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Calderon-Martinez E, Landazuri-Navas S, Vilchez E, Cantu-Hernandez R, Mosquera-Moscoso J, Encalada S, Al lami Z, Zevallos-Delgado C, Cinicola J. Prognostic Scores and Survival Rates by Etiology of Hepatocellular Carcinoma: A Review. J Clin Med Res 2023; 15:200-207. [PMID: 37187717 PMCID: PMC10181349 DOI: 10.14740/jocmr4902] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a common cancer and ranks sixth among all malignancies worldwide. Risk factors for HCC can be classified as infectious or behavioral. Viral hepatitis and alcohol abuse are currently the most common risk factors for HCC; however, nonalcoholic liver disease is expected to become the most common cause of HCC in upcoming years. HCC survival rates vary according to the causative risk factors. As in any malignancy, staging is crucial in making therapeutic decisions. The selection of a specific score should be individualized according to patient characteristics. In this review, we summarize the current data on epidemiology, risk factors, prognostic scores, and survival in HCC.
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Affiliation(s)
- Evelyn Calderon-Martinez
- Department of Internal Medicine, UPMC Harrisburg, Harrisburg, PA, USA
- Corresponding Author: Evelyn Calderon-Martinez, Department of Internal Medicine, UPMC Harrisburg, Harrisburg, PA 17104, USA.
| | | | | | - Raul Cantu-Hernandez
- Department of Internal Medicine, Monterrey Institute of Technology and Higher Studies, Mexico
| | | | - Sebastian Encalada
- Department of Internal Medicine, University of the Americas, Quito, Ecuador
| | - Zahraa Al lami
- Department of Internal Medicine, University of Baghdad, College of Medicine, Iraq
| | | | - John Cinicola
- Department of Internal Medicine, UPMC Harrisburg, Harrisburg, PA, USA
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Shannon AH, Ruff SM, Pawlik TM. Expert Insights on Current Treatments for Hepatocellular Carcinoma: Clinical and Molecular Approaches and Bottlenecks to Progress. J Hepatocell Carcinoma 2022; 9:1247-1261. [PMID: 36514693 PMCID: PMC9741819 DOI: 10.2147/jhc.s383922] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a primary liver tumor that typically occurs in the setting of chronic liver disease/cirrhosis. Treatment modalities for HCC have evolved and given the variety of treatment options, a multi-disciplinary approach requiring input from surgical, medical, and radiation oncology, hepatology, and interventional radiology is necessary. Multiple advances have been made over the last decade regarding treatment of HCC, especially advanced disease. Resection and transplantation remain as cornerstone curative-intent treatment options. For patients who are not candidates for curative-intent therapy, exciting progress has been made in molecular and cellular approaches to systemic therapy for HCC including immunotherapies and tyrosine kinase inhibitors. Although the prognosis for advanced HCC remains poor, the armamentarium of therapies has increased, and valuable years of life can be gained with these therapies. While the main therapeutic modality for early-stage disease remains resection, multimodal immunotherapy has emerged as first-line treatment for advanced disease. We herein review different clinical and molecular treatment modalities related to the treatment of HCC, as well as provide insights into future directions for HCC treatment. We highlight how research and progress are needed to move into a new era of molecular and cellular treatments.
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Affiliation(s)
- Alexander H Shannon
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samantha M Ruff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA,Correspondence: Timothy M Pawlik, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Professor of Surgery, Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA, Tel +1 614 293 8701, Fax +1 614 293 4063, Email
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3
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Granito A, Facciorusso A, Sacco R, Bartalena L, Mosconi C, Cea UV, Cappelli A, Antonino M, Modestino F, Brandi N, Tovoli F, Piscaglia F, Golfieri R, Renzulli M. TRANS-TACE: Prognostic Role of the Transient Hypertransaminasemia after Conventional Chemoembolization for Hepatocellular Carcinoma. J Pers Med 2021; 11:jpm11101041. [PMID: 34683182 PMCID: PMC8539564 DOI: 10.3390/jpm11101041] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023] Open
Abstract
The aim of the present study was to correlate laboratory data and postprocedural parameters after conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) with the radiological response. The study consisted of a retrospective analysis of prospectively collected data from 70 consecutive patients who underwent cTACE. Laboratory parameters were assessed daily after cTACE and compared to pretreatment values. Post-treatment radiological response was assessed using mRECIST at one month from cTACE, and factors associated with treatment response (complete and objective response) were assessed by logistic regression analysis. The optimal cutoff points in predicting the complete response of target lesions were a 52% ALT and a 46% AST increase after cTACE compared to the pre-treatment values. Using multivariate analyses, >46% AST and >52% ALT increases with respect to the pre-treatment value were significantly correlated with the objective response (p = 0.03 and p = 0.04, respectively) and the complete response (p = 0.02 and p = 0.02, respectively). No patients experienced liver function deterioration after cTACE, and no specific treatment was required. This study showed that post-treatment transient transaminase elevation was predictive of objective response to superselective cTACE in clinical practice, representing a simple tool to guide treatment strategy of HCC patients in a tailored approach.
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Affiliation(s)
- Alessandro Granito
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40137 Bologna, Italy; (A.G.); (F.T.); (F.P.)
| | - Antonio Facciorusso
- Gastroenterology and Digestive Endoscopy, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (A.F.); (R.S.); (U.V.C.); (M.A.)
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (A.F.); (R.S.); (U.V.C.); (M.A.)
| | - Laura Bartalena
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40137 Bologna, Italy; (L.B.); (C.M.); (A.C.); (F.M.); (N.B.); (R.G.)
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40137 Bologna, Italy; (L.B.); (C.M.); (A.C.); (F.M.); (N.B.); (R.G.)
| | - Ugo Vittorio Cea
- Gastroenterology and Digestive Endoscopy, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (A.F.); (R.S.); (U.V.C.); (M.A.)
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40137 Bologna, Italy; (L.B.); (C.M.); (A.C.); (F.M.); (N.B.); (R.G.)
| | - Matteo Antonino
- Gastroenterology and Digestive Endoscopy, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (A.F.); (R.S.); (U.V.C.); (M.A.)
| | - Francesco Modestino
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40137 Bologna, Italy; (L.B.); (C.M.); (A.C.); (F.M.); (N.B.); (R.G.)
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40137 Bologna, Italy; (L.B.); (C.M.); (A.C.); (F.M.); (N.B.); (R.G.)
| | - Francesco Tovoli
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40137 Bologna, Italy; (A.G.); (F.T.); (F.P.)
| | - Fabio Piscaglia
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40137 Bologna, Italy; (A.G.); (F.T.); (F.P.)
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40137 Bologna, Italy; (L.B.); (C.M.); (A.C.); (F.M.); (N.B.); (R.G.)
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40137 Bologna, Italy; (L.B.); (C.M.); (A.C.); (F.M.); (N.B.); (R.G.)
- Correspondence:
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Müller L, Stoehr F, Mähringer-Kunz A, Hahn F, Weinmann A, Kloeckner R. Current Strategies to Identify Patients That Will Benefit from TACE Treatment and Future Directions a Practical Step-by-Step Guide. J Hepatocell Carcinoma 2021; 8:403-419. [PMID: 34012930 PMCID: PMC8128497 DOI: 10.2147/jhc.s285735] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 12/11/2022] Open
Abstract
Treatment of hepatocellular carcinoma (HCC) depends on the stage of disease. In the Western Hemisphere, the Barcelona Clinic Liver Cancer classification (BCLC) is the preferred staging system. Approximately one-third of patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. However, the intermediate-stage comprises a heterogeneous subgroup of patients with considerable differences in tumor burden and liver function. In addition, differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate further evaluation of these patients. Due to these differences, not all patients benefit equally from TACE. Several tools and scoring systems have been devised to provide decision-making support. All of these have shown promising initial results but failed external evaluation and have not been translated to the clinic. Nevertheless, criteria for objectifying treatment decisions in daily clinical practice are needed in all stages of disease. Therefore, this review provides a concise practical step-by-step guide on current strategies for patient selection and decision-making, with a focus on TACE, to critically evaluate the existing decision-support tools and provide a summary of the latest updates in the field.
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Affiliation(s)
- Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Fabian Stoehr
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Aline Mähringer-Kunz
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
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D'Amore B, Smolinski-Zhao S, Daye D, Uppot RN. Role of Machine Learning and Artificial Intelligence in Interventional Oncology. Curr Oncol Rep 2021; 23:70. [PMID: 33880651 DOI: 10.1007/s11912-021-01054-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight the current role of machine learning and artificial intelligence and in the field of interventional oncology. RECENT FINDINGS With advancements in technology, there is a significant amount of research regarding the application of artificial intelligence and machine learning in medicine. Interventional oncology is a field that can benefit greatly from this research through enhanced image analysis and intraprocedural guidance. These software developments can increase detection of cancers through routine screening and improve diagnostic accuracy in classifying tumors. They may also aid in selecting the most effective treatment for the patient by predicting outcomes based on a combination of both clinical and radiologic factors. Furthermore, machine learning and artificial intelligence can advance intraprocedural guidance for the interventional oncologist through more accurate needle tracking and image fusion technology. This minimizes damage to nearby healthy tissue and maximizes treatment of the tumor. While there are several exciting developments, this review also discusses limitations before incorporating machine learning and artificial intelligence in the field of interventional oncology. These include data capture and processing, lack of transparency among developers, validating models, integrating workflow, and ethical challenged. In summary, machine learning and artificial intelligence have the potential to positively impact interventional oncologists and how they provide cancer care treatments.
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Affiliation(s)
- Brian D'Amore
- Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA, 19129, USA
| | - Sara Smolinski-Zhao
- Division of Interventional Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street; Gray #290, Boston, MA, 02114, USA
| | - Dania Daye
- Division of Interventional Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street; Gray #290, Boston, MA, 02114, USA
| | - Raul N Uppot
- Division of Interventional Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street; Gray #290, Boston, MA, 02114, USA.
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Overview of Prognostic Systems for Hepatocellular Carcinoma and ITA.LI.CA External Validation of MESH and CNLC Classifications. Cancers (Basel) 2021; 13:cancers13071673. [PMID: 33918125 PMCID: PMC8037197 DOI: 10.3390/cancers13071673] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 02/07/2023] Open
Abstract
Prognostic assessment in patients with HCC remains an extremely difficult clinical task due to the complexity of this cancer where tumour characteristics interact with degree of liver dysfunction, patient general health status, and a large span of available treatment options. Several prognostic systems have been proposed in the last three decades, both from the Asian and European/North American countries. Prognostic scores, such as the CLIP score and the recent MESH score, have been generated on a solid statistical basis from real life population data, while staging systems, such as the BCLC scheme and the recent CNLC classification, have been created by experts according to recent HCC prognostic evidences from the literature. A third category includes combined prognostic systems that can be used both as prognostic scores and staging systems. A recent example is the ITA.LI.CA prognostic system including either a prognostic score and a simplified staging system. This review focuses first on an overview of the main prognostic systems for HCC classified according to the above three categories, and, second, on a comprehensive description of the methodology required for a correct comparison between different systems in terms of prognostic performance. In this second section the main studies in the literature comparing different prognostic systems are described in detail. Lastly, a formal comparison between the last prognostic systems proposed for each of the above three categories is performed using a large Italian database including 6882 HCC patients in order to concretely apply the comparison rules previously described.
