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Chan SM, Cornman-Homonoff J, Lucatelli P, Madoff DC. Image-guided percutaneous strategies to improve the resectability of HCC: Portal vein embolization, liver venous deprivation, or radiation lobectomy? Clin Imaging 2024; 111:110185. [PMID: 38781614 DOI: 10.1016/j.clinimag.2024.110185] [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: 06/26/2023] [Revised: 04/20/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
Despite considerable advances in surgical technique, many patients with hepatic malignancies are not operative candidates due to projected inadequate hepatic function following resection. Consequently, the size of the future liver remnant (FLR) is an essential consideration when predicting a patient's likelihood of liver insufficiency following hepatectomy. Since its initial description 30 years ago, portal vein embolization has become the standard of care for augmenting the size and function of the FLR preoperatively. However, new minimally invasive techniques have been developed to improve surgical candidacy, chief among them liver venous deprivation and radiation lobectomy. The purpose of this review is to discuss the status of preoperative liver augmentation prior to resection of hepatocellular carcinoma with a focus on these three techniques, highlighting the distinctions between them and suggesting directions for future investigation.
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Affiliation(s)
- Shin Mei Chan
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Joshua Cornman-Homonoff
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Pierleone Lucatelli
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA; Department of Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA; Department of Surgery, Section of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA.
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2
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Park SH, Kim B, Kim S, Park S, Park YH, Shin SK, Sung PS, Choi JI. Estimating postsurgical outcomes of patients with a single hepatocellular carcinoma using gadoxetic acid-enhanced MRI: risk scoring system development and validation. Eur Radiol 2023; 33:3566-3579. [PMID: 36933020 DOI: 10.1007/s00330-023-09539-7] [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: 04/03/2022] [Revised: 12/14/2022] [Accepted: 02/06/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES To develop and validate risk scoring systems using gadoxetic acid-enhanced liver MRI features and clinical factors that predict recurrence-free survival (RFS) of a single hepatocellular carcinoma (HCC). METHODS Consecutive 295 patients with treatment-naïve single HCC who underwent curative surgery were retrospectively enrolled from two centers. Cox proportional hazard models developed risk scoring systems whose discriminatory powers were validated using external data and compared to the Barcelona Clinic Liver Cancer (BCLC) or American Joint Committee on Cancer (AJCC) staging systems using Harrell's C-index. RESULTS Independent variables-tumor size (per cm; hazard ratio [HR], 1.07; 95% confidence interval [CI]: 1.02-1.13; p = 0.005), targetoid appearance (HR, 1.74; 95% CI: 1.07-2.83; p = 0.025), radiologic tumor in vein or tumor vascular invasion (HR, 2.59; 95% CI: 1.69-3.97; p < 0.001), the presence of a nonhypervascular hypointense nodule on the hepatobiliary phase (HR, 4.65; 95% CI: 3.03-7.14; p < 0.001), and pathologic macrovascular invasion (HR, 2.60; 95% CI: 1.51-4.48; p = 0.001)-with tumor markers (AFP ≥ 206 ng/mL or PIVKA-II ≥ 419 mAU/mL) derived pre- and postoperative risk scoring systems. The risk scores showed comparably good discriminatory powers in the validation set (C-index, 0.75-0.82) and outperformed the BCLC (C-index, 0.61) and AJCC staging systems (C-index, 0.58; ps < 0.05). The preoperative scoring system stratified the patients into low-, intermediate-, and high-risk for recurrence, whose 2-year recurrence rate was 3.3%, 31.8%, and 85.7%, respectively. CONCLUSION The developed and validated pre- and postoperative risk scoring systems can estimate RFS after surgery for a single HCC. KEY POINTS • The risk scoring systems predicted RFS better than the BCLC and AJCC staging systems (C-index, 0.75-0.82 vs. 0.58-0.61; ps < 0.05). • Five variables-tumor size, targetoid appearance, radiologic tumor in vein or vascular invasion, the presence of a nonhypervascular hypointense nodule on the hepatobiliary phase, and pathologic macrovascular invasion-combined with tumor markers derived risk scoring systems predicting postsurgical RFS for a single HCC. • In the risk scoring system using preoperatively-available factors, patients were classified into three distinct risk groups, with 2-year recurrence rates in the low-, intermediate-, and high-risk groups being 3.3%, 31.8%, and 85.7% in the validation set.
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Affiliation(s)
- So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodae-ro, Seocho-Gu, 06591, Seoul, Korea.
| | - Sehee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Suyoung Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yeon Ho Park
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodae-ro, Seocho-Gu, 06591, Seoul, Korea
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3
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Wong JK, Lim HJ, Tam VC, Burak KW, Dawson LA, Chaudhury P, Abraham RJ, Meyers BM, Sapisochin G, Valenti D, Samimi S, Ramjeesingh R, Mujoomdar A, Martins I, Dixon E, Segedi M, Liu DM. Clinical consensus statement: Establishing the roles of locoregional and systemic therapies for the treatment of intermediate-stage hepatocellular carcinoma in Canada. Cancer Treat Rev 2023; 115:102526. [PMID: 36924644 DOI: 10.1016/j.ctrv.2023.102526] [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: 12/09/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) a leading cause of cancer mortality worldwide and approximately one-third of patients present with intermediate-stage disease. The treatment landscape of intermediate-stage HCC is rapidly evolving due to developments in local, locoregional and systemic therapies. Treatment recommendations focused on this heterogenous disease stage and that take into account the Canadian reality are lacking. To address this gap, a pan-Canadian group of experts in hepatology, transplant, surgery, radiation therapy, nuclear medicine, interventional radiology, and medical oncology came together to develop consensus recommendations on management of intermediate-stage HCC relevant to the Canadian context. METHODS A modified Delphi framework was used to develop consensus statements with strengths of recommendation and supporting levels of evidence graded using the AHA/ACC classification system. Tentative consensus statements were drafted based on a systematic search and expert input in a series of iterative feedback cycles and were then circulated via online survey to assess the level of agreement. RESULTS & CONCLUSION The pre-defined ratification threshold of 80 % agreement was reached for all statements in the areas of multidisciplinary treatment (n = 4), intra-arterial therapy (n = 14), biologics (n = 5), radiation therapy (n = 3), surgical resection and transplantation (n = 7), and percutaneous ablative therapy (n = 4). These generally reflected an expansion in treatment options due to developments in previously established or emergent techniques, introduction of new and more active therapies and increased therapeutic flexibility. These developments have allowed for greater treatment tailoring and personalization as well as a paradigm shift toward strategies with curative intent in a wider range of disease settings.
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Affiliation(s)
- Jason K Wong
- University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Howard J Lim
- BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
| | - Vincent C Tam
- Tom Baker Cancer Centre, University of Calgary, 1331 29 St NW, Calgary, AB T2N 4N2, Canada.
| | - Kelly W Burak
- University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Laura A Dawson
- Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, ON M5G 2C1, Canada.
| | | | - Robert J Abraham
- Department of Diagnostic Radiology, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada.
| | - Brandon M Meyers
- Juravinski Cancer Centre, 699 Concession St, Hamilton, ON L8V 5C2, Canada.
| | | | - David Valenti
- McGill University, 845 Rue Sherbrooke O, Montréal, QC H3A 0G4, Canada.
| | - Setareh Samimi
- Hopital Sacre-Coeur de Montreal, University of Montreal, 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada.
| | - Ravi Ramjeesingh
- Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada.
| | - Amol Mujoomdar
- Western University, 1151 Richmond Street, London, ON N6A 5B9, Canada.
| | - Ilidio Martins
- Kaleidoscope Strategic, Inc. 1 King Street W, Suite 4800 - 117, Toronto, ON M5H 1A1, Canada.
| | - Elijah Dixon
- University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Maja Segedi
- Department of Surgery, Vancouver General Hospital, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada.
| | - David M Liu
- School of Biomedical Engineering, University of British Columbia, 2329 West Mall Vancouver, BC V6T 1Z4, Canada.
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Jeon D, Song GW, Lee HC, Shim JH. Treatment patterns for hepatocellular carcinoma in patients with Child-Pugh class B and their impact on survival: A Korean nationwide registry study. Liver Int 2022; 42:2830-2842. [PMID: 36287103 DOI: 10.1111/liv.15464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/25/2022] [Accepted: 10/20/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS There are no established practice guidelines for treating hepatocellular carcinoma (HCC) in patients with Child-Turcotte-Pugh (CTP) class B liver function. To evaluate the impact of various initial treatment modalities on these patients, we conducted a nationwide registry study in Korea. MATERIALS AND METHODS Treatment patterns and overall survival (OS) of patients with HCC and CTP class B according to initial treatment modalities in each Barcelona Clinic Liver Cancer (BCLC) stage were analysed using data from the Korean Primary Liver Cancer Registry between 2008 and 2016. Initial treatment modalities were categorized as standard, alternative treatment and supportive care only, referring to the 2018 BCLC guidelines, irrespective of liver function. RESULTS Of the 2318 newly diagnosed Korean patients with HCC and CTP class B, 29.7%, 60.3% and 15.6% of patients in BCLC stages A, B and C, respectively, underwent standard treatment. Adjusted OS hazard ratios of alternative treatment referring to standard treatment were 1.55 (95% confidence interval [CI], 1.25-1.94; p < .001) in BCLC-A, 0.82 (95% CI, 0.43-1.56; p = .550) for curative alternative treatment, 1.89 (95% CI, 0.97-3.68; p = .059) for non-curative alternative treatment in BCLC-B, 0.40 (95% CI, 0.28-0.56; p < .001) for curative alternative treatment, 0.84 (95% CI, 0.69-1.02; p = .076) for non-curative alternative treatment for BCLC-C. CONCLUSION Regardless of BCLC stages, chemoembolization was conducted the most among patients with CTP class B. Treatment in line with the BCLC treatment algorithm resulted in favourable OS outcomes, except for those with BCLC stage C, as systemic therapy showed poor OS.
