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Bezinover D, Iskandarani K, Chinchilli V, McQuillan P, Saner F, Kadry Z, Riley TR, Janicki PK. Autoimmune conditions are associated with perioperative thrombotic complications in liver transplant recipients: A UNOS database analysis. BMC Anesthesiol 2016; 16:26. [PMID: 27207434 PMCID: PMC4875607 DOI: 10.1186/s12871-016-0192-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND End stage liver disease (ESLD) is associated with significant thrombotic complications. In this study, we attempted to determine if patients with ESLD, due to oncologic or autoimmune diseases, are susceptible to thrombosis to a greater extent than patients with ESLD due to other causes. METHODS In this retrospective study, we analyzed the UNOS database to determine the incidence of thrombotic complications in orthotopic liver transplant (OLT) recipients with autoimmune and oncologic conditions. Between 2000 and 2012, 65,646 OLTs were performed. We found 4,247 cases of preoperative portal vein thrombosis (PVT) and 1,233 cases of postoperative vascular thrombosis (VT) leading to graft failure. RESULTS Statistical evaluation demonstrated that patients with either hepatocellular carcinoma (HCC) or autoimmune hepatitis (AIC) had a higher incidence of PVT (p = 0.05 and 0.03 respectively). Patients with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and AIC had a higher incidence of postoperative VT associated with graft failure (p < 0.0001, p < 0.0001, p = 0.05 respectively). Patients with preoperative PVT had a higher incidence of postoperative VT (p < 0.0001). Multivariable logistic regression demonstrated that patients with AIC, and BMI ≥40, having had a transjugular intrahepatic portosystemic shunt, and those with diabetes mellitus were more likely to have preoperative PVT: odds ratio (OR)(1.36, 1.19, 1.78, 1.22 respectively). Patients with PSC, PBC, AIC, BMI ≤18, or with a preoperative PVT were more likely to have a postoperative VT: OR (1.93, 2.09, 1.64, 1.60, and 2.01, respectively). CONCLUSION Despite the limited number of variables available in the UNOS database potentially related to thrombotic complications, this analysis demonstrates a clear association between autoimmune causes of ESLD and perioperative thrombotic complications. Perioperative management of patients at risk should include strategies to reduce the potential for these complications.
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Affiliation(s)
- Dmitri Bezinover
- Department of Anesthesiology, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
| | - Khaled Iskandarani
- Department of Public Health Sciences, Penn State College of Medicine/Penn State Hershey Medical Center, 90 Hope Drive, Hershey, PA, 17033, USA
| | - Vernon Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine/Penn State Hershey Medical Center, 90 Hope Drive, Hershey, PA, 17033, USA
| | - Patrick McQuillan
- Department of Anesthesiology, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Fuat Saner
- Department of General, Visceral- and Transplant Surgery/Essen University Medical Center, Hufelandstr. 55, Essen, 45147, Germany
| | - Zakiyah Kadry
- Department of Surgery, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Dr, Hershey, PA, 17033, USA
| | - Thomas R Riley
- Department of Gastroenterology, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Piotr K Janicki
- Department of Anesthesiology, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
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Can A, Dogan E, Bayoglu IV, Tatli AM, Besiroglu M, Kocer M, Dulger AC, Uyeturk U, Kivrak D, Orakci Z, Bal O, Kacan T, Olmez S, Turan N, Ozbay MF, Alacacioglu A. Multicenter epidemiologic study on hepatocellular carcinoma in Turkey. Asian Pac J Cancer Prev 2015; 15:2923-7. [PMID: 24761926 DOI: 10.7314/apjcp.2014.15.6.2923] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatocellular cancer (HCC) is one of the important health problems in Turkey, being very common and highly lethal. The aim of this study was to determine clinical, demographic features and risk factors. MATERIALS AND METHODS Nine hundred and sixth-three patients with HCC from 13 cities in Turkey were included in this study. RESULTS Only 205 (21%) of the 963 patients were women, with a male:female predominance of 4.8:1 and a median age of 61 years. The etiologic risk factors for HCC were hepatitis B in 555 patients (57.6%), 453 (81%) in men, and 102 (19%) in women, again with male predominance, hepatitis C in 159 (16.5%), (14.9% and 22.4%, with a higher incidence in women), and chronic alcohol abuse (more than ten years) in 137 (14.2%) (16.8% and 4.9%, higher in males). The Child-Pugh score paralleled with advanced disease stage amd also a high level of AFP. CONCLUSIONS According to our findings the viral etiology (hepatitis B and hepatitis C infections) in the Turkish population was the most important factor in HCC development, with alcohol abuse as the third risk factor. The Child-Pugh classification and AFP levels were determined to be important prognostic factors in HCC patients.