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Superiority of log odds of positive lymph nodes (LODDS) for prognostic prediction after gastric cancer surgery: a multi-institutional analysis of 7620 patients in China. Surg Today 2020; 51:101-110. [PMID: 32754844 DOI: 10.1007/s00595-020-02091-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare the 8th pN system with ratio-based and Log odds of positive lymph nodes (LODDS) staging systems for predicting the overall survival (OS) of gastric cancer (GC) patients after curative gastric resection. METHODS We analyzed, retrospectively, clinicopathologic and prognostic data from three Chinese medical centers, on 7620 patients who underwent curative surgery for GC. We established a hypothetical tumor-LODDS-metastasis (TLM) and tumor-ratio-metastasis (TRM) staging system. The relative discriminative abilities of the different staging systems were assessed using Akaike's Information Criterion (AIC), a linear trend chi-square test, and a likelihood ratio chi-square test. RESULTS The cut-off points of the LODDS were set as: ≤ - 1.5, - 1.5 to - 1.0, - 1.0 to - 0.5, - 0.5 to 0, and > 0. There were significant differences in the survival of patients in different LODDS classifications for each pN or LNR group. When stratified by the LODDS classification, the prognosis was more homologous according to the pN or lymph-node ratio (LNR) classifications. The modified TLM staging system had better discriminatory ability and better optimistic prognostic stratification than the 8th TNM or the TRM staging systems for predicting the prognosis of patients with GC. CONCLUSIONS The LODDS staging system was superior to other lymph-node classifications for predicting the prognosis of patients undergoing gastrectomy GC. LODDS may be incorporated into a GC staging system if these results are confirmed by other studies.
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Liu J, Gan Y, Song H, Zhu K, Zhang Q. The predictive value of the preoperative fibrinogen-albumin ratio on the postoperative prognosis of renal cell carcinoma. Transl Androl Urol 2020; 9:1053-1061. [PMID: 32676389 PMCID: PMC7354337 DOI: 10.21037/tau-19-873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Urologists urgently need a simple, effective, accurate clinical biomarker to identify renal cell carcinoma (RCC) patients with poor prognosis and those with a high risk of recurrence as early as possible. Therefore, we investigated the prognostic value of the preoperative fibrinogen-albumin ratio (FAR) in patients with RCC. Methods We retrospectively analyzed data from 279 cases of renal cancer admitted to the First Hospital of Peking University from 2010 to 2012. The best cutoff value of the FAR was obtained using receiver operating characteristic (ROC) curve analysis, and patients were divided into high- and low-FAR groups. The correlation between the preoperative FAR and clinicopathological features was analyzed by χ2 test. Log-rank test and Cox proportional hazard regression model were used to evaluate the predictive value of clinicopathological parameters for overall survival (OS). Results The best cutoff value for the FAR was 0.116. A FAR >0.116 was associated with higher Fuhrman grade (P<0.0001) and later pathological T stage (P<0.0001). Patients with a high FAR (>0.116) had worse OS [hazard ratio (HR) 10.497, 95% confidence interval (CI): 3.263–33.766, P<0.0001]. In multivariate analysis, the FAR was an independent risk factor for OS (HR 5.047, 95% CI: 2.109–12.076, P=0.003). Moreover, in Fuhrman grade I–II patients, the FAR could distinguish patients with worse prognosis (P<0.0001). Conclusions The preoperative FAR is an independent prognostic factor of OS in renal cancer patients. A FAR >0.116 was significantly related to decreased survival in renal cancer patients.
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Affiliation(s)
- Jun Liu
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Research Center for Genitourinary Oncology, Beijing 100034, China.,Peking University Applied Lithotripsy Institute, Peking University, Beijing 100044, China.,Urology and lithotripsy center, Peking University People's Hospital, Beijing 100044, China
| | - Ying Gan
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Research Center for Genitourinary Oncology, Beijing 100034, China
| | - Haifeng Song
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Research Center for Genitourinary Oncology, Beijing 100034, China
| | - Kun Zhu
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Research Center for Genitourinary Oncology, Beijing 100034, China
| | - Qian Zhang
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Research Center for Genitourinary Oncology, Beijing 100034, China
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Understanding the Lymphatics: Review of the N Category in the Updated TNM Staging of Cancers of the Digestive System. AJR Am J Roentgenol 2020; 215:58-68. [PMID: 32432907 DOI: 10.2214/ajr.19.22636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE. The N category has been significantly updated in the 8th edition of the American Joint Committee on Cancer's TNM classification. To ensure correct tumor staging, prognosis, and management, it is critical to be aware of these changes. This article reviews the updated N category, organ-specific regional lymph nodes, and lymphatic drainage pathways for cancers of the digestive system from the esophagus to the anal canal. CONCLUSION. Detection of lymph node involvement may be challenging, and knowledge of nodal characteristics, lymphatic drainage pathways, and imaging modalities is essential to optimize detection rate to ensure accurate staging, prognosis estimation, and streamlined management.
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Lin J, Ko CJ, Hung YJ, Lin PY, Lin KH, Hsieh CE, Chou CT, Chen YL. Prognostic Role of Serum Wisteria Floribunda Agglutinin-Positive Mac-2 Binding Protein Level in Early Stage Hepatocellular Carcinoma. Sci Rep 2020; 10:5651. [PMID: 32221384 PMCID: PMC7101373 DOI: 10.1038/s41598-020-62631-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/27/2020] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study is to evaluate the prognostic value of preoperative Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA+-M2BP) in predicting overall survival for patients with hepatitis B- and hepatitis C-related early-stage hepatocellular carcinoma (ESHCC) after liver resection. Post-operative survival rates were compared according to WFA+-M2BP level and tumor stage. Six hundred and ten patients were identified and 198 were removed after application of the exclusion criteria; the median follow-up time was 4.33 years, and cancer-related death occurred in 117 (28.4%) patients. Age (p = 0.03), fibrosis grade (p = 0.042), cancer stage (p = 0.01), and WFA+-M2BP level (p = 0.001) were identified as independent risk factors for poor overall survival. The overall survival rates at 3 and 5 years for patients with WFA+-M2BP ≤ 1.12 were 0.92 and 0.90, respectively, and 0.76 and 0.61 for patients with WFA+-M2BP > 1.12 (p < 0.001). During the analysis of survival prediction, serum WFA+-M2BP level exhibited a higher log-likelihood and a lower AIC value compared to TNM stage (log likelihood: -638; AIC: 1279). Pre-operative serum WFA+-M2BP level provided important prognostic information after curative hepatic resection in our study.
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Affiliation(s)
- Joseph Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Jan Ko
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ju Hung
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ping-Yi Lin
- Transplant Medicine & Surgery Research Centre, Changhua Christian Hospital, Changhua, Taiwan
| | - Kuo-Hua Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-En Hsieh
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chen-Te Chou
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Molecular Biotechnology, College of Biotechnology and Bioresources, Dayeh University, Changhua City, Taiwan. .,Department of Radiology, Changhua Christian Hospital, Changhua City, Taiwan.
| | - Yao-Li Chen
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan. .,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Transplant Medicine & Surgery Research Centre, Changhua Christian Hospital, Changhua, Taiwan. .,College of Nursing and Health Sciences, Dayeh University, Changhua City, Taiwan.
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Zhang J, Zou S, Luo R, Zhu Z, Xu H, Huang B. Proposal of a novel stage grouping of the Eighth Edition of American Joint Committee on Cancer TNM Staging System for Gastric Cancer: results from a retrospective study of 30 years clinical data from a single institute in China. Expert Rev Gastroenterol Hepatol 2020; 14:55-64. [PMID: 31062631 DOI: 10.1080/17474124.2019.1613152] [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] [Indexed: 12/13/2022]
Abstract
Objectives: To improve the prognostic accuracy of 8th edition of American Joint Committee on Cancer TNM staging system for gastric cancer by reclassifying N3a category.Methods: 1446 patients who underwent R0 surgery for histologically proven gastric cancers with ≥16 lymph nodes retrieved were selected.Results: Significant prognostic difference was observed among patients in N3a category ('7-10' group vs '11-15' group; P = 0.029). We proposed a revised pN category in which patients with '7-10' metastatic lymph nodes were categorized as r-N3a, '11-15' as r-N3b, and '>15' as r-N3c. Prognosis for patients in T2r-N3aM0 was similar to that of patients in T4aN0M0/T3N1M0/T2N2M0/T1r-N3bM0 (P = 0.584), but significantly better than that of patients in T4bN0M0/T4aN1-2M0/T3N2M0/T2r-N3bM0 (P = 0.031). Similarly, prognoses for patients in T3r-N3aM0 and T4ar-N3aM0 were similar to that of patients in T4bN0M0/T4aN1-2M0/T3N2M0/T2r-N3bM0 (P = 0.136; P = 0.193), but significantly better than that of patients in T4bN1-2M0/T4ar-N3bM0/T3r-N3bM0/T1-2r-N3cM0 (P = 0.011; P = 0.017). A revised TNM system was also proposed, in which T2r-N3aM0 was incorporated into stage IIB, T3r-N3aM0 and T4ar-N3aM0 into stage IIIA. The revised TNM system had better homogeneity, discriminatory ability, and monotonicity of gradients than the 8th edition system.Conclusion: Patients with 7-10 metastatic lymph nodes in T2-T4a categories should be considered lower stage in the final TNM stage.
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Affiliation(s)
- Jiale Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Shihui Zou
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Rui Luo
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Zhi Zhu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Huimian Xu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Baojun Huang
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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Zhang N, Deng J, Wang W, Sun Z, Wang Z, Xu H, Zhou Z, Liang H. Negative lymph node count as an independent prognostic factor in stage III patients after curative gastrectomy: A retrospective cohort study based on a multicenter database. Int J Surg 2019; 74:44-52. [PMID: 31874262 DOI: 10.1016/j.ijsu.2019.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/26/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the prognostic value of negative lymph node (NLN) count in stage III gastric cancer (GC) patients after curative gastrectomy. METHODS The clinicopathological data of 2942 stage III patients who underwent curative gastrectomy between 2001 and 2011 were analyzed. Only patients with ≥16 examined lymph nodes (ELNs) were included. After cut-point survival analysis, the 2942 patients were divided into three subgroups with NLN counts of 0, 1-9, and ≥10. Survival differences among the subgroups were analyzed to assess the effects of NLN count on stage migration and overall survival (OS) in stage III GC patients. Spearman's correlation coefficient was used to assess the relationships between the ELN count and the positive lymph node (PLN) count, the ELN count and the NLN count, and the NLN count and the PLN count. RESULTS Survival analyses revealed that the NLN count was significantly associated with OS (P = 0.001) and was an independent predictor (P < 0.01) of prognosis in stage III GC patients. Subgroup analysis showed that the prognostic evaluation accuracy was highest when the NLN count was ≥10 for stage III patients. Stage migrations were mainly detected in the following pathological tumor-node (pTN) subgroups: pT2N3a with 1-9 NLNs and pT2N3b with ≥10 NLNs, and pT3N3a with 1-9 NLNs and pT3N3b with ≥10 NLNs. NLN count was positively correlated with the ELN and the PLN counts for pT2N3 and pT3N3 stage GC patients (r = 0.694 and r = 0.881 for pT2N3 patients; r = 0.685 and r = 0.902 for pT3N3 patients, respectively; P < 0.001). These findings indicate that the NLN count may be a useful prognostic predictor in stage III GC patients. CONCLUSIONS The NLN count may improve the prognostic prediction efficiency of the tumor-node-metastasis (TNM) classification for GC, especially for stage III patients, and should be recommended for clinical applications.
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Affiliation(s)
- Nannan Zhang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, Tianjin, 300060, China
| | - Jingyu Deng
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, Tianjin, 300060, China.
| | - Wei Wang
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Zhe Sun
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Zhenning Wang
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Huimian Xu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
| | - Zhiwei Zhou
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
| | - Han Liang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, Tianjin, 300060, China.
