Tissue Diagnosis Is Associated With Worse Survival in Hepatocellular Carcinoma: A National Cancer Database Analysis

2021 ◽  
pp. 000313482199198
Author(s):  
Fadi S. Dahdaleh ◽  
Samer A. Naffouje ◽  
Scott K. Sherman ◽  
Sivesh K. Kamarajah ◽  
George I. Salti
Keyword(s):  
Hepatocellular Carcinoma ◽  
Clinical Diagnosis ◽  
Cox Regression ◽  
National Cancer Database ◽  
Tissue Diagnosis ◽  
Needle Tract ◽  
User File ◽  
Propensity Matching ◽  
Needle Tract Seeding ◽  
Procedure Type

Background Biopsy to achieve tissue diagnosis (TD) of hepatocellular carcinoma (HCC) risks needle tract seeding. With chest wall and peritoneal recurrences reported, TD could worsen cancer outcomes. We investigated HCC outcomes after TD compared to clinical diagnosis (CD), hypothesizing that TD adversely affects overall survival (OS). Methods The National Cancer Database (NCDB) Participant User File for liver cancer was reviewed, including patients with nonmetastatic HCC treated with major hepatectomy or transplantation. Clinical diagnosis patients were matched 1:1 to TD patients per propensity score. Survival was examined in the unmatched and matched cohorts. Results Of 172 283 cases, 16 366 met inclusion criteria. Mean age was 60.8 years, 12 100 (73.9%) were male, and 48.4% of patients received hepatectomies. Clinical diagnosis occurred in 70.4% of cases, and 29.6% underwent TD. Cox regression confirmed the diagnostic method as an independent predictor of OS in addition to age, Charlson-Deyo score, grade, delay of surgery, lymphovascular invasion, nodal stage, and procedure type, favoring transplantation over hepatectomy. After propensity matching on these factors, 4251 patients were matched from each group. In the matched cohort, patients with TD had a significantly lower OS than patients with CD (median: 65.5 vs. 85.6 ± 2.7 months, P < .001). The corresponding 5-year survival was lower in the TD group (47.6% vs. 60.9% P < .001). Conclusion Hepatocellular carcinoma patients with preoperative TD had decreased OS compared to CD, which persisted after propensity matching. This study supports avoiding biopsy for HCC whenever possible.

2218 Recurrent Hepatocellular Carcinoma From Needle Tract Seeding 13 Years Post-Transplant

2019 ◽  
Vol 114 (1) ◽  
pp. S1242-S1243
Author(s):  
Quinton D. Palmer ◽  
Abhilash Perisetti ◽  
Brannon Broadfoot ◽  
Kemmian D. Johnson ◽  
Mauricio Garcia-Saenz-de-Sicilia
Keyword(s):  
Hepatocellular Carcinoma ◽  
Post Transplant ◽  
Recurrent Hepatocellular Carcinoma ◽  
Needle Tract ◽  
Needle Tract Seeding

Incidence of needle tract seeding and responses of soft tissue metastasis by hepatocellular carcinoma postradiotherapy

2007 ◽  
Vol 27 (2) ◽  
pp. 192-200 ◽  
Author(s):  
Wei-Chih Tung ◽  
Yu-Jie Huang ◽  
Stephen Wan Leung ◽  
Fang-Ying Kuo ◽  
Hung-Da Tung ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Soft Tissue ◽  
Soft Tissue Metastasis ◽  
Needle Tract ◽  
Needle Tract Seeding

Comparative effectiveness of nonsurgical therapies for localized hepatocellular carcinoma: Analysis of the National Cancer Database.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 425-425 ◽  
Author(s):  
Devalkumar Rajyaguru ◽  
Andrew Borgert ◽  
Peter James Polewski ◽  
Angela Smith
Keyword(s):  
Hepatocellular Carcinoma ◽  
Treatment Options ◽  
International Normalized Ratio ◽  
Stage I ◽  
Treatment Modalities ◽  
Median Income ◽  
National Cancer Database ◽  
Treatment Groups ◽  
Propensity Matching ◽  
Ishak Fibrosis Score

425 Background: Data guiding selection of optimal nonsurgical therapies for management of localized hepatocellular carcinoma (HCC) are lacking. Because there are limited prospective comparative data for these treatment modalities, we aimed to compare the effectiveness of chemotherapy (systemic or arterial directed) versus radiofrequency ablation (RFA) versus radioembolization (RE) in nonsurgically managed patients with stage I and II HCC using the National Cancer Database. Methods: We identified patients who received chemotherapy, RFA or RE for nonsurgically managed Stage I (T1N0M0) and II (T2N0M0) HCC between 2008 and 2013. Patients excluded included those who received upfront lobectomy or resection or extended lobectomy or hepatectomy or transplant, and if they had Ishak fibrosis score of 5-6 or total bilirubin > 3 mg/dl or international normalized ratio (INR) of > 3. Overall survival (OS) was compared between treatment groups using propensity score matched (1:1:1) and weighted analyses. We also verified balance of all available confounders, and assessed sensitivity to unobserved confounding. Results: Overall 2622 (73.2%), 837 (23.3%) and 125 (3.5%) patients with nonsurgically managed stage I and II HCC received chemotherapy, RFA and RE, respectively. RE treated patients tend to be older, live in the areas with a higher median income and higher percentage of high school- educated residents, and have stage II disease. The propensity matched cohort included 303 patients with baseline characteristics well balance between all arms. After propensity matching, 5-year OS was 17.4% (95% CI, 6.6% to 32.3%) in the chemotherapy group, 27.2% (95% CI, 14.2% to 42%) in the RFA group and 36.6% (95% CI, 23.1% to 50.1%) in RE group (p = 0.48). Conclusions: To our knowledge, this is the first study comparing various different nonsurgical therapies for localized HCC. All chemotherapy, RFA and RE are effective treatment options for nonsurgically managed patients with stage I and II HCC. Although these data are retrospective, RE appears to be a reasonable first-line treatment of nonsurgically managed stage I and II HCC in carefully selected patients.