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Affiliation(s)
- Alper Can
- Department of Medical Oncology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey E-mail :
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Cho JY, Paik YH, Park HC, Yu JI, Sohn W, Gwak GY, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC. The feasibility of combined transcatheter arterial chemoembolization and radiotherapy for advanced hepatocellular carcinoma. Liver Int 2014; 34:795-801. [PMID: 24350564 DOI: 10.1111/liv.12445] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/11/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Sorafenib is regarded as the standard treatment of care in Barcelona Clinic Liver Cancer (BCLC) stage C patients. However, the modest overall survival (OS) and disease control rate warrants for a better treatment modality. This study aimed to investigate the feasibility of combined transarterial chemoembolization and radiotherapy (TACE+RT) in comparison with sorafenib for advanced hepatocellular carcinoma (HCC). METHODS AND MATERIALS From 2007 to 2011, a total of 116 patients with locally advanced HCC were retrospectively enrolled. Sixty-seven patients treated with TACE+RT were compared with 49 patients treated with sorafenib. Propensity score matching generated a matched cohort composed of 27 patients from each group. OS was the primary endpoint for the analysis. RESULTS At baseline, the sorafenib group had a tendency for a tumour size ≥10 cm, presence of lymph node metastasis and main portal vein tumour thrombosis compared to the TACE+RT group. The OS in the TACE+RT group was significantly longer compared to the sorafenib group (14.1 months vs. 3.3 months, P < 0.001). In the propensity score-matched cohort, baseline characteristics did not differ between the two groups. The TACE+RT group showed prolonged OS compared to the sorafenib group (6.7 months vs. 3.1 months, P < 0.001). Multivariate analysis revealed that TACE+RT was the only independent prognostic factor associated with survival in the propensity score-matched cohort (HR = 0.172, P < 0.001). CONCLUSIONS The OS of TACE+RT was longer compared to sorafenib treatment in locally advanced HCC patients without distant metastasis. Further prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Ju-Yeon Cho
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Gomaa AI, Hashim MS, Waked I. Comparing staging systems for predicting prognosis and survival in patients with hepatocellular carcinoma in Egypt. PLoS One 2014; 9:e90929. [PMID: 24603710 PMCID: PMC3946382 DOI: 10.1371/journal.pone.0090929] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/05/2014] [Indexed: 12/12/2022] Open
Abstract
Introduction Several hepatocellular carcinoma (HCC) staging systems are available. Although the European Association for Study of Liver Diseases (EASL) and American Association for the Study of Liver Diseases (AASLD) recommended the use of Barcelona Clinic Liver Cancer (BCLC), many studies in different populations revealed heterogeneous results. The aim of this study was to compare different staging systems for predicting prognosis and survival, and for stratifying HCC patients for treatment at a national referral centre for liver disease in Egypt. Methods 2000 Patients were included in this study. Baseline demographic, clinical, laboratory, and radiological data were determined at diagnosis. Patients were stratified using the Okuda, BCLC, Cancer of the Liver Italian Program (CLIP), and Japan Integrated Staging (JIS). Patients’ survival in different stages within each staging system and the validity of the system in predicting survival were compared. Results The overall survival was 15 months. The 1-, 2-, 3- and 4-year survival of the entire cohort was 56%, 34%, 25% and 15% respectively. The presence of ascites, multiple focal lesions, large tumour size >5 cm, portal vein thrombosis, extra-hepatic spread, AFP≥200 ng/ml and poor Child score were independent predictors of survival (p<0.001). All staging systems were significant in determining overall survival in univariate and multivariate analyses. BCLC was the most predictive staging system for the whole cohort (p<0.001). Among the subgroup of patients offered potentially curative therapy, BCLC was the most informative system in predicting patient survival (p<0.001). For patients with advanced HCC not amenable for specific therapy, CLIP was the best staging system for predicting prognosis (p<0.001). Conclusion BCLC staging system provided the best prognostic stratification for HCC patients. However, CLIP score has the highest stratification ability in patients with advanced HCC highlighting the importance of including AFP in best staging system.
