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Dioguardi Burgio M, Garzelli L, Cannella R, Ronot M, Vilgrain V. Hepatocellular Carcinoma: Optimal Radiological Evaluation before Liver Transplantation. Life (Basel) 2023; 13:2267. [PMID: 38137868 PMCID: PMC10744421 DOI: 10.3390/life13122267] [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: 09/04/2023] [Revised: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
Liver transplantation (LT) is the recommended curative-intent treatment for patients with early or intermediate-stage hepatocellular carcinoma (HCC) who are ineligible for resection. Imaging plays a central role in staging and for selecting the best LT candidates. This review will discuss recent developments in pre-LT imaging assessment, in particular LT eligibility criteria on imaging, the technical requirements and the diagnostic performance of imaging for the pre-LT diagnosis of HCC including the recent Liver Imaging Reporting and Data System (LI-RADS) criteria, the evaluation of the response to locoregional therapy, as well as the non-invasive prediction of HCC aggressiveness and its impact on the outcome of LT. We will also briefly discuss the role of nuclear medicine in the pre-LT evaluation and the emerging role of artificial intelligence models in patients with HCC.
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Affiliation(s)
- Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France (V.V.)
- Centre de Recherche sur l’Inflammation, UMR1149, Université Paris Cité, 75018 Paris, France
| | - Lorenzo Garzelli
- Service d’Imagerie Medicale, Centre Hospitalier de Cayenne, Avenue des Flamboyants, Cayenne 97306, French Guiana
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France (V.V.)
- Centre de Recherche sur l’Inflammation, UMR1149, Université Paris Cité, 75018 Paris, France
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France (V.V.)
- Centre de Recherche sur l’Inflammation, UMR1149, Université Paris Cité, 75018 Paris, France
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Shimamura T, Goto R, Watanabe M, Kawamura N, Takada Y. Liver Transplantation for Hepatocellular Carcinoma: How Should We Improve the Thresholds? Cancers (Basel) 2022; 14:cancers14020419. [PMID: 35053580 PMCID: PMC8773688 DOI: 10.3390/cancers14020419] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary The ideal treatment for hepatocellular carcinoma (HCC) is liver transplantation (LT), which both eliminates the HCC and cures the diseased liver. Once considered an experimental treatment with dismal survival rates, LT for HCC entered a new era with the establishment of the Milan criteria over 20 years ago. However, over the last two decades, the Milan criteria, which are based on tumor morphology, have come under intense scrutiny and are now largely regarded as too restrictive, and limit the access of transplantation for many patients who would otherwise achieve good clinical outcomes. The liver transplant community has been making every effort to reach a goal of establishing more reliable selection criteria. This article addresses how the criteria have been extended, as well as the concept of pre-transplant down-staging to maximize the eligibility. Abstract Hepatocellular carcinoma (HCC) is the third highest cause of cancer-related mortality, and liver transplantation is the ideal treatment for this disease. The Milan criteria provided the opportunity for HCC patients to undergo LT with favorable outcomes and have been the international gold standard and benchmark. With the accumulation of data, however, the Milan criteria are not regarded as too restrictive. After the implementation of the Milan criteria, many extended criteria have been proposed, which increases the limitations regarding the morphological tumor burden, and incorporates the tumor’s biological behavior using surrogate markers. The paradigm for the patient selection for LT appears to be shifting from morphologic criteria to a combination of biologic, histologic, and morphologic criteria, and to the establishment of a model for predicting post-transplant recurrence and outcomes. This review article aims to characterize the various patient selection criteria for LT, with reference to several surrogate markers for the biological behavior of HCC (e.g., AFP, PIVKA-II, NLR, 18F-FDG PET/CT, liquid biopsy), and the response to locoregional therapy. Furthermore, the allocation rules in each country and the present evidence on the role of down-staging large tumors are addressed.
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Affiliation(s)
- Tsuyoshi Shimamura
- Division of Organ Transplantation, Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo 060-8648, Hokkaido, Japan
- Correspondence:
| | - Ryoichi Goto
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan;
| | - Masaaki Watanabe
- Department of Transplant Surgery, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan; (M.W.); (N.K.)
| | - Norio Kawamura
- Department of Transplant Surgery, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan; (M.W.); (N.K.)
| | - Yasutsugu Takada
- Department of HBP and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon 791-0295, Ehime, Japan;
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Liver Transplantation in Patients with Hepatocellular Carcinoma beyond the Milan Criteria: A Comprehensive Review. J Clin Med 2021; 10:jcm10173932. [PMID: 34501381 PMCID: PMC8432180 DOI: 10.3390/jcm10173932] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/22/2021] [Accepted: 08/29/2021] [Indexed: 02/07/2023] Open
Abstract
The Milan criteria (MC) were developed more than 20 years ago and are still considered the benchmark for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). However, the strict application of MC might exclude some patients who may receive a clinical benefit of LT. Several expanded criteria have been proposed. Some of these consider pretransplant morphological and biological variables of the tumor, others consider post-LT variables such as the histology of the tumor, and others combine pre- and post-LT variables. More recently, the HCC response to locoregional treatments before transplantation emerged as a surrogate marker of the biological aggressiveness of the tumor to be used as a better selection criterion for LT in patients beyond the MC at presentation. This essential review aims to present the current data on the pretransplant selection criteria for LT in patients with HCC exceeding the MC at presentation based on morphological and histological characteristics of the tumor and to critically discuss those that have been validated in clinical practice. Moreover, the role of HCC biological markers and the tumor response to downstaging procedures as new tools for selecting patients with a tumor burden outside of the MC for LT is evaluated.
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Gregory J, Dioguardi Burgio M, Corrias G, Vilgrain V, Ronot M. Evaluation of liver tumour response by imaging. JHEP Rep 2020; 2:100100. [PMID: 32514496 PMCID: PMC7267412 DOI: 10.1016/j.jhepr.2020.100100] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Abstract
The goal of assessing tumour response on imaging is to identify patients who are likely to benefit - or not - from anticancer treatment, especially in relation to survival. The World Health Organization was the first to develop assessment criteria. This early score, which assessed tumour burden by standardising lesion size measurements, laid the groundwork for many of the criteria that followed. This was then improved by the Response Evaluation Criteria in Solid Tumours (RECIST) which was quickly adopted by the oncology community. At the same time, many interventional oncology treatments were developed to target specific features of liver tumours that result in significant changes in tumours but have little effect on tumour size. New criteria focusing on the viable part of tumours were therefore designed to provide more appropriate feedback to guide patient management. Targeted therapy has resulted in a breakthrough that challenges conventional response criteria due to the non-linear relationship between response and tumour size, requiring the development of methods that emphasize the appearance of tumours. More recently, research into functional and quantitative imaging has created new opportunities in liver imaging. These results have suggested that certain parameters could serve as early predictors of response or could predict later tumour response at baseline. These approaches have now been extended by machine learning and deep learning. This clinical review focuses on the progress made in the evaluation of liver tumours on imaging, discussing the rationale for this approach, addressing challenges and controversies in the field, and suggesting possible future developments.
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Key Words
- (c)TACE, (conventional) transarterial chemoembolisation
- (m)RECIST, (modified) Response Evaluation Criteria in Solid Tumours
- 18F-FDG, 18F-fluorodeoxyglucose
- 90Y, yttrium-90
- ADC, apparent diffusion coefficient
- APHE, arterial phase hyperenhancement
- CEUS, contrast-enhanced ultrasound
- CRLM, colorectal liver metastases
- DWI, diffusion-weighted imaging
- EASL
- EASL, European Association for the Study of the Liver criteria
- GIST, gastrointestinal stromal tumours
- HCC, hepatocellular carcinoma
- HU, Hounsfield unit
- Imaging
- LI-RADS
- LI-RADS, Liver Imaging Reporting And Data System
- Liver
- Metastases
- PD, progressive disease
- PET, positron emission tomography
- PR, partial response
- RECIST
- SD, stable disease
- SIRT, selective internal radiotherapy
- TR, treatment response
- Tumours
- WHO, World Health Organization
- mRECIST
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Affiliation(s)
- Jules Gregory
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Giuseppe Corrias
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
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Tohyama T, Sakamoto K, Tamura K, Nakamura T, Watanabe J, Wakisaka H, Takada Y. Pharyngeal metastasis following living-donor liver transplantation for hepatocellular carcinoma: a case report and literature review. World J Surg Oncol 2020; 18:109. [PMID: 32466780 PMCID: PMC7257203 DOI: 10.1186/s12957-020-01873-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/06/2020] [Indexed: 12/12/2022] Open
Abstract
Background The most common sites of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been reported to be the liver, lung, bone, and adrenal glands, but there have also been many reports of cases of multiple recurrence. The prognosis after recurrence is poor, with reported median survival after recurrence of HCC ranging from 9 to 19 months. Here, we report a case of long-term survival after recurrence of pharyngeal metastasis following living-donor liver transplantation (LDLT) for HCC within the Milan criteria, by resection of the metastatic region and cervical lymph node dissection. Case presentation A 47-year-old man with a Model End-stage Liver Disease (MELD) score of 11 underwent LDLT for HCC within the Milan criteria for liver cirrhosis associated with hepatitis B virus infection, with his 48-year-old elder brother as the living donor. One year and 10 months after liver transplantation, he visited a nearby hospital with a chief complaint of discomfort on swallowing. A pedunculated polyp was found in the hypopharynx, and biopsy revealed HCC metastasis. We performed pharyngeal polypectomy. Two years later, cervical lymph node metastasis appeared, and neck lymph node dissection was performed. Although recurrence subsequently occurred three times in the grafted liver, the patient is still alive 12 years and 10 months after recurrence of pharyngeal metastasis. He is now a tumor-free outpatient taking sorafenib. Conclusion It is necessary to recognize that the nasopharyngeal region is a potential site of HCC metastasis. Prognostic improvement can be expected with close follow-up, early detection, and multidisciplinary treatment, including radical resection.
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Affiliation(s)
- Taiji Tohyama
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan. .,Department of Surgery, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan.
| | - Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kei Tamura
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Taro Nakamura
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Jota Watanabe
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hiroyuki Wakisaka
- Laboratory of Head and Neck Surgery, Ehime Prefectural University of Health Sciences, 543, Takoda, Tobe-cho, Iyo-gun, Ehime, 791-2101, Japan
| | - Yasutsugu Takada
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Lingiah VA, Niazi M, Olivo R, Paterno F, Guarrera JV, Pyrsopoulos NT. Liver Transplantation Beyond Milan Criteria. J Clin Transl Hepatol 2020; 8:69-75. [PMID: 32274347 PMCID: PMC7132012 DOI: 10.14218/jcth.2019.00050] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/04/2020] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide, being the fifth most common cancer and the third most common cause of cancer-related mortality. The incidence of HCC has been rising in the USA over the last 20 years. Liver transplantation is an optimal treatment option, as it eliminates HCC as well as the underlying liver disease. The Milan criteria (1 lesion greater than or equal to 2 cm and less than or equal to 5 cm, or up to 3 lesions, each greater than or equal to 1 cm and less than or equal to 3 cm) have been adopted by many transplant societies worldwide as the criteria to determine whether patients with HCC can move forward with liver transplantation. However, many believe that the Milan criteria may be too strict in regard to its size requirements for lesions. This has led to a number of expanded criteria for liver transplantation, concerning both overall size and number of lesions, as well as incorporation of other markers of tumor biology. Tumor markers, such as alpha-fetoprotein, can also be used to follow treatment of HCC and possibly exclude patients from transplant. HCC presenting beyond Milan criteria can also be down-staged with locoregional therapy. Monitoring response to locoregional therapy and longer wait times after locoregional therapy prior to transplant can serve as surrogate markers of tumor biology as well.
