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Luo MC, Wu JY, Wu JY, Lin ZT, Li YN, Zeng ZX, Wei SM, Yan ML. Early Tumor Marker Response Predicts Treatment Outcomes in Patients with Unresectable Hepatocellular Carcinoma Receiving Combined Lenvatinib, Immune Checkpoint Inhibitors, and Transcatheter Arterial Chemoembolization Therapy. J Hepatocell Carcinoma 2023; 10:1827-1837. [PMID: 37850079 PMCID: PMC10578160 DOI: 10.2147/jhc.s425674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose Few reliable biomarkers for predicting the efficacy of triple therapy (lenvatinib + immune checkpoint inhibitors + transarterial chemoembolization) exist for patients with unresectable hepatocellular carcinoma (uHCC). This study explored the prognostic role of alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP) levels in patients with uHCC receiving triple therapy. Patients and Methods This retrospective study included 93 patients with uHCC who received triple therapy at Fujian Provincial Hospital between August 2020 and November 2022. Depending on the respective baseline levels, the patients were divided into high-AFP and high-DCP groups. An early response was defined as an AFP or DCP concentration >50% less than the baseline concentration after 6 weeks of triple therapy. The primary endpoint was the objective response rate (ORR). The secondary endpoints were progression-free survival (PFS) and overall survival (OS). Results After 6 weeks of triple therapy, 75.3% (58/77) and 78.9% (60/76) of patients in the high-AFP and high-DCP groups achieved an objective response. Early AFP and DCP responses were positively associated with ORR (high-AFP group: odds ratio [OR]: 13.542; 95% confidence interval [CI]: 3.991-45.950, p<0.001; high-DCP group: OR: 17.853; 95% CI: 4.478-71.179, p<0.001). In the high-AFP group, the 6-month, 12-month, and 18-month PFS and OS rates were higher in the AFP responders than those in the non-responders (PFS: 66.4%, 59.6%, 48.2% vs 42.3%, 19.3%, 0%, p<0.001; OS: 94.5%, 90.4%, 77.3% vs 75.6%, 66.2%, 49.6%, p=0.006). In the high-DCP group, the 6-month, 12-month, and 18-month PFS and OS rates were higher in the DCP responders than those in the non-responders (PFS: 67.4%, 57.7%, 39.0% vs 38.9%, 8.1%, 0%, p<0.001; OS: 94.7%, 94.7%, 83.3% vs 77.0%, 53.9%, 36.0%, p<0.001). Conclusion After 6 weeks of triple therapy, an AFP or DCP reduction of >50% predicts better treatment outcomes in uHCC patients.
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Affiliation(s)
- Meng-Chao Luo
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, People’s Republic of China
- Department of General Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China
| | - Jia-Yi Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, People’s Republic of China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China
| | - Jun-Yi Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, People’s Republic of China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China
| | - Zhong-Tai Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, People’s Republic of China
- Department of General Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China
| | - Yi-Nan Li
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China
| | - Zhen-Xin Zeng
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China
| | - Shao-Ming Wei
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, People’s Republic of China
- Department of General Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China
| | - Mao-Lin Yan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, People’s Republic of China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China
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Tamaki N, Tada T, Kurosaki M, Yasui Y, Ochi H, Mashiba T, Sakamoto A, Marusawa H, Narita R, Uchida Y, Akahane T, Kondo M, Mori N, Takaki S, Tsuji K, Kobashi H, Kusakabe A, Furuta K, Arai H, Nonogi M, Ogawa C, Sato T, Tamada T, Nakamura S, Hasebe C, Tsuchiya K, Izumi N. Optimal threshold of alpha-fetoprotein response in patients with unresectable hepatocellular carcinoma treated with atezolizumab and bevacizumab. Invest New Drugs 2022; 40:1290-1297. [PMID: 36152108 DOI: 10.1007/s10637-022-01303-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
Alpha-fetoprotein (AFP) response (relative decline in AFP) is associated with imaging response evaluated by response evaluation criteria in solid tumors ver1.1 (RECIST) and survival in treatment for hepatocellular carcinoma (HCC). However, the optimal threshold of AFP response is still unknown, especially in atezolizumab and bevacizumab (Atez/Bev) treatment. In this prospective multicenter study, we aimed to investigate an optimal threshold of AFP response in Atez/Bev treatment. Out of 284 patients with unresectable HCC who were treated with Atez/Bev, 91 patients with AFP ≥ 10 ng/ml were enrolled in the multicenter study. We investigated the relationship between various AFP response thresholds (relative decline ≥ 20%, ≥ 50%, and ≥ 75%) and treatment response and progression-free survival (PFS). An AFP relative decrease of ≥ 50% was associated with an overall response rate (ORR) with an odds ratio (95% confidence interval [CI]) of 5.7 (1.9-17). Disease control rate (DCR) was associated with an AFP relative decrease of ≥ 20%, with a 100% positive predictive value and a 52.0% sensitivity. AFP relative decreases of ≥ 50% and ≥ 20% were significantly associated with PFS with a hazard ratio (HR) of 5.60 (95% CI: 1.6-19, p = 0.006) and a HR of 4.44 (95% CI: 1.9-10, p < 0.001), respectively. AFP response of ≥ 50% and ≥ 20% were related to ORR and DCR, respectively, and both of these responses were also associated with PFS. AFP can be used as a real-time monitor during Atez/Bev treatment and is helpful for treatment optimization.
