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Fan W, Zhu B, Chen S, Wu Y, Zhao X, Qiao L, Huang Z, Tang R, Chen J, Lau WY, Chen M, Li J, Kuang M, Peng Z. Survival in Patients With Recurrent Intermediate-Stage Hepatocellular Carcinoma: Sorafenib Plus TACE vs TACE Alone Randomized Clinical Trial. JAMA Oncol 2024:2820216. [PMID: 38900435 PMCID: PMC11190833 DOI: 10.1001/jamaoncol.2024.1831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/29/2023] [Indexed: 06/21/2024]
Abstract
Importance Transarterial chemoembolization (TACE) is commonly used to treat patients with recurrent intermediate-stage hepatocellular carcinoma (HCC) and positive microvascular invasion (MVI); however, TACE alone has demonstrated unsatisfactory survival benefits. A previous retrospective study suggested that TACE plus sorafenib (SOR-TACE) may be a better therapeutic option compared with TACE alone. Objective To investigate the clinical outcomes of SOR-TACE vs TACE alone for patients with recurrent intermediate-stage HCC after R0 hepatectomy with positive MVI. Design, Setting, and Participants In this phase 3, open-label, multicenter randomized clinical trial, patients with recurrent intermediate-stage HCC and positive MVI were randomly assigned in a 1:1 ratio via a computerized minimization technique to either SOR-TACE treatment or TACE alone. This trial was conducted at 5 hospitals in China, and enrolled patients from October 2019 to December 2021, with a follow-up period of 24 months. Data were analyzed from June 2023 to September 2023. Interventions Randomization to on-demand TACE (conventional TACE: doxorubicin, 50 mg, mixed with lipiodol and gelatin sponge particles [diameter: 150-350 μm]; drug-eluting bead TACE: doxorubicin, 75 mg, mixed with drug-eluting particles [diameter: 100-300 μm or 300-500 μm]) (TACE group) or sorafenib, 400 mg, twice daily plus on-demand TACE (SOR-TACE group) (conventional TACE: doxorubicin, 50 mg, mixed with lipiodol and gelatin sponge particles [diameter, 150-350 μm]; drug-eluting bead TACE: doxorubicin, 75 mg, mixed with drug-eluting particles [diameter: 100-300 μm or 300-500 μm]). Main Outcomes and Measures The primary end point was overall survival by intention-to-treat analysis. Safety was assessed in patients who received at least 1 dose of study treatment. Results A total of 162 patients (median [range] age, 55 [28-75] years; 151 males [93.2%]), were randomly assigned to be treated with either SOR-TACE (n = 81) or TACE alone (n = 81). The median overall survival was significantly longer in the SOR-TACE group than in the TACE group (22.2 months vs 15.1 months; hazard ratio [HR], 0.55; P < .001). SOR-TACE also prolonged progression-free survival (16.2 months vs 11.8 months; HR, 0.54; P < .001), and improved the objective response rate when compared with TACE alone based on the modified Response Evaluation Criteria in Solid Tumors criteria (80.2% vs 58.0%; P = .002). Any grade adverse events were more common in the SOR-TACE group, but all adverse events responded well to treatment. No unexpected adverse events or treatment-related deaths occurred in this study. Conclusions and Relevance The results of this randomized clinical trial demonstrated that SOR-TACE achieved better clinical outcomes than TACE alone. These findings suggest that combined treatment should be used for patients with recurrent intermediate-stage HCC after R0 hepatectomy with positive MVI. Trial Registration ClinicalTrials.gov Identifier: NCT04103398.
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Affiliation(s)
- Wenzhe Fan
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bowen Zhu
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuling Chen
- Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanqin Wu
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao Zhao
- Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liangliang Qiao
- Department of Interventional Oncology, Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhen Huang
- Department of Interventional Angiology, Huizhou First People’s Hospital, Huizhou, China
| | - Rong Tang
- Department of Hepatopancreatobiliary Surgery, Hainan General Hospital, Haikou, China
| | - Jinghua Chen
- Cancer Center, Guangzhou Twelfth People’s Hospital, Guangzhou, China
| | - Wan Yee Lau
- Faculty of Medicine, the Chinese University of Hong Kong, Prince of Wale Hospital, Shatin, New Territories, Hongkong, SAR, China
| | - Minshan Chen
- Department of Liver Surgery, Cancer Center of Sun Yat-sen University, Guangzhou, China
| | - Jiaping Li
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ming Kuang
- Center of Hepato-PancreatoBiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhenwei Peng
- Cancer Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Lee J, Jin YJ, Shin SK, Kwon JH, Kim SG, Yu JH, Lee JW, Kwon OS, Nahm SW, Kim YS. Clinical outcomes of transarterial chemoembolization in Child-Turcotte Pugh class A patients with a single small (≤3 cm) hepatocellular carcinoma. J Gastroenterol Hepatol 2024. [PMID: 38711168 DOI: 10.1111/jgh.16581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/09/2024] [Accepted: 03/31/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND AND AIM Transarterial chemoembolization (TACE) is one of the standard modalities used to treat unresectable hepatocellular carcinoma (HCC), but the effectiveness of TACE for treating patients with a solitary small (≤3 cm) HCC and well-preserved liver function has not been definitively established. This study aimed to determine the therapeutic impact of TACE in patients with these characteristics. METHODS This multicenter (four university hospitals) retrospective cohort study analyzed the medical records of 250 patients with a solitary small (≤3 cm) HCC and Child-Turcotte-Pugh (CTP) class A liver function diagnosed over 10 years. Posttreatment outcomes, including overall survival (OS), recurrence-free survival (RFS), and adverse events, were assessed following TACE therapy. RESULTS One hundred and thirty-eight of the 250 patients (55.2%) treated with TACE achieved complete remission (CR). Overall median OS was 77.7 months, and median OS was significantly longer in the CR group than in the non-CR group (89.1 vs. 58.8 months, P = 0.001). Median RFS was 19.1 months in the CR group. Subgroup analysis identified hypertension, an elevated serum albumin level, and achieving CR as significant positive predictors of OS, whereas diabetes, hepatitis c virus infection, and tumor size (>2 cm) were poor prognostic factors of OS. CONCLUSIONS The study demonstrates the effectiveness of TACE as a viable alternative for treating solitary small (≤3 cm) HCC in CTP class A patients.
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Affiliation(s)
- Jungnam Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Young-Joo Jin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jung Hyun Kwon
- Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, South Korea
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea
| | - Jung Hwan Yu
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Soon Woo Nahm
- Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, South Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea
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Young S, Sanghvi T, Ragulojan R, Torkian P, Todatry S, D'Souza D, Flanagan S, Golzarian J. Local recurrence following a complete radiologic response in hepatocellular carcinoma patients: comparison of transarterial chemoembolisation and transarterial radioembolisation. Clin Radiol 2024; 79:371-377. [PMID: 38341344 DOI: 10.1016/j.crad.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
AIM To evaluate and compare the rates of local recurrence in hepatocellular carcinoma (HCC) patients who undergo selective transarterial radioembolisation (TARE) or transarterial chemoembolisation (TACE) and achieve a complete response (CR) radiologically. MATERIALS AND METHODS All patients undergoing treatment with TARE or TACE at a single academic institution were reviewed retrospectively. Those who had been treated previously, presented with multifocal disease, had non-selective TARE or TACE, or did not achieve a complete response (CR) radiologically were excluded. RESULTS In total 110 patients were included (TACE n=60 [54.5%]; TARE n=50 [45.5%]). TARE patients were older (66.4 ± 9.4 versus 61.2 ± 5.6 years, p<0.001) and had larger tumours (4.4 ± 2.2 versus 3 ± 1.4 cm, p=0.002). TACE patients were significantly more likely to suffer a local recurrence (31/60, 51.7% versus 9/50, 18%, p<0.001) and had a significantly shorter time to recurrence (median 8.3 {interquartile range [IQR]}: 12 versus median 17.9 [IQR: 23.5] months, p=0.001). A local time to progression (TTP) Kaplan-Meier curve demonstrated TACE patients had a significantly shorter local TTP (hazard ratio [HR]: 7.2; 95% confidence interval [CI]: 3.64-14.24; p<0.001) and treatment modality (TACE or TARE; HR: 0.05; 95% CI: 0.005-0.5; p=0.01) was found to be associated with local recurrences on multivariate Cox proportional HR analysis. When overall TTP was evaluated, again TACE patients were found to have a significantly shorter TTP (HR: 2.13 [1.28-3.53], p=0.004). CONCLUSION In HCC patients undergoing selective treatment who achieve a CR radiologically, those treated with TARE may be less likely to suffer recurrence, either local or general, than those treated with TACE.
