scholarly journals Factors predicting long-term outcome of early stage hepatocellular carcinoma after primary curative treatment - the role of surgical or nonsurgical methods

2020 ◽  
Author(s):  
Ming-Jeng Kuo ◽  
Chi-Ling Chen ◽  
Lein-ray Mo
Keyword(s):  
Hepatocellular Carcinoma ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Curative Treatment ◽  
Treatment Modalities ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Significant Difference ◽  
Early Hcc ◽  
Time Varying Covariates

Abstract Background The effect of putative factors on the clinical course of early hepatocellular carcinoma (HCC) after primary surgical or nonsurgical curative treatment, which remains elusive, was quantified. Methods Patients with newly diagnosed early HCC who received surgical resection (SR) or percutaneous radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) from January 2003 to December 2016 were enrolled. The cumulative overall survival (OS) and disease-free survival (DFS) were compared. A polytomous logistic regression was used to estimate factors regarding early and late recurrence. Independent predictors of OS were identified using Cox proportional hazard regression. Results One hundred twenty-five patients underwent SR, and 176 patients underwent RFA, of whom 72 were treated with TACE followed by RFA. Either match analysis based on propensity score or multiple adjustment regression showed no significant difference in DFS and OS between the two groups. Multivariate analysis showed high AFP (>= 20 ng/mL), and multinodularity significantly increased risk of early recurrence (<=1year). In contrast, hepatitis B virus, hepatitis C virus and multinodularity were significantly associated with late recurrence (>1year). Multivariate Cox regression with recurrent events as time-varying covariates identified older age (HR=1.55, 95% CI:1.01-2.36), clinically significant portal hypertension (CSPH) (HR=1.97, 95% CI:1.26-3.08), early recurrence (HR=6.62, 95% CI:3.79-11.6) and late recurrence (HR=3.75, 95% CI:1.99-7.08) as independent risk factors of mortality. A simple risk score showed fair calibration and discrimination in early HCC patients after primary curative treatment. In the Barcelona Clinic Liver Cancer (BCLC) stage A subgroup, SR significantly improved DFS comparing to those received RFA with or without TACE. Conclusion Host and tumor factors rather than the initial treatment modalities determine the outcomes of early HCC after primary curative treatment. Statistical models based on recurrence types can predict early HCC prognosis but further external validation is necessary.

scholarly journals Factors predicting long-term outcomes of early-stage hepatocellular carcinoma after primary curative treatment: the role of surgical or nonsurgical methods

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ming-Jeng Kuo ◽  
Lein-Ray Mo ◽  
Chi-Ling Chen
Keyword(s):  
Hepatocellular Carcinoma ◽  
External Validation ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Curative Treatment ◽  
Treatment Modalities ◽  
Increased Risk ◽  
Significant Difference ◽  
Early Hcc ◽  
Time Varying Covariates

Abstract Background We quantified the elusive effects of putative factors on the clinical course of early hepatocellular carcinoma (HCC) after primary surgical or nonsurgical curative treatment. Methods Patients with newly diagnosed early HCC who received surgical resection (SR) or percutaneous radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) from January 2003 to December 2016 were enrolled. The cumulative overall survival (OS) and disease-free survival (DFS) rates were compared. A polytomous logistic regression was used to estimate factors for early and late recurrence. Independent predictors of OS were identified using Cox proportional hazard regression. Results One hundred twenty-five patients underwent SR, and 176 patients underwent RFA, of whom 72 were treated with TACE followed by RFA. Neither match analysis based on propensity score nor multiple adjustment regression yielded a significant difference in DFS and OS between the two groups. Multivariate analysis showed high AFP (> 20 ng/mL), and multinodularity significantly increased risk of early recurrence (< 1 year). In contrast, hepatitis B virus, hepatitis C virus and multinodularity were significantly associated with late recurrence (> 1 year). Multivariate Cox regression with recurrent events as time-varying covariates identified older age (HR = 1.55, 95% CI:1.01–2.36), clinically significant portal hypertension (CSPH) (HR = 1.97, 95% CI:1.26–3.08), early recurrence (HR = 6.62, 95% CI:3.79–11.6) and late recurrence (HR = 3.75, 95% CI:1.99–7.08) as independent risk factors of mortality. A simple risk score showed fair calibration and discrimination in early HCC patients after primary curative treatment. In the Barcelona Clinic Liver Cancer (BCLC) stage A subgroup, SR significantly improved DFS compared to RFA with or without TACE. Conclusion Host and tumor factors rather than the initial treatment modalities determine the outcomes of early HCC after primary curative treatment. Statistical models based on recurrence types can predict early HCC prognosis but further external validation is necessary.

