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Tadokoro T, Tani J, Morishita A, Fujita K, Masaki T, Kobara H. The Treatment of Hepatocellular Carcinoma with Major Vascular Invasion. Cancers (Basel) 2024; 16:2534. [PMID: 39061174 PMCID: PMC11274937 DOI: 10.3390/cancers16142534] [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: 06/29/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Vascular invasion of hepatocellular carcinoma involves tumor plugs in the main trunk of the portal vein, bile ducts, and veins, and it indicates poor prognosis. It is often associated with portal hypertension, which requires evaluation and management. Treatment includes hepatic resection, systemic pharmacotherapy, hepatic arterial infusion chemotherapy, and radiation therapy. Recurrence rates post-hepatic resection are high, and systemic drug therapy often has limited therapeutic potential in patients with a poor hepatic reserve. Single therapies are generally inadequate, necessitating combining multiple therapies with adjuvant and systemic pharmacotherapy before and after hepatectomy. This narrative review will provide an overview of the treatment of hepatocellular carcinoma with vascular invasion.
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Affiliation(s)
| | | | - Asahiro Morishita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Takamatsu 761-0793, Kagawa, Japan; (T.T.); (J.T.); (K.F.); (T.M.); (H.K.)
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2
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Chierici A, El Zibawi M, Liddo G, Anty R, Granieri S, Chevallier P, Iannelli A. Multimodal treatment confers best overall survival results in patients with huge hepatocellular carcinoma: a systematic review and network meta-analysis. HPB (Oxford) 2024; 26:895-902. [PMID: 38702254 DOI: 10.1016/j.hpb.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/18/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Huge (>10 cm) hepatocellular carcinoma is burdened by elevated mortality due to its peculiar characteristics and delayed diagnosis. Liver resection is considered the gold standard although survival is poor. Recently, some different strategies have been evaluated to improve results in tumor recurrence and survival. The aim of this research is to identify which strategy offers the best results in terms of overall survival for resectable huge hepatocellular carcinoma. METHODS A systematic review and network meta-analysis of 13 studies was conducted from PubMed, Embase, Scopus, Cochrane Library, and Web of Science databases including research comparing two or more treatments to manage huge hepatocellular carcinoma. Results were synthesized through forest plots and risk of bias assessed with the CINeMA framework as recommended. RESULTS The association of liver resection and transcatheter arterial chemoembolization confers a significant improvement in survival compared to liver resection alone (HR: 0.55) while transcatheter arterial chemoembolization, radioembolization, and ethanol ablation alone were associated to decreased overall survival. Within-study bias, indirectness and incoherence were the domains mainly affected by concerns in risk of bias analysis. CONCLUSION Multimodal treatment including liver resection and transcatheter arterial chemoembolization increases survival in patients with resectable huge hepatocellular carcinoma.
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Affiliation(s)
- Andrea Chierici
- Centre Hospitalier Universitaire de Nice- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Mohamed El Zibawi
- Department of Radiology, University Hospital Centre Nice, Nice, France
| | - Guido Liddo
- Centre Hospitalier Universitaire de Nice- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Rodolphe Anty
- Université Côte d'Azur, Nice, France; Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", France; Université Côte d'Azur, Digestive Center, Centre Hospitalier Universitaire, Archet 2 Hospital, Nice, France
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Patrick Chevallier
- Department of Radiology, University Hospital Centre Nice, Nice, France; Université Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Université Côte d'Azur, Nice, France; Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", France.