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Affiliation(s)
- Vivek A Lingiah
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
- Correspondence to: Nikolaos T Pyrsopoulos, Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, MSB H-355, 185 S Orange Ave, Newark, NJ 07103, USA. Tel: +1-973-972-5252, Fax: +1-973-972-3144, E-mail: ; Vivek A Lingiah, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, MSB H-350, 185 S Orange Ave, Newark, NJ 07103, USA. Tel: +1-973-972-5252, Fax: +1-973-972-3144, E-mail:
| | - Mumtaz Niazi
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Raquel Olivo
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Flavio Paterno
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - James V Guarrera
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Nikolaos T Pyrsopoulos
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
- Correspondence to: Nikolaos T Pyrsopoulos, Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, MSB H-355, 185 S Orange Ave, Newark, NJ 07103, USA. Tel: +1-973-972-5252, Fax: +1-973-972-3144, E-mail: ; Vivek A Lingiah, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, MSB H-350, 185 S Orange Ave, Newark, NJ 07103, USA. Tel: +1-973-972-5252, Fax: +1-973-972-3144, E-mail:
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7
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Lipiodol retention pattern after TACE for HCC is a predictor for local progression in lesions with complete response. Cancer Imaging 2019; 19:75. [PMID: 31730491 PMCID: PMC6858631 DOI: 10.1186/s40644-019-0260-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/05/2019] [Indexed: 12/23/2022] Open
Abstract
Background To evaluate the predictive value of the lipiodol retention pattern for local progression of HCC with a complete response (CR) on CT according to mRECIST criteria after a first session of conventional chemoembolization (cTACE). Methods From January 2014 to May 2016 all consecutive patients undergoing a first cTACE session for HCC were identified. Inclusion criteria were the presence of ≤3 HCCs and available pre- and post-cTACE CT. Tumor response was classified according to mRECIST criteria. The analysis focused on tumors with a CR. The lipiodol retention pattern in these tumors was classified as complete (C-Lip, covering the entire tumor volume), or incomplete (I-Lip). Local progression was defined as the reappearance of areas of enhancement on arterial-phase images with washout on portal/delayed phase images within 2 cm from treated tumors on follow-up CT. Results The final population included 50 patients with 82 HCCs. A total of 46 (56%) HCCs were classified with a CR, including 16 (35%) with I-Lip, and 30 (65%) with C-Lip. After a median follow-up of 14 months (3.2–35.9 months), 15/16 (94%) and 10/30 (30%) of I-Lip and C-Lip HCCs showed local progression on CT, respectively (p < 0.001), with no significant difference in the time to progression (mean 11.1 ± 2 vs. 13.4 ± 3 months for I-Lip and C-Lip, respectively p = 0.51). Conclusions HCCs with incomplete lipiodol retention after a first cTACE session have a high risk of local progression even when there is a CR according to mRECIST, and should be considered to be incompletely treated.
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Seo N, Kim MS, Park MS, Choi JY, Do RKG, Han K, Kim MJ. Evaluation of treatment response in hepatocellular carcinoma in the explanted liver with Liver Imaging Reporting and Data System version 2017. Eur Radiol 2019; 30:261-271. [PMID: 31418085 DOI: 10.1007/s00330-019-06376-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/04/2019] [Accepted: 07/17/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the performance of Liver Imaging Reporting and Data System (LI-RADS) v2017 treatment response algorithm for predicting hepatocellular carcinoma (HCC) viability after locoregional therapy (LRT) using the liver explant as reference. METHODS One hundred fourteen patients with 206 HCCs who underwent liver transplantation (LT) after LRT for HCCs were included in this retrospective study. Two radiologists independently evaluated tumor viability using the LI-RADS and modified RECIST (mRECIST) with CT and MRI, respectively. The sensitivity and specificity of arterial phase hyperenhancement (APHE) and LR-TR viable criteria (any of three findings: APHE, washout, and enhancement pattern similar to pretreatment imaging) were compared using logistic regression. Receiver operating characteristics (ROC) analysis was used to compare the diagnostic performance between LI-RADS and mRECIST and between CT and MRI. RESULTS The sensitivity and specificity for diagnosing viable tumor were not significantly different between APHE alone and LR-TR viable criteria on CT (p = 0.054 and p = 0.317) and MRI (p = 0.093 and p = 0.603). On CT, the area under the ROC curve (AUC) of LI-RADS was significantly higher than that of mRECIST (0.733 vs. 0.657, p < 0.001). On MRI, there was no significant difference in AUCs between LI-RADS and mRECIST (0.802 vs. 0.791, p = 0.500). Intra-individual comparison of CT and MRI showed comparable AUCs using LI-RADS (0.783 vs. 0.795, p = 0.776). CONCLUSIONS LI-RADS v2017 treatment response algorithm showed better diagnostic performance than mRECIST on CT. With LI-RADS, CT and MRI were comparable to diagnose tumor viability of HCC after LRT. KEY POINTS • Using Liver Imaging Reporting and Data System (LI-RADS) v2017 treatment response algorithm, the viability of hepatocellular carcinoma (HCC) after locoregional therapy (LRT) can be accurately diagnosed. • LI-RADS v2017 treatment response algorithm is superior to modified Response Evaluation Criteria in Solid Tumors for evaluating HCC viability using CT. • Either CT or MRI can be performed to assess tumor viability after LRT using LI-RADS v2017 treatment response algorithm.
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Affiliation(s)
- Nieun Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Mi-Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Jin-Young Choi
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Yonsei Biomedical Research Institute, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Myeong-Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
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Fiorentini G, Sarti D, Carandina R, Mulazzani L, Mincarelli C, Candelari R, Argirò R, Fiorentini C, Aliberti C. A review discussing the use of polyethylene glycol microspheres in the treatment of hepatocellular carcinoma. Future Oncol 2019; 15:695-703. [DOI: 10.2217/fon-2018-0425] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Transarterial chemoembolization (TACE) is indicated in unresectable hepatocellular carcinoma and allows the delivery of embolics inside tumor vascularization to reduce blood supply and release gradually the drug. This lowers the systemic exposure to chemotherapeutics, while increasing their local concentration and tissue necrosis that is higher than conventional TACE. The technology of TACE has seen the introduction of several types of embolics that are made of different materials. Available embolics for TACE include: drug-eluting beads (DC beads), acrylic copolymer, tris-acrylic microspheres and polyethylene glycol (PEG) microspheres. Few studies are available on PEG embolics and their use for TACE. This review focuses on the efficacy and safety of TACE performed with PEG microspheres for the treatment of hepatocellular carcinoma and discusses future therapeutic advantages.
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Affiliation(s)
- Giammaria Fiorentini
- Department of Onco-Hematology, Azienda Ospedaliera ‘Ospedali Riuniti Marche Nord’, 61122 Pesaro, Italy
| | - Donatella Sarti
- Department of Onco-Hematology, Azienda Ospedaliera ‘Ospedali Riuniti Marche Nord’, 61122 Pesaro, Italy
| | - Riccardo Carandina
- Oncology Radiodiagnostics, Oncology Institute of Veneto, Institute for the Research & Treatment of Cancer (IRCC), 35128 Padova, Italy
| | - Luca Mulazzani
- Diagnostics for Images Unit & Interventional Radiology, Azienda Ospedaliera ‘Ospedali Riuniti Marche Nord’, 61122 Pesaro, Italy
| | - Cinzia Mincarelli
- Interventional Radiology, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, 60126 Torrette, Ancona, Italy
| | - Roberto Candelari
- Interventional Radiology, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, 60126 Torrette, Ancona, Italy
| | - Renato Argirò
- Department of Radiological Oncological & Pathological Sciences, Sapienza University, 0161 Rome, Italy
| | - Caterina Fiorentini
- Department of Medical Biothecnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Camillo Aliberti
- Oncology Radiodiagnostics, Oncology Institute of Veneto, Institute for the Research & Treatment of Cancer (IRCC), 35128 Padova, Italy
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10
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Cho CW, Choi GS, Kim JM, Kwon CHD, Kim DJ, Joh JW. Clinical usefulness of transarterial chemoembolization response prior to liver transplantation as predictor of optimal timing for living donor liver transplantation. Ann Surg Treat Res 2018; 95:111-120. [PMID: 30079328 PMCID: PMC6073044 DOI: 10.4174/astr.2018.95.2.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 12/13/2022] Open
Abstract
Purpose Response to preoperative transarterial chemoembolization (TACE) has been recommended as a biological selection criterion for liver transplantation (LT). The aim of our study was to identify optimal timing of living donor liver transplantation (LDLT) after TACE based on the TACE response. Methods We performed a retrospective study to assess recurrence in 128 hepatocellular carcinoma (HCC) patients who underwent LDLT following sequential TACE from January 2002 to March 2015 at a single institute. Cox proportional hazard models and Kaplan-Meier analysis were utilized to estimate HCC recurrence and find optimal timing for LDLT. Results Seventy-three and 61 patients were divided as the responder and nonresponder, respectively. Multivariate analysis showed independent pre-liver transplantation (pre-LT) predictors of recurrence were larger sized tumor (>3 cm, P = 0.024), nonresponse to TACE (P = 0.031), vascular invasion (P = 0.002), and extrahepatic nodal involvement (P = 0.001). In the 3-month time difference between last pre-LT TACE and LDLT subgroup, TACE responders showed significantly higher adjusted hazard ratio (aHR) of recurrence free survival (aHR, 6.284; P = 0.007), cancer specific survival (aHR, 7.033; P = 0.016), and overall survival (aHR, 7.055; P = 0.005). Moreover, for overall patients and responder groups, the significant time difference between last pre-LT TACE and LDLT was 2 months in the minimum P-value approach. Conclusion In selected patients who showed good response to pre-LT TACE, a shorter time interval between TACE and LDLT may be associated with higher recurrence free survival, cancer specific survival, and overall survival.
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Affiliation(s)
- Chan Woo Cho
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Jin Kim
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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11
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Veloso Gomes F, Oliveira JA, Correia MT, Costa NV, Abrantes J, Torres D, Pereira P, Ferreira AI, Luz JH, Spaepen E, Bilhim T, Coimbra É. Chemoembolization of Hepatocellular Carcinoma with Drug-Eluting Polyethylene Glycol Embolic Agents: Single-Center Retrospective Analysis in 302 Patients. J Vasc Interv Radiol 2018; 29:841-849. [DOI: 10.1016/j.jvir.2018.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/31/2018] [Accepted: 02/04/2018] [Indexed: 01/27/2023] Open
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12
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Shaker MK, Montasser IF, Sakr M, Elgharib M, Dabbous HM, Ebada H, Dorry AE, Bahaa M, Meteini ME. Efficacy of loco-regional treatment for hepatocellular carcinoma prior to living donor liver transplantation: a report from a single center in Egypt. J Hepatocell Carcinoma 2018. [PMID: 29520343 PMCID: PMC5833771 DOI: 10.2147/jhc.s147098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and aim The number of loco-regional therapies (LRTs) for hepatocellular carcinoma (HCC) has increased dramatically during the past decade, bridging or downstaging patients on the waiting list for liver transplantation. This study aimed to analyze the outcomes of LRTs prior to living donor liver transplantation in patients with HCC. Methods Sixty-two HCC patients received living donor liver transplantation at Ain Shams Center for Organ Transplantation over a 2-year period. Data from 29 HCC patients were analyzed. Twenty patients (68.97%) met the Milan Criteria and 4 patients (13.8%) exceeded the Milan Criteria, but met the University of California, San Francisco Criteria. Five patients (17.2%) exceeded the University of California, San Francisco Criteria. All patients underwent preoperative LRTs. The protocol of bridging/downstaging, methods, duration of follow-up, the number of patients who were successfully downstaged before liver transplantation (LT), and their outcomes after LT were recorded. Results There was a decrease in the mean overall size of focal lesions (from mean 5.46 to 4.11 cm) in the last abdominal computed tomography (CT) scan after LRT (p=0.0018). Discrepancies between the radiological findings and histopathology were as follows: in 16 patients (55.17%) the CT findings were consistent with the histopathological examination of the explanted liver. Underestimated tumor stage was documented in 10 patients (34.48%), and was overestimated by CT scan findings in 3 patients (10.34%). The 1-year survival rate was 93%. No patient had HCC recurrence after median follow-up of 21 months (range 1–46 months). Conclusion These results encouraged tumor bridging/downstaging as a potential treatment option among carefully selected patients with HCC beyond conventional criteria for LT. Further studies on a large number of patients are necessary.