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Affiliation(s)
- Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Toshifumi Tada
- Department of Internal Medicine, Himeji Red Cross Hospital, Hyogo, Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
| | - Yutaka Yasui
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hironori Ochi
- Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Toshie Mashiba
- Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Azusa Sakamoto
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroyuki Marusawa
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Ryoichi Narita
- Department of Gastroenterology, Oita Red Cross Hospital, Oita, Japan
| | - Yasushi Uchida
- Department of Gastroenterology, Matsue Red Cross Hospital, Shimane, Japan
| | - Takehiro Akahane
- Department of Gastroenterology, Ishinomaki Red Cross Hospital, Miyagi, Japan
| | - Masahiko Kondo
- Department of Gastroenterology, Otsu Red Cross Hospital, Shiga, Japan
| | - Nami Mori
- Department of Gastroenterology, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Shintaro Takaki
- Department of Gastroenterology, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Keiji Tsuji
- Department of Gastroenterology, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Haruhiko Kobashi
- Department of Gastroenterology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Atsunori Kusakabe
- Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Koichiro Furuta
- Department of Gastroenterology, Masuda Red Cross Hospital, Shimane, Japan
| | - Hirotaka Arai
- Department of Gastroenterology, Maebashi Red Cross Hospital, Gunma, Japan
| | - Michiko Nonogi
- Department of Gastroenterology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Kagawa, Japan
| | - Takashi Sato
- Department of Gastroenterology, Nasu Red Cross Hospital, Tochigi, Japan
| | - Takashi Tamada
- Department of Gastroenterology, Takatsuki Red Cross Hospital, Osaka, Japan
| | | | - Chitomi Hasebe
- Department of Gastroenterology, Japanese Red Cross Asahikawa Hospital, Hokkaido, Japan
| | - Kaoru Tsuchiya
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
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Yang Y, Li G, Lu Z, Liu Y, Kong J, Liu J. Progression of Prothrombin Induced by Vitamin K Absence-II in Hepatocellular Carcinoma. Front Oncol 2021; 11:726213. [PMID: 34900676 PMCID: PMC8660097 DOI: 10.3389/fonc.2021.726213] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third leading cause of cancer-related death worldwide. Due to the lack of efficient tools for early detection, asymptomatic HCC patients are diagnosed at an advanced stage, leading to a poor prognosis. To improve survival, serum biomarker prothrombin induced by vitamin K absence-II (PIVKA-II) was under investigation. PIVKA-II is an abnormal protein produced in HCC. The coagulation function was insufficient due to the lack of Gla residues. Elevated PIVKA-II was associated with bad tumor behavior in terms of proliferation, metastasis, and invasion. Three major signaling pathways were proposed to clarify the mechanism. With the advantages including affordability, minimal invasiveness, convenience, and efficiency, PIVKA-II could improve HCC management consisting of four aspects. First, PIVKA-II was an effective and dynamic tool for improving HCC surveillance in high-risk population. Changes in the serum levels of PIVKA-II provided valuable molecular alteration information before imaging discovery. Second, PIVKA-II offered a complementary approach for HCC early detection. Compared to traditional diagnostic approaches, the combination of PIVKA-II and other biomarkers had better performance. Third, PIVKA-II was an indicator for the assessment of response to treatment in HCC. Preoperative assessment was for selecting personalized therapy, and postoperative measurement was for assessing treatment efficacy. Fourth, PIVKA-II was considered as a prognostic predictor for HCC. Patients with elevated PIVKA-II were more likely to develop microvascular invasion, metastasis, and recurrence.
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Affiliation(s)
- Yang Yang
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guangbing Li
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ziwen Lu
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yong Liu
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Junjie Kong
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jun Liu
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Nyman SS, Creusen AD, Johnsson U, Rorsman F, Vessby J, Barbier CE. Peritumoral portal enhancement during transarterial chemoembolization: a potential prognostic factor for patients with hepatocellular carcinoma. Acta Radiol 2021; 63:1323-1331. [PMID: 34665054 PMCID: PMC9490438 DOI: 10.1177/02841851211041832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tumor response and survival varies in patients treated with transarterial chemoembolization (TACE) for intermediate stage hepatocellular carcinoma (HCC) and may be associated with several factors. PURPOSE To evaluate safety and efficacy of TACE in patients with intermediate stage HCC and to identify factors related to tumor response and survival. MATERIAL AND METHODS Consecutive patients with HCC treated with TACE between September 2008 and September 2018 were retrospectively reviewed. RESULTS In 87 patients (71 men; mean age = 68 ± 9 years), 327 TACE treatments were performed (mean = 3/patient; range = 1-12). Mean and median overall survival were 32 and 19 months, respectively. Survival rates at 30 days, one, three, and five years were 99%, 71%, 19%, and 8%, respectively. Objective response (OR) was seen in 84% and disease control (DC) was seen in 92% of the patients. Patients in whom peritumoral portal lipiodol enhancement (PPLE) was seen during TACE had better OR (97 vs. 73%; P = 0.007) and DC (100 vs. 85%; P = 0.024), and a reduced risk of death (hazard ratio [HR] = 0.52; 95% confidence interval = 0.32-0.86) compared to those without PPLE. Severe adverse events were rare (15%) and occurred more often in patients with a larger tumor size. CONCLUSIONS TACE was effective and safe in patients with intermediate stage HCC. Patients with PPLE during TACE had better tumor response and longer survival than those without PPLE. Severe adverse events occurred more often in patients with larger tumors.