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Affiliation(s)
- Dongsub Jeon
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- The Korean Liver Cancer Study Group, Seoul, Republic of Korea
| | - Gi-Won Song
- Department of Surgery, 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
- The Korean Liver Cancer Study Group, 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
- The Korean Liver Cancer Study Group, Seoul, Republic of Korea
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5
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Nguyen-Khac V, Brustia R, Rhaiem R, Regnault H, Sessa A, Mule S, Duvoux C, Laurent A, Leroy V, Calderaro J, Luciani A, Roudot-Thoraval F, Amaddeo G, Sommacale D. Liver resection for single large hepatocellular carcinoma: a prognostic factors study. Ann Hepatol 2022; 27:100739. [PMID: 35781089 DOI: 10.1016/j.aohep.2022.100739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Liver resection is the only curative therapeutic option for large hepatocellular carcinoma (> 5 cm), but survival is worse than in smaller tumours, mostly due to the high recurrence rate. There is currently no proper tool for stratifying relapse risk. Herein, we investigated prognostic factors before hepatectomy in patients with a single large hepatocellular carcinoma (HCC). MATERIAL AND METHODS We retrospectively identified 119 patients who underwent liver resection for a single large HCC in 2 tertiary academic French centres and collected pre- and post-operative clinical, biological and radiological features. The primary outcome was overall survival at five years. Secondary outcomes were recurrence-free survival at five years and prognostic factors for recurrence. RESULTS A total of 84% of the patients were male, and the median age was 66 years old (IQR 58-74). Thirty-nine (33%) had Child-Pugh A cirrhosis, and the mean Model for End-Stage Liver Disease (MELD) score was 6 (6-6). The aetiology of liver disease was predominantly alcohol-related (48%), followed by nonalcoholic steatohepatitis (22%), hepatitis B (18%) and hepatitis C (10%). The mean tumour size was 70 mm (55-110). The median overall survival was 72.5 months (IC 95%: 56.2-88.7), and the five-year overall survival was 55.1 ± 5.5%. The median recurrence-free survival was 26.6 months (95% CI: 16.0-37.1), and the five-year recurrence-free survival rate was 37.8 ± 5%. In multivariate analysis, preoperative prognostic factors for recurrence were baseline alpha-fetoprotein (AFP) > 7 ng/mL (p<0.001), portal veinous invasion (p=0.003) and cirrhosis (p=0.020). Using these factors, we created a simple recurrence-risk scoring system that classified three groups with distinct disease-free survival medians (p<0.001): no risk factors (65 months), 1 risk factor (36 months), and ≥2 risk factors (8.9 months). CONCLUSION Liver resection is the only curative option for large HCC, and we confirmed that survival could be acceptable in experienced centres. Recurrence is the primary issue of surgery, and we proposed a simple preoperative score to help identify patients with the most worrisome prognosis and possible candidates for combined therapy.
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Affiliation(s)
- Vincent Nguyen-Khac
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Raffaele Brustia
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Digestive and Hepatobiliary Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Rami Rhaiem
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, Robert Debré University Hospital, University Reims Champagne-Ardenne, Reims 51100, France
| | - Hélène Regnault
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France; Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France
| | - Anna Sessa
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France; Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Sebastien Mule
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Christophe Duvoux
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France; Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Alexis Laurent
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Digestive and Hepatobiliary Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Vincent Leroy
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France; Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France
| | - Julien Calderaro
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Pathology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Alain Luciani
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Francoise Roudot-Thoraval
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France
| | - Giuliana Amaddeo
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France; Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France.
| | - Daniele Sommacale
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Department of Pathology, INSERM, Unit U955, Team 18, Créteil 94000, France; Department of Digestive and Hepatobiliary Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil 94000, France.
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Shukla A, Patkar S, Sundaram S, Shah SR, Ingle M, Gupta A, Gopan A, Kamat M, Mohanka R, Singh S, Walke S, Pandey V, Goel M. Clinical Profile, Patterns of Care & adherence to Guidelines in Patients with Hepatocellular Carcinoma: Prospective multi-center Study. J Clin Exp Hepatol 2022; 12:1463-1473. [PMID: 36340319 PMCID: PMC9630010 DOI: 10.1016/j.jceh.2022.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 05/27/2022] [Indexed: 12/12/2022] Open
Abstract
Background and aims Increasing incidence of hepatocellular carcinoma (HCC) in India is a matter of concern and need for adequate profiling and streamlining management strategies cannot be over-emphasized. Methods This is a prospective multi-centric observational cohort study comprising of an oncology center, one university tertiary hospital with specialized hepatology service, one public hospital with gastroenterology service, and a private liver transplant center located within a 3-km radius. The demographic and clinical parameters were recorded on a prospectively maintained database. The clinical profile, demographics, characteristics of HCC and the allocated treatment were noted and compared among the four centers. Results In total, 672 patients were enrolled from June 2016 till January 2020. Abdominal pain (64.3%) and weight loss (47.3%) were the most common symptoms. Most common identified etiology was hepatitis B (39%). The cancer center received lesser patients with hepatitis C and those with advanced stage of HCC. The private transplant center reported the highest proportion of NASH, which was also significantly higher in those belonging to higher socioeconomic strata, and lowest proportion of alcoholic cirrhosis. Metastasis was seen in almost one-fifth (19%) cases at diagnosis. Portal vein thrombosis was evident in 40%. Adherence to treatment guidelines was seen in three-fourth cases (76%). Conclusions Hepatitis B is the most common underlying cause for HCC, whereas other causes like NASH are on the rise. Etiologic profile may vary with selective specialization of centers catering to patients with HCC. Adherence to guideline while allocating treatment was high among all centers with highest non-adherence in BCLC A.
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Key Words
- AASLD, American Association of Study of Liver Disease
- AFP, Alpha fetoprotein
- ALP, Alkaline phosphatase
- ALT, Alanine transaminase
- AST, Aspartate transaminase
- BCLC, Barcelona Clinic Liver Cancer staging
- BCS, Budd Chiari syndrome
- CT, Computed tomography
- EASL, European Association for Study of Liver
- GGT, Gamma glutamyl transpeptidase
- HBV, Hepatitis B virus
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- HKLC, Hong-Kong Liver Cancer staging
- HVPG, Hepatic venous pressure gradient
- INR, International normalized ratio
- MDT, Multidisciplinary team
- MRI, Magnetic resonance imaging
- NAFLD, Non-alcoholic fatty liver disease
- PHT, Portal hypertension
- PVTT, Portal venous tumor thrombosis
- clinical profile
- hepatocellular carcinoma
- milan criteria
- multicenter
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Affiliation(s)
- Akash Shukla
- Department of Gastroenterology, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Shraddha Patkar
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Sridhar Sundaram
- Department of Gastroenterology, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Samir R. Shah
- Department of Hepatology, Institute of Liver Disease, Hepato-pancreatico-biliary Surgery and Transplant, Global Hospitals, Mumbai, India
| | - Meghraj Ingle
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Amit Gupta
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Amrit Gopan
- Department of Gastroenterology, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Mrunal Kamat
- Department of Hepatology, Institute of Liver Disease, Hepato-pancreatico-biliary Surgery and Transplant, Global Hospitals, Mumbai, India
| | - Ravi Mohanka
- Department of Hepatology, Institute of Liver Disease, Hepato-pancreatico-biliary Surgery and Transplant, Global Hospitals, Mumbai, India
| | - Sandeep Singh
- Department of Hepatology, Institute of Liver Disease, Hepato-pancreatico-biliary Surgery and Transplant, Global Hospitals, Mumbai, India
| | - Swapnil Walke
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Vikas Pandey
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Mahesh Goel
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
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Lessons learned from hepatocellular carcinoma may cause a paradigm shift in intraductal papillary mucinous neoplasms: a narrative review and discussion of conceptual similarities in tumor progression and recurrence. JOURNAL OF PANCREATOLOGY 2022. [DOI: 10.1097/jp9.0000000000000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kim HI, An J, Kim JY, Shin HP, Park SY, Song GW, Lee HC, Shim JH. Postresection Period-Specific Hazard of Recurrence as a Framework for Surveillance Strategy in Patients with Hepatocellular Carcinoma: A Multicenter Outcome Study. Liver Cancer 2021; 11:141-151. [PMID: 35634426 PMCID: PMC9109079 DOI: 10.1159/000518837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/01/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION In spite of the high frequency of recurrence of hepatocellular carcinoma (HCC) after resection, little evidence exists to directly help to plan a reasonable schedule for the frequency and intensity of postoperative surveillance for recurrence. METHODS 1,918 consecutive patients with Child-Turcott-Pugh class A who had T1- or T2-staged HCCs detected by active surveillance and underwent curative resection for their tumors at 3 teaching hospitals in Korea, followed by recurrence screening at 6-monthly or shorter intervals. To set an evidence-based timetable for postoperative surveillance, we investigated the annual hazard rate of recurrence through postoperative year 10 in patients undergoing hepatectomy for HCC, and the clinical and morphological phenotypes associated with early versus late recurrence. RESULTS The estimated hazard rate for recurrence peaked during year 0-1 (21.7%), with a subsequent gradual decrease through 5 years, followed by stabilization at <7.0% until year 10, except in the case of cirrhotics, who had a rate of 10.5% during year 4-5. Multivariate time-to-recurrence analysis by recurrence period revealed that serum alpha-fetoprotein ≥200 ng/mL, larger size of tumor, tumor multiplicity, microvascular invasion, capsular invasion, and higher METAVIR fibrosis stage were significantly related to disease recurrence within 5 years after resection, while cirrhosis (METAVIR F4) alone was related to disease recurrence beyond 5 years (Ps < 0.05). Post-relapse overall survival was better in the latter group (p = 0.033). CONCLUSIONS Our chronological and morphological insights into recurrence after resection of primary HCCs may help implement an optimal intensity of surveillance for recurrence.
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Affiliation(s)
- Ha Il Kim
- Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jihyun An
- Gastroenterology and Hepatology, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Ji Yoon Kim
- Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun Phil Shin
- Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seo Young Park
- Statistics and Data Science, Korea National Open University, Seoul, Republic of Korea
| | - Gi-Won Song
- Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han Chu Lee
- Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ju Hyun Shim
- Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,*Ju Hyun Shim,
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9
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Romano F, Chiarelli M, Garancini M, Scotti M, Zago M, Cioffi G, De Simone M, Cioffi U. Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery? World J Gastroenterol 2021; 27:2784-2794. [PMID: 34135554 PMCID: PMC8173387 DOI: 10.3748/wjg.v27.i21.2784] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/24/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
According to Barcelona Clinic Liver Cancer recommendations, intermediate stage hepatocellular carcinomas (stage B) are excluded from liver resection and are referred to palliative treatment. Moreover, Child-Pugh B patients are not usually candidates for liver resection. However, many hepatobiliary centers in the world manage patients with intermediate stage hepatocellular carcinoma or Child-Pugh B cirrhosis with liver resection, maintaining that hepatic resection is not contraindicated in selected patients with non–early-stage hepatocellular carcinoma and without normal liver function. Several studies demonstrate that resection provides the best survival benefit for selected patients in very early/early and even in intermediate stages of Barcelona Clinic Liver Cancer classification, and this treatment gives good results in the setting of multinodular, large tumors in patients with portal hypertension and/or Child-Pugh B cirrhosis. In this review we explore this controversial topic, and we show through the literature analysis how liver resection may improve the short- and long-term survival rate of carefully selected Barcelona Clinic Liver Cancer B and Child-Pugh B hepatocellular carcinoma patients. However, other large clinical studies are needed to clarify which patients with intermediate stage hepatocellular carcinoma are most likely to benefit from liver resection.