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Affiliation(s)
- Asmaa Ibrahim Gomaa
- Hepatology Department, National Liver Institute, Menoufiya University, Shebeen Elkom, Menoufiya, Egypt
- * E-mail:
| | - Mohamed Saad Hashim
- Hepatology Department, National Liver Institute, Menoufiya University, Shebeen Elkom, Menoufiya, Egypt
| | - Imam Waked
- Hepatology Department, National Liver Institute, Menoufiya University, Shebeen Elkom, Menoufiya, Egypt
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Cho JY, Paik YH, Lim HY, Kim YG, Lim HK, Min YW, Gwak GY, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC. Clinical parameters predictive of outcomes in sorafenib-treated patients with advanced hepatocellular carcinoma. Liver Int 2013; 33:950-7. [PMID: 23601249 DOI: 10.1111/liv.12168] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 02/28/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sorafenib is an orally active multikinase inhibitor approved for the treatment of advanced hepatocellular carcinoma (HCC). However, clinical parameters that may predict the treatment outcomes in sorafenib-treated advanced HCC patients remains unknown. METHODS A total of 99 advanced (BCLC C) HCC patients treated with sorafenib as an initial treatment modality from January 2007 to December 2011 were retrospectively reviewed. Overall survival was the primary endpoint for the analysis. Various clinical parameters including tumour stage and adverse effects to sorafenib were analysed. Univariate and multivariate analysis were carried out to identify clinical parameters predictive of the effect of sorafenib. RESULTS There were 86 males and 13 females included in this study, with a median age of 53 years. The median overall survival was 91 days. Sixty-nine patients had Child-Pugh class A cirrhosis and 30 patients had Child-Pugh class B cirrhosis. Hepatitis B virus was the predominant cause of HCC (75.8%). Noted adverse effects were hand-foot syndrome, diarrhoea, fatigue, abdominal pain, nausea and stomatitis. The presence of hand-foot syndrome and diarrhoea and the absence of portal vein thrombosis and lymph node metastasis predicted a better overall survival in the multivariate analysis. Excluding the absence of lymph node metastasis, the same parameters were associated with a longer radiological time to progression. CONCLUSION Advanced HCC patients treated with sorafenib who experienced hand-foot syndrome and diarrhoea showed better overall survival than patients without these side effects. These side effects may be used as clinical parameters predictive of sorafenib response in patients with HCC.