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13
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Wang M. Comparison of prognostic value of three objective nutritional indicators in patients with hepatocellular carcinoma before radical resection. Shijie Huaren Xiaohua Zazhi 2019; 27:1263-1270. [DOI: 10.11569/wcjd.v27.i20.1263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Various nutrition-based prognostic scores, including control of nutritional status (CONUT) score, nutritional risk index (NRI), and prognostic nutritional index (PNI), are associated with survival rates in patients with various types of cancer.
AIM To compare the prognostic value of the above-mentioned scores in patients with hepatocellular carcinoma (HCC) before radical resection.
METHODS A retrospective analysis of 470 patients who underwent radical resection for HCC at the Yiwu Central Hospital from January 2007 to June 2016 was performed. Clinical pathological parameters, CONUT score, NRI, and PNI were collected and compared. The area under the receiver operating characteristic curve (AUC) was calculated to compare the predictive power of each scoring system. Univariate and multivariate analyses were performed using the COX proportional hazards model to identify risk factors associated with overall survival (OS).
RESULTS In the univariate analysis, albumin, PNI, NRI, CONUT score, and histology were significantly associated with OS in patients with HCC. PNI, NRI, and CONUT score were significantly associated with 1-year, 3-year, and 5-year HCC survival rates. NRI always had a higher AUC value than other nutrition-based prognostic scores. In the multivariate analysis, AST (hazard ratio [HR] = 1.503, P = 0.031), FIB status (HR = 1.981, P = 0.001), and NRI (HR = 1.584, P = 0.014) were independent risk factors for prognosis in patients with HCC.
CONCLUSION Our study suggests that NRI is superior to other nutrition-based prognostic scores in predicting overall survival in patients undergoing radical surgery for HCC.
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Affiliation(s)
- Miao Wang
- Department of Gastroenterology, Yiwu Central Hospital, Yiwu 322000, Zhejiang Province, China
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14
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Morshid A, Elsayes KM, Khalaf AM, Elmohr MM, Yu J, Kaseb AO, Hassan M, Mahvash A, Wang Z, Hazle JD, Fuentes D. A machine learning model to predict hepatocellular carcinoma response to transcatheter arterial chemoembolization. Radiol Artif Intell 2019; 1:e180021. [PMID: 31858078 PMCID: PMC6920060 DOI: 10.1148/ryai.2019180021] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 05/25/2019] [Accepted: 08/05/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE Some patients with hepatocellular carcinoma (HCC) are more likely to experience disease progression despite transcatheter arterial chemoembolization (TACE) treatment, and thus would benefit from early switching to other therapeutic regimens. We sought to evaluate a fully automated machine learning algorithm that uses pre-therapeutic quantitative computed tomography (CT) image features and clinical factors to predict HCC response to TACE. MATERIALS AND METHODS Outcome information from 105 patients receiving first-line treatment with TACE was evaluated retrospectively. The primary clinical endpoint was time to progression (TTP) based on follow-up CT radiological criteria (mRECIST). A 14-week cutoff was used to classify patients as TACE-susceptible (TTP ≥14 weeks) or TACE-refractory (TTP <14 weeks). Response to TACE was predicted using a random forest classifier with the Barcelona Clinic Liver Cancer (BCLC) stage and quantitative image features as input as well as the BCLC stage alone as a control. RESULTS The model's response prediction accuracy rate was 74.2% (95% CI=64%-82%) using a combination of the BCLC stage plus quantitative image features versus 62.9% (95% CI= 52%-72%) using the BCLC stage alone. Shape image features of the tumor and background liver were the dominant features correlated to the TTP as selected by the Boruta method and were used to predict the outcome. CONCLUSION This preliminary study demonstrates that quantitative image features obtained prior to therapy can improve the accuracy of predicting response of HCC to TACE. This approach is likely to provide useful information for aiding HCC patient selection for TACE.
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Affiliation(s)
- Ali Morshid
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Khaled M. Elsayes
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Ahmed M. Khalaf
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Mohab M. Elmohr
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Justin Yu
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Ahmed O. Kaseb
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Manal Hassan
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Armeen Mahvash
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Zhihui Wang
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - John D. Hazle
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - David Fuentes
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
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Samawi HH, Sim HW, Chan KK, Alghamdi MA, Lee-Ying RM, Knox JJ, Gill P, Romagnino A, Batuyong E, Ko YJ, Davies JM, Lim HJ, Cheung WY, Tam VC. Prognosis of patients with hepatocellular carcinoma treated with sorafenib: a comparison of five models in a large Canadian database. Cancer Med 2018; 7:2816-2825. [PMID: 29766659 PMCID: PMC6051235 DOI: 10.1002/cam4.1493] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/09/2018] [Accepted: 03/20/2018] [Indexed: 02/06/2023] Open
Abstract
Several systems (tumor-node-metastasis [TNM], Barcelona Clinic Liver Cancer [BCLC], Okuda, Cancer of the Liver Italian Program [CLIP], and albumin-bilirubin grade [ALBI]) were developed to estimate the prognosis of patients with hepatocellular carcinoma (HCC) mostly prior to the prevalent use of sorafenib. We aimed to compare the prognostic and discriminatory power of these models in predicting survival for HCC patients treated with sorafenib and to identify independent prognostic factors for survival in this population. Patients who received sorafenib for the treatment of HCC between 1 January 2008 and 30 June 2015 in the provinces of British Columbia and Alberta, and two large cancer centers in Toronto, Ontario, were included. Survival was assessed using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of survival. The models were compared with respect to homogeneity, discriminatory ability, monotonicity of gradients, time-dependent area under the curve, and Akaike information criterion. A total of 681 patients were included. 80% were males, 86% had Child-Pugh class A, and 37% of patients were East Asians. The most common etiology for liver disease was hepatitis B (34%) and C (31%). In all model comparisons, CLIP performed better while BCLC and TNM7 performed less favorably but the differences were small. The utility of each system in allocating patients into different prognostic groups varied, for example, TNM poorly differentiated patients in advanced stages (8.7 months (m) (95% CI 6.5-11.5) versus 8.4 m (95% CI 7.0-9.6) for stages III and IV, respectively) while ALBI had excellent discrimination of early grades (15.6 m [95% CI 13.0-18.4] versus 8.3 m [95% CI 7.0-9.2] for grades 1 and 2, respectively). On multivariate analysis, hepatitis C, alcoholism, and prior hepatic resection were independently prognostic of better survival (P < 0.01). In conclusion, none of the prognostic systems was optimal in predicting survival in sorafenib-treated patients with HCC. Etiology of liver disease should be considered in future models and clinical trial designs.
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Affiliation(s)
- Haider H Samawi
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Hao-Wen Sim
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kelvin K Chan
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | | | | | | | - Parneet Gill
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Yoo-Joung Ko
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Janine M Davies
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Howard J Lim
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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16
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Liu S, Li X, Li H, Guo L, Zhang B, Zhang J, Ye Q. Is the Hong Kong Liver Cancer staging system the best guide for hepatitis B virus-related hepatocellular carcinoma patients with multiple tumors? Oncotarget 2018; 7:51598-51607. [PMID: 27323396 PMCID: PMC5239499 DOI: 10.18632/oncotarget.9956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/26/2016] [Indexed: 12/17/2022] Open
Abstract
It still must be confirmed whether the newly developed Hong Kong Liver Cancer Staging (HKLC) system can effectively stratify patients with multiple tumors and identify patients who could obtain a survival benefit with radical resection. In this study, we retrospectively compared survival rates of surgery versus transcatheter arterial chemoembolization for hepatitis B virus-related hepatocellular carcinoma patients with multiple tumors by using the propensity score method. In addition, the prognostic roles of tumor size, number and thrombus status together with other covariates on postoperative survival were analyzed by multivariate analysis. In matched cohorts, surgical treatment could significantly reduce patient mortality in patients within or outside HKLC criteria (odds ratio (OR) = 0.5, P < 0.001, OR = 0.6, P = 0.001, respectively). In 941 patients undergoing radical resection, the state of tumor thrombus demonstrated a significant interaction with tumor size on postoperative survival (P for interaction = 0.041). Tumor number was not a predictor of postoperative survival in patients with multiple tumors (adjusted OR = 1.1, P = 0.202). In patients without tumor thrombus, tumor size > 5 cm was an independent risk factor of postoperative survival (OR = 1.7, P < 0.001). In patients without tumor thrombus, patient survival was mainly influenced by tumor location (OR = 2.1, P < 0.001). In summary, patients with multiple tumors could obtain a survival benefit from radical surgery based on the more aggressive HKLC staging system. However, parameters in this staging system still need further adjustments.
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Affiliation(s)
- Shuang Liu
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Xiaoqiang Li
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Hui Li
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Lei Guo
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Bo Zhang
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Jubo Zhang
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Qinghai Ye
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
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17
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Yang ZJ, Yu Y, Chi JR, Guan M, Zhao Y, Cao XC. The combined pN stage and breast cancer subtypes in breast cancer: a better discriminator of outcome can be used to refine the 8th AJCC staging manual. Breast Cancer 2018; 25:315-324. [PMID: 29353447 DOI: 10.1007/s12282-018-0833-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/08/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND pN stage and breast cancer subtypes (BCS) are both well-recognized prognostic indicators. Our previous work has highlighted that patients even with the same pN stage exhibited a significant survival difference in different BCS. Given this achievement, we hypothesized that a statistical interaction might exist between pN stage and BCS. The aim of this retrospective cohort study was to compare the prognostic value of the combined pN stage and BCS (pNnew stage) with either pN stage or BCS alone, and to determine if this combined new stage could serve as an alternative discriminator of outcome. METHODS We combined pN stage and BCS to create a new variable named pNnew stage and then divided it into four groups: pN0new, pN1new, pN2new, and pN3new. Survival analysis was performed with the use of the Kaplan-Meier method and the log-rank test was used for univariate analysis. For multivariate analysis, cox proportional hazard models were applied, allowing for the estimation of disease-free survival (DFS). To assess discriminatory accuracy of the models, we compared the area under the receiver-operating characteristic curve (AUROC), the Akaike information criterion (AIC), and the Bayesian information criterion (BIC) values. Then, we used this pNnew stage to generate a TNnewM staging system according to the 7th AJCC staging system. RESULTS A statistical interaction between pN stage and BCS was found. In multivariate survival analysis, the pNnew stage has been confirmed as an independent prognostic variable of 5-year DFS. The pNnew stage, with a smaller AIC or BIC value and larger AUROC, was a more powerful predictor of DFS than either pN stage or BCS alone. Results were validated in a separate cohort of patients. The TNnewM stage proposed in our present study was found comparable to the new 8th AJCC edition which includes anatomic T, N, and M plus tumor grade and the status of the biomarkers Her-2, ER, and PR with respect to prognostic value for breast cancer patients. CONCLUSIONS The pNnew stage (combined pN stage and BCS) appears to be a more powerful predictor and discriminator for the outcome of breast cancer, as compared to pN stage or BCS alone, and the TNnewM stage may serve as a simple, easy-to-use alternative to the 8th AJCC edition staging manual.
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Affiliation(s)
- Zheng-Jun Yang
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin Medical University, Tianjin, 300060, China
| | - Yue Yu
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin Medical University, Tianjin, 300060, China
| | - Jiang-Rui Chi
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin Medical University, Tianjin, 300060, China
| | - Meng Guan
- Cancer Center, The First Hospital of Jilin University, Jilin, 130021, China
| | - Ying Zhao
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China. .,Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China. .,Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China. .,Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin Medical University, Tianjin, 300060, China.
| | - Xu-Chen Cao
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China. .,Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China. .,Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China. .,Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin Medical University, Tianjin, 300060, China.
