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Adhoute X, Pénaranda G, Raoul JL, Bronowicki JP, Anty R, Bourlière M. “Six-and-twelve” score for outcome prediction of hepatocellular carcinoma following transarterial chemoembolization. In-depth analysis from a multicenter French cohort. World J Hepatol 2020; 12:525-532. [PMID: 32952879 PMCID: PMC7475776 DOI: 10.4254/wjh.v12.i8.525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/05/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
The “six-and-twelve” (6&12) score is a new hepatocellular carcinoma (HCC) prognostic index designed for recommended transarterial chemoembolization (TACE) candidates. Quick and easy to use by the sum of tumor size (cm) and number, this model identifies three groups with different survival time (the sum is ≤ 6; or > 6 but ≤ 12; or > 12); a survival benefit with TACE can be expected for HCC patients with a score not exceeding twelve. Recently, Wang ZW et al showed that the “6&12” model was the best system correlated with radiological response after the first TACE. Thus, we wanted to assess its survival prediction ability as well as its prognostic value and compared it to other systems (Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer (HKLC) staging, Albumin-Bilirubin grade, tumor nodularity, infiltrative nature of the tumor, alpha-fetoprotein, Child-Pugh class, and Performance Status score, Cancer of the Liver Italian Program, Model to Estimate Survival for HCC scores, up-to-seven criteria) different from Wang ZW et al study in a multicenter French cohort of HCC including only recommended TACE candidates retrospectively enrolled. As previously demonstrated, we show that the "6&12” score can classify survival within this French cohort, with a prognostic value comparable to that of other systems, except HKLC staging. More importantly, the “6&12” score simplicity and ability in patients’ stratification outperform other systems for a routine clinical practice.
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Affiliation(s)
- Xavier Adhoute
- Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, Marseille 13008, France
| | | | - Jean-Luc Raoul
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes 44805, France
| | - Jean-Pierre Bronowicki
- Department of Gastroenterology and Hepatology, Centre Hospitalo-Universitaire de, Nancy 54511, France
| | - Rodolphe Anty
- Department of Gastroenterology and Hepatology, Hôpital Universitaire de l’Archet, Nice 06200, France
| | - Marc Bourlière
- Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, Marseille 13008, France
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Prognostic factors in hepatocellular carcinoma patients undergoing transarterial chemoembolization and radioembolization: a retrospective study. Eur J Gastroenterol Hepatol 2020; 32:1036-1041. [PMID: 31851090 DOI: 10.1097/meg.0000000000001625] [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: 12/17/2022]
Abstract
OBJECTIVE Most patients with hepatocellular carcinoma are diagnosed at intermediate or advanced stages (BCLC B or C) and undergo palliative local treatments such as transarterial chemoembolization or selective internal radiation therapy, also called radioembolization. In terms of liver function and tumor extent, stages BCLC B and C comprise a wide spectrum of tumor manifestations. Predictors of survival in these patients undergoing transarterial chemoembolization and selective internal radiation therapy might help stratification into different prognostic groups and help to select the optimal treatment modality. METHODS In this retrospective study, all patients with hepatocellular carcinoma who underwent transarterial chemoembolization between January 2010 and December 2014 and all hepatocellular carcinoma patients who underwent selective internal radiation therapy between August 2012 and December 2016 were recruited. The prognostic value of pretherapeutic clinical and laboratory parameters for the prediction of overall survival was analyzed using uni- and multi-variable Cox regression models. RESULTS We enrolled 129 patients in the transarterial chemoembolization group and 34 patients in the selective internal radiation therapy group. The predictive value of the albumin-bilirubin grade was validated for both the transarterial chemoembolization and the selective internal radiation therapy group. Multivariable analysis identified albumin-bilirubin grade and tumor size as independent predictors for the transarterial chemoembolization group and tumor size, serum albumin and serum sodium as independent predictors for the selective internal radiation therapy group. CONCLUSION While measures of liver dysfunction predicted survival similarly in both cohorts, we found tumor size to predict survival differently in transarterial chemoembolization- and selective internal radiation therapy-treated patients. Tumor size might help to select the most appropriate treatment in hepatocellular carcinoma patients, although this finding has to be validated in further studies.