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Affiliation(s)
- Ju-Yeon Cho
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Jang ES, Yoon JH, Chung JW, Cho EJ, Yu SJ, Lee JH, Kim YJ, Lee HS, Kim CY. Survival of infiltrative hepatocellular carcinoma patients with preserved hepatic function after treatment with transarterial chemoembolization. J Cancer Res Clin Oncol. 2013;139:635-643. [PMID: 23283527 DOI: 10.1007/s00432-012-1364-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 12/10/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE Transarterial chemoembolization (TACE) is highly effective and safe therapeutic modality for unresectable hepatocellular carcinoma (HCC). However, the role of TACE for infiltrative HCC has never been elucidated owing to the concern about hepatic failure and subsequent mortality after the procedure. In this study, we aimed to document whether patients with infiltrative HCC would benefit from TACE. METHODS Child-Pugh class A/B patients who were newly diagnosed as infiltrative HCC and treated with curative-intent TACE were enrolled. All radiological images were reviewed by a radiologist with more than 20 years of experience in TACE. RESULTS Among 1,184 patients newly diagnosed as HCC, 233 (19.7 %) had infiltrative-type tumors and 128 (54.9 %) underwent curative-intent TACE. Although the median overall survival was 5.4 months (IQR 3.1-13.9 months) and 16 (12.5 %) patients had experienced significant complications, 19 (15.9 %) patients survived more than 2 years after the first diagnosis. In multivariable analysis, age >60 years old (HR 0.54, 95 % CI 0.31-0.92), Child-Pugh class A (HR 0.48, 95 % CI 0.30-0.76), and a major PVT without parasitic supply (HR 0.66, 95 % CI 0.44-0.99) were independent favorable prognostic factors. Development of significant complication after TACE was a significant hazard factor of survival (HR 1.99, 95 % CI 1.09-3.62). CONCLUSIONS In carefully selected patients with preserved hepatic function and good performance, TACE may achieve long-term survival of infiltrative HCC patients with major PVT without parasitic supply. However, the risk of morbidity and immediate mortality after TACE should be considered to select subjects for the procedure.
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Tyson GL, Duan Z, Kramer JR, Davila JA, Richardson PA, El-Serag HB. Level of α-fetoprotein predicts mortality among patients with hepatitis C-related hepatocellular carcinoma. Clin Gastroenterol Hepatol 2011; 9:989-94. [PMID: 21820396 PMCID: PMC3200479 DOI: 10.1016/j.cgh.2011.07.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 07/15/2011] [Accepted: 07/25/2011] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) can result from hepatitis C virus (HCV)-related liver disease and is the fastest-growing cause of cancer-related death in the United States. α-fetoprotein (AFP) has been used as a prognostic factor for HCC, but the value of AFP as a prognostic factor for HCV-related HCC in the United States is unknown. We investigated whether higher levels of AFP at the time of diagnosis are associated with increased mortality of patients with HCV-related HCC. METHODS In a retrospective study, we collected data from a cohort of HCV-infected veterans, identifying incident HCC cases from October 1, 1998, to January 1, 2007 (n = 1480 patients). The mean serum levels of AFP, obtained within 60 days before to 30 days after HCC diagnosis, were determined for 1064 patients and categorized as less than 10 ng/mL (18%), 10 to less than 100 ng/mL (30%), 100 to less than 1000 ng/mL (22%), or 1000 ng/mL or more (29%). Cox proportional hazard models were used to associate serum levels of AFP with mortality, adjusting for demographic features, clinical factors, and treatment. RESULTS The median survival times were significantly lower among patients with higher levels of AFP: 709 days for patients with less than 10 ng/mL, 422 days for patients with 10 to less than 100 ng/mL, 208 days for patients with 100 to less than 1000 ng/mL, and 68 days for patients with 1000 ng/mL or more. In the multivariate analysis, increased levels of AFP (10 to <100, 100 to <1000, and ≥1000) were associated significantly with increased mortality, compared with a serum AFP level of less than 10; hazard ratios were 1.50, 2.23, and 4.35, respectively. CONCLUSIONS Serum AFP level at the time of diagnosis with HCV-related HCC is an independent predictor of mortality.