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Affiliation(s)
- Fabrizio Romano
- Department of Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Marco Chiarelli
- Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco 23900, Italy
| | - Mattia Garancini
- Department of General Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Mauro Scotti
- Department of General Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Mauro Zago
- Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco 23900, Italy
| | - Gerardo Cioffi
- Department of Sciences and Technologies, Università degli Studi del Sannio di Benevento, Benevento 82100, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano 20122, Italy
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10
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Fung AK, Cheng NM, Chong CC, Lee KF, Wong J, Cheung SY, Lok HT, Lai PB, Ng KK. Single-center experience on actual mid-term (≥5 years) and long-term (≥10 years) survival outcome in patients with hepatocellular carcinoma after curative hepatectomy: A bimodal distribution. Medicine (Baltimore) 2020; 99:e23358. [PMID: 33235106 PMCID: PMC7710257 DOI: 10.1097/md.0000000000023358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Analysis for actual mid-term (≥5 years) and long-term (≥10 years) survivors with hepatocellular carcinoma (HCC) following curative hepatectomy are rarely reported in the literature.This retrospective study aims to study the mid- and long-term survival outcome and associated prognostic factors following curative hepatectomy for HCC in a tertiary referral center.The clinical data of 325 patients who underwent curative hepatectomy for HCC were reviewed. They were stratified into 3 groups for comparison (Group 1, overall survival <5 years; Group 2, overall survival ≥5, and <10 years; Group 3, overall survival ≥10 years). Favorable independent prognostic factors for mid- and long-term survival were analyzed.A bimodal distribution of actual survival outcome was observed, with short-term (<5 years) survival of 52.7% (n = 171), mid-term survival of 18.1% (n = 59), and long-term survival of 29.2% (n = 95). Absence of microvascular invasion (OR 3.690, 95% CI: 1.562-8.695) was independent good prognostic factor for mid-term survival. Regarding long-term overall survival, young age (OR 1.050, 95% CI: 0.920-0.986), ASA grade ≤2 (OR 3.746, 95% CI: 1.325-10.587), high albumin level (OR 1.008, 95% CI: 0.920-0.986), solitary tumor (OR 3.289, 95% CI: 1.149-7.625) and absence of microvascular invasion (OR 4.926, 95% CI: 2.192-11.111) were independent good prognostic factors.Curative hepatectomy results in bimodal actual survival outcome with favorable long-term survival rate of 29.2%. Favorable independent prognostic factors (age, ASA grade, albumin level, tumor number, and microvascular invasion) are identified for overall survival.
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Affiliation(s)
- Andrew K.Y. Fung
- Department of Surgery, Prince of Wales Hospital, New Territories
| | | | - Charing C.N. Chong
- Department of Surgery, Prince of Wales Hospital, New Territories
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Kit-Fai Lee
- Department of Surgery, Prince of Wales Hospital, New Territories
| | - John Wong
- Department of Surgery, Prince of Wales Hospital, New Territories
| | | | - Hon-Ting Lok
- Department of Surgery, Prince of Wales Hospital, New Territories
| | - Paul B.S. Lai
- Department of Surgery, Prince of Wales Hospital, New Territories
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Kelvin K.C. Ng
- Department of Surgery, Prince of Wales Hospital, New Territories
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
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11
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Pommergaard HC, Rostved AA, Adam R, Rasmussen A, Salizzoni M, Bravo MAG, Cherqui D, De Simone P, Houssel-Debry P, Mazzaferro V, Soubrane O, García-Valdecasas JC, Prous JF, Pinna AD, O'Grady J, Karam V, Duvoux C, Thygesen LC. Mortality after Transplantation for Hepatocellular Carcinoma: A Study from the European Liver Transplant Registry. Liver Cancer 2020; 9:455-467. [PMID: 32999871 PMCID: PMC7506266 DOI: 10.1159/000507397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/17/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. METHODS We included patients from the European Liver Transplant Registry transplanted due to HCC from 1990 to November 2016 and compared cirrhotic and non-cirrhotic patients using propensity score (PS) calibration of Cox regression estimates to adjust for unmeasured confounding. RESULTS We included 22,787 patients, of whom 96.5% had cirrhosis. In the unadjusted analysis, non-cirrhotic patients had an increased risk of overall mortality with a hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.23-1.52). However, the HR approached unity with increasing adjustment and was 1.11 (95% CI 0.99-1.25) when adjusted for unmeasured confounding. Unadjusted, non-cirrhotic patients had an increased risk of HCC-specific mortality (HR 2.62, 95% CI 2.21-3.12). After adjustment for unmeasured confounding, the risk remained significantly increased (HR 1.62, 95% CI 1.31-2.00). CONCLUSIONS Using PS calibration, we showed that HCC in non-cirrhotic liver has similar overall mortality, but higher HCC-specific mortality. This may be a result of a more aggressive cancer form in the non-cirrhotic liver as higher mortality could not be explained by tumour characteristics or other prognostic variables.
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Affiliation(s)
- Hans-Christian Pommergaard
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,*Hans-Christian Pommergaard, Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK–2100 Copenhagen (Denmark),
| | - Andreas Arendtsen Rostved
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - René Adam
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Allan Rasmussen
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Mauro Salizzoni
- Liver Transplant Centre and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | | | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, Pisa, Italy
| | - Pauline Houssel-Debry
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Université de Rennes 1, and INSERM, UMR991, Foie, Métabolisme et Cancer, Université de Rennes 1, Rennes, France
| | - Vincenzo Mazzaferro
- University of Milan and Division of Gastrointestinal Surgery and Liver Transplantation, Istituto Nazionale Tumori, Fondazione IRCCS, Milan, Italy
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, University Denis Diderot, Paris, France
| | | | - Joan Fabregat Prous
- Unitat de Cirurgia Hepato-bilio-pancreàtica, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Antonio D. Pinna
- General Surgery and Transplant Division, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - John O'Grady
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Vincent Karam
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris Est University, Créteil, France
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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12
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Cheng JY, Liu CM, Wang YM, Hsu HC, Huang EY, Huang TT, Lee CH, Hung SP, Huang BS. Proton versus photon radiotherapy for primary hepatocellular carcinoma: a propensity-matched analysis. Radiat Oncol 2020; 15:159. [PMID: 32605627 PMCID: PMC7325065 DOI: 10.1186/s13014-020-01605-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/23/2020] [Indexed: 12/18/2022] Open
Abstract
Background Proton radiotherapy has a dosimetric advantage over photon radiotherapy. Many retrospective studies have shown promising results with proton radiotherapy in treating hepatocellular carcinoma (HCC). However, clinical evidence demonstrating the benefit of protons over photons is still limited. We therefore compared the clinical outcomes of the two modalities using medical research databases from our medical foundation. Methods We conducted a propensity score-matched cohort study based on our multi-institution medical organization research database. From January 2007 to January 2018, a total of 413 patients (photon: 349; proton: 64) who were diagnosed with HCC and primarily treated with radiotherapy with curative intent were enrolled. Overall survival (OS) and radiation-induced liver disease (RILD) were assessed. Stratified analysis was also performed to evaluate the heterogeneous effects of the two arms. Results A total of 110 patients (photon: 55; proton: 55) were analyzed in the propensity-matched series. The matched groups were balanced for baseline tumor risk factors. Cox regression analysis revealed a significant survival benefit in the proton group (p = 0.032, HR 0.56, 95% CI 0.33–0.96). The median overall survival in the proton group was not reached and that in the photon group was 17.4 months. The biological equivalent dose of radiotherapy was significantly higher in the proton group than in the photon group (median, 96.56 Gray [relative biological effectiveness] vs. 62.5 Gray, p < 0.001). The risk of RILD was significantly lower in the proton group (11.8% vs. 36%, p = 0.004). Conclusions Proton radiotherapy could deliver a higher radiation dose than photon radiotherapy without increasing the risk of RILD and result in a better overall survival rate for those diagnosed with HCC and treated with radiotherapy with curative intent.
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Affiliation(s)
- Jen-Yu Cheng
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chieh-Min Liu
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ming Wang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Chih Hsu
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Eng-Yen Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Ting Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hsin Lee
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Ping Hung
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. .,Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan.
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13
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Shimada S, Kamiyama T, Orimo T, Nagatsu A, Asahi Y, Sakamoto Y, Kamachi H, Taketomi A. Long-term prognostic factors of patients with hepatocellular carcinoma who survive over 10 years after hepatectomy. J Surg Oncol 2020; 121:1209-1217. [PMID: 32198765 DOI: 10.1002/jso.25910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim was to evaluate long-term prognostic factors in hepatocellular carcinoma (HCC) patients who survived over 10 years after hepatectomy and compare prognostic factors between patients with recurrence who died and survived 10 years after initial hepatectomy. METHODS We analyzed the HCC patients without recurrence over 10 years after hepatectomy (n = 35), those with recurrence who survived over 10 years (n = 48), and those who died within 10 years (n = 132). RESULTS The rate of recurrence was 16.3%, 10-year overall survival rate was 38.6%, and the 10-year recurrence-free survival (RFS) rate was 16.7%. Nonviral, solitary tumor, well differentiation, and without severe fibrosis were independent favorable factors for long-term RFS. High cholinesterase levels, small tumors and without portal vein invasion were independent favorable factors for long-term survival among patients with recurrence. Long-term survivors with recurrence showed significantly low early recurrence, extrahepatic recurrence, multiple intrahepatic recurrences. CONCLUSION Important factors for long-term prognoses in HCC patients were a solitary tumor, small tumors, and no advanced fibrosis. A treatment for nonviral hepatitis is needed to achieve long-term RFS. Even patients who relapse might survive long term if they have a late or solitary intrahepatic recurrence, nonsevere cirrhosis, and curative treatment at recurrence.
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Affiliation(s)
- Shingo Shimada
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Akihisa Nagatsu
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoh Asahi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuzuru Sakamoto
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Hirofumi Kamachi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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14
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The correlations between hepatitis B virus infection and hepatocellular carcinoma with portal vein tumor thrombus or extrahepatic metastasis. Eur J Gastroenterol Hepatol 2020; 32:373-377. [PMID: 31441795 DOI: 10.1097/meg.0000000000001514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Portal vein tumor thrombus (PVTT) and extrahepatic metastasis are associated with the prognosis of hepatocellular carcinoma (HCC). We aimed to investigate the effect of hepatitis B virus (HBV) infection on HCC patients with PVTT or extrahepatic metastasis. PATIENTS AND METHODS The clinical data of 639 patients with HCC from our hospital were retrospectively analyzed to analyze the correlation between HBV and HCC with PVTT or extrahepatic metastasis. RESULTS Univariate analysis revealed that positive hepatitis B virus surface antigen (HBsAg), a detectable serum hepatitis B virus DNA load (>500 IU/ml), cirrhosis and ascites were associated with the presence of PVTT. Positive hepatitis B virus e antigen (HBeAg), cirrhosis and ascites were associated with the presence of extrahepatic metastasis. In a multivariate regression analysis carried out a detectable serum hepatitis B virus DNA load, cirrhosis and ascites were independent risk factors of PVTT. Ascites was an independent risk factor of extrahepatic metastasis. The patients in the PVTT of type III/IV group and the PVTT of type I/II group had a significantly higher rate of positive serum HBsAg, a detectable serum hepatitis B virus DNA load (>500 IU/ml) and HBsAg + HBeAb + HBcAb test positive compared with those in the PVTT-negative group. HBsAg + HBeAb + HBcAb test positive was significantly associated with the presence of extrahepatic metastasis (P=0.028). CONCLUSIONS HBV infection and replication status are associated with the formation of PVTT or extrahepatic metastasis in patients with HCC.