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3
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Duan X, Liu J, Han X, Ren J, Li H, Li F, Ju S. Comparison of Treatment Response, Survival Profiles, as Well as Safety Profiles Between CalliSpheres ® Microsphere Transarterial Chemoembolization and Conventional Transarterial Chemoembolization in Huge Hepatocellular Carcinoma. Front Oncol 2022; 11:793581. [PMID: 35127501 PMCID: PMC8814413 DOI: 10.3389/fonc.2021.793581] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/15/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose CalliSpheres® microspheres (CSM) are the first drug-eluting beads (DEB) developed in China. This study aimed to compare treatment response, survival, and safety profiles between DEB transarterial chemoembolization (DEB-TACE) with CSM and conventional TACE (cTACE) in huge hepatocellular carcinoma (HCC) patients. Methods A total of 71 patients with huge HCC who underwent DEB-TACE or cTACE were consecutively enrolled in this retrospective cohort study. Treatment response was assessed at first month (M1), third month (M3), and sixth month (M6) after TACE therapy; progression-free survival (PFS) and overall survival (OS) were evaluated; liver function indexes were recorded before TACE operation (M0), at first week (W1), M1 and M6 after TACE therapy; adverse events which occurred after TACE operation were recorded. Results DEB-TACE presented with higher objective response rate (60.0% vs. 29.7%, p < 0.05) and disease control rate (86.7% vs. 59.4%, p < 0.05) compared with cTACE at M3. Regarding survival profiles, PFS [median: 3.3 months (95% CI: 2.8–3.7) vs. 2.1 months (95% CI: 1.7–2.5)] as well as OS [median: 7.8 months (95% CI: 4.6–11.0) vs. 5.7 months (95% CI: 5.0–6.3)] were longer in DEB-TACE group compared with cTACE group (both p < 0.01). Multivariate Cox’s regression further illustrated that DEB-TACE vs. cTACE was an independent protective factor for PFS and OS (both p < 0.01). As for safety profiles, patients’ liver function injury was reduced in the DEB-TACE group compared with the cTACE group. The incidence of fever was lower, and CINV was less severe in the DEB-TACE group compared with the cTACE group (both p < 0.05), while no difference in occurrence of liver abscess, increase of ascites, or moderate pain between two groups was observed. Conclusion DEB-TACE with CSM presents with better treatment response, survival profiles, as well as safety profiles compared with cTACE in treatment for huge HCC patients.
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Affiliation(s)
- Xuhua Duan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juanfang Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengyao Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuguang Ju
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wang XH, Liu QB, Xiang CL, Mao XH, Yang B, Li Q, Zhou QF, Li SQ, Zhou ZG, Chen MS. Multi-institutional validation of novel models for predicting the prognosis of patients with huge hepatocellular carcinoma. Int J Cancer 2021; 149:127-138. [PMID: 33586134 DOI: 10.1002/ijc.33516] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 01/06/2023]
Abstract
The population of patients with huge hepatocellular carcinoma (H-HCC diameter > 10.0 cm) is an odd group that is not well adjudicated in the current staging systems, whose prognosis after curative resection varies. We aimed to develop novel models to predict the long-term outcomes of patients with H-HCC without portal vein tumor thrombus after hepatectomy. There were 1076 H-HCC patients enrolled who underwent curative liver resection in five institutions in China. In total, 670 patients were recruited from our center and randomly divided into the training cohort (n = 502) and internal validation (n = 168) cohorts. Additionally, 406 patients selected from other four centers as the external validation cohort. Novel models were constructed based on independent preoperative and postoperative predictors of postsurgical recurrence (PSR) and postsurgical mortality (PSM) determined in multivariable cox regression analysis. The predictive accuracy and discriminative ability of the model were measured using Harrell's concordance index (C index) and calibration curve and compared with five conventional HCC staging systems. PSR model and PSM model were constructed based on tumor number, microscopic vascular invasion, tumor differentiation, preoperative alpha-fetoprotein level, albumin-bilirubin grade, liver segment invasion, neutrophil-to-lymphocyte ratio or platelet-to-neutrophil ratio, and surgical margin or intraoperative blood transfusion. The C-indexes were 0.84 (95% CI, 0.78-0.90) and 0.85 (95% CI, 0.78-0.91) for the PSR and PSM models, respectively, which were substantially higher than those of the five conventional HCC staging systems (0.63-0.75 for PSR; 0.66-0.77 for PSM). The two novel models achieved more accurate prognostic predictions of PSR and PSM for H-HCC patients after curative liver resection.