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Affiliation(s)
- S Young
- Department of Radiology, University of Arizona, Division of Interventional Radiology, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724, USA.
| | - T Sanghvi
- Minneapolis VA Hospital, 1 Veterans Dr, Minneapolis, MN 55417, USA
| | - R Ragulojan
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - P Torkian
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - S Todatry
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - D D'Souza
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - S Flanagan
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - J Golzarian
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
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Hu Z, Wang X, Fu Y, Yang D, Zhou Z, Chen M, Song X, Zhang Y. Survival benefit of liver resection following complete response to transarterial chemoembolization for intermediate-stage hepatocellular carcinoma: a retrospective, multicenter, cohort study. Int J Surg 2024; 110:1019-1027. [PMID: 38006301 PMCID: PMC10871594 DOI: 10.1097/js9.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND High rate of tumor recurrence jeopardized the long-term survival of hepatocellular carcinoma (HCC) patients with complete response to transarterial chemoembolization (TACE). This study aims to evaluate the survival benefit of liver resection (LR) following the complete response to TACE for intermediate-stage HCC. METHODS A total of 281 intermediate-stage HCC patients with complete response to TACE followed by persistent observation (TACE group) or LR (TLR group) from 01 January 2011 to 31 December 2021 from three institutions in China were included. Overall survival (OS) and disease-free survival (DFS) of patients were compared between the two groups by propensity score-matching (PSM). RESULTS After PSM, the 1-year, 3-year, and 5-year OS rates were 91.4, 71.5, and 57.1% in the TACE group, and 96.6, 81.8, and 72.1% in the TLR group. The 1-year, 3-year, and 5-year DFS rates were 50.6, 22.6, and 6.8% in the TACE group, and 77.3, 56.3, and 38.7% in the TLR group. Compared with the TACE group, the TLR group showed significantly longer OS (HR, 0.528; 95% CI: 0.315-0.887; P =0.014) and DFS (HR, 0.388; 95% CI: 0.260-0.580; P <0.001). In patients beyond up-to-seven criterion, no difference was observed with OS (HR, 0.708; 95% CI: 0.354-1.419; P =0.329). LR following the complete response to TACE was safety. CONCLUSIONS This study suggests that intermediate-stage HCC patients could benefit from LR following the complete response to TACE, resulting in longer OS and DFS. In addition, patients beyond up-to-seven could not benefit from the LR treatments.
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Affiliation(s)
- Zili Hu
- Department of Liver Surgery
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Xiaohui Wang
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University) Changsha
| | - Yizhen Fu
- Department of Liver Surgery
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Dinghua Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Jishou University, Jishou, People’s Republic of China
| | - Zhongguo Zhou
- Department of Liver Surgery
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Minshan Chen
- Department of Liver Surgery
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Xin Song
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Jishou University, Jishou, People’s Republic of China
| | - Yaojun Zhang
- Department of Liver Surgery
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou
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Asano K, Kageyama K, Yamamoto A, Jogo A, Uchida-Kobayashi S, Sohgawa E, Murai K, Kawada N, Miki Y. Transcatheter Arterial Chemoembolization for Treatment-Naive Hepatocellular Carcinoma Has Different Treatment Effects Depending on Central or Peripheral Tumor Location. Liver Cancer 2023; 12:576-589. [PMID: 38058422 PMCID: PMC10697731 DOI: 10.1159/000530441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/27/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction The purpose of this study was to evaluate the treatment efficacy of transcatheter arterial chemoembolization (TACE) for treatment-naive hepatocellular carcinoma (HCC) according to tumor location and burden. Methods Between 2010 and 2019, consecutive patients who underwent TACE as the first treatment were enrolled. Tumors were classified into two categories based on their location, as central or peripheral tumors. Tumors in the central zone, which is within 1 cm of the main trunk or the first branch of the portal vein, were classified as central tumors, while those located in the peripheral zone were classified as peripheral tumors. Patients were grouped according to the HCC location and up-to-7 criteria. Patients with central tumors were classified into the central arm and those with only peripheral tumors were classified into the peripheral arm. Patients within and beyond the up-to-7 criteria were classified into the up-to-7 in and up-to-7 out-groups, respectively. Local recurrence-free survival (LRFS) and progression-free survival (PFS) were compared per nodule (central tumor vs. peripheral tumor) and per patient (central arm vs. peripheral arm), respectively. The prognostic factors of LRFS and PFS were analyzed by univariate and multivariate analyses. Results A total of 174 treatment-naive patients with 352 HCCs were retrospectively enrolled. Ninety-six patients and 130 lesions were selected by propensity score matching. Median LRFS was longer for peripheral tumors than central tumors (not reached vs. 3.3 months, p < 0.001). Median PFS was 17.1 months (8.3-24.9) in the peripheral arm and up-to-7 in, 7.0 months (3.3-12.7) in the peripheral arm and up-to-7 out, 8.4 months (4.0-12.6) in the central arm and up-to-7 in, and 3.0 months (1.2-4.9) in the central arm and up-to-7 out-groups. The peripheral arm and up-to-7 in-groups had significantly longer PFS than the other three groups (p = 0.013, p = 0.015, p < 0.001, respectively). Multivariate analysis confirmed that the central zone and central arm were associated with high adjusted hazard ratios for tumor recurrence or death (2.87, p < 0.001; 2.89, p < 0.001, respectively). Conclusion Treatment-naive HCCs in the peripheral zone had a longer LRFS and PFS following TACE compared to those in the central zone.
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Affiliation(s)
- Kazuo Asano
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Ken Kageyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Atsushi Jogo
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Sawako Uchida-Kobayashi
- Department of Premier Preventive Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Etsuji Sohgawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kazuki Murai
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Norifumi Kawada
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Gwon DI, Kim GH, Chu HH, Kim JH, Ko GY, Yoon HK. Local Recurrence following Radiological Complete Response in Patients Treated with Subsegmental Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:4991. [PMID: 37894358 PMCID: PMC10605316 DOI: 10.3390/cancers15204991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
The aim of this study was to determine the local recurrence (LR) rate and identify factors associated with LR in patients who achieve a radiological complete response (CR) after undergoing balloon-occluded transcatheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC). From November 2017 to September 2021, 60 patients (44 men, 16 women; mean age, 63.5 years; range, 39-82 years) with 72 HCCs (mean diameter, 31 mm; range, 10-50 mm) who underwent subsegmental B-TACE were included in this retrospective study. Radiological and clinical evaluation of oily subsegmentectomy, defined as radiological CR of the HCC and peritumoral parenchymal necrosis, was performed. The CR rate was 97.2% (70 of 72 HCCs) at first follow-up (mean, 41 days; range, 14-110 days). Overall, 13 HCCs (19.7%) demonstrated LR at a mean of 29.8 months (range, 3-63 months) and cumulative LR rates were 1.5% 14.2% 21%, 21%, and 21% at 6, 12, 24, 36, and 48 months, respectively. In 28 (38.9%) of 72 HCCs, oily subsegmentectomy was achieved, tumor markers were normalized, and LR did not occur. The oily subsegmentectomy-positive group had a significantly lower LR rate than the oily subsegmentectomy-negative group (p = 0.001). Age ≥65 years (adjusted hazard ration (HR), 0.124; 95% confidence interval (CI), 0.037-0.412; p < 0.001) and peripheral location (adjusted HR, 0.112; 95% CI, 0.046-0.272; p < 0.001) were independent predictive factors of LR. Subsegmental B-TACE can be an effective method with a high initial CR rate and low LR incidence. Oily subsegmentectomy can be considered as an index of successful treatment because it did not demonstrate any LR.
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Affiliation(s)
- Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea; (G.H.K.); (H.H.C.); (J.H.K.); (G.-Y.K.); (H.-K.Y.)