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Affiliation(s)
- Gia L. Tyson
- Houston VA Health Services Research and Development Center of Excellence, Department of Medicine, Baylor College of Medicine, Houston, TX
- Michael E. DeBakey Veterans Affairs Medical Center and Sections of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX
- Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Zhigang Duan
- Houston VA Health Services Research and Development Center of Excellence, Department of Medicine, Baylor College of Medicine, Houston, TX
- Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Jennifer R. Kramer
- Houston VA Health Services Research and Development Center of Excellence, Department of Medicine, Baylor College of Medicine, Houston, TX
- Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Jessica A. Davila
- Houston VA Health Services Research and Development Center of Excellence, Department of Medicine, Baylor College of Medicine, Houston, TX
- Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Peter A. Richardson
- Houston VA Health Services Research and Development Center of Excellence, Department of Medicine, Baylor College of Medicine, Houston, TX
- Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Hashem B. El-Serag
- Houston VA Health Services Research and Development Center of Excellence, Department of Medicine, Baylor College of Medicine, Houston, TX
- Michael E. DeBakey Veterans Affairs Medical Center and Sections of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX
- Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
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Zhou L, Rui JA, Wang SB, Chen SG, Qu Q. Prognostic factors of solitary large hepatocellular carcinoma: The importance of differentiation grade. Eur J Surg Oncol 2011; 37:521-5. [DOI: 10.1016/j.ejso.2011.03.137] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 02/10/2011] [Accepted: 03/28/2011] [Indexed: 12/19/2022] Open
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Abstract
BACKGROUND Although there are many studies of the predictors of death in hepatocellular carcinoma (HCC), most combine patients with and without cirrhosis and many combine those with compensated and decompensated cirrhosis. OBJECTIVE To perform a systematic review of the literature evaluating the predictors of death in patients with cirrhosis and HCC and to evaluate whether the predictors differ between patients with compensated and decompensated cirrhosis. INCLUSION CRITERIA (i) publication in English, (ii) adult patients, (c) >80% of the patients had cirrhosis, (iv) follow-up >6 months and (v) multivariable analysis. Quality was based on the accepted quality criteria for prognostic studies. RESULTS Of the 1106 references obtained, 947 were excluded because they did not meet the inclusion criteria. A total of 23 968 patients were included in 72 studies (median, 177/study); 77% male, median age 64, 55% Child-Pugh class A. The most robust predictors of death were portal vein thrombosis, tumour size, alpha-foetoprotein and Child-Pugh class. Sensitivity analysis using only 15 'good' studies and 22 studies in which all patients had cirrhosis yielded the same variables. In the studies including mostly compensated or decompensated patients, the predictors were both liver and tumour related. However, these studies were few and the results were not robust. CONCLUSIONS This systematic review of 72 studies shows that the most robust predictors of death in patients with cirrhosis and HCC are tumour related and liver related. Future prognostic studies should include these predictors and should be performed in specific patient populations to determine whether specific prognostic indicators are more relevant at different stages of cirrhosis.
