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Haruki K, Harimoto N, Furukawa K, Taniai T, Yanagaki M, Igarashi Y, Tsunematsu M, Shirai Y, Shirabe K, Ikegami T. Proposal for Prognosis-Oriented Definition of Borderline Resectable Hepatocellular Carcinoma. J Am Coll Surg 2024; 238:1137-1147. [PMID: 38323632 DOI: 10.1097/xcs.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Owing to advances in the multidisciplinary treatment of hepatocellular carcinoma (HCC), a conceptualization and definition for borderline resectable (BR) HCC, which carries a high risk of recurrence, is warranted. In this study, we aimed to define BR-HCC using a prognosis-oriented approach. STUDY DESIGN The study included an original cohort of 221 patients and an independent validation cohort of 181 patients who had undergone primary hepatic resection for HCC. To define biological BR-HCC, we evaluated the risk factors for early recurrence beyond the Milan criteria within 1 year after hepatic resection using multivariable logistic regression models. Subsequently, we developed high-risk scores using the identified risk factors and defined BR-HCC. The utility of high-risk score was validated in the validation cohort. RESULTS In the original cohort (hepatitis B virus:hepatitis C virus = 20%:29%), recurrence beyond the Milan criteria within 1 year was observed in 28 patients (13%), with a 5-year survival rate of 25%. Multivariable analysis identified risk factors for recurrence beyond the Milan criteria within 1 year, including serum alpha-fetoprotein levels of 12 ng/mL or more (p = 0.02), tumor diameters less than 5 cm (p = 0.02), tumor number 3 or more (p = 0.001), and macrovascular invasion (p = 0.04). BR-HCC was defined as a tumor with 2 or more identified risk factors, and 42 patients (19%) were diagnosed with BR-HCC, with a 5-year survival rate of 51%. In the validation cohort, 45 (25%) patients had BR-HCC, with a 5-year survival rate of 42%. CONCLUSIONS The prognosis-oriented definition of BR-HCC enabled us to identify patients who are susceptible to early unresectable recurrence and have poor survival after hepatic resection for HCC. For patients with BR-HCC, preoperative systemic therapy may be a viable option to improve postresection outcomes.
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Affiliation(s)
- Koichiro Haruki
- From the Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan (Haruki, Furukawa, Taniai, Yanagaki, Igarashi, Tsunematsu, Shirai, Ikegami)
| | - Norifumi Harimoto
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan (Harimoto, Shirabe)
| | - Kenei Furukawa
- From the Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan (Haruki, Furukawa, Taniai, Yanagaki, Igarashi, Tsunematsu, Shirai, Ikegami)
| | - Tomohiko Taniai
- From the Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan (Haruki, Furukawa, Taniai, Yanagaki, Igarashi, Tsunematsu, Shirai, Ikegami)
| | - Mitsuru Yanagaki
- From the Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan (Haruki, Furukawa, Taniai, Yanagaki, Igarashi, Tsunematsu, Shirai, Ikegami)
| | - Yosuke Igarashi
- From the Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan (Haruki, Furukawa, Taniai, Yanagaki, Igarashi, Tsunematsu, Shirai, Ikegami)
| | - Masashi Tsunematsu
- From the Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan (Haruki, Furukawa, Taniai, Yanagaki, Igarashi, Tsunematsu, Shirai, Ikegami)
| | - Yoshihiro Shirai
- From the Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan (Haruki, Furukawa, Taniai, Yanagaki, Igarashi, Tsunematsu, Shirai, Ikegami)
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan (Harimoto, Shirabe)
| | - Toru Ikegami
- From the Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan (Haruki, Furukawa, Taniai, Yanagaki, Igarashi, Tsunematsu, Shirai, Ikegami)
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Shen J, Zhou Y, Yu B, Zhao K, Ding Y. Construction and validation of a nomogram for patients with multiple hepatocellular carcinoma: A SEER-based study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106966. [PMID: 37365056 DOI: 10.1016/j.ejso.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND American Joint Committee on Cancer (AJCC)-TNM system doesn't accurately predict prognosis. Our study was designed to identify prognostic factors in patients with multiple hepatocellular carcinoma (MHCC), establish and validate a nomogram model to predict the risk and overall survival (OS) of MHCC patients. METHODS We selected eligible HCC patients from the Surveillance, Epidemiology, and End Results (SEER) database, used univariate and multivariate COX regression to determine prognostic factors in MHCC patients, and used these factors to build a nomogram. The accuracy of the prediction was evaluated using the C-index, receiver operating characteristic (ROC) and calibration curve. Decision curve analysis (DCA), net reclassification index (NRI) and integrated discrimination improvement (IDI) were used to compare the nomogram with AJCC-TNM staging system. Finally, the prognosis of different risks was analyzed using Kaplan-Meier (K-M) method. RESULTS 4950 eligible patients with MHCC were enrolled in our study and randomly assigned to the training cohort and test cohort in a 7:3 ratio. After COX regression analysis, age, sex, histological grade, AJCC-TNM stage, tumor size, alpha-fetoprotein (AFP), surgery, radiotherapy and chemotherapy in total 9 factors could be used to independently determine OS of patients. the above factors were used to construct a nomogram, and the consistency C-index was 0.775. C-index, DCA, NRI and IDI showed that our nomogram was superior to the AJCC-TNM staging system. K-M plots for OS were performed using the log-rank test, the P-value of which was <0.001. CONCLUSIONS The practical nomogram can provide more accurate prognostic prediction for multiple hepatocellular carcinoma patients.