scholarly journals Preferred Treatment with Curative Intent for Left Lateral Segment Early Hepatocellular Carcinoma under the Era of Minimal Invasive Surgery

2022 ◽  
Vol 12 (1) ◽  
pp. 79
Author(s):  
Tsung-Han Wu ◽  
Yu-Chao Wang ◽  
Hao-Chien Hung ◽  
Jin-Chiao Lee ◽  
Chia-Ying Wu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Invasive Surgery ◽  
Survival Rates ◽  
Curative Treatment ◽  
Treatment Modalities ◽  
Curative Intent ◽  
Lateral Segment ◽  
Left Lateral Segment ◽  
Early Hcc ◽  
Hcc Recurrence

Background: Hepatocellular carcinoma (HCC) occurring at the left lateral segment (LLS) is relatively susceptible to treatment with curative intent in terms of tumor location. However, outcomes might vary depending on the selection of treatment modalities. This study aimed to analyze patients who had undergone curative treatment for early HCC at LLS. Methods: A retrospective analysis of 179 patients who underwent curative treatment for early HCC at LLS was performed. Patients were grouped based on treatment modalities, including radiofrequency ablation (RFA) and liver resection (LR). The long-term outcomes of the two groups were compared. Additionally, the impact of the LR approach on patient outcomes was analyzed. Results: Among these patients, 60 received RFA and 119 underwent LR as primary treatment with curative intent. During follow-up, a significantly higher incidence of HCC recurrence was observed in the RFA group (37/60, 61.7%) than in the LR group (45/119, 37.8%) (p = 0.0025). The median time of HCC recurrence was 10.8 (range: 1.1–60.9 months) and 17.6 (range: 2.4–94.8 months) months in the RFA and LR groups, respectively. In addition, multivariate analysis showed that liver cirrhosis, multiple tumors, and RFA treatment were significant risk factors for HCC recurrence. The 1-, 2-, and 5-year overall survival rates in the RFA and LR groups were 96.4%, 92.2%, and 71.5% versus 97.3%, 93.6%, and 87.7%, respectively. (p = 0.047). Moreover, outcomes related to LR were comparable between laparoscopic and conventional open methods. The 1-, 2-, and 5-year recurrence free survival rates in the laparoscopic (n = 37) and conventional open (n = 82) LR groups were 94.1%, 82.0%, and 66.9% versus 86.1%, 74.6%, and 53.1%, respectively. (p = 0.506) Conclusion: Early HCC at LLS had satisfactory outcomes after curative treatment, in which LR seems to have a superior outcome, as compared to RFA treatment. Moreover, laparoscopic LR could be considered a preferential option in the era of minimally invasive surgery.

scholarly journals Current Trends and Characteristics of Hepatocellular Carcinoma in Patients with Autoimmune Liver Diseases

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1023
Author(s):  
Eirini I. Rigopoulou ◽  
George N. Dalekos
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Liver Diseases ◽  
Treatment Modalities ◽  
Primary Biliary Cholangitis ◽  
Autoimmune Liver Diseases ◽  
Increased Risk ◽  
Liver Cancers ◽  
Medium Risk ◽  
Causes Of Mortality

Hepatocellular carcinoma (HCC), the commonest among liver cancers, is one of the leading causes of mortality among malignancies worldwide. Several reports demonstrate autoimmune liver diseases (AILDs), including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) to confer increased risk of hepatobiliary malignancies, albeit at lower frequencies compared to other liver diseases. Several parameters have been recognized as risk factors for HCC development in AIH and PBC, including demographics such as older age and male sex, clinical features, the most decisive being cirrhosis and other co-existing factors, such as alcohol consumption. Moreover, biochemical activity and treatment response have been increasingly recognized as prognostic factors for HCC development in AIH and PBC. As available treatment modalities are effective only when HCC diagnosis is established early, surveillance has been proven essential for HCC prognosis. Considering that the risk for HCC is not uniform between and within disease groups, refinement of screening strategies according to prevailing demographic, clinical, and molecular risk factors is mandated in AILDs patients, as personalized HCC risk prediction will offer significant advantage in patients at high and/or medium risk. Furthermore, future investigations should draw attention to whether modification of immunosuppression could benefit AIH patients after HCC diagnosis.