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Nam JY, Choe AR, Sinn DH, Lee JH, Kim HY, Yu SJ, Kim YJ, Yoon JH, Lee JM, Chung JW, Choi SY, Lee JK, Baek SY, Lee HA, Kim TH, Yoo K. A differential risk assessment and decision model for Transarterial chemoembolization in hepatocellular carcinoma based on hepatic function. BMC Cancer 2020; 20:504. [PMID: 32487089 PMCID: PMC7268402 DOI: 10.1186/s12885-020-06975-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Abstract
Background The decision of transarterial chemoembolization (TACE) initiation and/or repetition remains challenging in patients with unresectable hepatocellular carcinoma (HCC). The aim was to develop a prognostic scoring system to guide TACE initiation/repetition. Methods A total of 597 consecutive patients who underwent TACE as their initial treatment for unresectable HCC were included. We derived a prediction model using independent risk factors for overall survival (OS), which was externally validated in an independent cohort (n = 739). Results Independent risk factors of OS included Albumin-bilirubin (ALBI) grade, maximal tumor size, alpha-fetoprotein, and tumor response to initial TACE, which were used to develop a scoring system (“ASAR”). C-index values for OS were 0.733 (95% confidence interval [CI] = 0.570–0.871) in the derivation, 0.700 (95% CI = 0.445–0.905) in the internal validation, and 0.680 (95% CI = 0.652–0.707) in the external validation, respectively. Patients with ASAR< 4 showed significantly longer OS than patients with ASAR≥4 in all three datasets (all P < 0.001). Among Child-Pugh class B patients, a modified model without TACE response, i.e., “ASA(R)”, discriminated OS with a c-index of 0.788 (95% CI, 0.703–0.876) in the derivation, and 0.745 (95% CI, 0.646–0.862) in the internal validation, and 0.670 (95% CI, 0.605–0.725) in the external validation, respectively. Child-Pugh B patients with ASA(R) < 4 showed significantly longer OS than patients with ASA(R) ≥ 4 in all three datasets (all P < 0.001). Conclusions ASAR provides refined prognostication for repetition of TACE in patients with unresectable HCC. For Child-Pugh class B patients, a modified model with baseline factors might guide TACE initiation.
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Affiliation(s)
- Joon Yeul Nam
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - A Reum Choe
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Dong Hyun Sinn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Hwi Young Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Young Choi
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jeong Kyong Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Seung Yon Baek
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Tae Hun Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Kwon Yoo
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
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Peng Z, Cao G, Hou Q, Li L, Ying S, Sun J, Zhou G, Zhou J, Zhang X, Ji W, Yu Z, Li T, Zhu D, Hu W, Ji J, Du H, Shi C, Guo X, Fang J, Han J, Gu W, Xie X, Sun Z, Xu H, Wu X, Hu T, Huang J, Hu H, Zheng J, Luo J, Chen Y, Yu W, Shao G. The Comprehensive Analysis of Efficacy and Safety of CalliSpheres ® Drug-Eluting Beads Transarterial Chemoembolization in 367 Liver Cancer Patients: A Multiple-Center, Cohort Study. Oncol Res 2019; 28:249-271. [PMID: 31856933 PMCID: PMC7851534 DOI: 10.3727/096504019x15766663541105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This study aimed to investigate the efficacy, safety, and prognostic factors of drug-eluting beads transarterial chemoembolization (DEB-TACE) in treating Chinese patients with liver cancer. A total of 367 liver cancer patients from 24 medical centers were consecutively enrolled in this multiple-center, prospective cohort study, including 275 hepatocellular carcinoma (HCC) cases, 37 intrahepatic cholangiocarcinoma (ICC) cases, and 55 secondary liver cancer cases. All the patients received CalliSpheres® DEB-TACE treatment. Treatment response, overall survival (OS), change of liver function, and adverse events (AEs) were assessed. DEB-TACE treatment achieved 19.9% complete response (CR) and 79.6% objective response rate (ORR), with mean OS of 384 days [95% confidence interval (CI): 375–393 days]. CR and ORR were both higher in HCC patients compared with primary ICC patients and secondary liver cancer patients, while no difference was discovered in OS. Portal vein invasion was an independent risk factor for CR, while portal vein invasion, previous conventional TACE (cTACE) treatment, and abnormal blood creatinine (BCr) were independent risk factors for ORR. In addition, largest nodule size ≥5.0 cm, abnormal albumin (ALB), and abnormal total bilirubin (TBIL) independently correlated with unfavorable OS. Most liver function indexes were recovered to baseline levels at 1–3 months after DEB-TACE. Common AEs were pain, fever, vomiting, and nausea; most of them were at mild grade. CalliSpheres® DEB-TACE is efficient and well tolerated in Chinese liver cancer patients. Portal vein invasion, previous cTACE treatment, largest nodule size, abnormal BCr, ALB, and TBIL correlate with worse prognosis independently.