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Prateepchaiboon T, Chang A, Pungpipattrakul N, Akarapatima K, Rattanasupar A, Songjamrat A, Pakdeejit S, Piratvisuth T. Factors affecting prognosis in hepatocellular carcinoma patients post-transarterial chemoembolization. Indian J Gastroenterol 2022; 41:352-361. [PMID: 36029371 DOI: 10.1007/s12664-021-01227-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND To evaluate the factors influencing the achievement of a sustained complete response (CR) and overall survival (OS) in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). METHODS We retrospectively reviewed the records of HCC patients who underwent TACE as the first modality of treatment between 2014 and 2019. We investigated the factors affecting sustained CR (no recurrence within 6 months) and OS (time from diagnosis until either death or last follow-up). RESULTS The study enrolled 161 patients; 159 (98.8%) had cirrhosis. Post-TACE, 19.9% (32/161) achieved sustained CR. In the multivariate analysis, a tumor size < 5 cm was a positive factor for achieving sustained CR (odds ratio, 5.012; p = 0.006). In the proportional hazards model, the factors associated with decreased survival included alcohol-related liver disease (hazards ratio [HR] 1.683; p = 0.036), presence of symptoms (HR 1.816; p = 0.005) and portal hypertension (HR 1.608; p = 0.038) at initial diagnosis, serum alpha-fetoprotein (AFP) > 100 ng/mL (HR 2.082; p < 0.001), and higher Child-Pugh classification (HR 1.1.639; p = 0.024). Achievement of sustained CR (HR, 0.355; p = 0.002) was independently associated with increased survival. CONCLUSIONS The tumor size was a predictive factor for sustained CR. Alcohol-related liver disease, presence of symptoms and portal hypertension at initial diagnosis, elevated serum AFP, liver reserve status, and achieved sustained CR were independent factors affecting survival. We demonstrated the effect of alcohol-related liver disease on survival after TACE. Our results will aid physicians in the management and prognostication of HCC.
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Affiliation(s)
| | - Arunchai Chang
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand.
| | | | - Keerati Akarapatima
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand
| | - Attapon Rattanasupar
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand
| | - Apiradee Songjamrat
- Division of Intervention Radiology, Department of Radiology, Hatyai Hospital, Songkhla, Thailand
| | - Songklod Pakdeejit
- Division of Intervention Radiology, Department of Radiology, Hatyai Hospital, Songkhla, Thailand
| | - Teerha Piratvisuth
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkhla University, Songkhla, Thailand
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Tischfield DJ, Gurevich A, Johnson O, Gatmaytan I, Nadolski GJ, Soulen MC, Kaplan DE, Furth E, Hunt SJ, Gade TPF. Transarterial Embolization Modulates the Immune Response within Target and Nontarget Hepatocellular Carcinomas in a Rat Model. Radiology 2022; 303:215-225. [PMID: 35014906 PMCID: PMC8962821 DOI: 10.1148/radiol.211028] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 12/24/2022]
Abstract
Background Transarterial embolization (TAE) is the most common treatment for hepatocellular carcinoma (HCC); however, there remain limited data describing the influence of TAE on the tumor immune microenvironment. Purpose To characterize TAE-induced modulation of the tumor immune microenvironment in a rat model of HCC and identify factors that modulate this response. Materials and Methods TAE was performed on autochthonous HCCs induced in rats with use of diethylnitrosamine. CD3, CD4, CD8, and FOXP3 lymphocytes, as well as programmed cell death protein ligand-1 (PD-L1) expression, were examined in three cohorts: tumors from rats that did not undergo embolization (control), embolized tumors (target), and nonembolized tumors from rats that had a different target tumor embolized (nontarget). Differences in immune cell recruitment associated with embolic agent type (tris-acryl gelatin microspheres [TAGM] vs hydrogel embolics) and vascular location were examined in rat and human tissues. A generalized estimating equation model and t, Mann-Whitney U, and χ2 tests were used to compare groups. Results Cirrhosis-induced alterations in CD8, CD4, and CD25/CD4 lymphocytes were partially normalized following TAE (CD8: 38.4%, CD4: 57.6%, and CD25/CD4: 21.1% in embolized liver vs 47.7% [P = .02], 47.0% [P = .01], and 34.9% [P = .03], respectively, in cirrhotic liver [36.1%, 59.6%, and 4.6% in normal liver]). Embolized tumors had a greater number of CD3, CD4, and CD8 tumor-infiltrating lymphocytes relative to controls (191.4 cells/mm2 vs 106.7 cells/mm2 [P = .03]; 127.8 cells/mm2 vs 53.8 cells/mm2 [P < .001]; and 131.4 cells/mm2 vs 78.3 cells/mm2 [P = .01]) as well as a higher PD-L1 expression score (4.1 au vs 1.9 au [P < .001]). A greater number of CD3, CD4, and CD8 lymphocytes were found near TAGM versus hydrogel embolics (4.1 vs 2.0 [P = .003]; 3.7 vs 2.0 [P = .01]; and 2.2 vs 1.1 [P = .03], respectively). The number of lymphocytes adjacent to embolics differed based on vascular location (17.9 extravascular CD68+ peri-TAGM cells vs 7.0 intravascular [P < .001]; 6.4 extravascular CD68+ peri-hydrogel embolic cells vs 3.4 intravascular [P < .001]). Conclusion Transarterial embolization-induced dynamic alterations of the tumor immune microenvironment are influenced by underlying liver disease, embolic agent type, and vascular location. © RSNA, 2022 Online supplemental material is available for this article. See also the editorials by Kennedy et al and by White in this issue.
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Affiliation(s)
| | | | - Omar Johnson
- From the Penn Image-Guided Interventions Laboratory (D.J.T., A.G.,
O.J., I.G., G.J.N., S.J.H., T.P.F.G.), Department of Radiology (D.J.T., O.J.,
G.J.N., M.C.S., S.J.H., T.P.F.G.), and Department of Pathology (E.F.), Hospital
of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104;
Division of Gastroenterology and Hepatology (D.E.K.) and Department of Cancer
Biology (T.P.F.G.), Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, Pa; and Gastroenterology Section, Corporal Michael
J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pa (D.E.K.)
| | - Isabela Gatmaytan
- From the Penn Image-Guided Interventions Laboratory (D.J.T., A.G.,
O.J., I.G., G.J.N., S.J.H., T.P.F.G.), Department of Radiology (D.J.T., O.J.,
G.J.N., M.C.S., S.J.H., T.P.F.G.), and Department of Pathology (E.F.), Hospital
of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104;
Division of Gastroenterology and Hepatology (D.E.K.) and Department of Cancer
Biology (T.P.F.G.), Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, Pa; and Gastroenterology Section, Corporal Michael
J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pa (D.E.K.)
| | - Gregory J. Nadolski
- From the Penn Image-Guided Interventions Laboratory (D.J.T., A.G.,
O.J., I.G., G.J.N., S.J.H., T.P.F.G.), Department of Radiology (D.J.T., O.J.,
G.J.N., M.C.S., S.J.H., T.P.F.G.), and Department of Pathology (E.F.), Hospital
of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104;
Division of Gastroenterology and Hepatology (D.E.K.) and Department of Cancer
Biology (T.P.F.G.), Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, Pa; and Gastroenterology Section, Corporal Michael
J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pa (D.E.K.)
| | - Michael C. Soulen
- From the Penn Image-Guided Interventions Laboratory (D.J.T., A.G.,
O.J., I.G., G.J.N., S.J.H., T.P.F.G.), Department of Radiology (D.J.T., O.J.,
G.J.N., M.C.S., S.J.H., T.P.F.G.), and Department of Pathology (E.F.), Hospital
of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104;
Division of Gastroenterology and Hepatology (D.E.K.) and Department of Cancer
Biology (T.P.F.G.), Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, Pa; and Gastroenterology Section, Corporal Michael
J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pa (D.E.K.)
| | - David E. Kaplan
- From the Penn Image-Guided Interventions Laboratory (D.J.T., A.G.,
O.J., I.G., G.J.N., S.J.H., T.P.F.G.), Department of Radiology (D.J.T., O.J.,
G.J.N., M.C.S., S.J.H., T.P.F.G.), and Department of Pathology (E.F.), Hospital
of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104;
Division of Gastroenterology and Hepatology (D.E.K.) and Department of Cancer
Biology (T.P.F.G.), Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, Pa; and Gastroenterology Section, Corporal Michael
J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pa (D.E.K.)
| | - Emma Furth
- From the Penn Image-Guided Interventions Laboratory (D.J.T., A.G.,
O.J., I.G., G.J.N., S.J.H., T.P.F.G.), Department of Radiology (D.J.T., O.J.,
G.J.N., M.C.S., S.J.H., T.P.F.G.), and Department of Pathology (E.F.), Hospital
of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104;
Division of Gastroenterology and Hepatology (D.E.K.) and Department of Cancer
Biology (T.P.F.G.), Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, Pa; and Gastroenterology Section, Corporal Michael
J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pa (D.E.K.)
| | - Stephen J. Hunt
- From the Penn Image-Guided Interventions Laboratory (D.J.T., A.G.,
O.J., I.G., G.J.N., S.J.H., T.P.F.G.), Department of Radiology (D.J.T., O.J.,
G.J.N., M.C.S., S.J.H., T.P.F.G.), and Department of Pathology (E.F.), Hospital
of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104;
Division of Gastroenterology and Hepatology (D.E.K.) and Department of Cancer
Biology (T.P.F.G.), Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, Pa; and Gastroenterology Section, Corporal Michael
J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pa (D.E.K.)
| | - Terence P. F. Gade
- From the Penn Image-Guided Interventions Laboratory (D.J.T., A.G.,
O.J., I.G., G.J.N., S.J.H., T.P.F.G.), Department of Radiology (D.J.T., O.J.,
G.J.N., M.C.S., S.J.H., T.P.F.G.), and Department of Pathology (E.F.), Hospital
of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104;
Division of Gastroenterology and Hepatology (D.E.K.) and Department of Cancer
Biology (T.P.F.G.), Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, Pa; and Gastroenterology Section, Corporal Michael
J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pa (D.E.K.)
