of Medicine, Jiaxing University, Jiaxing, China
| | - Shuang Feng
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Naval Medical University Shanghai, Shanghai, China
| | - Qian-Zhi Ni
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.,CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Hong-Fei Zhu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Wei-Wei Pan
- Department of Cell Biology, College of Medicine, Jiaxing University, Jiaxing, China.,G60 STI Valley Industry & Innovation Institute, Jiaxing University, Jiaxing, China
| | - Jing-Jing Li
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Chao Liang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong-Kun Zhou
- The First Hospital of Jiaxing Affiliated Hospital of Jiaxing University, Jiaxing University, Jiaxing, China
| | - Yan Meng
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Naval Medical University Shanghai, Shanghai, China
| | - Wan Yee Lau
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.,Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.,Department of Cell Biology, College of Medicine, Jiaxing University, Jiaxing, China.,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,The First Hospital of Jiaxing Affiliated Hospital of Jiaxing University, Jiaxing University, Jiaxing, China
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9
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Lee RM, Darby R, Medin CR, Haser GC, Mason MC, Miller LS, Staley CA, Maithel SK, Russell MC. Implementation of a Hepatocellular Carcinoma Screening Program for At-risk Patients Safety-Net Hospital: A Model for National Dissemination. Ann Surg 2022; 276:545-553. [PMID: 35837969 PMCID: PMC9675906 DOI: 10.1097/sla.0000000000005582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to enhance hepatocellular carcinoma (HCC) screening to achieve earlier diagnosis of patients with hepatitis C (HCV) cirrhosis in our Safety-Net population. BACKGROUND Adherence to HCC screening guidelines at Safety-Net hospitals is poor. Only 23% of patients with HCC at our health system had a screening exam within 1-year of diagnosis and 46% presented with stage IV disease. HCV-induced cirrhosis remains the most common etiology of HCC (75%) in our patients. METHODS In the setting of an established HCV treatment clinic, an HCC screening quality improvement initiative was initiated for patients with stage 3 fibrosis or cirrhosis by transient elastography. The program consisted of semiannual imaging. Navigators scheduled imaging appointments and tracked compliance. RESULTS From April 2018 to April 2021, 318 patients were enrolled (mean age 61 years, 81% Black race, 38% uninsured). Adherence to screening was higher than previously reported: 94%, 75%, and 74% of patients completed their first, second, and third imaging tests. Twenty-two patients (7%) were diagnosed with HCC; 55% stage I and 14% stage IV. All patients were referred and 13 (59%) received treatment. Median time to receipt of treatment was 77 days (range, 32-282). Median overall survival for treated patients was 32 months. CONCLUSIONS Implementation of an HCC screening program at a safety-net hospital is feasible and facilitated earlier diagnosis in this study. Patient navigation and tracking completion of imaging tests were key components of the program's success. Next steps include expanding the program to additional at-risk populations.
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Affiliation(s)
- Rachel M Lee
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Rapheisha Darby
- Grady Liver Clinic, Primary Care Centers, Grady Memorial Hospital, Atlanta, GA
| | - Caroline R Medin
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Grace C Haser
- Department of Medicine, Division of General Internal Medicine, Emory University, Atlanta, GA
| | - Meredith C Mason
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Lesley S Miller
- Department of Medicine, Division of General Internal Medicine, Emory University, Atlanta, GA
| | - Charles A Staley
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Shishir K Maithel
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Maria C Russell
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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10
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Li Z, Han N, Ren X, Zhang Y, Chu X. Effectiveness of TKI Inhibitors Combined With PD-1 in Patients With Postoperative Early Recurrence of HCC: A Real-World Study. Front Oncol 2022; 12:833884. [PMID: 35433466 PMCID: PMC9008361 DOI: 10.3389/fonc.2022.833884] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To observe the efficacy of TKI inhibitor combined with PD-1 treatment in patients with early recurrence after radical resection of HCC, and to analyze the factors that affect the efficacy. Methods The baseline demographic and clinical data of 58 patients with early recurrence after radical resection of HCC (including surgical resection and liver transplantation) were collected. Recurrence and metastasis were classified into early (< or =2 years) and late phase (>2 years). After systemic drug treatment (sorafenib, lenvatinib, PD-1), the efficacy was evaluated based on the RECIST 1.1 standard. COX regression model was used to analyze the factors affecting PFS and OS in HCC patients. Survival curves were drawn by Kaplan-Meier method. Results The study finally included 58 patients who underwent radical resection of HCC, of which 39 were in the TKIs group and 19 were in the TKIs + ICIs combined treatment group. There was no statistical difference in the baseline data of the two groups in HB, PLT, Child-Pugh score and other indicators. Efficacy evaluation results showed that in the 39 TKIs group, 7 patients were PD and 9 patients were PR; while in the 19 TKIs combined with PD-1 group, 2 patients were PD and 6 patients were PR. The median PFS of the TKIs group was 6.2 months, while the median PFS of the TKIs combined PD-1 group was 14.0 months (HR= 0.469, P=0.031). The median OS of the TKIs group was 18.0 months, while the median OS of the TKIs combined with PD-1 group was 35.8 months, an extension of 17.8 months (HR= 0.444, P=0.053). Conclusion In the first-line treatment of patients with early recurrence after radical resection of HCC, patients treated with TKIs combined with PD-1 therapy has a survival advantage over those treated with TKIs alone. Ascites, HBV DNA positivity, and high levels of AFP often indicate poor efficacy of systemic drug therapy, suggesting that such patients should be closely monitored after surgery and that comprehensive systemic treatment should be administrated in time to improve the prognosis.
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Affiliation(s)
- Zixiong Li
- Department of Oncology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Ning Han
- Department of Oncology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xueying Ren
- Department of Oncology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Yuanjing Zhang
- Department of Infection, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xiaoyuan Chu
- Department of Oncology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
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11
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Cheon J, Yoo C, Hong JY, Kim HS, Lee DW, Lee MA, Kim JW, Kim I, Oh SB, Hwang JE, Chon HJ, Lim HY. Efficacy and safety of atezolizumab plus bevacizumab in Korean patients with advanced hepatocellular carcinoma. Liver Int 2022; 42:674-681. [PMID: 34792284 DOI: 10.1111/liv.15102] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Atezolizumab plus bevacizumab (Ate/Bev) has demonstrated efficacy and safety in patients with advanced hepatocellular carcinoma (HCC) in the phase III trial. Further evaluation is necessary to investigate the safety and efficacy of Ate/Bev in real settings. METHODS This was a multicentre retrospective analysis. Between May 2020 and February 2021, 138 patients received Ate/Bev as first-line treatment for advanced HCC from 11 institutions. We excluded patients with Child-Pugh B or C and BCLC D stage, and the remaining 121 patients were included in this analysis. RESULTS According to RECIST 1.1, the objective response and disease control rates were 24.0% and 76.0%. The median follow-up duration was 5.9 months (95% confidence interval [CI], 5.4-6.4), the median progression-free survival (PFS) was 6.5 months (95% CI, 4.1-9.0), and median overall survival (OS) was not reached (95% CI, not available). The most frequent grade 3-4 adverse event was aspartate aminotransferase elevation (10.7%). In the multivariate analyses, AFP increase (P = .037), baseline neutrophil-to-lymphocyte ratio (NLR) ≥ 5 (P = .023), and best response to stable disease or progressive disease (P = .019) were significantly associated with worse PFS. Macrovascular invasion (P = .048) and baseline NLR ≥5 (P < .001) were significantly associated with worse OS. CONCLUSIONS Ate/Bev showed real-life efficacy and safety in Korean patients with advanced HCC, in line with results from phase III trial. Considering unfavourable survival outcomes of Ate/Bev in patients with elevated NLR, careful assessment of treatment response needs to be performed in this group.
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Affiliation(s)
- Jaekyung Cheon
- Department of Hematology-Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.,Department of Medical Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Yong Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Han Sang Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Brain Korea 21 FOUR Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae-Won Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung Ah Lee
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, Catholic Cancer Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ilhwan Kim
- Department of Oncology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Sang-Bo Oh
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, South Korea
| | - Jun-Eul Hwang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Hong Jae Chon
- Department of Medical Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Ho Yeong Lim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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12
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Huang DQ, Hoang JK, Leong J, Riveiro-Barciela M, Maeda M, Yang JD, Accarino EV, Thin K, Trinh L, Cheung RC, Roberts LR, Buti M, Schwartz M, Nguyen MH. Differential characteristics and outcomes of Asian and non-Asian patients with HBV-related hepatocellular carcinoma. Liver Int 2021; 41:1922-1932. [PMID: 33713386 DOI: 10.1111/liv.14877] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/16/2021] [Accepted: 03/07/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS The epidemiology of hepatitis B virus (HBV) infection differs between Asians and non-Asians, but little is known regarding the effect of ethnicity on outcomes of HBV-related hepatocellular carcinoma (HCC). We aim to characterize the presentation and survival outcomes in Asian and non-Asian patients with HBV-related HCC. METHODS We analyzed the baseline characteristics and long-term survival of 613 Asian and 410 non-Asian patients with HBV-related HCC from three US and one Spanish centre. RESULTS Overall, non-Asian patients were more likely to have HIV or hepatitis C co-infection, cirrhosis, decompensated liver disease and advanced BCLC stage (all P ≤ .04). Compared with Asians, non-Asians were more likely to be listed for transplantation (P < .0001) and undergo HCC treatment with curative intent (P = .003). Propensity-score matching on HCC diagnosis year, gender and age was performed to balance the two groups for survival analysis and yielded 370 pairs of patients. There was no significant difference in survival overall (P = .43) and among patients with cirrhosis (P = .57). Among patients without cirrhosis, non-Asians had poorer 5-year survival compared with Asians (37.6% vs 53.7%, P = .01), and was associated with poorer survival after adjusting for age, gender, diabetes, alcohol, co-infections, diagnosis date, antiviral therapy, BCLC stage and HCC treatment (adjusted HR 2.01 [95% CI 1.07-3.74], P = .03). CONCLUSION Among HBV-related HCC patients, non-Asians presented with more advanced BCLC stage compared to Asians. Non-Asian ethnicity was independently associated with twice the risk of mortality among patients without cirrhosis, but not among those with cirrhosis. Additional studies are needed to clarify this disparity.
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Affiliation(s)
- Daniel Q Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - Joseph K Hoang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Jennifer Leong
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mar Riveiro-Barciela
- Liver Unit, Internal Medicine Department, Hospital Universitari Valle d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERehd, Instituto Carlos III, Madrid, Spain
| | - Mayumi Maeda
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Ju Dong Yang
- Division of Digestive and Liver Diseases, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, USA
| | - Elena Vargas Accarino
- Liver Unit, Internal Medicine Department, Hospital Universitari Valle d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERehd, Instituto Carlos III, Madrid, Spain
| | - Khin Thin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Lindsey Trinh
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Ramsey C Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Maria Buti
- Liver Unit, Internal Medicine Department, Hospital Universitari Valle d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERehd, Instituto Carlos III, Madrid, Spain
| | - Myron Schwartz
- Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
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13
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Zhou Y, Yang Y, Zhou B, Wang Z, Zhu R, Chen X, Ouyang J, Li Q, Zhou J. Challenges Facing Percutaneous Ablation in the Treatment of Hepatocellular Carcinoma: Extension of Ablation Criteria. J Hepatocell Carcinoma 2021; 8:625-644. [PMID: 34189133 PMCID: PMC8232857 DOI: 10.2147/jhc.s298709] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
As an emerging minimally invasive treatment method, percutaneous ablation is more and more widely used in the treatment of liver tumors. It has been recommended by guidelines for diagnosis and treatment of hepatocellular carcinoma (HCC) as a curative treatment alongside surgical resection and liver transplantation. In recent years, with the continuous advancement and innovation of percutaneous ablation technologies, their clinical efficacy and safety have been significantly improved, which has led to the expanded application of percutaneous ablation in the treatment of HCC—more and more patients who were previously considered unsuitable for ablation therapies are now being treated with percutaneous ablation. Obviously, percutaneous ablation can reduce the risk of treatment changes from curative strategies to palliative strategies. Based on clinical practice experience, this review enumerates the advantages and disadvantages of different ablative modalities and summarizes the existing combinations of ablation techniques, thus will help clinicians choose the most appropriate ablative modality for each patient and will provide scientific guidance for improving prognosis and making evidence-based treatment decisions. In addition, we point out the challenges and future prospects of the ablation therapies, thereby providing direction for future research.
