Sorafenib versus transarterial chemoembolization as adjuvant therapies for patients with hepatocellular carcinoma and microvascular invasion.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 244-244 ◽  
Author(s):  
Xinyu Bi ◽  
Jie Gao ◽  
Jianqiang Cai
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Resection ◽  
Transarterial Chemoembolization ◽  
Standard Of Care ◽  
Intermediate Stage ◽  
Microvascular Invasion ◽  
Rank Test ◽  
Control Group ◽  
Adjuvant Therapies ◽  
Sorafenib Group

244 Background: Microvascular invasion (MVI) is a risk factor for poor prognosis following curative resection in hepatocellular carcinoma (HCC). Currently, there is no standard of care for patients with HCC and MVI. The present study compared the effectiveness of sorafenib and transarterial chemoembolization (TACE) as adjuvant therapies following hepatic resection in patients with early and intermediate-stage HCC and MVI. Methods: This bi-center retrospective study examined 70 patients with HCC and MVI treated by hepatic resection between June 2009 and March 2018. Twenty-four patients received no postoperative adjuvant therapy (control), 19 received TACE and 27 received sorafenib. Recurrence-free survival (RFS) and overall survival (OS) were compared by the log-rank test. Results: Subjects consisted of 62 males and 8 females, with a median age of 53.5 (range, 28-82) years. The median follow-up was 26.0 (range, 4.1-103.1) months. RFS in the sorafenib group was significantly improved compared with the TACE group (P=0.048), but not with the control group. OS in the sorafenib group was significantly improved compared with both TACE (P=0.015; 2-year OS: 100% vs. 78.6%) and control (P=0.023; 2-year OS: 100% vs. 80.0%) groups. Conclusions: Adjuvant sorafenib following hepatic resection improved OS in patients with HCC and MVI and might be a better choice than adjuvant TACE.

scholarly journals Hepatic Resection Versus Transarterial Chemoembolization for Intermediate-Stage Hepatocellular Carcinoma: A Cohort Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Linbin Lu ◽  
Peichan Zheng ◽  
Zhixian Wu ◽  
Xiong Chen
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Resection ◽  
Transarterial Chemoembolization ◽  
Proportional Hazards ◽  
Intermediate Stage ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Real World Data ◽  
Risk Of Death ◽  
The Impact

BackgroundThe selection criteria for hepatic resection (HR) in intermediate-stage (IM) hepatocellular carcinoma (HCC) are still controversial. We used real-world data to evaluate the overall survival (OS) in treatment with HR or transarterial chemoembolization (TACE).MethodsIn total, 942 patients with IM-HCC were categorized into the HR group and the TACE group. OS was analyzed using the Kaplan–Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched (PSM) analysis. Curve smoothing was performed through the generalized additive model. The interaction test was performed to evaluate the impact of HR on OS concerning risk factors. Also, we used multiple imputation to deal with missing data.ResultsIn total, 23.0% (n = 225) of patients received HR. At a median OS of 23.7 months, HR was associated with improved OS in the multivariate analysis [hazard ratio (HzR) = 0.45, 95%CI = 0.35–0.58; after PSM: HzR = 0.56, 95%CI = 0.41–0.77]. Landmark analyses limited to long-term survivors of ≥6 months, ≥1 year, and ≥2 years demonstrated better OS with HR in all subsets (all p < 0.05). After PSM analysis, however, HR increased the risk of death by 20% (HzR = 1.20, 95%CI = 0.67–2.15) in the subgroup of patients with lactate dehydrogenase (LDH) ≤192 U/L (p for interaction = 0.037). Furthermore, the significant interaction was robust between the LDH and HR with respect to the 1-, 3-, and 5-year observed survival rates (all p < 0.05).ConclusionHR was superior to TACE for intermediate-stage HCC in patients with LDH levels >192 U/L. Moreover, TACE might be suitable for patients with LDH levels ≤192 U/L.

scholarly journals Transarterial Chemoembolization Combined with Radiofrequency Ablation in the Treatment of Stage B1 Intermediate Hepatocellular Carcinoma

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Furong Liu ◽  
Minshan Chen ◽  
Jie Mei ◽  
Li Xu ◽  
Rongping Guo ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Transarterial Chemoembolization ◽  
Progression Free Survival ◽  
Intermediate Stage ◽  
Multivariate Regression Analysis ◽  
Rank Test ◽  
Free Survival ◽  
Kaplan Meier ◽  
Tace Group