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9
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Local recurrence following complete radiologic response in patients treated with transarterial chemoembolization for hepatocellular carcinoma. Diagn Interv Imaging 2022; 103:143-149. [PMID: 35115276 DOI: 10.1016/j.diii.2022.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to determine the local progression rate and identify factors that may predict local progression, in patients who achieve a complete response (CR) radiologically after undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS One-hundred-forty-seven patients, who achieved CR of 224 HCCs after TACE, were retrospectively reviewed. There were 109 men and 38 women with a mean age of 61.6 ± 6.8 (SD) years (range: 45.4-86.9 years). Logistic mixed-effects and Cox regression models were used to evaluate associations between clinical factors and local progression. RESULTS A total of 75 patients (75/147; 51%) and 99 (99/224,44.2%) lesions showed local progression at a median of 289.5 days (Q1: 125, Q3: 452; range: 51-2245 days). Pre-treatment, international normalization ratio (INR) (1.17 ± 0.15 [SD] vs. 1.25 ± 0.16 [SD]; P <0.001), model for end-stage liver disease (9.4 ± 2.6 [SD] vs. 10.6 ± 3.2 [SD]; P = 0.010) and Child-Pugh score (6 ± 1 [SD] vs. 6.4 ± 1.3 [SD]; P = 0.012) were significantly lower while albumin serum level (3.4 ± 0.62 [SD] vs. 3.22 ± 0.52 [SD]; P = 0.033) was significantly greater in those who showed local progression as compared to those who did not. In terms of local-recurrence free survival, the number of TACE treatments (hazard ratio [HR]: 2.05 [95% CI: 1.57-2.67]; P<0.001), INR (HR: 0.13 [95% CI: 0.03-0.61]; P = 0.010) and type of TACE (P = 0.003) were significant. Patients with local progression on any tumor did not differ from those who did in terms of overall survival (P = 0.072), however, were less likely to be transplanted (20/75, 26.7%) than those who did not (33/72; 36.1%) (P = 0.016). CONCLUSION A significant number of patients who achieve CR of HCC after TACE have local progression. This emphasizes the importance of long-term follow up.
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10
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Cortes AC, Nishiofuku H, Polak U, Minhaj AA, Lopez MS, Kichikawa K, Qayyum A, Whitley EM, Avritscher R. Effect of bead size and doxorubicin loading on tumor cellular injury after transarterial embolization and chemoembolization in a rat model of hepatocellular carcinoma. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2022; 39:102465. [PMID: 34571240 PMCID: PMC9206412 DOI: 10.1016/j.nano.2021.102465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/08/2021] [Accepted: 09/01/2021] [Indexed: 01/03/2023]
Abstract
Embolic agents used in transarterial embolization for intermediate stage hepatocellular carcinoma reduce blood flow into tumors and can deliver anticancer drugs. Tumor blood supply can be interrupted using doxorubicin-eluting beads (DEB-TACE) or non-loaded beads (TAE) of different calibers. In this preclinical study, we characterized the extent of remaining stressed tumor cells after treatment, hypoxia within the surviving tumor regions, and inflammatory immune cell infiltrates after embolization with 40-60 or 70-150 μm with non-loaded or doxorubicin-loaded beads at 3 and 7 days after treatment. TAE-treated tumors had more stressed and surviving tumor cells after 3 days, irrespective of bead size, compared with DEB-TACE-treated tumors. Hypoxic stress of residual cells increased after treatment with 70-150 μm beads without or with doxorubicin. Treatment with DEB-TACE of 70-150 μm resulted in increased inflammation and proliferation in the adjacent parenchyma. Inflammatory cell infiltrates were reduced at the periphery of tumors treated with 40-60 μm DEB-TACE.
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Affiliation(s)
- Andrea C Cortes
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hideyuki Nishiofuku
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX,Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Urszula Polak
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Adeeb A Minhaj
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mirtha S Lopez
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kimihiko Kichikawa
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Aliya Qayyum
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth M. Whitley
- Department of Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rony Avritscher
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX,Corresponding author at: Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX. (R. Avritscher)
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11
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Akarapatima K, Chang A, Prateepchaiboon T, Pungpipattrakul N, Songjamrat A, Pakdeejit S, Rattanasupar A, Piratvisuth T. Predictive Outcomes Using Child-Turcotte-Pugh and Albumin-Bilirubin Scores in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization. J Gastrointest Cancer 2021; 53:1006-1013. [PMID: 34761340 DOI: 10.1007/s12029-021-00743-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION We assessed the ability of the Child-Turcotte-Pugh score and the albumin-bilirubin grade to predict the outcomes of hepatocellular carcinoma (HCC) in patients treated with transarterial chemoembolization. METHODS We retrospectively assessed 158 patients with HCC who underwent transarterial chemoembolization. The ability of the Child-Turcotte-Pugh score and the albumin-bilirubin grade to predict patient survival was assessed using the Kaplan-Meier method. The Cox proportional hazards model was used to evaluate survival-predictive variables and the relationship between the obtained score and overall survival. RESULTS Child-Turcotte-Pugh A (n = 102 (64.6%)) patients showed better overall survival than Child-Turcotte-Pugh B (n = 56 (35.4%)) patients (log-rank P = 0.017), while no significant difference in the overall survival between albumin-bilirubin ≤ 1 (n = 37 (23.4%)) and albumin-bilirubin > 1 (n = 121 (76.6%)) was detected (log-rank P = 0.140). Multivariate analysis identified alcoholic liver disease (P = 0.029), tumor size > 5 cm (P = 0.004), and serum alpha-fetoprotein > 200 ng/mL (P < 0.001) as independent predictive factors of mortality risk. A higher Child-Turcotte-Pugh score was positively associated with decreased overall survival (P = 0.031); however, a higher albumin-bilirubin grade showed marginally significant association (P = 0.088). CONCLUSIONS The Child-Turcotte-Pugh score precisely categorized the outcomes of HCC in patients undergoing transarterial chemoembolization, and cirrhotic patients with Child-Turcotte-Pugh A will have a better overall survival than those with Child-Turcotte-Pugh B, regardless of HCC status. These results suggest that the Child-Turcotte-Pugh classification system is a more powerful tool to predict patient outcomes than the albumin-bilirubin grading system.
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Affiliation(s)
- Keerati Akarapatima
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand
| | - Arunchai Chang
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand.
| | | | | | - Apiradee Songjamrat
- Division of Intervention Radiology, Department of Radiology, Hatyai Hospital, Songkhla, Thailand
| | - Songklod Pakdeejit
- Division of Intervention Radiology, Department of Radiology, Hatyai Hospital, Songkhla, Thailand
| | - Attapon Rattanasupar
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand
| | - Teerha Piratvisuth
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkhla University, Songkhla, Thailand
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12
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Perkons NR, Kiefer RM, Noji MC, Pourfathi M, Ackerman D, Siddiqui S, Tischfield D, Profka E, Johnson O, Pickup S, Mancuso A, Pantel A, Denburg MR, Nadolski GJ, Hunt SJ, Furth EE, Kadlecek S, Gade TPF. Hyperpolarized Metabolic Imaging Detects Latent Hepatocellular Carcinoma Domains Surviving Locoregional Therapy. Hepatology 2020; 72:140-154. [PMID: 31553806 PMCID: PMC7307779 DOI: 10.1002/hep.30970] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/08/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Advances in cancer treatment have improved survival; however, local recurrence and metastatic disease-the principal causes of cancer mortality-have limited the ability to achieve durable remissions. Local recurrences arise from latent tumor cells that survive therapy and are often not detectable by conventional clinical imaging techniques. Local recurrence after transarterial embolization (TAE) of hepatocellular carcinoma (HCC) provides a compelling clinical correlate of this phenomenon. In response to TAE-induced ischemia, HCC cells adapt their growth program to effect a latent phenotype that precedes local recurrence. APPROACH AND RESULTS In this study, we characterized and leveraged the metabolic reprogramming demonstrated by latent HCC cells in response to TAE-induced ischemia to enable their detection in vivo using dynamic nuclear polarization (DNP) magnetic resonance spectroscopic imaging (MRSI) of 13 carbon-labeled substrates. Under TAE-induced ischemia, latent HCC cells demonstrated reduced metabolism and developed a dependence on glycolytic flux to lactate. Despite the hypometabolic state of these cells, DNP-MRSI of 1-13 C-pyruvate and its downstream metabolites, 1-13 C-lactate and 1-13 C-alanine, predicted histological viability. CONCLUSIONS These studies provide a paradigm for imaging latent, treatment-refractory cancer cells, suggesting that DNP-MRSI provides a technology for this application.