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15
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Sakon M, Kobayashi S, Wada H, Eguchi H, Marubashi S, Takahashi H, Akita H, Gotoh K, Yamada D, Asukai K, Hasegawa S, Ohue M, Yano M, Nagano H. "Logic-Based Medicine" Is More Feasible than "Evidence-Based Medicine" in the Local Treatment for Hepatocellular Carcinoma. Oncology 2020; 98:259-266. [PMID: 32045926 DOI: 10.1159/000505554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/12/2019] [Indexed: 01/18/2023]
Abstract
The optimal type of surgery (e.g., anatomic or non-anatomic resection) or radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is still under debate despite numerous comparative studies based on overall survival. This debate continues not only because these endpoints are influenced by non-surgical factors, such as liver function, but because the definition of non-anatomic resection for HCC has remained unclear. The optimal surgery could be logically determined based on the mechanism of local intrahepatic metastasis, that is, the drainage of tumour blood flow (TBF), because HCC spreads locally through tumour blood flowing to the peri-tumourous liver parenchyma. Since TBF is clearly demonstrated by CT scan under hepatic arteriography, the surgical margin can be determined individually based on the drainage of TBF without deteriorating local curability. Controversy regarding RFA and surgery does not result from the curability of treatment itself but from the lack of scientific evidence on safety margins. Based on proper concepts and self-evident truths, an algorithm of loco-regional treatment for HCC is proposed.
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Affiliation(s)
- Masato Sakon
- Department of Surgery, Osaka International Cancer Institute, Osaka, Japan,
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hiroshi Wada
- Department of Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Hidenori Takahashi
- Department of Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kunihito Gotoh
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Daisaku Yamada
- Department of Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kei Asukai
- Department of Surgery, Osaka International Cancer Institute, Osaka, Japan
| | | | - Masayuki Ohue
- Department of Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Yano
- Department of Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University, Yamaguchi, Japan
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16
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Comparative Analysis of the Discriminatory Performance of Different Well-Known Risk Assessment Scores for Extended Hepatectomy. Sci Rep 2020; 10:930. [PMID: 31969586 PMCID: PMC6976620 DOI: 10.1038/s41598-020-57748-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/06/2020] [Indexed: 02/08/2023] Open
Abstract
The aim of this study was to assess and compare the discriminatory performance of well-known risk assessment scores in predicting mortality risk after extended hepatectomy (EH). A series of 250 patients who underwent EH (≥5 segments resection) were evaluated. Aspartate aminotransferase-to-platelet ratio index (APRI), albumin to bilirubin (ALBI) grade, predictive score developed by Breitenstein et al., liver fibrosis (FIB-4) index, and Heidelberg reference lines charting were used to compute cut-off values, and the sensitivity and specificity of each risk assessment score for predicting mortality were also calculated. Major morbidity and 90-day mortality after EH increased with increasing risk scores. APRI (86%), ALBI (86%), Heidelberg score (81%), and FIB-4 index (79%) had the highest sensitivity for 90-day mortality. However, only the FIB-4 index and Heidelberg score had an acceptable specificity (70% and 65%, respectively). A two-stage risk assessment strategy (Heidelberg–FIB-4 model) with a sensitivity of 70% and a specificity 86% for 90-day mortality was proposed. There is no single specific risk assessment score for patients who undergo EH. A two-stage screening strategy using Heidelberg score and FIB-4 index was proposed to predict mortality after major liver resection.
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17
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Fernandes EDSM, Rodrigues PD, Álvares-da-Silva MR, Scaffaro LA, Farenzena M, Teixeira UF, Waechter FL. Treatment strategies for locally advanced hepatocellular carcinoma. Transl Gastroenterol Hepatol 2019; 4:12. [PMID: 30976715 DOI: 10.21037/tgh.2019.01.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/04/2019] [Indexed: 01/27/2023] Open
Abstract
Liver cancer ranks fifth in incidence and fourth in overall cancer-related mortality, with approximately 854,000 new cases and 810,000 deaths per year worldwide. Hepatocellular carcinoma (HCC) accounts for 90% of these cases, and, over time, both the incidence and mortality of this cancer have been rising in many regions. Several staging systems are used to assess the extent of primary tumor, presence of metastasis, and underlying liver disease, and thereby aid in the definition of treatment strategies and prognosis for these patients. The consequence of this heterogeneity in HCC staging is that no consensual definition of advanced disease exists, and there is still ongoing debate on the optimal treatment for these patients. Patients with advanced tumors can be candidates for multiple therapies, ranging from potentially curative options such as transplantation and resection-to locoregional and systemic treatments; these should be evaluated on an individual basis by a multidisciplinary team. This paper provides an overview of treatment options for advanced stage HCC, based on a review of the latest relevant literature and the personal experience of the authors.
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Affiliation(s)
- Eduardo De Souza Martins Fernandes
- Department of Surgery, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Pablo Duarte Rodrigues
- Digestive Surgery Division, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Mário Reis Álvares-da-Silva
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,School of Medicine, Universidade Federal do Rio Grande Do Sul (UFGRS), Porto Alegre, RS, Brazil
| | | | | | - Uirá Fernandes Teixeira
- Digestive Surgery Division, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Fábio Luiz Waechter
- Digestive Surgery Division, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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18
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Abstract
For patients with unresectable or medically inoperable hepatocellular carcinoma, there are many local and regional therapies available, including stereotactic body radiotherapy, radiofrequency ablation, and transcatheter embolic approaches. This article will describe these treatment options and review the current comparative literature, suggesting that stereotactic body radiotherapy provides similar or better tumor control and a favorable side effect profile.
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Affiliation(s)
- Yao Yu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Mary Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
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19
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Jo HS, Kim DS, Jung SW, Yu YD, Choi SB, Kim WB, Han HJ, Song TJ. Clinical significance of post-hepatectomy hepatic failure in patients with liver metastases from colorectal cancer. Ann Hepatobiliary Pancreat Surg 2018; 22:93-100. [PMID: 29896569 PMCID: PMC5981151 DOI: 10.14701/ahbps.2018.22.2.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 12/17/2022] Open
Abstract
Backgrounds/Aims This study attempted to identify risk factors for development of post-hepatectomy hepatic failure (PHF) and its effect on long-term survival of patients with liver metastases from colorectal cancer. Methods We carried out a retrospective study of 143 patients who had been diagnosed with liver metastases from colorectal cancer and who had undergone hepatectomy between 2003 and 2010. We allocated these patients to PHF and non-PHF groups, using the definition of the International Study Group of Liver Surgery, and compared the clinical factors of the two groups, using Cox regression and Kaplan-Meier analysis to evaluate the differences in overall survival (OS) and recurrence-free survival (RFS) between these groups. Results The PHF group comprised 19 patients (13.3%); all had Grade A PHF. Independent risk factors for development of PHF were metachronous liver metastases and major hepatectomy. The differences between the PHF and non-PHF groups in OS or RFS were not statistically significant; however, the PHF group tended to have a worse prognosis. Multivariate analysis revealed significant associations between OS and the factors of poor differentiation of the primary colorectal cancer, major hepatectomy, and positive resection margin. Conclusions Major hepatectomy is an important risk factor for PHF in patients with liver metastases from colorectal cancer. The pathological characteristics of the primary tumor are more important as predictors than is Grade A PHF.
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Affiliation(s)
- Hye-Sung Jo
- Division of Hepatobiliary, Pancreas Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Dong-Sik Kim
- Division of Hepatobiliary, Pancreas Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sung-Won Jung
- Division of Hepatobiliary, Pancreas Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young-Dong Yu
- Division of Hepatobiliary, Pancreas Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sae-Byeol Choi
- Division of Hepatobiliary, Pancreas Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Wan-Bae Kim
- Division of Hepatobiliary, Pancreas Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyung-Joon Han
- Division of Hepatobiliary, Pancreas Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Division of Hepatobiliary, Pancreas Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea
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20
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Burt AD, Alves V, Bedossa P, Clouston A, Guido M, Hübscher S, Kakar S, Ng I, Park YN, Reeves H, Wyatt J, Yeh MM, Ellis DW. Data set for the reporting of intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma and hepatocellular carcinoma: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2018; 73:369-385. [DOI: 10.1111/his.13520] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Alastair D Burt
- Faculty of Health and Medical Sciences; University of Adelaide; Adelaide Australia
| | - Venâncio Alves
- Department of Pathology; University of São Paulo School of Medicine; São Paulo Brazil
| | - Pierre Bedossa
- Pathology Department; AP-HP; Beaujon Hospital; Clichy France
- Centre de Recherche Bichat-Beaujon; University Paris-Diderot; Paris France
| | - Andrew Clouston
- Envoi Specialist Pathologists; Brisbane Queensland Australia
| | - Maria Guido
- Surgical Pathology and Cytopathology Unit; Department of Medicine-DIMED; University of Padova; Padova Italy
| | - Stefan Hübscher
- Department of Cellular Pathology; Institute of Immunology and Immunotherapy; University of Birmingham; Queen Elizabeth Hospital; Birmingham UK
| | | | - Irene Ng
- Department of Pathology; State Key Laboratory for Liver Research; The University of Hong Kong; Hong Kong Hong Kong
| | - Young N Park
- Department of Pathology Yonsei; Univesity College of Medicine Seodaemun-gu; Seoul Korea
| | - Helen Reeves
- Northern Institute for Cancer Research, Newcastle University; Newcastle upon Tyne UK
| | - Judith Wyatt
- Department of Histopathology; St James University Hospital; Leeds UK
| | - Matthew M Yeh
- Department of Pathology; University of Washington School of Medicine; Seattle WA USA
| | - David W Ellis
- Clinpath Laboratories; Kent Town South Australia Australia
- ICCR Steering Group Representative; Adelaide Australia
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21
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Zhou S, Zhu H, Li Z, Ying X, Xu M. Safety of laparoscopic resection for colorectal cancer in patients with liver cirrhosis: A retrospective cohort study. Int J Surg 2018; 55:110-116. [PMID: 29842931 DOI: 10.1016/j.ijsu.2018.05.730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/12/2018] [Accepted: 05/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with liver cirrhosis represent a high risk group for colorectal surgery. The safety and effectiveness of laparoscopy in colorectal surgery for cirrhotic patients is not clear. The aim of this study was to compare the outcomes of laparoscopic colorectal surgery with those of open procedure for colorectal cancer in patients with liver cirrhosis. MATERIALS AND METHODS A total of 62 patients with cirrhosis who underwent radical resections for colorectal cancer from 2005 to 2014 were identified retrospectively from a prospective database according to the technique adopted (laparoscopic or open). Short- and long-term outcomes were compared between the two groups. RESULTS Comparison of laparoscopic group and open group revealed no significant differences at baseline. In the laparoscopic group, the laparoscopic surgery was associated with reduced estimated blood loss (136 vs. 266 ml, p = 0.015), faster first flatus (3 vs. 4 days, p = 0.002) and shorter days to first oral intake (4 vs. 5 days, p = 0.033), but similar operative times (p = 0.856), number of retrieved lymph nodes (p = 0.400) or postoperative hospital stays (p = 0.170). Despite the similar incidence of overall complications between the two groups (50.0% vs. 68.8%, p = 0.133), we observed lower morbidities in laparoscopic group in terms of the rate of Grade II complication (20.0% vs. 50.0%, p = 0.014). Long-term of overall and Disease-free survival rates did not differ between the two groups. CONCLUSION Laparoscopic colorectal surgery appears to be a safe and less invasive alternative to open surgery in some elective cirrhotic patients in terms of less blood loss or early recovery and does not result in additional harm in terms of the postoperative complications or long-term oncological outcomes.