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Affiliation(s)
- Yanzhao Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Yi Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Bingyan Zhou
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People's Republic of China
| | - Zhengzheng Wang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Ruili Zhu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Xun Chen
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Jingzhong Ouyang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Qingjun Li
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Jinxue Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
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14
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Lim J, Kim HI, Kim E, Kim J, An J, Chang S, Kim SO, Lee HC, Lee YS, Shim JH. Variceal bleeding is aggravated by portal venous invasion of hepatocellular carcinoma: a matched nested case-control study. BMC Cancer 2021; 21:11. [PMID: 33402105 PMCID: PMC7786454 DOI: 10.1186/s12885-020-07708-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background We hypothesized that portal vein tumor thrombosis (PVTT) in hepatocellular carcinoma (HCC) increases portal pressure and causes esophageal varices and variceal bleedings. We examined the incidence of high-risk varices and variceal bleeding and determined the indications for variceal screening and prophylaxis. Methods This study included 1709 asymptomatic patients without any prior history of variceal hemorrhage or endoscopic prophylaxis who underwent upper endoscopy within 30 days before or after initial anti-HCC treatment. Of these patients, 206 had PVTT, and after 1:2 individual matching, 161 of them were matched with 309 patients without PVTT. High-risk varices were defined as large/medium varices or small varices with red-color signs and variceal bleeding. Bleeding rates from the varices were compared between matched pairs. Risk factors for variceal bleeding in the entire set of patients with PVTT were also explored. Results In the matched-pair analysis, the proportion of high-risk varices at screening (23.0% vs. 13.3%; P = 0.003) and the cumulative rate of variceal bleeding (4.5% vs. 0.4% at 1 year; P = 0.009) were significantly greater in the PVTT group. Prolonged prothrombin time, lower platelet count, presence of extrahepatic metastasis, and Vp4 PVTT were independent risk factors related to high-risk varices in the total set of 206 patients with PVTT (Adjusted odds ratios [95% CIs], 1.662 [1.151–2.401]; 0.985 [0.978–0.993]; 4.240 [1.783–10.084]; and 3.345 [1.457–7.680], respectively; Ps < 0.05). During a median follow-up of 43.2 months, 10 patients with PVTT experienced variceal bleeding episodes, 9 of whom (90%) had high-risk varices. Presence of high-risk varices and sorafenib use for HCC treatment were significant predictors of variceal bleeding in the complete set of patients with PVTT (Adjusted hazard ratios [95% CIs], 26.432 [3.230–216.289]; and 5.676 [1.273–25.300], respectively; Ps < 0.05). Conclusions PVTT in HCC appears to increase the likelihood of high-risk varices and variceal bleeding. In HCC patients with PVTT, endoscopic prevention could be considered, at least in high-risk variceal carriers taking sorafenib.
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Affiliation(s)
- Jihye Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Ha Il Kim
- Gastroenterology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Eunju Kim
- Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Jiyoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jihyun An
- Gastroenterology, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
| | - Seheon Chang
- Internal Medicine, Myongji St. Mary's Hospital, Seoul, Republic of Korea
| | - Seon-Ok Kim
- Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han Chu Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.,Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yung Sang Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.,Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ju Hyun Shim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. .,Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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15
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Iida H, Kaibori M, Hirokawa F, Inoue Y, Ueno M, Matsui K, Ishizaki M, Tanaka S, Takemura S, Nomi T, Hokutou D, Noda T, Eguchi H, Nakai T, Maehira H, Mori H, Tani M, Kubo S. New Hepatic Resection Criteria for Intermediate-Stage Hepatocellular Carcinoma Can Improve Long-Term Survival: A Retrospective, Multicenter Collaborative Study. Asian Pac J Cancer Prev 2020; 21:2903-2911. [PMID: 33112547 PMCID: PMC7798158 DOI: 10.31557/apjcp.2020.21.10.2903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 10/09/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hepatic resection (HR) is not recommended for intermediate-stage hepatocellular carcinoma (HCC) by the Barcelona Clinic Liver Cancer criteria. We examined the prognostic factors of HR for intermediate-stage HCC and developed new HR criteria for intermediate-stage HCC. METHODS A total of 110 patients who underwent HR without any prior treatment for intermediate-stage HCC between January 2007 and December 2012 were enrolled at eight university hospitals. The outcomes and prognostic factors of HR were evaluated to develop new HR criteria. RESULTS In terms of tumor size and number, the most significant prognostic factors were within the up-to-seven criteria. Furthermore, serum albumin level ≥35 g/L and serum alpha-fetoprotein (AFP) level.
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Affiliation(s)
- Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
| | - Masaki Kaibori
- Department of Surgery, Kansai Medical University, Hirakata, Japan.
| | - Fumitoshi Hirokawa
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan.
| | - Yoshihiro Inoue
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan.
| | - Masaki Ueno
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
| | - Kousuke Matsui
- Department of Surgery, Kansai Medical University, Hirakata, Japan.
| | | | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Shigekazu Takemura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Takeo Nomi
- Department of Surgery, Nara Medical University, Kashihara, Japan.
| | - Daisuke Hokutou
- Department of Surgery, Nara Medical University, Kashihara, Japan.
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.
| | - Takuya Nakai
- Department of Surgery, Faculty of Medicine, Kinki University, Osaka-sasayama, Japan.
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
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16
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Lu HS, Hsin IF, Chen PH, Yang TC, Chang CY, Huang YH, Hou MC. The indocyanine green retention test as a noninvasive marker for esophageal varices in patients with hepatocellular carcinoma. J Chin Med Assoc 2020; 83:737-742. [PMID: 32649412 DOI: 10.1097/jcma.0000000000000378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The indocyanine green 15-minute retention (ICG-r15) test was considered as a noninvasive marker of esophageal varices (EV) in cirrhotic patients. However, the performance of ICG-r15 in patients with hepatocellular carcinoma (HCC) has rarely been assessed. The aim of this study is to evaluate the value of ICG-r15 as a noninvasive marker of EV in patients with HCC. METHODS From October 2007 to December 2018, the study retrospectively enrolled 137 HCC patients with compensated hepatic function who received ICG-r15 tests and endoscopy screening for EV. The predictive value of the ICG-r15 test and other noninvasive markers was also evaluated for the diagnosis of EV, including the aspartate aminotransferase (AST)/alanine aminotransferase ratio, platelet count/spleen diameter ratio, AST/platelet ratio index, Lok index, FIB-4, and Park index. RESULTS In the study cohort, 30 (21.9%) patients had EV. The area under the receiver operating characteristic curve for determining EV by ICG-r15 was 0.784 (95% CI: 0.686-0.881, -2 ln (L): 77.889, Akaike information criterion: 79.889), and it had the best predictive value compared with other noninvasive markers. The cutoff value of ICG-r15 to identify EV was 31.0%, and it had 40.0% sensitivity and 98.1% specificity. The cutoff value to exclude EV was 9.5% with 86.7% sensitivity and 50.5% specificity. In the multivariate analysis, ICG-r15 (odds ratio [OR]: 1.062, 1.014-1.114; p = 0.015) and the Park index (OR: 1.535, 1.091-2.159; p = 0.014) were independently related to the presence of EV. CONCLUSION ICG-r15 is a practical noninvasive marker with cutoff values of 9.5% for excluding EV and 31.0% for identifying EV in patients with HCC.
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Affiliation(s)
- Hsiao-Sheng Lu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - I-Fang Hsin
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ping-Hsien Chen
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tsung-Chieh Yang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chung-Yu Chang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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17
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Yoo JJ, Yu SJ, Lee B, Cho EJ, Lee JH, Kim SG, Kim YJ, Kim YS, Yoon JH. Appraisal of a Model to Estimate Survival in Ambulatory Patients with Hepatocellular Carcinoma Classified as Barcelona Clinic Liver Cancer Stage B. Gut Liver 2020; 14:377-386. [PMID: 31533399 PMCID: PMC7234889 DOI: 10.5009/gnl19112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/11/2019] [Accepted: 05/23/2019] [Indexed: 12/28/2022] Open
Abstract
Background/Aims Patients with an intermediate stage of hepatocellular carcinoma (HCC) represent a highly heterogeneous population; therefore, many models have been proposed to predict the survival of these patients. The aim of this study was to evaluate the prognostic performance of a novel subclassification for tumors classified as Barcelona Clinic Liver Cancer (BCLC) stage B using the Model to Estimate Survival in Ambulatory HCC patients (MESIAH). Methods This analysis was based on 377 patients with HCC treated at Seoul National University Hospital (training cohort) and 189 patients at the Soonchunhyang University Bucheon Hospital (validation cohort). Four subclassification systems were tested: MESIAH; original BCLC B subclassification (B1, B2, B3, and B4); modified model A (B1, B2, and B3+B4); and modified model B (B1, B2+B3, and B4). Results Median survival progressively decreased from stage B1 through stages B2 to B3 according to the new MESIAH subclassification (p<0.001). Moreover, significantly different survival among contiguous stages was observed. In the multivariable Cox regression, the MESIAH subclassification was an independent predictor of overall survival (p<0.001). In terms of discrimination and calibration, MESIAH performed better than the original BCLC B subclassification, modified model A and modified model B. Conclusions The MESIAH model would be an effective tool for stratifying heterogeneous BCLC stage B cancer, and the ability of this model to predict survival is better than that of the other previously proposed models.
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Affiliation(s)
- Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Bora Lee
- Department of Statistics, Graduate School, Chung-Ang University, Seoul, Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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18
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Renzulli M, Tovoli F, Clemente A, Ierardi AM, Pettinari I, Peta G, Marasco G, Festi D, Piscaglia F, Cappabianca S, Carrafiello G, Golfieri R. Ablation for hepatocellular carcinoma: beyond the standard indications. Med Oncol 2020; 37:23. [PMID: 32166482 DOI: 10.1007/s12032-020-01348-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/20/2020] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC), the most common primary liver neoplasia, represents the fifth most common malignant disease in men. Percutaneous ablation treatment is recommended among the treatments suggested for HCC patients in the very early/early stage. In the last decade, very important results in terms of survival benefits have been obtained with local ablative therapies, also outside the standard indications, thanks to many technical innovations. In particular, important results of ablation as a safe and effective technique have been obtained in the treatment of intermediate- or advanced-stage patients with HCC, and in the treatment of unfavourable tumour locations. Moreover, awareness is growing regarding the necessity of overcoming the rigidity of traditional guidelines in the treatment of HCC due to the complexity of patients with HCC, focusing on Precision Medicine. In this context, it is important to know the standard and non-standard indications of ablation in the treatment of HCC in order to offer the best therapeutic option tailored for each patient. The aim of this study was to analyse the possible clinical applications of ablative therapies for HCC patients, beyond the traditional indications recommended in the most widespread clinical practice guidelines for the management of HCC.