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Affiliation(s)
- Nicholas R. Perkons
- Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA 19104,Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104
| | - Ryan M. Kiefer
- Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA 19104,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Michael C. Noji
- Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA 19104,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Mehrdad Pourfathi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Daniel Ackerman
- Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA 19104,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Sarmad Siddiqui
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - David Tischfield
- Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA 19104,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Enri Profka
- Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA 19104,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Omar Johnson
- Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA 19104,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Stephen Pickup
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Anthony Mancuso
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Austin Pantel
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Michelle R. Denburg
- Department of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104
| | - Gregory J. Nadolski
- Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA 19104,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Stephen J. Hunt
- Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA 19104,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Emma E. Furth
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Stephen Kadlecek
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Terence P. F. Gade
- Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA 19104,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104,Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104,Corresponding author: Terence P. F. Gade, University of Pennsylvania Perelman School of Medicine, 652 BRB II/III, 421 Curie Boulevard, Philadelphia, PA 19104-6160, Tel: 215-573-9756, Fax: 215-746-5511,
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13
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Mishra G, Dev A, Paul E, Cheung W, Koukounaras J, Jhamb A, Marginson B, Lim BG, Simkin P, Borsaru A, Burnes J, Goodwin M, Ramachandra V, Spanger M, Lubel J, Gow P, Sood S, Thompson A, Ryan M, Nicoll A, Bell S, Majeed A, Kemp W, Roberts SK. Prognostic role of alpha-fetoprotein in patients with hepatocellular carcinoma treated with repeat transarterial chemoembolisation. BMC Cancer 2020; 20:483. [PMID: 32471447 PMCID: PMC7257176 DOI: 10.1186/s12885-020-06806-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Repeat transarterial chemoembolisation (rTACE) is often required for hepatocellular carcinoma (HCC) to achieve disease control, however, current practice guidelines regarding treatment allocation vary significantly. This study aims to identify key factors associated with patient survival following rTACE to facilitate treatment allocation and prognostic discussion. METHOD Patients with HCC undergoing rTACE at six Australian tertiary centers from 2009 to 2014 were included. Variables encompassing clinical, tumour, treatment type and response factors were analysed against the primary outcome of overall survival. Univariate analysis and multivariate Cox regression modelling were used to identify factors pre- and post-TACE therapy significantly associated with survival. RESULTS Total of 292 consecutive patients underwent rTACE with mainly Child Pugh A cirrhosis (61%) and BCLC stage A (57%) disease. Median overall survival (OS) was 30 months (IQR 15.2-50.2) from initial TACE. On multivariate analysis greater tumour number (p = 0.02), higher serum bilirubin (p = 0.007) post initial TACE, and hepatic decompensation (p = 0.001) post second TACE were associated with reduced survival. Patients with serum AFP ≥ 200 ng/ml following initial TACE had lower survival (p = 0.001), compared to patients with serum AFP level that remained < 200 ng/ml post-initial TACE, with an overall survival of 19.4 months versus 34.7 months (p = 0.0001) respectively. CONCLUSION Serum AFP level following initial treatment in patients undergoing repeat TACE for HCC is a simple and useful clinical prognostic marker. Moreover, it has the potential to facilitate appropriate patient selection for rTACE particularly when used in conjunction with baseline tumour burden and severity of hepatic dysfunction post-initial TACE.
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Affiliation(s)
- Gauri Mishra
- Gastroenterology, Monash Health, Melbourne, Australia
| | - Anouk Dev
- Gastroenterology, Monash Health, Melbourne, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Wa Cheung
- Radiology, Alfred Health, Melbourne, Australia
| | | | - Ashu Jhamb
- Radiology, St. Vincent's Hospital, Melbourne, Australia
| | - Ben Marginson
- Radiology, St. Vincent's Hospital, Melbourne, Australia
| | - Beng Ghee Lim
- Radiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Paul Simkin
- Radiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Adina Borsaru
- Radiology, Monash Health Eastern Health, Melbourne, Australia
| | - James Burnes
- Radiology, Monash Health Eastern Health, Melbourne, Australia
| | | | | | | | - John Lubel
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia
| | - Paul Gow
- Gastroenterology, Austin Health, Melbourne, Australia
| | - Siddharth Sood
- Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Marno Ryan
- Gastroenterology, St. Vincent's Hospital, Melbourne, Australia
| | - Amanda Nicoll
- Gastroenterology, Eastern Health, Melbourne, Australia
| | - Sally Bell
- Gastroenterology, Monash Health, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia.
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14
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Adhoute X, Pénaranda G, Raoul JL, Pietri O, Bronowicki JP, Castellani P, Perrier H, Monnet O, Bayle O, Oules V, Pol B, Beaurain P, Muller C, Cassagneau P, Bourlière M. Hepatocellular carcinoma macroscopic gross appearance on imaging: predictor of outcome after transarterial chemoembolization in a real-life multicenter French cohort. Eur J Gastroenterol Hepatol 2019; 31:1414-1423. [PMID: 31045613 DOI: 10.1097/meg.0000000000001420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Conventional transarterial chemoembolization (cTACE) with lipiodol is widely performed in patients with hepatocellular carcinoma (HCC) unsuitable for curative treatment. Additional tumor parameters such as HCC macroscopic appearance based on imaging might be helpful for transarterial chemoembolization prognostication and management. PATIENTS AND METHODS A total of 405 patients with HCC who underwent cTACE between 2008 and 2016 from a real-life multicenter French cohort were retrospectively reviewed. Tumors were classified into two macroscopic types according to HCC gross appearance on imaging: nodular versus non-nodular. The study population was stratified into two groups: derivation and validation cohorts. Independent prognostic factors of survival based on multivariate cox regression models were determined and then assessed in the validation set. Thereafter, time to progression (TTP) and radiological response rate were investigated for each prognostic factors of survival. RESULTS Median overall survival (OS) was 35 months for Barcelona Clinic Liver Cancer (BCLC) stage A, 22 months for BCLC stage B and 12 months for BCLC stage C patients (P < 0.0001). The corresponding TTP for these patients was 12 (7-17) months, 5 (3-6) months and 1.2 (1.2-3) months (P < 0.0001). Multivariate analysis revealed that tumors size and number, non-nodular type, alpha-fetoprotein, aspartate aminotransferase serum levels and impairment of performance status-1 were independent predictors of survival among the study groups. Non-nodular type was the most powerful factor that influences OS, TTP and radiological response rate for the recommended transarterial chemoembolization candidates. TTP was consistent with OS within each stage. CONCLUSION HCC macroscopic appearance on imaging is a determinant predictor of outcome after cTACE in a real-life multicenter cohort.