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18
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Xu Q, Yan Y, Gu S, Mao K, Zhang J, Huang P, Zhou Z, Chen Z, Zheng S, Liang J, Lin Z, Wang J, Yan J, Xiao Z. A Novel Inflammation-Based Prognostic Score: The Fibrinogen/Albumin Ratio Predicts Prognoses of Patients after Curative Resection for Hepatocellular Carcinoma. J Immunol Res 2018; 2018:4925498. [PMID: 30027102 PMCID: PMC6031154 DOI: 10.1155/2018/4925498] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/18/2018] [Accepted: 02/04/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammation is an important hallmark of cancer. Fibrinogen and albumin are both vital factors in systemic inflammation. This study investigated the prognostic value of the fibrinogen/albumin ratio in HCC patients who underwent curative resection. METHODS HCC patients (n = 151) who underwent curative resection were evaluated retrospectively. The optimal cutoff value for the fibrinogen/albumin ratio was selected by receiver operating characteristic (ROC) curve analysis. Correlations between preoperative fibrinogen/albumin ratios and clinicopathologic characteristics were analyzed by χ2 test. The area under the receiver operating characteristic curve (AUC) was calculated to compare the prognostic value of the fibrinogen/albumin ratio with other prognostic scores (neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and albumin-bilirubin (ALBI) score). The overall survival (OS) and time to recurrence (TTR) were assessed by the log-rank test and the Cox proportional hazard regression model. RESULTS An optimal cutoff value of the preoperative fibrinogen/albumin ratio (0.062) was determined for 151 patients who underwent curative resection for HCC via a ROC curve analysis. Fibrinogen/albumin ratio > 0.062 was significantly associated with microvascular invasion, an advanced BCLC stage, and ALBI grade. Multivariate analyses revealed that fibrinogen/albumin ratio was an independent predictor for OS (P = 0.003) and TTR (P = 0.035). The prognostic ability of fibrinogen/albumin ratio was comparable to other prognostic scores (NLR, PLR, and ALBI score) by AUC analysis. Patients with a fibrinogen/albumin ratio > 0.062 had lower 1-, 3-, and 5-year OS rates (66.0%, 41.8%, and 28.2% versus 81.9%, 69.3%, and 56.1%, resp., P < 0.001) and higher 1-, 3-, and 5-year recurrence rates (60.9%, 79.2%, and 90.5% versus 49.5%, 69.1%, and 77.1%, resp., P = 0.008) compared with patients with fibrinogen/albumin ratio ≤ 0.062. CONCLUSION The preoperative fibrinogen/albumin ratio is an effective prognostic factor for HCC patients who underwent curative resection. An elevated fibrinogen/albumin ratio significantly correlates with poorer survival and a higher risk of recurrence in HCC patients.
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Affiliation(s)
- Qiaodong Xu
- Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-sen Memorial Hospital, No. 107 Yanjiang Western Road, Guangzhou 510120, China
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, No. 33 Yingfeng Road, Guangzhou 510289, China
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China
| | - Yongcong Yan
- Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-sen Memorial Hospital, No. 107 Yanjiang Western Road, Guangzhou 510120, China
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, No. 33 Yingfeng Road, Guangzhou 510289, China
| | - Songgang Gu
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China
| | - Kai Mao
- Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-sen Memorial Hospital, No. 107 Yanjiang Western Road, Guangzhou 510120, China
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, No. 33 Yingfeng Road, Guangzhou 510289, China
| | - Jianlong Zhang
- Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-sen Memorial Hospital, No. 107 Yanjiang Western Road, Guangzhou 510120, China
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, No. 33 Yingfeng Road, Guangzhou 510289, China
| | - Pinbo Huang
- Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-sen Memorial Hospital, No. 107 Yanjiang Western Road, Guangzhou 510120, China
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, No. 33 Yingfeng Road, Guangzhou 510289, China
| | - Zhenyu Zhou
- Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-sen Memorial Hospital, No. 107 Yanjiang Western Road, Guangzhou 510120, China
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, No. 33 Yingfeng Road, Guangzhou 510289, China
| | - Zheng Chen
- Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-sen Memorial Hospital, No. 107 Yanjiang Western Road, Guangzhou 510120, China
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, No. 33 Yingfeng Road, Guangzhou 510289, China
| | - Shaodong Zheng
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China
| | - Jiahong Liang
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China
| | - Zhihua Lin
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China
| | - Jie Wang
- Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-sen Memorial Hospital, No. 107 Yanjiang Western Road, Guangzhou 510120, China
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, No. 33 Yingfeng Road, Guangzhou 510289, China
| | - Jiang Yan
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China
| | - Zhiyu Xiao
- Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-sen Memorial Hospital, No. 107 Yanjiang Western Road, Guangzhou 510120, China
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, No. 33 Yingfeng Road, Guangzhou 510289, China
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Transarterial chemoembolization for hepatocellular carcinoma: development and external validation of the Munich-TACE score. Eur J Gastroenterol Hepatol 2018; 30:44-53. [PMID: 29076939 DOI: 10.1097/meg.0000000000001005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Allocation of patients with hepatocellular carcinoma (HCC) to the adequate therapy is determined by both tumor burden and liver function. The Barcelona Clinic Liver Cancer (BCLC) staging system and therapeutic algorithm recommends transarterial chemoembolization (TACE) based on the best evidence available to patients with intermediate-stage HCC (BCLC-B). However, many centers also treat subgroups of patients outside these recommendations and with more advanced disease by TACE. The purpose of this study was to identify prognostic factors in a TACE cohort, including BCLC-B patients, as well as patients treated outside of BCLC-B, to test the prognostic capabilities of published staging systems and to optimize prognostication for TACE patients. PATIENTS AND METHODS A cohort of 186 first-line TACE patients was analyzed. Independent prognostic factors were identified and used to construct the Munich-TACE score (M-TACE). M-TACE was tested against established staging systems (including BCLC and two recently published TACE-specific scores) and a ranking using concordance index and Akaike Information Criterion was performed. Finally, an external validation in an independent TACE cohort (n=71) was conducted. RESULTS Bilirubin, Quick/international normalized ratio, C-reactive protein, creatinine, α-feto protein, and tumor extension were identified as independent prognostic factors and used to construct M-TACE. M-TACE identifies three distinct subgroups (P<0.0001) with median survival times of 35.2, 16.9, and 8.6 months, respectively. Compared with established staging systems, M-TACE showed the best prognostic capabilities in both cohorts of patients (cohort 1: c-index, 0.71; Akaike Information Criterion: 1276; cohort 2: c-index, 0.754). CONCLUSION We identified independent risk factors for patients treated with TACE. The newly constructed M-TACE score is superior to established staging systems and might prove helpful to identify patients who are most suitable for TACE.
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Hasan S, Thai N, Uemura T, Kudithipudi V, Renz P, Abel S, Kirichenko AV. Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy. World J Gastrointest Surg 2017; 9:256-263. [PMID: 29359031 PMCID: PMC5752960 DOI: 10.4240/wjgs.v9.i12.256] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/15/2017] [Accepted: 12/06/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the control, survival, and hepatic function for Child Pugh (CP)-A patients after Stereotactic body radiotherapy (SBRT) in hepatocellular carcinoma (HCC).
METHODS From 2009 to 2016, 40 patients with Barcelona Liver Clinic (BCLC) stages 0-B HCC and CP-A cirrhosis completed liver SBRT. The mean prescription dose was 45 Gy (40 to 50 Gy in 4-5 fractions). Local relapse, defined as recurrence within the planning target volume was assessed with intravenous multiphase contrast computed tomography or magnetic resonance imaging every 4-6 mo after completion of SBRT. Progression of cirrhosis was evaluated by CP and Model for End Stage Liver Disease scores every 3-4 mo. Toxicities were graded per the Common Terminology Criteria for Adverse Events (v4.03). Median follow-up was 24 mo.
RESULTS Forty-nine HCC lesions among 40 patients were analyzed in this IRB approved retrospective study. Median tumor diameter was 3.5 cm (1.5-8.9 cm). Six patients with tumors ≥ 5 cm completed planned selected transarterial chemoembolization (TACE) in combination with SBRT. Eight patients underwent orthotropic live transplant (OLT) with SBRT as a bridging treatment (median time to transplant was 12 mo, range 5 to 23 mo). The Pathologic complete response (PCR) rate in this group was 62.5%. The 2-year in-field local control was 98% (1 failure). Intrahepatic control was 82% and 62% at 1 and 2 years, respectively. Overall survival (OS) was 92% and 60% at 1 and 2 years, with a median survival of 41 mo per Kaplan Meier analysis. At 1 and 2 years, 71% and 61% of patients retained CPA status. Of the patients with intrahepatic failures, 58% developed progressive cirrhosis, compared to 27% with controlled disease (P = 0.06). Survival specific to hepatic failure was 92%, 81%, and 69% at 12, 18, and 24 mo. There was no grade 3 or higher toxicity. On univariate analysis, gross tumor volume (GTV) < 23 cc was associated with freedom from CP progression (P = 0.05), hepatic failure-specific survival (P = 0.02), and trended with OS (P = 0.10).
CONCLUSION SBRT is safe and effective in HCC with early cirrhosis and may extend waiting time for transplant in patients who may not otherwise be immediate candidates.
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Affiliation(s)
- Shaakir Hasan
- Division of Radiation Oncology, Allegheny General Hospital Cancer Institute, Pittsburgh, PA 15212, United States
| | - Ngoc Thai
- Division of Radiation Oncology, Allegheny General Hospital Cancer Institute, Pittsburgh, PA 15212, United States
- Division of Transplant Surgery, Allegheny General Hospital Cancer Institute, Pittsburgh, PA 15212, United States
| | - Tadahiro Uemura
- Division of Radiation Oncology, Allegheny General Hospital Cancer Institute, Pittsburgh, PA 15212, United States
- Division of Transplant Surgery, Allegheny General Hospital Cancer Institute, Pittsburgh, PA 15212, United States
| | - Vijay Kudithipudi
- Division of Radiation Oncology, Allegheny General Hospital Cancer Institute, Pittsburgh, PA 15212, United States
| | - Paul Renz
- Division of Radiation Oncology, Allegheny General Hospital Cancer Institute, Pittsburgh, PA 15212, United States
| | - Stephen Abel
- Division of Radiation Oncology, Allegheny General Hospital Cancer Institute, Pittsburgh, PA 15212, United States
| | - Alexander V Kirichenko
- Division of Radiation Oncology, Allegheny General Hospital Cancer Institute, Pittsburgh, PA 15212, United States
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Choi WM, Yu SJ, Ahn H, Cho H, Cho YY, Lee M, Yoo JJ, Cho Y, Lee DH, Cho EJ, Lee JH, Kim YJ, Yoon JH. A model to estimate survival in ambulatory patients with hepatocellular carcinoma: Can it predict the natural course of hepatocellular carcinoma? Dig Liver Dis 2017; 49:1273-1279. [PMID: 28807489 DOI: 10.1016/j.dld.2017.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/27/2017] [Accepted: 07/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several hepatocellular carcinoma (HCC) staging systems are available including the newly developed staging system, the Model to Estimate Survival in Ambulatory HCC patients (MESIAH); however, whether these staging systems could predict the natural course of HCC is largely unknown. METHODS 1013 patients with history of HCC treatment and 111 patients without any history of treatment till death or last follow-up at a single tertiary hospital were included. RESULTS The MESIAH score showed a better discrimination ability, with a C-statistic of 0.835 [95% confidence interval (CI), 0.810-0.861] in the group of treated patients compared to the Barcelona Clinic Liver Cancer (BCLC) staging system [0.739 (95% CI, 0.709-0.769)] before propensity score matching. However, the MESIAH score failed to stratify patients according to their risk of death in the group of untreated patients unlike the BCLC staging system. Propensity score matching analysis confirmed that the MESIAH score was most strongly influenced by whether treatment was given or not. CONCLUSIONS Although the MESIAH score provided better prognostic stratification than other staging systems in treated HCC patients, it was not helpful in predicting the natural course of HCC. Since the treatment affects patient outcome and prognosis, it is necessary to develop a new staging system that can also reflect the natural course of HCC.
