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De Toni EN, Schlesinger-Raab A, Fuchs M, Schepp W, Ehmer U, Geisler F, Ricke J, Paprottka P, Friess H, Werner J, Gerbes AL, Mayerle J, Engel J. Age independent survival benefit for patients with hepatocellular carcinoma (HCC) without metastases at diagnosis: a population-based study. Gut 2020; 69:168-176. [PMID: 30878947 PMCID: PMC6943246 DOI: 10.1136/gutjnl-2018-318193] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC) is a major cause of death worldwide and its incidence is expected to increase globally. Aim of this study was to assess whether the implementation of screening policies and the improvement of treatment options translated into a real-world survival benefit in HCC patients. DESIGN 4078 patients diagnosed with HCC between 1998 and 2016 from the Munich Cancer Registry were analysed. Tumour characteristics and outcome were analysed by time period and according to age and presence of metastases at diagnosis. Overall survival (OS) was analysed using Kaplan-Meier method and relative survival (RS) was computed for cancer-specific survival. Cox proportional hazard models were conducted to control for prognostic variables. RESULTS While incidence of HCC remained substantially stable, tumours were diagnosed at increasingly earlier stages, although the median age at diagnosis increased. The 3 years RS in HCC improved from 19.8% in 1998-2002, 22.4% in 2003-2007, 30.6% in 2008-2012 up to 31.0% in 2013-2016. Median OS increased from 6 months in 1998-2002 to 12 months in 2008-2016. However, analysis according to the metastatic status showed that survival improved only in patients without metastases at diagnosis whereas the prognosis of patients with metastatic disease remained unchanged. CONCLUSION These real-world data show that, in contrast to the current assumptions, the incidence of HCC did not increase in a representative German region. Earlier diagnosis, likely related to the implementation of screening programmes, translated into an increasing employment of effective therapeutic options and a clear survival benefit in patients without metastases at diagnosis, irrespective of age.
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Affiliation(s)
- Enrico N De Toni
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Anne Schlesinger-Raab
- Munich Cancer Registry, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Martin Fuchs
- Department of Gastroenterology, Hepatology and GI-Oncology, Hospital Bogenhausen, Munich, Germany
| | - Wolfgang Schepp
- Department of Gastroenterology, Hepatology and GI-Oncology, Hospital Bogenhausen, Munich, Germany
| | - Ursula Ehmer
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Fabian Geisler
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Jens Ricke
- Department of Clinical Radiology, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Philipp Paprottka
- Department of Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Jens Werner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Alexander L Gerbes
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jutta Engel
- Munich Cancer Registry, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University (LMU), Munich, Germany
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Trojan J, Zangos S, Schnitzbauer AA. Diagnostics and Treatment of Hepatocellular Carcinoma in 2016: Standards and Developments. Visc Med 2016; 32:116-20. [PMID: 27413729 PMCID: PMC4926883 DOI: 10.1159/000445730] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a frequent complication of liver cirrhosis. Worldwide, HCC is one of the most common cancers, with a rising incidence. METHODS A selective literature search was conducted, taking into account current studies, reviews, meta-analyses, and guidelines. RESULTS The diagnosis is established either non-invasively by dynamic imaging, showing a typical contrast enhancement and wash-out, or histopathologically. Pathological diagnosis of HCC is recommended for all atypical nodules in patients with cirrhosis and for those in non-cirrhotic patients. Tumor therapy as well as treatment of the underlying chronic liver disease and/or preservation of liver function are important for the management of patients with HCC. Standard stage-adapted treatments are based on the widely applied Barcelona Clinic Liver Cancer staging system including liver resection and transplantation, interventional treatments such as thermal ablation and transarterial therapies, and systemic treatment with the tyrosine kinase inhibitor sorafenib. After failure of sorafenib, anti-angiogenic drugs, MET inhibitors, and immunotherapeutics are currently under advanced clinical investigation. CONCLUSION Treatment of HCC is multidisciplinary and therefore requires a close cooperation between various disciplines such as hepatology, visceral surgery, radiology, and oncology to achieve the best outcome depending on the tumor stage and degree of liver function impairment.