Background. Due to the heterogeneity of patients with Barcelona clinic liver cancer (BCLC) intermediate-stage hepatocellular carcinoma (HCC), Bolondi criteria were proposed and patients were divided into four substages. The purpose of this study was to compare the survival of substage B1 patients who were initially treated with a combination of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) (TACE-RFA) or TACE alone. Methods. 404 patients with stage B1 HCC were retrospectively analyzed from January 2005 to December 2012. 209 patients received TACE-RFA, and 195 received TACE alone as initial treatment. The overall survival (OS) and progression-free survival (PFS) rates were estimated by the Kaplan–Meier method and compared by the log-rank test. Results. 1-, 3-, and 5-year OS rates were 83.7%, 45.8%, and 24.8% in the TACE-RFA group and 80.7%, 26.4%, and 16.7% in the TACE group, respectively (P=0.003). The corresponding PFS rates were 71.8%, 26.6%, and 13.0% and 59.1%, 11.0%, and 2.2% in the TACE-RFA group and TACE group, respectively (P<0.001). Multivariate regression analysis indicated that tumor size (OS: hazard ratio (HR) = 0.683, P=0.001; PFS: HR = 0.761, P=0.013), along with treatment allocation (OS: HR = 0.701, P=0.003; PFS: HR = 0.620, P<0.001), was the independent prognostic factor for both OS and PFS. Conclusions. Combination TACE and RFA treatment yielded better survival than TACE alone for patients with stage B1 HCC according to the Bolondi criteria.

Hepatocellular Carcinoma Tumor Board: Making Sense of the Technologies

2015 ◽  
pp. e213-e220 ◽  
Author(s):  
Ghassan K. Abou-Alfa ◽  
Jorge Marrero ◽  
John Renz ◽  
Riccardo Lencioni
Keyword(s):  
Hepatocellular Carcinoma ◽  
Transarterial Chemoembolization ◽  
Viral Infections ◽  
Surgical Techniques ◽  
Standard Of Care ◽  
Intermediate Stage ◽  
Tumor Board ◽  
Nonalcoholic Fatty Liver ◽  
Advanced Hcc ◽  
Curative Therapy

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death, with a rising global incidence. The vast majority of HCC cases occur in the setting of liver cirrhosis, mainly due to chronic hepatitis C (HCV) or hepatitis B (HBV) viral infections, alcohol consumption, and nonalcoholic fatty liver disease. The new approval of curative therapy with two NS5A inhibitors, ledipasvir and sofosbuvir, for the treatment of HCV will no doubt affect HCC incidence and outcome. No studies have evaluated the use of the new antivirals in patients with HCC. Staging and scoring remain an integral part of the management of patients with advanced HCC. Curative therapies for the treatment of HCC are evolving. Improvements in surgical techniques and risk stratification for orthotopic liver transplantation (OLT) have expanded access and improved the outlook for patients suffering from HCC. Interventional locoregional treatments continue to play a key role in the management of HCC. Transarterial chemoembolization is considered the standard of care for patients with noninvasive multinodular tumors at the intermediate stage. Bland embolization appears to have similar virtues in some studies. Y90 radioembolization represents a promising treatment option for patients unfit or refractory to transarterial chemoembolization. The advent of sorafenib as a standard of care with an improvement in survival sadly remain the only major breakthrough in the treatment of advanced HCC, with mounting negative data from multiple clinical trials. Advances in immunotherapy and customized therapy may hopefully help reverse this tide.

scholarly journals Nomograms including the controlling nutritional status (CONUT) score in patients with hepatocellular carcinoma undergoing transarterial chemoembolization for prediction survival: A retrospective analysis

2021 ◽  
pp. 1-28
Author(s):  
Yi Chen ◽  
Wen-ji Xu ◽  
Yi Yang ◽  
Yu-Jing Xin ◽  
Xin-yuan Zhang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Nutritional Status ◽  
Transarterial Chemoembolization ◽  
Cox Regression ◽  
Multivariate Analyses ◽  
Intermediate Stage ◽  
Rank Test ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Conut Score

Abstract Objectives: This retrospective study investigated the predictive value of the Controlling Nutritional Status (CONUT) score in patients with intermediate-stage hepatocellular carcinoma (HCC) who received transarterial chemoembolization (TACE). Nomograms were developed to predict progression-free and overall survival (PFS, OS). Methods: The medical data of 228 patients with HCC and treated with TACE were collected. The patients were apportioned to 2 groups according to CONUT score: low or high (<4, ≥4). Univariate and multivariate analyses were performed using Cox regression for OS and PFS. OS and PFS were estimated by the Kaplan-Meier curve and compared with the log-rank test. Nomograms were constructed to predict patient OS and PFS. The nomograms were evaluated for accuracy, discrimination, and efficiency. Results: The cut-off value of CONUT score was 4. The higher the CONUT score, the worse the survival; Kaplan-Meier curves showed significant differences in OS and PFS between the low and high CONUT score groups (P = 0.033, 0.047). The nomograms including CONUT, based on the prognostic factors determined by the univariate and multivariate analyses, to predict survival in HCC after TACE were generated. Conclusions: The CONUT score is an important prognostic factor for both OS and PFS for patients with intermediate HCC who underwent TACE. The cut-off value of the CONUT score was 4. A high CONUT score suggests poor survival outcomes. Nomograms generated based on the CONUT score were good models to predict patient OS and PFS.