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Affiliation(s)
- Xiao-Hui Wang
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Qing-Bo Liu
- Department of Hepatobiliary Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong Province, China
| | - Cai-Ling Xiang
- Department of General Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Xian-Hai Mao
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Bing Yang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Qiang Li
- Department of General Surgery, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Qun-Fang Zhou
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Shao-Qiang Li
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zhong-Guo Zhou
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Min-Shan Chen
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
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Ding X, Sun W, Chen J, Li W, Shen Y, Guo X, Teng Y, Liu X, Sun S, Wei J, Li W, Chen H, Liu B. Percutaneous Radiofrequency Ablation Combined With Transarterial Chemoembolization Plus Sorafenib for Large Hepatocellular Carcinoma Invading the Portal Venous System: A Prospective Randomized Study. Front Oncol 2020; 10:578633. [PMID: 33194699 PMCID: PMC7644860 DOI: 10.3389/fonc.2020.578633] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/28/2020] [Indexed: 01/27/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) portends a worse prognosis. The objective of this study was to compare the efficacy of percutaneous radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) plus sorafenib to that of the most commonly utilized regimen of TACE plus sorafenib in large HCCs with type I/II PVTT. Methods An open-label, single-center, prospective, randomized trial of participants with tumors ≥5 cm and type I/II PVTT was performed. Participants with previously untreated HCCs were divided into two groups: RFA + cTACE + sorafenib (study group, n = 40) and cTACE + sorafenib (control group, n = 40). The primary endpoint was the objective response rate (ORR), the secondary endpoints included the overall survival (OS); time to progression (TTP); and toxicity. Prognostic factors were analyzed using cox-regression analysis. Results 80 patients were enrolled into this study with integrated clinical data. Under a median follow-up of 506 days, the median age was 57.5 years (range: 28–80 years). The ORR of study group was higher than control group (70% vs 22.5%, p<0.001). Furthermore, the median OS of study group was superior to that of control group (468 days vs 219 days, HR: 0.44 [95% CI: 0.25–0.78], P = 0.005). Adverse events occurred with 100% probability in both groups (p>0.99), but no treatment-related deaths were recorded. Tumor encapsulation and attaining treatment response predict favorable OS in a multivariate Cox model. The rates of adverse events in both groups were 100% (p>0.99). There were no treatment-related deaths. Conclusions RFA combined with TACE plus sorafenib is a safe, well-tolerated three-modality treatment for large HCCs with types I/II PVTT, and it demonstrated better efficacy than TACE plus sorafenib alone.
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Affiliation(s)
- Xiaoyan Ding
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wei Sun
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jinglong Chen
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yanjun Shen
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaodi Guo
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ying Teng
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaomin Liu
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Shasha Sun
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jianying Wei
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wendong Li
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Bozhi Liu
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Ma JW, Miao Y, Liang CN, Wang N, Jiang B, Wang QY, Kang J, Hou G, Yin Y. Malignant Transformation of a Borderline Ovarian Tumor With Pulmonary and Pleural Metastases After Years of Latency: A Case Report and Literature Review. Front Med (Lausanne) 2020; 7:571348. [PMID: 33102505 PMCID: PMC7555605 DOI: 10.3389/fmed.2020.571348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/28/2020] [Indexed: 11/14/2022] Open
Abstract
Borderline ovarian tumor (BOT) refers to a distinct tumor of the ovary of epithelial origin and typically has a favorable prognosis. However, these tumors are not exempt from risks of recurrence and malignant transformation, which can arise from the remaining ovarian tissue, peritoneal implants, or distant localization. Here, we report a case of a mucinous BOT with multiple pulmonary cystic nodules without evidence of pulmonary metastasis even after two fine needle biopsies. Staging surgery was performed, and no evidence of peritoneal implants or invasion to adjacent organs found. At the end of the 7-year monitored follow-up after surgery, the pulmonary lesions were found to be increased in size. The transbronchial lung biopsy and pleural biopsy confirmed transformation into malignant mucinous adenocarcinoma with pleural metastasis. In the current case, we observed potential pulmonary metastasis of the BOT with malignant transformation and a latency as long as 7 years, which reminds us that multiple pulmonary cystic changes in patients with BOTs should be screened carefully to evaluate the pulmonary involvement of BOTs and potentially false-negative results after fine needle biopsy. Thus, a thorough check-up for complete staging of the disease and a close long-term follow-up to monitor potential recurrence and malignant transformation are advised.