scholarly journals Homeostatic Model Assessment of Insulin Resistance for Predicting the Recurrence of Hepatocellular Carcinoma after Curative Treatment

2019 ◽  
Vol 20 (3) ◽  
pp. 605 ◽  
Author(s):  
Kenji Imai ◽  
Koji Takai ◽  
Tatsunori Hanai ◽  
Atsushi Suetsugu ◽  
Makoto Shiraki ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Insulin Resistance ◽  
Curative Treatment ◽  
Diabetic Patients ◽  
Model Assessment ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Significant Difference ◽  
The Impact ◽  
Hcc Recurrence

Diabetes mellitus (DM) is a risk factor for hepatocellular carcinoma (HCC). The purpose of this study was to investigate the impact of the disorder of glucose metabolism on the recurrence of HCC after curative treatment. Two hundred and eleven patients with HCC who received curative treatment in our hospital from 2006 to 2017 were enrolled in this study. Recurrence-free survival was estimated using the Kaplan–Meier method, and the differences between the groups partitioned by the presence or absence of DM and the values of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), fasting immunoreactive insulin (FIRI), and homeostasis model assessment-insulin resistance (HOMA-IR) were evaluated using the log-rank test. There were no significant differences in the recurrence-free survival rate between the patients with and without DM (p = 0.144), higher and lower levels of HbA1c (≥6.5 and <6.5%, respectively; p = 0.509), FPG (≥126 and <126 mg/dL, respectively; p = 0.143), and FIRI (≥10 and <10 μU/mL, respectively; p = 0.248). However, the higher HOMA-IR group (≥2.3) had HCC recurrence significantly earlier than the lower HOMA-IR group (<2.3, p = 0.013). Moreover, there was a significant difference between the higher and lower HOMA-IR groups without DM (p = 0.009), and there was no significant difference between those groups with DM (p = 0.759). A higher HOMA-IR level, particularly in non-diabetic patients, was a significant predictor for HCC recurrence after curative treatment.

scholarly journals Outcome of Oligonodular Hepatocellular Carcinoma after Hepatectomy

2020 ◽  
Vol 15 (1) ◽  
pp. 55-57
Author(s):  
SM Shakhwat Hossain ◽  
Md Mahboob Hasan ◽  
Md Mahbubur Rahman
Keyword(s):  
Hepatocellular Carcinoma ◽  
Recurrence Rate ◽  
Armed Forces ◽  
Early Recurrence ◽  
Intrahepatic Metastasis ◽  
High Rate ◽  
Preoperative Imaging ◽  
Military Hospital ◽  
Multicentric Occurrence ◽  
Significant Difference

Introduction: Hepatocellular carcinoma (HCC) is a common cancer and is the third most common cause of cancer-related death worldwide. Frequent recurrence of HCC after resection is a major surgical limitation. Early recurrence is the most disappointing outcome after surgery for multinodular HCC. Several studies found good results after hepatectomy for oligonodular (2 or 3 nodules) HCC. Objectives: To observe the recurrence rate three months after hepatectomy for oligonodular HCC and study the possible risk factors. Materials and Methods: The study population consisted of 102 patients with oligonodular HCC and received hepatectomy in Combined Military Hospital (CMH) between July 2011 and July 2017 according to the following criteria: (1) numbers of tumour nodules determined by preoperative imaging (computed tomography or magnetic resonance imaging) and intraoperative exploration; (2) diagnosis of HCC confirmed by postoperative histopathology; (3) incision margins negative; (4) complete clinicopathologic data; (5) adjuvant chemotherapy advised one month after operation. Multicentric occurrence (MO) and intrahepatic metastasis (IM) were determined in each patient according to the histopathologic examination. Results: Among 102 patients, 43(42.2%) had small tumor stain three months after surgery, 22(21.6%) and 21(20.6%) were definded as single and multiple recurrence respectively. The recurrence rate of patients with microvascular involvement was higher (64.3%) than those without (33.8%), (p<0.05). IM or MO, complete tumor capsule or not, number of tumors (2 versus 3), liver condition (cirrhosis versus chronic hepatitis) showed no significant difference. Conclusion: There was a high rate of very early recurrence for patients with oligonodular HCC three months ater hepatectomy, and the hepatic resection seems no-account for these patients regardless of very early recurrence or not a curative resection. Microvascular involvement was a risk factor while IM or MO is not. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 55-57

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