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Affiliation(s)
- Senjun Zhou
- Department of Colorectal and Anal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, 312000, Shaoxing, China
| | - Hepan Zhu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016, Hangzhou, China
| | - Zhenjun Li
- Department of Colorectal and Anal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, 312000, Shaoxing, China
| | - Xiaojiang Ying
- Department of Colorectal and Anal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, 312000, Shaoxing, China
| | - Miaojun Xu
- Department of General Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, 312000, Shaoxing, China.
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22
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Ronald J, Wang Q, Choi S, Suhocki P, Hall M, Smith T, Kim C. Albumin-bilirubin grade versus MELD score for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) creation. Diagn Interv Imaging 2018; 99:163-168. [DOI: 10.1016/j.diii.2017.10.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/17/2017] [Accepted: 10/24/2017] [Indexed: 12/13/2022]
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23
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Donadon M, Di Tommaso L, Soldani C, Franceschini B, Terrone A, Mimmo A, Vitali E, Roncalli M, Lania A, Torzilli G. Filamin A expression predicts early recurrence of hepatocellular carcinoma after hepatectomy. Liver Int 2018; 38:303-311. [PMID: 28727243 DOI: 10.1111/liv.13522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/14/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND & AIMS Recurrence of hepatocellular carcinoma (HCC) after hepatectomy is very high. A predictive marker of early recurrence (ER) capable of personalizing follow-up and developing a new target therapy would be beneficial. The overexpression of Filamin-A (FLNA), a cytoskeleton protein with scaffolding properties, has recently been associated with progression in tumours. The aim of this study was to test the expression of FLNA in a cohort of patients operated for HCC. METHODS A retrospective cohort of patients who underwent hepatic resection at Humanitas Clinical and Research Center between January 2004 and December 2014 was analysed. FLNA was tested, using a tissue microarray, in the HCC and in the surrounding tissues. The endpoint was the role of FLNA expression in predicting ER of HCC after hepatectomy. Analyses were performed following the REMARK guidelines. RESULTS A total of 113 patients were considered. FLNA was expressed only in the tumoral tissue. Several variables, including T stage, tumour number, tumour size, type of viral hepatitis, type of hepatectomy and intra and peritumoral immune-reactivity to FLNA were significantly associated with ER by univariate analysis. With multivariate analysis, only T stage (HR=2.108; P=.002), tumour number (HR=1.586; P=.023), intra-tumoral (HR=2.672; P<.001) and peritumoral immune-reactivity to FLNA (HR=2.569; P<.001), significantly correlated with ER. The logistic regression analysis revealed that advanced T stage (OR=2.985; P=.001), HCV-infection (OR=1.219; P=.008) and advanced tumour grading (OR=2.781; P=.002) were associated with intratumoral FLNA immune-reactivity. CONCLUSIONS FLNA expression predicts recurrence of HCC after hepatectomy. This finding provides important insights that would help physicians to personalize follow-up strategies.
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Affiliation(s)
- Matteo Donadon
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Luca Di Tommaso
- Department of Pathology, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy.,Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Cristiana Soldani
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Barbara Franceschini
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Alfonso Terrone
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Antonio Mimmo
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Eleonora Vitali
- Department of Endocrinology, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Massimo Roncalli
- Department of Pathology, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy.,Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Andrea Lania
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy.,Department of Endocrinology, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Guido Torzilli
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy.,Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
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24
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Benzoni E, Lorenzin D, Favero A, Adani G, Baccarani U, Molaro R, Zompicchiatti A, Saccomano E, Avellini C, Bresadola F, Uzzau A. Liver Resection for Hepatocellular Carcinoma: a Multivariate Analysis of Factors Associated with Improved Prognosis. the Role of Clinical, Pathological and Surgical Related Factors. TUMORI JOURNAL 2018; 93:264-8. [PMID: 17679461 DOI: 10.1177/030089160709300306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aims and background Hepatocellular carcinoma (Hcc) is the third most common cause of cancer death. The aim of this study is to examine the factors associated with improved prognosis in Hcc after liver resection. Patients and methods From September 1989 to March 2005, 134 consecutive patients had liver resection for Hcc on cirrhosis at our department. We performed 54 major liver resections and 80 limited resections. All patients enrolled in the study were followed-up three times during the first year after resection and twice the next years. Results In-hospital mortality rate was 7.4%, about 50% of these cases were Child-Pugh B patients. Morbidity rate was 47.7%, caused by the rising of ascites, temporary liver impairment function, biliary fistula, hepatic abscess, hemoperitoneum and pleural effusion. Overall survival resulted to be influenced by etiology (P = 0.03), underlying liver disease, in particular Child A vs BC (P = 0.04), Endmondson-Steiner grading (P = 0.01), the absence of a capsule (P = 0.004), the presence of more than one lesion (P = 0.02), lesion's size over 5 cm (P = 0.04), Pringle maneuver length over than 20 minutes (P = 0.03), an amount of resected liver volume lesser than 50% of total liver volume (P = 0. 03), and the relapse of Hcc (P = 0.01). Conclusions The treatment of hepatocellular carcinoma should be both the most radical to obtain the best outcome and to reduce the recurrence's rate, and the most suitable according to the patient's condition, lesion's characteristics and underlying liver disease: because of the large number of factors affecting the outcome of Hcc, unfortunately, we are still far from an agreement upon a group of criteria useful to select the best candidates for liver resection.
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Affiliation(s)
- Enrico Benzoni
- Department of Surgery, School of Medicine, University of Udine, Udine, Italy.
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25
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Rajyaguru DJ, Borgert AJ, Smith AL, Thomes RM, Conway PD, Halfdanarson TR, Truty MJ, Kurup AN, Go RS. Radiofrequency Ablation Versus Stereotactic Body Radiotherapy for Localized Hepatocellular Carcinoma in Nonsurgically Managed Patients: Analysis of the National Cancer Database. J Clin Oncol 2018; 36:600-608. [PMID: 29328861 DOI: 10.1200/jco.2017.75.3228] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Data that guide selection of optimal local ablative therapy for the management localized hepatocellular carcinoma (HCC) are lacking. Because there are limited prospective comparative data for these treatment modalities, we aimed to compare the effectiveness of radiofrequency ablation (RFA) versus stereotactic body radiotherapy (SBRT) by using the National Cancer Database. Methods We conducted an observational study to compare the effectiveness of RFA versus SBRT in nonsurgically managed patients with stage I or II HCC. Overall survival was compared by using propensity score-weighted and propensity score-matched analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to evaluate the effect of severe fibrosis/cirrhosis. In addition, we performed exploratory analyses to determine the effectiveness of RFA and SBRT in clinically relevant patient subsets. Results Overall, 3,684 (92.6%) and 296 (7.4%) nonsurgically managed patients with stage I or II HCC received RFA or SBRT, respectively. After propensity matching, 5-year overall survival was 29.8% (95% CI, 24.5% to 35.3%) in the RFA group versus 19.3% (95% CI, 13.5% to 25.9%) in the SBRT group ( P < .001). Inverse probability-weighted analysis yielded similar results. The benefit of RFA was consistent across all subgroups examined and was robust to the effects of severe fibrosis/cirrhosis. Conclusion Our study suggests that treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC. Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending local ablative therapy for localized unresectable HCC.
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Affiliation(s)
- Devalkumar J Rajyaguru
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Andrew J Borgert
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Angela L Smith
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Reggie M Thomes
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Patrick D Conway
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Thorvardur R Halfdanarson
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Mark J Truty
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - A Nicholas Kurup
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
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26
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Famularo S, Giani A, Di Sandro S, Sandini M, Giacomoni A, Pinotti E, Lauterio A, Gianotti L, De Carlis L, Romano F. Does the Pringle maneuver affect survival and recurrence following surgical resection for hepatocellular carcinoma? A western series of 441 patients. J Surg Oncol 2017; 117:198-206. [PMID: 29082526 DOI: 10.1002/jso.24819] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/31/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Simone Famularo
- School of Medicine and Surgery; University of Milano-Bicocca; Milan Italy
- Department of Surgery; San Gerardo Hospital; Monza Italy
| | - Alessandro Giani
- School of Medicine and Surgery; University of Milano-Bicocca; Milan Italy
- Department of Surgery; San Gerardo Hospital; Monza Italy
| | - Stefano Di Sandro
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Marta Sandini
- School of Medicine and Surgery; University of Milano-Bicocca; Milan Italy
- Department of Surgery; San Gerardo Hospital; Monza Italy
| | - Alessandro Giacomoni
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Enrico Pinotti
- School of Medicine and Surgery; University of Milano-Bicocca; Milan Italy
- Department of Surgery; San Gerardo Hospital; Monza Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Luca Gianotti
- School of Medicine and Surgery; University of Milano-Bicocca; Milan Italy
- Department of Surgery; San Gerardo Hospital; Monza Italy
| | - Luciano De Carlis
- School of Medicine and Surgery; University of Milano-Bicocca; Milan Italy
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Fabrizio Romano
- School of Medicine and Surgery; University of Milano-Bicocca; Milan Italy
- Department of Surgery; San Gerardo Hospital; Monza Italy
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27
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Donadon M, Fontana A, Palmisano A, Viganò L, Procopio F, Cimino M, Del Fabbro D, Torzilli G. Individualized risk estimation for postoperative morbidity after hepatectomy: the Humanitas score. HPB (Oxford) 2017; 19:910-918. [PMID: 28743491 DOI: 10.1016/j.hpb.2017.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/01/2017] [Accepted: 06/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Estimation of postoperative morbidity after hepatectomy remains challenging. The aim of this prospective study was to develop a surgical score to predict an individual risk of post-hepatectomy complications. METHODS All consecutive patients scheduled for hepatectomy from February 2012 to September 2015 were included and randomly assigned into a derivation or validation cohort. We developed a score based on preoperative variables, and we tested them using multivariate analyses. Odds-ratio (OR) values were used to build the score. RESULTS 340 patients were included, 240 in the derivation and 100 in the validation cohort. Multivariate analysis showed that major hepatectomy (OR = 1.62; 95% CI 1.39-3.51), liver stiffness ≥9.7 kPa (OR = 2.46; 95% CI 1.16-5.28), BILCHE score (combination of serum bilirubin and cholinesterase) ≥2 (OR = 2.76; 95% CI 0.82-4.28) and esophageal varices (OR = 1.59; 95% CI 1.51-3.61) were independent complications predictors. A 10-point scoring system was introduced. Patients with a score ≤4 did not experience complications, whereas patients with ≥7 points experienced up to 54% of complications (P < 0.001). CONCLUSIONS A new, easy and clinically reliable surgical score based on the liver stiffness, BILCHE score, type of hepatectomy, and presence of varices may be used to predict post-hepatectomy morbidity. CLINICAL TRIAL NUMBER NCT02454686 (https://www.clinicaltrials.gov/).