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Affiliation(s)
- Jiang-Wei Ma
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Yuan Miao
- Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Chao-Nan Liang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Ning Wang
- Gynecology Department, The Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Bin Jiang
- Department of Ultrasound, First Hospital of China Medical University, Shenyang, China
| | - Qiu-Yue Wang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Jian Kang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Yan Yin
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
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Gatti P, Giorgio A, Ciracì E, Roberto I, Anglani A, Sergio S, Rizzello F, Giorgio V, Semeraro S. Hepatocellular carcinoma tumor thrombus entering the inferior vena cava treated with percutaneous RF ablation: a case report. J Ultrasound 2019; 22:363-370. [PMID: 30864004 DOI: 10.1007/s40477-019-00361-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/23/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Hepatocellular carcinoma (HCC) is the most common form of liver cancer. In advanced cancer stages (metastatic disease and/or vascular invasion), the generally accepted standard of care is systemic therapy using sorafenib as first-line treatment and, recently, regorafenib and nivolumab as second-line treatment, but the quality of life and the prognosis of patients remain very poor. Our paper reports a case of US-guided radiofrequency ablation (RFA) of both intraparenchymal HCC and inferior vena cava tumor thrombus. METHODS We treated a patient with HCC associated with tumor thrombus extending into vena cava after failure of sorafenib therapy using US-guided radiofrequency ablation (RFA). RESULTS A good radiological and clinical response was observed in association with excellent tolerability. The patient has been followed up for 15 months from the ablation, is alive, and is in a good clinical condition without evidence of tumor recurrence. CONCLUSION This is the first case in which this minimally invasive percutaneous procedure has been successfully used to treat an HCC thrombus entering the vena cava.
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Affiliation(s)
- Pietro Gatti
- Internal Medicine Division, Ostuni Hospital, Ostuni, BR, Italy
| | - Antonio Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
| | - Emanuela Ciracì
- Internal Medicine Division, Ostuni Hospital, Ostuni, BR, Italy
| | - Italia Roberto
- Internal Medicine Division, Ostuni Hospital, Ostuni, BR, Italy
| | | | - Spano Sergio
- Interventional Radiology Unit, Perrino Hospital, Brindisi, Italy
| | - Fernando Rizzello
- Anesthesiology and Reanimation Unit, Ostuni Hospital, Ostuni, BR, Italy
| | - Valentina Giorgio
- Pediatric Gastroenterology Unit, Policlinico Gemelli, Sacred Heart University, Rome, Italy
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Li M, Zhao Y, Liu X, Dang Z, Wang X, Jiang Y, Yang Z. Association and interaction between model for end-stage liver disease score and minimally invasive treatment with regard to mortality of patients with hepatitis B virus-associated hepatocellular carcinoma and portal vein tumor thrombi. Oncol Lett 2018; 17:119-126. [PMID: 30655746 DOI: 10.3892/ol.2018.9590] [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: 01/23/2018] [Accepted: 08/08/2018] [Indexed: 11/06/2022] Open
Abstract
The development of minimally invasive treatment over the last two decades has had a great impact on hepatitis B virus (HBV)-associated primary liver cancer. The model for end-stage liver disease (MELD) score is the optimal evaluated parameter for mortality in patients with end-stage liver disease. However, the association between MELD score and minimally invasive treatment with regard to the mortality of patients with HBV-associated hepatocellular carcinoma (HCC) with a portal vein tumor thrombus (PVTT) remains unclear. In the present study, a total of 173 patients who had been diagnosed with HBV-associated HCC and PVTT in the Beijing Ditan Hospital (Beijing, China), between January 2012 and January 2015, were screened. Follow-up was performed to observe the survival time and collect information on the demographic characteristics and associated clinical indicators present in the cohort. The patient's age, sex, laboratory parameters and the use of minimally invasive treatment were analyzed with SPSS 20.0 software. Independent risk factors for mortality were screened by Cox regression analysis. Logistic regression indicated that there was an interaction between the MELD score and minimally invasive treatment. In addition, a MELD score ≤17.85 was associated with a lower mortality rate subsequent to minimally invasive treatment.