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Affiliation(s)
- Puneeta Tandon
- Digestive Diseases Section, Yale University School of MedicineNew Haven, CT, USA,VA Connecticut Healthcare SystemWest Haven, CT, USA,Division of Gastroenterology, University of AlbertaEdmonton, AB, Canada
| | - Guadalupe Garcia-Tsao
- Digestive Diseases Section, Yale University School of MedicineNew Haven, CT, USA,VA Connecticut Healthcare SystemWest Haven, CT, USA
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Kim YI, Ki HS, Kim MH, Cho DK, Cho SB, Joo YE, Kim HS, Choi SK, Rew JS. Analysis of the clinical characteristics and prognostic factors of ruptured hepatocellular carcinoma. Korean J Hepatol 2009; 15:148-58. [DOI: 10.3350/kjhep.2009.15.2.148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Young-Il Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ho-Seok Ki
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Min-Hyoung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Keun Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Bum Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Kyu Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong-Sun Rew
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Zeng ZC, Fan J, Tang ZY, Zhou J, Wang JH, Wang BL, Guo W. Prognostic factors for patients with hepatocellular carcinoma with macroscopic portal vein or inferior vena cava tumor thrombi receiving external-beam radiation therapy. Cancer Sci 2008; 99:2510-7. [PMID: 19032365 DOI: 10.1111/j.1349-7006.2008.00981.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Prognostic factors in patients with hepatocellular carcinoma (HCC) with tumor thrombosis are not well established, especially for those given external-beam radiation therapy (EBRT). Patients (n = 136) with HCC who had portal vein (PV) or inferior vena cava (IVC) tumor thrombus received EBRT between January 1998 and October 2007. Demographic variables, laboratory values, tumor characteristics, and treatment modalities were determined at diagnosis and before EBRT. The total radiation dose ranged from 30 to 60 Gy (median, 50 Gy) and was focused on the tumor thrombi. Predictors of survival were identified using the univariate and multivariate analysis. Of the 136 patients, the tumor thrombus completely disappeared in 41 patients (30.1%), 36 patients (26.5%) had a partial response, 49 patients (36%) had stable disease, and 10 patients (7.4%) had progressive disease. On multivariate analysis, pretreatment unfavorable predictors were associated with lower albumin, higher gamma-glutamyltransferase and alpha-fetoprotein levels, poorer Child-Pugh classification, intrahepatic multifocality, lymph node metastases, poorer response to EBRT, and 2-dimension EBRT technique. Survival rates at 1, 2, and 3 years were 31.8%, 17.5%, and 8.8% for patients with PV tumor thrombi; 66.3%, 21.1%, and 15.8% for IVC tumor thrombi; and 25%, 8.3%, and 0% for PV plus IVC tumor thrombi, respectively. Overall median survival was 9.7 months. This study provides detailed information about the survival outcomes and prognostic factors of HCC with tumor thrombi in a relatively large cohort of patients treated with radiation, and the results will help in understanding the potential factors that influence survival for patients with HCC after EBRT.
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Affiliation(s)
- Zhao-Chong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 136 Yi Xue Road, Shanghai 200032, China.
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Alacacioglu A, Somali I, Simsek I, Astarcioglu I, Ozkan M, Camci C, Alkis N, Karaoglu A, Tarhan O, Unek T, Yilmaz U. Epidemiology and survival of hepatocellular carcinoma in Turkey: outcome of multicenter study. Jpn J Clin Oncol 2008; 38:683-8. [PMID: 18753360 DOI: 10.1093/jjco/hyn082] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Hepatocellular cancer (HCC) is one of the important health problems in Turkey. We aimed to determine the clinical and demographic features of HCC in the Turkish population and to evaluate the prognostic and survival features. METHOD Two hundred and twenty-one patients with HCC from five hospitals in Turkey are included in this study. RESULTS In 44.4% of the 221 patients with hepatitis B virus and in 21.3% of the 221 patients with hepatitis C virus were found to be responsible for HCC etiology. It has been shown that HCC developed on cirrhosis basis in 74.2% of the patients. HCC was presented with single solitary nodule in 69.2% of the patients. Non-liver metastasis was present in 12.5% of the patients. In 21.7% of the patients, alpha-fetoprotein (AFP) levels were above the diagnostics level of 400 ng/ml. The median overall survival (OS) of 221 patients was 14 months. The median OS of the patients with Child-Pugh A class was significantly longer than that with Child-Pugh B and C classes. The OS of the individuals with normal AFP levels was also longer than that with high AFP levels. The OS of the patients with Stage I HCC according to tumor node metastasis (TNM) classification, the female patients and the treated patients group was found to be significantly good. CONCLUSIONS In conclusion, the viral etiology (hepatitis B and C infections) in Turkish population is found to be an important factor in HCC development. The Child-Pugh classification, AFP levels, TNM classification, being female and treatment were determined to be important prognostic factors in HCC patients.