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Affiliation(s)
- Sofi Sennefelt Nyman
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | | | - Ulf Johnsson
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | - Fredrik Rorsman
- Department of Medical Sciences, Section of Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden
| | - Johan Vessby
- Department of Medical Sciences, Section of Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden
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Núñez KG, Sandow T, Fort D, Patel J, Hibino M, Carmody I, Cohen AJ, Thevenot P. Baseline Alpha-Fetoprotein, Alpha-Fetoprotein-L3, and Des-Gamma-Carboxy Prothrombin Biomarker Status in Bridge to Liver Transplant Outcomes for Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13194765. [PMID: 34638251 PMCID: PMC8507524 DOI: 10.3390/cancers13194765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/08/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary An abnormal alpha-fetoprotein (AFP) test is often associated with hepatocellular carcinoma (HCC) development, although as many as 40% of HCC diagnoses are made in the absence of an abnormal AFP test. In Japan and other Asian countries, Lens culinaris agglutinin-reactive AFP fraction (AFP-L3) and des-gamma-carboxy prothrombin (DCP) are used in combination with AFP for HCC diagnosis. Combined testing with all three biomarkers increases early diagnosis in addition to providing a patient-specific profile of HCC aggressiveness. The utility of AFP, AFP-L3, and DCP for HCC prognosis in the bridge to liver transplantation has not been established. The goal of this study is to define prognosis to first-line HCC treatment and the risk of progression prior to liver transplantation associated with biomarker profile at diagnosis. Biomarker profiling may have future implications in precision therapeutic management of HCC as a bridge to transplantation. Abstract The biomarkers α-fetoprotein (AFP), Lens culinaris agglutinin-reactive AFP fraction (AFP-L3), and des-γ-carboxy prothrombin (DCP) have emerging implications in hepatocellular carcinoma (HCC) surveillance, overall prognosis, and post-surgical recurrence risk. This retrospective study investigated treatment and bridge to liver transplant (LT) prognosis associated with AFP, AFP-L3%, and DCP biomarker profiles prior to liver-directed therapy (LDT). In a 140-patient cohort, each biomarker was associated with HCC progression risk using the established thresholds of AFP > 20 ng/mL, AFP-L3 > 15%, and DCP > 7.5 ng/mL. Over 60% of the cohort expressed at least one biomarker at baseline. Although most biomarker-positive patients expressed the clinical standard AFP (57/87), only 32% were positive for AFP alone. Biomarker accumulation increased HCC progression risk but was not associated with demographic factors or preserved liver function. Biomarker triple negative patients had smaller index HCC (p = 0.003), decreased multifocal burden (p = 0.010), and a higher objective response rate (ORR, 62% compared to 46%, p = 0.011). Expressing all three biomarkers at baseline was associated with dismal first-line ORR (12%) with a median time to progression (TTP) of only 181 days post-LDT. Patients with triple negative status for the HCC biomarkers AFP, AFP-L3%, and DCP have the highest first-line ORR with < 5% HCC progression 1-year post-LDT. Biomarker profiling can establish baseline prognosis for identifying optimal bridge to LT and downstaging to LT candidates with triple negative biomarker status and providing an ideal post-LDT target as a compliment to radiographic response.
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Affiliation(s)
- Kelley G. Núñez
- Institute of Translational Research, Ochsner Health, New Orleans, LA 70121, USA; (K.G.N.); (J.P.); (M.H.); (A.J.C.)
| | - Tyler Sandow
- Department of Radiology, Ochsner Health, New Orleans, LA 70121, USA;
| | - Daniel Fort
- Center for Outcomes and Health Services Research, Ochsner Health, New Orleans, LA 70121, USA;
| | - Jai Patel
- Institute of Translational Research, Ochsner Health, New Orleans, LA 70121, USA; (K.G.N.); (J.P.); (M.H.); (A.J.C.)
| | - Mina Hibino
- Institute of Translational Research, Ochsner Health, New Orleans, LA 70121, USA; (K.G.N.); (J.P.); (M.H.); (A.J.C.)
| | - Ian Carmody
- Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA 70121, USA;
| | - Ari J. Cohen
- Institute of Translational Research, Ochsner Health, New Orleans, LA 70121, USA; (K.G.N.); (J.P.); (M.H.); (A.J.C.)
- Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA 70121, USA;
- Faculty of Medicine, The University of Queensland, New Orleans, LA 70121, USA
| | - Paul Thevenot
- Institute of Translational Research, Ochsner Health, New Orleans, LA 70121, USA; (K.G.N.); (J.P.); (M.H.); (A.J.C.)
- Correspondence:
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Charoenvisal C, Tanaka T, Nishiofuku H, Anai H, Sato T, Matsumoto T, Marugami N, Kichikawa K. Feasibility and Techniques of Securing 3D-Safety Margin in Superselective Transarterial Chemoembolization to Improve Local Tumor Control for Small Hepatocellular Carcinoma: An Intend-to-Treat Analysis. Liver Cancer 2021; 10:63-71. [PMID: 33708640 PMCID: PMC7923884 DOI: 10.1159/000512337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/15/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The aim of this study was to investigate the technical success rate of obtaining 3D-safety margin in superselective conventional transarterial chemoembolization (cTACE) using 3D images for small hepatocellular carcinoma (HCC). METHODS Consecutive 48 HCC nodules (diameter, 1-3 cm) in 44 patients were intentionally treated by superselective cTACE in an attempt to achieve 3D-safety margin. Superselective CT during hepatic arteriography (CTHA) was obtained before cTACE. When negative 3D-safety margin was found, branches supplied into the margin area were detected by using a 3D workstation. The technical success rate to obtain 3D-safety margin was investigated by intend-to-treat analysis. Local tumor recurrence rate and adverse events were also evaluated. RESULT Nine of 48 tumors (18.8%) had 3D-safety margin in the initial superselective CTHA. After pulling back of the catheter and/or selection of another branch based on 3D images, 3D-safety margin was finally achieved in 45 (93.8%). There were 8 of 46 tumors (17.4%) with local recurrence after 5-year follow-up. Grade 3-4 of aspartate aminotransferase, alanine aminotransferase, and total bilirubin were found in 38.6, 36.4, and 2.3%, respectively. One portal vein thrombus and 3 biliary dilation or biloma were developed. CONCLUSION Superselective cTACE obtaining 3D-safety margin in small HCC was feasible with a high success rate by using 3D images, which could be tolerable and prevent local tumor recurrence.