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Affiliation(s)
- Mengge Li
- Department of Traditional Chinese Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, P.R. China
| | - Yalin Zhao
- Digestive Department, The People's Hospital of Hebi, Hebi, Henan 458000, P.R. China
| | - Xiaoli Liu
- Department of Traditional Chinese Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, P.R. China
| | - Zhibo Dang
- Department of Traditional Chinese Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, P.R. China
| | - Xinhui Wang
- Department of Traditional Chinese Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, P.R. China
| | - Yuyong Jiang
- Department of Traditional Chinese Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, P.R. China.,Collabrorative Innovation Center of Infectious Diseases, Capital Medical University, Beijing 100015, P.R. China
| | - Zhiyun Yang
- Department of Traditional Chinese Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, P.R. China.,Collabrorative Innovation Center of Infectious Diseases, Capital Medical University, Beijing 100015, P.R. China
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Thompson SM, Wells ML, Andrews JC, Ehman EC, Menias CO, Hallemeier CL, Roberts LR, Venkatesh SK. Venous invasion by hepatic tumors: imaging appearance and implications for management. Abdom Radiol (NY) 2018; 43:1947-1967. [PMID: 28929197 DOI: 10.1007/s00261-017-1298-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Venous invasion by hepatic tumors most commonly occurs with hepatocellular carcinoma and is associated with worse patient prognosis. Imaging plays an important role in the diagnosis of tumor thrombus in the liver. Moreover, differentiating between bland and tumor thrombus in the liver has important diagnostic, staging, therapeutic, and prognostic implications and may require a multimodal imaging approach including ultrasound, computed tomography, and/or magnetic resonance imaging. Treatment of hepatic malignancies with associated tumor thrombus is dependent on tumor type, disease extent within the liver, liver hemodynamics, and underlying liver function. Treatment of such tumors may involve surgical, locoregional and/or systemic therapies. The current review will focus on the imaging characteristics of venous invasion by hepatic tumors. The imaging findings most useful for differentiating hepatic venous tumor thrombus and bland thrombus will be highlighted and demonstrated with imaging examples. Imaging findings with implications for subsequent patient management will be described.
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Affiliation(s)
- Scott M Thompson
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Michael L Wells
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - James C Andrews
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Eric C Ehman
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Christopher L Hallemeier
- Department of Radiation Oncology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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10
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Peng Z, Chen S, Wei M, Lin M, Jiang C, Mei J, Li B, Wang Y, Li J, Xie X, Chen M, Qian G, Kuang M. Advanced Recurrent Hepatocellular Carcinoma: Treatment with Sorafenib Alone or in Combination with Transarterial Chemoembolization and Radiofrequency Ablation. Radiology 2018; 287:705-714. [PMID: 29390197 DOI: 10.1148/radiol.2018171541] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose To retrospectively investigate the safety and efficacy of sorafenib combined with transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) (hereafter, TACE-RFA) in the treatment of recurrent hepatocellular carcinoma (rHCC) with portal vein tumor thrombosis, extrahepatic metastases (advanced hepatocellular carcinoma), or both after initial hepatectomy. Materials and Methods The study was centrally approved by the ethics committee of three tertiary medical centers in China. From January 2010 to January 2015, 207 consecutive patients with advanced rHCC after initial hepatectomy received sorafenib combined with TACE-RFA (combination group, n = 106) or sorafenib alone (sorafenib group, n = 101) at the three medical centers. Overall survival (OS) and time to progression (TTP) were compared between the two groups. Complications were assessed. Survival curves were constructed with the Kaplan-Meier method and were compared with the log-rank test. Results Baseline characteristics were balanced between the two groups. No treatment-related death occurred in either group. The toxicity profile in the combination group was similar to that in the sorafenib group. After treatment, median OS (14.0 vs 9.0 months, respectively; P < .001) and TTP (7.0 vs 4.0 months, respectively; P < .001) were significantly longer in the combination group than in the sorafenib group. Multivariate analysis showed that treatment allocation was a significant predictor of OS and TTP, while the number of intrahepatic tumors was another prognostic factor of OS. Conclusion Sorafenib combined with TACE-RFA was well tolerated and safe and was superior to sorafenib alone in improving survival outcomes in patients with advanced rHCC after initial hepatectomy. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Zhenwei Peng
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Shuling Chen
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Mengchao Wei
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Manxia Lin
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Chunlin Jiang
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Jie Mei
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Bin Li
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Yu Wang
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Jiaping Li
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Xiaoyan Xie
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Minshan Chen
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Guojun Qian
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
| | - Ming Kuang
- From the Department of Oncology (Z.P.), Clinical Trials Unit (Z.P., J.M., B.L.), Division of Interventional Ultrasound (S.C., M.L., C.J., X.X., M.K.), Department of Liver Surgery (M.W., M.K.), and Department of Interventional Oncology (Y.W., J.L.), The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China (M.C.); and Department of Minimal Invasion Therapy, The Affiliated Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China (G.Q.)
