101
|
Chai NX, Chapiro J. Therapy of Intermediate-Stage Hepatocellular Carcinoma: Current Evidence and Clinical Practice. Semin Intervent Radiol 2020; 37:456-465. [PMID: 33328701 PMCID: PMC7732559 DOI: 10.1055/s-0040-1719186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Intermediate-stage Hepatocellular Carcinoma (HCC) represents a wide range of disease burden. Patients with different levels of liver function, tumor size, and number of lesions may all have intermediate-stage disease according to the Barcelona Clinic Liver Cancer (BCLC) staging system. Several minimally invasive image-guided locoregional therapies are available for the treatment of intermediate-stage HCC, including conventional transarterial chemoembolization (cTACE), drug-eluting bead TACE (DEB-TACE), yttrium-90 radioembolization (Y-90 RE), thermal ablation, bland embolization, and combination therapy. Available clinical evidence points to cTACE as the current gold standard for the locoregional treatment of intermediate-stage HCC. DEB-TACE is at best non-inferior to cTACE in terms of survival benefit. Y-90 RE is a maturing therapy, and some institutions have adopted it as first-line therapy for intermediate-stage HCC. Thermal ablation combined with TACE may be used in select patients, while bland embolization has only limited evidence for its use. The combination of locoregional therapy with VEGF inhibitors or immune checkpoint inhibitors has also been explored. This article will examine in detail the clinical evidence supporting available locoregional treatment options for intermediate-stage HCC.
Collapse
Affiliation(s)
- Nathan X. Chai
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Julius Chapiro
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
102
|
Zhou Q, Tuo F, Li R, Wang X, Wang J, Huang Z, Chen M, Huang J. Transarterial Chemoembolization Combined With Hepatectomy for the Treatment of Intermediate-Stage Hepatocellular Carcinoma. Front Oncol 2020; 10:578763. [PMID: 33251141 PMCID: PMC7672209 DOI: 10.3389/fonc.2020.578763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/01/2020] [Indexed: 01/27/2023] Open
Abstract
Background Transarterial chemoembolization (TACE) is currently the recommended treatment for intermediate-stage hepatocellular carcinoma (HCC). Liver resection (LR) may be an effective option, although recurrences are not uncommon. TACE prior to LR has been proposed as an even better alternative. Methods Patients with intermediate-stage HCC who underwent curative resection were enrolled between January 2007 and December 2015. We compared overall survival (OS) and recurrence-free survival (RFS) for the 2 groups using the Kaplan-Meier method, and we determined independent risk factors for death and recurrence using multivariate regression analyses. Results A total of 488 patients with HCC at BCLC B (265 patients with LR, 223 patients with TACE+LR) enrolled from our center. Mean follow-up was 40.2 (range, 3.0-128.7) months. For patients receiving TACE+LR and LR, estimated 1-, 3-, and 5-year OS rates were 90.6% and 73.3%, 61.7% and 43.5%, and 52.9% and 33.8%, respectively (all P < 0.001) and estimated 1-, 2-, and 3-year RFS rates were 54.6% and 39.4%, 41.4% and 29.4%, and 36.3% and 26.3%, respectively (P < 0.001, P = 0.002, and P = 0.008, respectively). Significant independent predictors of poor OS were more than 3 (vs. 3 or fewer) tumors (HR=2.19, 95% CI 1.69-2.84), non-anatomical (vs. anatomical) hepatectomy (HR=1.29, 95% CI 1.01-1.66), microscopic vascular invasion (HR=1.46, 95% CI 1.15-.90), cirrhosis (HR=2.41, 95%CI 1.88-3.01), and intraoperative blood transfusion (HR=1.29, 95% CI 1.01-1.66). Conclusion Preoperative TACE with LR may result in better oncological outcomes than either TACE or LR alone, without a substantial increase in morbidity, and could be considered an effective combination treatment for intermediate-stage HCC.
Collapse
Affiliation(s)
- Qunfang Zhou
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fei Tuo
- Department of Ultrasound Diagnose, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Ruixia Li
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaohui Wang
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Juncheng Wang
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Zhimei Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Minshan Chen
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Jinhua Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
103
|
Six months as a cutoff time point to define early recurrence after liver resection of hepatocellular carcinoma based on post-recurrence survival. Updates Surg 2020; 73:399-409. [PMID: 33245549 DOI: 10.1007/s13304-020-00931-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023]
Abstract
To determine the optimal cutoff time point of early versus late recurrence relative to post-recurrence survival (PRS) among patients who underwent liver resection (LR) for hepatocellular carcinoma (HCC) in a high-volume liver surgery center in East Asia. This was a retrospective study. Patients who underwent LR for HCC between 2011 and 2018 at Kaohsiung Chang Gung Memorial Hospital were enrolled. The optimal cutoff time point to differentiate early versus late recurrence was evaluated relative to PRS. Among 826 patients, 282 (34.1%) of the patients experienced recurrence, with a median time to recurrence of 12.2 months. 6 months was defined as the optimal cutoff time point based on sensitivity analyses relative to PRS. Ninety (31.9%) of the patients developed early recurrence within 6 months, and 192 patients (68.1%) developed late recurrence beyond 6 months. Early recurrence was associated with worse PRS (median PRS, 13.2 versus 48.9 months, p < 0.001), as well as overall survival (OS) (median OS, 16.2 versus 65.4 months, p < 0.001), than late recurrence. Six months was identified as the cutoff time point to differentiate early versus late recurrence among patients undergoing LR for HCC.
Collapse
|
104
|
Li S, Zhou L, Chen R, Chen Y, Niu Z, Qian L, Fang Y, Xu L, Xu H, Zhang L. Diagnostic efficacy of contrast-enhanced ultrasound versus MRI Liver Imaging Reporting and Data System (LI-RADS) for categorising hepatic observations in patients at risk of hepatocellular carcinoma. Clin Radiol 2020; 76:161.e1-161.e10. [PMID: 33198943 DOI: 10.1016/j.crad.2020.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022]
Abstract
AIM To investigate the diagnostic efficacy of the contrast-enhanced ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) for categorising hepatic observations in patients at risk of hepatocellular carcinoma (HCC) compared with magnetic resonance imaging (MRI) LI-RADS. MATERIALS AND METHODS CEUS and MRI data were analysed retrospectively according to the LI-RADS scheme. Follow-up results and pathological findings served as the reference standard. Receiver operating characteristic (ROC) curve analysis was used to reveal the area under the curve (AUC). The sensitivity, specificity, accuracy, and positive (PPV) and negative predictive values (NPV) of LR-5 for determining HCC were calculated. The intra-observer agreement of CEUS LI-RADS was also evaluated. RESULTS Eighty-four patients with 86 liver observations were enrolled. Forty-two observations were classified as LR-5 by CEUS and MRI, respectively. Based on the reference standard, 53 nodules were HCC. The AUCs were 0.876 for CEUS and 0.873 for MRI, without a significant difference (Z=0.050, p=0.960). The sensitivity, specificity, PPV, NPV, and accuracy of LR-5 was 75.47%, 93.94%, 95.24%, 70.45%, 82.56% with CEUS and 73.58%, 90.9%, 92.86%, 68.18%, 80.23% with MRI, respectively. There was a significant difference in specificity between CEUS and MRI (p=0.006). There was almost perfect agreement for arterial phase hyperenhancement (k=0.870), substantial agreement for washout (k=0.765) and CEUS LI-RADS category (k=0.787). CONCLUSION The CEUS LI-RADS scheme is an effective diagnostic tool for HCC with substantial intra-observer reliability. The diagnostic performance of CEUS LI-RADS for determining HCC was comparable to MRI LI-RADS, and the specificity of CEUS LR-5 was significantly higher.
Collapse
Affiliation(s)
- S Li
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - L Zhou
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - R Chen
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Y Chen
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Z Niu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - L Qian
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Y Fang
- Department of Oncology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - L Xu
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - H Xu
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - L Zhang
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University, School of Medicine, Hangzhou, China.
| |
Collapse
|
105
|
Malaguarnera G, Catania VE, Latteri S, Borzì AM, Bertino G, Madeddu R, Drago F, Malaguarnera M. Folate levels in hepatocellular carcinoma patients with portal vein thrombosis. BMC Gastroenterol 2020; 20:375. [PMID: 33172390 PMCID: PMC7653717 DOI: 10.1186/s12876-020-01525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Portal vein thrombosis (PVT) occurs frequently in hepatocellular carcinoma (HCC) and is often diagnosed in the course of a routine patient evaluation and surveillance for liver cancer. The purpose of this study is to investigate the relationship between folate status and portal vein thrombosis. METHODS HCC with PVT patients were 78, HCC without PVT were 60 and control subjects were 70 randomly selected. We evaluate serum and red blood cellular folate, homocysteine, alpha fetal protein cholesterol, triglycerides, prothrombin time. RESULTS HCC patients with PVT showed lower levels of serum folate, respect HCC patients without PVT, with an average difference of 1.6 nmol/l p < 0.01 (95% CI - 2.54 to - 0.66), red cell folate 33.6 nmol/l p < 0.001 (95% CI - 43.64 to - 23.55) and albumin 0.29 g/dl p < 0.001 (95% CI - 0.42 to - 0.15); PVT patients displayed higher levels of bilirubin 0.53 mg/dl p < 0.001 (95% CI 0.23 to 0.78), INR 0.91 p < 0.001 (95% CI 0.72 to 1.09), γGT 7.9 IU/l (95% CI 4.14 to 11.65) and homocysteine 4.6 μmol/l p < 0.05 (95% CI 0.32 to 8.87) CONCLUSION: The low folate concentration and higher levels of homocysteine are associated with the loss of antithrombotic function, and with a more aggressive course of HCC and with a higher change of complications related to portal vein thrombosis.
Collapse
Affiliation(s)
- Giulia Malaguarnera
- Department of Biomedical and Biotechnological Science, University of Catania, 95123, Catania, Italy
| | - Vito Emanuele Catania
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Saverio Latteri
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Maria Borzì
- Research Centre "The Great Senescence", University of Catania, 95120, Catania, Italy
| | - Gaetano Bertino
- Hepatology Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", Catania, Italy
| | - Roberto Madeddu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Science, University of Catania, 95123, Catania, Italy
| | - Michele Malaguarnera
- Research Centre "The Great Senescence", University of Catania, 95120, Catania, Italy
| |
Collapse
|
106
|
An JY, Peña MA, Cunha GM, Booker MT, Taouli B, Yokoo T, Sirlin CB, Fowler KJ. Abbreviated MRI for Hepatocellular Carcinoma Screening and Surveillance. Radiographics 2020; 40:1916-1931. [PMID: 33136476 PMCID: PMC7714535 DOI: 10.1148/rg.2020200104] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/10/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023]
Abstract
To detect potentially curable hepatocellular carcinoma (HCC), clinical practice guidelines recommend semiannual surveillance US of the liver in adult patients at risk for developing this malignancy, such as those with cirrhosis and some patients with chronic hepatitis B infection. However, cirrhosis and a large body habitus, both of which are increasingly prevalent in the United States and the rest of the world, may impair US visualization of liver lesions and reduce the sensitivity of surveillance with this modality. The low sensitivity of US for detection of early-stage HCC contributes to delayed diagnosis and increased mortality. Abbreviated MRI, a shortened MRI protocol tailored for early-stage detection of HCC, has been proposed as an alternative surveillance option that provides high sensitivity and specificity. Abbreviated MRI protocols include fewer sequences than a complete multiphase MRI examination and are specifically designed to identify small potentially curable HCCs that may be missed at US. Three abbreviated MRI strategies have been studied: (a) nonenhanced, (b) dynamic contrast material-enhanced, and (c) hepatobiliary phase contrast-enhanced abbreviated MRI. Retrospective studies have shown that simulated abbreviated MRI provides high sensitivity and specificity for early-stage HCC, mostly in nonsurveillance cohorts. If it is supported by scientific evidence in surveillance populations, adoption of abbreviated MRI could advance clinical practice by increasing early detection of HCC, allowing effective treatment and potentially prolonging life in the growing number of individuals with this cancer. Online supplemental material is available for this article. ©RSNA, 2020.
Collapse
Affiliation(s)
| | | | - Guilherme M. Cunha
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
| | - Michael T. Booker
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
| | - Bachir Taouli
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
| | - Takeshi Yokoo
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
| | - Claude B. Sirlin
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
| | - Kathryn J. Fowler
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
| |
Collapse
|
107
|
Obi S, Sato T, Sato S. Immune checkpoint inhibitor in liver cancer-unique regional differences. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1336. [PMID: 33313081 PMCID: PMC7723575 DOI: 10.21037/atm-20-3378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shuntaro Obi
- Department of Internal Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Takahisa Sato
- Department of Internal Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Shinpei Sato
- Department of Internal Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| |
Collapse
|
108
|
Chang Y, Jeong SW, Young Jang J, Jae Kim Y. Recent Updates of Transarterial Chemoembolilzation in Hepatocellular Carcinoma. Int J Mol Sci 2020; 21:E8165. [PMID: 33142892 PMCID: PMC7662786 DOI: 10.3390/ijms21218165] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 12/24/2022] Open
Abstract
Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC). In this review, we summarize recent updates on the use of TACE for HCC. TACE can be performed using two techniques; conventional TACE (cTACE) and drug-eluting beads using TACE (DEB-TACE). The anti-tumor effect of the two has been reported to be similar; however, DEB-TACE carries a higher risk of hepatic artery and biliary injuries and a relatively lower risk of post-procedural pain than cTACE. TACE can be used for early stage HCC if other curative treatments are not feasible or as a neoadjuvant treatment before liver transplantation. TACE can also be considered for selected patients with limited portal vein thrombosis and preserved liver function. When deciding to repeat TACE, the ART (Assessment for Retreatment with TACE) score and ABCR (AFP, BCLC, Child-Pugh, and Response) score can guide the decision process, and TACE refractoriness needs to be considered. Studies on the combination therapy of TACE with other treatment modalities, such as local ablation, radiation therapy, or systemic therapy, have been actively conducted and are still ongoing. Recently, new prognostic models, including analysis of the neutrophil-lymphocyte ratio, radiomics, and deep learning, have been developed to help predict survival after TACE.
