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Owusuaa C, Dijkland SA, Nieboer D, van der Heide A, van der Rijt CCD. Predictors of Mortality in Patients with Advanced Cancer-A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:328. [PMID: 35053493 PMCID: PMC8774229 DOI: 10.3390/cancers14020328] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 02/01/2023] Open
Abstract
To timely initiate advance care planning in patients with advanced cancer, physicians should identify patients with limited life expectancy. We aimed to identify predictors of mortality. To identify the relevant literature, we searched Embase, MEDLINE, Cochrane Central, Web of Science, and PubMed databases between January 2000-April 2020. Identified studies were assessed on risk-of-bias with a modified QUIPS tool. The main outcomes were predictors and prediction models of mortality within a period of 3-24 months. We included predictors that were studied in ≥2 cancer types in a meta-analysis using a fixed or random-effects model and summarized the discriminative ability of models. We included 68 studies (ranging from 42 to 66,112 patients), of which 24 were low risk-of-bias, and 39 were included in the meta-analysis. Using a fixed-effects model, the predictors of mortality were: the surprise question, performance status, cognitive impairment, (sub)cutaneous metastases, body mass index, comorbidity, serum albumin, and hemoglobin. Using a random-effects model, predictors were: disease stage IV (hazard ratio [HR] 7.58; 95% confidence interval [CI] 4.00-14.36), lung cancer (HR 2.51; 95% CI 1.24-5.06), ECOG performance status 1+ (HR 2.03; 95% CI 1.44-2.86) and 2+ (HR 4.06; 95% CI 2.36-6.98), age (HR 1.20; 95% CI 1.05-1.38), male sex (HR 1.24; 95% CI 1.14-1.36), and Charlson comorbidity score 3+ (HR 1.60; 95% CI 1.11-2.32). Thirteen studies reported on prediction models consisting of different sets of predictors with mostly moderate discriminative ability. To conclude, we identified reasonably accurate non-tumor specific predictors of mortality. Those predictors could guide in developing a more accurate prediction model and in selecting patients for advance care planning.
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Affiliation(s)
- Catherine Owusuaa
- Department of Medical Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands;
| | - Simone A. Dijkland
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (S.A.D.); (D.N.); (A.v.d.H.)
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (S.A.D.); (D.N.); (A.v.d.H.)
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (S.A.D.); (D.N.); (A.v.d.H.)
| | - Carin C. D. van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands;
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Okamura S, Shimose S, Niizeki T, Kamachi N, Noda Y, Shirono T, Iwamoto H, Nakano M, Kuromatsu R, Koga H, Torimura T. Association between contrast enhancement on contrast-enhanced CT and lenvatinib effectiveness in hepatocellular carcinoma. Mol Clin Oncol 2022; 16:8. [PMID: 34881028 PMCID: PMC8647186 DOI: 10.3892/mco.2021.2442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/19/2021] [Indexed: 01/27/2023] Open
Abstract
The aim of the present study was to investigate whether the degree of contrast enhancement on contrast-enhanced (CE)-CT can predict the prognosis of patients with hepatocellular carcinoma (HCC) treated with lenvatinib (LEN). A total of 67 consecutive patients with LEN-treated HCC were retrospectively analysed. In the pretreatment CE-CT, the CT values were measured using a region of interest within the main nodule and the liver parenchyma in the arterial phase, and the macroscopic degree of contrast enhancement of the tumour area was quantified by calculating the enhancement ratio (ER) of the liver parenchyma. The associations of pretreatment ER with progression-free survival (PFS) and overall survival (OS) were then investigated. There were 20, 27 and 20 patients in the ER ≥1.5, 1.0≤ ER <1.5 and ER <1.0 groups, respectively. There was no significant difference in the PFS and OS among the three ER groups (PFS, P=0.63; OS, P=0.455). The ER <1.0 group had significantly more patients with larger tumour diameters, Barcelona Clinic Liver Cancer (BCLC) stage C with extrahepatic metastases, and higher des-γ-carboxy prothrombin values compared with the ER ≥1.0 group, suggesting that ER <1.0 reflected more aggressive types of HCC. The multivariate analysis revealed tumour size and α-fetoprotein as independent predictors of shorter PFS. Albumin-bilirubin grade 2 and BCLC stage C were significant predictors of poor OS, whereas the ER was confirmed as a non-significant predictor of both PFS and OS. Only non-alternating LEN and transarterial therapy (AT) were identified as independent predictors of unfavourable OS in patients with BCLC stage B HCC. Therefore, LEN has a strong therapeutic effect on HCC, regardless of the degree of contrast enhancement. Furthermore, AT may prolong the OS of LEN-treated patients with BCLC stage B HCC, regardless of tumour vascularity.