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Affiliation(s)
| | | | - Jean-Luc Raoul
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Nantes, Saint-Herblain
| | | | - Jean-Pierre Bronowicki
- Department of Gastroenterology and Hepatology, Centre Hospitalo-Universitaire de Nancy, Nancy, France
| | | | | | - Olivier Monnet
- Department of Interventional Radiology and Medical Imaging
| | - Olivier Bayle
- Department of Interventional Radiology and Medical Imaging
| | | | - Bernard Pol
- Department of Hepatobiliary Surgery, Hôpital Saint-Joseph Marseille
| | | | - Cyrille Muller
- Department of Interventional Radiology and Medical Imaging
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15
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Song W, Yu X, Guo D, Liu H, Tang Z, Liu X, Zhou J, Zhang H, Liu Y, Liu X. MRI-Based Radiomics: Associations With the Recurrence-Free Survival of Patients With Hepatocellular Carcinoma Treated With Conventional Transcatheter Arterial Chemoembolization. J Magn Reson Imaging 2019; 52:461-473. [PMID: 31675174 DOI: 10.1002/jmri.26977] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Preoperative estimation of hepatocellular carcinoma (HCC) recurrence after conventional transcatheter arterial chemoembolization (c-TACE) is crucial for subsequent follow-up and therapy decisions. PURPOSE To evaluate the associations of radiomics models based on pretreatment contrast-enhanced MRI, a clinical-radiological model and a combined model with the recurrence-free survival (RFS) of patients with HCC after c-TACE, and to develop a radiomics nomogram for individual RFS estimations and risk stratification. STUDY TYPE Retrospective. POPULATION In all, 184 consecutive HCC patients. FIELD STRENGTH/SEQUENCE 1.5T or 3.0T, including T2 WI, T1 WI, and contrast-enhanced T1 WI. ASSESSMENT All HCC patients were randomly divided into the training (n = 110) and validation datasets (n = 74). Radiomics signatures capturing intratumoral and peritumoral expansion (1, 3, and 5 mm) were constructed, and the radiomics models were set up using least absolute shrinkage and selection operator (LASSO) Cox regression. Clinical-radiological features were identified by univariate and multivariate Cox regression. The clinical-radiological model and the combined model fusing the radiomics signature with the clinical-radiological risk factors were developed by a multivariate Cox proportional hazard model. A radiomics nomogram derived from the combined model was established. STATISTICAL TESTS LASSO Cox regression, univariate and multivariate Cox regression, Kaplan-Meier analysis were performed. The discrimination performance of each model was quantified by the C-index. RESULTS Among the different peritumoral expansion models, only the 3-mm peritumoral expansion model (C-index, 0.714) showed a comparable performance (P = 0.4087) to that of the portal venous phase intratumoral model (C-index, 0.727). The combined model showed the best performance and the C-index was 0.802. Kaplan-Meier analysis showed that the cutoff values of the combined model relative to a median value (1.7426) perfectly stratified these patients into high-risk and low-risk subgroups. DATA CONCLUSION The combined model is more valuable than the clinical-radiological model or radiomics model alone for evaluating the RFS of HCC patients after c-TACE, and the radiomics nomogram can be used to preoperatively and individually estimate RFS. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 4 J. Magn. Reson. Imaging 2020;52:461-473.
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Affiliation(s)
- Wenlong Song
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangling Yu
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dajing Guo
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Zhuoyue Tang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Xinjie Liu
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Zhou
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiping Zhang
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yangyang Liu
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Liu
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wattanasatesiri T, Kim HC, Choi JW, Lee JH, Joo I, Hur S, Lee M, Jae HJ, Chung JW. Cone-Beam CT-Guided Chemoembolization in Patients with Complete Response after Previous Chemoembolization but Subsequent Elevated α-Fetoprotein without Overt Hepatocellular Carcinoma. J Vasc Interv Radiol 2019; 30:1273-1280. [PMID: 31235410 DOI: 10.1016/j.jvir.2019.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/10/2019] [Accepted: 03/17/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the performance of C-arm computed tomography (CT)-guided chemoembolization in patients with hepatocellular carcinoma (HCC) with serum α-fetoprotein (AFP) level > 20 ng/mL but with no overt tumor on CT and/or magnetic resonance imaging. MATERIALS AND METHODS From May 2010 to May 2017, 34 patients with HCC (25 men and 9 women; mean age, 59.7 y) who had elevated serum AFP levels (> 20 ng/mL) but no overt tumor on 6-mo imaging studies and had shown complete response (CR) after previous chemoembolization underwent C-arm CT-guided conventional chemoembolization. Three radiologists retrospectively reviewed the imaging studies (preprocedural images, C-arm CT scans, and follow-up images) in consensus, and clinical data including AFP levels were retrospectively obtained. Tumor detection by C-arm CT and treatment response after chemoembolization were assessed. RESULTS HCC was imaged at the time of chemoembolization in 24 of 34 patients (70.6%). C-arm CT detected tumors in 25 patients (73.5%); 23 detections were true positives, 2 were false positives, and 1 was a false negative (diaphragm metastasis). Among the 23 patients with true-positive results, the first follow-up enhanced imaging studies showed CR (n = 17), partial response (n = 1), progressive disease (n = 4), and indeterminate status (n = 1; treated by percutaneous ethanol injection). CONCLUSIONS C-arm CT-guided chemoembolization may help to detect and treat recurrent tumors in patients who have shown CR after previous chemoembolization but subsequently, during follow-up surveillance, had serum AFP levels > 20 ng/mL without an overt tumor evident on imaging studies.
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Affiliation(s)
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea.
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
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Peng Z, Chen S, Xiao H, Wang Y, Li J, Mei J, Chen Z, Zhou Q, Feng S, Chen M, Qian G, Peng S, Kuang M. Microvascular Invasion as a Predictor of Response to Treatment with Sorafenib and Transarterial Chemoembolization for Recurrent Intermediate-Stage Hepatocellular Carcinoma. Radiology 2019; 292:237-247. [PMID: 31135299 DOI: 10.1148/radiol.2019181818] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The evidence of combining sorafenib with transarterial chemoembolization (TACE) for intermediate-stage recurrent hepatocellular carcinoma (HCC) is limited. Patient responses to this treatment varied because of the heterogeneous nature of intermediate-stage recurrent HCC, making it important to identify patients who are most likely to benefit from this combination therapy. Purpose To compare sorafenib administered in combination with TACE versus TACE alone in the treatment of recurrent intermediate-stage HCC after initial hepatectomy and to determine the relationship of microvascular invasion (MVI) to survival. Materials and Methods In this retrospective multicenter study, 3652 consecutive patients were found to have intrahepatic recurrences after initial hepatectomy of primary HCC from January 2010 to December 2016. Of these, 260 patients with intermediate-stage recurrent HCC underwent combination treatment with sorafenib and TACE or TACE alone. Overall survival (OS) and progression-free survival (PFS) were compared between these two treatments according to MVI status by using log-rank tests. Results A total of 128 patients were administered combination therapy (mean age, 55 years ± 7.6 [standard deviation]; 107 men) and 132 patients were administered TACE alone (mean age, 56 years ± 8.3; 110 men). The 5-year OS and PFS were higher in the combination group than in the TACE group (OS: 38.9% vs 20.5%, respectively, P = .01; PFS, 37.5% vs 18.7%, respectively, P = .003). For patients with MVI-positive lesions, the median OS and PFS after combination treatment (n = 55) were longer than those after TACE alone (n = 72; OS: 17.2 months vs 12.1 months, respectively, P = .02; PFS: 17.0 months vs 11.0 months, respectively, P = .02). Multivariable analysis showed that tumor number, MVI status, and treatment allocation were significant predictors of OS and PFS, whereas tumor size was a prognostic factor for PFS. Conclusion Patients with recurrent intermediate-stage hepatocellular carcinoma and lesions positive for microvascular invasion (MVI) had longer survival times by using a combined treatment of sorafenib with transarterial chemoembolization (TACE) compared with TACE alone; patients with MVI-negative lesions did not show survival benefit from combined therapy. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Malloy in this issue.
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Affiliation(s)
- Zhenwei Peng
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Shuling Chen
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Han Xiao
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Yu Wang
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Jiaping Li
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Jie Mei
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Zebin Chen
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Qian Zhou
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Shiting Feng
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Minshan Chen
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Guojun Qian
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Sui Peng
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
| | - Ming Kuang
- From the Clinical Trials Unit (Z.P., J.M., Q.Z., S.P.), Department of Oncology (Z.P.), Division of Interventional Ultrasound (S.C., M.K.), Departments of Gastroenterology (H.X., S.P.), Interventional Oncology (Y.W., J.L.), Liver Surgery (Z.C., M.K.), and Radiology (S.F.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Guangzhou, China (G.Q.)
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Nakano MM, Yamamoto A, Nishida N, Hamuro M, Hamamoto S, Jogo A, Sohgawa E, Kageyama K, Minami T, Miki Y. Risk factors for local recurrence of hepatocellular carcinoma after transcatheter arterial chemoembolization with drug-eluting beads (DEB-TACE). Jpn J Radiol 2019; 37:543-548. [DOI: 10.1007/s11604-019-00840-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/18/2019] [Indexed: 12/11/2022]
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Wen T, Jin C, Facciorusso A, Donadon M, Han HS, Mao Y, Dai C, Cheng S, Zhang B, Peng B, Du S, Jia C, Xu F, Shi J, Sun J, Zhu P, Nara S, Millis JM. Multidisciplinary management of recurrent and metastatic hepatocellular carcinoma after resection: an international expert consensus. Hepatobiliary Surg Nutr 2018; 7:353-371. [PMID: 30498711 DOI: 10.21037/hbsn.2018.08.01] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hepatocellular carcinoma (HCC) is the sixth-most common cancer and the third leading cause of cancer-related death in the world. However, 40-70% patients eventually suffer from postoperative recurrence within 5 years. HCC recurrence after surgery severely affects prognosis of the patients. Nevertheless, there is an opportunity to improve patients' prognosis if doctors and researchers can recognize the importance of a standardized perioperative management and study it in clinical and pre-clinical settings. Hence, based on our own experience and published studies from other researchers, we develop this consensus regarding multidisciplinary management of locally recurrent and metastatic hepatocellular carcinoma after resection. This consensus consists of the entire course of recurrent hepatocellular carcinoma (RHCC) management, including prediction of recurrence, prevention, diagnosis, treatment and surveillance of RHCC. Consensus recommendations are presented with grades of evidences (Ia, Ib, IIa, IIb, III and IV), and strength of recommendations (A, B, C, D and E). We also develop a decision-making path for RHCC treatment, which can intuitively demonstrate the management for RHCC. It is hoped that we may make some effort to standardize the management of RHCC and ultimately understand how to improve outcomes.