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Affiliation(s)
- Zhiyi Peng
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Guohong Cao
- Department of Radiology, Shulan (Hangzhou) Hospital, Zhejiang University International HospitalHangzhouChina
| | - Qinming Hou
- Department of Radiology, Xixi Hospital of Hangzhou, Hangzhou 6th People's HospitalHangzhouChina
| | - Ling Li
- Department of Liver Oncology, Ningbo No. 2 HospitalNingboChina
| | - Shihong Ying
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Junhui Sun
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Guanhui Zhou
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Jian Zhou
- Department of Radiology, Hangzhou Cancer HospitalHangzhouChina
| | - Xin Zhang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Wenbin Ji
- Department of Radiology, Taizhou Hospital of Zhejiang ProvinceLinhaiChina
| | - Zhihai Yu
- Department of Vascular and Interventional Radiology, The Affiliated Hospital of Medical College of Ningbo UniversityNingboChina
| | - Tiefeng Li
- Department of Radiology, Beilun District People's Hospital of NingboNingboChina
| | - Dedong Zhu
- Department of Liver Oncology, Ningbo No. 2 HospitalNingboChina
| | - Wenhao Hu
- Department of Intervention, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Jiansong Ji
- Department of Radiology, Lishui Central Hospital, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical UniversityLishuiChina
| | - Haijun Du
- Department of Intervention, Dongyang People's HospitalDongyangChina
| | - Changsheng Shi
- Department of Intervention, The Third Affiliated Hospital of Wenzhou Medical UniversityRuianChina
| | - Xiaohua Guo
- Department of Intervention, Jinhua Central HospitalJinhuaChina
| | - Jian Fang
- Department of Hepatobiliary Surgery, Quzhou People's HospitalQuzhouChina
| | - Jun Han
- Department of Intervention, Jiaxing First HospitalJiaxingChina
| | - Wenjiang Gu
- Department of Intervention, Jiaxing Second HospitalJiaxingChina
| | - Xiaoxi Xie
- Interventional Center, Xinchang People's HospitalShaoxingChina
| | - Zhichao Sun
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Huanhai Xu
- Division of Digestive Endoscopy, Yueqing City People's HospitalYueqingChina
| | - Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of MedicineHangzhouChina
| | - Tingyang Hu
- Department of Intervention, Zhejiang Provincial People's HospitalHangzhouChina
| | - Jing Huang
- Department of Hepatobiliary Surgery, Ningbo Medical Center, Lihuili Eastern HospitalNingboChina
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of MedicineHangzhouChina
| | - Jiaping Zheng
- Department of Intervention, Zhejiang Cancer HospitalHangzhouChina
| | - Jun Luo
- Department of Intervention, Zhejiang Cancer HospitalHangzhouChina
| | - Yutang Chen
- Department of Intervention, Zhejiang Cancer HospitalHangzhouChina
| | - Wenqiang Yu
- Department of Intervention, Zhejiang Provincial People's HospitalHangzhouChina