Collapse
Affiliation(s)
- Young Chang
- Department of Internal Medicine, Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul 04401, Korea; (Y.C.); (J.Y.J.)
| | - Soung Won Jeong
- Department of Internal Medicine, Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul 04401, Korea; (Y.C.); (J.Y.J.)
| | - Jae Young Jang
- Department of Internal Medicine, Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul 04401, Korea; (Y.C.); (J.Y.J.)
| | - Yong Jae Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Seoul 04401, Korea;
| |
Collapse
|
109
|
Ito K, Takemura N, Inagaki F, Mihara F, Kokudo N. Difference in treatment algorithms for hepatocellular carcinoma between world's principal guidelines. Glob Health Med 2020; 2:282-291. [PMID: 33330822 DOI: 10.35772/ghm.2020.01066] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related death globally. Clinical guidelines for HCC have been established and revised by many countries and regions. We summarized and compared the treatment algorithms in the updated HCC guidelines established by Japan, China, Hong Kong, the Asian-Pacific Association for the Study of the Liver, the American Association for the Study of Liver Diseases, and the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer. Variations in treatment algorithms between the guidelines is inevitable, considering the differences in the prevalence and etiology of HCC, local clinical practice, and medical and insurance systems between countries or regions, and this might be confusing for practitioners worldwide. A comprehensive understanding of the guidelines that are globally available might be useful for future improvement of each guideline.
Collapse
Affiliation(s)
- Kyoji Ito
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Fuminori Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
110
|
Kuo FY, Liu YW, Lin CC, Yong CC, Wang CC, Chen CL, Cheng YF, Wang JH, Yen YH. Microscopic portal vein invasion is a powerful predictor of prognosis in patients with hepatocellular carcinoma who have undergone liver resection. J Surg Oncol 2020; 123:222-235. [PMID: 33084068 DOI: 10.1002/jso.26260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/27/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES A recent study proposed simple classifications of microscopic vascular invasion (MVI): microscopic portal vein invasion (MPVI) and microvessel invasion (MI). We aim to validate these classifications of MVI. METHODS This retrospective study consecutively enrolled 514 Barcelona Clinic Liver Cancer stage 0, A, and B naïve hepatocellular carcinoma patients who underwent liver resection in our institution from 2011 to 2017. RESULTS Among these 514 patients, 240 patients were classified as having no MVI at all (designated as no vascular invasion, NVI), 157 patients were classified as having MI only, and 117 patients were classified as having MPVI. The 5-year overall survival (OS) rate in the MI-only group was 83.3%, which was not significantly different from that of the NVI group (87.2%), p = .20. Using NVI as a reference, multivariate analysis showed that MI-only is not an independent variable associated with OS. The 5-year OS in the MPVI group was 59.2%, which was significantly lower than those for MI-only (p < .001) and NVI groups (p < .001). Using NVI as a reference, multivariate analysis showed that MPVI is an independent variable associated with OS (HR, 3.12; 95% CI, 1.80-5.40; p < .001). CONCLUSIONS The results of this study validate the simple MVI classifications to be clinically useful.
Collapse
Affiliation(s)
- Fang-Ying Kuo
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Wei Liu
- Department of Surgery, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Che Lin
- Department of Surgery, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chee-Chien Yong
- Department of Surgery, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Chi Wang
- Department of Surgery, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Department of Surgery, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Department of Diagnostic Radiology, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jing-Houng Wang
- Department of Internal Medicine, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Hao Yen
- Department of Internal Medicine, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
111
|
Sugimoto K, Kakegawa T, Takahashi H, Tomita Y, Abe M, Yoshimasu Y, Takeuchi H, Kasai Y, Itoi T. Usefulness of Modified CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma Using Sonazoid. Diagnostics (Basel) 2020; 10:diagnostics10100828. [PMID: 33076435 PMCID: PMC7602639 DOI: 10.3390/diagnostics10100828] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023] Open
Abstract
The Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) was introduced for classifying suspected hepatocellular carcinoma (HCC). However, it cannot be applied to Sonazoid. We assessed the diagnostic usefulness of a modified CEUS LI-RADS for HCC and non-HCC malignancies based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Patients with chronic liver disease at risk for HCC were evaluated retrospectively. Nodules ≥1 cm with arterial phase hyperenhancement, no early washout (within 60 s), and contrast defects in the Kupffer phase were classified as LR-5. Nodules showing early washout, contrast defects in the Kupffer phase, and/or rim enhancement were classified as LR-M. A total of 104 nodules in 104 patients (median age: 70.0 years; interquartile range: 54.5-78.0 years; 74 men) were evaluated. The 48 (46.2%) LR-5 lesions included 45 HCCs, 2 high-flow hemangiomas, and 1 adrenal rest tumor. The PPV of LR-5 for HCC was 93.8% (95% confidence interval (CI): 82.8-98.7%). The 22 (21.2%) LR-M lesions included 16 non-HCC malignancies and 6 HCCs. The PPV of LR-M for non-HCC malignancies, including six intrahepatic cholangiocarcinomas, was 100% (95% CI: 69.8-100%). In conclusion, in the modified CEUS LI-RADS for Sonazoid, LR-5 and LR-M are good predictors of HCC and non-HCC malignancies, respectively.
Collapse
|
112
|
Chen Z, Xie H, Hu M, Huang T, Hu Y, Sang N, Zhao Y. Recent progress in treatment of hepatocellular carcinoma. Am J Cancer Res 2020; 10:2993-3036. [PMID: 33042631 PMCID: PMC7539784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. In the past decade, there have been improvements in non-drug therapies and drug therapies for HCC treatment. Non-drug therapies include hepatic resection, liver transplantation, transarterial chemoembolization (TACE) and ablation. The former two surgical treatments are beneficial for patients with early and mid-stage HCC. As the first choice for non-surgical treatment, different TACE methods has been developed and widely used in combination therapy. Ablation has become an important alternative therapy for the treatment of small HCC or cases of unresectable surgery. Meanwhile, the drugs including small molecule targeted drugs like sorafenib and lenvatinib, monoclonal antibodies such as nivolumab are mainly used for the systematic treatment of advanced HCC. Besides strategies described above are recommended as first-line therapies due to their significant increase in mean overall survival, there are also potential drugs in clinical trials or under preclinical development. In addition, a number of potential preclinical surgical or adjuvant therapies are being studied, such as oncolytic virus, mesenchymal stem cells, biological clock, gut microbiome composition and peptide vaccine, all of which have shown different degrees of inhibition on HCC. With some potential anti-HCC drugs being reported, many promising therapeutic targets in related taxonomic signaling pathways including cell cycle, epigenetics, tyrosine kinase and so on that affect the progression of HCC have also been found. Together, the rational application of existing therapies and drugs as well as the new strategies will bring a bright future for the global cure of HCC in the coming decades.
Collapse
Affiliation(s)
- Zhiqian Chen
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
| | - Hao Xie
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
| | - Mingming Hu
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
| | - Tianyi Huang
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
| | - Yanan Hu
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
| | - Na Sang
- Cancer Center, West China Hospital, West China Medical School, and Collaborative Innovation Center for Biotherapy, Sichuan UniversityChengdu 610041, China
| | - Yinglan Zhao
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
- Cancer Center, West China Hospital, West China Medical School, and Collaborative Innovation Center for Biotherapy, Sichuan UniversityChengdu 610041, China
| |
Collapse
|
113
|
Zeng J, Lin K, Liu H, Huang Y, Guo P, Zeng Y, Zeng J, Liu J. Prognosis Factors of Young Patients Undergoing Curative Resection for Hepatitis B Virus-Related Hepatocellular Carcinoma: A Multicenter Study. Cancer Manag Res 2020; 12:6597-6606. [PMID: 32848453 PMCID: PMC7425652 DOI: 10.2147/cmar.s261368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023] Open
Abstract
Background The prognosis of young and older patients with hepatocellular carcinoma (HCC) is controversial. We aim to compare the clinicopathological features and prognosis of young (age ≤40 years) versus older patients (aged >40 years) with hepatitis B virus (HBV)-related HCC after curative resection. Methods A total of 4504 patients with HBV-related HCC who underwent curative resection were included in this study and divided into young group (n=699) and older group (n=3805). Subgroup analyses were conducted to compare. Independent risk factors were identified by Cox regression analysis. Results Young patients had better ALBI grade, lower rates of liver cirrhosis, higher rates of elevated serum AFP levels, larger tumor size, higher rates of microvascular invasion and macrovascular invasion, higher rates of Edmondson grade III–IV, lower rates of tumor capsular, more advanced AJCC TNM stages and more advanced BCLC stages than older patients (All p<0.05). Meanwhile, young patients had a worse overall survival (OS) rate (p=0.0091) and a worse recurrence-free survival (RFS) rate (p=0.045) than older patients. Multivariate analysis revealed that AFP, resection margin, tumor size, tumor capsular, and macrovascular invasion were associated with OS. The independent risk factors associated with RFS were ALB, tumor size, microvascular invasion, and macrovascular invasion. Conclusion Young patients had better liver function, more aggressive tumor characteristics, and worse prognosis than older patients. A tumor size of ≥5 cm and macrovascular invasion were associated with poor OS and RFS in young patients. If tumors could be detected at the early stage by more frequent surveillance, long-term survival can be expected in the young patients.
Collapse
Affiliation(s)
- Jianxing Zeng
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China.,The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People's Republic of China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Kongying Lin
- Southeast Big Data Institute of Hepatobiliary Health, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Huocheng Liu
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Yao Huang
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China.,The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People's Republic of China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Pengfei Guo
- Southeast Big Data Institute of Hepatobiliary Health, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Yongyi Zeng
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China.,The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People's Republic of China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Jinhua Zeng
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China.,The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People's Republic of China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Jingfeng Liu
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China.,The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People's Republic of China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, People's Republic of China
| |
Collapse
|
114
|
Latteri S, Malaguarnera G, Catania VE, La Greca G, Bertino G, Borzì AM, Drago F, Malaguarnera M. Homocysteine Serum Levels as Prognostic Marker of Hepatocellular Carcinoma with Portal Vein Thrombosis. Curr Mol Med 2020; 19:532-538. [PMID: 31187711 DOI: 10.2174/1566524019666190610120416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 04/23/2019] [Accepted: 05/17/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a common complication of endstage hepatocellular carcinoma (HCC). The aim of our study was to evaluate the role of Homocysteine (Hcy) in HCC patient with PVT. Hcy is a sulphur amino-acid involved in two pathways, trans-sulphuration and remethylation, that involve vitamins B6, B12 and folates. METHODS We recruited 54 patients with HCC and PVT, 60 patients with HCC and without PVT and 60 control subjects. We measured serum levels of Hcy, folate, vitamins B6 and B12. RESULTS The comparison between HCC patients with PVT versus HCC without PVT was shown that mean values of Hcy were 6.4 nmol/L (p<0.0073) higher, LDL cholesterol were 4.8 mg/dl (p<0.0079) lower, vitamin B6 were 4.6 nmol/L(p=0.0544) lower, vitamins B 12 were 22.1 pg/ml (p=0.0001) lower. CONCLUSION High serum levels of Hcy are an established thrombotic risk factor in the general population. We found significantly higher levels of Hcy in HCC patients with PVT versus both HCC patients without PVT and controls.
Collapse
Affiliation(s)
- Saverio Latteri
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Giulia Malaguarnera
- Department of Biomedical and Biotechnological Science, University of Catania, Catania 95123, Italy.,Research Centre "The Great Senescence", University of Catania, 95100 Catania, Italy
| | - Vito Emanuele Catania
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Gaetano La Greca
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Gaetano Bertino
- Department of Internal Medicine and Systemic Diseases, University of Catania, 95123 Catania, Italy
| | - Antonio Maria Borzì
- Research Centre "The Great Senescence", University of Catania, 95100 Catania, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Science, University of Catania, Catania 95123, Italy
| | - Michele Malaguarnera
- Department of Biomedical and Biotechnological Science, University of Catania, Catania 95123, Italy.,Research Centre "The Great Senescence", University of Catania, 95100 Catania, Italy
| |
Collapse
|
115
|
Liu YW, Yong CC, Lin CC, Wang CC, Chen CL, Cheng YF, Wang JH, Yen YH, Chen CH. Liver resection of hepatocellular carcinoma within and beyond the Barcelona Clinic Liver Cancer guideline recommendations: Results from a high-volume liver surgery center in East Asia. J Surg Oncol 2020; 122:1587-1594. [PMID: 32815189 DOI: 10.1002/jso.26183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Barcelona Clinic Liver Cancer (BCLC) guidelines were updated in 2012, and a single large hepatocellular carcinoma (HCC) more than 5 cm was regarded as BCLC stage A rather than B in the updated version. In this study, we sought to re-evaluate the outcomes of patients with HCC who underwent liver resection (LR) within (stage 0 and A) and beyond (stage B and C) the BCLC guideline recommendations of the updated BCLC staging system. METHODS This retrospective study enrolled 774 consecutive patients with naïve HCC who underwent LR from 2011 to 2018 at our institution. The overall survival (OS) and recurrence-free survival (RFS) of these patients were examined. RESULTS Of the patients, 606 had BCLC stage 0 or A HCC, and 168 had BCLC stage B or C HCC. The 5-year OS and RFS among the patients within the BCLC criteria for LR were 75.2% and 56.1%, respectively, vs 54.9% and 34.0%, respectively, among the patients beyond the BCLC criteria (P < .001). Alpha-fetoprotein more than 400 ng/mL (hazard ratio = 2.06, 95% confidence interval, 1.31-3.26, P = .002) was the only independent variable associated with recurrence among the patients beyond the BCLC criteria. CONCLUSIONS LR provided acceptable outcomes among selected patients with BCLC stage B and C HCC.