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Affiliation(s)
- Shusuke Okamura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Shigeo Shimose
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Takashi Niizeki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Naoki Kamachi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Yu Noda
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Tomotake Shirono
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Hideki Iwamoto
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Masahito Nakano
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Ryoko Kuromatsu
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Hironori Koga
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Takuji Torimura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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Barman PM, Sharma P, Krishnamurthy V, Willatt J, McCurdy H, Moseley RH, Su GL. Predictors of mortality in patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Dig Dis Sci 2014; 59:2821-5. [PMID: 24973040 PMCID: PMC4359914 DOI: 10.1007/s10620-014-3247-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/03/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM Transarterial chemoembolization (TACE) is the recommended treatment for patients with Barcelona stage B hepatocellular carcinoma; however, community practice varies from these American Association for the Study of Liver Diseases guidelines. In this study, we sought to assess factors determining outcome after TACE and examine adherence to guidelines. METHODS From January 2006 to December 2012, 308 patients with newly diagnosed HCC were treated at the Veterans Affairs (VA) Ann Arbor Healthcare System. Of these, 109 patients underwent TACE. The primary outcome measured mortality. Kaplan-Meier analysis was used to determine the cumulative probability of death. Cox regression was used to assess the predictors of mortality. RESULTS The median age of the 109 patients was 60 years (48-90), 97 % were males and 82 % had chronic HCV infection. The median size of the largest lesion was 4 cm, 51 % were multifocal, and portal vein thrombosis was present in 3.6 %. Sixty-two patients died after median 333 days from the index TACE treatment. Median overall survival from index TACE was 11.2 months. Unadjusted 1-, 2-, and 3-year survival was 64, 35, and 24 %, respectively. CTP score (B vs. A: HR 2.51, p = 0.002; C vs. A: HR 7.96, p < 0.0001) and presence of complete response to TACE (HR 0.51, p = 0.004) were independent predictors of mortality. Barcelona stage (p = 0.88) and performance status as measured by ECOG (p = 0.98) were not associated with mortality after TACE. CONCLUSIONS In this community based, single VA center study, we found a significant number of patients beyond Barcelona stage B were treated with TACE. Advanced TNM stage, poor liver synthetic function and achieving CR with TACE were better predictors of mortality than guideline-directed decisions based on Barcelona stage. These factors may be useful to guide future patient selection for TACE.
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Affiliation(s)
- Pranab M. Barman
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Pratima Sharma
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Venkat Krishnamurthy
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA. VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jonathon Willatt
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA. VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | - Richard H. Moseley
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Grace L. Su
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Chen BB, Shih IL, Wu CH, Hsu C, Chen CH, Shih TTF, Liu KL, Liang PC. Comparison of characteristics and transarterial chemoembolization outcomes in patients with unresectable hepatocellular carcinoma and different viral etiologies. J Vasc Interv Radiol 2014; 25:371-8. [PMID: 24468045 DOI: 10.1016/j.jvir.2013.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 10/11/2013] [Accepted: 10/12/2013] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To determine any differences in patient characteristics and outcomes after transarterial chemoembolization between different viral etiologies of hepatocellular carcinoma (HCC). METHODS This retrospective study consisted of 201 patients undergoing first-time transarterial chemoembolization for unresectable HCC from January to December 2009. The patients were divided into four groups: hepatitis B virus (HBV) only (n = 104), hepatitis C virus (HCV) only (n = 63), HBV and HCV (n = 10), and no viral hepatitis (n = 24). The clinical and laboratory data were obtained from electronic medical records, and imaging findings obtained before transarterial chemoembolization were analyzed. Kaplan-Meier analyses were used to assess the impact of HBV or HCV status, clinical characteristics, and imaging results on overall survival. RESULTS After a median follow-up of 28.3 months ± 16.2, the 1-, 2-, and 3-year overall survival rates were 74.1%, 59.7%, and 53.2%. Patients with HBV had a significant association with younger age (P = .001), higher male-to-female ratio (P = .003), lower alanine aminotransferase levels (P = .018), higher albumin levels (P = .009), and multifocal tumors at diagnosis (P = .04) compared with patients with HCV. Patients with both HBV and HCV had significantly higher serum bilirubin levels compared with the other groups (P = .002). No significant difference was found in overall survival among the different hepatitis groups (P = .943). Multivariate analysis showed that statistically significant determinants for overall survival were Child-Pugh class (P = .002), Barcelona Clinic Liver Cancer stage (P < .001), tumor size (P < .001), and distribution (P < .001). CONCLUSIONS Viral etiology has no correlation with the outcome of patients with HCC undergoing transarterial chemoembolization.