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Affiliation(s)
- Jie Shen
- Dept of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China
| | - Yu Zhou
- Dept of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China
| | - Bin Yu
- Dept of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China
| | - Kailiang Zhao
- Dept of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China.
| | - Youming Ding
- Dept of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China.
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Schneider C, Bogatu D, Leahy J, Zen Y, Ross P, Sarker D, Suddle A, Agarwal K, Srinivasan P, Prachalias AA, Heaton N, Menon K. Predictors of recurrence following laparoscopic minor hepatectomy for hepatocellular carcinoma in the UK. Surg Oncol 2023; 49:101965. [PMID: 37348195 DOI: 10.1016/j.suronc.2023.101965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/10/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
AIMS Minor hepatectomy, which is increasingly carried out laparoscopically (LLR), is a cornerstone of curative treatment for hepatocellular carcinoma (HCC). The majority of relevant publications however originate from regions with endemic viral hepatitis. Although the incidence of HCC in the UK is increasing, little is known about outcomes following LLR. METHODS Consecutive patients undergoing minor (involving ≤2 segments) LLR or open resection (OLR) at our institute between 2014 and 2021 were compared. Selection from a plethora of factors potentially impacting on overall (OS) and disease free survival (DFS) was optimised with Lasso regression. To enable analysis of patients having repeat resection, multivariate frailty modelling was utilised to calculate hazard ratios (HR). RESULTS The analysis of 111 liver resections included 55 LLR and 56 OLR. LLR was associated with a shorter hospital stay (5 ± 2 vs. 7 ± 2 days; p < 0.001) and a lower comprehensive complication index (4.43 vs. 9.96; p = 0.006). Mean OS (52.3 ± 2.3 vs. 49.9 ± 3.0 months) and DFS (33.9 ± 3.4 vs. 36.5 ± 3.6 months; p = 0.59) were comparable between LLR and OLR, respectively (median not reached). Presence of mixed cholangiocarcinoma/HCC, satellite lesions and AFP level predicted OS and DFS. In addition tumour size was predictive of DFS. CONCLUSIONS In the studied population minor LLR was associated with shorter hospital stay and fewer complications while offering non-inferior long-term outcomes. A number of predictors for disease free survival have been elucidated that may aid in identifying patients with a high risk of disease recurrence and need for further treatment.
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Affiliation(s)
- C Schneider
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - D Bogatu
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - J Leahy
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - Y Zen
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - P Ross
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - D Sarker
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - A Suddle
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - K Agarwal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - P Srinivasan
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - A A Prachalias
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - N Heaton
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - K Menon
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom.