Collapse
Affiliation(s)
- Yueh-Wei Liu
- Department of Surgery, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chee-Chien Yong
- Department of Surgery, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Che Lin
- Department of Surgery, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Chi Wang
- Department of Surgery, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Department of Surgery, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Department of Diagnostic Radiology, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jing-Houng Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Hao Yen
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hung Chen
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
116
|
Liu JJ, Lee CH, Tan CH. Evaluation of non-contrast magnetic resonance imaging as an imaging surveillance tool for hepatocellular carcinoma in at-risk patients. Singapore Med J 2020; 63:203-208. [PMID: 32798363 DOI: 10.11622/smedj.2020120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION This study aimed to evaluate the potential of non-contrast enhanced magnetic resonance (MR) imaging as an imaging surveillance tool for hepatocellular carcinoma (HCC) detection in at-risk patients and to compare the performance of non-contrast MR imaging with ultrasonography (US) as a screening modality for the same. METHODS In this retrospective study, patients diagnosed with HCC between 1 January 2010 and 31 December 2015 were selected from our institution's cancer registry. Patients with MR imaging and US scanning performed within three months of the MR imaging were included. For each MR imaging, two non-contrast MR imaging sequences - T2-weighted fat-saturated sequence (T2w-FS) and diffusion-weighted imaging (DWI) - were reviewed for the presence of suspicious lesions. A non-contrast MR image was considered positive if the lesion was seen on both sequences. The performance of non-contrast MR imaging was compared to that of hepatobiliary US for the detection of HCC. RESULTS A total of 73 patients with 108 HCCs were evaluated. Sensitivity of non-contrast MR imaging for the detection of HCC using T2w-FS and DWI was 93.2%, which was significantly higher than that of US, at 79.5% (p = 0.02). In a subgroup of 55 patients with imaging features of liver cirrhosis, the sensitivity of non-contrast MR imaging was 90.9%, which was also significantly higher than US, at 74.5% (p = 0.02). CONCLUSION Our pilot study showed that non-contrast MR imaging, using a combination of T2w-FS and DWI, is a potential alternative to US as a screening tool for the surveillance of patients at risk for HCC.
Collapse
Affiliation(s)
- JingKai Joel Liu
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Chau Hung Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
117
|
Mao X, Guo Y, Lu Z, Wen F, Liang H, Sun W. Enhanced CT Textures Derived From Computer Mathematic Distribution Analysis Enables Arterial Enhancement Fraction Being an Imaging Biomarker Option of Hepatocellular Carcinoma. Front Oncol 2020; 10:1337. [PMID: 32850426 PMCID: PMC7431458 DOI: 10.3389/fonc.2020.01337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose: This study aims to explore the imaging–clinic relationship and an optional imaging biomarker of hepatocellular carcinoma (HCC) by using texture analysis on arterial enhancement fraction (AEF). Materials and Methods: The HCC patients treated in No. 2 Interventional Ward, ShengJing Hospital of China Medical University from June 2018 to June 2019 were enrolled, for whom tri-phasic enhanced CT scans were acquired. Perfusion analysis and texture analysis were then performed on the tri-phasic enhanced CT images. After the region of interest (ROI) of viable HCC was drawn, 13 AEF textures describing the values distribution were conducted. A between-groups comparison of AEF textures was made where the cases had grouping properties, a correlation analysis was made between AEF textures and alpha-fetoprotein (AFP) as well as other clinical data which were digital, and regression analysis was made when a significant correlation was found. SPSS 19.0 (IBM) was utilized for statistical analysis; a significant difference was considered when P < 0.05. Results: Twenty-five HCC patients were enrolled. Several AEF textures were found to have a correlation with clinical features, including previous surgery history, age, glutamic oxaloacetylase, indirect bilirubin, creatinine, and AFP. The majority of AEF textures (up to 9/13) were found to have a correlation with AFP (SD, variance, uniformity, energy, entropy, inertia, correlation, inverse difference moment, and cluster prominence), while six or seven textures have a linear or cubic relationship with AFP (SD, variance, uniformity, inertia, correlation, cluster prominence, plus inverse difference moment). Conclusion: The AEF textures of HCC are strongly correlated with and are impacted by AFP, which may enable AEF to act as an optional imaging biomarker of HCC.
Collapse
Affiliation(s)
- Xiaonan Mao
- Department of Radiology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Yan Guo
- GE Healthcare, Shanghai, China
| | - Zaiming Lu
- Department of Radiology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Feng Wen
- Department of Radiology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Hongyuan Liang
- Department of Radiology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Radiology, ShengJing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
118
|
Shinkawa H, Tanaka S, Takemura S, Amano R, Kimura K, Kinoshita M, Miyazaki T, Kubo S. Prognostic value of expanded liver transplantation criteria-the 5-5-500 rule-in patients with hepatic resection for intermediate-stage hepatocellular carcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:682-689. [PMID: 32578373 DOI: 10.1002/jhbp.792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study aimed to evaluate the prognostic impact of the 5-5-500 rule in patients after hepatic resection for the intermediate stage of hepatocellular carcinoma (HCC; The Barcelona Clinic Liver Cancer classification [BCLC] B). METHODS 177 patients had hepatic resection for BCLC-B HCC. The 5-5-500 rule was defined by tumor size ≤5 cm in diameter, tumor number ≤5, and α-fetoprotein ≤500 ng/mL. RESULTS The 3-, 5-, and 7-year recurrence-free survival rates were 22%, 14%, and 11% in patients within the 5-5-500 rule, and 16%, 10%, and 10% in patients beyond the 5-5-500 rule, respectively (P = .015). The 3-, 5-, and 7-year overall survival rates were 72%, 47%, and 34% in patients within the 5-5-500 rule, and 52%, 31%, and 25% in patients beyond the 5-5-500 rule, respectively (P = .035). Being beyond the 5-5-500 rule and liver cirrhosis were independent prognostic factors for recurrence-free survival. For overall survival, being beyond the 5-5-500 rule, age ≥65 years, Child-Pugh class B, and anti-hepatitis C antibody positive were identified as independent prognostic factors. CONCLUSIONS The 5-5-500 rule could predict prognosis in BCLC-B patients with hepatic resection. Hepatic resection might provide survival benefit for selected patients with BCLC-B HCC within the 5-5-500 rule.
Collapse
Affiliation(s)
- Hiroji Shinkawa
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, 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
| | - Ryosuke Amano
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenjiro Kimura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Kinoshita
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toru Miyazaki
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
119
|
Wu Y, Qi H, Cao F, Shen L, Chen S, Xie L, Huang T, Song Z, Zhou D, Fan W. TACE-Sorafenib With Thermal Ablation Has Survival Benefits in Patients With Huge Unresectable Hepatocellular Carcinoma. Front Pharmacol 2020; 11:1130. [PMID: 32903854 PMCID: PMC7438914 DOI: 10.3389/fphar.2020.01130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose To investigate the effectiveness and safety of transarterial chemoembolization (TACE) combined with sorafenib and thermal ablation in patients with huge hepatocellular carcinoma (HCC). Materials and Methods This retrospective study examined 50 patients with huge unresectable HCC treated from January 2009 to December 2015. Among them, 28 cases received TACE-sorafenib treatment (TACE-sorafenib group), and 22 cases received TACE-sorafenib plus thermal ablation treatment (TACE-sorafenib-thermal ablation group). The Overall survival (OS), progression-free survival (PFS), and adverse events (AEs) were compared. Results The median follow-up was 13.5 months (ranges 4.2 to 96.7 months). The median OS was significantly longer in the TACE-sorafenib-thermal ablation group than that in the TACE-sorafenib group (20.8 vs. 10.4 months, P=0.003). The median PFS of the ablation and no ablation groups were 4.3 vs. 7.1 months (P=0.546). The treatment modality was an independent predictor of OS (P=0.004). There were no notable drug-related high grade adverse events or permanent adverse sequelae. Conclusion TACE-sorafenib-thermal ablation provided extended OS to patients with huge unresectable HCC and could be a better choice than TACE-sorafenib.
Collapse
Affiliation(s)
- Ying Wu
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Han Qi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fei Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuanggang Chen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lin Xie
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tao Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ze Song
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Danyang Zhou
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
120
|
Kadomoto S, Izumi K, Mizokami A. The CCL20-CCR6 Axis in Cancer Progression. Int J Mol Sci 2020; 21:ijms21155186. [PMID: 32707869 PMCID: PMC7432448 DOI: 10.3390/ijms21155186] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022] Open
Abstract
Chemokines, which are basic proteins that exert their effects via G protein-coupled receptors and a subset of the cytokine family, are mediators deeply involved in leukocyte migration during an inflammatory reaction. Chemokine (C-C motif) ligand 20 (CCL20), also known as macrophage inflammatory protein (MIP)-3α, liver activation regulated chemokine (LARC), and Exodus-1, is a small protein that is physiologically expressed in the liver, colon, and skin, is involved in tissue inflammation and homeostasis, and has a specific receptor C-C chemokine receptor 6 (CCR6). The CCL20-CCR6 axis has long been known to be involved in inflammatory and infectious diseases, such as rheumatoid arthritis and human immunodeficiency virus infections. Recently, however, reports have shown that the CCL20-CCR6 axis is associated with several cancers, including hepatocellular carcinoma, colorectal cancer, breast cancer, pancreatic cancer, cervical cancer, and kidney cancer. The CCL20-CCR6 axis promotes cancer progression directly by enhancing migration and proliferation of cancer cells and indirectly by remodeling the tumor microenvironment through immune cell control. The present article reviewed the role of the CCL20-CCR6 axis in cancer progression and its potential as a therapeutic target.
Collapse
Affiliation(s)
| | - Kouji Izumi
- Correspondence: ; Tel.: +81-76-265-2393; Fax: +81-76-234-4263
| | | |
Collapse
|
121
|
Huang JY, Li JW, Ling WW, Li T, Luo Y, Liu JB, Lu Q. Can contrast enhanced ultrasound differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma? World J Gastroenterol 2020; 26:3938-3951. [PMID: 32774068 PMCID: PMC7385563 DOI: 10.3748/wjg.v26.i27.3938] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/09/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) differ in treatment and prognosis, warranting an effective differential diagnosis between them. The LR-M category in the contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) was set up for lesions that are malignant but not specific to HCC. However, a substantial number of HCC cases in this category elevated the diagnostic challenge.
AIM To investigate the possibility and efficacy of differentiating ICC from HCC classified in the LR-M category according to the CEUS LI-RADS.
METHODS Patients with complete CEUS records together with pathologically confirmed ICC and LR-M HCC (HCC classified in the CEUS LI-RADS LR-M category) between January 2015 and October 2018 were included in this retrospective study. Each ICC was assigned a category as per the CEUS LI-RADS. The enhancement pattern, washout timing, and washout degree between the ICC and LR-M HCC were compared using the χ2 test. Logistic regression analysis was used for prediction of ICC. Receiver operating characteristic (ROC) curve analysis was used to investigate the possibility of LR-M criteria and serum tumor markers in differentiating ICC from LR-M HCC.
RESULTS A total of 228 nodules (99 ICCs and 129 LR-M HCCs) in 228 patients were included. The mean sizes of ICC and LR-M HCC were 6.3 ± 2.8 cm and 5.5 ± 3.5 cm, respectively (P = 0.03). Peripheral rim-like arterial phase hyperenhancement (APHE) was detected in 50.5% (50/99) of ICCs vs 16.3% (21/129) of LR-M HCCs (P < 0.001). Early washout was found in 93.4% (93/99) of ICCs vs 96.1% (124/129) of LR-M HCCs (P > 0.05). Marked washout was observed in 23.2% (23/99) of ICCs and 7.8% (10/129) of LR-M HCCs (P = 0.002), while this feature did not show up alone either in ICC or LR-M HCC. Homogeneous hyperenhancement was detected in 15.2% (15/99) of ICCs and 37.2% (48/129) of LR-M HCCs (P < 0.001). The logistic regression showed that rim APHE, carbohydrate antigen 19-9 (CA 19-9), and alpha fetoprotein (AFP) had significant correlations with ICC (r = 1.251, 3.074, and -2.767, respectively; P < 0.01). Rim APHE presented the best enhancement pattern for diagnosing ICC, with an area under the ROC curve (AUC) of 0.70, sensitivity of 70.4%, and specificity of 68.8%. When rim hyperenhancement was coupled with elevated CA 19-9 and normal AFP, the AUC and sensitivity improved to 0.82 and 100%, respectively, with specificity decreasing to 63.9%.
CONCLUSION Rim APHE is a key predictor for differentiating ICC from LR-M HCC. Rim APHE plus elevated CA 19-9 and normal AFP is a strong predictor of ICC rather than LR-M HCC. Early washout and marked washout have limited value for the differentiation between the two entities.
Collapse
Affiliation(s)
- Jia-Yan Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Wu Li
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wen-Wu Ling
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tao Li
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan Luo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Qiang Lu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
122
|
Attia F, Fathy S, Anani M, Hassan A, Attia F, Ibrahim G, Elazab M. Human equilibrative nucleoside transporter-1 and deoxycytidine kinase can predict gemcitabine effectiveness in Egyptian patients with Hepatocellular carcinoma. J Clin Lab Anal 2020; 34:e23457. [PMID: 32671914 PMCID: PMC7676182 DOI: 10.1002/jcla.23457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 01/30/2023] Open
Abstract
Background Several biomarkers of gemcitabine effectiveness have been studied in cancers, but less so in hepatocellular carcinoma (HCC), which is identified as the fifth most common cancer worldwide. Investigation of human equilibrative nucleoside transporter‐1 (HENT‐1) and deoxycytidine kinase (DCK), genes involved in gemcitabine uptake and metabolism, can be beneficial in the selection of potential cancer patients who could be responding to the treatment. Aim To study HENT‐1 and DCK gene expression in HCC patients with different protocols of treatment. Methods Using real‐time PCR, we analyzed expression levels of HENT‐1 and DCK genes from peripheral blood samples of 109 patients (20 controls & 89 HCC patients) between March 2015 and March 2017. All the 89 HCC patients received the antioxidants selenium (Se) and vitamin E (Vit.E) either alone (45 patients) or in combination with gemcitabine (24 patients) or radiofrequency ablation (RFA) (20 patients). Results There was a significant increase in HENT‐1 expression levels in HCC patients treated with Se and Vit.E alone as compared to controls (P ˂ .0001), while there was no significant difference between HCC patients treated with gemcitabine or RFA as compared to controls. In contrast, expression of DCK was significantly increased in all groups of HCC patients as compared to controls (P ˂ .0001). Conclusions HENT‐1 and DCK mRNA expressions are important markers of HCC and for GEM effect and GEM sensitivity in patients with HCC. This could be beneficial in the selection of HCC patients sensitive to gemcitabine to avoid subjecting resistant patients to unnecessary chemotherapy.