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Affiliation(s)
- Matteo Donadon
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Andrea Fontana
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Angela Palmisano
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Luca Viganò
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Fabio Procopio
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Matteo Cimino
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Daniele Del Fabbro
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Guido Torzilli
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Milan, Rozzano, Italy.
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28
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Lobo L, Yakoub D, Picado O, Ripat C, Pendola F, Sharma R, ElTawil R, Kwon D, Venkat S, Portelance L, Yechieli R. Unresectable Hepatocellular Carcinoma: Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 2016; 39:1580-1588. [PMID: 27586657 DOI: 10.1007/s00270-016-1426-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transarterial radioembolization (TARE) has emerged as a newer regional therapy to transarterial chemoembolization (TACE) for treatment of unresectable hepatocellular carcinoma (HCC). The aim of this study is to compare clinical outcomes of both the techniques. METHODS Online search for studies comparing TARE to TACE from 2005 to present was performed. Primary outcome was overall survival rate for up to 4 years. Secondary outcomes included post-treatment complications and treatment response. Quality of included studies was evaluated by STrengthening the Reporting of OBservational studies in Epidemiology criteria. Relative risk (RR) and 95 % confidence intervals (CI) were calculated from pooled data. RESULTS The search strategy yielded 172 studies, five met selection criteria and included 553 patients with unresectable HCC, 284 underwent TACE and 269 underwent TARE. Median ages were 63 and 64 years for TACE and TARE, respectively. Meta-analysis showed no statistically significant difference in survival for up to 4 years between the two groups (HR = 1.06; 95 % CI 0.81-1.46, p = 0.567). TACE required at least one day of hospital stay compared to TARE which was mostly an outpatient procedure. TACE had more post-treatment pain than TARE (RR = 0.51, 95 % CI 0.36-0.72, p < 0.01), but less subjective fatigue (RR = 1.68, 95 % CI 1.08-2.62, p < 0.01). There was no difference between the two groups in the incidence of post-treatment nausea, vomiting, fever, or other complications. In addition, there was no difference in partial or complete response rates between the two groups. CONCLUSION TARE appears to be a safe alternative treatment to TACE with comparable complication profile and survival rates. Larger prospective randomized trials, focusing on patient-reported outcomes and cost-benefit analysis are required to consolidate these results.
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Affiliation(s)
- Laila Lobo
- Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Danny Yakoub
- Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Omar Picado
- Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Caroline Ripat
- Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Fiorella Pendola
- Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Rishika Sharma
- Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Rana ElTawil
- Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Deukwoo Kwon
- Department of Biostatistics and Bioinformatics, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Shree Venkat
- Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Loraine Portelance
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Raphael Yechieli
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA. .,Department of Radiation Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, 1475 NW 12th Ave, Suite 1500, Miami, FL, 33136, USA.
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29
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Xing M, Kokabi N, Prajapati HJ, Close O, Ludwig JM, Kim HS. Survival in unresectable AJCC stage I and II HCC and the effect of DEB-TACE: SEER versus tertiary cancer center cohort study. J Comp Eff Res 2016; 5:141-54. [PMID: 26946950 DOI: 10.2217/cer.15.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM To evaluate overall survival (OS) in unresectable American Joint Committee on Cancer (AJCC) stage I/II hepatocellular carcinoma (HCC) treated with drug-eluting-bead transarterial chemoembolization (DEB-TACE) versus best supportive care. MATERIALS & METHODS OS in consecutive patients with AJCC stage I/II unresectable HCC diagnosed in 2005-2010 who underwent DEB-TACE and similar patients from SEER with no surgery/radiation recommended/performed was evaluated. RESULTS Median OS from HCC diagnosis was 28.9 months (DEB-TACE) versus 10.0 months (SEER), p < 0.0001. Median OS was 36.3 months (DEB-TACE) versus 12.0 months (SEER) in AJCC I, and 27.9 months (DEB-TACE) versus 10.0 months (SEER) in AJCC II, p < 0.0001. Significant independent prognostic factors for OS were single primary tumor, no vascular invasion, normal α-fetoprotein and DEB-TACE. CONCLUSION DEB-TACE in patients with unresectable AJCC stage I/II HCC was a significant independent prognostic factor for greater OS in a population-based study.
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Affiliation(s)
- Minzhi Xing
- Interventional Radiology, Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Nima Kokabi
- Interventional Radiology & Image-guided Medicine, Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Hasmukh J Prajapati
- Interventional Radiology & Image-guided Medicine, Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Orrie Close
- Interventional Radiology, Department of Radiology, University of Pittsburgh, PA, USA
| | - Johannes M Ludwig
- Interventional Radiology, Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Hyun S Kim
- Interventional Radiology, Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven Hospital, 333 Cedar Street, New Haven, CT 06510, USA
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van Meer S, van Erpecum KJ, Sprengers D, Coenraad MJ, Klümpen HJ, Jansen PLM, IJzermans JNM, Verheij J, van Nieuwkerk CMJ, Siersema PD, de Man RA. Hepatocellular carcinoma in cirrhotic versus noncirrhotic livers: results from a large cohort in the Netherlands. Eur J Gastroenterol Hepatol 2016; 28:352-9. [PMID: 26629867 DOI: 10.1097/meg.0000000000000527] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Hepatocellular carcinoma (HCC) usually occurs in patients with cirrhosis, but can also develop in noncirrhotic livers. In the present study we explored associated risk factors for HCC without cirrhosis and compared patient and tumor characteristics and outcomes in HCC patients with and without underlying cirrhosis. METHODS Patients with HCC diagnosed in the period 2005-2012 in five Dutch academic centers were evaluated. Patients were categorized according to the presence of cirrhosis on the basis of histology or combined radiological and laboratory features. RESULTS In total, 19% of the 1221 HCC patients had no underlying cirrhosis. Noncirrhotic HCC patients were more likely to be female and to have nonalcoholic fatty liver disease or no risk factors for underlying liver disease, and less likely to have hepatitis C virus or alcohol-related liver disease than did cirrhotic HCC patients. HCCs in noncirrhotic livers were more often unifocal (67 vs. 48%), but tumor size was significantly larger (8 vs. 4 cm). Despite the larger tumors, more patients underwent resection (50 vs. 10%) and overall survival was significantly better than in cirrhotics. In multivariate analyses, absence of cirrhosis [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.38-0.63] and presence of hepatitis B (HR 0.68, 95% CI 0.51-0.91) were independent predictors for lower mortality, whereas hepatitis C virus was associated with higher mortality (HR 1.32, 95% CI 1.01-1.65). CONCLUSION HCC without cirrhosis was strongly associated with female sex and presence of nonalcoholic fatty liver disease or no risk factors for underlying liver disease. In absence of cirrhosis, resections were more often performed, with better survival despite larger tumor size.
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Affiliation(s)
- Suzanne van Meer
- aDepartment of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht Departments of bGastroenterology and Hepatology cSurgery, Erasmus Medical Center, Rotterdam dDepartment of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden Departments of eMedical Oncology fGastroenterology and Hepatology gPathology, Academic Medical Center Amsterdam hDepartment of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
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Severity of cirrhosis should determine the operative modality for patients with early hepatocellular carcinoma and compensated liver function. Surgery 2016; 159:621-31. [DOI: 10.1016/j.surg.2015.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/18/2015] [Accepted: 09/02/2015] [Indexed: 01/08/2023]
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Abstract
Pathologic organ fibrosis is a condition that can affect all major tissues and is typically ascribed to the excessive accumulation of extracellular matrix components, predominantly collagens. It typically leads to compromise of organ function and subsequent organ failure, and it is estimated that 45% of deaths in the developed world are linked to fibrotic disease. Fibrosis and cancer are known to be inextricably linked; however, we are only just beginning to understand the common and overlapping molecular pathways between the two. Here, we discuss what is known about the intersection of fibrosis and cancer, with a focus on cancer metastasis, and highlight some of the exciting new potential clinical targets that are emerging from analysis of the molecular pathways associated with these two devastating diseases.
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Affiliation(s)
- Thomas R Cox
- Authors' Affiliation: Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Janine T Erler
- Authors' Affiliation: Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
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Microvascular infiltration has limited clinical value for treatment and prognosis in hepatocellular carcinoma. World J Surg 2015; 38:1769-76. [PMID: 24378549 DOI: 10.1007/s00268-013-2426-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Microvascular infiltration (MVI) is considered a necessary step in the metastatic evolution of hepatocellular carcinoma (HCC), but its prognostic value after liver resection (LR) is uncertain. We studied the clinical value of MVI compared to the Milan criteria in a consecutive series of patients submitted to radical LR. METHODS A total of 441 patients were retrospectively evaluated. MVI and the Milan criteria were analyzed and compared as prognostic factors for overall and disease-free survival (DFS). RESULTS MVI was present in 189 patients (42.8 %). Grading, satellitosis, size of cancer, and alfa fetoprotein value were significantly related to MVI, which was present in 34.3 and 53.2 % of Milan+ and Milan- patients, respectively (p = 0.00001). Both MVI and the Milan criteria were associated with a lower overall and DFS, but only the Milan criteria were associated with the rate of early recurrence and the feasibility of a curative treatment of the recurrence. The application of MVI parameters to patients classified by the Milan criteria further selects the outcome in Milan+ patients (5-year survival rate of 54.1 and 67.9 %, respectively, in the presence or absence of MVI) but not in Milan- patients. CONCLUSIONS MVI is related to survival after LR for HCC, but the clinical value of this information is limited. In Milan+ patients, the absence of MVI selects the cases with better prognosis. In the presence of a liver recurrence, the Milan criteria related to the primary HCC show a better prognostic accuracy and have clinical relevance in the decision-making process.