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Affiliation(s)
- Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
| | - Francesco Tovoli
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alfredo Clemente
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Irene Pettinari
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Giuliano Peta
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabio Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Salvatore Cappabianca
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy
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19
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Tian Y, Lyu H, He Y, Kanduri HK. Evaluating the Ability of the New Subclassification to Prognosticate Outcomes Following Hepatectomy for Patients with HBV-Related HCC. J Gastrointest Cancer 2020; 50:400-407. [PMID: 29512001 DOI: 10.1007/s12029-018-0085-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recently, experts proposed subclassification for BCLC B patients. In this study, we aimed to evaluate the efficient of subclassification of patients with hepatitis B virus-related hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer (BCLC) staging system. METHODS Seven hundred twenty-nine consecutive hepatitis B virus-related HCC patients with BCLC stage B classification who underwent hepatectomy in the period 2006-2012 were retrospectively analyzed. Patients were reclassified based on the new proposed subclassification of the BCLC B stage from B1 to B4. The prognosis of subclassification was tested using Kaplan-Meier statistics analysis. RESULTS There were 145 (19.9%), 480 (65.8%), 62 (8.5%), and 42 (5.8%) patients in B1, B2, B3, and B4, respectively. The result suggested that overall and tumor-free survival rates among the B1, B2, and B3 subclassification in the Bolondi system had significant difference (P < 0.05). However, no significant difference was found between B3 and B4 subclassifications. Cox regression showed that BCLC B subclassification, largest/smallest diameter, and anatomic liver resection were independent predictors of tumor-free survival. BCLC B subclassification and anatomic liver resection were independent predictors of overall survival. CONCLUSIONS The subclassification of BCLC stage B can be used in patients with HBV-related HCC who underwent curative intent hepatectomy. Patients in BCLC B1 and B2 subgroups should be treated more aggressively than patients in B3 and B4 subgroups. B3 and B4 groups should be merged for patients with HBV-related HCC who underwent curative intent hepatectomy.
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Affiliation(s)
- Yunhong Tian
- The Third Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China. .,Department of General Surgery, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, Sichuan, 215006, China.
| | - Huan Lyu
- Department of General Surgery, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, Sichuan, 215006, China
| | - Yunhong He
- Department of General Surgery, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, Sichuan, 215006, China
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20
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Kumar A, Acharya SK, Singh SP, Arora A, Dhiman RK, Aggarwal R, Anand AC, Bhangui P, Chawla YK, Datta Gupta S, Dixit VK, Duseja A, Kalra N, Kar P, Kulkarni SS, Kumar R, Kumar M, Madhavan R, Mohan Prasad V, Mukund A, Nagral A, Panda D, Paul SB, Rao PN, Rela M, Sahu MK, Saraswat VA, Shah SR, Shalimar, Sharma P, Taneja S, Wadhawan M. 2019 Update of Indian National Association for Study of the Liver Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri II Recommendations. J Clin Exp Hepatol 2020; 10:43-80. [PMID: 32025166 PMCID: PMC6995891 DOI: 10.1016/j.jceh.2019.09.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/15/2019] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality, and healthcare expenditure in patients with chronic liver disease in India. The Indian National Association for Study of the Liver (INASL) had published its first guidelines on diagnosis and management of HCC (The Puri Recommendations) in 2014, and these guidelines were very well received by the healthcare community involved in diagnosis and management of HCC in India and neighboring countries. However, since 2014, many new developments have taken place in the field of HCC diagnosis and management, hence INASL endeavored to update its 2014 consensus guidelines. A new Task Force on HCC was constituted that reviewed the previous guidelines as well as the recent developments in various aspects of HCC that needed to be incorporated in the new guidelines. A 2-day round table discussion was held on 5th and 6th May 2018 at Puri, Odisha, to discuss, debate, and finalize the revised consensus statements. Each statement of the guideline was graded according to the Grading of Recommendations Assessment Development and Evaluation system with minor modifications. We present here the 2019 Update of INASL Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri-2 Recommendations.
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Key Words
- AFP, alpha-fetoprotein
- AIH, autoimmune hepatitis
- ALT, alanine aminotransferase
- DAA, direct-acting antiviral
- DALY, disability-adjusted life-year
- DNA, deoxyribonucleic acid
- GRADE, Grading of Recommendations Assessment Development and Evaluation
- Gd-BOPTA, gadolinium benzyloxypropionictetraacetate
- Gd-EOB-DTPA, gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid
- HBV, hepatitis B virus
- HBeAg, hepatitis B envelope antigen
- HCC, hepatocellular carcinoma
- HIV, human immunodeficiency virus
- IARC, International Agency for Research on Cancer
- IFN, interferon
- INASL, Indian National Association for Study of the Liver
- MiRNA, micro-RNA
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- PIVKA, protein induced by vitamin K absence
- RFA
- RNA, ribonucleic acid
- SVR, sustained virological response
- TACE
- TACE, trans-arterial chemoembolization
- TARE, transarterial radioembolization
- TNF, tumor necrosis factor
- WHO, World Health Organization
- liver cancer
- targeted therapy
- transplant
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Affiliation(s)
- Ashish Kumar
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Subrat K. Acharya
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
| | - Anil Arora
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | - Anil C. Anand
- Department of Gastroenterology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110 076, India
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, CH Baktawar Singh Road, Sector 38, Gurugram, Haryana, 122 001, India
| | - Yogesh K. Chawla
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
| | - Siddhartha Datta Gupta
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Vinod K. Dixit
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221 005, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Naveen Kalra
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Premashish Kar
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
| | - Suyash S. Kulkarni
- Division of Interventional Radiology, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai, Maharashtra, 400 012, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Ram Madhavan
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita University, Peeliyadu Road, Ponekkara, Edappally, Kochi, Kerala, 682 041, India
| | - V.G. Mohan Prasad
- Department of Gastroenterology, VGM Gastro Centre, 2100, Trichy Road, Rajalakshmi Mills Stop, Singanallur, Coimbatore, Tamil Nadu, 641 005, India
| | - Amar Mukund
- Department of Radiology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
| | - Dipanjan Panda
- Department of Oncology, Institutes of Cancer, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110 076, India
| | - Shashi B. Paul
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Padaki N. Rao
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, No. 6-3-661, Punjagutta Road, Somajiguda, Hyderabad, Telangana, 500 082, India
| | - Mohamed Rela
- The Institute of Liver Disease & Transplantation, Gleneagles Global Health City, 439, Cheran Nagar, Perumbakkam, Chennai, Tamil Nadu, 600 100, India
| | - Manoj K. Sahu
- Department of Medical Gastroenterology, IMS & SUM Hospital, K8 Kalinga Nagar, Shampur, Bhubaneswar, Odisha 751 003, India
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | - Samir R. Shah
- Department of Gastroenterology, Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Praveen Sharma
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Manav Wadhawan
- Liver & Digestive Diseases Institute, Institute of Liver & Digestive Diseases, BLK Super Specialty Hospital, Delhi, 110 005, India
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Elshaarawy O, Gomaa A, Omar H, Rewisha E, Waked I. Intermediate stage hepatocellular carcinoma: a summary review. J Hepatocell Carcinoma 2019; 6:105-117. [PMID: 31372364 PMCID: PMC6628956 DOI: 10.2147/jhc.s168682] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/14/2019] [Indexed: 12/12/2022] Open
Abstract
It is well known that intermediate stage hepatocellular carcinoma (HCC) encompasses the widest class of patients with this disease. The main characteristic of this special sub-group of patients is that it is extensively heterogenous. This substantial heterogeneity is due to the wide range of liver functions of such patients and variable tumor numbers and sizes. Real world clinical data show huge support for transarterial chemo-embolization (TACE) as a therapeutic modality for intermediate stage HCC, applied in 50%-60% of those class of patients. There are special considerations in various international guidelines regarding treatment allocation in intermediate stage HCC. There is an epidemiological difference in HCC in eastern and western cohorts, and various guidelines have been proposed. In patients with HCC, it has frequently been reported that there is poor correlation between the clinical benefit and real gain in patient condition and the conventional way of tumor response assessment after locoregional treatments. This is due to the evaluation criteria in addition to the scoring systems used for treatment allocation in those patients. It became clear that intermediate stage HCC patients receiving TACE need a proper prognostic score that offers valid clinical prediction and supports proper decision-making. Also, it is the proper time to study more treatment options beyond TACE, such as multimodal regimens for this class of patients. In this review, we tried to provide a summary of the challenges and future directions in managing patients with intermediate stage HCC.
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Affiliation(s)
- Omar Elshaarawy
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt
| | - Asmaa Gomaa
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt
| | - Hazem Omar
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt
| | - Eman Rewisha
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt
| | - Imam Waked
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt
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22
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Liu Y, Xue D, Tan S, Zhang Q, Yang X, Li Y, Zhu B, Niu S, Jiang L, Wang X. Comparison of macrovascular invasion-free survival in early-intermediate hepatocellular carcinoma after different interventions: A propensity score-based analysis. J Cancer 2019; 10:4063-4071. [PMID: 31417651 PMCID: PMC6692624 DOI: 10.7150/jca.29850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 05/17/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives: The purpose of this study was to compare macrovascular invasion (MVI)-free survival (MFS) at the three-year follow-up in patients with hepatocellular carcinoma (HCC) who underwent hepatic resection (HR), transcatheter arterial chemoembolization (TACE), or TACE combined with radiofrequency ablation (TACE-RFA). Materials and Methods: We retrospectively analyzed the medical records of 828 patients who were diagnosed with Barcelona Clinic Liver Cancer (BCLC) stage A or stage B HCC. Of these patients, 116 underwent HR, 395 underwent TACE-RFA, 239 underwent TACE, and 78 patients received conservative treatment (control group). A validation cohort of 158 patients was included. The MFS and overall survival (OS) before and after propensity score (PS) matching were evaluated using Kaplan-Meier analysis. Results: The baseline characteristics between the control and TACE groups were comparable. MFS was higher in the TACE group than in the control group at the three-year follow-up (p = 0.0091), and OS was similar in the two groups (p = 0.0549). PS matching was used to generate 68 pairs of patients in the control versus HR group and 74 pairs of patients in the control versus TACE-RFA group (1-to-1 matched). MFS was significantly higher in the HR or TACE-RFA groups than in the control group (p < 0.0001 (HR versus control) and p = 0.0001 (TACE-RFA versus control), respectively). Furthermore, for patients in the HR versus TACE-RFA versus TACE groups that were generated by PS matching, the Kaplan-Meier analysis showed that MFS and OS were higher with HR or TACE-RFA than with TACE at three years. In the study, similar results were obtained in the validation cohort. Conclusions: MFS and OS were higher with HR or TACE-RFA than with TACE for HCC patients without MVI.
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Affiliation(s)
- Yao Liu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Dongying Xue
- Department of Infections Disease, Putuo Hospital, Shanghai University of Traditional Chinese Medicine. Shanghai 200062, China
| | - Shanzhong Tan
- Department of Integrated TCM and Western Medicine, the Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, China
| | - Qun Zhang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Xue Yang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Yuxin Li
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Bingbing Zhu
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine. Beijing 100700, China
| | - Shuaishuai Niu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Li Jiang
- Department of Surgery, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Xianbo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
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Watanabe M, Yokomori H, Takahashi Y, Okada T, Shibuya A, Koizumi W. Assessing the characteristics and feasibility of preventing early mortality in patients with hepatocellular carcinoma. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:541-548. [PMID: 31144660 DOI: 10.5152/tjg.2019.18654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIMS To determine strategies to prevent early death (ED) and improve the prognosis of patients with advanced hepatocellular carcinoma (HCC). MATERIALS AND METHODS Patients who were diagnosed with HCC from January 2012 to June 2017 were considered for the study. Those who survived for ≤6 months from the date of diagnosis were classified into the ED group (n=21) and those who survived for ≥12 months from the date of diagnosis were classified into the non-ED group (n=88). RESULTS There were significant differences between the ED and non-ED groups in the following conditions: when the patient age was ≥80 years (38.1% vs. 14.8% patients); maximum nodule size was >3 cm (90.5% vs. 27.3%); Child-Pugh class C liver disease was seen (66.7% vs. 26.1%); tumor-node-metastasis (TNM) Stage III-IV tumor was present (85.7% vs. 21.6%); BCLC stage C/D of liver cancer was seen (81.0% vs. 21.6%); JIS score was ≥4 (52.4% vs. 3.4%); serum creatinine level was ≥1.0 mg/dL (52.4% vs. 22.7%); and there was absence of aggressive treatments such as hepatic resection, radiofrequency ablation, transarterial chemoembolization, and chemotherapy (66.7% vs. 4.5%). Logistic regression analysis identified maximum nodule size of >3 cm (p=0.005, OR=58.7, 95% CI=3.43-1003.9), JIS score of ≥4 (p=0.021, OR=12.0, 95% CI=1.44-100.1), and absence of aggressive treatments (p=0.006, OR=24.7, 95% CI=2.47-247.2) as predictive factors for ED. The presence of aggressive treatments significantly improved the 12-month survival rate of advanced HCC patients with BCLC stage C/D (presence vs. absence: 78.3% vs. 7.4%), a maximum nodule size of >3 cm (76.7% vs. 7.7%), and a JIS score of ≥4 (60.0% vs. 0%). CONCLUSION Although delayed detection of HCC strongly increased the onset ED, the aggressiveness of HCC treatment is not readily downgraded, and the most aggressive treatment possible should be considered to prevent ED in patients with advanced HCC.