Collapse
Affiliation(s)
- Fadia Attia
- Departments of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Sara Fathy
- Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Maha Anani
- Departments of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Adel Hassan
- Infectious and Endemic Disease Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Fawzy Attia
- Internal Medicine Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Gehan Ibrahim
- Departments of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mona Elazab
- Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| |
Collapse
|
123
|
Nomura A, Ishigami M, Honda T, Kuzuya T, Ishizu Y, Ito T, Kamei H, Onishi Y, Ogura Y, Fujishiro M. Limitation of non-transplant treatment and proper timing for liver transplantation in patients with hepatocellular carcinoma considering long-term survival. Medicine (Baltimore) 2020; 99:e21161. [PMID: 32664152 PMCID: PMC7360274 DOI: 10.1097/md.0000000000021161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In this study, we investigated the long-term survival of patients with hepatocellular carcinoma (HCC) after conventional treatment other than liver transplantation (LT) in our institute and discuss the limitation of non-transplant treatment for HCC and the proper indictors of LT in the recent comprehensive era.Between 2003 and 2016, 181 patients with HCC aged ≦70 years received active treatment including liver resection, radiofrequency ablation (RFA), and transcatheter arterial chemoembolization (TACE). We analyzed the factors associated with overall survival and proposed new priority for the indicators of LT in HCC patients according to the extracted factors by comparing the survival with 39 transplanted patients with HCC.Child-Turcotte-Pugh (CTP) score (HR: 1.276; 95% CI: 1.049-1.552, P = .015), and number of tumors (HR: 1.238; 95% CI: 1.112-1.377, P < .001) were selected as significant factors associated with the survival after active treatments for HCC. Patients with LT had significantly better long-term survival compared with those with non-transplant patients regardless of aforementioned factors. However, regarding relatively short survival (3 years), patients with CTP score of ≧9 and/or ≧3 tumors with non-transplant treatment had poorer survival compared with those of transplanted patients (P < .05).We propose that CTP score of 9 and/or 3 tumors before non-transplant, intensive treatment might be a new priority for considering indicators of LT in patients with HCC.
Collapse
Affiliation(s)
- Aya Nomura
- Department of Gastroenterology and Hepatology
| | | | | | | | - Yoji Ishizu
- Department of Gastroenterology and Hepatology
| | | | - Hideya Kamei
- Department of Transplant Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Yasuharu Onishi
- Department of Transplant Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Yasuhiro Ogura
- Department of Transplant Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | | |
Collapse
|
124
|
Jasirwan COM, Fahira A, Siregar L, Loho I. The alpha-fetoprotein serum is still reliable as a biomarker for the surveillance of hepatocellular carcinoma in Indonesia. BMC Gastroenterol 2020; 20:215. [PMID: 32646378 PMCID: PMC7346661 DOI: 10.1186/s12876-020-01365-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/02/2020] [Indexed: 02/08/2023] Open
Abstract
Background and aims Hepatocellular carcinoma (HCC), the most common type of liver cancer, is one of the leading causes of cancer-related death worldwide with an inferior prognosis. In Indonesia, the average life expectancy is less than 5 months, with most patients being in an advanced stage wherein the survival rate is very low. Early detection through surveillance program is very crucial. HCC guidelines worldwide have provided surveillance recommendation through the examination of α-fetoprotein (AFP) and ultrasound for patients at risk in developing HCC. However, there have been some controversies regarding the usage of AFP concerning its low sensitivity and specificity in detecting HCC. Therefore, the effectiveness of AFP in the surveillance of HCC patients and identifying the parameters most associated with the increase of AFP ≥ 10 ng/ml in Indonesia should be evaluated. Methods We analyzed medical records of HCC patients and those at high risk of developing HCC through cross-sectional study, including patients with cirrhosis and hepatitis B and C, from 2015 to 2017 who underwent treatment at the Cipto Mangunkusumo National General Hospital and Dharmais National Cancer Hospital, Indonesia. Results The sensitivity and specificity of AFP in the surveillance of HCC in Indonesia with a cut-off of 10 ng/ml were 82.6 and 71.2%, respectively. The parameters most associated with the increase of AFP ≥10 ng/ml according to multivariate analysis were the etiology of hepatitis B, the stage of Barcelona Clinic Liver Cancer (BCLC) B and C, and the presence of cirrhosis, respectively. Conclusion AFP can still be used in the surveillance of HCC in Indonesia for its high sensitivity value.
Collapse
Affiliation(s)
- Chyntia Olivia Maurine Jasirwan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
| | - Alessa Fahira
- Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Lianda Siregar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dharmais National Cancer Hospital, Jakarta, Indonesia
| | - Imelda Loho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dharmais National Cancer Hospital, Jakarta, Indonesia
| |
Collapse
|
125
|
Liu BJ, Gao S, Zhu X, Guo JH, Zhang X, Chen H, Wang XD, Yang RJ. Sorafenib combined with embolization plus hepatic arterial infusion chemotherapy for inoperable hepatocellular carcinoma. World J Gastrointest Oncol 2020; 12:663-676. [PMID: 32699581 PMCID: PMC7341000 DOI: 10.4251/wjgo.v12.i6.663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/08/2020] [Accepted: 05/27/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is little evidence of combining sorafenib with hepatic arterial infusion chemotherapy (HAIC) after transarterial chemoembolization (TACE) for intermediate and advanced hepatocellular carcinoma (HCC). It is important to identify that patients with intermediate and advanced HCC are most likely to benefit from this combination therapy. AIM To investigate the safety and clinical outcomes of sorafenib combined with HAIC with folinic acid, 5-fluorouracil (5-FU), and oxaliplatin (FOLFOX) after TACE for intermediate and advanced HCC. METHODS This prospective phase II study enrolled patients with intermediate and advanced HCC who underwent treatment with sorafenib combined with TACE-HAIC. All patients initially received the standard 400 mg dose of sorafenib twice daily before TACE-HAIC. Participants at our institute with intermediate and advanced HCC underwent routine TACE. Then, the catheter used for embolization was kept in place in the hepatic artery, and oxaliplatin was intra-arterially administered for 6 h, followed by 5-FU for 18 h, and folinic acid was intravenously administered for 2 h. The primary endpoints were safety, as evaluated by the Common Terminology and Criteria for Adverse Events version 4.0, and 12-mo progression-free survival (PFS), as analyzed by the Kaplan-Meier method. As secondary endpoints, the objective response rate (ORR) was evaluated by the modified Response Evaluation Criteria for Solid Tumors, and survival time [overall survival (OS)] was analyzed by the Kaplan-Meier method. RESULTS Sixty-six participants at our institute with intermediate and advanced HCC were enrolled in this prospective study (mean age, 53.3 ± 11.7 years). Approximately 56.1% of participants had Barcelona Clinic Liver Cancer (BCLC) stage C disease, and 43.9% had BCLC stage B disease. The ORR was 42.4%. The disease control rate was 87.9%. The grade 3-4 toxicities consisted of thrombocytopenia (4.5%), neutropenia (3.0%), and elevated aspartate aminotransferase (12.2%). Hand-foot skin reaction was also observed (40.9%). The median PFS was 13.1 mo (13.5 mo in the BCLC stage B participants and 9.4 mo in the BCLC stage C participants). The 6-mo, 12-mo, and 24-mo PFS rates were 75.0%, 54.7%, and 30.0%, respectively. The median OS was 21.8 mo. CONCLUSION Sorafenib combined with HAIC (FOLFOX) after TACE may be a feasible treatment choice for intermediate and advanced HCC because this treatment met the prespecified endpoint of a 6-mo PFS rate exceeding 50% and had good patient tolerance. Prospective randomized controlled trials are needed to confirm the effect of this combination therapy.
Collapse
Affiliation(s)
- Bao-Jiang Liu
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
| | - Song Gao
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
| | - Xu Zhu
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
| | - Jian-Hai Guo
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
| | - Xin Zhang
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
| | - Hui Chen
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
| | - Xiao-Dong Wang
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
| | - Ren-Jie Yang
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
| |
Collapse
|
126
|
Cong M, Ou X, Huang J, Long J, Li T, Liu X, Wang Y, Wu X, Zhou J, Sun Y, Shang Q, Chen G, Ma H, Xie W, Piao H, Yang Y, Gao Z, Xu X, Tan Z, Chen C, Zeng N, Wu S, Kong Y, Liu T, Wang P, You H, Jia J, Zhuang H. A Predictive Model Using N-Glycan Biosignatures for Clinical Diagnosis of Early Hepatocellular Carcinoma Related to Hepatitis B Virus. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2020; 24:415-423. [PMID: 32522092 DOI: 10.1089/omi.2020.0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Early diagnosis of hepatic cancer is a major public health challenge. While changes in serum N-glycans have been observed as patients progress from liver fibrosis/cirrhosis to hepatocellular carcinoma (HCC), the predictive performance of N-glycans is yet to be determined for HCC early diagnosis as well as differential diagnosis from liver fibrosis/cirrhosis. In a total sample of 247 patients with hepatitis B virus-related liver disease, we characterized and compared the serum N-glycans in very early/early and intermediate/advanced stages of HCC and those with liver fibrosis/cirrhosis. Additionally, we performed a retrospective timeline analysis of the serum N-glycans 6 and 12 months before a diagnosis of the very early/early stage of HCC (EHCC). A predictive model was built, named hereafter as Glycomics-EHCC, incorporating the glycan peaks (GPs) 1, 2, and 4. The model showed a larger area under the receiver operating characteristic curve compared with a traditional model with the α-fetoprotein (0.936 vs. 0.731, respectively). The Glycomics-EHCC model had a sensitivity of 84.6% and specificity of 85.0% at a cutoff value of -0.39 to distinguish EHCC from liver fibrosis/cirrhosis. Moreover, the Glycomics-EHCC model was able to forecast a future EHCC diagnosis with a sensitivity and specificity over 90% and 85%, respectively, using the serum N-glycan biosignatures 6 or 12 months earlier when the patients were suffering from liver fibrosis/cirrhosis before being diagnosed with EHCC. This serum glycomic biosignature model warrants further clinical studies in independent population samples and offers promise to forecast EHCC and its differential diagnosis from liver fibrosis/cirrhosis.
Collapse
Affiliation(s)
- Min Cong
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.,Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Xiaojuan Ou
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Jian Huang
- Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiang Long
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Li
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Xueen Liu
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Yanhong Wang
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Xiaoning Wu
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Jialing Zhou
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Yameng Sun
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Qinghua Shang
- Department of Liver Diseases, The No. 88 Hospital of the People's Liberation Army, Taian, China
| | - Guofeng Chen
- Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Military Hospital of China, Beijing, China
| | - Hui Ma
- Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
| | - Wen Xie
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxin Piao
- Department of Infectious Diseases, Affiliated Hospital of Yanbian University, Yanji, China
| | - Yongping Yang
- Center of Therapeutic Research for Liver Cancer, Beijing 302 Hospital, Beijing, China
| | - Zhiliang Gao
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyuan Xu
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | | | | | - Na Zeng
- Clinical Epidemiology and Evidence-Based Medicine Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shanshan Wu
- Clinical Epidemiology and Evidence-Based Medicine Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuanyuan Kong
- Clinical Epidemiology and Evidence-Based Medicine Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Tianhui Liu
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Ping Wang
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Hong You
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Hui Zhuang
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| |
Collapse
|
127
|
Bae JS, Lee JM, Yoon JH, Jang S, Chung JW, Lee KB, Yi NJ, Lee JH. How to Best Detect Portal Vein Tumor Thrombosis in Patients with Hepatocellular Carcinoma Meeting the Milan Criteria: Gadoxetic Acid-Enhanced MRI versus Contrast-Enhanced CT. Liver Cancer 2020; 9:293-307. [PMID: 32647632 PMCID: PMC7325130 DOI: 10.1159/000505191] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/03/2019] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The detection of portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) meeting the Milan criteria is of critical importance as PVTT is known to be a contraindication to transplantation and an indicator of a dismal prognosis. OBJECTIVE To determine which modality may best detect PVTT, we compared the diagnostic performance of gadoxetic acid-enhanced MRI (GA-MRI) and contrast-enhanced CT (CECT) in HCC patients meeting the Milan criteria. METHODS We retrospectively enrolled 310 patients with HCCs meeting the Milan criteria who underwent both GA-MRI and CECT between June 2007 and May 2017. Among them, 44 patients were demonstrated to have PVTT while 266 patients had no PVTT. Two radiologists then assessed GA-MRI and CECT images for the presence of PVTT on a 5-point scale as well as vessel expansion, continuity with tumors, and enhancement on both modalities, as well as T2 hyperintensity and diffusion restriction on GA-MRI. The McNemar test was used to compare sensitivity and specificity of GA-MRI and CECT for the detection of PVTT, and Fisher's exact test was used to compare their imaging features. RESULTS GA-MRI showed higher sensitivity values than CECT in detecting PVTT (reviewer 1, 93.2% [41/44] vs. 77.3% [34/44]; reviewer 2, 88.6% [39/44] vs. 70.5% [31/44]) (both p = 0.039). Specificity of GA-MRI and CECT demonstrated no difference (reviewer 1, 95.5% [254/266] vs. 95.1% [253/266]; reviewer 2, 97.0% [258/266] vs. 97.4% [259/266]) (both p > 0.999). Continuity with tumors and enhancement were more frequently observed on GA-MRI than on CECT (p < 0.050, both reviewers). CONCLUSION GA-MRI detected PVTT more often than CECT in HCC patients meeting the Milan criteria and better depicted PVTT in continuity with tumors and those showing enhancement than CECT.