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - I-Lun Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Chih-Horng Wu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Chiun Hsu
- Department of Oncology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Chien-Hung Chen
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Kao-Lang Liu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Po-Chin Liang
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100.
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Morse MA, Hanks BA, Suhocki P, Doan PL, Liu EA, Frost P, Bernard SA, Tsai A, Moore DT, O'Neil BH. Improved Time to Progression for Transarterial Chemoembolization Compared With Transarterial Embolization for Patients With Unresectable Hepatocellular Carcinoma. Clin Colorectal Cancer 2012; 11:185-90. [DOI: 10.1016/j.clcc.2011.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 09/20/2011] [Accepted: 11/14/2011] [Indexed: 10/14/2022]
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Song MJ, Bae SH, Yoo IR, Park CH, Jang JW, Chun HJ, Choi BG, Lee HG, Choi JY, Yoon SK. Predictive value of 18F-fluorodeoxyglucose PET/CT for transarterial chemolipiodolization of hepatocellular carcinoma. World J Gastroenterol 2012; 18:3215-22. [PMID: 22783045 PMCID: PMC3391758 DOI: 10.3748/wjg.v18.i25.3215] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 04/27/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the correlation of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) with clinical features and the prediction of treatment response.
METHODS: A total of 83 hepatocellular carcinoma (HCC) patients undergoing 18F-FDG PET before transarterial chemolipiodolization with systemic chemo-infusion between October, 2006 and May, 2009 were retrospectively enrolled. The patients included 68 men and 15 women (mean age, 60 ± 10.7 years). The effect of 18F-FDG-monitored PET uptake on clinical features and on the evaluated treatment response was ascertained with modified Response Evaluation Criteria in Solid Tumors. The PET parameters of maximal standardized uptake value of the tumor (Tsuvmax), the ratio of the tumor maximal standardized uptake value (SUV) to the liver maximal SUV (Tsuvmax/Lsuvmax) and the ratio of tumor maximal SUV to the liver mean SUV (Tsuvmax/Lsuvmean) were tested as predictive factors.
RESULTS: Among the 3 SUV parameters, the Tsuvmax/Lsuvmean ratio (cutoff value of 1.90) was significantly associated with tumor burden including tumor size, tumor number, α-fetoprotein levels and tumor stage (P < 0.001, P = 0.008, P = 0.011, P < 0.001, respectively). The objective response rates in patients with a high SUV ratio (≥ 1.90) were significantly better than those with a low SUV ratio (< 1.90) (P = 0.020). The overall survival rates of patients exhibiting a low Tsuvmax/Lsuvmean ratio (< 1.90) and those with a high SUV ratio (≥ 1.90) was 38.2 and 10.3 mo, respectively (P < 0.01). However, the time to progression showed no significant difference between the groups (P = 0.15).
CONCLUSION: 18F-FDG PET can be an important predictor of HCC treatment. In particular, the Tsuvmax/Lsuvmean ratio (cutoff value of 1.90) can provide useful information in treatment prognosis for HCC patients treated with locoregional therapy.