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Affiliation(s)
- Masaaki Watanabe
- Department of Gastroenterology, Kitasato University Medical Center, Kitamoto, Saitama, Japan
| | - Hiroaki Yokomori
- Department of General Internal Medicine, Kitasato University Medical Center, Kitamoto, Saitama, Japan
| | - Yoshihito Takahashi
- Department of Surgery, Kitasato University Medical Center, Kitamoto, Saitama, Japan
| | - Takemichi Okada
- Department of Radiology, Kitasato University Medical Center, Kitamoto, Saitama, Japan
| | - Akitaka Shibuya
- Department of Risk Management and Health Care Administration, Kitasato University School of Medicine, Kitamoto, Saitama, Japan
| | - Wasaburo Koizumi
- Department of Gastroenterology, Kitasato University School of Medicine, Kitamoto, Saitama, Japan
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Sun JY, Yin T, Zhang XY, Lu XJ. Therapeutic advances for patients with intermediate hepatocellular carcinoma. J Cell Physiol 2019; 234:12116-12121. [PMID: 30648254 DOI: 10.1002/jcp.28019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor and constitutes a major health threat globally. Intermediate HCC (Barcelona Clinic Liver Cancer Staging, stage B) encompasses a wide range of patients and is characterized by substantial heterogeneity with varying tumor burdens and liver functions. Therefore, it is paramount to evaluate the patient's overall conditions and to select the most appropriate therapy based on available evidence. Transarterial chemoembolization is the recommended first-line therapy for intermediate HCC patients. However, in clinical practice, other treatment options are also used as alternative therapies, such as hepatic resection, percutaneous thermal ablation, radiotherapy (RT), systemic treatment, immunotherapy, and so forth. In this review, we will introduce current treatment strategies for intermediate HCC, discuss their advantages and disadvantages, and propose future directions.
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Affiliation(s)
- Jin-Yu Sun
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Sparkfire Scientific Research Group, Nanjing Medical University, Nanjing, China
| | - Tailang Yin
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiao-Yu Zhang
- Department of General Surgery, Division of Gastrointestinal Surgery, Huai'an Second People's Hospital and The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Xiao-Jie Lu
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Sparkfire Scientific Research Group, Nanjing Medical University, Nanjing, China
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Chen PC, Chiu NC, Su CW, Huang YH, Hou MC, Lin HC, Wu JC. Albumin-bilirubin grade may determine the outcomes of patients with very early stage hepatocellular carcinoma after radiofrequency ablation therapy. J Chin Med Assoc 2019; 82:2-10. [PMID: 30839396 DOI: 10.1097/jcma.0000000000000001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND To assess long-term prognoses of patients with solitary hepatocellular carcinoma (HCC) < 2 cm (the Barcelona Clinic Liver Cancer, BCLC stage 0) after radiofrequency ablation (RFA). METHODS We retrospectively enrolled 271 patients with BCLC stage 0 HCC who had undergone RFA at Taipei Veterans General Hospital from 2002 to 2016. Factors determining poor overall survival (OS) and recurrence after RFA were analyzed by Cox proportional hazards model. RESULTS After a median follow-up duration of 43.4 months, 76 patients had died. The cumulative 5- and 10-year OS rates were 67.1% and 56.4%, respectively. Multivariate analysis disclosed age > 65 years (hazard ratio [HR] 1.608, 95% confidence interval, [CI] 1.015-2.545; p = 0.043), platelet count < 100,000/mm (HR 1.704, 95% CI 1.027-2.828; p = 0.039), and albumin-bilirubin (ALBI) grade 2 or 3 (HR 2.191, 95% CI 1.261-3.805; p = 0.005) were the independent risk factors predicting worse OS. One-hundred twelve patients had tumor recurrence after undergoing RFA. Multivariate analysis showed that ALBI grade 2 or 3 (HR 1.825, 95% CI 1.288-2.585; p = 0.001) was the only one independent risk factor associated with poor recurrence-free survival (RFS) after RFA. Most of the subgroup analyses also demonstrated that patients with ALBI grade 2 or 3 had poorer OS and RFS than those with ALBI grade 1. CONCLUSION For patients with BCLC stage 0 HCC, RFA could provide a long-term outcome with a 10-year overall survival rate of 56.4%. Moreover, the ALBI grade can discriminate prognosis in such patients.
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Affiliation(s)
- Po-Chun Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Nai-Chi Chiu
- Division of Gastrointestinal Radiology, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chien-Wei Su
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Jaw-Ching Wu
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Improvement of clinical management and outcome in hepatocellular carcinoma nowadays compared with historical cohorts. Eur J Gastroenterol Hepatol 2018; 30:1422-1427. [PMID: 30052538 DOI: 10.1097/meg.0000000000001221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Therapeutic approaches in the treatment of hepatocellular carcinoma (HCC) depend on tumour stage, liver function and patient comorbidities. The aim of this study was to investigate the influence of tumour stage and therapeutic approach on overall survival in HCC. MATERIALS AND METHODS Two hundred and fourteen patients with HCC diagnosed between December 2012 and May 2017 were assessed retrospectively for tumour stage [Barcelona Clinic Liver Cancer (BCLC)], liver function (Child-Pugh score), therapeutic approach and outcome (mean survival time). The results were compared to two historical cohorts from our centre diagnosed between 1999 and 2013 and 1988 and 1999, respectively. RESULTS Nowadays, HCC is diagnosed in earlier tumour stages and with better liver function compared with the historical cohorts (P<0.001). Survival times depend on both BCLC stages and liver function for all therapeutic approaches. The 1-year survival rate in the present cohort was 79.4% compared with 58.6% in the historical cohort.In terms of BCLC stages, therapeutic approaches followed HCC guidelines in 43.9% of cases.Whereas the percentage of patients receiving resection or ablation did not change between the historical and the present cohort, there was a tendency towards a decrease in transarterial chemoembolization, with a shift towards selective internal radiotherapy, accompanied by an increase in systemic therapy with sorafenib.Also, the percentage of patients receiving single instead of multiple therapies was significantly higher in the present cohort compared with the historical cohort (P=0.016). In 62/83 patients receiving single therapy (64.7%), tumour remission was maintained during the period of follow-up. CONCLUSION HCC is increasingly being diagnosed in earlier stages, so that single therapy is often sufficient. Besides BCLC stages, therapy in HCC must consider liver function, tumour location, local expertise and patients' comorbidities and preferences. Further research is needed to evaluate the benefit of early multimodal concepts. Therapeutic approaches in HCC remain individual decisions.
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Fang KC, Kao WY, Su CW, Chen PC, Lee PC, Huang YH, Huo TI, Chang CC, Hou MC, Lin HC, Wu JC. The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade. Liver Cancer 2018; 7:335-358. [PMID: 30488023 PMCID: PMC6249598 DOI: 10.1159/000487407] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/04/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND/AIMS Whether single large hepatocellular carcinoma (SLHCC) is classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B is still controversial. We aimed to compare the clinical manifestations, treatment modalities, and prognoses among patients with SLHCC and those in BCLC stage A and B. METHODS We enrolled 2,285 treatment-naive hepatocellular carcinoma (HCC) patients with BCLC stage A or B from October 2007 to December 2015. Factors in terms of prognoses were analyzed by multivariate analysis. RESULTS We enrolled 1,210, 466, and 609 patients in a BCLC-A, SLHCC, and BCLC-B group, respectively. After a median follow-up duration of 21.2 months, 898 patients had died. The cumulative 5-year survival rates were 57.0, 42.6, and 27.3% for patients in the BCLC-A, SLHCC, and BCLC-B groups, respectively, which were significantly different (p < 0.001). Multivariate analysis indicated that the following independent risk factors were associated with poor prognosis: age > 65 years, alkaline phosphatase > 100 U/L, creatinine > 1.0 mg/dL, alpha-fetoprotein > 20 mg/mL, noncurative treatment, albumin-bilirubin (ALBI) grade, and HCC staging. Subgroup analysis also confirmed that patients in the SLHCC group had a survival rate intermediate to those in the BCLC-A and BCLC-B groups. However, for patients in the SLHCC group and with ALBI grade 1, outcomes were close to those in the BCLC-A group, especially in the setting of curative treatment. For those with ALBI grades 2 or 3, the prognoses were similar to those of the SLHCC and BCLC-B groups. CONCLUSION Patients in the SLHCC group had an overall survival rate intermediate to those of the BCLC-A and BCLC-B groups. It is suggested that the SLHCC group could be classified as occupying a different stage from the BCLC stages A and B. The ALBI grade could help to stratify SLHCC into a different prognostic group. However, the results need to be validated externally in other regions of the world.
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Affiliation(s)
- Kuan-Chieh Fang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wei-Yu Kao
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan,Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Wei Su
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan,*Chien-Wei Su, MD, PhD, Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, #201, Section 2, Shih-Pai Road, Taipei 112 (Taiwan), E-Mail
| | - Po-Chun Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Teh-Ia Huo
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Chao Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan,Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan,Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jaw-Ching Wu
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan,*Jaw-Ching Wu, MD, PhD, Department of Medical Research, Taipei Veterans General Hospital, #201, Section 2, Shih-Pai Road, Taipei 112 (Taiwan), E-Mail
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Sangiovanni A, Triolo M, Iavarone M, Forzenigo LV, Nicolini A, Rossi G, La Mura V, Colombo M, Lampertico P. Multimodality treatment of hepatocellular carcinoma: How field practice complies with international recommendations. Liver Int 2018; 38:1624-1634. [PMID: 29791968 DOI: 10.1111/liv.13888] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/12/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND Management of hepatocellular carcinoma (HCC) is framed within standardized protocols released by Scientific Societies, whose applicability and efficacy in field practice need refining. AIM We evaluated the applicability and effectiveness of guidelines for the treatment of HCC of the American Association for the Study of the Liver (AASLD). METHODS 370 consecutive cirrhotic patients with de novo HCC in different stages, 253 BCLC A, 66 BCLC B, 51 BCLC C received treatment through a multidisciplinary team (MDT) decision and were followed until death or end of follow-up. RESULTS Treatment was adherent to AASLD recommendations in 205 (81%) BCLC A patients, 36 (54%) BCLC B, and 27 (53%) BCLC C. Radiological complete response was achieved in 165 (45%) patients after the first-line treatment, in 22 (19%) after a second-line and in 9 (23%) after a third-line treatment. Adherence to AASLD recommendation allowed a lower yearly mean mortality rate in BCLC A patients compared with other treatment (5.0% vs 10.4% P = .004), whereas upward treatment stage migration compared with the standard of care was associated with reduced yearly mortality in BCLC B (8.6% vs 20.7%, P = .029) and BCLC C (42.6% vs 59.0%, P = .04) patients. CONCLUSIONS HCC multimodality treatment including other than first-line therapy is common in clinical practice and impact on the achievement of complete response. Personalized treatment was able to provide survival benefits to patients whose profile is not accounted for by international recommendations, which need to be amended.