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Affiliation(s)
- Tianfu Wen
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chen Jin
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Donadon
- Department of Hepatobiliary & General Surgery, Humanitas University, Humanitas Clinical and Research Center, Milan, Italy
| | - Ho-Seong Han
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Chaoliu Dai
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110000, China
| | - Shuqun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Bixiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Baogang Peng
- Department of Liver Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Shunda Du
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Changjun Jia
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110000, China
| | - Feng Xu
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110000, China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Juxian Sun
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Satoshi Nara
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
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Predisposing factors for hepatocellular carcinoma recurrence following initial remission after transcatheter arterial chemoembolization. Oncol Lett 2017; 14:3028-3034. [PMID: 28927051 DOI: 10.3892/ol.2017.6489] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/23/2017] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is prone to recurrence following curative treatment. The purpose of the present study was to identify the predisposing factors of HCC recurrence following complete remission achieved by transarterial chemoembolization (TACE). A retrospective cohort study of 70 consecutive patients with HCC who underwent TACE as the initial treatment was conducted. The patients were divided into two groups according to their 1-year disease-free survival (DFS) status; the early recurrence group (ER group; n=32), with HCC recurring within 1 year of initial TACE; and the non-early recurrence group (NER group; n=38), who did not experience recurrence within 1 year. The parameters identified as significantly associated with DFS time on univariate analysis were aspartate aminotransferase (AST), alanine aminotransferase and α-fetoprotein levels, as well as the tumor number (P=0.003, P=0.027, P=0.002 and P=0.005, respectively). Multivariate analysis revealed that AST levels and tumor number were significantly associated with a shorter DFS period (P=0.009 and P=0.038, respectively). The Mantel-Haenszel test revealed a significant trend of decreasing DFS with increasing tumor number. Among the patients with HCC in the ER group, locoregional recurrence occurred more frequently in those who received TACE alone compared with those treated with TACE combined with radiofrequency ablation treatment. In summary, multinodularity of HCC is the most potent predictive factor for the recurrence of HCC within 1 year of initial TACE.
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Gade TPF, Tucker E, Nakazawa MS, Hunt SJ, Wong W, Krock B, Weber CN, Nadolski GJ, Clark TWI, Soulen MC, Furth EE, Winkler JD, Amaravadi RK, Simon MC. Ischemia Induces Quiescence and Autophagy Dependence in Hepatocellular Carcinoma. Radiology 2017; 283:702-710. [PMID: 28253108 DOI: 10.1148/radiol.2017160728] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To characterize hepatocellular carcinoma (HCC) cells surviving ischemia with respect to cell cycle kinetics, chemosensitivity, and molecular dependencies that may be exploited to potentiate treatment with transarterial embolization (TAE). Materials and Methods Animal studies were performed according to institutionally approved protocols. The growth kinetics of HCC cells were studied in standard and ischemic conditions. Viability and cell cycle kinetics were measured by using flow cytometry. Cytotoxicity profiling was performed by using a colorimetric cell proliferation assay. Analyses of the Cancer Genome Atlas HCC RNA-sequencing data were performed by using Ingenuity Pathway Analysis software. Activation of molecular mediators of autophagy was measured with Western blot analysis and fluorescence microscopy. In vivo TAE was performed in a rat model of HCC with (n = 5) and without (n = 5) the autophagy inhibitor Lys05. Statistical analyses were performed by using GraphPad software. Results HCC cells survived ischemia with an up to 43% increase in the fraction of quiescent cells as compared with cells grown in standard conditions (P < .004). Neither doxorubicin nor mitomycin C potentiated the cytotoxic effects of ischemia. Gene-set analysis revealed an increase in mRNA expression of the mediators of autophagy (eg, CDKN2A, PPP2R2C, and TRAF2) in HCC as compared with normal liver. Cells surviving ischemia were autophagy dependent. Combination therapy coupling autophagy inhibition and TAE in a rat model of HCC resulted in a 21% increase in tumor necrosis compared with TAE alone (P = .044). Conclusion Ischemia induces quiescence in surviving HCC cells, resulting in a dependence on autophagy, providing a potential therapeutic target for combination therapy with TAE. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Terence P F Gade
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Elizabeth Tucker
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Michael S Nakazawa
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Stephen J Hunt
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Waihay Wong
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Bryan Krock
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Charles N Weber
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Gregory J Nadolski
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Timothy W I Clark
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Michael C Soulen
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Emma E Furth
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Jeffrey D Winkler
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - Ravi K Amaravadi
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
| | - M Celeste Simon
- From the Penn Image-Guided Interventions Laboratory (T.P.F.G., S.J.H., C.N.W., G.J.N.), Department of Radiology (T.P.F.G., S.J.H., C.N.W., G.J.N., T.W.I.C., M.C. Soulen), and Department of Pathology (E.E.F.), Hospital of the University of Pennsylvania, Philadelphia, Pa; Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, 421 Curie Blvd, 456 BRB II/III, Philadelphia, PA 19104 (E.T., M.S.N., W.W., B.K., M.C. Simon); Abramson Family Cancer Center (B.K., R.K.A.) and Department of Chemistry (J.D.W.), University of Pennsylvania, Philadelphia, Pa
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Dai WC, Cheung TT. Strategic overview on the best treatment option for intrahepaitc hepatocellular carcinoma recurrence. Expert Rev Anticancer Ther 2016; 16:1063-72. [PMID: 27548586 DOI: 10.1080/14737140.2016.1226136] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The long-term survival after hepatectomy for HCC remains unsatisfactory because of the high incidence of recurrence. The cumulative 5-year recurrence rate ranged from 60-100% in previous studies and majority of them remains intrahepatic recurrence. The therapeutic modalities commonly used for primary tumors, including surgical resection, liver transplantation, TACE, local ablative therapy and radiotherapy have been used to treat recurrent tumors in the liver remnant and the outcomes with the heterogeneous therapeutic options are reviewed. It is important to note that the level of evidence for most therapeutic options is limited to cohort investigations with few RCTs and most were limited due to enrollment of various tumor stages and did not compare treatment modalities for specific tumor stages. AREAS COVERED A literature search for recurrent HCC was performed using Medline and PubMed up to May 2016. Expert commentary: The long term survival results after re-resection for recurrent HCC were favourable and aggressive management of postoperative intrahepatic recurrence remains the most important strategy in prolonging the survival of patients after resection of HCC.
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Affiliation(s)
- Wing Chiu Dai
- a Department of Surgery , The University of Hong Kong , Hong Kong , China
| | - Tan To Cheung
- a Department of Surgery , The University of Hong Kong , Hong Kong , China
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Choi SJ, Kim J, Seo J, Kim HS, Lee JM, Park H. Parametric response mapping of dynamic CT for predicting intrahepatic recurrence of hepatocellular carcinoma after conventional transcatheter arterial chemoembolization. Eur Radiol 2015; 26:225-34. [PMID: 25991485 DOI: 10.1007/s00330-015-3825-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The aim of our study was to determine the diagnostic value of a novel image analysis method called parametric response mapping (PRM) for prediction of intrahepatic recurrence of hepatocellular carcinoma (HCC) treated with conventional transcatheter arterial chemoembolization (TACE). METHODS This retrospective study was approved by the IRB. We recruited 55 HCC patients who achieved complete remission (CR) after TACE and received longitudinal multiphasic liver computed tomography (CT). The patients fell into two groups: the recurrent tumour group (n = 29) and the non-recurrent tumour group (n = 26). We applied the PRM analysis to see if this technique could distinguish between the two groups. The results of the PRM analysis were incorporated into a prediction algorithm. We retrospectively removed data from the last time point and attempted to predict the response to therapy of the removed data. RESULTS The PRM analysis was able to distinguish between the non-recurrent and recurrent groups successfully. The prediction algorithm detected response to therapy with an area under the curve (AUC) of 0.76, while the manual approach had AUC 0.64. CONCLUSIONS Adopting PRM analysis can potentially distinguish between recurrent and non-recurrent HCCs and allow for prediction of response to therapy after TACE. KEY POINTS Parametric response mapping (PRM) could help assess patients with recurrent HCCs after TACE. Parametric response mapping could direct patients to individualized therapy. Longitudinal CT images were analyzed with advanced image analysis method.