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Affiliation(s)
- Won-Mook Choi
- Lab of Liver Research, Graduate School of Medical Science and Engineering, KAIST, Daejeon, Republic of Korea; Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Hongkeun Ahn
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeki Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Youn Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minjong Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Jeong-Ju Yoo
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Yuri Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Dong Hyeon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Bala MM, Mituś JW, Riemsma RP, Wolff R, Hetnal M, Kukielka A, Kleijnen J. Transarterial (chemo)embolisation versus chemotherapy for colorectal cancer liver metastases. Hippokratia 2017. [DOI: 10.1002/14651858.cd012757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Malgorzata M Bala
- Jagiellonian University Medical College; Department of Hygiene and Dietetics; Systematic Reviews Unit - Polish Cochrane Branch; Kopernika 7 Krakow Poland 31-034
| | - Jerzy W. Mituś
- Centre of Oncology, Maria Skłodowska - Curie Memorial Institute, Krakow Branch. Department of Anatomy, Jagiellonian University Medical College Krakow, Poland; Department of Surgical Oncology; ul. Garncarska 11 Krakow Poland 31-115
| | - Robert P Riemsma
- Kleijnen Systematic Reviews Ltd; Unit 6, Escrick Business Park Riccall Road, Escrick York UK YO19 6FD
| | - Robert Wolff
- Kleijnen Systematic Reviews Ltd; Unit 6, Escrick Business Park Riccall Road, Escrick York UK YO19 6FD
| | - Marcin Hetnal
- Rydygier Memorial Hospital; Radiotherapy Centre Amethyst; os. Zlotej Jesieni 1 Krakow Poland 31-826
| | - Andrzej Kukielka
- NU-MED; Centrum Diagnostyki i Terapii Onkologicznej; Aleje Jana Pawła II 10 Zamość Poland 22-400
| | - Jos Kleijnen
- School for Public Health and Primary Care (CAPHRI), Maastricht University; Maastricht Netherlands 6200 MD
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Meng ZW, Pan W, Hong HJ, Chen JZ, Chen YL. Modified staging classification for intrahepatic cholangiocarcinoma based on the sixth and seventh editions of the AJCC/UICC TNM staging systems. Medicine (Baltimore) 2017; 96:e7891. [PMID: 28834905 PMCID: PMC5572027 DOI: 10.1097/md.0000000000007891] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) was differentiated from hepatocellular carcinoma, as defined in the American Joint Committee on Cancer (AJCC) 6th edition staging manual, using the revised staging system described in the AJCC 7th edition staging manual. This study was conducted to analyze the application of the AJCC 6th and 7th edition staging classifications and to evaluate a modified staging classification to potentially reduce the limitations associated with the different AJCC staging systems.We compared the prognostic value of cancer staging using data from the Surveillance, Epidemiology, and End Results database (N = 2124). The Kaplan-Meier method and Cox regression models were used to analyze survival. The Harrell concordance index (C-index) was used to analyze the discriminative abilities of cancer staging.Patients with stages I and II disease were found to have similar prognoses according to the 6th edition staging system. Using the 7th edition staging system, a low proportion of patients had stage III disease (5.0%), and the hazard ratio (HR) for stage III disease was comparable to that of stage IV disease (stage III and IV, 2.653 and 2.694). We modified the AJCC staging classification by adopting the 7th edition T, N, and M definitions and the 6th edition staging definitions. Consequently, the proportion of patients with stage III disease increased (22.8%). The HR for stage IV disease was higher than that for stage III disease (stage III and IV, 2.425 and 2.956). Meanwhile, the C-index of the modified AJCC staging system was 0.721 (95% CI: 0.696-0.745), which was significantly higher than the AJCC 7th edition staging system (0.694, P < .001), and the AJCC 6th edition staging system (0.712, P = .033). Moreover, in the stratified data, the differences between the stages identified using the modified AJCC staging classification were significant, especially among patients over 60 years in age, white patients and patients who underwent surgery.These findings suggest that the modified AJCC staging classification may be applicable to the staging of ICC and can be adopted in clinical practice.
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Affiliation(s)
- Ze-Wu Meng
- Department of Hepatobiliary Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Wei Pan
- Department of Hepatobiliary Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Hai-Jie Hong
- Department of Hepatobiliary Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Jiang-zhi Chen
- Department of Hepatobiliary Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Yan-Ling Chen
- Department of Hepatobiliary Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
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24
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Hansmann J, Ray CE. Overview of Staging Systems for Hepatocellular Carcinoma and Implications for Interventional Radiology. Semin Intervent Radiol 2017; 34:213-219. [PMID: 28579689 DOI: 10.1055/s-0037-1602757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Jan Hansmann
- Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Charles E Ray
- Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
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Yamashita H, Deng J, Liang H, Seto Y. Re-evaluating the prognostic validity of the negative to positive lymph node ratio in node-positive gastric cancer patients. Surgery 2017; 161:1588-1596. [DOI: 10.1016/j.surg.2016.12.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/19/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023]
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Sohn JH, Duran R, Zhao Y, Fleckenstein F, Chapiro J, Sahu S, Schernthaner RE, Qian T, Lee H, Zhao L, Hamilton J, Frangakis C, Lin M, Salem R, Geschwind JF. Validation of the Hong Kong Liver Cancer Staging System in Determining Prognosis of the North American Patients Following Intra-arterial Therapy. Clin Gastroenterol Hepatol 2017; 15:746-755.e4. [PMID: 27847278 PMCID: PMC5823259 DOI: 10.1016/j.cgh.2016.10.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is debate over the best way to stage hepatocellular carcinoma (HCC). We attempted to validate the prognostic and clinical utility of the recently developed Hong Kong Liver Cancer (HKLC) staging system, a hepatitis B-based model, and compared data with that from the Barcelona Clinic Liver Cancer (BCLC) staging system in a North American population that underwent intra-arterial therapy (IAT). METHODS We performed a retrospective analysis of data from 1009 patients with HCC who underwent IAT from 2000 through 2014. Most patients had hepatitis C or unresectable tumors; all patients underwent IAT, with or without resection, transplantation, and/or systemic chemotherapy. We calculated HCC stage for each patient using 5-stage HKLC (HKLC-5) and 9-stage HKLC (HKLC-9) system classifications, and the BCLC system. Survival information was collected up until the end of 2014 at which point living or unconfirmed patients were censored. We compared performance of the BCLC, HKLC-5, and HKLC-9 systems in predicting patient outcomes using Kaplan-Meier estimates, calibration plots, C statistic, Akaike information criterion, and the likelihood ratio test. RESULTS Median overall survival time, calculated from first IAT until date of death or censorship, for the entire cohort (all stages) was 9.8 months. The BCLC and HKLC staging systems predicted patient survival times with significance (P < .001). HKLC-5 and HKLC-9 each demonstrated good calibration. The HKLC-5 system outperformed the BCLC system in predicting patient survival times (HKLC C = 0.71, Akaike information criterion = 6242; BCLC C = 0.64, Akaike information criterion = 6320), reducing error in predicting survival time (HKLC reduced error by 14%, BCLC reduced error by 12%), and homogeneity (HKLC chi-square = 201, P < .001; BCLC chi-square = 119, P < .001) and monotonicity (HKLC linear trend chi-square = 193, P < .001; BCLC linear trend chi-square = 111, P < .001). Small proportions of patients with HCC of stages IV or V, according to the HKLC system, survived for 6 months and 4 months, respectively. CONCLUSIONS In a retrospective analysis of patients who underwent IAT for unresectable HCC, we found the HKLC-5 staging system to have the best combination of performances in survival separation, calibration, and discrimination; it consistently outperformed the BCLC system in predicting survival times of patients. The HKLC system identified patients with HCC of stages IV and V who are unlikely to benefit from IAT.
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Affiliation(s)
- Jae Ho Sohn
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Rafael Duran
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Yan Zhao
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Florian Fleckenstein
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Sonia Sahu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Rüdiger E Schernthaner
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Tianchen Qian
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Howard Lee
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Li Zhao
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - James Hamilton
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | | | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut; U/S Imaging and Interventions (UII), Philips Research North America, Cambridge, Massachusetts
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Jean-Francois Geschwind
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut.
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Wu SG, Sun JY, Yang LC, Zhou J, Li FY, Li Q, Lin HX, Lin Q, He ZY. Prognosis of patients with esophageal squamous cell carcinoma after esophagectomy using the log odds of positive lymph nodes. Oncotarget 2017; 6:36911-22. [PMID: 26426993 PMCID: PMC4742220 DOI: 10.18632/oncotarget.5366] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/17/2015] [Indexed: 12/14/2022] Open
Abstract
To compare the log odds of positive lymph nodes (LODDS) with the number of positive lymph nodes (pN), lymph node ratio (LNR), removed lymph node (RLN) count, and negative lymph node (NLN) count in determining the prognosis of patients with esophageal squamous cell carcinoma (ESCC) after esophagectomy. The records of patients with ESCC who received esophagectomy were retrospectively reviewed. The log-rank test was used to compare curves for overall survival (OS), and Cox regression analysis was performed to identify prognostic factors. The prognostic performance of the different lymph node staging systems were compared using the linear trend chi-square test, likelihood ratio chi-square test, and Akaike information criterion. A total of 589 patients were enrolled. Univariate Cox analysis showed that pN stage, LNR, RLN count, NLN count, and the LODDS were significantly associated with OS (p < 0.05 for all). Multivariate Cox analysis adjusted for significant factors indicated that LODDS was independent risk factor on overall survival (OS), and a higher LODDS was associated with worse OS (hazard ratio = 3.297, 95% confidence interval: 2.684–4.050, p < 0.001). The modified Tumor-LODDS-Metastasis staging system had better discriminatory ability, monotonicity, and homogeneity, and better optimistic prognostic stratification than the Tumor-Node-Metastasis staging system in determining the prognosis of patients with ESCC. The LODDS staging system was superior to other lymph node classifications in determining the prognosis of patients with ESCC after esophagectomy. LODDS may be incorporated into esophageal staging system if these results are eventually confirmed by other studies.