| | - Guoliang Shao
- Department of Intervention, Zhejiang Cancer HospitalHangzhouChina
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Mazmishvili K, Jayant K, Janikashvili N, Kikodze N, Mizandari M, Pantsulaia I, Paksashvili N, Sodergren MH, Reccia I, Pai M, Habib N, Chikovani T. Study to evaluate the immunomodulatory effects of radiofrequency ablation compared to surgical resection for liver cancer. J Cancer 2018; 9:3187-3195. [PMID: 30210642 PMCID: PMC6134816 DOI: 10.7150/jca.25084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/05/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction: Hepatic cancer is a highly lethal tumour with increasing worldwide incidence. These tumours are characterized by the proliferation of malignant cells, generalised immunosuppression and chronic inflammation marked with an increase in inflammatory markers as a neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR) and overexpression of CD4+CD39+ on T lymphocytes. The studies have outlined immunomodulatory changes in liver cancer patients as the plausible explanation for the better survival. The aim of this pilot study was understand the possible immunomodulatory effect of radiofrequency (RF) energy and liver resection (non-radiofrequency based devices; non-RF device) in relation to NLR, PLR and expression of CD4+CD39+ T lymphocytes and compare the magnitude of these changes. Material and Methods: In the present study, 17 patients with hepatic cancer were prospectively divided into treatment groups radiofrequency ablation (RFA group) and Liver resection using non-RF devices (LR group). A blood sample was collected from each patient, one month before and after the procedure and compared with the blood samples of age-matched healthy volunteers for group wise comparison. The Mann-Whitney U test, Mc Nemar test and Wilcoxon rank test were used for statistical comparisons as appropriate. Results: A decrease in NLR was reported after RFA from 4.7±3.3 to 3.8±1.8 (P=0.283), in contrary to an increase from 3.5±2.8 to 4.5±3.2 (P=0.183) in LR group. Likewise, a decrease was discerned in PLR following RFA from 140.5±79.5 to 137±69.2 respectively (P=0.386) and increase in the LR group from 116±42.2 to 120.8±29 respectively (P=0.391). A significant decrease in CD4+CD39+ lymphocytes from 55.8±13.8 to 24.6±21.1 (P=0.03) was observed in RFA group whilst a significant increase was reported in LR group from 47.6±8.8 to 55.7±33.2 (P=0.38). Conclusion: Studies have shown that decrease in the NLR, PLR and expression of CD4+CD39+ on T lymphocytes as the marker of better survival in hepatic cancer patients and our findings have confirmed that these changes can be induced following application of RF energy. Moreover, this could be the explanation of better survival observed in different studies using RFA or other RF-based devices in comparison to non-RF based liver resection techniques. However, further larger studies are needed to confirm these findings.