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Affiliation(s)
- Angelo Sangiovanni
- Division of Gastroenterology and Hepatology, CRC "A.M. and A. Migliavacca" Center for the study of Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Michela Triolo
- Division of Internal Medicine, Policlinico S. Donato, University of Milan, San Donato Milanese, Italy
| | - Massimo Iavarone
- Division of Gastroenterology and Hepatology, CRC "A.M. and A. Migliavacca" Center for the study of Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Laura V Forzenigo
- Division of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Nicolini
- Division of Interventional Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Rossi
- Division of Surgery and Liver Transplant, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Vincenzo La Mura
- Internal Medicine Hemostasis and Thrombosis Division, Biomedical Sciences for Health Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Massimo Colombo
- Department of Medicine and Hepatology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, CRC "A.M. and A. Migliavacca" Center for the study of Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Mazmishvili K, Jayant K, Janikashvili N, Kikodze N, Mizandari M, Pantsulaia I, Paksashvili N, Sodergren MH, Reccia I, Pai M, Habib N, Chikovani T. Study to evaluate the immunomodulatory effects of radiofrequency ablation compared to surgical resection for liver cancer. J Cancer 2018; 9:3187-3195. [PMID: 30210642 PMCID: PMC6134816 DOI: 10.7150/jca.25084] [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] [Received: 01/22/2018] [Accepted: 04/05/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction: Hepatic cancer is a highly lethal tumour with increasing worldwide incidence. These tumours are characterized by the proliferation of malignant cells, generalised immunosuppression and chronic inflammation marked with an increase in inflammatory markers as a neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR) and overexpression of CD4+CD39+ on T lymphocytes. The studies have outlined immunomodulatory changes in liver cancer patients as the plausible explanation for the better survival. The aim of this pilot study was understand the possible immunomodulatory effect of radiofrequency (RF) energy and liver resection (non-radiofrequency based devices; non-RF device) in relation to NLR, PLR and expression of CD4+CD39+ T lymphocytes and compare the magnitude of these changes. Material and Methods: In the present study, 17 patients with hepatic cancer were prospectively divided into treatment groups radiofrequency ablation (RFA group) and Liver resection using non-RF devices (LR group). A blood sample was collected from each patient, one month before and after the procedure and compared with the blood samples of age-matched healthy volunteers for group wise comparison. The Mann-Whitney U test, Mc Nemar test and Wilcoxon rank test were used for statistical comparisons as appropriate. Results: A decrease in NLR was reported after RFA from 4.7±3.3 to 3.8±1.8 (P=0.283), in contrary to an increase from 3.5±2.8 to 4.5±3.2 (P=0.183) in LR group. Likewise, a decrease was discerned in PLR following RFA from 140.5±79.5 to 137±69.2 respectively (P=0.386) and increase in the LR group from 116±42.2 to 120.8±29 respectively (P=0.391). A significant decrease in CD4+CD39+ lymphocytes from 55.8±13.8 to 24.6±21.1 (P=0.03) was observed in RFA group whilst a significant increase was reported in LR group from 47.6±8.8 to 55.7±33.2 (P=0.38). Conclusion: Studies have shown that decrease in the NLR, PLR and expression of CD4+CD39+ on T lymphocytes as the marker of better survival in hepatic cancer patients and our findings have confirmed that these changes can be induced following application of RF energy. Moreover, this could be the explanation of better survival observed in different studies using RFA or other RF-based devices in comparison to non-RF based liver resection techniques. However, further larger studies are needed to confirm these findings.
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Affiliation(s)
- Ketevan Mazmishvili
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Kumar Jayant
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Nona Janikashvili
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Nino Kikodze
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Malkhaz Mizandari
- Department of Interventional Radiology, Tbilisi State Medical University, High Technology University Clinic, 0144 Tbilisi, Georgia
| | - Ia Pantsulaia
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Natela Paksashvili
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
- Department of Interventional Radiology, Tbilisi State Medical University, High Technology University Clinic, 0144 Tbilisi, Georgia
| | - Mikael H Sodergren
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Isabella Reccia
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Tinatin Chikovani
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
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30
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Koh YX, Tan HL, Lye WK, Kam JH, Chiow AKH, Tan SS, Choo SP, Chung AYF, Goh BKP. Systematic review of the outcomes of surgical resection for intermediate and advanced Barcelona Clinic Liver Cancer stage hepatocellular carcinoma: A critical appraisal of the evidence. World J Hepatol 2018; 10:433-447. [PMID: 29988922 PMCID: PMC6033716 DOI: 10.4254/wjh.v10.i6.433] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/10/2018] [Accepted: 03/03/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To perform a systematic review to determine the survival outcomes after curative resection of intermediate and advanced hepatocellular carcinomas (HCC).
METHODS A systematic review of the published literature was performed using the PubMed database from 1st January 1999 to 31st Dec 2014 to identify studies that reported outcomes of liver resection as the primary curative treatment for Barcelona Clinic Liver Cancer (BCLC) stage B or C HCC. The primary end point was to determine the overall survival (OS) and disease free survival (DFS) of liver resection of HCC in BCLC stage B or C in patients with adequate liver reserve (i.e., Child’s A or B status). The secondary end points were to assess the morbidity and mortality of liver resection in large HCC (defined as lesions larger than 10 cm in diameter) and to compare the OS and DFS after surgical resection of solitary vs multifocal HCC.
RESULTS We identified 74 articles which met the inclusion criteria and were analyzed in this systematic review. Analysis of the resection outcomes of the included studies were grouped according to (1) BCLC stage B or C HCC, (2) Size of HCC and (3) multifocal tumors. The median 5-year OS of BCLC stage B was 38.7% (range 10.0-57.0); while the median 5-year OS of BCLC stage C was 20.0% (range 0.0-42.0). The collective median 5-year OS of both stages was 27.9% (0.0-57.0). In examining the morbidity and mortality following liver resection in large HCC, the pooled RR for morbidity [RR (95%CI) = 1.00 (0.76-1.31)] and mortality [RR (95%CI) = 1.15 (0.73-1.80)] were not significant. Within the spectrum of BCLC B and C lesions, tumors greater than 10 cm were reported to have median 5-year OS of 33.0% and multifocal lesions 54.0%.
CONCLUSION Indication for surgical resection should be extended to BCLC stage B lesions in selected patients. Further studies are needed to stratify stage C lesions for resection.
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Affiliation(s)
- Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Weng Kit Lye
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - Juinn Huar Kam
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Adrian Kah Heng Chiow
- Department of General Surgery, Hepatopancreatobiliary Service, Changi General Hospital, Singapore 529889, Singapore
| | - Siong San Tan
- Department of General Surgery, Hepatopancreatobiliary Service, Changi General Hospital, Singapore 529889, Singapore
| | - Su Pin Choo
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Alexander Yaw Fui Chung
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Brian Kim Poh Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore
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Guarino M, Tortora R, de Stefano G, Coppola C, Morisco F, Salomone Megna A, Izzo F, Nardone G, Piai G, Adinolfi LE, D'Adamo G, Gaeta GB, Messina V, Francica G, De Girolamo V, Coppola N, Persico M, Di Costanzo GG. Adherence to Barcelona Clinic Liver Cancer guidelines in field practice: Results of Progetto Epatocarcinoma Campania. J Gastroenterol Hepatol 2018; 33:1123-1130. [PMID: 28994145 DOI: 10.1111/jgh.14013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/24/2017] [Accepted: 10/03/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM The Barcelona Clinic Liver Cancer (BCLC) algorithm is the standard system for clinical management of hepatocellular carcinoma (HCC). Data on adherence to this therapeutic paradigm are scarce. This field practice study aimed to provide a description of HCC cirrhotic patients in Southern Italy, to evaluate the adherence to BCLC guidelines and its impact on patients' survival. METHODS We analyzed the region-wide Italian database of Progetto Epatocarcinoma Campania, which includes data of HCC cirrhotic patients, prospectively collected from January 2013 to December 2015 in 16 regional centers. RESULTS Overall, 1008 HCC patients were enrolled: 70.6% patients received therapies recommended by BCLC algorithm, while 29.4% underwent different treatments. Among patients who were treated in adherence to guidelines, a higher rate of diagnosis on surveillance programs, better liver function, lower rate of alpha-fetoprotein > 200 ng/mL, more early-stage and monofocal HCC, lower frequency of nodules > 5 cm, portal vein thrombosis and metastases were observed. The overall survival was evaluated according to HCC stage and no differences between groups and patients managed differently were found. The multivariate analysis showed that non-adherence to treatment guidelines was independently associated to the BCLC stage B, Child-Pugh classes B and C, and the presence of neoplastic thrombosis and metastases. CONCLUSION Adherence to BCLC algorithm in field practice was high in early and end-stage HCC patients, but it was poor in intermediate and advanced patients.
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Affiliation(s)
- Maria Guarino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Giorgio de Stefano
- IX Interventional Ultrasound Unit for Infectious Diseases, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | | | - Filomena Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Francesco Izzo
- Department of Abdominal Surgical Oncology and Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Gerardo Nardone
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Guido Piai
- Unit for Liver Transplant Management, Department of Medical Sciences, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Luigi Elio Adinolfi
- Department of Medical, Surgical, Neurological, Geriatric and Metabolic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | | | - Vincenzo Messina
- Infectious and Tropical Diseases Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy
| | - Giampiero Francica
- Interventional Ultrasound Unit, Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | | | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marcello Persico
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Kikuchi L, Chagas AL, Alencar RS, Tani C, Diniz MA, D’Albuquerque LA, Carrilho FJ. Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage. Clinics (Sao Paulo) 2017; 72:454-460. [PMID: 28954003 PMCID: PMC5577619 DOI: 10.6061/clinics/2017(08)01] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/24/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES: This study sought to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the Barcelona Clinic Liver Cancer system treatment guidelines and to examine the impact of adherence on the survival of patients in different stages of the disease. METHODS: This study included all patients referred for the treatment of hepatocellular carcinoma between 2010 and 2012. Patients (n=364) were classified according to the Barcelona Clinic Liver Cancer guidelines. Deviations from the recommended guidelines were discussed, and treatment was determined by a multidisciplinary team. The overall survival curves were estimated with the Kaplan-Meier method and were compared using the log-rank test. RESULTS: The overall rate of adherence to the guidelines was 52%. The rate of adherence of patients in each scoring group varied as follows: stage 0, 33%; stage A, 45%; stage B, 78%; stage C, 35%; and stage D, 67%. In stage 0/A, adherent patients had a significantly better overall survival than non-adherent patients (hazard ratio=0.19, 95% confidence interval (CI): 0.09-0.42; p<0.001). Among the stage D patients, the overall survival rate was worse in adherent patients than in non-adherent patients (hazard ratio=4.0, 95% CI: 1.67-9.88; p<0.001), whereas no differences were observed in patients in stages B or C. CONCLUSIONS: The rate of adherence to the Barcelona Clinic Liver Cancer staging system in clinical practice varies according to clinical disease stage. Adherence to the recommended guidelines positively impacts survival, especially in patients with early-stage disease.
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Affiliation(s)
- Luciana Kikuchi
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Aline Lopes Chagas
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Regiane S.S.M. Alencar
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Claudia Tani
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcio A. Diniz
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz A.C. D’Albuquerque
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Flair José Carrilho
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
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Galle PR, Tovoli F, Foerster F, Wörns MA, Cucchetti A, Bolondi L. The treatment of intermediate stage tumours beyond TACE: From surgery to systemic therapy. J Hepatol 2017; 67:173-183. [PMID: 28323121 DOI: 10.1016/j.jhep.2017.03.007] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/01/2017] [Accepted: 03/09/2017] [Indexed: 02/07/2023]
Abstract
Treatment of hepatocellular carcinoma (HCC) is dependent on the stage of the disease. Intermediate stage HCC encompasses the largest subgroup of patients with the disease, and is characterized by substantial heterogeneity. The standard therapeutic approach, transarterial chemoembolization (TACE), is probably over-used and may not be appropriate for all patients with intermediate stage HCC. In patients with extensive tumour bulk, multi-nodular spread or impaired liver function, TACE may not be optimal and other treatments can be considered as a first-line treatment. These include surgery, percutaneous ablation, radioembolization or systemic treatment. In addition, patients who do not achieve complete or partial necrosis (TACE failure) and patients with early recurrence after TACE, should be managed individually, considering systemic treatments usually reserved for advanced disease. In selected cases and in patients who achieve downstaging, radical approaches such as hepatic resection or even liver transplantation can be considered. In this review, we evaluate the current literature for the treatment strategies for patients with intermediate Barcelona Clinic Liver Cancer (BCLC) B stage HCC.