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Affiliation(s)
- Ching Charoenvisal
- Department of Radiology, Nara Medical University, Kashihara, Japan,King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Toshihiro Tanaka
- Department of Radiology, Nara Medical University, Kashihara, Japan,*Toshihiro Tanaka, Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522 (Japan),
| | | | - Hiroshi Anai
- Department of Radiology, Nara City Hospital, Nara, Japan
| | - Takeshi Sato
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | | | - Nagaaki Marugami
- Department of Radiology, Nara Medical University, Kashihara, Japan
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Lee JS, Chon YE, Kim BK, Park JY, Kim DY, Ahn SH, Han KH, Kang W, Choi MS, Gwak GY, Paik YH, Lee JH, Koh KC, Paik SW, Kim HY, Kim TH, Yoo K, Ha Y, Kim MN, Lee JH, Hwang SG, Kim SS, Cho HJ, Cheong JY, Cho SW, Park SH, Heo NY, Hong YM, Yoon KT, Cho M, Park JG, Kang MK, Park SY, Kweon YO, Tak WY, Jang SY, Sinn DH, Kim SU. Prognostic Value of Alpha-Fetoprotein in Patients Who Achieve a Complete Response to Transarterial Chemoembolization for Hepatocellular Carcinoma. Yonsei Med J 2021; 62:12-20. [PMID: 33381930 PMCID: PMC7820452 DOI: 10.3349/ymj.2021.62.1.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC. MATERIALS AND METHODS Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR. RESULTS Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001). CONCLUSION High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.
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Affiliation(s)
- Jae Seung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Young Eun Chon
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Kwang Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Wonseok Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Seok Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Geum Youn Gwak
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Han Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Hyeok Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Cheol Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woon Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwi Young Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Tae Hun Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kwon Yoo
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yeonjung Ha
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Mi Na Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Ho Lee
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seong Gyu Hwang
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Soon Sun Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Jung Cho
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Youn Cheong
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Sung Won Cho
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Ha Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Nae Yun Heo
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Young Mi Hong
- Liver Center, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ki Tae Yoon
- Liver Center, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Mong Cho
- Liver Center, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jung Gil Park
- Department of Internal Medicine, Yeungnam University Medical Centre, Daegu, Korea
| | - Min Kyu Kang
- Department of Internal Medicine, Yeungnam University Medical Centre, Daegu, Korea
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Oh Kweon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Won Young Tak
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Se Young Jang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea.
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8
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Saito N, Tanaka T, Nishiohuku H, Sato T, Masada T, Matsumoto T, Anai H, Sakaguchi H, Sueyoshi S, Marugami N, Kichikawa K. Transarterial- chemoembolization remains an effective therapy for intermediate-stage hepatocellular carcinoma with preserved liver function. Hepatol Res 2020; 50:1176-1185. [PMID: 32721060 DOI: 10.1111/hepr.13550] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 12/11/2022]
Abstract
AIM To evaluate outcomes as well as prognostic factors of transarterial chemoembolization (TACE) in intermediate-stage hepatocellular carcinoma (HCC) with preserved liver function to determine positioning of TACE. METHODS Of 158 treatment-naïve patients with intermediate-stage HCC who received initial TACE from February 2007 to January 2016, 113 patients met the following inclusion criteria: no combined therapy within 4 weeks after initial TACE, and Child-Pugh score under 7. Response rate and overall survival were evaluated. The prognostic factors were investigated in univariate and multivariate analyses using Cox proportional hazards models. The deterioration of liver function after repeated TACE was also evaluated. RESULTS The response rate was 92.7% (complete response, 63.3%; partial response, 29.4%). The median survival time was 45.2 months. Survival rates at 1, 2, and 3 years were 90.4%, 77.0%, and 60.8% respectively. Age ≥ 75 years (P = 0.022), serum α-fetoprotein level ≥ 200 ng/mL (P = .010), tumor number ≥ 11 (P = 0.008), and heterogeneous enhancement on dynamic computed tomography (P = 0.024) were poor prognostic factors. The deterioration rate of Child-Pugh score and albumin-bilirubin grade was 18.5% and 12.3%, respectively, after the first TACE, 15.6% and 5.1%, respectively, after the second TACE, and 14.5% and 11.1%, respectively, after the third TACE. CONCLUSION Superselective TACE can achieve high tumor response rates with prolonged overall survival for patients with intermediate-stage HCC with preserved liver function. Age, serum α-fetoprotein level, tumor number ≥ 11, and heterogeneous enhancement on dynamic computed tomography indicated significantly poor prognosis.