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Affiliation(s)
- Ketevan Mazmishvili
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Kumar Jayant
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Nona Janikashvili
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Nino Kikodze
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Malkhaz Mizandari
- Department of Interventional Radiology, Tbilisi State Medical University, High Technology University Clinic, 0144 Tbilisi, Georgia
| | - Ia Pantsulaia
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Natela Paksashvili
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
- Department of Interventional Radiology, Tbilisi State Medical University, High Technology University Clinic, 0144 Tbilisi, Georgia
| | - Mikael H Sodergren
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Isabella Reccia
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Tinatin Chikovani
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
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Waked I, Berhane S, Toyoda H, Chan SL, Stern N, Palmer D, Tada T, Yeo W, Mo F, Bettinger D, Kirstein MM, Iñarrairaegui M, Gomaa A, Vogel A, Meyer T, Sangro B, Lai P, Kumada T, Johnson PJ. Transarterial chemo-embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion. Br J Cancer 2017; 116:448-454. [PMID: 28125820 PMCID: PMC5318968 DOI: 10.1038/bjc.2016.423] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/17/2016] [Accepted: 11/28/2016] [Indexed: 02/08/2023] Open
Abstract
Background: Transarterial chemo-embolisation (TACE) is recommended for patients with BCLC intermediate stage hepatocellular carcinoma (stage B), particularly in patients with good underlying liver function and minimal symptoms. The hepatoma arterial embolisation prognostic (HAP) score combines measures of liver function and tumour-related factors to offer a simple prognostic scoring system. The Albumin-Bilirubin (ALBI) grade permits assessment of the impact of liver function on survival. We aimed to investigate these two models and vascular invasion (VI). Methods: In an international cohort of 3030 patients undergoing TACE, we examined the impact of liver function as assessed by the ALBI score, the HAP score and VI on survival. Results: Classification according to ALBI grade resulted in non-overlapping survival curves in the overall data set and all regional cohorts. The HAP score was also validated. Tumour number, aetiology and VI were identified as additional independent prognostic risk factors not currently included in the HAP score. Survival was particularly poor for patients with VI. Conclusions: The ALBI grade categorised patients receiving TACE into three clear prognostic groups, thereby emphasising the importance of underlying liver function in the outcome of TACE. The HAP score has been validated internationally and the serious adverse impact of VI is clearly shown.
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Affiliation(s)
- Imam Waked
- Department of Hepatology, National Liver Institute, Menoufeya University, Menoufia Governorate, Egypt
| | - Sarah Berhane
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, The Sherrington Building, Ashton Street, Liverpool L69 3GA, UK
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan
| | - Stephen L Chan
- Department of Anatomical & Cellular Pathology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China
| | - Nicholas Stern
- Digestive Diseases Unit, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Liverpool, UK
| | - Daniel Palmer
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, The Sherrington Building, Ashton Street, Liverpool L69 3GA, UK
| | - Toshifumi Tada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan
| | - Winnie Yeo
- State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China
| | - Frankie Mo
- State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China
| | - Dominik Bettinger
- Department of Internal Medicine II, University Hospital Freiburg, Hugstetter Street 55, Freiburg D-79106, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl Neuberg Street 1, Hannover 30625, Germany
| | - Mercedes Iñarrairaegui
- Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra; and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Asmaa Gomaa
- Department of Hepatology, National Liver Institute, Menoufeya University, Menoufia Governorate, Egypt
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl Neuberg Street 1, Hannover 30625, Germany
| | - Tim Meyer
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra; and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Paul Lai
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Takashi Kumada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan
| | - Philip J Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, The Sherrington Building, Ashton Street, Liverpool L69 3GA, UK.,The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral CH63 4JY, UK
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Adhoute X, Penaranda G, Raoul JL, Le Treut P, Bollon E, Hardwigsen J, Castellani P, Perrier H, Bourlière M. Usefulness of staging systems and prognostic scores for hepatocellular carcinoma treatments. World J Hepatol 2016; 8:703-715. [PMID: 27330679 PMCID: PMC4911504 DOI: 10.4254/wjh.v8.i17.703] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023] Open
Abstract
Therapeutic management of hepatocellular carcinoma (HCC) is quite complex owing to the underlying cirrhosis and portal vein hypertension. Different scores or classification systems based on liver function and tumoral stages have been published in the recent years. If none of them is currently “universally” recognized, the Barcelona Clinic Liver Cancer (BCLC) staging system has become the reference classification system in Western countries. Based on a robust treatment algorithm associated with stage stratification, it relies on a high level of evidence. However, BCLC stage B and C HCC include a broad spectrum of tumors but are only matched with a single therapeutic option. Some experts have thus suggested to extend the indications for surgery or for transarterial chemoembolization. In clinical practice, many patients are already treated beyond the scope of recommendations. Additional alternative prognostic scores that could be applied to any therapeutic modality have been recently proposed. They could represent complementary tools to the BCLC staging system and improve the stratification of HCC patients enrolled in clinical trials, as illustrated by the NIACE score. Prospective studies are needed to compare these scores and refine their role in the decision making process.
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