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Affiliation(s)
| | | | | | | | | | | | - Ahmed El Dorry
- Department of Radiodiagnosis and Interventional Radiology
| | - Mohamed Bahaa
- Department of Hepatobiliary Surgery and Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
| | - Mahmoud El Meteini
- Department of Hepatobiliary Surgery and Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
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13
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Kambadakone AR, Fung A, Gupta RT, Hope TA, Fowler KJ, Lyshchik A, Ganesan K, Yaghmai V, Guimaraes AR, Sahani DV, Miller FH. LI-RADS technical requirements for CT, MRI, and contrast-enhanced ultrasound. Abdom Radiol (NY) 2018; 43:56-74. [PMID: 28940042 DOI: 10.1007/s00261-017-1325-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accurate detection and characterization of liver observations to enable HCC diagnosis and staging using LI-RADS requires a technically adequate imaging exam. To help achieve this objective, LI-RADS has proposed technical requirements for CT, MR, and contrast-enhanced ultrasound of liver. This article reviews the technical requirements for liver imaging, including the description of minimum acceptable technical standards, such as the scanner hardware requirements, recommended dynamic imaging phases, and common technical challenges of liver imaging.
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Affiliation(s)
- Avinash R Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
| | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Thomas A Hope
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Karthik Ganesan
- Department of Radiology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Vahid Yaghmai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexander R Guimaraes
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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14
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Kulik L, Heimbach JK, Zaiem F, Almasri J, Prokop LJ, Wang Z, Murad MH, Mohammed K. Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: A systematic review and meta-analysis. Hepatology 2018; 67:381-400. [PMID: 28859222 DOI: 10.1002/hep.29485] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/03/2017] [Accepted: 06/02/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED Patients with hepatocellular carcinoma (HCC) who are listed for liver transplantation (LT) are often treated while on the waiting list with locoregional therapy (LRT), which is aimed at either preventing progression of HCC or reducing the measurable disease burden of HCC in order to receive increased allocation priority. We aimed to synthesize evidence regarding the effectiveness of LRT in the management of patients with HCC who were on the LT waitlist. We conducted a comprehensive search of multiple databases from 1996 to April 25, 2016, for studies that enrolled adults with cirrhosis awaiting LT and treated with bridging or down-staging therapies before LT. Therapies included transcatheter arterial chemoembolization, transarterial radioembolization, ablation, and radiotherapy. We included both comparative and noncomparative studies. There were no randomized controlled trials identified. For adults with T1 HCC and waiting for LT, there were only two nonrandomized comparative studies, both with a high risk of bias, which reported the outcome of interest. In one series, the rate of dropout from all causes at 6 months in T1 HCC patients who underwent LRT was 5.3%, while in the other series of T1 HCC patients who did not receive LRT, the dropout rate at median follow-up of 2.4 years and the progression rate to T2 HCC were 30% and 88%, respectively. For adults with T2 HCC awaiting LT, transplant with any bridging therapy showed a nonsignificant reduction in the risk of waitlist dropout due to progression (relative risk [RR], 0.32; 95% confidence interval [CI], 0.06-1.85; I2 = 0%) and of waitlist dropout from all causes (RR, 0.38; 95% CI, 0.060-2.370; I2 = 85.7%) compared to no therapy based on three comparative studies. The quality of evidence is very low due to high risk of bias, imprecision, and inconsistency. There were five comparative studies which reported on posttransplant survival rates and 10 comparative studies which reported on posttransplant recurrence, and there was no significant difference seen in either of these endpoints. For adults initially with stage T3 HCC who received LRT, there were three studies reporting on transplant with any down-staging therapy versus no downstaging, and this showed a significant increase in 1-year (two studies, RR, 1.11; 95% CI, 1.01-1.23) and 5-year (1 study, RR, 1.17; 95% CI, 1.03-1.32) post-LT survival rates for patients who received LRT. The quality of evidence is very low due to serious risk of bias and imprecision. CONCLUSION In patients with HCC listed for LT, the use of LRT is associated with a nonsignificant trend toward improved waitlist and posttransplant outcomes, though there is a high risk of selection bias in the available evidence. (Hepatology 2018;67:381-400).
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Affiliation(s)
- Laura Kulik
- Division of Gastroenterology and Hepatology, Northwestern School of Medicine, Chicago, IL
| | | | - Feras Zaiem
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Jehad Almasri
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Larry J Prokop
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Zhen Wang
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Khaled Mohammed
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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15
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Lei J, Zhong J, Luo Y, Yan L, Zhu J, Wang W, Li B, Wen T, Yang J. Response to transarterial chemoembolization may serve as selection criteria for hepatocellular carcinoma liver transplantation. Oncotarget 2017; 8:91328-91342. [PMID: 29207647 PMCID: PMC5710927 DOI: 10.18632/oncotarget.20511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/02/2017] [Indexed: 02/05/2023] Open
Abstract
Aims This study sought to extend the inclusion criteria for hepatocellular carcinoma (HCC) liver transplantation (LT), particularly addressing the safety and effectiveness of pre-LT transarterial chemoembolization (TACE). Materials and Methods Our study included 115 patients with HCC who underwent LT after TACE. The response measured after each TACE session was based on the mRECIST criteria: complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD). We defined CR and PR patients as responders (64 cases) and SD and PD patients as non-responders (51 cases). Results The majority of responders could be identified after the first or second TACE sessions (57 cases, 89.1%). Overall survival rates at 1, 3 and 5 years were 95.3%, 89.1% and 75.0%, respectively, in the responder group, and these rates were much higher than those in the non-responder group (86.3%, 66.7% and 54.9%, P=0.016). In addition, the tumor-free survival rate in the responder group was also higher than in the non-responder group (P=0.009). In the responder group, a statistically improved long-term outcome was observed in patients whose HCC did not satisfy the Milan criteria (P<0.05). Univariate and multivariate Cox analyses showed that achieving CR or PR was the best predictor of survival and tumor-free survival following TACE. Conclusion The response to TACE, particularly following the first two sessions, primarily and robustly predicted overall and tumor-free survival in HCC patients, particularly those whose HCC did not satisfy the Milan criteria.
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Affiliation(s)
- Jianyong Lei
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.,Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China.,Present address: Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jinjing Zhong
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Yefang Luo
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Lunan Yan
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jinqiang Zhu
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wentao Wang
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Bo Li
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Tianfu Wen
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jiaying Yang
- Transplantation Center,West China Hospital of Sichuan University, Chengdu, China
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16
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Nicolini D, Agostini A, Montalti R, Mocchegiani F, Mincarelli C, Mandolesi A, Robertson NL, Candelari R, Giovagnoni A, Vivarelli M. Radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation. World J Gastroenterol 2017; 23:3690-3701. [PMID: 28611522 PMCID: PMC5449426 DOI: 10.3748/wjg.v23.i20.3690] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/07/2017] [Accepted: 05/04/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the prognostic value of the radiological response after transarterial chemoembolization (TACE) and inflammatory markers in patients affected by hepatocellular carcinoma (HCC) awaiting liver transplantation (LT).
METHODS We retrospectively evaluated the preoperative predictors of HCC recurrence in 70 patients treated with conventional (n = 16) or doxorubicin-eluting bead TACE (n = 54) before LT. The patient and tumour characteristics, including the static and dynamic alpha-fetoprotein, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (PLR) measurements, were recorded. Treatment response was classified according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST) and the European Association for the Study of the Liver (EASL) criteria as complete response (CR), partial response (PR), stable disease or progressive disease. After examination of the explanted livers, histological necrosis was classified as complete (100% of the cumulative tumour area), partial (50%-99%) or minimal (< 50%) and was correlated with the preoperative radiological findings.
RESULTS According to the pre-TACE radiological evaluation, 22/70 (31.4%) and 12/70 (17.1%) patients were beyond Milan and University of San Francisco (UCSF) criteria, respectively. After TACE procedures, the objective response (CR + PR) rates were 71.4% and 70.0% according to mRECIST and EASL criteria, respectively. The agreement between the two guidelines in defining the radiological response was rated as very good both for the overall and target lesion response (weighted k-value: 0.98 and 0.93, respectively). Complete and partial histological necrosis were achieved in 14/70 (20.0%) and 28/70 (40.0%) patients, respectively. Using histopathology as the reference standard, mRECIST criteria correctly classified necrosis in 72.9% (51/70) of patients and EASL criteria in 68.6% (48/70) of cases. The mRECIST non-response to TACE [Exp(b) = 9.2, p = 0.012], exceeding UCSF criteria before TACE [Exp(b) = 4.7, p = 0.033] and a preoperative PLR > 150 [Exp(b) = 5.9, p = 0.046] were independent predictors of tumour recurrence.
CONCLUSION The radiological response and inflammatory markers are predictive of tumour recurrence and allow the proper selection of TACE-treated candidates for LT.
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17
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Ye XD, Yuan Z, Zhang J, Yuan Z. Radiological biomarkers for assessing response to locoregional therapies in hepatocellular carcinoma: From morphological to functional imaging (Review). Oncol Rep 2017; 37:1337-1346. [PMID: 28184942 DOI: 10.3892/or.2017.5420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/16/2017] [Indexed: 11/05/2022] Open
Abstract
Many hepatocellular carcinoma (HCC) patients do not qualify for curative surgical intervention and are instead treated with locoregional therapies (LRTs) including ablative and endovascular therapies. Assessment of imaging response is essential in the management of HCC for determining efficacy of therapy and as a surrogate marker for improved survival. The established morphological image biomarkers for tumor burden measurement continue to be applied, as size measurement can easily be used in clinical practice. However, in the setting of liver-directed LRTs for HCC, simple tumor morphological changes can be less informative and usually appear later than biologic changes. Functional imaging (such as perfusion and diffusion imaging, PET-CT/MR and MR spectroscopy) has the potential to be a promising technique for assessment of HCC response to LRTs. Although promising, none of these functional imaging biomarkers have gone through all the required steps of standardization and validation and established accepted criteria for clinical practice.