Collapse
Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea,*Jeong Min Lee, Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080 (Republic of Korea), E-Mail
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Siwon Jang
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Kyung Bun Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
128
|
Akbar N, Nasir M, Naeem N, Ahmad M, Saeed F, Anjum FM, Iqbal S, Imran M, Tufail T, Shah F, Atif M. Assessment of aflatoxin in milk and feed samples and impact of seasonal variations in the Punjab, Pakistan. Food Sci Nutr 2020; 8:2699-2709. [PMID: 32566187 PMCID: PMC7300088 DOI: 10.1002/fsn3.1557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/14/2023] Open
Abstract
The present study was designed to assess the incidence of aflatoxin contamination in animal feed and raw milk samples (total 240 each) collected from dairy farms during the complete year of 2015. These samples were collected through a cluster random sampling technique by dividing the province of Punjab, Pakistan into five clusters (north, south, east, west and central). Factors (environmental & physical) affecting aflatoxin contamination in milk and animal feed at farms were also studied. The AFM1 levels in raw milk & AFB1 levels in feed samples were analyzed by using the ELISA technique. Results demonstrated that overall about 53% raw milk samples from dairy farms were contaminated beyond the US MRL (0.50 µg/L) for AFM1 with than average level of 0.59 µg/L, while the 95% farm feed samples were exceeding the FDA MRL (20 µg/kg) of AFB1 with average level of 43 µg/kg. During winter season, the concentration of AFM1 was higher in all clusters with avg 0.68 µg/L, while the AFB1 contamination was highest in the spring season with avg 54 µg/kg. Market feed prices had negative correlation with AFB1 contamilevels, which were further supported by the positive correlation between quantity of feed at farms with AFM1 and AFB1 contamination. Results exhibited significantly positive impact of environmental factors on milk and feed aflatoxin contamination levels, whereas temperature showed an inverse relationship with AFM1 and AFB1 levels. The study recommends need of synergistic extension work to support dairy farms and highlight the contamination levels for regulatory bodies to introduce strategic policies for control measures.
Collapse
Affiliation(s)
- Naveed Akbar
- Department of Food Science and Human NutritionUniversity of Veterinary and Animal SciencesLahorePakistan
| | - Muhammad Nasir
- Department of Food Science and Human NutritionUniversity of Veterinary and Animal SciencesLahorePakistan
| | - Naureen Naeem
- Department of Food Science and Human NutritionUniversity of Veterinary and Animal SciencesLahorePakistan
| | - Mansur‐ud‐Din Ahmad
- Department of Epidemiology and Public HealthUniversity of Veterinary and Animal SciencesLahorePakistan
| | - Farhan Saeed
- Institute of Home and Food SciencesGovernment College UniversityFaisalabadPakistan
| | | | - Sanaullah Iqbal
- Department of Food Science and Human NutritionUniversity of Veterinary and Animal SciencesLahorePakistan
| | - Muhammad Imran
- University Institute of Diet and Nutritional SciencesFaculty of Allied Health SciencesThe University of LahoreLahorePakistan
| | - Tabussam Tufail
- University Institute of Diet and Nutritional SciencesFaculty of Allied Health SciencesThe University of LahoreLahorePakistan
| | - Faiz‐ul‐Hassan Shah
- University Institute of Diet and Nutritional SciencesFaculty of Allied Health SciencesThe University of LahoreLahorePakistan
| | - Muhammad Atif
- Department of Clinical Laboratory SciencesCollege of Applied Medical SciencesJouf UniversityKingdom of Saudi ArabiaSakaka
| |
Collapse
|
129
|
Huang Y, Zeng J, Liu T, Lin X, Guo P, Zeng J, Zhou W, Liu J. Prognostic Significance of Elevated Preoperative Serum CA125 Levels After Curative Hepatectomy for Hepatocellular Carcinoma. Onco Targets Ther 2020; 13:4559-4567. [PMID: 32547086 PMCID: PMC7250700 DOI: 10.2147/ott.s236475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/07/2020] [Indexed: 12/22/2022] Open
Abstract
Objective The aim of this study was to investigate predictive and prognostic significance of elevated carbohydrate antigen 125 (CA125) serum level preoperatively. Methods A total of 3440 HCC patients were retrospectively enrolled into this study, and all of them underwent curative hepatectomy. The clinical and pathological variables together with CA125, AFP serum level were collected at diagnosis and postoperative care stages. A chi-square test was used to compare the differences between variables. Overall survival (OS) and recurrence-free survival (RFS) were measured with the Kaplan-Meier method. To estimate prognostic factors, a multivariate Cox regression analysis was performed. Results Of the 3440 enrolled patients, 409 (11.9%) exhibited elevated preoperative serum CA125 level, and high preoperative serum CA125 level was significantly associated with younger age, female, higher ALBI grade, higher serum AFP level, blood transfusion, more operative bleeding loss, larger tumor size, multiple tumor, increased macro- or micro-vascular invasion, Edmondson grade III-IV, absence of tumor capsular, satellite nodules, liver cirrhosis, more advanced TNM stages and BCLC stages. HCC patients with high preoperative serum CA125 level usually had a shorter OS rate and experienced a higher probability of recurrence than those with normal preoperative serum level of CA125 (p<0.0001). The multivariate analysis suggested that elevated serum CA125 level serves as an independent predictor of OS and RFS in HCC patients after surgical resection. Conclusion Elevated preoperative serum CA125 correlated with many malignant characterizations of HCC and served as an independent prognostic factor of OS and RFS.
Collapse
Affiliation(s)
- Yao Huang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People's Republic of China.,Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Jianxing Zeng
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China.,Southeast Big Data Institute of Hepatobiliary Health, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Teng Liu
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Xinju Lin
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Pengfei Guo
- Southeast Big Data Institute of Hepatobiliary Health, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Jinhua Zeng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People's Republic of China.,Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Weiping Zhou
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, People's Republic of China
| | - Jingfeng Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People's Republic of China.,Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, People's Republic of China.,Southeast Big Data Institute of Hepatobiliary Health, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People's Republic of China
| |
Collapse
|
130
|
Mei J, Li SH, Wang QX, Lu LH, Ling YH, Zou JW, Lin WP, Wen YH, Wei W, Guo RP. Resection vs. Sorafenib for Hepatocellular Carcinoma With Macroscopic Vascular Invasion: A Real World, Propensity Score Matched Analytic Study. Front Oncol 2020; 10:573. [PMID: 32432036 PMCID: PMC7214621 DOI: 10.3389/fonc.2020.00573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Macroscopic vascular invasion (MVI) commonly occurs in patients with advanced hepatocellular carcinoma (HCC) for which resection and sorafenib are the common therapies prescribed. Here, we aimed to compare the survival outcomes of these two therapies in HCC patients with MVI. Methods: In total, 496 patients diagnosed with HCC and MVI without extrahepatic metastasis, treated with resection (resection-based group, n = 388) and sorafenib (sorafenib-based group, n = 108) were included in this study. A one-to-one propensity score-matching analysis (PSM) was performed to minimize the effect of potential confounders. Results: The median OS in the resection- and sorafenib-based group was 20.7 months (95% CI: 16.9-24.5) and 11.6 months (95% CI: 8.4-14.9) (p < 0.001), respectively. The median PFS was 4.7 months (95% CI: 3.8-5.5) in the resection-based group and 4.4 months (95% CI: 3.6-5.2) in the sorafenib-based group (p < 0.001). After PSM, 72 patients from each group were matched. The median OS was 27.2 months (95% CI: 16.4-38.0) in the resection-based group and 13.0 months (95% CI: 9.6-16.3) in the sorafenib-based group (p < 0.001). The median PFS was 5.3 months (95% CI: 3.2-7.4) in the resection-based group and 4.8 months (95% CI: 3.6-6.0) in the sorafenib-based group (p = 0.061). Conclusion: Findings from this study showed that, compared with sorafenib-based treatment, surgical resection might be associated with better survival benefits to HCC patients with MVI.
Collapse
Affiliation(s)
- Jie Mei
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shao-Hua Li
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qiao-Xuan Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Liang-He Lu
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yi-Hong Ling
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing-Wen Zou
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wen-Ping Lin
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yu-Hua Wen
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wei Wei
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Rong-Ping Guo
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| |
Collapse
|
131
|
Tian H, Cao S, Hu M, Wang Y, Fu Q, Pan Y, Qin T. Identification of predictive factors in hepatocellular carcinoma outcome: A longitudinal study. Oncol Lett 2020; 20:765-773. [PMID: 32566003 PMCID: PMC7285798 DOI: 10.3892/ol.2020.11581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/19/2020] [Indexed: 12/24/2022] Open
Abstract
Various surgical methods impact the prognosis of patients with hepatocellular carcinoma (HCC) differently. However, clinical guidelines remain inconsistent and the relative importance of predictors of survival outcomes requires further evaluation. The present study aimed to rank the importance of predictive factors that impact the survival outcomes of patients with HCC and to compare the prognosis associated with different surgical methods based on data obtained from the Surveillance, Epidemiology and End Results database. To achieve these aims, the present study used a random forest (RF) model to detect important predictive factors associated with survival outcomes in patients with HCC. Cox regression analysis was used to compare different surgery methods. The variables included in the Cox regression model were selected based on the Gini index calculated by the RF model. Using the RF model, the present study demonstrated that surgery method, tumor size and age were the first, second and third most important factors associated with HCC prognosis, respectively. Overall, patients who underwent local tumor destruction [(hazard ratio (HR)=0.48; 95% confidence interval (CI), 0.45–0.51; P<0.001)], wedge or segmental resection (HR, 0.31; 95% CI, 0.29–0.33; P<0.001), lobectomy (HR, 0.29, 95% CI, 0.27–0.31; P<0.001) or liver transplantation (HR, 0.16; 95% CI, 0.14–0.17; P<0.001) demonstrated improved overall survival time compared with those treated with surgery, with a gradual decreasing trend observed in HRs. The present study demonstrated that the surgical method used is the most important predictor of the survival outcomes of patients with HCC. Liver transplantation resulted in the best prognosis for patients with HCC, except for those with undifferentiated tumors or distant metastasis.
Collapse
Affiliation(s)
- Huiyuan Tian
- Department of Research and Discipline Development, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Shaofeng Cao
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Mingxing Hu
- Department of Hepatobiliary and Pancreatic Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Yuzhu Wang
- Department of Hepatobiliary and Pancreatic Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Qiang Fu
- Department of Hepatobiliary and Pancreatic Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Yanfeng Pan
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Tao Qin
- Department of Hepatobiliary and Pancreatic Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, P.R. China
| |
Collapse
|
132
|
Aby ES, Winters AC, Lin J, Bui A, Kawamoto J, Goetz MB, Bhattacharya D, Pisegna JR, May FP, Patel AA, Benhammou JN. A Telephone and Mail Outreach Program Successfully Increases Uptake of Hepatocellular Carcinoma Surveillance. Hepatol Commun 2020; 4:825-833. [PMID: 32490319 PMCID: PMC7262281 DOI: 10.1002/hep4.1511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 12/13/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer‐related death worldwide. Society guidelines recommend surveillance with abdominal ultrasound with or without serum alpha‐fetoprotein every 6 months for adults at increased risk of developing HCC. However, adherence is often suboptimal. We assessed the feasibility of a coordinated telephone outreach program for unscreened patients with cirrhosis within the Veteran’s Affairs (VA) health care system. Using a patient care dashboard of advanced chronic liver disease in the VA Greater Los Angeles Healthcare System, we identified veterans with a diagnosis of cirrhosis, a platelet count ≤ 150,000/uL, and no documented HCC surveillance in the previous 8 months. Eligible veterans received a telephone call from a patient navigator to describe the risks and benefits of HCC surveillance. Orders for an abdominal ultrasound and alpha‐fetoprotein were placed for veterans who agreed to surveillance. Veterans who were not reached by telephone received an informational letter by mail to encourage participation. Of the 129 veterans who met the eligibility criteria, most were male (96.9%). The most common etiology for cirrhosis was hepatitis C (64.3%), and most of the patients had compensated cirrhosis (68.2%). The patient navigators reached 32.5% of patients by phone. Patients in each group were similar across clinical and demographic characteristics. Patients who were called were more likely to undergo surveillance (adjusted odds ratio = 2.56, 95% confidence interval: 1.03‐6.33). Most of the patients (72.1%) completed abdominal imaging when reached by phone. Conclusion: Targeted outreach increased uptake of HCC surveillance among patients with cirrhosis in a large, integrated, VA health care system.
Collapse
Affiliation(s)
- Elizabeth S Aby
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine University of California Los Angeles Los Angeles CA
| | - Adam C Winters
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine University of California Los Angeles Los Angeles CA
| | - Jonathan Lin
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine University of California Los Angeles Los Angeles CA
| | - Aileen Bui
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine University of California Los Angeles Los Angeles CA
| | - Jenna Kawamoto
- Division of Gastroenterology, Hepatology and Parenteral Nutrition VA Greater Los Angeles Healthcare System Los Angeles CA
| | - Matthew B Goetz
- Division of Infectious Diseases VA Greater Los Angeles Healthcare System Los Angeles CA.,David Geffen School of Medicine University of California Los Angeles Los Angeles CA
| | - Debika Bhattacharya
- Division of Infectious Diseases VA Greater Los Angeles Healthcare System Los Angeles CA.,Division of Infectious Diseases Department of Medicine David Geffen School of Medicine University of California Los Angeles Los Angeles CA
| | - Joseph R Pisegna
- Division of Gastroenterology, Hepatology and Parenteral Nutrition VA Greater Los Angeles Healthcare System Los Angeles CA
| | - Folasade P May
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine University of California Los Angeles Los Angeles CA.,Division of Gastroenterology, Hepatology and Parenteral Nutrition VA Greater Los Angeles Healthcare System Los Angeles CA
| | - Arpan A Patel
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine University of California Los Angeles Los Angeles CA.,Division of Gastroenterology, Hepatology and Parenteral Nutrition VA Greater Los Angeles Healthcare System Los Angeles CA
| | - Jihane N Benhammou
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine University of California Los Angeles Los Angeles CA.,Division of Gastroenterology, Hepatology and Parenteral Nutrition VA Greater Los Angeles Healthcare System Los Angeles CA
| |
Collapse
|
133
|
Duan Y, Xie X, Li Q, Mercaldo N, Samir AE, Kuang M, Lin M. Differentiation of regenerative nodule, dysplastic nodule, and small hepatocellular carcinoma in cirrhotic patients: a contrast-enhanced ultrasound-based multivariable model analysis. Eur Radiol 2020; 30:4741-4751. [PMID: 32307563 DOI: 10.1007/s00330-020-06834-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To develop a contrast-enhanced ultrasound (CEUS)-based model for differentiating cirrhotic liver lesions and for active surveillance of hepatocellular carcinoma (HCC). METHODS Patients with focal liver lesions (FLLs) with biopsy/resection-proven pathology and pre-procedure CEUS were enrolled from our institution between January 2011 and November 2014. Univariable and multivariable regression models were constructed using qualitative CEUS features and/or contrast arrival time ratio (CATR). The optimism-adjusted Harrell's generalized concordance index (CH) was used to quantify the discriminatory ability of each CEUS feature and model. RESULTS A total of 149 patients (113 men and 36 women) with 162 FLLs were enrolled with mean age 53.4 ± 12.7 years. A 0.1-unit reduction in CATR was associated with a 68% increase in the odds of having a higher nodule ranking (RN < DN < small HCC) (OR, 0.32; 95% CI, 0.20-0.50, p < .001). Arterial phase hypoenhancement and isoenhancement were inversely associated with a higher nodule ranking compared to hyperenhancement. Late-phase isoenhancement was associated with lower odds of a higher nodule ranking. The CEUS + CATR model (CH 0.92, 0.89-0.95) provided greater discriminatory ability when compared to the CATR model (ΔCH 0.09, 0.04-0.13, p < .001) and the CEUS model (ΔCH 0.03, 0.01-0.05, p = .02). CONCLUSIONS Our results provide preliminary evidence that multivariable regression model constructed using both qualitative CEUS features and CATR provides the greatest discriminatory ability to differentiate RN, DN, and small HCC in patients with cirrhosis, and might allow for active surveillance of the progression of cirrhotic liver lesions. KEY POINTS • Proportional odds logistic regression models based on qualitative CEUS features and/or CATR can be used for differentiating cirrhotic liver lesions and for active surveillance of HCC. • The reduction of CATR (RN < DN < small HCC) was strongly associated with high-risk cirrhotic liver nodules. • Inclusion of CATR in the CEUS prediction model significantly improved its performance for cirrhotic liver lesions risk-stratification.
