Embolization with microspheres alone for hepatocellular carcinoma with portal vein tumor: analysis of outcome and liver function at disease progression

Background: Recent advances in the development of tyrosine kinase inhibitors (TKIs) have enabled patients with unresectable hepatocellular carcinoma (HCC) to receive multiple TKIs in sequence. The aim of this study was to identify predictors of good candidates for second-line treatment after disease progression during sorafenib treatment. Methods: This is a retrospective cohort study of 190 consecutive HCC patients who were treated with sorafenib in our hospital. Three criteria of good candidates for second-line TKI at the time of disease progression during sorafenib treatment were defined as follows: criterion 1 was the same as the inclusion criteria of the regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE) study, criterion 2 was the inclusion criteria of the RESORCE study plus Child–Pugh score 5, and criterion 3 was the inclusion criteria of the RESORCE study plus albumin–bilirubin (ALBI) grade 1. Factors at baseline and at week 4 during sorafenib treatment were used to predict patients fulfilling each of these three criteria. Results: The distribution of patients was 29%, 13%, and 6% in criteria 1, 2, and 3, respectively. Significant factors for meeting criterion 1 was the combination of baseline albumin >3.7 g/dL (odds ratio (OR) 2.7) plus degree of decrease in albumin (Δalbumin) at week 4 <0.2 g/dL (OR 2.6), or the combination of baseline ALBI score <−2.33 (OR 2.5) and ΔALBI at week 4 <0.255 (OR 4.9). For criterion 2, the value of baseline albumin and ALBI score was identical to criterion 1; however, Δalbumin (<0.1 g/dL) and ΔALBI score (<0.19) became stricter. For criterion 3, the value of baseline albumin (>3.8 g/dL) and ALBI (<−2.55) became stricter, as did Δalbumin (<0.1 g/dL) and ΔALBI (<0.085). Furthermore, tumor burden (>11) was selected as an additional predictor (OR 5.4). Conclusion: Predictors to satisfy the RESORCE study inclusion criteria were as follows: preserved liver function at baseline, as reflected by albumin or ALBI score, and small deterioration of liver function early during sorafenib therapy, as reflected by Δalbumin or ΔALBI at week 4. Liver function at baseline and degree of change in liver function during sorafenib treatment need to be stricter for better outcomes of liver function with disease progression.

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The influence on liver function and therapeutical evaluation of lipiodol mitomycin emulsion infusion therapy for hepatocellular carcinoma with portal vein invasion or severe liver cirrhosis.

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.22.2032 ◽

1989 ◽

Vol 22 (8) ◽

pp. 2032-2038

Author(s):

Shinya ADACHI ◽

Katashi FUKAO ◽

Akio ISHIKAWA ◽

Yoji IWASAKI ◽

Naomi TANAKA ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Cirrhosis ◽

Liver Function ◽

Portal Vein ◽

Infusion Therapy ◽

Portal Vein Invasion ◽

Severe Liver

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3:18 PM Abstract No. 363 Do liver function scoring systems predict outcomes after portal vein embolization in non-hepatocellular carcinoma liver cancer?

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2018.01.403 ◽

2018 ◽

Vol 29 (4) ◽

pp. S156

Author(s):

A. Som ◽

C. Noda ◽

R. Ramaswamy ◽

S. Kim ◽

O. Akinwande

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Cancer ◽

Liver Function ◽

Portal Vein ◽

Portal Vein Embolization ◽

Scoring Systems

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Sorafenib for the treatment of patients with advanced hepatocellular carcinoma and alcoholic cirrhosis.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.352 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 352-352

Author(s):