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Affiliation(s)
- San-Gang Wu
- Xiamen Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Jia-Yuan Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Li-Chao Yang
- Department of Basic Medical Science, Medical College, Xiamen University, Xiamen, People's Republic of China
| | - Juan Zhou
- Xiamen Cancer Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Feng-Yan Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Qun Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Huan-Xin Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Qin Lin
- Xiamen Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Zhen-Yu He
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
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Dasse KD, Lander MJ, Novelli PM. Chemoembolization With Drug-Eluting Beads for the Treatment of Hepatocellular Carcinoma. J Adv Pract Oncol 2016; 7:764-778. [PMID: 29670812 PMCID: PMC5902156 DOI: 10.6004/jadpro.2016.7.7.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Kathy Diener Dasse
- Department of Pharmacy Services, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Michael J Lander
- Pharmacy Services, Mayo Clinic - St. Mary's Hospital, Rochester, Minnesota
| | - Paula M Novelli
- Division of Vascular and Interventional Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Deng J, Yamashita H, Seto Y, Liang H. Increasing the Number of Examined Lymph Nodes is a Prerequisite for Improvement in the Accurate Evaluation of Overall Survival of Node-Negative Gastric Cancer Patients. Ann Surg Oncol 2016; 24:745-753. [PMID: 27770340 DOI: 10.1245/s10434-016-5513-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study aims to elucidate whether increasing the number of examined lymph nodes (NELN) is mandatory for the accurate prognosis of node-negative gastric cancer (GC) patients after curative gastrectomy in Eastern countries (China and Japan). METHODS The clinicopathological data of 2455 GC patients (including 1137 node-negative cases) were included to demonstrate whether a minimum NELN is inevitable for guaranteeing the accurate prognosis of node-negative GC patients after curative gastrectomy. RESULTS Survival analyses revealed that the NELN significantly positively correlated with overall survival (p < 0.001) and was an independent prognostic predictor (hazard ratio 0.447; p = 0.025) of 1137 node-negative GC patients. Stratum analysis within the Kaplan-Meier method showed that sex, tumor size, and extent of lymphadenectomy did not affect the NELN in predicting the prognosis of all node-negative GC patients. Stage migration was mainly detected in the subgroup of node-negative GC Chinese patients who presented considerably lower mean NELN and more advanced staging than patients from Japan. The NELN was identified as the most intensively independent predictor of prognosis of 600 node-negative GC patients from China, with the smallest Akaike information criterion (176.964) and Bayesian information criterion values (194.552). These findings indicate that increasing the NELN is a prerequisite to guaranteeing precise TNM classification. CONCLUSIONS The NELN should be considered a mandatory requirement for improving the accuracy of prognostic evaluation of GC patients, especially for advanced-stage patients.
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Affiliation(s)
- Jingyu Deng
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Hiroharu Yamashita
- Department of Stomach and Esophageal Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Stomach and Esophageal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
| | - Han Liang
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China.
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31
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Hsu CY, Liu PH, Hsia CY, Lee YH, Al Juboori A, Lee RC, Lin HC, Huo TI. Nomogram of the Barcelona Clinic Liver Cancer system for individual prognostic prediction in hepatocellular carcinoma. Liver Int 2016; 36:1498-506. [PMID: 26972815 DOI: 10.1111/liv.13114] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/05/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS The predictive accuracy of the Barcelona Clinic Liver Cancer (BCLC) staging system on a single patient is not clear. This study aimed to develop a nomogram to predict individualized survival of patients with hepatocellular carcinoma (HCC) based on the BCLC system. METHODS A total of 3179 patients were randomly grouped into derivation (n = 2119) and validation (n = 1060) sets. The multivariate Cox proportional hazards model was used to generate the nomogram from tumour burden, cirrhosis and performance status (PS). The performance of the nomogram was evaluated by concordance indices and calibration tests. RESULTS Beta coefficients from the Cox model were used to assign nomogram points to different degrees of tumour burden, Child-Turcotte-Pugh classification and PS. A nomogram with a scale of 0-26 was developed and the predicted survival rates at 3 and 5 years were calculated. The derivation set had a concordance index of 0.766 (95% confidence interval [CI]: 0.686-0.838); and the validation set showed a concordance index of 0.775 (95% CI: 0.607-0.909). The calibration plots were close to the 45-degree line for 3- and 5-year survival prediction of BCLC stages 0-C patients in both derivation and validation groups. For BCLC stage D patients, calibration plots in both groups showed deviation from the 45-degree line for 3- and 5-year prediction. CONCLUSIONS This study provides quantitative evidence to support the prognostic ability of BCLC system. This straightforward and easy-to-use nomogram may accurately predict the survival at 3 and 5 years for individual HCC patient except for BCLC stage D patients.
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Affiliation(s)
- Chia-Yang Hsu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV, USA
| | - Po-Hong Liu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Cheng-Yuan Hsia
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Hsuan Lee
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Alhareth Al Juboori
- Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV, USA
| | - Rheun-Chuan Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Teh-Ia Huo
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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32
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Choo SP, Tan WL, Goh BKP, Tai WM, Zhu AX. Comparison of hepatocellular carcinoma in Eastern versus Western populations. Cancer 2016; 122:3430-3446. [PMID: 27622302 DOI: 10.1002/cncr.30237] [Citation(s) in RCA: 197] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/23/2016] [Accepted: 06/28/2016] [Indexed: 01/27/2023]
Abstract
Hepatocellular carcinoma (HCC) is a heterogeneous disease that remains highly prevalent in many Asian countries and is the second most common cause of cancer-related mortality worldwide. Significant differences exist between Eastern and Western populations on many key aspects of HCC, contributing to the potential different treatment outcomes and challenges of clinical trial design and data interpretation. In this review, the authors compare HCC in Asia versus the West and highlight 1) differences in terms of epidemiology and trends and their correlation with etiology, 2) differences in genetics and how they relate to underlying etiology, 3) differences in treatment approaches based on existing guidelines and consensus statements, and 4) differences in clinical outcomes for Asian versus non-Asian patients with HCC in clinical trials and the implications for future clinical trial design. Cancer 2016;122:3430-3446. © 2016 American Cancer Society.
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Affiliation(s)
- Su Pin Choo
- Department of Medical Oncology, National Cancer Center, Singapore
| | - Wan Ling Tan
- Department of Medical Oncology, National Cancer Center, Singapore
| | - Brian K P Goh
- Department of Hepato-Pancreaticobiliary Surgery, Singapore General Hospital, Singapore
| | - Wai Meng Tai
- Department of Medical Oncology, National Cancer Center, Singapore
| | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
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33
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Su L, Zhou T, Zhang Z, Zhang X, Zhi X, Li C, Wang Q, Jia C, Shi W, Yue Y, Gao Y, Cheng B. Optimal staging system for predicting the prognosis of patients with hepatocellular carcinoma in China: a retrospective study. BMC Cancer 2016; 16:424. [PMID: 27387757 PMCID: PMC4937540 DOI: 10.1186/s12885-016-2420-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/27/2016] [Indexed: 02/08/2023] Open
Abstract
Background Several staging systems have been developed to evaluate patients with hepatocellular carcinoma (HCC), including the China Staging System (CS), the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system, and seventh edition; the Barcelona Clinic Liver Cancer (BCLC) staging system, and Cancer of the Liver Italian Program (CLIP) staging system. The optimal staging system for to evaluate patients in China with HCC has not been determined. This study was designed to determine the optimal staging system for predicting patient prognosis by comparing the performances of these four staging systems in a cohort of Chinese patients with HCC. Methods This study enrolled 307 consecutive Chinese patients with HCC in Shandong Province. The performances of the CS, TNM, BCLC, and CLIP staging systems were compared and ranked using a concordance index. Predictors of survival were identified using univariate and multivariate Cox model analyses. Results The mean overall survival of the patient cohort was 12.08 ± 11.87 months. Independent predictors of survival included tumor size, number of lesions, tumor thromboses, cirrhosis, serum albumin level and serum total bilirubin level. Compared with the other three staging systems, the CS staging system showed optimal performance as an independent predictor of patient survival. The BCLC staging system showed the poorest performance; its treatment algorithm was not suitable for patients in this study. Conclusions CS was the most suitable staging system for predicting survival of patients with HCC in China. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2420-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lihui Su
- Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China
| | - Tao Zhou
- Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China
| | - Zongli Zhang
- Department of Hepatobiliary Surgery, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China
| | - Xiuguo Zhang
- Department of Hepatobiliary Surgery, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China
| | - Xuting Zhi
- Department of Hepatobiliary Surgery, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China
| | - Caixia Li
- Department of Intervention, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China
| | - Qingliang Wang
- Department of Intervention, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China
| | - Chongqi Jia
- Department of Epidemiology and Health Statistics, Shandong University, Jinan, 250012, China
| | - Wenna Shi
- Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China
| | - Yanqiu Yue
- Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China
| | - Yanjing Gao
- Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China.
| | - Baoquan Cheng
- Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China.
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Yuksel OH, Akan S, Urkmez A, Yildirim C, Sahin A, Verit A. Preoperative Glasgow prognostic score as a predictor of primary bladder cancer recurrence. Mol Clin Oncol 2016; 5:201-206. [PMID: 27330798 DOI: 10.3892/mco.2016.901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/27/2016] [Indexed: 11/06/2022] Open
Abstract
The correlation between systemic inflammatory markers and malignancies has been assessed by a number of recent studies. The aim of this study was to prospectively assess preoperative inflammation markers and Glasgow prognostic scores (GPS) in patients who underwent surgery for primary bladder cancer (BC), and evaluate the predictive value of GPS for disease recurrence and progression. A total of 38 patients (mean age, 60.16±9.71 years; range, 33-76 years) who were treated in our department between May, 2014 and August, 2015 were enrolled in the present study. Preoperatively, patient information regarding gender, body mass index, serum C-reactive protein (CRP) and albumin levels, GPS and comorbidities, were collected and recorded. Transurethral resection of the bladder was performed, followed by histopathological evaluation of the resected material. The tumor size, stage and grade and the presence of necrosis were determined. According to the international TNM classification, the results of the histopathological analysis were as follows: Ta low- (n=24) and high-grade (n=4); and T1 low- (n=2) and high-grade (n=8). The median follow-up period was 10.1 months (range, 6-12 months). During this period, recurrence was observed in 10 cases and disease progression was detected in 1 patient. Hypoalbuminemia was encountered in 40% of the cases with recurrence, which was significantly higher compared with that in patients without recurrence (7.1%; P=0.031). In patients who had recurrence, a GPS of 1-2 points and tumor necrosis were more frequently detected compared with those without recurrence (60 vs. 7.1%, P=0.002; and 80 vs. 7.1%, P=0.001, respectively). Excluding a cystectomized case with a diagnosis of muscle-invasive BC, disease progression was not detected in any of the cases with recurrence during follow-up. Therefore, we consider that GPS and serum markers of systemic inflammatory response may be used as predictors of recurrence in patients with transitional cell BC.
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Affiliation(s)
- Ozgur Haki Yuksel
- Department of Urology, Fatih Sultan Mehmet Research and Training Hospital, TR-34752 Istanbul, Turkey
| | - Serkan Akan
- Department of Urology, Fatih Sultan Mehmet Research and Training Hospital, TR-34752 Istanbul, Turkey
| | - Ahmet Urkmez
- Department of Urology, Haydarpasa Numune Research and Training Hospital, TR-34668 Istanbul, Turkey
| | - Caglar Yildirim
- Department of Urology, Fatih Sultan Mehmet Research and Training Hospital, TR-34752 Istanbul, Turkey
| | - Aytac Sahin
- Department of Urology, Fatih Sultan Mehmet Research and Training Hospital, TR-34752 Istanbul, Turkey
| | - Ayhan Verit
- Department of Urology, Fatih Sultan Mehmet Research and Training Hospital, TR-34752 Istanbul, Turkey
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Tovoli F, Negrini G, Bolondi L. Comparative analysis of current guidelines for the treatment of hepatocellular carcinoma. Hepat Oncol 2016; 3:119-136. [PMID: 30191033 PMCID: PMC6095419 DOI: 10.2217/hep-2015-0006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/15/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma is one of the most common malignancies and represents a unique challenge for physicians and patients. Treatment patterns are not uniform between areas despite efforts to promote a common protocol. Even if most hepatologists worldwide adopt the Barcelona Clinic Liver Cancer staging system, Asian and North American physicians are also independently making an effort to expand the indications of each treatment, combining therapies for better outcomes. Also, new therapeutic techniques have emerged and an increasing number of studies are trying to include these paradigm shifts into newer treatment guidelines. Controversial and diverging points in the current international guidelines are emphasized and discussed. Unanswered questions are also analyzed to identify the most needed and promising future perspectives.