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Affiliation(s)
- Thomas R Cox
- Biotech Research & Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Janine T Erler
- Biotech Research & Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
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Presurgical planning for hepatobiliary malignancies: clinical and imaging considerations. Magn Reson Imaging Clin N Am 2014; 22:447-65. [PMID: 25086939 DOI: 10.1016/j.mric.2014.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There are many considerations in the evaluation of liver malignancy before planned surgical treatment. This article focuses on interpretation of MR imaging of the liver for surgical treatment planning of hepatocellular carcinoma, colorectal cancer metastases, and hilar cholangiocarcinoma. Clinical status, anatomic variants, future liver remnant, and underlying liver disease are all important factors in the decision to proceed with liver resection. The primary objective of preoperative imaging is to correctly identify patients who are candidates for curative intervention and to accurately stage their disease. Treatment planning for these complex patients is best done with a multidisciplinary team approach.
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Liao M, Huang J, Wu H, Zeng Y. Shall we take a second thought before applying radiofrequency ablation for resectable HCC ≤2 cm? Hepatobiliary Surg Nutr 2014; 3:109-11. [PMID: 25019070 DOI: 10.3978/j.issn.2304-3881.2014.06.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 06/04/2014] [Indexed: 02/05/2023]
Abstract
Hepatocellular carcinoma (HCC), a disease with poor survival rates unless recognized and treated early, ranks as the fifth most common cancer worldwide. Previous researches has led some authors to choose radiofrequency ablation (RFA) as the primary treatment even the tumor is resectable. Dr. Roayaie's study retrospectively analyzed the surgical outcome of HCC ≤2 cm. The results obtained in the studies indicate that anatomic resection may achieve better survival for patients with well-preserved liver function, and without liver cirrhosis. This research also revealed the presence of satellite lesions and microvascular invasion were evident in such early tumors, as the benefit of anatomic resection is unique and cannot be duplicated by ablation. Further RCTs with large sample sizes and long-term follow-up are still required to clarify which should be the best treatment of choice.
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Affiliation(s)
- Mingheng Liao
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiwei Huang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hong Wu
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yong Zeng
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
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37
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Wei CK, Tsai SJ, Yin WY, Chang CM, Chiou WY, Lee MS, Su YC, Lin HY, Hung SK. Treatment results and prognostic factors in resectable hepatocellular carcinoma—Results from a local general hospital. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Prognostic role of Child-Pugh score 5 and 6 in hepatocellular carcinoma patients who underwent curative hepatic resection. Am J Surg 2014; 209:199-205. [PMID: 25312843 DOI: 10.1016/j.amjsurg.2014.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 03/18/2014] [Accepted: 03/28/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND It is unclear whether Child-Pugh score discriminates a prognosis of the Child-Pugh A patients who underwent hepatic resection for hepatocellular carcinoma. METHODS Between April 2000 and March 2011, 361 patients with Child-Pugh A who underwent curative hepatectomy were divided into 2 groups: Child-Pugh score 5 points group (CPS5) and Child-Pugh score 6 points group (CPS6); both CPS5 (n = 274) and CPS6 (n = 87) groups were compared. RESULTS Overall survival rates (1/2/5 years of the CPS5 and CPS6 groups were 90.9%/82.5%/62.4% and 80.6%/68.0%/47.6%, respectively) and disease-free survival rates (67.6%/51.8%/30.1% and 36.9%/16.0%/5.9%, respectively) showed that the CPS5 group was significantly better than the CPS6 group. Multivariate analysis revealed that Child-Pugh score at overall survival (P = .0125) and disease-free survival (P = .0103) was a significant prognostic factor. CONCLUSIONS The overall survival and disease-free survival in Child-Pugh A showed quite a difference between the CPS5 and CPS6 groups. However, CPS5 and CPS6 may be a useful prognostic marker of hepatocellular carcinoma patients with hepatic resection.
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Müller V, Förtsch T, Gündel M, Croner RS, Langheinrich M, Yedibela S, Lohmüller C, Küffner M, Hohenberger W, Perrakis A. Long-term outcome of liver transplantation as treatment modality in patients with hepatocellular carcinoma in cirrhosis: a single-center experience. Transplant Proc 2014; 45:1957-60. [PMID: 23769082 DOI: 10.1016/j.transproceed.2013.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/03/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is among the most frequent malignant diseases worldwide. In the vast majority of cases, it is associated with liver cirrhosis. Liver transplantation (OLT) is potentially the gold standard treatment for patients suffering HCC in cirrhosis, because of synchronous eradication of HCC and of the underlying hepatic disease. The aim of this study was to evaluate long-term outcomes of OLT in HCC patients. MATERIAL AND METHODS Between January 2000 and December 2011, 43 patients who were diagnosed with HCC in liver cirrhosis and underwent OLT in our department, were identified from a prospective database. All patients received their grafts from deceased donors. We analyzed demographic data, laboratory values, number and size of lesions, primary liver disease, diagnostic methods, bridging therapy modalities, and postoperative outcomes, including complications, recurrences, and their treatment. RESULTS Patient follow-up as of January 2012 or to death ranged from 0 to 138 months (median, 59; mean, 63). None of the patients were lost to follow-up. The gender bias was 85%:15% (male:female) and the median age, 57.8 years (range, 44-69). The most common underlying diseases for cirrhosis and HCC were alcoholic (n = 12) and hepatitis C (n = 16). Thirty-one subjects underwent bridging therapy through transarterial chemoembolization (TACE), and/or radiofrequency ablation. All patients underwent OLT within the Milan criteria according to the preoperative evaluation and histopathologic examination of the explanted liver. Twenty-one of them suffered postoperative complications (48.8%). HCC recurrence, which occurred in 5 (10.4%), was treated by surgery (n = 3), systemic chemotherapy with sorafenib (n = 1), or TACE (n = 1). CONCLUSIONS OLT for HCC in cirrhosis, displays a relatively high complication rate. It shows good survivals with and low recurrence.
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Affiliation(s)
- V Müller
- Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Hatzaras I, Bischof DA, Fahy B, Cosgrove D, Pawlik TM. Treatment options and surveillance strategies after therapy for hepatocellular carcinoma. Ann Surg Oncol 2013; 21:758-66. [PMID: 24006095 DOI: 10.1245/s10434-013-3254-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and the third leading cause of cancer death worldwide. Recurrence rates after curative intent treatment for HCC are high; 5-year disease-free survival ranges from only 19 to 81 %. There is no direct evidence to guide the optimal frequency and method of surveillance for recurrent HCC after curative intent treatment. In contrast, there is strong evidence supporting both primary screening for HCC in patients with chronic liver disease. After resection, HCC tends to recur locally, whereas the pattern after transplantation is more at extrahepatic sites. In theory, if an HCC recurrence is discovered early, more therapeutic options are available for treatment of the recurrent HCC. As such, close surveillance after curative intent therapy may have the potential to prolong survival. We herein review the available literature derived from primary surveillance of patients with cirrhosis, as well as data on postoperative surveillance of HCC patients. In aggregate, although data remain scarce, close surveillance with α-fetoprotein and cross-sectional imaging every 3-4 months for 3 years after curative intent therapy, followed by surveillance every 6-12 months thereafter, seems the most prudent approach to follow-up of patients with HCC in the postsurgical setting.
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Affiliation(s)
- Ioannis Hatzaras
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Parisi A, Desiderio J, Trastulli S, Castellani E, Pasquale R, Cirocchi R, Boselli C, Noya G. Liver resection versus radiofrequency ablation in the treatment of cirrhotic patients with hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2013; 12:270-7. [PMID: 23742772 DOI: 10.1016/s1499-3872(13)60044-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatocellular carcinoma is the most common type of primary liver tumor and its incidence is increasing worldwide. The study aimed to compare patients subjected to liver resection or radiofrequency ablation. METHODS One hundred and forty cirrhotic patients in stage A or B of Child-Pugh with single nodular or multinodular hepatocellular carcinoma were included in this retrospective study. Among them, 87 underwent surgical resection, and 53 underwent percutaneous radiofrequency ablation. Patient characteristics, survival, and recurrence-free survival were analyzed. RESULTS Recurrence-free survival was longer in the resection group in comparison to the radiofrequency group with a median recurrence-free time of 36 versus 26 months, respectively (P=0.01, HR=1.52, 95% CI: 1.05-2.25). In the resection group, median survival was 46 months, with the 1-, 3- and 5-year survival rates of 89.7%, 72.4% and 40.2%. In the radiofrequency group, median survival was 32 months, with the 1-, 3- and 5-year survival rates of 83.0%, 43.4% and 22.6% (P<0.01). CONCLUSIONS Surgical resection improves the overall survival and recurrence-free survival in comparison with radiofrequency ablation. New evidences are needed to define the real role of the percutaneous technique as an alternative to surgery.
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Affiliation(s)
- Amilcare Parisi
- Department of Digestive Surgery and Liver Unit, St. Maria Hospital, Terni, Italy.
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A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC East-West study group. Ann Surg 2013; 257:929-37. [PMID: 23426336 DOI: 10.1097/sla.0b013e31828329b8] [Citation(s) in RCA: 388] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to investigate in a retrospective setting the patients' profile and results of those undergoing surgery for hepatocellular carcinoma (HCC) in high-volume surgical centers throughout the world. BACKGROUND Whether surgery for HCC is a suitable approach and for which subset of patients is still controversial. The EASL/AASLD (European Association for the Study of Liver Disease/American Association for the Study of Liver Disease) guidelines, based on the Barcelona Clinic Liver Cancer (BCLC) classification, leave little room for hepatic resection; inversely, other reports promote its wider application. METHODS On the basis of the network "Hepatocellular Carcinoma: Eastern & Western Experiences," data for 2046 consecutive patients resected for HCC in 10 centers were collected. According to the BCLC classification, 1012 (50%) were BCLC 0-A, 737 (36%) BCLC B, and 297 (14%) BCLC C. Analysis of overall survival and disease-free survival and multivariate analysis of prognostic factors were performed. FINDINGS The 90-day mortality rate was 2.7%. Overall morbidity was 42%. After a median follow-up of 25 months (range, 1-209 months), the 1-, 3-, and 5-year overall survival rates were 95%, 80%, and 61% for BCLC 0-A; 88%, 71%, and 57% for BCLC B; and 76%, 49%, and 38% for BCLC C (P = 0.000). The 1-, 3-, and 5-year disease-free survival rates were as follows: 77%, 41%, and 21% for BCLC 0-A; 63%, 38%, and 27% for BCLC B; and 46%, 28%, and 18% for BCLC C (P = 0.000). The multivariate analysis identified bilirubin, cirrhosis, esophageal varices, tumor size, and macrovascular invasion to be statistical and independent prognostic factors for overall survival. CONCLUSIONS This large multicentric survey shows that surgery is in current practice widely applied among patients with multinodular, large, and macrovascular invasive HCC, providing acceptable short- and long-term results and justifying an update of the EASL/AASLD therapeutic guidelines in this sense.