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Affiliation(s)
- Seung Joon Choi
- Department of Radiology, Gachon University Gil Hospital, Incheon, Korea
| | - Jonghoon Kim
- Department of Electronic Electrical and Computer Engineering, Sungkyunkwan University, Suwon, 440-746, Korea
| | - Jongbum Seo
- Department of Biomedical Engineering, Yonsei University, Wonju, Korea
| | - Hyung Sik Kim
- Department of Radiology, Gachon University Gil Hospital, Incheon, Korea
| | - Jong-min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Hyunjin Park
- School of Electronic and Electrical Engineering, Sungkyunwkan University, Suwon, 440-746, Korea.
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Rou WS, Lee BS, Moon HS, Lee ES, Kim SH, Lee HY. Risk factors and therapeutic results of early local recurrence after transcatheter arterial chemoembolization. World J Gastroenterol 2014; 20:6995-7004. [PMID: 24944494 PMCID: PMC4051943 DOI: 10.3748/wjg.v20.i22.6995] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/27/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify factors affecting early local recurrence after transcatheter arterial chemoembolization (TACE) and investigate treatments and outcomes for local recurrence.
METHODS: Early local recurrence and no early local recurrence groups drawn from 134 patients who were initially diagnosed with hepatocellular carcinoma (HCC) and showed a complete response (CR) to TACE treatment between January 1, 2006, and January 31, 2012, were analyzed by univariate and multivariate analyses. Additionally, the subsequent treatment for patients with recurrence was analyzed, and in cases in which TACE had been performed, the cumulative recurrence rates were calculated using the Kaplan-Meier method and compared with those of the primary lesion.
RESULTS: The 1-, 2-, and 3-year survival rates were 92.3%, 60.2%, and 39.8%, respectively, in the early local recurrence group, which were significantly lower than those in both the late local and no local recurrence groups (P < 0.001). On multivariate analyses, non-compact lipiodol uptake, large tumor size, and an alpha-fetoprotein > 20 ng/mL after achieving a CR were significant predictors. When TACE was performed for early and late locally recurrent lesions, a CR was observed in 15 patients (41.7%) and 11 patients (78.6%), and the cumulative recurrence rates at 6, 12, and 24 mo were 17.9%, 43.3%, and 71.2%, respectively, which did not differ significantly from those after the first CR of 20.5%, 44.0%, and 58.6%, respectively (P = 0.639).
CONCLUSION: Closer monitoring and active treatments must be provided to patients with risk factors for early local recurrence of HCC.
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Colecchia A, Schiumerini R, Cucchetti A, Cescon M, Taddia M, Marasco G, Festi D. Prognostic factors for hepatocellular carcinoma recurrence. World J Gastroenterol 2014; 20:5935-5950. [PMID: 24876717 PMCID: PMC4033434 DOI: 10.3748/wjg.v20.i20.5935] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/14/2013] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
The recurrence of hepatocellular carcinoma, the sixth most common neoplasm and the third leading cause of cancer-related mortality worldwide, represents an important clinical problem, since it may occur after both surgical and medical treatment. The recurrence rate involves 2 phases: an early phase and a late phase. The early phase usually occurs within 2 years after resection; it is mainly related to local invasion and intrahepatic metastases and, therefore, to the intrinsic biology of the tumor. On the other hand, the late phase occurs more than 2 years after surgery and is mainly related to de novo tumor formation as a consequence of the carcinogenic cirrhotic environment. Since recent studies have reported that early and late recurrences may have different risk factors, it is clinically important to recognize these factors in the individual patient as soon as possible. The aim of this review was, therefore, to identify predicting factors for the recurrence of hepatocellular carcinoma, by means of invasive and non-invasive methods, according to the different therapeutic strategies available. In particular the role of emerging techniques (e.g., transient elastography) and biological features of hepatocellular carcinoma in predicting recurrence have been discussed. In particular, invasive methods were differentiated from non-invasive ones for research purposes, taking into consideration the emerging role of the genetic signature of hepatocellular carcinoma in order to better allocate treatment strategies and surveillance follow-up in patients with this type of tumor.
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Jin YJ, Lee JW, Lee OH, Chung HJ, Kim YS, Lee JI, Cho SG, Jeon YS, Lee KY, Ahn SI, Shin WY. Transarterial chemoembolization versus surgery/radiofrequency ablation for recurrent hepatocellular carcinoma with or without microvascular invasion. J Gastroenterol Hepatol 2014; 29:1056-64. [PMID: 24372785 DOI: 10.1111/jgh.12507] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS Microvascular invasion (MVI) is a well-known prognostic factor of postoperative recurrence and of overall survival (OS) in patients with hepatocellular carcinoma (HCC). We compared the treatment outcomes of transarterial chemoembolization (TACE) and surgery/radiofrequency ablation (RFA) according to the presence of MVI in patients with early or late recurrent HCC that presented as Barcelona Clinical Liver Cancer (BCLC) stage 0 or A after curative resection for HCC. METHODS A consecutive 68 patients with recurrent HCC of BCLC stage 0 or A at our institution between 1998 and 2012 were retrospectively enrolled. We compared the outcomes of patients treated by TACE or surgery/RFA. Tumor recurrence after curative resection was classified as early (≤ 12 months) or late (> 12 months) recurrence. RESULTS Median tumor size was 1.5 cm (range, 1-10 cm), and 67 (98.5%) had HCCs within the Milan criteria. Median post-retreatment follow-up duration was 27 months (range, 1-109 months). Of the 68 patients, 19 (27.9%) underwent surgery/RFA, 47 (69.1%) TACE, and 2 (2.9%) were lost to follow-up. After retreatment, TACE showed significantly higher OS and recurrence-free survival rates than surgery/RFA in MVI-positive patients (P = 0.03 and P = 0.05, respectively), but not in MVI-negative patients (P = 0.95 and P = 0.98, respectively). In particular, in early recurred MVI-positive patients, TACE had a significantly higher OS rate than surgery/RFA (P = 0.01). CONCLUSIONS TACE may be the more effective treatment option for recurrent HCC of BCLC stage 0 or A than surgery/RFA in MVI-positive patients, especially in those that recur early after curative resection.
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Affiliation(s)
- Young-Joo Jin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
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Surgery versus transarterial chemoembolization for solitary large hepatocellular carcinoma of BCLC stage A. J Gastrointest Surg 2014; 18:555-61. [PMID: 24420729 DOI: 10.1007/s11605-013-2440-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/13/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIMS The aim of this study was to compare the outcomes of surgery and transarterial chemoembolization (TACE) for a solitary huge hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage A. METHODS One hundred twenty-three consecutive patients with a solitary large (>5 cm) HCC classified at the BCLC stage A were analyzed. The posttreatment survival outcomes of patients that underwent surgery or TACE were compared. RESULTS The median age was 58 years (range, 29-90 years). The most common cause of HCC is hepatitis B virus infection (61.8%). Median tumor size was 8.0 cm (range, 5.1-25 cm), and 97 patients (78.9%) were of Child-Turcotte-Pugh class A. Median posttreatment follow-up duration was 18 months (range, 0.1-136 months). Of the 123 patients, 62 (50.4%) underwent surgery and 61 (49.6%) underwent TACE. Cumulative overall survival rates in the surgical group at 1, 3, and 5 years were significantly higher than those in the TACE group (83.2, 75.7, and 65.0% vs 68.5, 45.0, and 17.5%, respectively, P < 0.01). In subgroup analysis, the cumulative overall survival in both surgical groups was significantly greater than in corresponding TACE subgroups (P = 0.04 for ≥ 8-cm subgroup and P < 0.01 for 5- to 8-cm-sized subgroups). Multivariate analysis showed that a larger tumor size (≥ 8 cm) (hazard ratio [HR] 2.14, P = 0.02) was significantly associated with posttreatment mortality, whereas surgery (HR 0.37, P < 0.01) compared with TACE was inversely associated with posttreatment mortality. CONCLUSIONS Surgery may be the more effective treatment modality than TACE for a solitary large HCC of the BCLC stage A, regardless of tumor size.
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