The FIB-4 index is a significant prognostic factor in patients with non-B non-C hepatocellular carcinoma after curative surgery

PURPOSE

The aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) index were developed as a non-invasive parameter for predicting liver fibrosis. This study aimed to validate the APRI and FIB-4 indexes in patients treated with curative therapy for non-B non-C (NBNC) hepatocellular carcinoma (HCC).

METHODS

Accumulated database comprising 399 patients who underwent hepatectomy was reviewed retrospectively. Analyses were performed to evaluate whether the APRI and FIB-4 indexes are predictors of liver cirrhosis and/or the prognosis in patients with NBNC-HCC. Forty-seven patients with NBNC-HCC who underwent curative radiofrequency ablation therapy (RFA) in the same period were enrolled as the validation set.

RESULTS

The APRI and FIB-4 indexes were significantly higher in the cirrhosis group than in the no-cirrhosis group (P = 0.001 and P < 0.001, respectively). A receiver operating characteristic curve analysis showed that the FIB-4 index was more accurate in predicting background liver cirrhosis than the APRI. According to a multivariate analysis, an FIB-4 index larger than 2.7 (hazard ratio 2.11 and 2.21, 95 % confidence interval 1.06-4.18 and 1.38-3.54, P = 0.033 and P = 0.001) remained significant independent predictors of overall and recurrence-free survival, respectively.

CONCLUSIONS

The present findings showed that the FIB-4 index is a significant predictor of background liver cirrhosis and the prognosis after curative resection for NBNB-HCC.

Comparison of epirubicin hydrochloride and miriplatin hydrate as anticancer agents for transcatheter arterial chemoembolization of hepatocellular carcinoma

AIM

The aim of this retrospective study was to compare the local control effects of transcatheter arterial chemoembolization (TACE) using epirubicin (EPIR) and that using miriplatin (MPT) for hepatocellular carcinoma (HCC).

METHODS

Between January 2010 and July 2011, 218 HCC cases were treated with TACE, including 69 cases using EPIR or MPT as initial treatment. All 69 patients were treated with iodized oil and gelatin sponge particles. The local control rate (modified Response Evaluation Criteria in Solid Tumors [RECIST] ver. 1.0), time to treatment failure (Kaplan-Meier and log-rank test) and adverse events were evaluated.

RESULTS

Forty-two cases were treated using EPIR, and 27 cases were treated using MPT. All 69 patients had no previous treatment with TACE or hepatic arterial infusion. No serious adverse events were observed in either group. The response rates, including complete response (CR) and partial response (PR), of the EPIR group and the MPT group were 85.7% and 81.5%, respectively, with a time to treatment failure of 5.1 and 7.5 months, respectively. Excluding whole liver TACE cases, time to treatment failure was 5.4 months for the EPIR group and 10.1 months for the MPT group.

CONCLUSION

In TACE naïve cases, there was no significant difference in local control between EPIR and MPT.

[Cancer treatment response evaluation based on imaging modalities, such as computed tomography, magnetic resonance imaging and FDG-PET]

RECIST, which is currently the standard evaluation criterion for clinical trials in cancer treatment, is widely extrapolated for use in clinical practice. However, the criteria depend on change in the size of tumors, and do not correspond to functional or metabolic change, or to changes in shape and texture such as tumor necrosis or cavitation due to molecular-targeted therapy. There will not be any changes that high-performance and high-resolution CT has been widely playing an important role in the future, in addition, so-called imaging biomarkers such as MRI and FDG-PET will have become used as diagnostic imaging modalities for the evaluation of cancer treatment and prognosis, because they can provide information concerning the morphological, functional and metabolic changes of tumors. Furthermore, in the current state where cancer treatment will be shifting towards individualized medicine by targeted therapies, we will need to evaluate these modalities to establish an adequate measurement method and timing, and the evaluation method. And the simplified and standardized criteria will be able to be achieved as future scientific cancer treatment evaluation.

[Content-based image-retrieval system - development, usefulness and perspectives of diagnostic assistant robot]

In recent years, diagnostic imaging modalities have proliferated from standard X-ray to CT, MRI and PET, and the working environments of radiologists have changed greatly with the popular spread of the PACS system. Radiologists are now facing enormous duties due to the dramatic increase in the volume of images from various modalities, and the shortage of radiologists in Japan has reached near-crisis levels. Furthermore, it is difficult to gain the knowledge needed to interpret diagnostic imaging and modalities under the growing, increasingly diverse and complex modalities and methods, for general physicians and trainees. On the other hand, there are some computer-aided diagnosis and detection systems that support radiologists. Here, we introduce a new diagnostic assistant robot that automatically retrieves cases on record that are similar to new cases, helps in making diagnoses, and can create CT reports semi-automatically, using an existing past CT database of pulmonary nodules with a structured report.