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Affiliation(s)
- Natsuhiko Saito
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Toshihiro Tanaka
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Hideyuki Nishiohuku
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Takeshi Sato
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Tetsuya Masada
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Takeshi Matsumoto
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Hiroshi Anai
- Department of Radiology, Nara City Hospital, Nara, Japan
| | | | - Satoru Sueyoshi
- Department of Radiology, Saiseikai Chuwa Hospital, Sakurai, Japan
| | - Nagaaki Marugami
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
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9
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Establishment and validation of a risk prediction model in patients with hepatocellular carcinoma treated with transarterial radioembolization. Eur J Gastroenterol Hepatol 2020; 32:739-747. [PMID: 31764406 DOI: 10.1097/meg.0000000000001585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIMS Few studies have reported the treatment outcomes of transarterial radioembolization (TARE) using yttrium-90 (Y) for hepatocellular carcinoma (HCC). We established and validated a new risk prediction model for patients with HCC treated with TARE. METHODS Between 2010 and 2017, 113 and 35 patients with intrahepatic HCC treated with TARE were selected for the training and validation cohorts, respectively. The modified response evaluation criteria in solid tumors (mRECIST) were used for response evaluation. RESULTS In the training cohort, the median age was 64.1 years (92 males and 21 females) and the mean survival after TARE was 50.3 months. The cumulative survival rates at six and 12 months were 92.0 and 84.0%, respectively. A new risk prediction model for patients with HCC treated with TARE (Y-scoring system) was established from the training cohort using five independent baseline variables [serum albumin < 3.5 g/dL, hazard ratio = 5.446; alpha-fetoprotein > 200 ng/mL (hazard ratio = 5.071); tumor number ≥ 3 (hazard ratio = 2.933); portal vein thrombosis (hazard ratio = 4.915); and hepatic vein invasion (hazard ratio = 8.500)] and two on-treatment variables [no des-gamma-carboxy prothrombin response (hazard ratio = 15.346) and progressive disease at three months (hazard ratio = 4.154)] for mortality (all P < 0.05). The predictive accuracy of the Y-scoring system was acceptable to predict six [area under the curve (AUC) = 0.845], nine (AUC = 0.868), and 12-month mortality (AUC = 0.886) (all P < 0.05). The predictive accuracy of the system was similarly maintained in the validation cohort (AUC 0.737-0.901 at 6-12 months). CONCLUSION Our new risk prediction model can be used to stratify different prognoses in patients with HCC treated with TARE. Validation studies are required.
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10
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Mishra G, Dev A, Paul E, Cheung W, Koukounaras J, Jhamb A, Marginson B, Lim BG, Simkin P, Borsaru A, Burnes J, Goodwin M, Ramachandra V, Spanger M, Lubel J, Gow P, Sood S, Thompson A, Ryan M, Nicoll A, Bell S, Majeed A, Kemp W, Roberts SK. Prognostic role of alpha-fetoprotein in patients with hepatocellular carcinoma treated with repeat transarterial chemoembolisation. BMC Cancer 2020; 20:483. [PMID: 32471447 PMCID: PMC7257176 DOI: 10.1186/s12885-020-06806-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Repeat transarterial chemoembolisation (rTACE) is often required for hepatocellular carcinoma (HCC) to achieve disease control, however, current practice guidelines regarding treatment allocation vary significantly. This study aims to identify key factors associated with patient survival following rTACE to facilitate treatment allocation and prognostic discussion. METHOD Patients with HCC undergoing rTACE at six Australian tertiary centers from 2009 to 2014 were included. Variables encompassing clinical, tumour, treatment type and response factors were analysed against the primary outcome of overall survival. Univariate analysis and multivariate Cox regression modelling were used to identify factors pre- and post-TACE therapy significantly associated with survival. RESULTS Total of 292 consecutive patients underwent rTACE with mainly Child Pugh A cirrhosis (61%) and BCLC stage A (57%) disease. Median overall survival (OS) was 30 months (IQR 15.2-50.2) from initial TACE. On multivariate analysis greater tumour number (p = 0.02), higher serum bilirubin (p = 0.007) post initial TACE, and hepatic decompensation (p = 0.001) post second TACE were associated with reduced survival. Patients with serum AFP ≥ 200 ng/ml following initial TACE had lower survival (p = 0.001), compared to patients with serum AFP level that remained < 200 ng/ml post-initial TACE, with an overall survival of 19.4 months versus 34.7 months (p = 0.0001) respectively. CONCLUSION Serum AFP level following initial treatment in patients undergoing repeat TACE for HCC is a simple and useful clinical prognostic marker. Moreover, it has the potential to facilitate appropriate patient selection for rTACE particularly when used in conjunction with baseline tumour burden and severity of hepatic dysfunction post-initial TACE.
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Affiliation(s)
- Gauri Mishra
- Gastroenterology, Monash Health, Melbourne, Australia
| | - Anouk Dev
- Gastroenterology, Monash Health, Melbourne, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Wa Cheung
- Radiology, Alfred Health, Melbourne, Australia
| | | | - Ashu Jhamb
- Radiology, St. Vincent's Hospital, Melbourne, Australia
| | - Ben Marginson
- Radiology, St. Vincent's Hospital, Melbourne, Australia
| | - Beng Ghee Lim
- Radiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Paul Simkin
- Radiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Adina Borsaru
- Radiology, Monash Health Eastern Health, Melbourne, Australia
| | - James Burnes
- Radiology, Monash Health Eastern Health, Melbourne, Australia
| | | | | | | | - John Lubel
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia
| | - Paul Gow
- Gastroenterology, Austin Health, Melbourne, Australia
| | - Siddharth Sood
- Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Marno Ryan
- Gastroenterology, St. Vincent's Hospital, Melbourne, Australia
| | - Amanda Nicoll
- Gastroenterology, Eastern Health, Melbourne, Australia
| | - Sally Bell
- Gastroenterology, Monash Health, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia.