scholarly journals Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma

2016 ◽  
Vol 37 (3) ◽  
pp. 423-433 ◽  
Author(s):  
Anna Pecorelli ◽  
Barbara Lenzi ◽  
Annagiulia Gramenzi ◽  
Francesca Garuti ◽  
Fabio Farinati ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Transarterial Chemoembolization ◽  
Standard Of Care ◽  
Intermediate Stage

scholarly journals Effect of Transarterial Chemoembolization on ALBI Grade in Intermediate-Stage Hepatocellular Carcinoma: Criteria for Unsuitable Cases Selection

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4325
Author(s):  
Chen-Ta Chi ◽  
I-Cheng Lee ◽  
Rheun-Chuan Lee ◽  
Ya-Wen Hung ◽  
Chien-Wei Su ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
At Risk ◽  
Transarterial Chemoembolization ◽  
Standard Of Care ◽  
Intermediate Stage ◽  
Tumor Burden ◽  
Factors Associated ◽  
Tumor Number ◽  
Tumor Involvement ◽  
Grade 3

Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC). We aimed to identify unsuitable cases who were at risk of ALBI-grade migration by TACE. Consecutive 531 BCLC-B HCC patients undergoing TACE were reviewed, and factors associated with ALBI-grade migration were analyzed. There were 129 (24.3%) patients experienced acute ALBI-grade migration after TACE, and 85 (65.9%) out of the 129 patients had chronic ALBI-grade migration. Incidences of acute ALBI-grade migration were 13.9%, 29.0% for patients within or beyond up-to-7 criteria (p < 0.001) and 20.0%, 36.2% for patients within or beyond up-to-11 criteria (p < 0.001), respectively. HBV infection, tumor size plus tumor number criteria were risk factors associated with acute ALBI-grade migration. Bilobar tumor involvement was the risk factor of chronic ALBI-grade migration in patients with acute ALBI-grade migration. Up-to-eleven (p = 0.007) performed better than up-to-seven (p = 0.146) to differentiate risk of dynamic ALBI score changes. Moreover, ALBI-grade migration to grade 3 has adverse effect on survival. In conclusion, tumor burden beyond up-to-eleven was associated with ALBI-grade migration after TACE, indicating that up-to-eleven can select TACE-unsuitable HCC patients who are at risk of liver function deterioration.

Hepatic resection is superior to transarterial chemoembolization for treating intermediate-stage hepatocellular carcinoma

2016 ◽  
Vol 37 (7) ◽  
pp. 1083-1084 ◽  
Author(s):  
Jian-Hong Zhong ◽  
Ning-Fu Peng ◽  
Xue-Mei You ◽  
Liang Ma ◽  
Le-Qun Li
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Resection ◽  
Transarterial Chemoembolization ◽  
Intermediate Stage

scholarly journals High Visceral Adipose Tissue Density Correlates With Unfavorable Outcomes in Patients With Intermediate-Stage Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

2021 ◽  
Vol 9 ◽  
Author(s):  
Qiang Li ◽  
Lei Zhang ◽  
Zhong-Heng Hou ◽  
Dong-Xu Zhao ◽  
Jian-Bin Li ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Body Composition ◽  
Adipose Tissue ◽  
Transarterial Chemoembolization ◽  
Cox Regression ◽  
Intermediate Stage ◽  
Rank Test ◽  
Muscle Area ◽  
Cox Regression Analysis ◽  
Kaplan Meier

Objectives: This study aimed to evaluate the association between different body composition features with prognostic outcomes of intermediate stage hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE).Methods: The areas and density of skeletal muscle area (SM) and adipose tissue [subcutaneous (SAT); visceral (VAT)] were calculated on the pre-TACE CT scans. Overall survival (OS) and progression-free survival (PFS) curves were calculated using the Kaplan–Meier method and compared with log-rank test. The discrimination and performance of body composition features were measured by area under time-dependent receiver operating characteristic (ROC) curve. Univariate and multivariate Cox proportional hazard analyses were applied to identify the association between body composition parameters and outcomes.Results: A significant prolonged OS and PFS was displayed by Kaplan–Meier curve analysis for HCC patients with VAT HU below −89.1 (25.1 months, 95% CI: 18.1–32.1 vs. 17.6 months, 95% CI: 16.3–18.8, p &lt; 0.0001, 15.4 months, 95% CI: 10.6–20.2 vs. 6.6 months, 95% CI: 4.9–8.3, p &lt; 0.0001, respectively). The 1-, 2-, 3-, and 5-year OS area under the curve (AUC) values of the VAT HU were higher than the other body composition parameters. Meanwhile, it is also found that 3-, 6-, 9-, and 12-month PFS AUC values of VAT HU were the highest among all the parameters. Univariate and multivariate Cox-regression analysis suggested a significant association between VAT density and outcomes (OS, HR: 1.015, 95% CI: 1.004–1.025, p = 0.005, PFS, HR: 1.026, 95% CI: 1.016–1.036, p &lt; 0.0001, respectively).Conclusion: The VAT density could provide prognostic prediction value and may be helpful to stratify the intermediate stage HCC patients.

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