P. Giovanis ◽

V. Vincenzi ◽

C. Manuppelli ◽

R. Berletti ◽

M. Marcante ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Function ◽

Disease Progression ◽

Median Time ◽

Alcoholic Cirrhosis ◽

Function Class ◽

Median Number ◽

Hcv Infection ◽

Advanced Hepatocellular Carcinoma ◽

Sorafenib Treatment

352 Background: Hepatocellular carcinoma (HCC) from alcoholic cirrhosis, associated or not with chronic hepatitis C virus (HCV) infection, is a particularly severe liver disease. Scanty and inconsistent data concerning the efficacy of sorafenib in patients (pts) with this disease are available. Methods: Since February 2009 we screened 26 Child-Pugh liver function class A pts bearing the above characteristics. Sixteen of them (61.5%), 15 males and 1 female with median age of 69 years (range 54-79), received 400 mg sorafenib b.i.d. Predominant cause of HCC was alcohol consumption in 13 pts (81.2%), associated with chronic HCV infection in 2 pts (12.5%), and hemosiderosis in 1 pt (6.2%). All pts suffered from multiple comorbidities, and 3 had been previously treated for Burkitt lymphoma, bladder and breast cancer. One pt with prostate cancer was on treatment with androgen blockade. Median number of concomitant medications was 4 (range 2-9). Four pts never received locoregional treatment, and none had received previous antineoplastic therapy. Results: Twelve pts (73%) discontinued sorafenib after a median time of 2 months (range 2-6). The reasons for treatment discontinuation were disease progression (4 pts), liver function deterioration (5 pts), and mild gastrointestinal adverse events (2 pts): 1 pt refused sorafenib treatment after 15 days. 2/4 patients still on treatment with sorafenib at 7, 8, 11, and 18 months showed partial response (RECIST criteria). Seven pts (40%) died because of disease progression at a median time of 5.5 months (range 2-9) and at a median overall survival time of 36 months from diagnosis (range 2-84). Conclusions: Treatment with sorafenib in pts affected by HCC and alcoholic cirrhosis seems effective and well tolerated with high-level compliance. The most common cause of discontinuation was progression of disease and liver function deterioration. No significant financial relationships to disclose.

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ASO Author Reflections: Portal Vein Embolization Followed by Hepatectomy for Hepatocellular Carcinoma in Patients with Impaired Liver Function: Is It Justified?

Annals of Surgical Oncology ◽

10.1245/s10434-020-08985-7 ◽

2020 ◽

Vol 27 (S3) ◽

pp. 876-877

Author(s):

Katsunori Imai ◽

Hideo Baba

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Function ◽

Portal Vein ◽

Portal Vein Embolization ◽

Impaired Liver Function ◽

Impaired Liver

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Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Tertiary Care Center Experience

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1734367 ◽

2021 ◽

Author(s):

Yashwant Patidar ◽

Amar Mukund ◽

Shiv K. Sarin ◽

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Liver Function ◽

Portal Vein ◽

Transarterial Chemoembolization ◽

Tumor Thrombus ◽

Portal Vein Tumor Thrombosis ◽

Main Portal Vein ◽

Portal Vein Invasion ◽

Tumor Thrombosis

Abstract Background Portal vein tumor thrombosis (PVTT) is a common complication of hepatocellular carcinoma (HCC) occurring in 30 to 40% of cases. The presence of PVTT in HCC is regarded as an advanced disease that confers poor prognosis and survival. Transarterial chemoembolization (TACE) has traditionally been considered to be contraindicated in cases of PVTT, due to the risk of hepatic infarction, and further deteriorate liver function. We evaluated safety, technical efficacy, and outcomes of TACE in HCC with PVTT. Methods From search results of the hospital database, out of 652 patients who underwent TACE for HCC, 73 patients of HCC with PVTT were retrospectively evaluated. Post-TACE tumor response by computed tomography (CT)/magnetic resonance imaging (MRI) imaging as per modified response evaluation criteria in solid tumors (mRECIST) criteria, if any occurrence of acute hepatic failure was assessed. Prognostic factors influencing survival were also determined. Results In our study population, the mean age of the patients was 58 years. The 12- and 24-month survival rates were 59 and 14%, respectively, with an overall median survival of 12.3 months. A total of 58.9% patients had branch portal vein tumor thrombus and 41.1% had tumor thrombus in the main portal vein. We did not encounter any mortality or acute liver failure following TACE in a 30-day period. Both univariate and multivariate analysis revealed Child–Pugh score (p = 0.01) and the extent of tumoral thrombus (p 0.004) as a significant prognostic factor. Patients with branch PVTT, no ascites, and Child–Pugh A had better survival than those having main portal vein tumor thrombus, ascites, and Child–Pugh B. Conclusion Our study concluded that TACE can achieve good disease control and improved survival in HCC with portal vein invasion despite being considered as a relative contraindication. Technical expertise, selection of patients, such as superselective catheterization and preserved liver function, are the key factors for a safe therapeutic procedure. Child–Pugh score and extent of portal vein invasion were the significant prognostic factors determining survival.

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