Collapse
Affiliation(s)
- Yu Duan
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Qian Li
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Nathaniel Mercaldo
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac Street, Suite 1010, Boston, MA, 02114, USA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ming Kuang
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Manxia Lin
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China.
| |
Collapse
|
134
|
Feng D, Wang M, Hu J, Li S, Zhao S, Li H, Liu L. Prognostic value of the albumin-bilirubin grade in patients with hepatocellular carcinoma and other liver diseases. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:553. [PMID: 32411776 PMCID: PMC7214886 DOI: 10.21037/atm.2020.02.116] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
One of the most commonly used systems for grading liver function in hepatocellular carcinoma (HCC) patients is the Child-Pugh (CP) score. However, the CP scoring system is not without its shortcomings: for example, the cut-off values for the parameters are calculated arbitrarily and the assessment of ascites and hepatic encephalopathy is subjective. More recently, an alternative to traditional CP grade has emerged in the form of albumin-bilirubin (ALBI) grade. The predictive value provided for HCC patients by the ALBI grade is comparable to that of the CP grade; however, it can also surpass CP grade by greatly reducing subjectivity and further subdividing CP A patients into several different groups, thus improving the prognosis judgment and helping to inform clinicians’ optimal decision-making. The application of the ALBI grade into currently used HCC staging systems such as the Barcelona Clinic Liver Cancer (BCLC) staging system, the Cancer of the Liver Italian Program (CLIP) staging system, and the Japan Integrated Staging (JIS) score, etc., as well as newly produced systems like the ALBI-PLT grade, the ALBI and progression disease (ALBI-PD) grade and Modified Intermediate Stage of Liver Cancer (MICAN) criteria, greatly elevates prognostic power.
Collapse
Affiliation(s)
- Dayun Feng
- Department of surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Mengmeng Wang
- Department of Drug and Equipment, Aeromedicine Identification and Training Centre of Air Force, Xi'an 710069, China
| | - Jie Hu
- Department of Clinical laboratory, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Songlun Li
- Department of Blood Transfusion, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Shoujie Zhao
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Huichen Li
- The State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Lei Liu
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| |
Collapse
|
135
|
Yen YH, Cheng YF, Wang JH, Lin CC, Chen YY, Yong CC, Liu YW, Cheng JY, Chen CH, Hu TH. Real world clinical practice in treating advanced hepatocellular carcinoma: When East meets West. PLoS One 2020; 15:e0230005. [PMID: 32163475 PMCID: PMC7067409 DOI: 10.1371/journal.pone.0230005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/18/2020] [Indexed: 12/31/2022] Open
Abstract
Background and aims The Barcelona Clinic Liver Cancer (BCLC) stage C (BCLC C) of hepatocellular carcinoma (HCC) includes a heterogeneous population for which sorafeninb is one of the recommended therapies. We aim to evaluate the real world clinical treatment and survival of BCLC stage C patients in an Asian cohort. Methods This is a retrospective cohort study that enrolled 427 consecutive BCLC stage C patients diagnosed between 2011 and 2017 by using the HCC registry data for our hospital. All patients were managed via a multidisciplinary team (MDT) approach. Results Hepatitis B surface antigen positive was noted in 50.6% of the patients. The patients were classified as performance status (PS)1 alone (n = 83; 19.4%), PS2 alone (n = 23; 5.4%), or macrovascular invasion (MVI) or extrahepatic spread (EHS) (n = 321; 75.2%). The median overall survival (OS) was 11.0 months in the whole cohort. The most frequent treatments were transcatheter arterial embolization (TAE) in the PS1 (45.8%) and PS2 patients (52.2%) and sorafenib (32.4%) in the MVI or EHS patients. The independent prognostic factors were the PS, Child-Pugh class, MVI or EHS, alpha fetoprotein levels, and treatment type. Conclusions We reported the real world management in BCLC stage C patients in an Asian cohort through the use of personalized management via a MDT approach.
Collapse
Affiliation(s)
- Yi-Hao Yen
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Liver Transplantation Center, Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jing-Houng Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Che Lin
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Yang Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chee-Chien Yong
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yueh-Wei Liu
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jen-Yu Cheng
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Hung Chen
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Hui Hu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
| |
Collapse
|
136
|
The correlations between hepatitis B virus infection and hepatocellular carcinoma with portal vein tumor thrombus or extrahepatic metastasis. Eur J Gastroenterol Hepatol 2020; 32:373-377. [PMID: 31441795 DOI: 10.1097/meg.0000000000001514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Portal vein tumor thrombus (PVTT) and extrahepatic metastasis are associated with the prognosis of hepatocellular carcinoma (HCC). We aimed to investigate the effect of hepatitis B virus (HBV) infection on HCC patients with PVTT or extrahepatic metastasis. PATIENTS AND METHODS The clinical data of 639 patients with HCC from our hospital were retrospectively analyzed to analyze the correlation between HBV and HCC with PVTT or extrahepatic metastasis. RESULTS Univariate analysis revealed that positive hepatitis B virus surface antigen (HBsAg), a detectable serum hepatitis B virus DNA load (>500 IU/ml), cirrhosis and ascites were associated with the presence of PVTT. Positive hepatitis B virus e antigen (HBeAg), cirrhosis and ascites were associated with the presence of extrahepatic metastasis. In a multivariate regression analysis carried out a detectable serum hepatitis B virus DNA load, cirrhosis and ascites were independent risk factors of PVTT. Ascites was an independent risk factor of extrahepatic metastasis. The patients in the PVTT of type III/IV group and the PVTT of type I/II group had a significantly higher rate of positive serum HBsAg, a detectable serum hepatitis B virus DNA load (>500 IU/ml) and HBsAg + HBeAb + HBcAb test positive compared with those in the PVTT-negative group. HBsAg + HBeAb + HBcAb test positive was significantly associated with the presence of extrahepatic metastasis (P=0.028). CONCLUSIONS HBV infection and replication status are associated with the formation of PVTT or extrahepatic metastasis in patients with HCC.
Collapse
|
137
|
Only one-third of hepatocellular carcinoma cases are diagnosed via screening or surveillance: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2020; 32:406-419. [PMID: 31490419 DOI: 10.1097/meg.0000000000001523] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTS Early hepatocellular carcinoma diagnosis is associated with better long-term survival. Studies of at-risk patients who are monitored in routine practice have reported an overall adherence rate to hepatocellular carcinoma screening/surveillance of approximately 60% and suboptimal diagnostic efficacy of the current screening/surveillance tools. However, it is unclear how many hepatocellular carcinoma patients were actually diagnosed via screening/surveillance given these obstacles. Therefore, via a systematic review of PubMed and Scopus databases from 2000 to 2019, we aimed to identify the proportion of patients with hepatocellular carcinoma diagnosed via screening/surveillance in routine practice. METHODS We included original research articles of studies of patients already diagnosed with hepatocellular carcinoma that reported the proportion of hepatocellular carcinoma diagnosed via screening/surveillance. RESULTS The study included 60 studies and 50 554 hepatocellular carcinoma cases. The pooled proportion of hepatocellular carcinoma diagnosed by screening/surveillance was 37% (95% confidence interval: 31%-44%) and differed by geographic region (North America/Asia/Europe/Oceania/Africa/South America, 31%/42%/41%/30%/29%/47%, P = 0.017, respectively) and by surveillance interval (<12 months 39% vs. 12 months 19%, P < 0.01) but not by disease etiology, cirrhosis status, clinical setting, practice setting, hepatocellular carcinoma diagnosis period, or surveillance method. CONCLUSION Globally, hepatocellular carcinoma was diagnosed via screening/surveillance in less than half of the patients (37%) regardless of healthcare setting or liver disease etiology and without improvement over time despite several recent guideline updates. Research is needed to understand the barriers to screening/surveillance to include medical as well as social and cultural influences.
Collapse
|
138
|
The threshold of alpha-fetoprotein (AFP) for the diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis. PLoS One 2020; 15:e0228857. [PMID: 32053643 PMCID: PMC7018038 DOI: 10.1371/journal.pone.0228857] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/23/2020] [Indexed: 02/08/2023] Open
Abstract
Objective Hepatocellular carcinoma (HCC) has become a pressing health problem facing the world today due to its high morbidity, high mortality, and late discovery. As a diagnostic criteria of HCC, the exact threshold of Alpha-fetoprotein (AFP) is controversial. Therefore, this study was aimed to systematically estimate the performance of AFP in diagnosing HCC and to clarify its optimal threshold. Methods Medline and Embase databases were searched for articles indexed up to November 2019. English language studies were included if both the sensitivity and specificity of AFP in the diagnosis of HCC were provided. The basic information and accuracy data included in the studies were extracted. Combined estimates for sensitivity and specificity were statistically analyzed by random-effects model using MetaDisc 1.4 and Stata 15.0 software at the prespecified threshold of 400 ng/mL, 200 ng/mL, and the range of 20–100 ng/mL. The optimal threshold was evaluated by the area under curve (AUC) of the summary receiver operating characteristic (SROC). Results We retrieved 29,828 articles and included 59 studies and 1 review with a total of 11,731 HCC cases confirmed by histomorphology and 21,972 control cases without HCC. The included studies showed an overall judgment of at risk of bias. Four studies with AFP threshold of 400 ng/mL showed the summary sensitivity and specificity of 0.32 (95%CI 0.31–0.34) and 0.99 (95%CI 0.98–0.99), respectively. Four studies with AFP threshold of 200 ng/mL showed the summary sensitivity and specificity of 0.49 (95%CI 0.47–0.50) and 0.98 (95%CI 0.97–0.99), respectively. Forty-six studies with AFP threshold of 20–100 ng/mL showed the summary sensitivity and specificity of 0.61 (95%CI 0.60–0.62) and 0.86 (95%CI 0.86–0.87), respectively. The AUC of SROC and Q index of 400 ng/mL threshold were 0.9368 and 0.8734, respectively, which were significantly higher than those in 200 ng/mL threshold (0.9311 and 0.8664, respectively) and higher than those in 20–100 ng/mL threshold (0.8330 and 0.7654, respectively). Furthermore, similar result that favored 400 ng/mL were shown in the threshold in terms of AFP combined with ultrasound. Conclusion AFP levels in serum showed good accuracy in HCC diagnosis, and the threshold of AFP with 400 ng/mL was better than that of 200 ng/mL in terms of sensitivity and specificity no matter AFP is used alone or combined with ultrasound.
Collapse
|
139
|
Rennert J, Wiesinger I, Beyer LP, Schicho A, Stroszczynski C, Wiggermann P, Jung EM. Color coded perfusion analysis and microcirculation imaging with contrast enhanced ultrasound (CEUS) for post-interventional success control following thermal ablative techniques of primary and secondary liver malignancies. Clin Hemorheol Microcirc 2020; 73:73-83. [PMID: 31561352 DOI: 10.3233/ch-199224] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM Evaluation of the post-interventional success following ablative techniques (radiofrequency and microwave) using a new color coded perfusion quantification software with CEUS in patients with primary and secondary liver malignancies. MATERIAL AND METHODS 75 patients (60 males, 15 females, age 24-84 years, mean 62.7 years) with 128 malignant liver lesions were included in this study. Between 01/2013 and 06/2018, the therapeutic interventional procedure in 88 lesions was MWA, in 40 lesions RFA. All patients underwent CEUS using a convex multifrequency probe (1-6 MHz) following application of 1-2.4 ml sulphur hexaflouride microbubbles, before and within 24 hours following RFA and MWA to detect residual tumor tissue. Postprocessing of the stored DICOM loops from 15 sec up to 1 min using a perfusion quantification software regarding peak enhancement (pE), time to peak (TTP), mean transit time (MTT), rise time (Ri) and Wash-in area under the curve (WiAUC) in the center of the lesion, the border area and periphery was performed. RESULTS In patients treated with RFA, pE differences between center of the lesion vs. surrounding liver were found to be statistically extremely significant (p < 0.001), differences between center of the lesion and margin were also statistically significant (p < 0.01). mTT, TTP, WiAuC and Ri showed no significant difference between center, margin or surrounding liver.In patients treated with MWA, statistically significant differences (p < 0.05) were found for pE, Ri and mTT regarding the differences between center of lesion and surrounding tissue. WiAuC and TTP showed no significant differences between center, margin or surrounding liver. CONCLUSION CEUS with perfusion imaging is a valuable supporting tool for post-interventional success control following RFA and MWA of primary and secondary liver maligancies. Focus should be placed upon pE following MWA and pE, Ri and mTT following RFA.