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Affiliation(s)
- Francesco Tovoli
- Department of Medical & Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Giulia Negrini
- Department of Medical & Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Luigi Bolondi
- Department of Medical & Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
- *Author for correspondence:
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36
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Deng J, Liang H, Zhang R, Dong Q, Hou Y, Yu J, Fan D, Hao X. Applicability of the methylated CpG sites of paired box 5 (PAX5) promoter for prediction the prognosis of gastric cancer. Oncotarget 2015; 5:7420-30. [PMID: 25277182 PMCID: PMC4202133 DOI: 10.18632/oncotarget.1973] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Paired box gene 5 (PAX5), a member of the paired box gene family, is involved in control of organ development and tissue differentiation. In previous study, PAX5 promoter methylation was found in gastric cancer (GC) cells and tissues. At present study, we found that the inconsistently methylated levels of PAX5 promoter were identified in the different GC tissues. The methylated CpG site count and the methylated statuses of four CpG sites (-236, -183, -162, and -152) were significantly associated with the survival of 460 GC patients, respectively. Ultimately, the methylated CpG -236 was the optimal prognostic predictor of patients identified by using the Cox regression with AIC value calculation. These findings indicated that the methylated CpG -236 of PAX5 promoter has the potential applicability for clinical evaluation the prognosis of GC.
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Affiliation(s)
- Jingyu Deng
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Han Liang
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Rupeng Zhang
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Qiuping Dong
- Central laboratory, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Yachao Hou
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Jun Yu
- Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Chinese University of HongKong, Shatin, HongKong
| | - Daiming Fan
- State Key Laboratory of Cancer Biology and Institute of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xishan Hao
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
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Abstract
Primary liver cancer, mostly hepatocellular carcinoma, remains a difficult-to-treat cancer. Incidence of liver cancer varies geographically and parallels with the geographic prevalence of viral hepatitis. A number of staging systems have been developed, reflecting the heterogeneity of primary liver cancer, regional preferences, and regional variations in resectability or transplant eligibility. Multimodality treatments are available for this heterogeneous malignancy, and there are variations in the management recommendations for liver cancers across specialties and geographic regions. Novel treatment strategies have merged with the advance of new treatment modalities. This work focuses on reviewing the incidence, staging, and treatment of liver cancer.
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Affiliation(s)
- Chun-Yu Liu
- Department of Medicine, Division of Hematology and Oncology, Taipei Veterans General Hospital, Taipei 112, Taiwan School of Medicine, National Yang-Ming University, Taipei 112, Taiwan Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei 112, Taiwan
| | - Kuen-Feng Chen
- Department of Medical Research, National Taiwan University College of Medicine, Taipei 112, Taiwan National Center of Excellence for Clinical Trial and Research, National Taiwan University College of Medicine, Taipei 112, Taiwan
| | - Pei-Jer Chen
- Department of Medical Research, National Taiwan University College of Medicine, Taipei 112, Taiwan National Center of Excellence for Clinical Trial and Research, National Taiwan University College of Medicine, Taipei 112, Taiwan Graduate Institute of Molecular Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 112, Taiwan
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Ku JH, Kim M, Choi WS, Kwak C, Kim HH. Preoperative serum albumin as a prognostic factor in patients with upper urinary tract urothelial carcinoma. Int Braz J Urol 2015; 40:753-62. [PMID: 25615244 DOI: 10.1590/s1677-5538.ibju.2014.06.06] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/06/2014] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The study evaluated whether preoperative measures of the C-reactive protein-systemic inflammatory response may predict cancer survival independent of tumor stage in patients with upper urinary tract urothelial carcinoma (UTUC). MATERIALS AND METHODS Between September 1999 and October 2010, 181 patients submitted to radical nephroureterectomy were available for evaluation. Multivariate survival analyses were performed using Cox's proportional hazards model and the coefficient for each factor was divided by the highest coefficient, multiplied by 4, and rounded to the nearest integer. RESULTS Multivariate analyses showed that tumor location, pathologic T stage, lymphovascular invasion, margin status, and albumin level were independent contributors. The bootstrap-corrected C statistics of the model were 0.813 for disease-specific survival and 0.755 for overall survival, respectively. For time to disease-specific and overall mortality for patients, integrated area under the curve values were 0.792 and 0.739, respectively. When patients were clustered into three groups according to their model-predicted survival, the 5-year disease-specific survival in the low-, intermediate- and high-risk group was 95.4%, 76.2%, and 36.9%, respectively (p<0.001), and were 87.8%, 54.4%, and 31.8%, respectively, for overall survival (p<0.001). Decision curve analysis revealed that the use of model was associated with net benefit gains relative to the treat-all strategy. CONCLUSIONS Pretreatment albumin is a simple biomarker based on routinely available well-standardized measures, and is not an expensive and time-consuming process. Hypoalbuminemia is an independent marker of poor prognosis in patients with upper urinary tract urothelial carcinoma.
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Affiliation(s)
- Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Myong Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Suk Choi
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Hyogo College of Medicine, Japan
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Li B, Li Y, Wang W, Qiu H, Seeruttun SR, Fang C, Chen Y, Liang Y, Li W, Chen Y, Sun X, Guan Y, Zhan Y, Zhou Z. Incorporation of N0 Stage with Insufficient Numbers of Lymph Nodes into N1 Stage in the Seventh Edition of the TNM Classification Improves Prediction of Prognosis in Gastric Cancer: Results of a Single-Institution Study of 1258 Chinese Patients. Ann Surg Oncol 2015; 23:142-8. [DOI: 10.1245/s10434-015-4578-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Indexed: 01/09/2023]
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Gomaa AI, Al-Khatib A, Abdel-Razek W, Hashim MS, Waked I. Ascites and alpha-fetoprotein improve prognostic performance of Barcelona Clinic Liver Cancer staging. World J Gastroenterol 2015; 21:5654-5662. [PMID: 25987792 PMCID: PMC4427691 DOI: 10.3748/wjg.v21.i18.5654] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 12/31/2014] [Accepted: 01/16/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess how ascites and alpha-fetoprotein (AFP) added to the Barcelona Clinic Liver Cancer (BCLC) staging predict hepatocellular carcinoma survival.
METHODS: The presence of underlying cirrhosis, ascites and encephalopathy, Child-Turcotte-Pugh (CTP) score, the number of nodules, and the maximum diameter of the largest nodule were determined at diagnosis for 1060 patients with hepatocellular carcinoma at a tertiary referral center for liver disease in Egypt. Demographic information, etiology of liver disease, and biochemical data (including serum bilirubin, albumin, international normalized ratio, alanine and aspartate aminotransferases, and AFP) were evaluated. Staging of the tumor was determined at the time of diagnosis using the BCLC staging system; 496 patients were stage A and 564 patients were stage B. Patients with mild ascites on initial ultrasound, computed tomography, or clinical examination, and who had a CTP score ≤ 9 were included in this analysis. All patients received therapy according to the recommended treatment based on the BCLC stage, and were monitored from the time of diagnosis to the date of death or date of data collection. The effect of the presence of ascites and AFP level on survival was analyzed.
RESULTS: At the time the data were censored, 123/496 (24.8%) and 218/564 (38.6%) patients with BCLC stages A and B, respectively, had died. Overall mean survival of the BCLC A and B patients during a three-year follow-up period was 31 mo [95% confidence interval (95%CI): 29.7-32.3] and 22.7 mo (95%CI: 20.7-24.8), respectively. The presence of ascites, multiple focal lesions, large tumor size, AFP level and CTP score were independent predictors of survival for the included patients on multivariate analysis (P < 0.001). Among stage A patients, 18% had ascites, 33% had AFP ≥ 200 ng/mL, and 8% had both. Their median survival in the presence of ascites was shorter if AFP was ≥ 200 ng/mL (19 mo vs 24 mo), and in the absence of ascites, patients with AFP ≥ 200 ng/mL had a shorter survival (28 mo vs 39 mo). For stage B patients, survival for the corresponding groups was 12, 18, 19 and 22 mo. The one-, two-, and three-year survival rates for stage A patients without ascites and AFP < 200 ng/mL were 94%, 77%, and 71%, respectively, and for patients with ascites and AFP ≥ 200 ng/mL were 83%, 24%, and 22%, respectively (P < 0.001). Adding ascites and AFP ≥ 200 ng/mL improved the discriminatory ability for predicting prognosis (area under the curve, 0.618 vs 0.579 for BCLC, P < 0.001).
CONCLUSION: Adding AFP and ascites to the BCLC staging classification can improve prognosis prediction for early and intermediate stages of hepatocellular carcinoma.
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Proposal of the performance status combined Japan Integrated Staging system in hepatocellular carcinoma complicated with cirrhosis. Int J Oncol 2015; 46:2371-9. [PMID: 25891119 DOI: 10.3892/ijo.2015.2969] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/30/2015] [Indexed: 11/05/2022] Open
Abstract
The present study examined the prognostic ability of our proposed performance status combined Japan Integrated Staging (PS-JIS) system in hepatocellular carcinoma (HCC) patients with liver cirrhosis (LC) comparing with other four prognostic systems including original JIS system, the Barcelona Clinic Liver Cancer classification system, TNM classification system and the Cancer of the Liver Italian Program (CLIP) scoring system. A total of 1,170 HCC patients complicated with LC were analysed. The disease was staged for all analysed patients by means of the five staging systems. The cumulative overall survival (OS) rate was calculated by Kaplan-Meier method and tested by log-rank test. We also examined prognostic factors associated with OS using univariate and multivariate analyses and compared the prognostic ability in each prognostic system using concordance index (c-index) at 1-, 3- and 5-year time-points. Overall significance in each prognostic system was P<0.001. In the multivariate analyses, tumor number, Child-Pugh classification, PS, initial treatment modality and several laboratory parameters were significant independent predictors linked to OS. For all cases, in each time-point, the c-index of PS-JIS system was the highest among five staging systems (0.847, 0.816 and 0.808, respectively), indicating that PS-JIS system has the best predictability among these staging systems. According to subgroup analyses stratified by initial treatment modality, in patients treated with surgical resection (n=205), CLIP scoring system had the highest c-index at every time-point, whereas in patients treated with percutaneous ablative therapies (n=632) at 3- and 5-year time-point and in those with transcatheter arterial therapies (n=281) at every time-point, the c-index of PS-JIS system was the highest. In conclusion, the proposed PS-JIS score can be a useful prognostic system for HCC patients complicated with liver cirrhosis.
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Deng J, Zhang R, Wu L, Zhang L, Wang X, Liu Y, Hao X, Liang H. Superiority of the Ratio Between Negative and Positive Lymph Nodes for Predicting the Prognosis for Patients With Gastric Cancer. Ann Surg Oncol 2015; 22:1258-1266. [DOI: 10.1245/s10434-014-4121-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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43
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Kinoshita A, Onoda H, Fushiya N, Koike K, Nishino H, Tajiri H. Staging systems for hepatocellular carcinoma: Current status and future perspectives. World J Hepatol 2015; 7:406-424. [PMID: 25848467 PMCID: PMC4381166 DOI: 10.4254/wjh.v7.i3.406] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/08/2014] [Accepted: 12/10/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a major health concern worldwide and the third cause of cancer-related death. Despite advances in treatment as well as careful surveillance programs, the mortality rates in most countries are very high. In contrast to other cancers, the prognosis and treatment of HCC depend on the tumor burden in addition to patient’s underlying liver disease and liver functional reserve. Moreover, there is considerable geographic and institutional variation in both risk factors attributable to the underlying liver diseases and the management of HCC. Therefore, although many staging and/or scoring systems have been proposed, there is currently no globally accepted system for HCC due to the extreme heterogeneity of the disease. The aim of this review is to focus on currently available staging systems as well as those newly reported in the literatures since 2012. Moreover, we describe problems with currently available staging systems and attempts to modify and/or add variables to existing staging systems.