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Han K, Kim JH, Ko GY, Gwon DI, Sung KB. Treatment of hepatocellular carcinoma with portal venous tumor thrombosis: A comprehensive review. World J Gastroenterol 2016; 22:407-416. [PMID: 26755886 PMCID: PMC4698503 DOI: 10.3748/wjg.v22.i1.407] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/15/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
The natural history of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal (approximately 2-4 mo), and PVTT is reportedly found in 10%-40% of HCC patients at diagnosis. According to the Barcelona Clinic Liver Cancer (BCLC) Staging System (which is the most widely adopted HCC management guideline), sorafenib is the standard of care for advanced HCC (i.e., BCLC stage C) and the presence of PVTT is included in this category. However, sorafenib treatment only marginally prolongs patient survival and, notably, its therapeutic efficacy is reduced in patients with PVTT. In this context, there have been diverse efforts to develop alternatives to current standard systemic chemotherapies or combination treatment options. To date, many studies on transarterial chemoembolization, 3-dimensional conformal radiotherapy, hepatic arterial chemotherapy, and transarterial radioembolization report better overall survival than sorafenib therapy alone, but their outcomes need to be verified in future prospective, randomized controlled studies in order to be incorporated into current treatment guidelines. Additionally, combination strategies have been applied to treat HCC patients with PVTT, with the hope that the possible synergistic actions among different treatment modalities would provide promising results. This narrative review describes the current status of the management options for HCC with PVTT, with a focus on overall survival.
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Microwave ablation of hepatocellular carcinoma with portal vein tumor thrombosis after transarterial chemoembolization: a prospective study. Hepatol Int 2016; 10:175-84. [DOI: 10.1007/s12072-015-9673-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023]
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Li Y, Xia Y, Li J, Wu D, Wan X, Wang K, Wu M, Liu J, Lau WY, Shen F. Prognostic Nomograms for Pre- and Postoperative Predictions of Long-Term Survival for Patients Who Underwent Liver Resection for Huge Hepatocellular Carcinoma. J Am Coll Surg 2015; 221:962-974.e4. [PMID: 26382973 DOI: 10.1016/j.jamcollsurg.2015.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver resection is an effective treatment in select patients with huge hepatocellular carcinoma (HCC, diameter ≥10 cm). This study aimed to develop nomograms for pre- and postoperative predictions of overall survival (OS) for these patients. STUDY DESIGN There were 464 consecutive patients who underwent liver resection for huge HCC at the Eastern Hepatobiliary Surgery Hospital (EHBH) between January 2008 and December 2009. They were collected and divided into a training cohort (n = 310) and an internal validation cohort (n = 154). Another 90 patients who were operated on at the Fujian Medical University (FMU) between January 2008 and April 2010 served as an external validation cohort. The surgical morbidity, mortality, time to recurrence, and OS were observed. Two prognostic nomograms were developed based separately on the data obtained before and after surgery. Discrimination and predictive accuracy of the models were measured using concordance index (C-index), calibration curves, and validation study. RESULTS The postoperative 4-year tumor recurrence and OS rates were, respectively, 79.0% and 41.2% in the patients from the EHBH and 78.8% and 37.6% in those from the FMU. Independent predictors of OS on multivariable analysis using pre- and postoperative data were respectively incorporated into the 2 nomograms. In the training cohort, calibration curves for the probability of 4-year postoperative survival fitted well. The C-indexes of the pre- and postoperative nomograms in predicting OS were 0.75 (95% CI 0.72 to 0.78) and 0.78 (95% CI 0.75 to 0.81), respectively. The internal and external validation studies optimally supported these results. CONCLUSIONS The 2 nomograms achieved accurate pre- or postoperative predictions of long-term survival for patients with huge HCC after liver resection.
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Affiliation(s)
- Yuntong Li
- Department of Hepatobiliary Surgery, the Mengchao Hepatobiliary Surgery Hospital, Fujian Medical University, Fuzhou, China; Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yong Xia
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jun Li
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Dong Wu
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xuying Wan
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Kui Wang
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Mengchao Wu
- Department of Hepatobiliary Surgery, the Mengchao Hepatobiliary Surgery Hospital, Fujian Medical University, Fuzhou, China; Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jingfeng Liu
- Department of Hepatobiliary Surgery, the Mengchao Hepatobiliary Surgery Hospital, Fujian Medical University, Fuzhou, China
| | - Wan Yee Lau
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Feng Shen
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
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Zhang ZM, Lai ECH, Zhang C, Yu HW, Liu Z, Wan BJ, Liu LM, Tian ZH, Deng H, Sun QH, Chen XP. The strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus. Int J Surg 2015; 20:8-16. [PMID: 26026424 DOI: 10.1016/j.ijsu.2015.05.009] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/26/2015] [Accepted: 05/06/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE To further improve the effectiveness and prognosis of primary hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT), the current status of treatment for HCC with PVTT was reviewed. METHODS A Medline search was undertaken to identify articles using the keywords "HCC", "PVTT" and "therapy". Additional papers were identified by a manual search of the references from the key articles. RESULTS PVTT, as a common complication of HCC, was divided into type I ∼ IV. The therapeutic approach is mainly composed of five types: surgical resection, regional interventional therapy, radiotherapy, combination therapy, targeted therapy. All of these therapeutic approaches were separately evaluated in detail. CONCLUSIONS For those resectable tumors, the better choice for treatment of HCC with PVTT should be hepatectomy and removal of PVTT. For those unresectable tumors, TACE (especially the super-selective TACE) has been the preferred palliative treatment, the other regional interventional therapy and/or radiotherapy could improve the therapeutic effects. The multidisciplinary treatments may further improve the quality of life and prolong the survival period for the HCC patients associated with PVTT.