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Affiliation(s)
- Xiao-Dan Ye
- Department of Radiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, P.R. China
| | - Zuguo Yuan
- Radiation Oncology Center, The 1st Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Jian Zhang
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Zheng Yuan
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China
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18
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Clinical validity of Metroticket calculator in transplant patients undergoing prior chemoembolization for hepatocellular carcinoma. Hepatol Int 2017; 11:209-219. [PMID: 28144812 DOI: 10.1007/s12072-017-9785-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/10/2017] [Indexed: 01/15/2023]
Abstract
AIM To test the predictive performance of the Metroticket calculator for survival after liver transplantation (LT) of patients with hepatocellular carcinoma (HCC) undergoing prior transarterial chemoembolization (TACE). METHODS A total of 142 patients treated with TACE and subsequent LT who had arterial enhancing HCC(s) were entered into this analysis. Tumor parameters measured by the enhancement radiological method pre-LT or by pathology post-LT were incorporated into the Metroticket analysis. The calculator was validated in terms of calibration and discrimination capacity. RESULTS Mean 3- and 5-year survival rates predicted in the radiological model for all 142 patients were 76.4 and 70.1 %, respectively, lying comfortably within the 95 % confidence interval (CI) of the observed survival rate estimates (72.8-86.2 and 68.6-83.2 %, respectively). In the pathological model incorporating microvascular invasion, the mean anticipated survival rate at 5 years of 120 patients with viable nodules on explants was 69.5 %, also lying inside the 95 % CI of the actuarial rates (67.9-83.5 %). The c-indices as measures of discriminatory power were 0.61 and 0.62, respectively, for the 3- and 5-year predictions in the radiological model, and 0.72 for the 5-year prediction in the pathological model. The corresponding findings were similar for subgroups with hepatitis B virus infection and undergoing living-donor LT. CONCLUSIONS The Metroticket calculation based on explant data accurately predicts post-LT survival of HCC patients with prior TACE. Imaging estimate-based predictions before LT appear to provide poorer discrimination than calibration.
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19
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Gadoxetic acid-enhanced magnetic resonance imaging characteristics of hepatocellular carcinoma occurring in liver transplants. Eur Radiol 2016; 27:3117-3127. [DOI: 10.1007/s00330-016-4662-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 11/03/2016] [Accepted: 11/16/2016] [Indexed: 12/13/2022]
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20
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Dioguardi Burgio M, Ronot M, Bruno O, Francoz C, Paradis V, Castera L, Durand F, Soubrane O, Vilgrain V. Correlation of tumor response on computed tomography with pathological necrosis in hepatocellular carcinoma treated by chemoembolization before liver transplantation. Liver Transpl 2016; 22:1491-1500. [PMID: 27543821 DOI: 10.1002/lt.24615] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/26/2016] [Indexed: 02/07/2023]
Abstract
The purpose of this article was to compare the results of Response Evaluation Criteria in Solid Tumors (RECIST), modified Response Evaluation Criteria in Solid Tumors (mRECIST), and European Association for the Study of the Liver (EASL) criteria for the evaluation of tumor necrosis in patients treated with transarterial chemoembolization before liver transplantation (LT) for hepatocellular carcinoma. Response to treatment was evaluated on computed tomography scan by 2 independent readers based on RECIST, mRECIST, and EASL criteria, and compared with tumor necrosis assessed by explant pathology. Necrosis was defined as major when >90%. Factors associated with major necrosis were tested by multivariate analysis. Fifty-eight patients (53 males; mean age, 54 years; range, 31-64 years) were included with 88 nodules. Fifty-one (58%) nodules were shown to have major necrosis. Among them readers 1 and 2 identified a complete response (CR) according to RECIST, mRECIST, and EASL criteria in 2 (4%), 47 (92%), and 47 (92%), and 1 (2%), 45 (88%), and 45 (88%) nodules, respectively. However, 12-14 of 59 nodules classified as CR on mRECIST or EASL criteria were found to have intermediate or minor necrosis (overestimation in 20%-24% of the patients). Combining the classification of CR by mRECIST and EASL criteria and complete lipiodol deposition reduced the overestimation to 11%. Among 59 nodules classified with a CR according to mRECIST or EASL, those with complete lipiodol deposition (n = 36, 61%) had a higher rate of necrosis than those with incomplete lipiodol deposition (n = 23, 39%): 95% versus 68% and 95% versus 63% for reader 1 and 2, respectively. In conclusion, CR based on mRECIST/EASL combined with complete lipiodol deposition was better for identification of major tumor necrosis. Even in the presence of CR according to mRECIST/EASL, incomplete lipiodol deposition should be considered indicative of substantial viable tumor remnant. Liver Transplantation 22 1491-1500 2016 AASLD.
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Affiliation(s)
- Marco Dioguardi Burgio
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Maxime Ronot
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. .,University Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Onorina Bruno
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Claire Francoz
- Department of Hepatology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Valérie Paradis
- Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Laurent Castera
- Department of Hepatology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - François Durand
- Department of Hepatology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Olivier Soubrane
- Department of Surgery, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
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21
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Wu SE, Charles HW, Park JS, Goldenberg AS, Deipolyi AR. Obesity conveys poor outcome in patients with hepatocellular carcinoma treated by transarterial chemoembolization. Diagn Interv Imaging 2016; 98:37-42. [PMID: 27372418 DOI: 10.1016/j.diii.2016.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of this retrospective study was to evaluate the impact of obesity on radiologic outcomes in patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE). MATERIALS AND METHODS A total of 100 TACE procedures performed in 57 patients (42 men, 15 women) with a mean age of 62 years±8.4 (SD) (range: 39-83 years) were retrospectively reviewed. The 1-2-month follow-up computed tomography or magnetic resonance imaging examinations was assessed for new or residual disease and radiologic response using mRECIST criteria. Patients were categorized into two groups according to body mass index (BMI). Patients with BMI<25kg/m2 were further referred as to low BMI patients and those with BMI≥25kg/m2 as high BMI patients. Outcomes were compared between the two groups. RESULTS Low and high BMI patients were similar in regard to age, gender, HCC etiology and stage, and pre-procedure disease burden. TACE for high BMI, compared to low BMI, patients resulted in lower complete response (39% vs. 66%) and higher progressive disease (21% vs. 5%) rates (P=0.04), and higher rates of residual disease (63% vs. 39%, P=0.02) and new lesions in untreated liver (39% vs. 18%, P=0.04) on 1-2-month follow-up imaging. CONCLUSIONS High BMI is associated with significantly more residual disease, new lesions, and progressive disease in patients with HCC treated by TACE.
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Affiliation(s)
- S E Wu
- Vascular and Interventional Radiology, NYU Langone Medical Center, 560 1st Avenue, 2nd Floor, New York, NY 10016, USA
| | - H W Charles
- Vascular and Interventional Radiology, NYU Langone Medical Center, 560 1st Avenue, 2nd Floor, New York, NY 10016, USA
| | - J S Park
- Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, 550 1st avenue, New York, NY 10016, USA
| | - A S Goldenberg
- Hematology, Department of Medicine, NYU Langone Medical Center, 157 East 32nd Street, 2nd Floor, New York, NY 10016, USA
| | - A R Deipolyi
- Vascular and Interventional Radiology, NYU Langone Medical Center, 560 1st Avenue, 2nd Floor, New York, NY 10016, USA.
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22
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Liver transplantation for hepatobiliary malignancies: a new era of "Transplant Oncology" has begun. Surg Today 2016; 47:403-415. [PMID: 27130463 DOI: 10.1007/s00595-016-1337-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/06/2016] [Indexed: 01/10/2023]
Abstract
The indications of liver transplantation for hepatobiliary malignancies have been carefully expanded in a stepwise fashion, despite the fundamental limitations in oncological, immunological, and technical aspects. A new era of "Transplant Oncology," the fusion of transplant surgery and surgical oncology, has begun, and we stand at the dawn of a paradigm shift in multidisciplinary cancer treatment. For hepatocellular carcinoma, new strategies have been undertaken to select recipients based on biological and dynamic markers instead of conventional morphological and static parameters, opening the doors for a more deliberate expansion of the Milan criteria and locoregional therapies before liver transplantation. Neoadjuvant chemoradiation therapy followed by liver transplantation for unresectable perihilar cholangiocarcinoma developed by the Mayo Clinic provided excellent outcomes in a US multicenter study; however, the surgical indications are not necessarily universal and await international validation. Similarly, an aggressive multidisciplinary approach has been applied for other tumors, including intrahepatic cholangiocarcinoma, hepatoblastoma, liver metastases from colorectal and neuroendocrine primary and gastrointestinal stromal tumors as well as rare tumors, such as hepatic undifferentiated embryonal sarcoma and infantile choriocarcinoma. In conclusion, liver transplantation is an important option for hepatobiliary malignancies; however, prospective studies are urgently needed to ensure the appropriate patient selection, organ allocation and living donation policies, and administration of antineoplastic immunosuppression.
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Lei JY, Zhong JJ, Yan LN, Zhu JQ, Wang WT, Zeng Y, Li B, Wen TF, Yang JY. Response to transarterial chemoembolization as a selection criterion for resection of hepatocellular carcinomas. Br J Surg 2016; 103:881-90. [PMID: 27027978 DOI: 10.1002/bjs.9864] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 04/18/2015] [Accepted: 05/01/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Liver resection for intermediate (Barcelona Clinic Liver Cancer (BCLC) stage B) hepatocellular carcinoma (HCC) remains controversial. This study attempted to demonstrate the effectiveness of preresection transarterial chemoembolization (TACE) as a selection criterion for BCLC-B HCC. METHODS The study included patients with BCLC-B HCC who underwent liver resection after TACE. The tumour response to TACE was evaluated according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST). Patients with a complete or partial response comprised the responder group, whereas those with stable or progressive disease were classified as non-responders. RESULTS A total of 242 patients were included. After between one and eight sessions of TACE, 141 patients were included in the responder group: 37 patients (15·3 per cent) who achieved a complete response and 104 who had a partial response. The cumulative 1-, 3- and 5-year overall survival rates were 97·2, 88·7 and 75·2 per cent respectively in the responder group, compared with 90·1, 67·3 and 53·5 per cent among 101 non-responders (P < 0·001). Tumour-free survival rates were also better among responders than non-responders (P < 0·001). In multivariable analysis, independent predictors of overall and tumour-free survival were response to TACE and microvascular invasion (all P < 0·001). CONCLUSION mRECIST may represent selection criterion for intermediate HCC for surgical treatment.
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Affiliation(s)
- J Y Lei
- Thyroid and Parathyroid Surgery Centre, West China Hospital of Sichuan University, Chengdu, China.,Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.,State Key Laboratory of Biotherapy/Collaborative Innovation Centre of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - J J Zhong
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - L N Yan
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - J Q Zhu
- Thyroid and Parathyroid Surgery Centre, West China Hospital of Sichuan University, Chengdu, China
| | - W T Wang
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Y Zeng
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - B Li
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - T F Wen
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - J Y Yang
- Transplantation Centre, West China Hospital of Sichuan University, Chengdu, China
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Does the Degree of Hepatocellular Carcinoma Tumor Necrosis following Transarterial Chemoembolization Impact Patient Survival? JOURNAL OF ONCOLOGY 2016; 2016:4692139. [PMID: 26949394 PMCID: PMC4754482 DOI: 10.1155/2016/4692139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/21/2015] [Accepted: 12/29/2015] [Indexed: 12/20/2022]
Abstract
Purpose. The association between transarterial chemoembolization- (TACE-) induced HCC tumor necrosis measured by the modified Response Evaluation Criteria In Solid Tumors (mRECIST) and patient survival is poorly defined. We hypothesize that survival will be superior in HCC patients with increased TACE-induced tumor necrosis. Materials and Methods. TACE interventions were retrospectively reviewed. Tumor response was quantified via dichotomized (responders and nonresponders) and the four defined mRECIST categories. Results. Median survival following TACE was significantly greater in responders compared to nonresponders (20.8 months versus 14.9 months, p = 0.011). Survival outcomes also significantly varied among the four mRECIST categories (p = 0.0003): complete, 21.4 months; partial, 20.8; stable, 16.8; and progressive, 7.73. Only progressive disease demonstrated significantly worse survival when compared to complete response. Multivariable analysis showed that progressive disease, increasing total tumor diameter, and non-Child-Pugh class A were independent predictors of post-TACE mortality. Conclusions. Both dichotomized (responders and nonresponders) and the four defined mRECIST responses to TACE in patients with HCC were predictive of survival. The main driver of the survival analysis was poor survival in the progressive disease group. Surprisingly, there was small nonsignificant survival benefit between complete, partial, and stable disease groups. These findings may inform HCC treatment decisions following first TACE.