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Affiliation(s)
- Ahmet Alacacioglu
- Dokuz Eylul University, Institute of Oncology, Balcova, Izmir, Turkey
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Connolly GC, Chen R, Hyrien O, Mantry P, Bozorgzadeh A, Abt P, Khorana AA. Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma. Thromb Res 2007; 122:299-306. [PMID: 18045666 DOI: 10.1016/j.thromres.2007.10.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 10/18/2007] [Accepted: 10/22/2007] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Hemostatic activation may be important for tumor biology. Hepatocellular carcinoma (HCC) is commonly associated with portal vein thrombosis (PVT). Little is known about factors predictive for PVT in patients with HCC or its correlation with systemic venous thromboembolism (VTE). METHODS We conducted a retrospective chart review of 194 consecutive patients diagnosed with HCC at the University of Rochester between 1998 and 2004 to identify the frequency and risk factors for PVT and its correlation with VTE and survival. RESULTS Sixty patients (31%) had PVT with a higher rate in the non-transplant group compared to transplanted patients (34% vs. 24%; p=0.15). In multivariate analysis, Child Turcotte Pugh (CTP) class, stage, major vessel involvement, serum albumin, and serum AFP were independently associated with PVT (p<0.05 for each). The presence of PVT was associated with reduced survival (median survival 2.3 months for those with PVT versus 17.6 months for those without PVT, HR 2.05, p=0.004). The incidence of systemic VTE in the total population was 6.7%, and patients with PVT had a higher rate of systemic VTE compared to patients without PVT (11.5% vs. 4.4%; p=0.04). CONCLUSION PVT is common in patients with HCC, indicates advanced disease, is associated with worse survival and correlates with systemic VTE, suggesting a common mechanism of hemostatic activation. Advanced stage, higher CTP class, major vessel involvement, low serum albumin, and high AFP levels are predictive of PVT in patients with HCC.
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Díaz Sánchez A, Núñez Martínez O, Prieto Martín M, Beceiro Pedreño I, Calleja Kempin J, Santos Castro L, Muro de la Fuente A, Clemente Ricote G, Matilla Peña A. [Prognostic factors in patients with non-active treatment of hepatocellular carcinoma]. Gastroenterol Hepatol 2007; 30:441-8. [PMID: 17949609 DOI: 10.1157/13110488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate factors associated with poor survival in patients with non-active treatment of hepatocellular carcinoma (HCC). MATERIAL AND METHODS Between May 2003 and June 2005, 50 patients with HCC were deemed unsuitable for active treatment, following the Barcelona Clinic Liver Cancer staging system. Symptomatic treatment was provided. Kaplan-Meier curves were constructed and compared by the log-rank test to identify factors associated with poor survival. Independent factors predictive of survival were evaluated by multivariate Cox regression analysis. RESULTS The mean age was 65.6 +/- 11.9 years and 84% of the patients were men. Forty-eight percent of the patients had hepatitis C infection and 58% were Child-Pugh grade A. HCC was multinodular in 54% and the total tumor size was more than 5 cm in 90% of patients. Thirty-four percent of the patients had malignant portal thrombosis and four patients had metastases. Thirty-eight percent of the patients had received previous treatment. The median follow-up was 9.2 months and 1- and 2-year survival was 46% and 17.5%, respectively. Poor survival was associated with male sex, alpha-fetoprotein values of > 400 ng/ml, albumin levels of < 3 g/dl, and metastases. Independent predictors identified by multivariate Cox regression analysis were male sex, albumin levels of < 3 g/dl, and alpha-fetoprotein values of > 400 ng/ml. The median survival in patients with two or more independent factors was significantly lower than that in patients with none or only one factor (14.2 vs. 4.1 months). CONCLUSION Survival in patients with non-active treatment of hepatocellular carcinoma can be estimated and the factors involved allow separate groups of patients with different short- to medium-term prognoses to be identified.
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Affiliation(s)
- Antonio Díaz Sánchez
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
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