Collapse
Affiliation(s)
- Janine Rennert
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Isabel Wiesinger
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Philipp Beyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Schicho
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Philipp Wiggermann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
140
|
Bak-Fredslund KP, Keiding S, Villadsen GE, Kramer S, Schlander S, Sørensen M. [ 18 F]-Fluoro-2-deoxy-D-galactose positron emission tomography/computed tomography as complementary imaging tool in patients with hepatocellular carcinoma. Liver Int 2020; 40:447-455. [PMID: 31705784 DOI: 10.1111/liv.14293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/11/2019] [Accepted: 10/28/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Positron emission tomography (PET) with the liver-specific tracer [18 F]-fluoro-2-deoxy-D-galactose (18 F-FDGal) can be used for imaging of hepatocellular carcinoma (HCC). Curative intended and locoregional treatments of HCC require absence of extrahepatic disease. The aim of this prospective study was to determine whether adding 18 F-FDGal PET/CT to standard work-up changes the planned treatment in patients with HCC deemed suitable for curative or locoregional treatment. METHODS Fifty patients with HCC were included at our tertiary liver centre. The primary study outcome was a change in treatment strategy. A subgroup of 29 patients was also examined with [18 F]-fluoro-2-deoxy-D-glucose (18 F-FDG) PET/CT for comparison. RESULTS 18 F-FDGal PET/CT detected eight extrahepatic HCC metastases in six patients (12%), which were primarily not detected by ceCT or MRI. These findings led to a change in treatment in five patients (10%). One of the eight extrahepatic HCC foci was also detected by 18 F-FDG PET/CT. A total of 85 malignant intrahepatic foci were examined, 12 of these were new findings by 18 F-FDGal PET/CT which had a sensitivity of 71%, highest for large foci. None of the additional intrahepatic foci found by 18 F-FDGal PET changed the planned treatment. CONCLUSIONS For the detection of extrahepatic HCC metastases, 18 F-FDGal PET/CT was superior both to standard clinical work-up with contrast-enhanced CT, and/or MRI, and to 18 F-FDG PET/CT in patients deemed suitable for locoregional treatment. 18 F-FDGal PET/CT led to a change in the planned treatment in 10% of the patients whereas 18 F-FDG PET/CT did not change the planned treatment in any patient.
Collapse
Affiliation(s)
- Kirstine P Bak-Fredslund
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark.,Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Keiding
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark.,Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Gerda E Villadsen
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Stine Kramer
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Sven Schlander
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Sørensen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark.,Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
141
|
Lin CH, Ho CM, Wu CH, Liang PC, Wu YM, Hu RH, Lee PH, Ho MC. Minimally invasive surgery versus radiofrequency ablation for single subcapsular hepatocellular carcinoma ≤ 2 cm with compensated liver cirrhosis. Surg Endosc 2020; 34:5566-5573. [PMID: 31993821 DOI: 10.1007/s00464-019-07357-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/24/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is currently no consensus regarding the relative applicability of minimally invasive treatment, including radiofrequency ablation (RFA) and minimally invasive surgery (MIS) in patients with a single small peripheral hepatocellular carcinoma (HCC) and compensated cirrhosis. This study investigated the clinical outcomes of MIS and RFA for single subcapsular HCC ≤ 2 cm in patients with compensated cirrhosis. METHODS In this retrospective study, we enrolled 75 patients who had a single subcapsular HCC ≤ 2 cm along with Child-Pugh class A cirrhosis and a preoperative platelet count ≥ 100 k/μl. These patients underwent RFA (n = 39) or MIS (n = 36) between 2010 and 2016. Clinical outcomes including disease-free survival (DFS), survival without recurrence beyond the Milan criteria (RBM), and overall survival (OS) were compared. RESULTS The 7-year DFS rates in the MIS and RFA groups were 86.1% and 35.9% (p < 0.001), respectively, the 7-year RBM rates were 88.9% and 66.7% (p = 0.014), respectively, and the 7-year OS rates were 97.2% and 82.1% (p = 0.008), respectively. RFA was associated with more ipsilateral lobe recurrence (20% vs. 83.4%, p = 0.004), and 40% were in direct contact with the ablation penumbra. A Cox proportional hazard analysis identified RFA as an independent predictor of mortality (adjusted hazard ratio, 9.625, p = 0.038). No major complications occurred in either group. RFA patients had a shorter hospital stay (median of 2 vs. 6 days, p < 0.001) and operation time (median of 23.5 vs. 216 min, p = 0.001). CONCLUSIONS MIS was associated with a better 7-year OS, RBM, and DFS among patients with single subcapsular HCC ≤ 2 cm, Child-Pugh A liver function, and no clinically significant portal hypertension when compared to those who underwent percutaneous RFA.
Collapse
Affiliation(s)
- Chih-Hao Lin
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC
| | - Chih-Horng Wu
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC.,Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC.,Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC.,Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC. .,Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
142
|
Hassanipour S, Vali M, Gaffari-Fam S, Nikbakht HA, Abdzadeh E, Joukar F, Pourshams A, Shafaghi A, Malakoutikhah M, Arab-Zozani M, Salehiniya H, Mansour-Ghanaei F. The survival rate of hepatocellular carcinoma in Asian countries: a systematic review and meta-analysis. EXCLI JOURNAL 2020; 19:108-130. [PMID: 32038120 PMCID: PMC7003639 DOI: 10.17179/excli2019-1842] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/19/2019] [Indexed: 12/18/2022]
Abstract
Hepatocellular carcinoma or Liver cancer (LC) is the sixth most common cancer and the fourth cause of death worldwide in 2018. There has not been a comprehensive study on the survival rate of patients with LC in Asia yet. Therefore, the present study was conducted to evaluate the survival rate of patients with LC in Asian countries. The methodology of the present study is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. The researchers searched five international databases including Medline/PubMed, Scopus, Embase, Web of Knowledge and ProQuest until July 1, 2018. We also searched Google Scholar for detecting grey literature. The Newcastle-Ottawa Quality Assessment Form was used to evaluate the quality of selected papers. A total of 1425 titles were retrieved. 63 studies met the inclusion criteria. Based on the random-effect model one-year, three-year and five-year survival rate of LC were 34.8 % (95 % CI; 30.3-39.3), 19 % (95 % CI ; 18.2-21.8) and 18.1 % (95 % CI ;16.1-20.1) respectively. According to the results of our study, the LC survival rate in Asian countries is relatively lower than in Europe and North America.
Collapse
Affiliation(s)
- Soheil Hassanipour
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran.,Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mouhebat Vali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saber Gaffari-Fam
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Elham Abdzadeh
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.,Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Akram Pourshams
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.,Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Shafaghi
- Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahdi Malakoutikhah
- Department of Occupational Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Fariborz Mansour-Ghanaei
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran.,Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.,Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
143
|
Development of a nomogram to predict outcome after liver resection for hepatocellular carcinoma in Child-Pugh B cirrhosis. J Hepatol 2020; 72:75-84. [PMID: 31499131 DOI: 10.1016/j.jhep.2019.08.032] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/29/2019] [Accepted: 08/31/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Treatment allocation in patients with hepatocellular carcinoma (HCC) on a background of Child-Pugh B (CP-B) cirrhosis is controversial. Liver resection has been proposed in small series with acceptable outcomes, but data are limited. The aim of this study was to evaluate the outcomes of patients undergoing liver resection for HCC in CP-B cirrhosis, focusing on the surgical risks and survival. METHODS Patients were retrospectively pooled from 14 international referral centers from 2002 to 2017. Postoperative and oncological outcomes were investigated. Prediction models for surgical risks, disease-free survival and overall survival were constructed. RESULTS A total of 253 patients were included, of whom 57.3% of patients had a preoperative platelet count <100,000/mm3, 43.5% had preoperative ascites, and 56.9% had portal hypertension. A minor hepatectomy was most commonly performed (84.6%) and 122 (48.2%) were operated on by minimally invasive surgery (MIS). Ninety-day mortality was 4.3% with 6 patients (2.3%) dying from liver failure. One hundred and eight patients (42.7%) experienced complications, of which the most common was ascites (37.5%). Patients undergoing major hepatectomies had higher 90-day mortality (10.3% vs. 3.3%; p = 0.04) and morbidity rates (69.2% vs. 37.9%; p <0.001). Patients undergoing an open hepatectomy had higher morbidity (52.7% vs. 31.9%; p = 0.001) than those undergoing MIS. A prediction model for surgical risk was constructed (https://childb.shinyapps.io/morbidity/). The 5-year overall survival rate was 47%, and 56.9% of patients experienced recurrence. Prediction models for overall survival (https://childb.shinyapps.io/survival/) and disease-free survival (https://childb.shinyapps.io/DFsurvival/) were constructed. CONCLUSIONS Liver resection should be considered for patients with HCC and CP-B cirrhosis after careful selection according to patient characteristics, tumor pattern and liver function, while aiming to minimize surgical stress. An estimation of the surgical risk and survival advantage may be helpful in treatment allocation, eventually improving postoperative morbidity and achieving safe oncological outcomes. LAY SUMMARY Liver resection for hepatocellular carcinoma in advanced cirrhosis (Child-Pugh B score) is associated with a high rate of postoperative complications. However, due to the limited therapeutic alternatives in this setting, recent studies have shown promising results after accurate patient selection. In our international multicenter study, we provide 3 clinical models to predict postoperative surgical risks and long-term survival following liver resection, with the aim of improving treatment allocation and eventually clinical outcomes.
Collapse
|
144
|
Yang H, Yang Y, Dou J, Cui R, Cheng Z, Han Z, Liu F, Yu X, Zhou X, Yu J, Liang P. Cholecystectomy is associated with higher risk of recurrence after microwave ablation of hepatocellular carcinoma: a propensity score matching analysis. Cancer Biol Med 2020; 17:478-491. [PMID: 32587783 PMCID: PMC7309471 DOI: 10.20892/j.issn.2095-3941.2019.0246] [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: 07/28/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022] Open
Abstract
Objective: To explore the association between cholecystectomy and the prognostic outcomes of patients with hepatocellular carcinoma (HCC) who underwent microwave ablation (MWA). Methods: Patients with HCC (n = 921) who underwent MWA were included and divided into cholecystectomy (n = 114) and non-cholecystectomy groups (n = 807). After propensity score matching (PSM) at a 1:2 ratio, overall survival (OS) and disease-free survival (DFS) rates were analyzed to compare prognostic outcomes between the cholecystectomy (n = 114) and non-cholecystectomy groups (n = 228). Univariate and multivariate Cox analyses were performed to assess potential risk factors for OS and DFS. Major complications were also compared between the groups. Results: After matching, no significant differences between groups were observed in baseline characteristics. The 1-, 3-, and 5-year OS rates were 96.5%, 82.1%, and 67.1% in the cholecystectomy group, and 97.4%, 85.2%, and 74.4% in the non-cholecystectomy group (P = 0.396); the 1-, 3-, and 5-year DFS rates were 58.4%, 34.5%, and 26.6% in the cholecystectomy group, and 73.6%, 44.7%, and 32.2% in the non-cholecystectomy group (P = 0.026), respectively. The intrahepatic distant recurrence rate in the cholecystectomy group was significantly higher than that in the non-cholecystectomy group (P = 0.026), and the local tumor recurrence and extrahepatic recurrence rates did not significantly differ between the groups (P = 0.609 and P = 0.879). Multivariate analysis revealed that cholecystectomy (HR = 1.364, 95% CI 1.023–1.819, P = 0.035), number of tumors (2 vs. 1: HR = 2.744, 95% CI 1.925–3.912, P < 0.001; 3 vs. 1: HR = 3.411, 95% CI 2.021–5.759, P < 0.001), and γ-GT levels (HR = 1.003, 95% CI 1.000–1.006, P < 0.024) were independent risk factors for DFS. The best γ-GT level cut-off value for predicting median DFS was 39.6 U/L (area under the curve = 0.600, P < 0.05). A positive correlation was observed between cholecystectomy and γ-GT level (r = 0.108, 95% CI −0.001–0.214, P = 0.047). Subgroup analysis showed that the DFS rates were significantly higher in the non-cholecystectomy group than the cholecystectomy group when γ-GT ≥39.6 U/L (P = 0.044). The 5-, 10-, 15-, 20-, and 25-year recurrence rates from the time of cholecystectomy were 2.63%, 21.93%, 42.11%, 58.77%, and 65.79%, respectively. A significant positive correlation was observed between cholecystectomy and the time from cholecystectomy to recurrence (r = 0.205, 95% CI 0.016–0.379, P = 0.029). There were no significant differences in complications between groups (P = 0.685). Conclusions: Patients with HCC who underwent cholecystectomy were more likely to develop intrahepatic distant recurrence after MWA, an outcome probably associated with increased γ-GT levels. Moreover, the recurrence rates increased with time.
Collapse
Affiliation(s)
- Hongcai Yang
- School of Medicine, Nankai University, Tianjin 300071, China.,Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, 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, China
| | - Jianping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Rui Cui
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiang Zhou
- 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, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Ping Liang
- School of Medicine, Nankai University, Tianjin 300071, China.,Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|
145
|
Huang JY, Li JW, Lu Q, Luo Y, Lin L, Shi YJ, Li T, Liu JB, Lyshchik A. Diagnostic Accuracy of CEUS LI-RADS for the Characterization of Liver Nodules 20 mm or Smaller in Patients at Risk for Hepatocellular Carcinoma. Radiology 2019; 294:329-339. [PMID: 31793849 DOI: 10.1148/radiol.2019191086] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background American College of Radiology contrast agent-enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) was developed to improve the accuracy of hepatocellular carcinoma (HCC) diagnosis at contrast agent-enhanced US. However, to the knowledge of the authors, the diagnostic accuracy of the system in characterization of liver nodules 20 mm or smaller has not been fully evaluated. Purpose To evaluate the diagnostic accuracy of CEUS LI-RADS in diagnosing HCC in liver nodules 20 mm or smaller in patients at risk for HCC. Materials and Methods Between January 2015 and February 2018, consecutive patients at risk for HCC presenting with untreated liver nodules 20 mm or less were enrolled in this retrospective double-reader study. Each nodule was categorized according to the CEUS LI-RADS and World Federation for Ultrasound in Medicine and Biology (WFUMB)-European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) criteria. Diagnostic performance of CEUS LI-RADS and WFUMB-EFSUMB characterization was evaluated by using tissue histologic analysis, multiphase contrast-enhanced CT and MRI, and imaging follow-up as reference standard and compared by using McNemar test. Results The study included 175 nodules (mean diameter, 16.1 mm ± 3.4) in 172 patients (mean age, 51.8 years ± 10.6; 136 men). The sensitivity of CEUS LR-5 versus WFUMB-EFSUMB criteria in diagnosing HCC was 73.3% (95% confidence interval [CI]: 63.8%, 81.5%) versus 88.6% (95% CI: 80.9%, 94%), respectively (P < .001). The specificity of CEUS LR-5 versus WFUMB-EFSUMB criteria was 97.1% (95% CI: 90.1%, 99.7%) versus 87.1% (95% CI: 77%, 94%), respectively (P = .02). No malignant lesions were found in CEUS LR-1 and LR-2 categories. Only two nodules (of 41; 5%, both HCC) were malignant in CEUS LR-3 category. The incidences of HCC in CEUS LR-4, LR-5, and LR-M were 48% (11 of 23), 98% (77 of 79), and 75% (15 of 20), respectively. Two of 175 (1.1%) histologic analysis-confirmed intrahepatic cholangiocarcinomas were categorized as CEUS LR-M by CEUS LI-RADS and misdiagnosed as HCC by WFUMB-EFSUMB criteria. Conclusion The contrast-enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) algorithm was an effective tool for characterization of small (≤20 mm) liver nodules in patients at risk for hepatocellular carcinoma (HCC). Compared with World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology criteria, CEUS LR-5 demonstrated higher specificity for diagnosing small HCCs with lower sensitivity. Published under a CC BY 4.0 license. See also the editorial by Crocetti in this issue.