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Hu HT, Kim JH, Lee LS, Kim KA, Ko GY, Yoon HK, Sung KB, Gwon DI, Shin JH, Song HY. Chemoembolization for hepatocellular carcinoma: multivariate analysis of predicting factors for tumor response and survival in a 362-patient cohort. J Vasc Interv Radiol 2011; 22:917-23. [PMID: 21571545 DOI: 10.1016/j.jvir.2011.03.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 01/31/2011] [Accepted: 03/07/2011] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To evaluate the factors associated with tumor response and survival after chemoembolization in 362 patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Between January 2006 and August 2006, 362 patients who underwent chemoembolization for unresectable HCC were evaluated. The endpoints were tumor response and patient survival. Factors associated with tumor response were evaluated using multivariate logistic regression analysis. Factors associated with patient survival were evaluated using multivariate Cox regression analysis. RESULTS After chemoembolization, 69% of the study patients showed a tumor response. On multivariate analysis, tumor size (centimeter) (odds ratio [OR] 2.85, P = .002), tumor number (OR 4.58, P < .001), tumor vascularity (OR 11.97, P < .001), and portal vein invasion (OR 4.24, P < .001) were significant factors for tumor response. The median survival was 23 months. On multivariate analysis, Child-Pugh class (hazard ratio [HR] 2.43, P < .001), maximal tumor size (HR 1.66, P = .002), tumor vascularity (HR 2.13, P = .001), portal vein invasion (HR 2.39, P < .001), tumor number (HR, 1.92, P < .001), and alpha fetoprotein (AFP) value (HR 1.54, P = .003) were significant factors associated with patient survival after chemoembolization. CONCLUSIONS Tumor size, tumor vascularity, tumor number, and portal vein invasion are significant independent predictors of tumor response after chemoembolization in patients with unresectable HCC. Child-Pugh class B or C, large tumor size (≥ 4 cm), multiple tumors (five or more), portal vein invasion, and a high AFP value (> 83 ng/mL) indicated poor prognosis for overall patient survival after chemoembolization.
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Affiliation(s)
- Hong Tao Hu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea
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Gadaleta CD, Ranieri G. Trans-arterial chemoembolization as a therapy for liver tumours: New clinical developments and suggestions for combination with angiogenesis inhibitors. Crit Rev Oncol Hematol 2010; 80:40-53. [PMID: 21067940 DOI: 10.1016/j.critrevonc.2010.10.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 09/15/2010] [Accepted: 10/05/2010] [Indexed: 12/14/2022] Open
Abstract
The liver is the primary site of metastases for many malignancies. Gastrointestinal cancers are especially prone to spread to the liver and other tumours, as breast cancer and melanoma often spread to the liver. On the other hand, hepatocellular cancer (HCC) is the fifth most common malignancy in the world due to its common etiology from chronic liver damage caused by hepatitis or cirrhosis. Treatments of liver tumours vary according to histology and liver invasion and until now trans-arterial chemoembolization (TACE) has represented a main approach in the therapy of liver tumours. This review takes into consideration: (i) the background to utilizing TACE in liver tumours; (ii) TACE methods and the biological rationale for utilizing chemotherapeutic agents coated to a new micro-particle such as DC-Beads and HepaSphere; (iii) clinical experiences employing TACE in different liver tumours; (iv) the pivotal role of angiogenesis and hypoxia-induced angiogenesis following TACE with special references to HCC. Finally, the rationale for the combination of TACE with angiogenesis inhibitors is also discussed.
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Affiliation(s)
- C Damiano Gadaleta
- Interventional Radiology Unit, Integrated Section of Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari, Italy.
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Transcatheter arterial chemoembolisation for hepatocellular carcinoma in cirrhosis: survival rate and prognostic factors. Dig Liver Dis 2010; 42:515-9. [PMID: 19914153 DOI: 10.1016/j.dld.2009.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 09/22/2009] [Accepted: 09/30/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND The role of prognostic variables in the treatment of hepatocellular carcinoma (HCC) by transarterial chemoembolisation (TACE) is controversial. AIMS To evaluate the survival of patients with HCC on cirrhosis treated with TACE and to analyse the prognostic factors affecting survival. METHODS From 1996 to 2006, 580 consecutive patients with HCC in cirrhosis were observed. Of these 194 patients underwent TACE. The primary end-point was survival. Independent predictors of survival were identified using the Cox model. RESULTS The cumulative 1-year, 3-year, and 5-year survival rates were 96%, 60%, and 41%, respectively. The multivariate analysis showed significant reduction of survival among patients with serum bilirubin values >2mg/dl compared to patients with values <2mg/dl (Hazard ratio 3.84; CI 95% 1.70-8.66; p-value=0.001). Multivariate analysis performed in the group of patients treated with TACE alone showed that elevated serum bilirubin (Hazard ratio 2.96; CI 95% 1.20-7.3; p-value 0.02) and incomplete tumour response (Hazard ratio 2.88; CI 95% 1.18-7.05; p-value 0.02) are correlated with a worse outcome. CONCLUSIONS TACE was well tolerated and overall survival rate was 41% after 5 years. Complete tumour response and serum bilirubin <2mg/dl were identified as predictors of survival.