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Affiliation(s)
- Zong-ming Zhang
- Department of General Surgery, Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Eric C H Lai
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chaiwan, Hong Kong, China
| | - Chong Zhang
- Department of General Surgery, Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Hong-wei Yu
- Department of General Surgery, Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Zhuo Liu
- Department of General Surgery, Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Bo-jiang Wan
- Department of General Surgery, Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Li-min Liu
- Department of General Surgery, Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Zu-hao Tian
- Department of General Surgery, Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Hai Deng
- Department of General Surgery, Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Qiu-hong Sun
- Department of General Surgery, Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Xiao-ping Chen
- Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
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Zheng JS, Long J, Sun B, Lu NN, Fang D, Zhao LY, Du N. Transcatheter arterial chemoembolization combined with radiofrequency ablation can improve survival of patients with hepatocellular carcinoma with portal vein tumour thrombosis: extending the indication for ablation? Clin Radiol 2014; 69:e253-63. [PMID: 24581962 DOI: 10.1016/j.crad.2014.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 12/02/2013] [Accepted: 01/14/2014] [Indexed: 12/13/2022]
Abstract
AIM To retrospectively assess long-term survival benefit and safety of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients with portal vein tumour thrombosis (PVTT), and to evaluate factors that significantly affect outcomes of these patients. MATERIALS AND METHODS One hundred and thirty-four HCC patients (118 men and 16 women; mean age 54.8 years, range 26-79 years) with PVTT were retrospectively assessed. Patients were treated with TACE combined with RFA. Data analysed included patient demographics, liver volume, Child-Pugh score, and Cancer of the Liver Italian Programme (CLIP) score and imaging findings. Survival time (from occurrence of PVTT to last follow-up) was calculated using the Kaplan-Meier method, predictive factors and its correlation with survival was assessed using the multivariate Cox proportional hazards regression method. RESULTS The median overall survival (OS) time was 29.5 months (range 16.6-42.4 months), the 1, 3, and 5 year OS were 63%, 40%, and 23%. Cox hazards regression analysis revealed that functional remnant liver volume (FRLV), remnant liver volume (RLV)/total liver volume (TLV), radiation, tumour number, vascular endothelial growth factor (VEGF) distribution, and gross type were the only independent predictive factors of outcome (p = 0.039, 0.010, 0.009, 0.034, 0.031, and 0.000, respectively). CONCLUSION TACE combined with RFA was found to be an effective therapy, FRLV and RLV/TLV have close correlation with survival for HCC patients with PVTT type I, II, or partial III and Child-Pugh A or B.
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Affiliation(s)
- J-S Zheng
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China.
| | - J Long
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - B Sun
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - N-N Lu
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - D Fang
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - L-Y Zhao
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - N Du
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
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Abstract
BACKGROUND The purpose of the present study was to analyze long-term survival and disease-free survival after liver resection for giant hepatocellular carcinoma (HCC) ≥ 10 cm compared to HCC < 10 cm in diameter. The surgical approach in the treatment of giant HCC may achieve long-term survival and disease-free survival comparable to treatment of smaller lesions. METHODS This retrospective analysis was a monocentric study conducted in a tertiary university center. It included 101 patients from 114 consecutive liver resections for HCC, separated into two groups: those with tumors less than 10 cm in diameter (small HCC; n = 79) and those with tumors larger than 10 cm (giant HCC; n = 22). The main outcome measures were overall five-year survival, five-year disease-free survival, recurrence rate, perioperative mortality at 30 days, surgical complication rate, and re-intervention rate. RESULTS The two groups were homogeneously distributed, apart from cirrhosis, which was found more frequently in the group with small HCC (77 vs. 41 %; p = 0.0013). Both median survival (24 vs. 27 months; p = 0.0085) and overall 5-year survival (21 vs. 45; p = 0.04) were significantly poorer in the small HCC group compared to the giant HCC group. There were no differences en terms of recurrence rate, pattern, and timing. CONCLUSIONS Liver resection for HCC larger than 10 cm is a valuable option in selected patients, one that provides overall survival and disease-free survival comparable to smaller lesions. Functional reserves of the liver, more than the size of the lesion, may be important in patient selection for surgical resection.