Collapse
Affiliation(s)
- Jia-Yan Huang
- From the Department of Medical Ultrasound (J.Y.H., J.W.L., Q.L., Y.L., L.L.), Laboratory of Pathology (Y.J.S.), and Department of Anesthesiology (T.L.), West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China; and Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (J.B.L., A.L.)
| | - Jia-Wu Li
- From the Department of Medical Ultrasound (J.Y.H., J.W.L., Q.L., Y.L., L.L.), Laboratory of Pathology (Y.J.S.), and Department of Anesthesiology (T.L.), West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China; and Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (J.B.L., A.L.)
| | - Qiang Lu
- From the Department of Medical Ultrasound (J.Y.H., J.W.L., Q.L., Y.L., L.L.), Laboratory of Pathology (Y.J.S.), and Department of Anesthesiology (T.L.), West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China; and Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (J.B.L., A.L.)
| | - Yan Luo
- From the Department of Medical Ultrasound (J.Y.H., J.W.L., Q.L., Y.L., L.L.), Laboratory of Pathology (Y.J.S.), and Department of Anesthesiology (T.L.), West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China; and Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (J.B.L., A.L.)
| | - Ling Lin
- From the Department of Medical Ultrasound (J.Y.H., J.W.L., Q.L., Y.L., L.L.), Laboratory of Pathology (Y.J.S.), and Department of Anesthesiology (T.L.), West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China; and Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (J.B.L., A.L.)
| | - Yu-Jun Shi
- From the Department of Medical Ultrasound (J.Y.H., J.W.L., Q.L., Y.L., L.L.), Laboratory of Pathology (Y.J.S.), and Department of Anesthesiology (T.L.), West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China; and Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (J.B.L., A.L.)
| | - Tao Li
- From the Department of Medical Ultrasound (J.Y.H., J.W.L., Q.L., Y.L., L.L.), Laboratory of Pathology (Y.J.S.), and Department of Anesthesiology (T.L.), West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China; and Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (J.B.L., A.L.)
| | - Ji-Bin Liu
- From the Department of Medical Ultrasound (J.Y.H., J.W.L., Q.L., Y.L., L.L.), Laboratory of Pathology (Y.J.S.), and Department of Anesthesiology (T.L.), West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China; and Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (J.B.L., A.L.)
| | - Andrej Lyshchik
- From the Department of Medical Ultrasound (J.Y.H., J.W.L., Q.L., Y.L., L.L.), Laboratory of Pathology (Y.J.S.), and Department of Anesthesiology (T.L.), West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China; and Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (J.B.L., A.L.)
| |
Collapse
|
146
|
Fang Q, Xie QS, Chen JM, Shan SL, Xie K, Geng XP, Liu FB. Long-term outcomes after hepatectomy of huge hepatocellular carcinoma: A single-center experience in China. Hepatobiliary Pancreat Dis Int 2019; 18:532-537. [PMID: 31543313 DOI: 10.1016/j.hbpd.2019.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Currently, hepatectomy remains the first-line therapy for hepatocellular carcinoma (HCC). However, surgery for patients with huge (>10 cm) HCCs is controversial. This retrospective study aimed to explore long-term survival after hepatectomy for patients with huge HCC. METHODS The records of 188 patients with pathologically confirmed HCC who underwent curative hepatectomy between 2007 and 2017 were reviewed; patients were divided into three groups according to tumor size: huge (>10 cm; n = 84), large (5-10 cm; n = 51) and small (<5 cm; n = 53) HCC. Kaplan-Meier analysis was used to assess overall survival (OS) and disease-free survival (DFS), and log-rank analysis was performed for pairwise comparisons among the three groups. Risk factors for survival and recurrence were analyzed using the Cox proportional hazard model. RESULTS The median follow-up period was 20 months. Although the prognosis of small HCC was better than that of huge and large HCC, OS and DFS were not significantly different between huge and large HCC (P = 0.099 and P = 0.831, respectively). A family history of HCC, poor Child-Pugh class, vascular invasion, diolame, pathologically positive margins, and operative time ≥240 min were identified as independent risk factors for OS and DFS in a multivariate model. Tumor size (>10 cm) had significant effect on OS, and postoperative antiviral therapy and postoperative complications also had significant effects on DFS. CONCLUSIONS Huge HCC is not a contraindication of hepatectomy. Although most of these patients experienced recurrence after surgery, OS and DFS were not significantly different from those of patients with large HCC after resection.
Collapse
Affiliation(s)
- Qiang Fang
- Division of General Surgery, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China
| | - Qing-Song Xie
- Division of General Surgery, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China
| | - Jiang-Ming Chen
- Division of General Surgery, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China
| | - Shen-Liang Shan
- Division of General Surgery, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China
| | - Kun Xie
- Division of General Surgery, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China
| | - Xiao-Ping Geng
- Division of General Surgery, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China
| | - Fu-Bao Liu
- Division of General Surgery, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China.
| |
Collapse
|
147
|
Zhang ZY, Dong KS, Zhang EL, Zhang LW, Chen XP, Dong HH. Resection might be a meaningful choice for hepatocellular carcinoma with portal vein thrombosis: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18362. [PMID: 31852141 PMCID: PMC6922393 DOI: 10.1097/md.0000000000018362] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND According to the Barcelona Clinic Liver Cancer (BCLC) staging system, the presence of portal vein tumor thrombosis (PVTT) is considered to indicate an advanced stage of hepatocellular carcinoma (HCC) with nearly no cure. Hepatic resection and transarterial chemoembolization (TACE) have recently been recommended for treatment of HCC with PVTT. METHODS We conducted a systematic review to compare the overall survival between patients with HCC and PVTT undergoing hepatectomy, TACE or conservative treatment including sorafenib chemotherapy. The PubMed, Web of Science, and Cochrane Library databases were searched. All relevant studies were considered. Hazard ratios with 95% confidence intervals were calculated for comparison of the cumulative overall survival. Ten retrospective studies met the inclusion criteria and were included in the review. RESULTS Overall survival was not higher in the hepatectomy group than TACE group. But survival rate was higher in hepatectomy group than conservative group. The subgroup analysis demonstrated that hepatectomy was superior in patients without PVTT in the main trunk than in patients with main portal vein invasion. In patients without main PVTT, hepatectomy has showed more benefit than TACE. However, there has been no significant difference between the hepatectomy and TACE groups among patients with main PVTT. CONCLUSION For patients with resectable HCC and PVTT, hepatectomy might be more effective in patients without PVTT in the main trunk than TACE or conservative treatment.
Collapse
|
148
|
Patel V, Ritchie CA, Padula C, McKinney JM. Radiofrequency Ablation, Where It Stands in Interventional Radiology Today. Semin Intervent Radiol 2019; 36:398-404. [PMID: 31798214 PMCID: PMC6887522 DOI: 10.1055/s-0039-1697945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Radiofrequency ablation (RFA) is one of the first developed minimally invasive definitive cancer therapies. The safety and efficacy of RFA is well documented and has led to its incorporation into multiple international societal guidelines. By expanding on the body of knowledge acquired during the clinical use of RFA, alternative ablative technologies have emerged and are successfully competing for locoregional therapy market share. The adaption of newer ablative technologies is leading to a rapid decline in the utilization of RFA by interventional radiologists despite the lack of proven superiority. In their 2010 article, Hong and Georgiades stated "… RFA is likely to remain the mainstay of ablations for small tumors until sufficient experience emerges for the widespread acceptance for alternative ablative modalities." Within a decade of this publication, has this time arrived?
Collapse
Affiliation(s)
| | | | - Carlos Padula
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | | |
Collapse
|
149
|
Zheng W, Li Q, Zou XB, Wang JW, Han F, Li F, Huang LS, Li AH, Zhou JH. Evaluation of Contrast-enhanced US LI-RADS version 2017: Application on 2020 Liver Nodules in Patients with Hepatitis B Infection. Radiology 2019; 294:299-307. [PMID: 31769742 DOI: 10.1148/radiol.2019190878] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Use of contrast material-enhanced (CE) US Liver Imaging Reporting and Data System (LI-RADS) version 2017 has not been validated in large populations where hepatitis B virus (HBV) is endemic. Purpose To evaluate the diagnostic performance of CE US LI-RADS version 2017 in a population with a high prevalence of HBV infection. Materials and Methods In this retrospective study, liver nodules in patients with HBV who were evaluated from January 2004 to December 2016 were categorized as CE US LR-1 to LR-5 through LR-M. A subgroup of LR-M nodules was reclassified as LR-5, and additional analysis was performed. The reference standard consisted of histologic evaluation or composite imaging and clinical follow-up findings. Diagnostic performance was assessed with sensitivity, specificity, positive predictive value (PPV), and negative predictive value. Results A total of 2020 nodules in 1826 patients (median age, 54 years ± 12 [standard deviation]; 1642 men) were included. Of the 1159 LR-5 lesions, 1141 were hepatocellular carcinoma (HCC); three, intrahepatic cholangiocarcinomas; six, other malignancies; six, atypical hyperplasia; and three, benign lesions. The PPV of LR-5 for HCC was 98% (95% confidence interval [CI]: 98%, 99%). In LR-M nodules, 153 showed arterial phase hyperenhancement, early washout, and absence of punched-out appearance within 5 minutes, and 142 of 153 (93%; 95% CI: 89%, 97%) were HCC. If these nodules were reclassified as LR-5, LR-M specificity and PPV as a predictor of non-HCC malignancy increased from 88% (95% CI: 87%, 89%) and 36% (95% CI: 31%, 41%) to 96% (95% CI: 95%, 97%) and 58% (95% CI: 51%, 65%), respectively (P < .001). Despite reclassification, LR-5 specificity and PPV remained high (94% [95% CI: 92%, 96%] and 98% [95% CI: 97%, 99%], respectively). Conclusion The contrast-enhanced US Liver Imaging Reporting and Data System version 2017 category LR-5 is effectively predictive of the presence of hepatocellular carcinoma. In patients with hepatitis B virus infection, performance may be further improved by reclassification of category LR-M nodules with arterial phase hyperenhancement, early washout, and no punched-out appearance to LR-5. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Sidhu in this issue.
Collapse
Affiliation(s)
- Wei Zheng
- From the Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Qing Li
- From the Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Xue-Bin Zou
- From the Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Jian-Wei Wang
- From the Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Feng Han
- From the Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Fei Li
- From the Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Li-Shu Huang
- From the Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - An-Hua Li
- From the Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Jian-Hua Zhou
- From the Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| |
Collapse
|
150
|
Lee SW, Lee TY, Peng YC, Yang SS, Yeh HZ, Chang CS. Sorafenib treatment on Chinese patients with advanced hepatocellular carcinoma: A study on prognostic factors of the viral and tumor status. Medicine (Baltimore) 2019; 98:e17692. [PMID: 31689794 PMCID: PMC6946266 DOI: 10.1097/md.0000000000017692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sorafenib is of proven efficacy in treating patients of hepatocellular carcinoma (HCC). Our study was aimed to determine the factors influence the sorafenib efficacy.We evaluated data of HCC patients receiving sorafenib from June 2012 to October 2016. All HCC cases were of the Barcelona Clinic Liver Cancer (BCLC) classification stage C. The exclusion criteria: those of BCLC classification stage A or B, with the absence or co-infection of hepatitis B (HBV) and hepatitis C (HCV). The presence of HBV, HCV, macoscopic vascular invasion (MVI) or extrahepatic spread (EHS) was recorded for each patient. Time-to-progression (TTP) and overall survival (OS) were analyzed.Among a total of 90 HCC patients, 48 (53.3%) had HBV infection, 42 (46.7%) had HCV infection, 51 (56.7%) had MVI, and 39 (43.3%) had EHS. Patients with HCV infection showed better TTP and OS than those with HBV infection. Patients with EHS had a longer TTP and OS than those with MVI. For patients with HBV infection, those with EHS had a longer TTP (mean 4.60 vs 2.64 months, P = .002) and OS (mean 6.65 vs 4.53 months, P = .045) compared to those with MVI. Among those with MVI, patients with HBV infection had a poorer TTP (mean 2.64 vs 4.74 months, P = .019) and shorter OS (mean 4.53 vs 7.00 months, P = .059) compared to those with HCV infection.HCC patients with HCV infection or with the presence of EHS showed better sorafenib efficacy.
Collapse
Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital
- Department of Internal Medicine, Chung Shan Medical University, Taichung
| | - Teng-Yu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital
- Department of Internal Medicine, Chung Shan Medical University, Taichung
| | - Yen-Chun Peng
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital
- Department of Internal Medicine, Yang Ming University, Taipei, Taiwan
| | - Sheng-Shun Yang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital
- Department of Internal Medicine, Yang Ming University, Taipei, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital
- Department of Internal Medicine, Yang Ming University, Taipei, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital
- Department of Internal Medicine, Chung Shan Medical University, Taichung
| |
Collapse
|