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Yoon HJ, Kim J, Kim KA, Lee IS, Ko GY, Song HY, Gwon D. Transcatheter arterial chemo-lipiodol infusion for unresectable hepatocellular carcinoma in 96 high-risk patients. Clin Radiol 2010; 65:271-7. [DOI: 10.1016/j.crad.2010.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 01/21/2010] [Accepted: 01/27/2010] [Indexed: 02/08/2023]
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Kim JH, Yoon HK, Ko GY, Gwon DI, Jang CS, Song HY, Shin JH, Sung KB. Nonresectable Combined Hepatocellular Carcinoma and Cholangiocarcinoma: Analysis of the Response and Prognostic Factors after Transcatheter Arterial Chemoembolization. Radiology 2010; 255:270-7. [DOI: 10.1148/radiol.09091076] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kim JH. Comments on “Chemoembolization (TACE) of Unresectable Intrahepatic Cholangiocarcinoma with Slow-Release Doxorubicin-Eluting Beads: Preliminary Results”. Cardiovasc Intervent Radiol 2010; 33:226. [DOI: 10.1007/s00270-009-9628-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 06/02/2009] [Indexed: 10/20/2022]
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Cho WC, Chen HY. Transcatheter arterial chemoembolization combined with or without Chinese herbal therapy for hepatocellular carcinoma: meta-analysis. Expert Opin Investig Drugs 2010; 18:617-35. [PMID: 19388879 DOI: 10.1517/13543780902855308] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Chinese herbal therapy is sometimes used in conjunction with transcatheter arterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC) in Asian countries. This study aims to systemically review the efficacy of Chinese herbal therapy in HCC patients receiving TACE. METHODS Meta-analysis was performed for clinical trials comparing Chinese herbal therapy versus no Chinese herbal therapy given to HCC patients receiving TACE. Publications in 10 electronic databases were extensively searched. RESULTS/CONCLUSION Chinese herbal therapy was associated with a significant rise in the number of patients with survival > 1-year, 2-year and 3-year, as well as a significant rise in the number of patients who reported complete or partial response and non-deterioration performance status. Chinese herbal therapy also showed significant efficacies in the increase of T cells and natural killer cells, whereas a significant lower blood alpha-fetoprotein concentration was reported. There were a significant increase in white blood cell count, a significant lower risk in patients with nausea and vomiting, and a significant rise in patients with increased body weight when Chinese herbal therapy was given. The evidence from this review supports the use of Chinese herbal therapy to enhance the efficacy of TACE in HCC patients. However, owing to limited data and heterogeneity of the included studies, further trials are required.
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Affiliation(s)
- William Cs Cho
- Queen Elizabeth Hospital, Department of Clinical Oncology, Room 1305, 13/F, Block R, 30 Gascoigne Road, Kowloon, Hong Kong.
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Transcatheter arterial chemoembolization for hepatocellular carcinoma after attempted portal vein embolization in 25 patients. AJR Am J Roentgenol 2009; 193:W446-51. [PMID: 19843726 DOI: 10.2214/ajr.09.2479] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Portal vein embolization (PVE) has been widely used to facilitate major liver resection; however, curative surgery even after PVE may not be possible mainly because of inadequate hypertrophy of remnant liver or disease progression. For these patients, transcatheter arterial chemoembolization (TACE) is the next therapeutic option. We evaluated the safety and efficacy of TACE after PVE in 25 patients with hepatocellular carcinoma (HCC). CONCLUSION TACE using a single chemotherapeutic agent can be performed safely and effectively in HCC patients who previously underwent PVE. TACE after PVE allowed two of the patients to be downstaged so they could undergo surgical resection.