Radiofrequency Ablation of Needle Tract Seeding in Hepatocellular Carcinoma

2005 ◽  
Vol 16 (5) ◽  
pp. 743-746 ◽  
Author(s):  
Sophie Espinoza ◽  
Patricio Briggs ◽  
Jean-Sébastien Duret ◽  
Matthieu Lapeyre ◽  
Thierry de Baère
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Needle Tract ◽  
Needle Tract Seeding

scholarly journals Stereotactic ablative body radiotherapy versus conventionally fractionated radiotherapy for early stage large cell neuroendocrine carcinoma of the lung

2020 ◽  
Vol 9 (3) ◽  
pp. LMT32
Author(s):  
Rodney E Wegner ◽  
Stephen Abel ◽  
Athanasios Colonias
Keyword(s):  
Neuroendocrine Carcinoma ◽  
Cox Regression ◽  
Early Stage ◽  
Large Cell ◽  
Large Cell Neuroendocrine Carcinoma ◽  
National Cancer Database ◽  
Fractionated Radiotherapy ◽  
Academic Center ◽  
Stereotactic Ablative Body Radiotherapy ◽  
Propensity Matching

Aim: Some patients with early stage large cell neuroendocrine carcinoma (LCNEC) of the lung are not surgical candidates and will be managed with radiotherapy. We used the national cancer database to identify predictors of stereotactic radiotherapy and compare outcomes. Materials & methods: We queried national cancer database for T1-2N0 LCNEC treated with radiation. Logistic regression and Cox regression identified predictors of stereotactic ablative body radiotherapy (SABR) and survival, respectively. Results: We identified 754 patients, with 238 (32%) treated with SABR. Predictors of SABR were distance to facility, no chemotherapy, academic center, T1 and recent year. After propensity matching, median survival was 34.7 months compared with 23.7 months in favor of SABR (p = 0.02). Conclusion: SABR for LCNEC has increased over time and was associated with improved survival.

scholarly journals A prognostic nomogram based on LASSO Cox regression in patients with alpha-fetoprotein-negative hepatocellular carcinoma following non-surgical therapy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dongdong Zhou ◽  
Xiaoli Liu ◽  
Xinhui Wang ◽  
Fengna Yan ◽  
Peng Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Therapy ◽  
Calibration Curve ◽  
Cox Regression ◽  
Validation Cohort ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Alpha Fetoprotein ◽  
Clinicopathologic Characteristics

Abstract Background Alpha-fetoprotein-negative hepatocellular carcinoma (AFP-NHCC) (< 8.78 ng/mL) have special clinicopathologic characteristics and prognosis. The aim of this study was to apply a new method to establish and validate a new model for predicting the prognosis of patients with AFP-NHCC. Methods A total of 410 AFP-negative patients with clinical diagnosed with HCC following non-surgical therapy as a primary cohort; 148 patients with AFP-NHCC following non-surgical therapy as an independent validation cohort. In primary cohort, independent factors for overall survival (OS) by LASSO Cox regression were all contained into the nomogram1; by Forward Stepwise Cox regression were all contained into the nomogram2. Nomograms performance and discriminative power were assessed with concordance index (C-index) values, area under curve (AUC), Calibration curve and decision curve analyses (DCA). The results were validated in the validation cohort. Results The C-index of nomogram1was 0.708 (95%CI: 0.673–0.743), which was superior to nomogram2 (0.706) and traditional modes (0.606–0.629). The AUC of nomogram1 was 0.736 (95%CI: 0.690–0.778). In the validation cohort, the nomogram1 still gave good discrimination (C-index: 0.752, 95%CI: 0.691–0.813; AUC: 0.784, 95%CI: 0.709–0.847). The calibration curve for probability of OS showed good homogeneity between prediction by nomogram1 and actual observation. DCA demonstrated that nomogram1 was clinically useful. Moreover, patients were divided into three distinct risk groups for OS by the nomogram1: low-risk group, middle-risk group and high-risk group, respectively. Conclusions Novel nomogram based on LASSO Cox regression presents more accurate and useful prognostic prediction for patients with AFP-NHCC following non-surgical therapy. This model could help patients with AFP-NHCC following non-surgical therapy facilitate a personalized prognostic evaluation.

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