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11
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Li S, Wang Q, Mei J, Wang J, Zhong XP, Ling Y, Guo Z, Lu LH, Wei W, Guo R. Risk factors of extra-hepatic progression after transarterial chemoembolization for hepatocellular carcinoma patients: a retrospective study in 654 cases. J Cancer 2019; 10:5007-5014. [PMID: 31598173 PMCID: PMC6775514 DOI: 10.7150/jca.35355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/13/2019] [Indexed: 02/05/2023] Open
Abstract
Aim: To investigate the risk factors of extra-hepatic progression after TACE in HCC. Methods: The study population included 654 HCC patients who underwent TACE between October 2005 and September 2012. We collected and analyzed their clinical characteristics and survival information. TACE was performed as previously described with minor modifications. When necessary, superselective chemoembolization was performed through the segmental or subsegmental arteries, based on the tumor location and extent and hepatic function reserve. If stasis could not be achieved in a tumor-feeding artery, iodized oil was used solely in some patients. Embolization was then performed with injection of absorbable gelfoam particles (1-2 mm in diameter) through the angiographic catheter. Results: The tumor response to initial TACE was evaluated in 645 patients. The CR rate, response rate (RR), and disease control rate (DCR) were 9.92%, 25.89%, and 70.39%, respectively. The median overall survival (OS) period was 14.5 months. The 6-month, 1-, 2-, 3-, and 5-year OS rates were 75.5%, 55.0%, 33.9%, 22.8%, and 14.9%, respectively. The median progression-free survival (PFS) period was 4.3 months. The 6-month, 1-, 2-, 3-, and 5-year PFS rates were 40.7%, 27.1%, 16.7%, 13.9%, and 9.3%, respectively. One hundred and fifty patients developed extrahepatic progression during follow-up. We demonstrated that in the absence of radical treatment after initial TACE (p<0.001), the presence of extrahepatic metastasis before initial TACE (p<0.001), AST >45 U/L (p=0.024), ALB <35 g/L (p=0.012), and tumor response were evaluated as PD and SD after initial TACE (p<0.001) and were found to be independent predictors of a poorer prognosis of extrahepatic PFS. Conclusions: We identified risk factors for extrahepatic progression after TACE in HCC patients. Early combination treatment was strongly recommended in patients that met these risk factors.
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Affiliation(s)
- Shaohua Li
- Department of Hepatobiliary Oncology of the Sun Yat-sen University Cancer Center; Guangzhou 510060, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Qiaoxuan Wang
- Department of Radiation Oncology of the Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Jie Mei
- Department of Hepatobiliary Oncology of the Sun Yat-sen University Cancer Center; Guangzhou 510060, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Jianwei Wang
- Department of Ultrasound of the Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Xiao-Ping Zhong
- Department of Burn and Plastic Surgery, 2nd Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Yihong Ling
- Department of pathology of the Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Zhixing Guo
- Department of Ultrasound of the Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Liang-He Lu
- Department of Hepatobiliary Oncology of the Sun Yat-sen University Cancer Center; Guangzhou 510060, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Wei Wei
- Department of Hepatobiliary Oncology of the Sun Yat-sen University Cancer Center; Guangzhou 510060, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Rongping Guo
- Department of Hepatobiliary Oncology of the Sun Yat-sen University Cancer Center; Guangzhou 510060, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
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12
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He C, Peng W, Liu X, Li C, Li X, Wen TF. Post-treatment alpha-fetoprotein response predicts prognosis of patients with hepatocellular carcinoma: A meta-analysis. Medicine (Baltimore) 2019; 98:e16557. [PMID: 31374020 PMCID: PMC6709300 DOI: 10.1097/md.0000000000016557] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Post-treatment alpha-fetoprotein (AFP) response has been reported to be associated with prognosis of hepatocellular carcinoma (HCC) patients, but the results were not consistent. This meta-analysis aimed to explore the relationship between AFP response and clinical outcomes of HCC. METHODS PubMed, Embase, Medline and Cochrane library were searched for relevant articles published before March 20, 2019. The data were analyzed using RevMan5.3 software. RESULTS Twenty-nine articles with 4726 HCC patients were finally included for analysis. The pooled results showed that post-treatment AFP response was significantly associated with overall survival (OS) (hazard ratio (HR) = 0.41, 95% confidence interval (CI): 0.35-0.47, P <.001), progression free survival (PFS) (HR = 0.46, 95% CI: 0.39-0.54, P <.001) and recurrence free survival (RFS) (HR = 0.41, 95% CI: 0.29-0.56, P <.001) of HCC patients. CONCLUSION post-treatment AFP response might be a useful prognostic marker for HCC patients.