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Fahrner R, Dondorf F, Ardelt M, Dittmar Y, Settmacher U, Rauchfuß F. Liver transplantation for hepatocellular carcinoma - factors influencing outcome and disease-free survival. World J Gastroenterol 2015; 21:12071-12082. [PMID: 26576092 PMCID: PMC4641125 DOI: 10.3748/wjg.v21.i42.12071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/04/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma is one of the leading causes of cancer-related death worldwide. Liver transplantation can be a curative treatment in selected patients. However, there are several factors that influence disease-free survival after transplantation. This review addresses the pre-, intra- and postoperative factors that influence the risk of tumor recurrence after liver transplantation.
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Zurera L, Espejo J, Lombardo S, Marchal T, Muñoz M, Canis M, Montero J. Histologic study of the effects of chemoembolization with preloaded doxorubicin beads in patients with hepatocellular carcinoma. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Allard MA, Sebagh M, Ruiz A, Guettier C, Paule B, Vibert E, Cunha AS, Cherqui D, Samuel D, Bismuth H, Castaing D, Adam R. Does pathological response after transarterial chemoembolization for hepatocellular carcinoma in cirrhotic patients with cirrhosis predict outcome after liver resection or transplantation? J Hepatol 2015; 63:83-92. [PMID: 25646884 DOI: 10.1016/j.jhep.2015.01.023] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 12/17/2014] [Accepted: 01/21/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS To investigate the prognostic significance of pathologic response (PR) after transarterial chemoembolization (TACE) in cirrhotic patients resected or transplanted for hepatocellular carcinoma (HCC), and to identify predictors of complete pathologic response (CPR). METHODS Between 1990 and 2010, 373 consecutive cirrhotic patients with HCC were treated by TACE followed by either liver resection (LR:184 patients) or liver transplantation (LT:189 patients). The PR was evaluated as the mean percentage of non-viable tumor area within each tumor. CPR was defined as the absence of any viable tumor area in all the present nodules. RESULTS A total of 59 (32%) and 37 (20%) patients had CPR after LR and LT, respectively. Five-year overall survival (OS) was higher in patients with CPR compared to those without, after LR (58% vs. 34%; p=0.0006) and tends to be higher after LT (84% vs. 65%; p=0.09). The 5-year recurrence-free survival (RFS) rates were significantly higher in both groups (24% vs. 13% after LR; p=0.008 and 94% vs. 73% after LT, p=0.007). A cut-off value of >90% necrosis emerged as an impacting factor on patient survival after LR or LT. On multivariate analysis stratified on the type of procedure (LR or LT), PR >90% remained an independent factor of better OS and RFS. Independent factors associated with CPR were: a maximal tumor size <30 mm (RR 2.17 [1.27-3.74]), a single tumor (RR 6.08 [3.29-12.07]), and an preoperative AFP<100 ng/ml (see results section) (RR 3.99 [1.63-11.98]). The probability to achieve a CPR ranged from 2% in the absence of any factors to 48% in the presence of all factors. CONCLUSION In cirrhotic patients with HCC, a complete or nearly complete PR improves long-term survival after LR and LT independently of other pathological factors. This underlines the importance of neoadjuvant treatment to obtain a significant decrease of active tumor load.
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Affiliation(s)
- Marc-Antoine Allard
- Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S776 Inserm, Villejuif, France
| | - Mylène Sebagh
- Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; Departement of Pathology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France; UMR-S785 Inserm, Villejuif, France
| | - Aldrick Ruiz
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catherine Guettier
- Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; Departement of Pathology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France; UMR-S785 Inserm, Villejuif, France
| | - Bernard Paule
- Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France
| | - Eric Vibert
- Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S785 Inserm, Villejuif, France
| | - Antonio Sa Cunha
- Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S776 Inserm, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S785 Inserm, Villejuif, France
| | - Didier Samuel
- Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S785 Inserm, Villejuif, France
| | - Henri Bismuth
- Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France
| | - Denis Castaing
- Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S785 Inserm, Villejuif, France
| | - René Adam
- Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S776 Inserm, Villejuif, France.
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Kurahashi S, Sano T, Natsume S, Senda Y, Yamaura H, Inaba Y, Shimizu Y. Surgical treatment after hepatic arterial infusion chemotherapy for hepatocellular carcinoma extending into the right atrium. Surg Case Rep 2015; 1:47. [PMID: 26366344 PMCID: PMC4560137 DOI: 10.1186/s40792-015-0047-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/25/2015] [Indexed: 02/07/2023] Open
Abstract
A resected case of hepatocellular carcinoma which extended into the right atrium after treatment with hepatic arterial infusion chemotherapy (HAIC) is described. An 81-year-old man presented with right hypochondralgia. CT demonstrated a hypervascular tumor 11.5 cm in diameter extending into the right atrium through the right hepatic vein. The patient underwent HAIC with 100 mg of cisplatin (CDDP IA-call®) particles three times every month. The tumor showed a marked shrinkage and an involution of the venous thrombus around the orifice of the right hepatic vein. Right hemihepatectomy with tumor thrombectomy was performed as a salvage surgery using a total hepatic vascular exclusion technique. Histologically, the tumor turned into diffuse necrosis and fibrosis, so viable tumor cells were encountered neither in the main tumor nor venous thrombus. The therapeutic effect of HAIC was pathological complete remission. The patient has been doing well for 6 years after the surgery without evidence of tumor recurrence. The salvage operation was safely achievable for the initially unresectable advanced hepatocellular carcinoma extending into the right atrium.
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Affiliation(s)
- Shintaro Kurahashi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
| | - Tsuyoshi Sano
- Department of Gastroenterological Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi Japan
| | - Seiji Natsume
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
| | - Yoshiki Senda
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
| | - Hidekazu Yamaura
- Department of Interventional Radiology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
| | - Yoshitaka Inaba
- Department of Interventional Radiology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
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Kim HD, Shim JH, Kim GA, Shin YM, Yu E, Lee SG, Lee D, Kim KM, Lim YS, Lee HC, Chung YH, Lee YS. Optimal methods for measuring eligibility for liver transplant in hepatocellular carcinoma patients undergoing transarterial chemoembolization. J Hepatol 2015; 62:1076-84. [PMID: 25529626 DOI: 10.1016/j.jhep.2014.12.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 12/01/2014] [Accepted: 12/08/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS We investigated the optimal radiologic method for measuring hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE) in order to assess suitability for liver transplantation (LT). METHODS 271 HCC patients undergoing TACE prior to LT were classified according to both Milan and up-to-seven criteria after TACE by using the enhancement or size method on computed tomography images. The cumulative incidence function curves with competing risks regression was used in post-LT time-to-recurrence analysis. The predictive accuracy for recurrence was compared using area under the time-dependent receiver operating characteristic curves (AUC) estimation. RESULTS Of the 271 patients, 246 (90.8%) and 164 (60.5%) fell within Milan and 252 (93.0%) and 210 (77.5%) fell within up-to-seven criteria, when assessed by enhancement and size methods, respectively. Competing risks regression analyses adjusting for covariates indicated that meeting the criteria by enhancement and by size methods was independently related to post-LT time-to-recurrence in the Milan or up-to-seven model. Higher AUC values were observed with the size method only in the up-to-seven model (p<0.05). Mean differences in the sum of tumor diameter and number of tumors between pathologic and radiologic findings were significantly less by the enhancement method (p<0.05). Cumulative incidence curves showed similar recurrence results between patients with and without prior TACE within the criteria based on either method, except for the within up-to-seven by the enhancement method (p=0.017). CONCLUSIONS The enhancement method is a reliable tool for assessing the control or downstaging of HCC within Milan after TACE, although the size method may be preferable when applying the up-to-seven criterion.
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Affiliation(s)
- Hyung-Don Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ju Hyun Shim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Gi-Ae Kim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Moon Shin
- Department of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eunsil Yu
- Department of Pathology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Gyu Lee
- Department of Surgery, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Danbi Lee
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kang Mo Kim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han Chu Lee
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Hwa Chung
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yung Sang Lee
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Donati OF, Do RKG, Hötker AM, Katz SS, Zheng J, Moskowitz CS, Beattie C, Brown KT. Interreader and inter-test agreement in assessing treatment response following transarterial embolization for hepatocellular carcinoma. Eur Radiol 2015; 25:2779-88. [PMID: 25850892 DOI: 10.1007/s00330-015-3677-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate interreader and inter-test agreement in applying size- and necrosis-based response assessment criteria after transarterial embolization (TAE) for hepatocellular carcinoma (HCC), applying two different methods of European Association for the Study of the Liver (EASL) criteria. METHODS Seventy-four patients (median age, 67 years) from a prospectively accrued study population were included in this retrospective study. Four radiologists independently evaluated CT data at 2-3 (1st follow-up, FU) and 10-12 (2nd FU) weeks after TAE and assessed treatment response using size-based (WHO, RECIST) and necrosis-based (mRECIST, EASL) criteria. Enhancing tissue was bidimensionally measured (EASLmeas) and also visually estimated (EASLest). Interreader and inter-test agreements were assessed using intraclass correlation coefficient (ICC) and κ statistics. RESULTS Interreader agreement for all response assessment methods ranged from moderate to substantial (κ = 0.578-0.700) at 1st FU and was substantial (κ = 0.716-0.780) at 2nd FU. Inter-test agreement was substantial between WHO and RECIST (κ = 0.610-0.799, 1st FU; κ = 0.655-0.782, 2nd FU) and excellent between EASLmeas and EASLest (κ = 0.899-0.918, 1st FU; κ = 0.843-0.877, 2nd FU). CONCLUSION Size- and necrosis-based criteria both show moderate to excellent interreader agreement in evaluating treatment response after TAE for HCC. Inter-test agreement regarding EASLmeas and EASLest was excellent, suggesting that either may be used. KEY POINTS • Applying EASL criteria, visual estimation and bidimensional measurements show comparable interreader agreement. • EASL meas and EASL est show substantial interreader agreement for treatment response in HCC. • Agreement was excellent for EASL meas and EASL est after TAE of HCC. • Visual estimation of enhancement is adequate to assess treatment response of HCC.
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Affiliation(s)
- Olivio F Donati
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Zurera LJ, Espejo JJ, Lombardo S, Marchal T, Muñoz MC, Canis M, Montero JL. Histologic study of the effects of chemoembolization with preloaded doxorubicin beads in patients with hepatocellular carcinoma. RADIOLOGIA 2014; 57:419-27. [PMID: 25535030 DOI: 10.1016/j.rx.2014.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 06/05/2014] [Accepted: 07/21/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the degree of tumor necrosis in surgical specimens of hepatocellular carcinomas treated with microspheres preloaded with doxorubicin and to analyze the relationship between the degree of necrosis and a) morphologic factors and b) imaging biomarkers. MATERIAL AND METHODS We studied the livers of 21 patients who had undergone selective arterial chemoembolization with DC beads (Biocompatibles, UK) before receiving liver transplants. RESULTS Imaging techniques detected 43 nodules (mean size, 25 mm). Angiography showed 25 hypervascularized nodules, 12 slightly vascularized nodules, and 6 avascular nodules. A total of 81 hepatocellular carcinomas (mean size, 15 mm) were detected in the specimens: two were capsular and two had vascular infiltration. The mean degree of necrosis after chemoembolization was 39%; necrosis was greater than 60% in 28 hepatocellular carcinomas and less than 60% in 52. The degree of necrosis correlated significantly with the time elapsed between the last chemoembolization treatment and liver transplantation (the degree of necrosis decreased as time increased), with the number of nodules in the specimen, and with capsular infiltration. When imaging techniques detected 1 or 2 nodules, there was a greater probability of achieving greater than 90% necrosis. No relation with the degree of necrosis achieved was found for the size of the nodules detected at imaging, the enhancement pattern, or the number of chemoembolization treatments. CONCLUSION The degree of necrosis achieved depends on the time spent on the waiting list, on the number of nodules in the specimen, and on whether capsular infiltration is present.