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Kim JH, Yoon HK, Kim SY, Kim KM, Ko GY, Gwon DI, Sung KB. Transcatheter arterial chemoembolization vs. chemoinfusion for unresectable hepatocellular carcinoma in patients with major portal vein thrombosis. Aliment Pharmacol Ther 2009; 29:1291-8. [PMID: 19392861 DOI: 10.1111/j.1365-2036.2009.04016.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transcatheter arterial chemoembolization (TACE) has been limited in palliative treatment of unresectable hepatocellular carcinoma (HCC) with major portal vein (PV) invasion due to the possibility of liver failure following embolization. Transcatheter arterial chemoinfusion (TACI) has been an option in such cases. AIM To compare clinical outcomes after TACE vs. TACI in HCC patients with major PV occlusion. METHODS We compared clinical outcomes after TACE vs. TACI in HCC patients with major PV occlusion. From 2005 to 2007, 110 HCC patients with major PV thrombosis were treated with TACE (n = 49) or TACI (n = 61). RESULTS The morbidity rate was similar for both TACE (6.1%) and TACI (6.5%) patients, and complications were adequately managed using medical treatment. The Kaplan-Meier survival analysis showed that the survival period was significantly longer for the TACE group (median: 14.9 months) than for the TACI (median: 4.4 months) group (P < 0.001). There was a higher probability of death in the TACI group than in the TACE group in both our multivariate Cox-proportional hazards (OR 3.09, P < 0.001) and the propensity score-matched (27 pairs) cohort analyses (OR 2.27, P = 0.024). CONCLUSIONS Transcatheter arterial chemoembolization can be safely performed in HCC patients with main PV occlusion. Compared with TACI, TACE may result in longer survival of HCC patients with major PV occlusion.
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Affiliation(s)
- J H Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Primary hepatic angiosarcoma: imaging findings and palliative treatment with transcatheter arterial chemoembolization or embolization. Clin Radiol 2009; 64:779-85. [PMID: 19589416 DOI: 10.1016/j.crad.2009.02.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 02/11/2009] [Accepted: 02/16/2009] [Indexed: 12/12/2022]
Abstract
AIM To describe the image findings and results of transcatheter arterial chemoembolization (TACE) or transcatheter arterial embolization (TAE) for treating primary hepatic angiosarcoma. MATERIALS AND METHODS A retrospective review of the electronic medical database from 2002 to 2007, revealed six patients with primary hepatic angiosarcoma confirmed by percutaneous liver biopsy. The computed tomography (CT) and angiography imaging findings, the TACE or TAE results, and the post-procedure course were evaluated in all patients. RESULTS On CT and angiography, each tumour appeared as a solitary mass or as multiple nodules or masses with heterogeneously early and progressive enhancement. One of the two patients with tumour response to TACE died 8 months after initial presentation, and the remaining patient was still alive at the last follow-up 12 months after initial presentation. However, two patients with no response to TACE and two patients who underwent emergent TAE for tumour rupture died 1 week to 5 months (mean 2.1 months) after initial presentation. CONCLUSIONS Primary hepatic angiosarcoma appears as a solitary or multiple, hypervascular lesions with heterogeneously early and progressive enhancement on CT and angiography. Although TAE may be the primary procedure for achieving emergent bleeding control caused by the rupture of hepatic angiosarcomas, TACE may be effective for treating patients with a dominant hepatic angiosarcoma with or without intrahepatic metastases.
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Kim JH, Kim JH, Choi JH, Kim CH, Jung YK, Yim HJ, Yeon JE, Park JJ, Kim JS, Bak YT, Byun KS. Value of the model for end-stage liver disease for predicting survival in hepatocellular carcinoma patients treated with transarterial chemoembolization. Scand J Gastroenterol 2009; 44:346-57. [PMID: 18991165 DOI: 10.1080/00365520802530838] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the prognostic value of the model for end-stage liver disease (MELD) and its modified forms, and to compare these scoring systems with other staging systems for hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE). MATERIAL AND METHODS A total of 325 patients who underwent TACE for the initial treatment of HCC between January 2000 and May 2007 were enrolled in the study. Before TACE was carried out, MELD, MELD-Na, Child-Pugh score, Okuda stage, CLIP score, JIS score, BCLC stage, and UICC stage were checked. After one month, delta MELD and delta MELD-Na were calculated. RESULTS Mean MELD/MELD-Na/delta MELD/delta MELD-Na scores were 7.5+/-3.7, 8.0+/-4.7, -0.2+/-3.5 and 0.04+/-4.5, respectively. MELD (p=0.009) and MELD-Na (p=0.017) significantly correlated with survival, but delta MELD and delta MELD-Na did not (p >0.05). The Child-Pugh score and other staging systems correlated significantly with survival (p <0.05). The AUROC values for 3, 12, and 36 months' survival were 0.633, 0.545, and 0.615 for MELD; 0.655, 0.555, and 0.612 for MELD-Na; 0.639, 0.616, and 0.691 for Child-Pugh score; 0.714, 0.662, and 0.717 for the Okuda score; 0.837, 0.86, and 0.792 for the CLIP score; 0.859, 0.814, and 0.808 for the JIS score; 0.846, 0.833, and 0.749 for BCLC stage; and 0.878, 0.812, and 0.735 for UICC stage, respectively. CONCLUSIONS MELD and MELD-Na showed good correlations with survival, especially for patients with early-stage disease. However, these were not superior to those of other staging systems or Child-Pugh score. These parameters should only be used as supportive data.