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Affiliation(s)
- Chao He
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University
| | - Wei Peng
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University
| | - Xiaojuan Liu
- Department of Anesthesia, West China Hospital of Sichuan University
| | - Chuan Li
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University
| | - Xueting Li
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, China
| | - Tian-Fu Wen
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University
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13
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Alpha-Fetoprotein, Des-Gamma-Carboxy Prothrombin, and Modified RECIST Response as Predictors of Survival after Transarterial Radioembolization for Hepatocellular Carcinoma. J Vasc Interv Radiol 2019; 30:1194-1200.e1. [PMID: 31235408 DOI: 10.1016/j.jvir.2019.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023] Open
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14
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Zhang Y, Zhang M, Chen M, Mei J, Xu L, Guo R, Lin X, Li J, Peng Z. Association of Sustained Response Duration With Survival After Conventional Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma. JAMA Netw Open 2018; 1:e183213. [PMID: 30646226 PMCID: PMC6324454 DOI: 10.1001/jamanetworkopen.2018.3213] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Defining early reliable surrogate end points for survival in patients with hepatocellular carcinoma (HCC) after conventional transarterial chemoembolization (cTACE) is of great value. OBJECTIVE To evaluate the association between sustained response duration (SRD) and overall survival (OS) after cTACE for intermediate HCC. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study enrolled 2403 consecutive patients in China with naive intermediate HCC between June 1, 2000, and December 31, 2008, as the primary cohort, and 331 consecutive patients with intermediate naive HCC between January 1, 2011, to June 30, 2012, as the validation cohort. All patients received cTACE as an initial treatment. Initial response and best response were defined as the radiological response after first cTACE or best radiological response after 2 or more sessions of cTACE, respectively. Responders were those who experienced complete response or partial response. Sustained response duration was defined as the time between the date when complete response, partial response, or stable disease was achieved and the date progressive disease occurred after cTACE. Response was evaluated by modified Response Evaluation Criteria in Solid Tumors. Information about patients in the study was collected from January 1, 2018, to March 31, 2018, and analysis of these data was performed in April 2018. MAIN OUTCOMES AND MEASURES Overall survival. RESULTS A total of 2734 total patients (2499 of 2734 [91.4%] male; median [range] age, 56.5 [18-75] years) were included in the analysis. In the primary cohort, SRD of 6 months or more was found to have the strongest association with 5-year OS after cTACE among different durations of sustained response. Patients with SRD of 6 months or more (387 of 430 male; median [range] age, 57 [18-75] years) had the longest median (range) OS (67.7 [64.8-72.1] months), followed by initial responders (760 of 874 male; median [range] age, 56 [18-75] years; median [range] OS, 55.8 [55.0-57.7] months) and best responders (939 of 1032 male; median [range] age, 57 [18-75] years; median [range] OS, 53.2 [52.2-54.6] months). Response duration of 6 months or more was found to be an independent prognostic factor for OS (hazard ratio, 0.145; 95% CI, 0.124-0.170; P < .001). The significance of SRD as a factor associated with OS was confirmed in the validation cohort. CONCLUSIONS AND RELEVANCE Sustained response duration of 6 months or more was associated with OS and may serve as an early surrogate end point after cTACE for intermediate HCC.
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Affiliation(s)
- Yaojun Zhang
- Cancer Center, Sun Yat-sen University, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Mengping Zhang
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minshan Chen
- Cancer Center, Sun Yat-sen University, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jie Mei
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Xu
- Cancer Center, Sun Yat-sen University, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Rongping Guo
- Cancer Center, Sun Yat-sen University, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiaojun Lin
- Cancer Center, Sun Yat-sen University, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jiaping Li
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhenwei Peng
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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15
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Golubnitschaja O, Polivka J, Yeghiazaryan K, Berliner L. Liquid biopsy and multiparametric analysis in management of liver malignancies: new concepts of the patient stratification and prognostic approach. EPMA J 2018; 9:271-285. [PMID: 30174763 DOI: 10.1007/s13167-018-0146-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/25/2018] [Indexed: 12/29/2022]
Abstract
Background The annually recorded incidence of primary hepatic carcinomas has significantly increased over the past two decades accounting for over 800 thousand of annual deaths caused by hepatocellular carcinoma (HCC) alone globally. Further, secondary liver malignancies are much more widespread compared to primary hepatic carcinomas: almost all solid malignancies are able to metastasise into the liver. The primary tumours most frequently metastasising to the liver are breast followed by colorectal carcinomas. Given the increased incidence of both primary and metastatic liver cancers, a new, revised approach is needed to advance medical care based on predictive diagnostics, innovative screening programmes, targeted preventive measures, and patient stratification for treatment algorithms tailored to individualised patient profile. Advantages of the approach taken The current pilot study took advantage of systemic alterations characteristic for liver malignancies, utilising liquid biopsy (blood samples) and specific biomarker patterns detected. Key molecular pathways relevant for pathomechanisms of liver cancers have been considered opening a perspective for both-individualised diagnostics and targeted treatment. Systemic alterations have been analysed prior to the therapy application avoiding molecular biological effects potentially diminishing predictive power of the biomarker-panel proposed. Multi-omics at DNA and protein (both expression and activity) levels has been applied. An established biomarker panel is considered as a powerful tool for individualised patient profiling and improved multi-level diagnostics-both predictive and prognostic ones. Results and conclusions Biomarker panels have been created for the patient stratification, prediction of a more optimal therapy and prognosis of survival based on the individualised patient profiling. Although there are some limitations of the pilot study performed, the results are encouraging, as it may be possible, through further research along these lines, to find a clinically and cost-effective means of stratifying liver cancer patients for personalised care and therapy. The benefits to the patient and society of accurate treatment stratification cannot be overemphasised.