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Lima HA, Endo Y, Alaimo L, Moazzam Z, Munir MM, Shaikh C, Resende V, Guglielmi A, Marques HP, Cauchy F, Lam V, Poultsides GA, Popescu I, Alexandrescu S, Martel G, Hugh T, Endo I, Kitago M, Shen F, Pawlik TM. Tumor Burden Score and Serum Alpha-fetoprotein Subclassify Intermediate-Stage Hepatocellular Carcinoma. J Gastrointest Surg 2022; 26:2512-2521. [PMID: 36171471 DOI: 10.1007/s11605-022-05469-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/17/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Resection of Barcelona Clinic Liver Cancer (BCLC) intermediate-stage hepatocellular carcinoma (HCC) remains controversial. While not recommended by the BCLC algorithm, some patients may indeed benefit from hepatectomy. We sought to identify that subset of patients who might derive long-term survival benefit from resection. METHODS Intermediate-stage HCC patients who underwent curative-intent resection were identified from an international multi-institutional database. Factors associated with long-term prognosis were identified using multivariate analysis and a risk score was developed and assessed. RESULTS Among 194 patients, most individuals had two tumors (n = 123, 63.4%) with a median size of 6.0 cm (IQR, 4.0-8.4) for a median tumor burden score (TBS) of 6.5 (IQR, 5.0-9.1); median alpha-fetoprotein (AFP) was 23.9 ng/mL (IQR, 5.0-503.2), and median overall survival (OS) was 69 months (IAR, 60.7-77.3). Factors associated with OS included AFP (referent ≤ 20 ng/mL, > 20 ng/mL: HR 1.78 95%CI, 1.09-2.89) and TBS (referent TBS ≤ 8.0, TBS > 8.0: HR 1.72 95%CI, 1.07-2.75). While 71 (36.6%) patients had neither risk factor, 79 (40.7%) and 44 (22.7%) had 1 or 2, respectively. A simplified score stratified patients relative to recurrence-free survival (RFS) (0: 33.6% vs. 1: 18.0% vs. 2: 14.7%) (AUC 0.60) and recurrence time (i.e., < 6 months after surgery) (0: 21.3% vs. 1: 43.1% vs. 2: 68.6%) (AUC 0.69) (both p < 0.001). Of note, a higher score was also associated with incrementally worse 5-year OS (0: 68.1% vs. 1: 61.0% vs. 2: 29.9%) (AUC 0.62) (p < 0.001). CONCLUSION Long-term OS and RFS outcomes varied considerably. Using a simple risk score, patients with low AFP and low TBS were identified as the subset of individuals most likely to benefit from resection.
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Affiliation(s)
- Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.,Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.,Department of Surgery, University of Verona, Verona, Italy
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Chanza Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Vivian Resende
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - François Cauchy
- Department of Hepatibiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | | | - Irinel Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | - Tom Hugh
- Department of Surgery, School of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Itaru Endo
- Yokohama City University School of Medicine, Yokohama, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University, Tokyo, Japan
| | - Feng Shen
- Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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Risaliti M, Bartolini I, Campani C, Arena U, Xodo C, Adotti V, Rosi M, Taddei A, Muiesan P, Amedei A, Batignani G, Marra F. Evaluating the best treatment for multifocal hepatocellular carcinoma: A propensity score-matched analysis. World J Gastroenterol 2022; 28:3981-3993. [PMID: 36157535 PMCID: PMC9367224 DOI: 10.3748/wjg.v28.i29.3981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/09/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a common tumour often diagnosed with a multifocal presentation. Patients with multifocal HCC represent a heterogeneous group. Although Trans-Arterial ChemoEmbolization (TACE) is the most frequently employed treatment for these patients, previous data suggested that liver resection (LR) could be a safe and effective procedure.
AIM To compare LR and TACE in patients with multifocal HCC in terms of procedure-related morbidity and oncologic outcomes.
METHODS All patients with multifocal HCC who underwent LR or TACE as the first procedure between May 2011 and March 2021 were enrolled. The decision to perform surgery or TACE was made after a multidisciplinary team evaluation. Only patients in Child-Pugh class A or B7 and stage B (according to the Barcelona Clinic Liver Cancer staging system, without severe portal hypertension, vascular invasion, or extrahepatic spread) were included in the final analysis. Propensity score matching was used to adjust the baseline differences between patients undergoing LR and the TACE group [number and diameter of lesions, presence of cirrhosis, alpha-fetoprotein (AFP) levels, and Model for End-Stage Liver Disease score]. The Kaplan-Meier method was used to estimate overall survival (OS) and disease-free survival (DFS). The outcomes of LR and TACE were compared using the log-rank test.
RESULTS After matching, 30 patients were eligible for the final analysis, 15 in each group. Morbidity rates were 42.9% and 40% for LR and TACE, respectively (P = 0.876). Median OS was not different in the LR and TACE groups (53 mo vs 18 mo, P = 0.312), while DFS was significantly longer with LR (19 mo vs 0 mo, P = 0.0001). Subgroup analysis showed that patients in the Italian Liver Cancer (ITA.LI.CA) B2 stage, with AFP levels lower than 400 ng/mL, less than 3 lesions, and lesions bigger than 41 mm, benefited more from LR in terms of DFS. Patients classified as ITA.LI.CA B3, with AFP levels higher than 400 ng/mL and with more than 3 lesions, appeared to receive more benefit from TACE in terms of OS.
CONCLUSION In a small cohort of patients with multifocal HCC, LR confers longer DFS compared with TACE, with similar OS and post-procedural morbidity.
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Affiliation(s)
- Matteo Risaliti
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
| | - Ilenia Bartolini
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
| | - Umberto Arena
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
| | - Carlotta Xodo
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
| | - Valentina Adotti
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
| | - Martina Rosi
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
| | - Antonio Taddei
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
| | - Paolo Muiesan
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
| | - Giacomo Batignani
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, AOU Careggi, Florence 50134, Italy
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