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Yamashita T. Current status of hepatocellular carcinoma treatment in Japan: hepatic arterial infusion chemotherapy. Clin Drug Investig 2013; 32 Suppl 2:15-23. [PMID: 22873624 DOI: 10.1007/bf03265493] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatic arterial infusion chemotherapy (HAIC) allows the long-term administration of cytotoxic drugs to the liver. In Japan, HAIC has traditionally been used to treat patients with advanced hepatocellular carcinoma (HCC) with vascular invasion or multiple intrahepatic lesions, or both. The most common chemotherapy drugs used for HAIC in Japan are 5-fluorouracil and cisplatin. Although HAIC is associated with a high rate of response in some studies, it is not associated with a survival benefit. Furthermore, HAIC is associated with complications that are not observed with systemic chemotherapy, including peptic ulcer, arterial occlusion and port infection. A molecular targeted agent, sorafenib, recently became the standard therapy for advanced HCC on the basis of data from two randomized controlled trials. For this reason, the position of HAIC in the treatment of advanced HCC in Japan is under discussion. Clinical trials must be undertaken to establish standardized protocols and regimens for HAIC, and to determine the efficacy of HAIC in comparison with other therapies for HCC. Without evidence from such trials, HAIC may not find an established role in the treatment of HCC, and may even fall out of use. Recent evidence suggests that HAIC may be useful in combination with molecular targeted therapy; this is currently being investigated in a number of clinical trials.
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Affiliation(s)
- Tatsuya Yamashita
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, Japan.
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Yamashita T. Current Status of Hepatocellular Carcinoma Treatment in Japan. Clin Drug Investig 2012; 32:15-23. [DOI: 10.2165/1163022-s0-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Moriguchi M, Takayama T, Higaki T, Kimura Y, Yamazaki S, Nakayama H, Ohkubo T, Aramaki O. Early cancer-related death after resection of hepatocellular carcinoma. Surgery 2010; 151:232-7. [PMID: 21176935 DOI: 10.1016/j.surg.2010.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 10/19/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgeons have attempted to prevent early cancer-related death after resection of hepatocellular carcinoma to identify risk factors associated with early death from hepatocellular carcinoma recurrence after liver resection. METHODS The study group comprised 350 patients who had undergone liver resection for hepatocellular carcinoma between 1997 and 2007. The preoperative risk factors for early death from intrahepatic recurrence (within 1 year after resection) were evaluated. RESULTS Fourteen (4%) patients died of intrahepatic recurrence in the first year after resection. Multivariate analyses identified the following risk factors for early cancer-related death: multiple tumors (odds ratio 10.4; 95% confidence interval, 2.42-44.3; P = .002), vascular invasion (odds ratio 10.1; 95% confidence interval 2.07-50; P = .004), serum alpha-fetoprotein level >20 ng/mL (odds ratio 9.52; 95% confidence interval 1.0--84.2; P = .043), and tumor size ≥50 mm (odds ratio 4.80; 95% confidence interval 1.06-21.9; P = .042). Each of these factors was assigned a score of 1 point, and an algorithm was developed to predict the risk of early death. Outcomes did not differ significantly between patients with 3 or 4 points (P = .48) or between those with 1 or 2 points (P = .49). Patients who underwent liver resection could be stratified into the following distinct groups according to the point score and the associated 1-year survival rate and median survival (shown respectively): 0 points, 99%, and not yet; 1 or 2 points, 96%, and 68 months; and 3 or 4 points, 50%, and 12 months) (P < .0001). CONCLUSION Even if hepatocellular carcinoma is resectable, patients with a score of 3 or 4 points may not be good candidates for liver resection.
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Affiliation(s)
- Masamichi Moriguchi
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
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