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Affiliation(s)
- L J Zurera
- Unidad de Radiología Intervencionista, Hospital Universitario Reina Sofía, Córdoba, España.
| | - J J Espejo
- Unidad de Radiología Intervencionista, Hospital Universitario Reina Sofía, Córdoba, España
| | - S Lombardo
- Unidad de Radiología Intervencionista, Hospital Universitario Reina Sofía, Córdoba, España
| | - T Marchal
- Departamento de Anatomía Patológica, Hospital Universitario Reina Sofía, Córdoba, España
| | - M C Muñoz
- IMIBIC, Hospital Universitario Reina Sofía, Córdoba, España
| | - M Canis
- Unidad de Radiología Intervencionista, Hospital Universitario Reina Sofía, Córdoba, España
| | - J L Montero
- Unidad de Hepatología, Hospital Universitario Reina Sofía, Córdoba, España
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Drug-Eluting Beads Loaded With Doxorubicin (DEBDOX) Chemoembolisation Before Liver Transplantation for Hepatocellular Carcinoma: An Imaging/Histologic Correlation Study. Cardiovasc Intervent Radiol 2014; 38:685-92. [DOI: 10.1007/s00270-014-0967-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/14/2014] [Indexed: 01/01/2023]
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Xing M, Kokabi N, Camacho JC, Kooby DA, El-Rayes BF, Kim HS. 90Y radioembolization versus chemoembolization in the treatment of hepatocellular carcinoma: an analysis of comparative effectiveness. J Comp Eff Res 2014; 2:435-44. [PMID: 24236684 DOI: 10.2217/cer.13.37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Locoregional catheter-based therapies for unresectable hepatocellular carcinoma (HCC) include conventional transarterial chemoembolization (cTACE), drug-eluting bead chemoembolization and yttrium-90 ((90)Y) radioembolization. Although current guidelines recommend cTACE for inoperable HCC, comparative effectiveness of drug-eluting bead chemoembolization and (90)Y radioembolization in the management of HCC remains undefined due to the lack of data evaluating safety and effectiveness among these therapies. A comprehensive search of the literature was carried out for studies examining comparative effectiveness of cTACE and (90)Y based on objective tumor response and overall patient survival. Further data on efficacy, safety, toxicity and cost-effectiveness was also examined. The National Cancer Institute Levels of Evidence for Cancer Treatment Studies provided a useful framework for the critical understanding and stratification of current evidence on locoregional therapy for unresectable HCC. Based on current retrospective cohort studies, evidence for similar efficacy and safety between cTACE and (90)Y radioembolization was demonstrated. Further prospective, randomized studies are required to validate these observations and to analyze cost-effectiveness of these interventions in unresectable HCC patients for definitive recommendations to be made.
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Affiliation(s)
- Minzhi Xing
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology & Imaging Sciences, Emory University School of Medicine, GA, USA
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Kim DJ, Clark PJ, Heimbach J, Rosen C, Sanchez W, Watt K, Charlton MR. Recurrence of hepatocellular carcinoma: importance of mRECIST response to chemoembolization and tumor size. Am J Transplant 2014; 14:1383-90. [PMID: 24801862 DOI: 10.1111/ajt.12684] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 01/16/2014] [Accepted: 01/21/2014] [Indexed: 01/25/2023]
Abstract
Determining risk for recurrence of hepatocellular carcinoma (HCC) following liver transplantation (LT) is an important clinical need. We assessed consecutive patients who underwent LT for HCC following sequential transarterial chemoembolization (TACE). Treatment response was assessed using modified response evaluation criteria in solid tumors (mRECIST) categories: complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Cox proportional hazard models were used to predict HCC recurrence. One hundred seventy-three patients underwent TACE and imaging to assess response prior to LT. TACE responses were: CR = 23.7%, PR = 24.3%, SD = 27.7% and PD = 24.3%. Five-year HCC recurrence rate was 5.3% in patients responding to TACE (CR/PR), versus 17.6%, among patients who did not respond (SD/PD, p = 0.014). In multivariate analysis, independent pre-LT predictors of recurrence were response to TACE and largest radiologic size of tumor (>3 cm vs. ≤3 cm). HCC recurrence rate for patients with tumor size >3 cm and no response to TACE was 35.8%, compared with 1.9% for patients with tumor size ≤3 cm and response to TACE (p = 0.0007). We conclude that mRECIST criteria and tumor size differentiate patients with high or low likelihood of HCC recurrence after LT. These findings raise the possibility of incorporating response to TACE and largest tumor size to identify patients at highest risk for HCC recurrence.
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Affiliation(s)
- D J Kim
- Department of Surgery, Hallym University Medical Center, Seoul, Republic of Korea
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Patel T, Harnois D. Assessment of response to therapy in hepatocellular carcinoma. Ann Med 2014; 46:130-7. [PMID: 24716738 PMCID: PMC4008698 DOI: 10.3109/07853890.2014.891355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/01/2014] [Indexed: 12/12/2022] Open
Abstract
The appropriate use of conventional or potential treatments for hepatocellular carcinoma requires that benefit can be shown. Therefore, the accurate assessment of response is both critical and essential. Demonstration of benefit observed will be determined by the criteria used. However, the use of conventional criteria based on anatomical imaging to assess response and progression is inadequate. Limitations occur due to the unique nature, presentation, and course of hepatocellular cancer, any underlying concomitant disease, the multiplicity of treatment options, and the challenges in assessing viable tumor. Locoregional therapies or cytostatic therapies can have beneficial effects and induce tumor necrosis without appreciable changes in tumor size. In recognition of the inherent limitations in conventional imaging criteria, various modifications have been proposed. In this review, the goals of assessing tumor response in clinical practice and in clinical trials are outlined. The varying patterns of response to different therapeutic modalities such as locoregional therapy and molecularly targeted therapy are reviewed, and an approach to the assessment of response based on clinical, biochemical, morphological, and functional criteria has been outlined. The implications of current and proposed approaches of assessing response for clinical practice or design of clinical trials are reviewed.
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Affiliation(s)
- Tushar Patel
- Department of Transplantation, Mayo Clinic , Jacksonville, Florida , USA
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Stampfl U, Bermejo JL, Sommer CM, Hoffmann K, Weiss KH, Schirmacher P, Schemmer P, Kauczor HU, Richter GM, Radeleff BA, Longerich T. Efficacy and nontarget effects of transarterial chemoembolization in bridging of hepatocellular carcinoma patients to liver transplantation: a histopathologic study. J Vasc Interv Radiol 2014; 25:1018-1026.e4. [PMID: 24768235 DOI: 10.1016/j.jvir.2014.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To histologically evaluate the efficacy and nontarget effects induced by transarterial chemoembolization as a "bridge" treatment of hepatocellular carcinoma (HCC) before liver transplantation (LT) and its relation to patient survival. MATERIALS AND METHODS Between October 2003 and January 2011, 51 patients with HCC underwent LT after chemoembolization with iodized oil, small spherical particles, and carboplatin. The decision for LT was made according to national guidelines. The efficacy and nontarget effects of chemoembolization were determined histologically in explanted livers, and their impact on patients' survival after LT was analyzed. RESULTS A total of 126 chemoembolization procedures were performed in 51 patients; the median number of procedures per patient was three (range, one to six). The extent of HCC necrosis was less than or equal to 50% in 32% of treated HCCs, more than 50% and less than or equal to 90% in 17%, and more than 90%-99% in 14%; 38% showed complete necrosis of the lesion. The most common nontarget effects were focal necrosis of the liver parenchyma adjacent to the embolized HCC nodule (28%), intralesional (micro)abscess (26%), intralesional hemorrhage (22%), and peritumoral bile duct necrosis (12%). Based on histopathologic examination, 35% of patients had HCC that did not meet Milan criteria. None of these findings was significantly associated with patient survival after LT. CONCLUSIONS Transarterial chemoembolization induces histopathologically confirmed HCC necrosis with a high degree of efficacy, but histologically proven complete HCC necrosis was not predictive of survival in this cohort of patients. Although histopathologic examination revealed (clinically relevant) nontarget effects in a subset of patients, they did not impair survival.
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Affiliation(s)
- Ulrike Stampfl
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Justo Lorenzo Bermejo
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Christof M Sommer
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Katrin Hoffmann
- Department of General and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Karl Heinz Weiss
- Department of Gastroenterology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Liver Cancer Center Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Peter Schirmacher
- Liver Cancer Center Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Peter Schemmer
- Department of General and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Liver Cancer Center Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Götz M Richter
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Boris A Radeleff
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Thomas Longerich
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Pompili M, Francica G, Ponziani FR, Iezzi R, Avolio AW. Bridging and downstaging treatments for hepatocellular carcinoma in patients on the waiting list for liver transplantation. World J Gastroenterol 2013; 19:7515-7530. [PMID: 24282343 PMCID: PMC3837250 DOI: 10.3748/wjg.v19.i43.7515] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 09/30/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma (HCC) awaiting liver transplantation (LT). The most used treatments include transarterial chemoembolization and radiofrequency ablation. Surgical resection has also been successfully used as a bridging procedure, and LT should be considered a rescue treatment in patients with previous HCC resection who experience tumor recurrence or post-treatment severe decompensation of liver function. The aims of bridging treatments include decreasing the waiting list dropout rate before transplantation, reducing HCC recurrence after transplantation, and improving post-transplant overall survival. To date, no data from prospective randomized studies are available; however, for HCC patients listed for LT within the Milan criteria, prolonging the waiting time over 6-12 mo is a risk factor for tumor spread. Bridging treatments are useful in containing tumor progression and decreasing dropout. Furthermore, the response to pre-LT treatments may represent a surrogate marker of tumor biological aggressiveness and could therefore be evaluated to prioritize HCC candidates for LT. Lastly, although a definitive conclusion can not be reached, the experiences reported to date suggest a positive impact of these treatments on both tumor recurrence and post-transplant patient survival. Advanced HCC may be downstaged to achieve and maintain the current conventional criteria for inclusion in the waiting list for LT. Recent studies have demonstrated that successfully downstaged patients can achieve a 5-year survival rate comparable to that of patients meeting the conventional criteria without requiring downstaging.
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He EX, Nie ZS, Zhu MY, Lin HF, Wang L, Zhang YH, Li MS. Correlation between computer tomography perfusion parameters and survival in patients with middle/advanced stage liver cancer after TACE: Analysis of 41 cases. Shijie Huaren Xiaohua Zazhi 2013; 21:2843-2848. [DOI: 10.11569/wcjd.v21.i27.2843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To observe the correlation between computed tomography (CT) perfusion parameters and survival in patients who had middle/advanced stage liver cancer after transarterial chemoembolization (TACE).