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Affiliation(s)
- Peter R Galle
- University Medical Centre Mainz, I. Dept. of Internal Medicine, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Francesco Tovoli
- Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina Interna, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Friedrich Foerster
- University Medical Centre Mainz, I. Dept. of Internal Medicine, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Marcus A Wörns
- University Medical Centre Mainz, I. Dept. of Internal Medicine, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Alessandro Cucchetti
- Dipartimento di Scienze Mediche e Chirurgiche, Unità di Chirurgia generale e Trapianti, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Luigi Bolondi
- Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina Interna, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
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Pecorelli A, Lenzi B, Gramenzi A, Garuti F, Farinati F, Giannini EG, Ciccarese F, Piscaglia F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Sacco R, Cabibbo G, Felder M, Morisco F, Gasbarrini A, Baroni GS, Foschi FG, Biasini E, Masotto A, Virdone R, Bernardi M, Trevisani F. Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma. Liver Int 2017; 37:423-433. [PMID: 27566596 DOI: 10.1111/liv.13242] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/16/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The Barcelona Clinic Liver Cancer intermediate stage (BCLC-B) of hepatocellular carcinoma (HCC) includes extremely heterogeneous patients in terms of tumour burden and liver function. Transarterial-chemoembolization (TACE) is the first-line treatment for these patients although it may be risky/useless for someone, while others could undergo curative treatments. This study assesses the treatment type performed in a large cohort of BCLC-B patients and its outcome. METHODS Retrospective analysis of 485 consecutive BCLC-B patients from the ITA.LI.CA database diagnosed with naïve HCC after 1999. Patients were stratified by treatment. RESULTS 29 patients (6%) were lost to follow-up before receiving treatment. Treatment distribution was: TACE (233, 51.1%), curative treatments (145 patients, 31.8%), sorafenib (18, 3.9%), other (39, 8.5%), best supportive care (BSC) (21, 4.6%). Median survival (95% CI) was 45 months (37.4-52.7) for curative treatments, 30 (24.7-35.3) for TACE, 14 (10.5-17.5) for sorafenib, 14 (5.2-22.7) for other treatments and 10 (6.0-14.2) for BSC (P<.0001). Independent prognosticators were gender and treatment. Curative treatments reduced mortality (HR 0.197, 95%CI: 0.098-0.395) more than TACE (HR 0.408, 95%CI: 0.211-0.789) (P<.0001) as compared with BSC. Propensity score matching confirmed the superiority of curative therapies over TACE. CONCLUSIONS In everyday practice TACE represents the first-line therapy in an half of patients with naïve BCLC-B HCC since treatment choice is driven not only by liver function and nodule characteristics, but also by contraindications to procedures, comorbidities, age and patient opinion. The treatment type is an independent prognostic factor in BCLC-B patients and curative options offer the best outcome.
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Affiliation(s)
- Anna Pecorelli
- Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina Interna, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Barbara Lenzi
- Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Annagiulia Gramenzi
- Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Francesca Garuti
- Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Fabio Farinati
- Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Unità di Gastroenterologia, Università di Padova, Padova, Italy
| | - Edoardo G Giannini
- Dipartimento di Medicina Interna, Unità di Gastroenterologia, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Università di Genova, Genova, Italy
| | | | - Fabio Piscaglia
- Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina Interna, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Gian Lodovico Rapaccini
- Unità di Medicina Interna e Gastroenterologia, Complesso Integrato Columbus, Università Cattolica di Roma, Roma, Italy
| | - Maria Di Marco
- Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy
| | - Eugenio Caturelli
- Unità Operativa di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy
| | - Marco Zoli
- Dipartimento di Gastroenterologia e Medicina Interna, Unità di Medicina Interna, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Franco Borzio
- Dipartimento di Medicina, Unità di Radiologia, Ospedale Fatebenefratelli, Milano, Italy
| | - Rodolfo Sacco
- Unità Operativa Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Cabibbo
- Dipartimento Biomedico di Medicina Interna e Specialistica, Unità di Gastroenterologia, Università di Palermo, Palermo, Italy
| | - Martina Felder
- Ospedale Regionale di Bolzano, Unità di Gastroenterologia, Bolzano, Italy
| | - Filomena Morisco
- Dipartimento di Medicina Clinica e Chirurgia, Unità di Gastroenterologia, Università di Napoli "Federico II", Napoli, Italy
| | - Antonio Gasbarrini
- Unità di Medicina Interna e Gastroenterologia, Policlinico Gemelli, Università Cattolica di Roma, Roma, Italy
| | | | - Francesco G Foschi
- Dipartimento di Medicina Interna, Ospedale per gli Infermi di Faenza, Faenza, Italy
| | - Elisabetta Biasini
- Unità di Malattie Infettive ed Epatologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Roberto Virdone
- Dipartimento Biomedico di Medicina Interna e Specialistica, Unità di Medicina Interna 2, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Mauro Bernardi
- Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Franco Trevisani
- Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
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Hsieh WY, Chen PH, Lin IY, Su CW, Chao Y, Huo TI, Huang YH, Hou MC, Lin HC, Wu JC. The impact of esophagogastric varices on the prognosis of patients with hepatocellular carcinoma. Sci Rep 2017; 7:42577. [PMID: 28209963 PMCID: PMC5314332 DOI: 10.1038/srep42577] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/12/2017] [Indexed: 02/07/2023] Open
Abstract
Whether or not esophagogastric varices (EGV) could determine the outcomes of patients with hepatocellular carcinoma (HCC) is still unclear. A total of 990 treatment-naive HCC patients who received an esophagogastroduodenoscopy at the time of HCC diagnosis were retrospectively enrolled. The factors in terms of prognosis were analyzed by Cox proportional hazards model and propensity score matching analysis. Among the enrolled patients, 480 (48.5%) patients had EGV. Patients with EGV had a significantly lower cumulative 5-year survival rate than those without EGV (24.9% versus 46.4%, p < 0.001). It was confirmed by a multivariate analysis and propensity score matching analysis. Stratified by tumor stage, the patients with EGV had lower survival rates than the patients without EGVs in all Barcelona Clinic Liver Cancer stages except stage D. Moreover, the patients with EGV had lower survival rates than those without EGV, both by curative or non-curative treatment modalities. In conclusion, EGV was an independent risk factor predicting poor prognosis for the patients with HCC by multivariate analysis, propensity score matching analysis, and subgroup analysis.
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Affiliation(s)
- Wei-Yao Hsieh
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ping-Hsien Chen
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan
| | - I-Yen Lin
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Wei Su
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yee- Chao
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Teh-Ia Huo
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jaw-Ching Wu
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
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Jianyong L, Jinjing Z, Lunan Y, Jingqiang Z, Wentao W, Yong Z, Bo L, Tianfu W, Jiaying Y. Preoperative adjuvant transarterial chemoembolization cannot improve the long term outcome of radical therapies for hepatocellular carcinoma. Sci Rep 2017; 7:41624. [PMID: 28155861 PMCID: PMC5290748 DOI: 10.1038/srep41624] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023] Open
Abstract
Combinations of transarterial chemoembolization (TACE) and radical therapies (pretransplantation, resection and radiofrequency ablation) for hepatocellular carcinoma (HCC) have been reported as controversial issues in recent years. A consecutive sample of 1560 patients with Barcelona Clinic Liver Cancer (BCLC) stage A/B HCC who underwent solitary Radiofrequency ablation (RFA), resection or liver transplantation (LT) or adjuvant pre-operative TACE were included. The 1-, 3- and 5-year overall survival rates and tumor-free survival rates were comparable between the solitary radical therapy group and TACE combined group in the whole group and in each of the subgroups (RFA, resection and LT) (P > 0.05). In the subgroup analysis, according to BCLC stage A or B, the advantages of adjuvant TACE were also not observed (P > 0.05). A Neutrophil-lymphocyte ratio (NLR) more than 4, multiple tumor targets, BCLC stage B, and poor histological grade were significant contributors to the overall and tumor-free survival rates. In conclusions, our results indicated that preoperative adjuvant TACE did not prolong long-term overall or tumor-free survival, but LT should nevertheless be considered the first choice for BCLC stage A or B HCC patients. Radical therapies should be performed very carefully in BCLC stage B HCC patients.
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Affiliation(s)
- Lei Jianyong
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.,Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zhong Jinjing
- Department of Pathology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yan Lunan
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zhu Jingqiang
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Wang Wentao
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zeng Yong
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Li Bo
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Wen Tianfu
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yang Jiaying
- Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, China
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37
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Chan AWH, Kumada T, Toyoda H, Tada T, Chong CCN, Mo FKF, Yeo W, Johnson PJ, Lai PBS, Chan ATC, To KF, Chan SL. Integration of albumin-bilirubin (ALBI) score into Barcelona Clinic Liver Cancer (BCLC) system for hepatocellular carcinoma. J Gastroenterol Hepatol 2016; 31:1300-6. [PMID: 26751608 DOI: 10.1111/jgh.13291] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/26/2015] [Accepted: 12/31/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The albumin-bilirubin (ALBI) grade is a recently reported, simpler, more objective, and evidence-based alternative to the Child-Pugh (CP) score for hepatocellular carcinoma (HCC). We aimed to study whether ALBI grade could substitute for CP score in Barcelona Clinic Liver Cancer (BCLC) for HCC. METHODS An international multicentre cohort (n = 3696) was accrued to compare the prognostic performance of the CP-based and ALBI-based BCLC system, in terms of homogeneity, discriminatory ability, and monotonicity of gradients that were numerically reflected by homogeneity likelihood, linear trend chi-squares, and c-indices, respectively. RESULTS The ALBI grade performed as well as CP score when integrated into the BCLC staging system in terms of predicting clinical outcome of HCC regardless of regions, etiology, and treatment options. CP-based and ALBI-based BCLC systems were highly concordant with weighted kappa value of 0.917. All restaged patients showed significantly different clinical outcomes compared with their original stage classification. In particular, ALBI-based BCLC upstaged 83 (2.2%) patients from lower CP-based BC LC stages to ALBI-based BCLC stage D, whose median overall survival was only 3 months. CONCLUSIONS The overall prognostic performance of ALBI-based and CP-based BCLC systems was similar. It also potentially allows more precise patient selection for clinical trials on systemic agents.
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Affiliation(s)
- Anthony W H Chan
- Department of Anatomical and Cellular Pathology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong
| | - Takshi Kumada
- Department of Gastroenterology Ogaki Municipal Hospital, Ogaki, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology Ogaki Municipal Hospital, Ogaki, Japan
| | - Toshifumi Tada
- Department of Gastroenterology Ogaki Municipal Hospital, Ogaki, Japan
| | - Charing C N Chong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong kong
| | - Frankie K F Mo
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong
| | - Winnie Yeo
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong
| | - Philip J Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool Liverpool, UK
| | - Paul B S Lai
- Department of Gastroenterology Ogaki Municipal Hospital, Ogaki, Japan.,Department of Molecular and Clinical Cancer Medicine, University of Liverpool Liverpool, UK
| | - Anthony T C Chan
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong
| | - Ka-Fai To
- Department of Anatomical and Cellular Pathology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong.,Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong kong.,Li Ka Shing Institute of Health Sciences, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong
| | - Stephen L Chan
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong.,Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong kong
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Molvar C, Lewandowski R. Yttrium-90 Radioembolization of Hepatocellular Carcinoma-Performance, Technical Advances, and Future Concepts. Semin Intervent Radiol 2015; 32:388-97. [PMID: 26622103 DOI: 10.1055/s-0035-1564704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hepatocellular carcinoma (HCC) is a lethal tumor, claiming over half a million lives per year. Treatment of HCC is commonly performed without curative intent, and palliative options dominate, including catheter-based therapies, namely, transarterial chemoembolization and yttrium-90 ((90)Y) radioembolization. This review will showcase the performance of (90)Y radioembolization for the treatment of HCC, focusing on recent seminal data and technical advances. In particular, novel radioembolization treatment concepts are discussed and compared with conventional HCC therapy.