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Affiliation(s)
- Olga Golubnitschaja
- 1Department of Radiology, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str 25, 53105 Bonn, Germany.,2Breast Cancer Research Centre, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,3Centre for Integrated Oncology, Cologne-Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Jiri Polivka
- 4Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic.,5Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic.,6Department of Neurology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Kristina Yeghiazaryan
- 1Department of Radiology, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str 25, 53105 Bonn, Germany.,2Breast Cancer Research Centre, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,3Centre for Integrated Oncology, Cologne-Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Leonard Berliner
- 7Interventional Radiology, Department of Radiology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY USA
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16
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Mähringer-Kunz A, Weinmann A, Schmidtmann I, Koch S, Schotten S, Pinto Dos Santos D, Pitton MB, Dueber C, Galle PR, Kloeckner R. Validation of the SNACOR clinical scoring system after transarterial chemoembolisation in patients with hepatocellular carcinoma. BMC Cancer 2018; 18:489. [PMID: 29703174 PMCID: PMC5923193 DOI: 10.1186/s12885-018-4407-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/18/2018] [Indexed: 02/06/2023] Open
Abstract
Background Transarterial chemoembolisation is the standard of care for intermediate stage (BCLC B) hepatocellular carcinoma, but it is challenging to decide when to repeat or stop treatment. Here we performed the first external validation of the SNACOR (tumour Size and Number, baseline Alpha-fetoprotein, Child-Pugh and Objective radiological Response) risk prediction model. Methods A total of 1030 patients with hepatocellular carcinoma underwent transarterial chemoembolisation at our tertiary referral centre from January 2000 to December 2016. We determined the following variables that were needed to calculate the SNACOR at baseline: tumour size and number, alpha-fetoprotein level, Child-Pugh class, and objective radiological response after the first transarterial chemoembolisation. Overall survival, time-dependent area under receiver-operating characteristic curves, Harrell’s C-index, and the integrated Brier score were calculated to assess predictive ability. Finally, multivariate analysis was performed to identify independent predictors of survival. Results The study included 268 patients. Low, intermediate, and high SNACOR scores predicted a median survival of 31.5, 19.9, and 9.2 months, respectively. The areas under the receiver-operating characteristic curve for overall survival were 0.641, 0.633, and 0.609 at 1, 3, and 6 years, respectively. Harrell’s C-index was 0.59, and the integrated Brier Score was 0.175. Independent predictors of survival included tumour size (P < 0.001), baseline alpha-fetoprotein level (P < 0.001) and Child-Pugh class (P < 0.004). Objective radiological response (P = 0.821) and tumour number (P = 0.127) were not additional independent predictors of survival. Conclusions The SNACOR risk prediction model can be used to identify patients with a dismal prognosis after the first transarterial chemoembolisation who are unlikely to benefit from further transarterial chemoembolisation. However, Harrell’s C-index showed only moderate performance. Accordingly, this risk prediction model can only serve as one of several components used to make the decision about whether to repeat treatment.
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Affiliation(s)
- Aline Mähringer-Kunz
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine, Johannes Gutenberg-University Medical Center Mainz, Mainz, Germany.,Clinical Registry Unit (CRU), Johannes Gutenberg-University Medical Center Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sandra Koch
- Clinical Registry Unit (CRU), Johannes Gutenberg-University Medical Center Mainz, Mainz, Germany
| | - Sebastian Schotten
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | | | - Michael Bernhard Pitton
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Christoph Dueber
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Peter Robert Galle
- Department of Internal Medicine, Johannes Gutenberg-University Medical Center Mainz, Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center Mainz, Langenbeckst. 1, 55131, Mainz, Germany.
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An J, Zhang Z, Liu Z, Wang R, Hui D, Jin Y. Overexpression of Cullin7 is associated with hepatocellular carcinoma progression and pathogenesis. BMC Cancer 2017; 17:828. [PMID: 29207970 PMCID: PMC5718086 DOI: 10.1186/s12885-017-3839-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 11/23/2017] [Indexed: 12/19/2022] Open
Abstract
Background Overexpression of Cullin7 is associated with some types of malignancies. However, the part of Cullin7 in hepatocellular carcinoma remains unclear. The aim of this study was to investigate the role of Cullin7 in pathogenesis and the progression of hepatocellular carcinoma. Methods In the present study, the expression of Cullin7 in hepatocellular carcinoma cell lines and five surgical hepatocellular carcinoma specimens was detected with quantitative reverse transcription PCR and western blotting. In addition, the protein expression of Cullin7 was examined in 162 cases of archived hepatocellular carcinoma using immunohistochemistry. Results We found elevated expression of both mRNA and protein levels of Cullin7 in hepatocellular carcinoma cell lines, and Cullin7 protein was significantly upregulated in hepatocellular carcinoma compared with paired normal hepatic tissues. The immunohistochemistry analysis revealed that overexpression of Cullin7 occurred in 69.1% of hepatocellular carcinoma samples, which was a significantly higher rate than that in adjacent normal hepatic tissue (P < 0.01). Statistical analysis found that overexpression of Cullin7 was significantly associated with lymph node metastasis, tumor thrombus of the portal vein and advanced clinical stage (P < 0.05). Furthermore, by overexpressing Cullin7 in hepatocellular carcinoma HepG2 cells, we revealed that Cullin7 could significantly enhance cell proliferation, growth, migration and invasion. Conversely, knocking down Cullin7 expression with short hairpin RNAi in hepatocellular carcinoma HepG2 cells inhibited cell proliferation, growth, migration and invasion. Conclusion Our studies provide evidence that overexpression of Cullin7 plays an important role in the pathogenesis and progression of hepatocellular carcinoma and may be a valuable marker for hepatocellular carcinoma management.
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Affiliation(s)
- Jun An
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhigang Zhang
- Department of Pathology, Guangdong Provincial Key Laboratory of Liver Disease Research, the Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China
| | - Zhiyong Liu
- Department of Emergency Medicine, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ruizhi Wang
- Department of Clinical Laboratory, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dayang Hui
- Department of Pathology, Guangdong Provincial Key Laboratory of Liver Disease Research, the Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China
| | - Yi Jin
- Department of Pathology, Guangdong Provincial Key Laboratory of Liver Disease Research, the Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China.
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