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Affiliation(s)
- Jörg Trojan
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
- Universitäres Leberzentrum, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Stephan Zangos
- Universitäres Leberzentrum, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Andreas A. Schnitzbauer
- Universitäres Leberzentrum, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
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Schmitz T, Blaickner M, Ziegner M, Bassler N, Grunewald C, Kratz JV, Schütz C, Langguth P, Sharpe P, Palmans H, Holzscheiter MH, Otto G, Hampel G. Dose determination using alanine detectors in a mixed neutron and gamma field for boron neutron capture therapy of liver malignancies. Acta Oncol 2011; 50:817-22. [PMID: 21767179 DOI: 10.3109/0284186x.2011.582516] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Boron Neutron Capture Therapy for liver malignancies is being investigated at the University of Mainz. One important aim is the set-up of a reliable dosimetry system. Alanine dosimeters have previously been applied for dosimetry of mixed radiation fields in antiproton therapy, and may be suitable for measurements in mixed neutron and gamma fields. MATERIAL AND METHODS Two experiments have been carried out in the thermal column of the TRIGA Mark II reactor at the University of Mainz. Alanine dosimeters have been irradiated in a phantom and in liver tissue. RESULTS For the interpretation and prediction of the dose for each pellet, beside the results of the measurements, calculations with the Monte Carlo code FLUKA are presented here. For the phantom, as well as for the liver tissue, the measured and calculated dose and flux values are in good agreement. DISCUSSION Alanine dosimeters, in combination with flux measurements and Monte Carlo calculations with FLUKA, suggest that it is possible to establish a system for monitoring the dose in a mixed neutron and gamma field for BNCT and other applications in radiotherapy.
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Affiliation(s)
- Tobias Schmitz
- Institute for Nuclear Chemistry, University of Mainz, Mainz, Germany.
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Möbius C, Demuth C, Aigner T, Wiedmann M, Wittekind C, Mössner J, Hauss J, Witzigmann H. Evaluation of VEGF A expression and microvascular density as prognostic factors in extrahepatic cholangiocarcinoma. Eur J Surg Oncol 2007; 33:1025-9. [PMID: 17400419 DOI: 10.1016/j.ejso.2007.02.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 02/12/2007] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Angiogenesis is essential for tumor growth and metastasis. An association between microvessel density, a measure of tumor angiogenesis, and conventional prognostic variables has been shown for many different tumor entities. In extrahepatic cholangiocarcinoma, the VEGF expression and microvessel density have rarely been investigated. METHODS Paraffin-embedded specimens from 51 resected adenocarcinomas of the extrahepatic bile duct were immunostained for vascular endothelial growth factor A (VEGF A) and CD 34 to evaluate the microvessel density (MVD). VEGF A staining was evaluated by combining intensity and percentage of positive tumor cells, as low (expression equal or below the median), or high (above the median). Microvessel density was assessed using a method published by Weidner et al. RESULTS Median disease free survival (DFS) of the study group was 12.5 months (range, 1-66.3 months). DFS was calculated in the 39 patients with complete resection. It was significantly better in patients with low microvessel density than DFS in patients with high microvessel density (33 months (range, 3-66.3 months) vs. 21.8 months (range, 1.6-31.6 months); p=0.022). In contrast, VEGF A expression did not correlate with survival. There was a trend toward a higher VEGF A expression in highly vascularized tumors (p=0.08), but failed to reach statistic significance. CONCLUSIONS The present study indicates, that vascularisation has an important impact on survival of extrahepatic cholangiocarcinoma patients. Other molecules than VEGF A are probably involved in neovascularization in extrahepatic cholangiocarcinoma.
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Affiliation(s)
- C Möbius
- Department of Surgery II, University of Leipzig, Leipzig, Germany.
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