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Affiliation(s)
- Jeong Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Pleguezuelo M, Marelli L, Misseri M, Germani G, Calvaruso V, Xiruochakis E, Manousou P, Burroughs AK. TACE versus TAE as therapy for hepatocellular carcinoma. Expert Rev Anticancer Ther 2009; 8:1623-41. [PMID: 18925854 DOI: 10.1586/14737140.8.10.1623] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Transarterial chemoembolization (TACE) improves survival in cirrhotic patients with hepatocellular carcinoma (HCC). The optimal schedule, best anticancer agent and best technique are still unclear. TACE may not be better than transarterial embolization (TAE). HCC is very chemoresistant, thus embolization may be more important than chemotherapy. Lipiodol cannot be considered as an embolic agent and there are no data to show that it can release chemotherapeutic agents slowly. It can mask residual vascularity on CT imaging and its use is not recommended. Both TACE and TAE result in hypoxia, which stimulates angiogenesis, promoting tumor growth; thus combination of TACE with antiangiogenic agents may improve current results. To date, there is no evidence that TACE pre-liver transplantation or resection helps to expand current selection criteria for patients with HCC, nor results in less recurrence after surgery. Combination with other techniques, such as radiofrequency ablation and drugs, may enhance the effect of TACE. New trials are being conducted to clarify these issues.
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Affiliation(s)
- Maria Pleguezuelo
- Department of Surgery & Liver Transplantation, The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, Hampstead Heath, London, UK.
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Kim JH, Yoon HK, Sung KB, Ko GY, Gwon DI, Shin JH, Song HY. Transcatheter arterial chemoembolization or chemoinfusion for unresectable intrahepatic cholangiocarcinoma: clinical efficacy and factors influencing outcomes. Cancer 2008; 113:1614-22. [PMID: 18704990 DOI: 10.1002/cncr.23787] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The role of transcatheter arterial chemoembolization (TACE) or transcatheter arterial chemoinfusion (TACI) for unresectable intrahepatic cholangiocarcinoma (ICC) has recently been questioned. The aim of the study was to evaluate the clinical efficacy of TACE or TACI in patients with unresectable ICC and to identify prognostic factors associated with clinical success. METHODS From 1997 to 2007, 49 patients with unresectable ICC were treated with TACE (n = 124) or transcatheter arterial chemoinfusion (TACI) (n = 96). Tumor response was evaluated based on computed tomography scans obtained 1 month to 3 months after TACE or TACI. Factors associated with clinical success were evaluated using multivariate logistic regression analysis. Factors associated with the survival period were evaluated using multivariate Cox regression analysis. RESULTS After treatment, 27 (55%) of the patients showed radiographic response. Multivariate analysis confirmed that tumor vascularity (odds ratio [OR], 31.2; P = .002) was the only independent factor associated with radiographic response. The median and mean survival periods in our study patients were 12 and 24 months. Multivariate Cox regression analyses showed that tumor size (OR, 2.64; P = .048), tumor vascularity (OR, 13.5; P < .001), and the Child-Pugh class (OR, 3.65; P = .014) were the independent factors associated with the length of the survival period. CONCLUSIONS Hepatic intra-arterial chemotherapy is well tolerated and may be effective to prolong survival of patients with unresectable ICC. Tumor vascularity is significantly associated with radiographic response. Large tumor size, tumor hypovascularity, and Child-Pugh class B were poor prognostic factors for determining the patient survival period.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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