METHODS: Forty-one patients who had middle/advanced stage liver cancer were selected to observe CT perfusion parameters four weeks after TACE. Hepatic blood flow (HBF), hepatic blood volume (HBV), mean transit time (MTT), hepatic artery fraction (HAF) and perfunctory transit (PT) were measured. The patients were followed for 1-2 years after TACE.
RESULTS: The blood flow disappeared in iodized oil deposited hepatoma regions in all the patients. HBF, HBV and MTT in non-iodized oil deposited hepatoma regions were significantly higher than those in normal liver tissue [451.67 mL/(100 g•min) ± 121.45 mL/(100 g•min) vs 88.43 mL/(100 g•min) ± 12.31 mL/(100 g•min), 31.61 mL/100 g ± 5.86 mL/100 g vs 12.15 mL/100 g ± 1.97 mL/100 g, 4.01 s ± 2.11 s vs 9.13 s ± 1.89 s, all P < 0.05]. HAF and PT showed no significant differences between non-iodized oil deposited liver cancer region and normal liver tissue [18.745 mL/(100 g•min) ± 13.669 mL/(100g•min) vs 20.114 mL/(100 g•min) ± 14.613 mL/(100 g•min), 0.451% ± 0.121% vs 0.395% ± 0.211%, both P > 0.05]. HBF, HBV, HAF and PT declined significantly in 19 dead patients compared to 22 surviving patients (all P < 0.05), but MTT showed no significant correlation with survival.
CONCLUSION: CT perfusion imaging has important value in predict the prognosis of liver cancer after TACE. CT perfusion parameters may be used to evaluate survival of patients with middle/advanced stage liver cancer.
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Nicolini D, Svegliati-Baroni G, Candelari R, Mincarelli C, Mandolesi A, Bearzi I, Mocchegiani F, Vecchi A, Montalti R, Benedetti A, Risaliti A, Vivarelli M. Doxorubicin-eluting bead vs conventional transcatheter arterial chemoembolization for hepatocellular carcinoma before liver transplantation. World J Gastroenterol 2013; 19:5622-5632. [PMID: 24039354 PMCID: PMC3769898 DOI: 10.3748/wjg.v19.i34.5622] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/10/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the possible effect of two different types of preoperative transcatheter arterial chemoembolization (TACE) on recurrence-free survival after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) and to analyze the effects of TACE on tumor histology.
METHODS: We retrospectively analyzed the histological features of 130 HCC nodules in 63 native livers removed at transplantation. Patients who received any other type of treatment such as radiofrequency tumor ablation, percutaneous ethanol ablation or who were not treated at all were excluded. All patients in the present study were within the Milan Criteria at the last imaging findings before transplantation. Doxorubicin-eluting bead TACE (DEB-TACE) was performed in 22 patients (38 nodules), and conventional TACE (c-TACE) in 16 (25 nodules). Patients’ and tumors’ characteristics were retrospectively reviewed. We performed a per-nodule analysis of the explanted livers to establish the mean percentage of necrosis of any nodule treated by TACE (conventional or DEB) and a per-patient analysis to establish the percentage of necrosis in the cumulative tumor area, including 21 nodules not reached by TACE. Inflammatory and fibrotic changes in the tissue surrounding the tumor nodule were analyzed and categorized as poor/absent, moderate and enhanced reaction. Uni- and multivariate analysis of risk factors for HCC-recurrence were performed.
RESULTS: The number and diameter of the nodules, the time spent on the waiting list and the number of treatments were similar in the two groups. A trend towards higher appropriate response rates (necrosis ≥ 90%) was observed in the DEB-TACE group (44.7% vs 32.0%, P = 0.2834). The mean percentage of necrosis in the cumulative tumor area was 58.8% ± 36.6% in the DEB-TACE group and 50.2% ± 38.1% in the c-TACE group (P = 0.4856). Fibrotic and inflammatory reactions surrounding the tumor nodule were markedly more common in the DEB-TACE group (P < 0.0001, for both the parameters). The three-year recurrence-free survival was higher in DEB-TACE-treated patients than in conventionally treated patients (87.4% vs 61.5%, P = 0.0493). Other factors affecting recurrence-free survival included viable tumor beyond Milan Criteria on histopathological examination, the percentage of necrosis on CTA ≤ 50% and a pre-transplant serum α-fetoprotein level greater than 70 ng/mL. On multivariate analysis, the lack of treatment with DEB-TACE, high levels of α-fetoprotein and viable tumor beyond Milan Criteria at histology examination were identified as independent predictors of tumor recurrence.
CONCLUSION: DEB-TACE can effectively promote tumor necrosis and improves recurrence-free survival after LT in HCC.
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Response Evaluation Criteria in Solid Tumors (RECIST) Criteria Are Superior to European Association for Study of the Liver (EASL) Criteria at 1 Month Follow-up for Predicting Long-term Survival in Patients Treated with Transarterial Chemoembolization before Liver Transplantation for Hepatocellular Cancer. J Vasc Interv Radiol 2013; 24:805-12. [DOI: 10.1016/j.jvir.2013.01.499] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 01/26/2013] [Accepted: 01/31/2013] [Indexed: 01/21/2023] Open
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Golfieri R, Renzulli M, Mosconi C, Forlani L, Giampalma E, Piscaglia F, Trevisani F, Bolondi L. Hepatocellular carcinoma responding to superselective transarterial chemoembolization: an issue of nodule dimension? J Vasc Interv Radiol 2013; 24:509-17. [PMID: 23428355 DOI: 10.1016/j.jvir.2012.12.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/19/2012] [Accepted: 12/08/2012] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the per-nodule efficacy of superselective transarterial chemoembolization of hepatocellular carcinomas (HCCs). MATERIALS AND METHODS From 2006-2009, 271 cirrhotic patients with 635 nodules underwent a first superselective transarterial chemoembolization, repeated "on demand" after local recurrences (LR) or partial responses (PR). Complete response (CR), time to nodule progression (TTnP), and local recurrence rate (LRR), according to three size classes (≤ 2 cm, 2.1-5 cm, and>5 cm) were evaluated. RESULTS After the first superselective transarterial chemoembolization, the CR was 64%, sustained over time in 77%, higher in small (68%) and intermediate-size (64%) nodules than in large nodules (25%; P<.001). The LRR was 23%:20% in small, 27% in intermediate, and 67% in large HCCs (P<.05). The median TTnP of large HCCs was 4 months versus 7-9 months for small and intermediate HCCs. The second superselective transarterial chemoembolization achieved a higher CR (63% in LR, 52% in PR) than the third superselective transarterial chemoembolization (32%). Median TTnP after the second superselective transarterial chemoembolization for LR and PR (8 months and 6 months) was longer than after the third superselective transarterial chemoembolization (3.5 months). Nodules ≤ 5 cm had a CR after the first superselective transarterial chemoembolization (66%) and the second superselective transarterial chemoembolization for LR (64%) or PR (55%) higher than after the third superselective transarterial chemoembolization (40%); nodules>5 cm had a CR of 25% after the first superselective transarterial chemoembolization, LR of 50% and PR of 25%, and after the second and third superselective transarterial chemoembolizations, PR of 0%. CONCLUSIONS Effectiveness of superselective transarterial chemoembolization has a clear cutoff above and below 5-cm nodules, with better results in smaller nodules. In HCCs ≤ 5 cm, the efficacy of the first and second superselective transarterial chemoembolizations performed for LR was higher than the second superselective transarterial chemoembolization for PR and the third superselective transarterial chemoembolization. For HCCs>5 cm, retreatment of PR is of little value, and the third cycle is ineffective.
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Affiliation(s)
- Rita Golfieri
- Radiology Unit, Alma Mater Studiorum-Sant'Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
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Bargellini I, Bozzi E, Campani D, Carrai P, De Simone P, Pollina L, Cioni R, Filipponi F, Bartolozzi C. Modified RECIST to assess tumor response after transarterial chemoembolization of hepatocellular carcinoma: CT-pathologic correlation in 178 liver explants. Eur J Radiol 2013; 82:e212-8. [PMID: 23332890 DOI: 10.1016/j.ejrad.2012.12.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/11/2012] [Accepted: 12/13/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE To retrospectively evaluate agreement between modified RECIST (mRECIST) assessed at Computed Tomography (CT) and pathology in a large series of patients with hepatocellular carcinoma (HCC) who were transplanted after transarterial chemoembolization (TACE). MATERIALS AND METHODS IRB approval was obtained. The study included 178 patients (M/F=155/23; mean age 55.8 ± 6.3 years) with HCC who were transplanted after TACE from January 1996 to December 2010 and with at least one CT examination before liver transplantation (LT). Two blinded independent readers retrospectively reviewed CT examinations, to assess tumor response to TACE according to mRECIST. Patients were classified in responders (complete and partial response) and non-responders (stable and progressive disease). On the explanted livers, percentage of tumor necrosis was classified as 100, >50 and <50%. RESULTS The mean interval between latest CT and LT was 57.4 ± 39.8 days. At latest CT examination, the objective response rate was 78.1% (139/178), with 86 cases (48.3%) of complete response (CR). A good intra- (k=0.75 and 0.86) and inter-observer (k=0.81) agreement was obtained. On a per-patient basis, agreement between mRECIST and pathology was obtained in 120 patients (67.4%), with 19 cases (10.7%) of underestimation and 39 cases (21.9%) of overestimation of tumor response at CT. CT sensitivity and specificity in differentiating between responders and non-responders were 93 and 82.9%, respectively. Out of 302 nodules, sensitivity and specificity of CT in detecting complete necrosis were 87.5 and 68.9%, respectively. CONCLUSIONS CT can overestimate tumor response after TACE. Nonetheless, mRECIST assessed at CT after TACE are reproducible and reliable in differentiating responders and non-responders.
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Affiliation(s)
- Irene Bargellini
- Department of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56100 Pisa, Italy.
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Shim JH, Han S, Shin YM, Yu E, Park W, Kim KM, Lim YS, Lee HC. Optimal measurement modality and method for evaluation of responses to transarterial chemoembolization of hepatocellular carcinoma based on enhancement criteria. J Vasc Interv Radiol 2013; 24:316-25. [PMID: 23312990 DOI: 10.1016/j.jvir.2012.10.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine the usefulness of enhancement by iodized oil deposits on computed tomography (CT) following transarterial chemoembolization for hepatocellular carcinoma (HCC), and to compare the reliability of such CT imaging with that of magnetic resonance (MR) imaging. MATERIALS AND METHODS Fifty-one patients for whom resected or explanted livers containing chemoembolized HCC lesions of at least 1 cm were available. Imaging responses were determined based on modified Response Evaluation Criteria In Solid Tumors (mRECIST) and European Association for the Study of the Liver (EASL) criteria for 59 target tumors on CT and MR scans before surgery. CT-based evaluation was performed per mRECIST and EASL criteria, considering iodized oil retention as indicating necrosis and, alternatively, as enhancing viable tissue ("mRECIST-Lipiodol" and "EASL-Lipiodol"). Pathologic necrosis was graded as 100%, 50%-99%, or less than 50%. RESULTS Goodman-Kruskal γ-values for radiologic-pathologic correlation were greater than 0.95 for mRECIST and EASL criteria on CT or MR imaging. However, mRECIST-Lipiodol and EASL-Lipiodol measurements showed weaker correlation with pathologic findings, with γ-values of 0.797 and 0.846, respectively. With respect to intermethod agreement, weighted γ-values for mRECIST by CT and MR, and for EASL criteria by CT and MR, both exceeded 0.80, whereas mRECIST-Lipiodol and EASL-Lipiodol showed only moderate levels of agreement with mRECIST/EASL criteria by CT or MR imaging, with γ-values of 0.522-0.631. CONCLUSIONS Response estimation based on measurement of iodized oil deposits as necrosis on CT when applying enhancement criteria after chemoembolization for HCC correlated well with actual pathologic class, and agreed with MR-based evaluation.