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Affiliation(s)
- Christopher Molvar
- Section of Vascular and Interventional Radiology, Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Robert Lewandowski
- Division of Interventional Oncology, Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Alkhatib A, Gomaa A, Allam N, Rewisha E, Waked I. Real Life Treatment of Hepatocellular Carcinoma: Impact of Deviation from Guidelines for Recommended Therapy. Asian Pac J Cancer Prev 2015; 16:6929-34. [DOI: 10.7314/apjcp.2015.16.16.6929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Active Treatments Prolong the Survival in Patients With Hepatocellular Carcinoma and Performance Status 3 or 4: A Propensity Score Analysis. J Clin Gastroenterol 2015; 49:878-84. [PMID: 25710525 DOI: 10.1097/mcg.0000000000000300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
GOALS AND BACKGROUNDS Best supportive care is suggested as the standard treatment for hepatocellular carcinoma (HCC) patients with performance status (PS) 3-4 by the Barcelona Clinic Liver Cancer (BCLC) system. To investigate the rationale of treatment allocation. STUDY A total of 2660 HCC patients were reviewed. One-to-one matched pairs between PS 3 and 4 patients receiving supportive care and anti-HCC treatments were generated by using the propensity score with matching model. The survival analysis was performed with the Kaplan-Meier method and log-rank test. The hazard ratio was calculated with the Cox proportional hazards model. RESULTS Among 328 patients with PS 3-4, 38% of patients received active anti-HCC treatments against the BCLC system. Compared with patients undergoing supportive care, patients receiving anti-HCC treatments more often had milder cirrhosis, smaller tumor burden, and lower serum α-fetoprotein levels (all P<0.05). Patients undergoing supportive care had significantly decreased survival (P<0.0001). With propensity scores, 101 pairs of similar HCC patients with PS 3-4 were selected from different treatment groups. They were comparable in age, sex, etiologies of liver disease, severity of cirrhosis, tumor burden, and prevalence of diabetes mellitus (all P>0.05) at baseline. In the matching model, patients with PS 3-4 undergoing supportive care had significantly shortened survival with an adjusted hazard ratio of 4.711 (confidence interval: 3.041-7.297, P<0.0001). CONCLUSIONS Over one-third of patients with PS 3-4 receive active anti-HCC treatments against the BCLC allocation algorithm in this study. Active anticancer therapies rather than best supportive care should be performed if there is no apparent contraindication.
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Vesselle G, Quirier-Leleu C, Velasco S, Charier F, Silvain C, Boucebci S, Ingrand P, Tasu JP. Predictive factors for complete response of chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma. Eur Radiol 2015; 26:1640-8. [PMID: 26455721 DOI: 10.1007/s00330-015-3982-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 08/17/2015] [Accepted: 08/27/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To identify clinical and imaging features associated with complete response (CR) to first session of transarterial chemoembolization (TACE) with drug-eluting beads (DEB) in patients with hepatocellular carcinoma. METHODS In this prospective historical cohort, 172 patients with 315 tumours who received at least one DEB-TACE from 2007 to 2013 were studied. Imaging response was evaluated according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST). Age, gender, aetiology of cirrhosis, Child and BCLC scores, particles size, location in the liver, size of the tumour, presence of a capsule, hypervascularisation on DSA and CT/MRI scans, and blush extinction were analysed. RESULTS After one session of treatment, CR was observed in 36 % of the 315 tumours treated. Nodule size, location in the liver, and complete blush extinction on DSA was statistically correlated to complete response, whereas capsule aspect on imaging and demographic criteria were not. In multivariate analysis only, location in the liver and nodule size were significant features. CONCLUSIONS Tumour location in the segments 1 and 4 is a pejorative factor for CR, whereas tumour size <5 cm is a positive predictive factor. These criteria could, therefore, be taken into consideration to improve the selection of patients for DEB-TACE. KEY POINTS • Literature on predictive factors of complete response after DEB-TACE is under-studied. • Tumour size <5 cm is associated with complete response. • Location in segments 1 or 4 is a pejorative factor for response. • No demographic parameter influences complete response.
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Affiliation(s)
- Guillaume Vesselle
- Diagnostic, Functional and Therapeutic Imaging Department, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France.
| | - Camille Quirier-Leleu
- Department of Gastroenterology, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Stéphane Velasco
- Diagnostic, Functional and Therapeutic Imaging Department, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Florian Charier
- Department of Gastroenterology, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Christine Silvain
- Department of Gastroenterology, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Samy Boucebci
- Diagnostic, Functional and Therapeutic Imaging Department, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Pierre Ingrand
- Epidemiology and Biostatistics, Clinical Investigation Center INSERM CIC-P 802, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Jean-Pierre Tasu
- Diagnostic, Functional and Therapeutic Imaging Department, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
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Kao WY, Chao Y, Chang CC, Li CP, Su CW, Huo TI, Huang YH, Chang YJ, Lin HC, Wu JC. Prognosis of Early-Stage Hepatocellular Carcinoma: The Clinical Implications of Substages of Barcelona Clinic Liver Cancer System Based on a Cohort of 1265 Patients. Medicine (Baltimore) 2015; 94:e1929. [PMID: 26512620 PMCID: PMC4985433 DOI: 10.1097/md.0000000000001929] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The prognostic implication of Barcelona Clinic Liver Cancer (BCLC) substages in Asian patients with hepatocellular carcinoma (HCC) is still obscure.The aim to this study is to compare the prognoses among HCC patients in different substages of the BCLC stage 0 and A.We enrolled 1265 treatment-naive HCC patients with BCLC stage 0 or A from 2007 to 2014. Factors in terms of prognoses were analyzed by multivariate analysis.There were 184, 446, 271, 92, and 272 patients in substage 0, A1, A2, A3, and A4, respectively. After a median follow-up period of 21.0 months, patients in stages 0 and A1 had comparable prognoses (P = 0.136). Both of them had significantly higher overall survival rates than those in stages A2-A4 (all P < 0.001). Multivariate analysis revealed that the factors associated with mortality were serum albumin ≤3.5 g/dL (hazard ratio [HR] 1.459), alpha-fetoprotein >20 ng/mL (HR 1.863), tumor size >3 cm (HR 1.542), BCLC stage A2-A4 (HR 1.488), and treatment modality. Surgical resection had the highest overall survival rate followed by radiofrequency ablation (RFA) (HR 1.598), transarterial chemoembolization (HR 2.224), and other treatments (HR 3.707). Verus patients receiving RFA, those who underwent resection had a higher overall survival rate and lower recurrence rate especially in BCLC stages A2-A4.The BCLC-staging system provided good prognostic stratification for early-stage HCC. Patients with a single tumor >2 cm but without portal hypertension or jaundice had similar prognosis to those in BCLC stage 0. Curative therapies-especially hepatic resection-are suggested in early-stage HCC.
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Affiliation(s)
- Wei-Yu Kao
- From the Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (W-YK, C-PL, C-WS, T-IH, Y-HH, H-CL); Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (W-YK, YC, C-PL, C-WS, H-CL); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, 252, WuHsing St., Taipei 11031, Taiwan (W-YK, C-CC); Division of Gastroenterology and Hepatology ,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 250, WuHsing St., Taipei 11031, Taiwan (W-YK, C-CC); Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (W-YK, Y-JC); Division of Chemo-radiotherapy, Department of Oncology Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology (YC); Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan (T-IH); Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (Y-HH, J-CW); Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan (YJC); Translational Research Laboratory, Cancer Center, Taipei Medical University Hospital, Taipei, Taiwan (YJC); Cancer Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan (Y-JC); and Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan (J-CW)
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Guarino M, Stroffolini T, Lombardo FL, Loperto I, Auriemma F, Gentile I, Caporaso N, Morisco F. Lack of evidence that adherence to standard of care therapy improves survival in subjects with hepatocellular carcinoma in clinical practice. J Med Virol 2015; 87:1368-76. [PMID: 25802203 DOI: 10.1002/jmv.24187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2015] [Indexed: 12/22/2022]
Abstract
Currently, the BCLC classification, which links tumor stage with treatment option, is the standard system for clinical management of HCC. Thus far, this approach has been considered the standard of care worldwide. This study aimed to evaluate the survival of patients with HCC according to the BCLC Stage, surveillance, and adherence to standards of care. A 3-year prospective study enrolled 92 consecutive patients with HCC in the Gastroenterology Unit of the University of Naples "Federico II". Predictors of the likelihood of death were evaluated by the multivariate Cox model. Forty out of 92 (43%) subjects died during three years of follow up. The overall mortality rate per 100 person-years was 16.7, while the mortality rate for hepatic causes was only 14.2; it was lower in subjects under surveillance (11.4 vs. 28.2), in subjects adherent to standards of care (12.0 vs. 21.1), and in those who were in a better BCLC stage (10.6 vs. 45.8). The multivariate Cox model showed that advanced BCLC stage (HR 4.1, 95% C.I. = 1.8-9.4) was the sole independent predictor of the likelihood of mortality. In this regard, we observed lack of evidence that the adherence to the BCLC recommendations reduces the mortality of patients with HCC; and that the BCLC system cannot be accepted as a "commandment" to be invariably followed in everyday practice. Strategies to help improve adherence to international guidelines for HCC in clinical practice are required.
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Affiliation(s)
- Maria Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Italy
| | - Tommaso Stroffolini
- Department of Infectious and Tropical Diseases, University "La Sapienza" Rome, Italy
| | - Flavia Lucia Lombardo
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome
| | - Ilaria Loperto
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Italy
| | - Francesco Auriemma
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Italy
| | - Ivan Gentile
- Department of Public Medicine and Social Security, Section of Infectious Diseases, University of Naples "Federico II", Italy
| | - Nicola Caporaso
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Italy
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Farinati F, Vanin V, Giacomin A, Pozzan C, Cillo U, Vitale A, Di Nolfo AM, Del Poggio P, Benvegnu' L, Rapaccini G, Zoli M, Borzio F, Giannini EG, Caturelli E, Trevisani F. BCLC stage B hepatocellular carcinoma and transcatheter arterial chemoembolization: a 20-year survey by the Italian Liver Cancer group. Liver Int 2015; 35:223-31. [PMID: 25074434 DOI: 10.1111/liv.12649] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 07/23/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS Significant proportion of Hepatocellular Carcinoma (HCC) cases are diagnosed in stage B of Barcelona Clinic Liver Cancer (BCLC) algorithm, in which the standard of care is Transcatheter Arterial ChemoEmbolization (TACE). We aimed to ascertain adherence to current guidelines, survival and prognostic factors in BCLC stage B patients. METHODS From 3027 HCC cases recruited from 1986 to 2008 by the Italian Liver Cancer group (2430 with data allowing a correct allocation in the BCLC system), a retrospective analysis was conducted on those diagnosed in BCLC stage B (405 patients, 17%). Statistics were performed with Kaplan-Meier (log rank) method and Cox multivariate analysis. RESULTS Median overall survival in BCLC stage B patients was 25 months (Confidence Interval - C.I. - 22-28 months) with a 5-year survival of 18%. Child-Pugh class, oesophageal varices and Alpha-foetoprotein (AFP) were the independent predictors of survival. TACE was applied in 40% of cases and did not offer the longest survival in comparison with surgical or percutaneous treatments (median 27 months vs. 37 and 36 months, respectively) (P < 0.001). BCLC stage B patients undergoing radical treatments were more frequently in Child-Pugh class A and had a significantly lower number of lesions; patients undergoing best supportive care were frequently in Child-Pugh class B and had a multifocal disease. Survival after TACE did not significantly increase over time. CONCLUSIONS In clinical practice, TACE cannot be considered the best approach for BCLC stage B patients who represent a heterogeneous population and are often suitable for more aggressive therapies, which lead to a better survival.