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Sogawa H, Shrager B, Jibara G, Tabrizian P, Roayaie S, Schwartz M. Resection or transplant-listing for solitary hepatitis C-associated hepatocellular carcinoma: an intention-to-treat analysis. HPB (Oxford) 2013; 15:134-41. [PMID: 23036070 PMCID: PMC3719920 DOI: 10.1111/j.1477-2574.2012.00548.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 06/08/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The relative roles of liver resection (LR) and liver transplantation (LT) in the treatment of a solitary hepatocellular carcinoma (HCC) remain unclear. This study was conducted to provide a retrospective intention-to-treat comparison of these two curative therapies. METHODS Records maintained at the study centre for all patients treated with LR or listed for LT for hepatitis C-associated HCC between January 2002 and December 2007 were reviewed. Inclusion criteria required: (i) an initial diagnosis of a solitary HCC lesion measuring ≤ 5 cm, and (ii) Child-Pugh class A or B cirrhosis. The primary endpoint analysed was intention-to-treat survival. RESULTS A total of 75 patients were listed for transplant (LT-listed group) and 56 were resected (LR group). Of the 75 LT-listed patients, 23 (30.7%) were never transplanted because they were either removed from the waiting list (n = 13) or died (n = 10). Intention-to-treat median survival was superior in the LR group compared with the LT-listed group (61.8 months vs. 30.6 months), but the difference did not reach significance. Five-year recurrence was higher in the LR group than in the 52 LT patients (71.5% vs. 30.5%; P < 0.001). CONCLUSIONS In the context of limited donor organ availability, partial hepatectomy represents an efficacious primary approach in properly selected patients with hepatitis C-associated HCC.
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Affiliation(s)
- Hiroshi Sogawa
- Recanati/Miller Transplantation Institute, Mount Sinai Medical CenterNew York, NY, USA
| | - Brian Shrager
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical CenterNew York, NY, USA
| | - Ghalib Jibara
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical CenterNew York, NY, USA
| | - Parissa Tabrizian
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical CenterNew York, NY, USA
| | - Sasan Roayaie
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical CenterNew York, NY, USA
| | - Myron Schwartz
- Recanati/Miller Transplantation Institute, Mount Sinai Medical CenterNew York, NY, USA
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical CenterNew York, NY, USA
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Schwartz ME, Shrager B. Surgical resection for hepatocellular carcinoma in the noncirrhotic: the Western experience. Recent Results Cancer Res 2013; 190:85-100. [PMID: 22941015 DOI: 10.1007/978-3-642-16037-0_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although hepatocellular carcinoma (HCC) is most often a sequela of severe hepatic fibrosis or cirrhosis, a proportion of cases arise in the noncirrhotic patient. The gold standard therapy in such cases is surgical resection. Innovations in operative technique allow for this treatment to be implemented with very low mortality and acceptable morbidity at high-volume hepatobiliary centers. This chapter discusses various etiologies of noncirrhotic HCC and presents a large single-center experience that is compared to other Western series.
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Affiliation(s)
- Myron E Schwartz
- Department of Surgery, Mount Sinai School of Medicine, NewYork, NY 10029-6574, USA.
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Torzilli G, Donadon M, Cimino M. Are Tumor Exposure and Anatomical Resection Antithetical during Surgery for Hepatocellular Carcinoma? A Critical Review. Liver Cancer 2012; 1:177-82. [PMID: 24159582 PMCID: PMC3760464 DOI: 10.1159/000343831] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Hepatic resection is the most potentially curative local therapy for patients with hepatocelluar carcinoma (HCC). However, the high rate of postoperative recurrence, 50-70% at 3 years, remains a major concern. Such recurrences usually occur in the liver owing to the high propensity of HCC to invade the portal vein branches and the underlying liver cirrhosis, which is the ideal background for HCC development. Two pivotal surgical techniques are commonly used to reduce such recurrences: anatomical resection (AR) and achievement of negative margins. However, controversies exist about the definition of anatomical resection and the requisite width of negative margins. Consequently, a consensus on these issues is far from being achieved in the specialized surgical community. Review of the literature and author's discernment support AR for HCC larger than 2cm, and tumor exposure when the tumor is in contact with major vessels. Therefore, tumor exposure is not a contradiction to an AR properly carried out.
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Affiliation(s)
- Guido Torzilli
- *Liver Surgery Unit, Department of General Surgery, University of Milan, School of Medicine, Humanitas Cancer Center, Via Manzoni 56, Rozzano, Milan 20089 (Italy), Tel. +39 02 8224 4083, E-Mail
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Truant S, Boleslawski E, Duhamel A, Bouras AF, Louvet A, Febvay C, Leteurtre E, Huet G, Zerbib P, Dharancy S, Hebbar M, Pruvot FR. Tumor size of hepatocellular carcinoma in noncirrhotic liver: a controversial predictive factor for outcome after resection. Eur J Surg Oncol 2012; 38:1189-96. [PMID: 22863304 DOI: 10.1016/j.ejso.2012.07.112] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 06/24/2012] [Accepted: 07/19/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma in noncirrhotic liver (NC-HCC) presents usually with large size, which is seen as a contraindication to liver transplantation (LT) or even resection. The objective of our single-center study was to identify prognostic factors following resection of large NC-HCCs and to subsequently devise a treatment strategy (including LT) in selected patients. METHODS From 2000 to 2010, 89 patients who had hepatic resection for NC-HCC (large ≥ 8 cm in 52) were analyzed with regard to pathological findings, postoperative and long-term outcome. RESULTS Five patients died postoperatively. After a mean follow-up of 35 ± 30 months, NC-HCC recurred in 36 patients (26/47 survivors in group 8 cm+, 10/37 in group 8 cm-; p = 0.007). Five-year overall (OS) and disease-free survival (DFS) rates were significantly worse for group 8 cm+ (43.4% vs. 89.2% and 39.3% vs. 60.7% for group 8 cm-, p < 0.05). Seven patients underwent re-hepatectomy and/or LT for isolated intrahepatic recurrence, with 5-year DFS of 57.1%. In a multivariate analysis, the factors associated with poor OS and DFS were vascular invasion and tumor size ≥ 8 cm in the overall population and vascular invasion, fibrosis and satellite nodules in group 8 cm+. Adjuvant transarterial chemotherapy was a protective factor in group 8 cm+. In 22 isolated NC-HCC cases with no vascular invasion or fibrosis, tumor size had no impact on five-year DFS (85%). CONCLUSIONS Although patients with NC-HCC ≥ 8 cm had a poorer prognosis, the absence of vascular invasion or fibrosis was associated with excellent survival, regardless of the tumor size. In recurrent patients, aggressive treatment (including LT) can be considered.
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Affiliation(s)
- S Truant
- Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, Rue M. Polonovski, CHU, Univ Nord de France, F-59000 Lille, France.
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Shrager B, Jibara G, Schwartz M, Roayaie S. Resection of Hepatocellular Carcinoma Without Cirrhosis. Ann Surg 2012; 255:1135-43. [DOI: 10.1097/sla.0b013e31823e70a3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Reddy SK, Steel JL, Chen HW, DeMateo DJ, Cardinal J, Behari J, Humar A, Marsh JW, Geller DA, Tsung A. Outcomes of curative treatment for hepatocellular cancer in nonalcoholic steatohepatitis versus hepatitis C and alcoholic liver disease. Hepatology 2012; 55:1809-19. [PMID: 22183968 DOI: 10.1002/hep.25536] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 12/06/2011] [Indexed: 12/11/2022]
Abstract
UNLABELLED Concomitant increasing incidences of hepatocellular carcinoma (HCC) and nonalcoholic steatohepatitis (NASH) suggest that a substantial proportion of HCC arises as a result of hepatocellular injury from NASH. The aim of this study was to determine differences in severity of liver dysfunction at HCC diagnosis and long-term survival outcomes between patients undergoing curative therapy for HCC in the background of NASH compared to hepatitis C virus (HCV) and/or alcoholic liver disease (ALD). Patient demographics and comorbidities, clinicopathologic data, and long-term outcomes among patients who underwent liver transplantation, hepatic resection, or radiofrequency ablation for HCC were reviewed. From 2000 to 2010, 303 patients underwent curative treatment of HCC; 52 (17.2%) and 162 (53.5%) patients had NASH and HCV and/or alcoholic liver disease. At HCC diagnosis, NASH patients were older (median age 65 versus 58 years), were more often female (48.1% versus 16.7%), more often had the metabolic syndrome (45.1% versus 14.8%), and had lower model for end-stage liver disease scores (median 9 versus 10) (all P < 0.05). NASH patients were less likely to have hepatic bridging fibrosis or cirrhosis (73.1% versus 93.8%; P < 0.001). After a median follow-up of 50 months after curative treatment, the most frequent cause of death was liver failure. Though there were no differences in recurrence-free survival after curative therapy (median, 60 versus 56 months; P = 0.303), NASH patients had longer overall survival (OS) (median not reached versus 52 months; P = 0.009) independent of other clinicopathologic factors and type of curative treatment. CONCLUSION Patients with HCC in the setting of NASH have less severe liver dysfunction at HCC diagnosis and better OS after curative treatment compared to counterparts with HCV and/or alcoholic liver disease.
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Affiliation(s)
- Srinevas K Reddy
- Departments of Surgery, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Rückert F, Grützmann R, Pilarsky C. Feedback within the inter-cellular communication and tumorigenesis in carcinomas. PLoS One 2012; 7:e36719. [PMID: 22615799 PMCID: PMC3355145 DOI: 10.1371/journal.pone.0036719] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/12/2012] [Indexed: 12/14/2022] Open
Abstract
The classical somatic mutation theory (SMT) of carcinogenesis and metastasis postulates that malignant transformation occurs in cells that accumulate a sufficient amount of mutations in the appropriate oncogenes and/or tumor suppressor genes. These mutations result in cell-autonomous activation of the mutated cell and a growth advantage relative to neighboring cells. However, the SMT cannot completely explain many characteristics of carcinomas. Contrary to the cell-centered view of the SMT with respect to carcinogenesis, recent research has revealed evidence that the tumor microenvironment plays a role in carcinogenesis as well. In this review, we present a new model that accommodates the role of the tumor microenvironment in carcinogenesis and complements the classical SMT. Our "feedback" model emphasizes the role of an altered spatiotemporal communication between epithelial and stromal cells during carcinogenesis: a dysfunctional intracellular signaling in tumorigenic epithelial cells leads to inappropriate cellular responses to stimuli from associated stromal or inflammatory cells. Thus, a positive feedback loop of the information flow between parenchymal and stromal cells results. This constant communication between the stromal cells and the tumor cells causes a perpetually activated state of tumor cells analogous to resonance disaster.
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Affiliation(s)
- Felix Rückert
- Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
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50
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Cauchy F, Fuks D, Belghiti J. HCC: current surgical treatment concepts. Langenbecks Arch Surg 2012; 397:681-95. [DOI: 10.1007/s00423-012-0911-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/17/2012] [Indexed: 12/28/2022]
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