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Affiliation(s)
- Ju Hyun Shim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-2dong, Songpa-gu, Seoul, 138-736, Korea.
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Chao Y, Wu CY, Kuo CY, Wang JP, Luo JC, Kao CH, Lee RC, Lee WP, Li CP. Cytokines are associated with postembolization fever and survival in hepatocellular carcinoma patients receiving transcatheter arterial chemoembolization. Hepatol Int 2012. [PMID: 26201926 DOI: 10.1007/s12072-012-9409-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Cytokines play important roles in angiogenesis, inflammation, and cell growth. The present study aimed to investigate the correlation between cytokine changes and clinical characteristics in hepatocellular carcinoma (HCC) patients receiving transcatheter arterial chemoembolization (TACE). METHODS Forty-one TACE-näive HCC patients receiving 73 sessions of TACE and 30 healthy controls were studied. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), angiogenin, epidermal growth factor (EGF), epidermal growth factor receptor, and transforming growth factor β1 (TGF-β1) before and at 1, 3, 5, 7, and 14 days after TACE as well as clinical parameters were analyzed. RESULTS Baseline serum levels of VEGF, bFGF, IL-6, IL-8, and TNF-α in HCC patients were significantly elevated, whereas EGF and TGF-β1 levels were lower compared to those in healthy controls (p < 0.05 for all). Serum IL-6 increased rapidly and peaked on day 1 after TACE administration, whereas VEGF increased more slowly and peaked on day 14 after TACE administration. Patients with post-TACE fever had higher serum IL-6 levels on days 1, 3, and 5 (p < 0.005 for all). Patients with pre-TACE serum VEGF < 200 pg/ml had a longer survival than those with pre-TACE serum VEGF levels ≥ 200 pg/ml (22.2 months vs. 11.6 months, p = 0.014). Cox multivariate analysis showed that baseline serum VEGF significantly predicted survival for HCC patients receiving TACE. CONCLUSIONS TACE is associated with the modulation of serum angiogenic, inflammatory, and cell growth cytokines in HCC patients. Serum IL-6 correlates with post-TACE fever, and baseline serum VEGF independently predicts patient survival.
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Affiliation(s)
- Yee Chao
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chen-Yi Wu
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Heping Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Chen-Yu Kuo
- National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
| | - Jack P Wang
- National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
| | - Jiing-Chyuan Luo
- National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
| | - Chien-Hui Kao
- National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
| | - Rheun-Chuan Lee
- National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ping Lee
- National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Pin Li
- National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.
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Hepatocellular carcinoma: initial tumour response after short-term and long-interval chemoembolization with drug-eluting beads using modified RECIST. Eur J Gastroenterol Hepatol 2012; 24:1325-32. [PMID: 22872074 DOI: 10.1097/meg.0b013e32835724bc] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the initial tumour response after one, respectively, two transarterial chemoembolizations (TACE) with drug-eluting (DC) beads in patients with hepatocellular carcinoma (HCC). METHODS A total of 26 patients with clinically approved HCC underwent one or two TACE with DC Beads within 6 weeks and were evaluated after 12 weeks by MRI or computed tomography on the basis of the modified Response Evaluation Criteria in the Solid Tumours guidelines for HCC. For improved comparability of both groups, 16 patients were matched in terms of Child-Pugh classification, Barcelona classification of liver cancer, age and sex. RESULTS The overall tumour response showed progressive disease in 11% and an objective response in 89% for the double TACE group compared with progressive disease in 29.5%, objective response in 34.5% and stable disease in 35% for the single TACE group. In the matched population, absolute tumour shrinkage was 61.1 ± 28.3% for the double TACE group and 14.1 ± 38.5% for the single TACE group (P<0.05). CONCLUSION This retrospective study shows significantly higher tumour shrinkage in patients who underwent two TACE within 6 weeks compared with patients who underwent a single intervention in terms of the initial response rate after 12 weeks. It emphasizes the use of matched populations for the evaluation of tumour response in HCC after TACE.
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Guan YS, He Q, Wang MQ. Transcatheter arterial chemoembolization: history for more than 30 years. ISRN GASTROENTEROLOGY 2012; 2012:480650. [PMID: 22966466 PMCID: PMC3433134 DOI: 10.5402/2012/480650] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/02/2012] [Indexed: 02/05/2023]
Abstract
Transcatheter arterial chemoembolization (TACE) is a minimally invasive technique to treat liver tumors, particularly hepatocellular carcinoma (HCC). TACE was used in early times to treat liver tumor patients with emergencies caused by symptomatic humoral hypercalcemia and develops gradually from the procedures of diagnostic angiography and transcatheter injection of agents and is in particular performed in the treatment of HCC. Since the beginning of this century, TACE has been used extensively in the palliative treatment of unresectable HCC. In recent years, it is indicated in selected patients with early-stage HCC. This review introduces the evolution of TACE for more than 30 years, its role in comprehensive treatment of HCC, the tendency of its refinement in future, and the combination use of TACE with other local ablative methods for the curative result of HCC.
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Affiliation(s)
- Yong-Song Guan
- Department of Oncology, West China Hospital of Sichuan University, Chengdu 610041, China
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Campistol JM, Cuervas-Mons V, Manito N, Almenar L, Arias M, Casafont F, Del Castillo D, Crespo-Leiro MG, Delgado JF, Herrero JI, Jara P, Morales JM, Navarro M, Oppenheimer F, Prieto M, Pulpón LA, Rimola A, Román A, Serón D, Ussetti P. New concepts and best practices for management of pre- and post-transplantation cancer. Transplant Rev (Orlando) 2012; 26:261-79. [PMID: 22902168 DOI: 10.1016/j.trre.2012.07.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 07/01/2012] [Indexed: 02/06/2023]
Abstract
Solid-organ transplant recipients are at increased risk of developing cancer compared with the general population. Tumours can arise de novo, as a recurrence of a preexisting malignancy, or from the donated organ. The ATOS (Aula sobre Trasplantes de Órganos Sólidos; the Solid-Organ Transplantation Working Group) group, integrated by Spanish transplant experts, meets annually to discuss current advances in the field. In 2011, the 11th edition covered a range of new topics on cancer and transplantation. In this review we have highlighted the new concepts and best practices for managing cancer in the pre-transplant and post-transplant settings that were presented at the ATOS meeting. Immunosuppression plays a major role in oncogenesis in the transplant recipient, both through impaired immunosurveillance and through direct oncogenic activity. It is possible to transplant organs obtained from donors with a history of cancer as long as an effective minimization of malignancy transmission strategy is followed. Tumour-specific wait-periods have been proposed for the increased number of transplantation candidates with a history of malignancy; however, the patient's individual risk of death from organ failure must be taken into consideration. It is important to actively prevent tumour recurrence, especially the recurrence of hepatocellular carcinoma in liver transplant recipients. To effectively manage post-transplant malignancies, it is essential to proactively monitor patients, with long-term intensive screening programs showing a reduced incidence of cancer post-transplantation. Proposed management strategies for post-transplantation malignancies include viral monitoring and prophylaxis to decrease infection-related cancer, immunosuppression modulation with lower doses of calcineurin inhibitors, and addition of or conversion to inhibitors of the mammalian target of rapamycin.
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Park WH, Shim JH, Han SB, Won HJ, Shin YM, Kim KM, Lim YS, Lee HC. Clinical utility of des-γ-carboxyprothrombin kinetics as a complement to radiologic response in patients with hepatocellular carcinoma undergoing transarterial chemoembolization. J Vasc Interv Radiol 2012; 23:927-36. [PMID: 22633621 DOI: 10.1016/j.jvir.2012.04.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 04/12/2012] [Accepted: 04/14/2012] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Serial α-fetoprotein (AFP) measurements are useful for assessing tumor responses to numerous therapies for hepatocellular carcinoma (HCC). This study tested the predictive value of changes in des-γ-carboxy prothrombin (DCP), in parallel with AFP, as an indicator of HCC response after transarterial chemoembolization. MATERIALS AND METHODS The study group consisted of 327 patients with HCC initially seropositive for DCP (≥ 40 mAU/mL) and/or AFP (≥ 100 ng/mL) who underwent repeated chemoembolization as first-line therapy. Radiologic responses were measured based on modified Response Evaluation Criteria In Solid Tumors guidelines. Serologic response was defined as a decrease of at least 50% in DCP or AFP level from baseline. Radiologic-serologic correlation and disease progression and survival according to serologic responses were analyzed. RESULTS Before treatment, 129 patients (39%) had high DCP alone, 66 (20%) had high AFP alone, and 58 (18%) had high levels of both. Radiologic and serologic responses were achieved in 88.2% and 91.4% of patients with high DCP levels and in 89.5% and 91.1% of those with high AFP levels, respectively. Serologic response based on AFP or DCP was significantly correlated with radiologic response, and this was confirmed by landmark analysis (P < .001). DCP and AFP responders had better times to progression and overall survival than nonresponders (P < .001). Cox models revealed that both serologic responses were independent estimates of survival (hazard ratios, 0.11 for DCP and 0.14 for AFP; P < .001). CONCLUSIONS After transarterial chemoembolization for HCC, DCP response may be a useful surrogate endpoint of immediate and prolonged clinical outcomes, along with AFP response.
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Affiliation(s)
- Won-Hyeong Park
- Department of Internal Medicine, Asan Liver Center, University of Ulsan College of Medicine, 388-1 Poongnap-2dong, Songpa-gu, Seoul, 138-736, Korea
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Maggs JRL, Suddle AR, Aluvihare V, Heneghan MA. Systematic review: the role of liver transplantation in the management of hepatocellular carcinoma. Aliment Pharmacol Ther 2012; 35:1113-34. [PMID: 22432733 DOI: 10.1111/j.1365-2036.2012.05072.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/18/2011] [Accepted: 03/02/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality worldwide. Liver transplantation offers a potential cure for this otherwise devastating disease. The selection of the most appropriate candidates is paramount in an era of graft shortage. AIM To review systematically the role of liver transplantation in the management of HCC in current clinical practice. METHODS An electronic literature search using PUBMED (1980-2010) was performed. Search terms included HCC, hepatoma, liver cancer, and liver transplantation. RESULTS Liver transplantation is a highly successful treatment for HCC, in patients within Milan criteria (MC), defined as a solitary tumour ≤50 mm in diameter or ≤3 tumours ≤30 mm in diameter in the absence of extra-hepatic or vascular spread. Other eligibility criteria for liver transplantation are also used in clinical practice, such as the University of California, San Francisco criteria, with outcomes comparable to MC. Loco-regional therapies have a role in the bridging treatment of HCC by minimising wait-list drop-out secondary to tumour progression. Beyond MC, encouraging results have been demonstrated for patients with down-staged tumours. Post-liver transplantation, there is no evidence to support a specific immunosuppressive regimen. In the context of an insufficient cadaveric donor pool to meet demand, the role of adult living donation may be increasingly important. CONCLUSIONS Liver transplantation offers a curative therapy for selected patients with HCC. The optimisation of eligibility criteria is paramount to ensure that maximum benefit is accrued. Although wait-list therapies have been incorporated into clinical practice, additional high quality data are required to support this strategy.
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Affiliation(s)
- J R L Maggs
- Institute of Liver Studies, King's College Hospital, London, UK
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