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Affiliation(s)
- Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, Section of Gastroenterology, University of Padua, Padua, Italy
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Sangro B. Chemoembolization and radioembolization. Best Pract Res Clin Gastroenterol 2014; 28:909-19. [PMID: 25260317 DOI: 10.1016/j.bpg.2014.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/15/2014] [Indexed: 01/31/2023]
Abstract
Chemoembolization and radioembolization are at the core of the treatment of patients with hepatocellular carcinoma who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. They differ in the mechanism of action (ischaemia and increase cytotoxic drug exposure for chemoembolization, internal irradiation for radioembolization) and may target different patient populations. Chemoembolization with cytotoxic drug-eluting beads is a more standardized although not necessarily more effective way of performing chemoembolization. Cytoreduction is achieved in most patients but complete tumor ablation may be achieved and lead to extended survival. Grade 1 level of evidence support the use of chemoembolization for the treatment of patients in the early and intermediate stages while grade 2 evidence supports the use of radioembolization for the treatment of patients in intermediate to advanced stages. Selecting the best candidates for both techniques is still a work in progress that ongoing clinical trials are trying to address.
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Affiliation(s)
- Bruno Sangro
- Clinica Universidad de Navarra, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Avda, Pio XII 36, 31008 Pamplona, Spain.
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Ho EY, Cozen ML, Shen H, Lerrigo R, Trimble E, Ryan JC, Corvera CU, Monto A. Expanded use of aggressive therapies improves survival in early and intermediate hepatocellular carcinoma. HPB (Oxford) 2014; 16:758-67. [PMID: 24467780 PMCID: PMC4113259 DOI: 10.1111/hpb.12214] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/27/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the increasing annual incidence of hepatocellular carcinoma (HCC) in the USA, now estimated at 2.7 cases per 100 000 population, only a small proportion of patients receive treatment and 5-year survival rates range from 9% to 17%. OBJECTIVES The present study examines the effects of multimodal treatment on survival in a mixed-stage HCC cohort, focusing on the impact of radical therapy in patients with Barcelona Clinic Liver Cancer (BCLC) stage B disease. METHODS A retrospective review of the medical records of 254 patients considered for HCC treatment between 2003 and 2011 at a large tertiary referral centre was conducted. RESULTS A total of 195 (76.8%) patients were treated with a median of two liver-directed interventions. Median survival time was 16 months. In proportional hazards analysis, radiofrequency ablation (RFA) and resection were associated with significantly improved 1- and 5-year survival among patients with BCLC stage 0-A disease. In patients with BCLC stage B disease, RFA conferred a survival benefit at 1 year and resection was associated with significantly improved survival at 5 years. CONCLUSIONS As one of few studies to track the complete course of sequential HCC therapies, the findings of the present study suggest that HCC patients with intermediate-stage (BCLC stage B) disease may benefit from aggressive interventions not currently included in societal guidelines.
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Affiliation(s)
- Edith Y Ho
- Division of Gastroenterology, Department of Medicine, University of California San FranciscoSan Francisco, CA, USA
| | - Myrna L Cozen
- Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
- Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
| | - Hui Shen
- Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
- Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
| | - Robert Lerrigo
- Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
| | - Erica Trimble
- Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
| | - James C Ryan
- Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
- Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
| | - Carlos U Corvera
- Department of Surgery, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
- Department of Surgery, University of California San FranciscoSan Francisco, CA, USA
| | - Alexander Monto
- Division of Gastroenterology, Department of Medicine, University of California San FranciscoSan Francisco, CA, USA
- Division of Gastroenterology, Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
| | - for the HOVAS Group (Hepatocellular Carcinoma Treatment Outcome at VA San Francisco)
- Division of Gastroenterology, Department of Medicine, University of California San FranciscoSan Francisco, CA, USA
- Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
- Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
- Department of Surgery, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
- Department of Surgery, University of California San FranciscoSan Francisco, CA, USA
- Division of Gastroenterology, Department of Medicine, San Francisco Veterans Affairs Medical CenterSan Francisco, CA, USA
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Memon K, Kulik LM, Lewandowski RJ, Wang E, Wang J, Ryu RK, Hickey R, Vouche M, Baker T, Ganger D, Gates VL, Habib A, Mulcahy MF, Salem R. Comparative study of staging systems for hepatocellular carcinoma in 428 patients treated with radioembolization. J Vasc Interv Radiol 2014; 25:1056-66. [PMID: 24613269 PMCID: PMC5097871 DOI: 10.1016/j.jvir.2014.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 12/30/2013] [Accepted: 01/11/2014] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare the utility of different staging systems and analyze independent predictors of survival in patients with hepatocellular carcinoma (HCC) treated with yttrium-90 ((90)Y) radioembolization. MATERIALS AND METHODS During the period 2004-2011, 428 patients with HCC were treated with (90)Y radioembolization. All patients were staged prospectively by the following staging systems: Child-Turcotte-Pugh (CTP), United Network for Organ Sharing, Barcelona Clinic Liver Cancer (BCLC), Okuda classification, Cancer of the Liver Italian Program (CLIP), Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire, Chinese University Prognostic Index, and Japan Integrated Staging. The ability of the staging systems to predict survival was assessed. The staging systems were compared using Cox proportional hazards regression model, linear regression, Akaike information criterion (AIC), and concordance index (C-index). Univariate and multivariate analyses were employed to assess independent predictors of survival. RESULTS When tested independently, all staging systems exhibited significant ability to discriminate early (long survival) from advanced (worse survival) disease. CLIP provided the most accurate information in predicting survival outcomes (AIC = 2,993, C-index = 0.8503); CTP was least informative (AIC = 3,074, C-index = 0.6445). Independent predictors of survival included Eastern Cooperative Oncology Group performance status grade 0 (hazard ration [HR], 0.56; confidence interval [CI], 0.34-0.93), noninfiltrative tumors (HR, 0.62; CI, 0.44-0.89), absence of portal venous thrombosis (HR, 0.60; CI, 0.40-0.89), absence of ascites (HR, 0.56; CI, 0.40-0.76), albumin ≥ 2.8 g/dL (HR, 0.72; CI, 0.55-0.94), alkaline phosphatase ≤ 200 U/L (HR, 0.68; CI, 0.50-0.92), and α-fetoprotein ≤ 200 ng/mL (HR, 0.67; CI, 0.51-0.86). CONCLUSIONS CLIP was most accurate in predicting survival in patients with HCC. Given that not all patients receive the recommended BCLC treatment strategy, this information is relevant for clinical trial design and predicting long-term outcomes after (90)Y radioembolization.
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Affiliation(s)
- Khairuddin Memon
- Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Laura M Kulik
- Department of Medicine, Division of Hematology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Edward Wang
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Jonathan Wang
- Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Robert K Ryu
- Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Ryan Hickey
- Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Michael Vouche
- Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Talia Baker
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Daniel Ganger
- Department of Medicine, Division of Hematology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Vanessa L Gates
- Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Ali Habib
- Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Mary F Mulcahy
- Department of Medicine, Division of Hematology and Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611; Department of Medicine, Division of Hematology and Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611; Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
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48
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Guo Z, Zhong JH, Jiang JH, Zhang J, Xiang BD, Li LQ. Comparison of survival of patients with BCLC stage A hepatocellular carcinoma after hepatic resection or transarterial chemoembolization: a propensity score-based analysis. Ann Surg Oncol 2014; 21:3069-76. [PMID: 24728740 DOI: 10.1245/s10434-014-3704-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND It is unclear whether hepatic resection (HR) or transarterial chemoembolization (TACE) is associated with better outcomes for patients with hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer (BCLC) stage A. The present study compared survival for patients with BCLC stage A HCC treated by HR or TACE. METHODS Our study examined 360 patients treated by HR and 221 treated by TACE. To reduce bias in patient selection, 152 pairs of propensity-score-matched patients were generated, and their long-term survival was compared using the Kaplan-Meier method. Independent predictors of survival were identified using the Cox proportional hazards model. RESULTS Among propensity-score-matched pairs of patients with Child-Pugh A liver function who were treated by HR or TACE, the 1-, 3-, and 5-year overall survival rates were 75.5, 44.8, and 30.2 % after HR and 64.5, 24.1, and 13.7 % after TACE (P < 0.001). Serum AST level, serum AFP level, tumor size, and TACE independently predicted survival in Cox regression analysis. CONCLUSIONS Our propensity-score-matched study confirmed that HR was associated with higher survival rates than was TACE in patients with BCLC stage A HCC.
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Affiliation(s)
- Zhe Guo
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
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Ha Y, Shim JH, Kim SO, Kim KM, Lim YS, Lee HC. Clinical appraisal of the recently proposed Barcelona Clinic Liver Cancer stage B subclassification by survival analysis. J Gastroenterol Hepatol 2014; 29:787-93. [PMID: 24224567 DOI: 10.1111/jgh.12452] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM To evaluate the usefulness of Barcelona Clinic Liver Cancer B subclassification (B1-B4) proposed by Bolondi et al. in subjects with hepatocellular carcinoma treated with transarterial chemoembolization according to the current Barcelona Clinic Liver Cancer policy. METHODS A total of 466 Barcelona Clinic Liver Cancer B patients initially treated with transarterial chemoembolization were included. The subclassification system was tested and modified on the basis of correlation with survival outcomes, which were examined by Kaplan-Meier method and log-rank test. RESULTS There were 101 (21.7%), 232 (49.8%), 35 (7.5%), and 98 (21.0%) patients in B1, B2, B3, and B4, respectively. There was a significant difference in median survival time between B1 and B2 (41.0 vs 22.1 months, P ≤ 0.001), and B2 and B3 (22.1 vs 14.1 months, P = 0.004), but not between B3 and B4 (14.1 vs 17.2 months, P = 0.48). We, therefore, developed a modified subclassification, in which B3 subclass was merged with B4 as BIII, and BI and BII corresponded to B1 and B2. The median survival times differed between all three modified subclasses (41.0 vs 22.1 vs 16.6 months, P ≤ 0.001), and multivariate Cox analysis revealed that the modified Barcelona Clinic Liver Cancer B subclasses independently predicted overall survival (hazard ratios, 1.92 and 2.78 for BII and BIII vs BI; P < 0.001 for each). CONCLUSIONS The modified subclassification, which divides the Barcelona Clinic Liver Cancer B stage into three substages, would be an effective tool for stratifying this heterogeneous population and facilitating per-subclass-based treatment options.
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Affiliation(s)
- Yeonjung Ha
- Department of Internal Medicine, Asan Liver Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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50
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Kim HC, Suk KT, Kim DJ, Yoon JH, Kim YS, Baik GH, Kim JB, Kim CH, Sung H, Choi JY, Han KH, Park SH. Transarterial chemoembolization in Barcelona Clinic Liver Cancer Stage 0/A hepatocellular carcinoma. World J Gastroenterol 2014; 20:745-754. [PMID: 24574748 PMCID: PMC3921484 DOI: 10.3748/wjg.v20.i3.745] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/06/2013] [Accepted: 10/22/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical characteristics of patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 and A hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).
METHODS: Between January 2001 and September 2011, 129 patients with BCLC stage 0 and stage A HCC who underwent TACE were retrospectively enrolled. Patient characteristics, routine computed tomography and TACE findings, survival time and 1-, 5-, and 10-year survival rates, risk factors for mortality, and survival rates according to the number of risk factors were assessed.
RESULTS: The mean size of HCC tumors was 2.4 ± 1.1 cm, and the mean number of TACE procedures performed was 2.5 ± 2.1. The mean overall survival time and 1-, 5-, and 10-year survival rates were 80.6 ± 4.9 mo and 91%, 63% and 49%, respectively. In the Cox regression analysis, a Child-Pugh score > 5 (P = 0.005, OR = 3.86), presence of arterio-venous shunt (P = 0.032, OR = 4.41), amount of lipiodol used (> 7 mL; P = 0.013, OR = 3.51), and female gender (P = 0.008, OR = 3.47) were risk factors for mortality. The 1-, 5-, and 10-year survival rates according to the number of risk factors present were 96%, 87% and 87% (no risk factors), 89%, 65%, and 35% (1 risk factor), 96%, 48% and unavailable (2 risk factors), and 63%, 17%, and 0% (3 risk factors), respectively (P < 0.001).
CONCLUSION: TACE may be used as curative-intent therapy in patients with BCLC stage 0 and stage A HCC. The Child-Pugh score, arterio-venous shunt, amount of lipiodol used, and gender were related to mortality after TACE.
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