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Deng J, Liang H, Dong Q, Hou Y, Xie X, Yu J, Fan D, Hao X. The survival decrease in gastric cancer is associated with the methylation of B-cell CLL/lymphoma 6 member B promoter. Open Biol 2015; 4:rsob.140067. [PMID: 25008234 PMCID: PMC4118602 DOI: 10.1098/rsob.140067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The methylation of B-cell CLL/lymphoma 6 member B (BCL6B) DNA promoter was detected in several malignancies. Here, we quantitatively detect the methylated status of CpG sites of BCL6B DNA promoter of 459 patients with gastric cancer (GC) by using bisulfite gene sequencing. We show that patients with three or more methylated CpG sites in the BCL6B promoter were significantly associated with poor survival. Furthermore, by using the Akaike information criterion value calculation, we show that the methylated count of BCL6B promoter was identified to be the optimal prognostic predictor of GC patients.
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Affiliation(s)
- Jingyu Deng
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Han Liang
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Qiuping Dong
- Central Laboratory, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Yachao Hou
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Xingming Xie
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Jun Yu
- Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Chinese University of HongKong, Shatin, Hong Kong
| | - Daiming Fan
- State Key Laboratory of Cancer Biology and Institute of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Xishan Hao
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, People's Republic of China
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Deng J, Liang H, Ying G, Zhang R, Wang B, Yu J, Fan D, Hao X. Methylation of CpG sites in RNF180 DNA promoter prediction poor survival of gastric cancer. Oncotarget 2015; 5:3173-83. [PMID: 24833402 PMCID: PMC4102801 DOI: 10.18632/oncotarget.1888] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RNF 180, a novel tumor suppressor, has been implicated in the carcinogenesis and progress of gastric cancer. At present study, we found that lower expression of RNA180 was specific in gastric cancer tissues, and the inconsistently methylated levels of RNF180 promoter were identified in the gastric cancer tissues. Importantly, we demonstrated that the methylated CpG site count and four hypermethylated CpG sites (-116, -80, +97, and +102) were significantly associated with the survival of 400 gastric cancer patients, respectively. With multivariate survival analyses, we demonstrated that both the methylation of combined CpG (-116, -80, +97, and +102) sites and N stage were the independent indictor of prognosis of gastric cancer patients. Eventually, the methylation of combined CpG (-116, -80, +97, and +102) sites was identified to have smaller AIC value than N stage by mean of AIC calculation with the Cox proportional hazards model. These findings indicated that the quantitative detection of RNF180 promoter methylation had the intensive feasibility for evaluation the prognosis of gastric cancer patients in clinic.
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Affiliation(s)
- Jingyu Deng
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
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Chan SL, Johnson PJ, Mo F, Berhane S, Teng M, Chan AWH, Poon MC, Lai PBS, Yu S, Chan ATC, Yeo W. International validation of the Chinese university prognostic index for staging of hepatocellular carcinoma: a joint United Kingdom and Hong Kong study. CHINESE JOURNAL OF CANCER 2014; 33:481-91. [PMID: 25223914 PMCID: PMC4198751 DOI: 10.5732/cjc.014.10133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The outcome of hepatocellular carcinoma (HCC) patients significantly differs between western and eastern population centers. Our group previously developed and validated the Chinese University Prognostic Index (CUPI) for the prognostication of HCC among the Asian HCC patient population. In the current study, we aimed to validate the CUPI using an international cohort of patients with HCC and to compare the CUPI to two widely used staging systems, the Barcelona Clinic Liver Cancer (BCLC) classification and the Cancer of the Liver Italian Program (CLIP). To accomplish this goal, two cohorts of patients were enrolled in the United Kingdom (UK; n = 567; 2006-2011) and Hong Kong (HK; n = 517; 2007-2012). The baseline clinical data were recorded. The performances of the CUPI, BCLC, and CLIP were compared in terms of a concordance index (C-index) and were evaluated in subgroups of patients according to treatment intent. The results revealed that the median follow-up durations of the UK and HK cohorts were 27.9 and 29.8 months, respectively. The median overall survival of the UK and HK cohorts were 22.9 and 8.6 months, respectively. The CUPI stratified the patients in both cohorts into three risk subgroups corresponding to distinct outcomes. The median overall survival of the CUPI low-, intermediate-, and high-risk subgroups were 3.15, 1.24, and 0.29 years, respectively, in the UK cohort and were 2.07, 0.32, and 0.10 years, respectively, in the HK cohort. For the patients who underwent curative treatment, the prognostic performance did not differ between the three staging systems, and all were suboptimal. For those who underwent palliative treatment, the CUPI displayed the highest C-index, indicating that this staging system was the most informative for both cohorts. In conclusion, the CUPI is applicable to both western and eastern HCC patient populations. The performances of the three staging systems differed according to treatment intent, and the CUPI was demonstrated to be optimal for those undergoing palliative treatment. A more precise staging system for early-stage disease patients is required.
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Affiliation(s)
- Stephen L Chan
- State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Deng J, Zhang R, Pan Y, Ding X, Cai M, Liu Y, Liu H, Bao T, Jiao X, Hao X, Liang H. Tumor size as a recommendable variable for accuracy of the prognostic prediction of gastric cancer: a retrospective analysis of 1,521 patients. Ann Surg Oncol 2014; 22:565-72. [PMID: 25155400 DOI: 10.1245/s10434-014-4014-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND It is still controversial whether tumor size (Ts) should be considered an important indicator for evaluation the prognosis of gastric cancer (GC). The purpose of this study was to elucidate the prognostic prediction superiority of Ts in the large-scale cohort of GC patients. METHODS Data from 1,521 patients who underwent the curative resection were analyzed for demonstration the prognostic value of Ts. In addition, a tumor size-node-metastasis (TsNM) classification system was proposed to evaluate the comparative superiorities of the prognostic prediction of GC patients. RESULTS With the univariate and multivariate analyses, Ts was identified as an independently prognostic predictor of GC patients, as was T stage. Ts was demonstrated to have smaller Akaike information criterion and Bayesian Information Criterion values within the Cox regression analyses than shown by T stage, which represented the optimum prognostic stratification. TsNM classification was also found to be competent for accurately prognostic evaluation of GC patients. The matched case-control logistic regression showed that TsNM classification could provide very powerful discriminations of patients' overall survival, compared with TNM classification. Additionally, Ts stage was found to enhance the survival discriminations in patients with certain clinicopathological characteristics, including male gender, T4a stage, N0 stage, diffuse type of Lauren classification, or age ≤60 years. CONCLUSIONS Ts should be recommended as an important clinicopathologic variable to enhance the accuracy of the prognostic prediction of GC clinical patients.
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Affiliation(s)
- Jingyu Deng
- Department of Gastric Cancer Surgery, National Clinical Research Center for Cancer, City Key Laboratory of Tianjin Cancer Center, Tianjin Medical University Cancer Hospital, Tianjin, China
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Cohen MJ, Levy I, Barak O, Bloom AI, Fernández-Ruiz M, Di Maio M, Perrone F, Poon RT, Shouval D, Yau T, Shibolet O. Trans-arterial chemo-embolization is safe and effective for elderly advanced hepatocellular carcinoma patients: results from an international database. Liver Int 2014; 34:1109-17. [PMID: 24512125 DOI: 10.1111/liv.12486] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 02/01/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC) incidence among elderly patients is increasing. Trans-arterial chemo-embolization (TACE) prolongs survival in selected HCC patients. The safety and efficacy of TACE in elderly patients has not been extensively studied. The objective of this study was to assess the safety and efficacy of TACE in elderly patients (older than 75) with HCC. DESIGN Combined HCC registries (Spain, Italy, China and Israel) and cohort design analysis of patients who underwent TACE for HCC. RESULTS Five hundred and forty-eight patients diagnosed and treated between 1988 and 2010 were included in the analysis (China 197, Italy 155, Israel 102 and Spain 94,). There were 120 patients (22%) older than 75 years and 47 patients (8.6%) older than 80. Median (95% CI) survival estimates were 23 (17-28), 21 (17-26) and 19 (15-23) months (P=0.14) among patients aged younger than 65, 65-75 and older than 75 respectively. An age above 75 years at diagnosis was not associated with worse prognosis, hazard ratio of 1.05 (95% CI 0.75-1.5), controlling for disease stage, sex, diagnosis year, HBV status and stratifying per database. No differences in complication rates were found between the age groups. CONCLUSIONS TACE is safe for patients older than 75 years. Results were similar over different eras and geographical locations. Though selection bias is inherent, the results suggest overall adequate selection of patients, given the similar outcomes among the different age groups.
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Affiliation(s)
- Matan J Cohen
- Division of Internal Medicine and Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Deng J, Liang H, Ying G, Dong Q, Zhang L, Yu J, Fan D, Hao X. Clinical significance of the methylated cytosine-phosphate-guanine sites of protocadherin-10 promoter for evaluating the prognosis of gastric cancer. J Am Coll Surg 2014; 219:904-13. [PMID: 25260683 DOI: 10.1016/j.jamcollsurg.2014.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/23/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Protocadherin-10 (PCDH10) has been identified as a tumor suppressor gene in multiple carcinomas. In this study, we intended to elucidate the clinical applicability of the methylation of CpG sites of PCDH10 promoter for prognostic prediction in gastric cancer (GC). STUDY DESIGN Qualitative and quantitative detections of PCDH10 promoter methylation were performed with methylation-specific polymerase chain reaction (MSP) and bisulphite genomic sequencing, respectively. The methylated statuses of 27 cytosine-phosphate-guanine (CpG) sites in PCDH10 promoter were detected in a series of 458 GC tissues to supply precise information of prognostic prediction. Associations between molecular, clinicopathologic, and survival data were analyzed. RESULTS Protocadherin-10 promoter methylation was found in 91.92% in all patients. Gastric cancer patients with 5 or more methylated CpG sites of PCDH10 promoter was significantly associated with poorer survival (p = 0.038). Meanwhile, methylation of combined CpG (-115, -108, -13, and +3) sites was also identified to provide elaborate survival discrimination for GC patients (p = 0.044). On multivariate survival analysis, methylation of combined CpG (-115, -108, -13, and +3) sites (hazard ratio [HR] = 1.255; p = 0.049) was identified to be an independent prognostic indicator of GC, as were N stage and T stage. Additionally, the methylation of combined CpG (-115, -108, -13, and +3) sites had smaller Akaike information criterion (AIC) and Bayesian information criterion (BIC) values than the other 2 independent predictors of the survival. Ultimately, we demonstrated that the methylation of combined CpG (-115, -108, -13, and +3) sites was negatively associated with PCDH10 expression in GC tissues. CONCLUSIONS The methylated CpG sites of PCDH10 promoter had significant applicability for clinical evaluation of the prognosis of GC.
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Affiliation(s)
- Jingyu Deng
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Han Liang
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Guoguang Ying
- Central Laboratory, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Qiuping Dong
- Central Laboratory, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Li Zhang
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Jun Yu
- Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daiming Fan
- State Key Laboratory of Cancer Biology and Institute of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xishan Hao
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China.
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Fong ZV, Tanabe KK. The clinical management of hepatocellular carcinoma in the United States, Europe, and Asia: A comprehensive and evidence-based comparison and review. Cancer 2014; 120:2824-38. [DOI: 10.1002/cncr.28730] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/18/2014] [Accepted: 03/21/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Zhi Ven Fong
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - Kenneth K. Tanabe
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
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