Use of a Novel Index, the A-Index, and Its Associated Nomogram to Predict Overall Survival Rates after Radical Resection of Primary Hepatocellular Carcinoma

Dendritic cells (DCs) and cytokine-induced killer (CIK) cells play an important role in the anti-tumor immune response. In this study, we evaluated the clinical effectiveness of DC/CIK-CD24 immunotherapies to primary hepatocellular carcinoma patients who received radical resection. 36 resected primary hepatocellular carcinoma (HCC) patients were enrolled from August 2014 to December 2015. All patients received two or four times of DC/CIK immunotherapy after radical resection. 1–4 years patients’ survival rates were evaluated during the follow-up. The 4-year survival rate of patients who received two times of immunotherapy was 47.1%, and the rate of those who received four times of immunotherapies was 52.6%. Compared to baseline, after receiving the DC/CIK-CD24 autotransfusion, the serum Treg concentration of the patients decreased, while CD3+, CD4+, CD56+ increased slightly. The adverse effect of immunotherapy was I–II° transient fever and could be tolerable. DC/CIK-CD24 immunotherapy can delay the relapse time.

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Poor Prognostic Factors after Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma in the Modern Era

The American Surgeon ◽

10.1177/000313481207800431 ◽

2012 ◽

Vol 78 (4) ◽

pp. 419-425 ◽

Cited By ~ 6

Author(s):

Eiji Tsujita ◽

Yo-Ichi Yamashita ◽

Kazuki Takeishi ◽

Ayumi Matsuyama ◽

Shin-Ichi Tsutsui ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Prognostic Factors ◽

Survival Rates ◽

Repeat Hepatectomy ◽

Recurrent Hepatocellular Carcinoma ◽

The Poor ◽

Estimated Blood Loss ◽

Poor Outcomes ◽

Overall Survival Rates

The purpose of this study was to determine the poor prognostic factors after repeat hepatectomy (Hx) in patients with recurrent hepatocellular carcinoma (HCC). Overall survival rates and clinicopathological variables in 112 patients with repeat Hx from 1992 to 2010 were compared with those in 531 patients who underwent a primary Hx. To clarify the poor prognosis factors after repeat Hx, survival data among 112 patients were univariately and multivariately analyzed. Overall survival after repeat Hx was similar for that of the patients who underwent a primary Hx. The mean age of repeat Hx group was significantly higher, and a well-preserved liver function was recognized than the primary Hx group. Multivariate analysis revealed that: 1) indocyanine green retention rate at 15 minutes; 2) disease-free interval; 3) tumor size; 4) portal vein invasion at primary Hx; 5) gender; and 6) estimated blood loss to be an independent and significant poor prognostic factors. The overall 3-year postrecurrence overall survival rates were 100, 91.3, 59.6, and 0 per cent at risk number (R) R0, R1/2, R3, R4, respectively ( P < 0.05). Repeat Hx provided a good compatible prognosis with primary Hx. In our findings, five risk factors to predict poor outcomes after repeat Hx were useful. Patients with recurrent HCC do not have universally poor outcomes, and our simple scoring system using five poor prognostic factors could serve to advise the prognosis and the potential benefit for patient selection about repeat Hx.

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Transarterial Embolization for Hepatocellular Carcinoma: A Comparison between Nonspherical PVA and Microspheres

BioMed Research International ◽

10.1155/2015/435120 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Leandro Armani Scaffaro ◽

Cleber Dario Pinto Kruel ◽

Steffan Frosi Stella ◽

Gabriela Leal Gravina ◽

Geraldo Machado Filho ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Tumor Response ◽

Transarterial Embolization ◽

Survival Rates ◽

Embolic Agent ◽

Single Center ◽

Embolic Agents ◽

Postembolization Syndrome ◽

Overall Survival Rates

Transarterial chemoembolization (TACE) and transarterial embolization (TAE) have improved the survival rates of patients with unresectable hepatocellular carcinoma (HCC); however, the optimal TACE/TAE embolic agent has not yet been identified. The aim of this study was to compare the effect of two different embolic agents such as microspheres (ME) and polyvinyl alcohol (PVA) on survival, tumor response, and complications in patients with HCC submitted to transarterial embolization (TAE). Eighty HCC patients who underwent TAE between June 2008 and December 2012 at a single center were retrospectively studied. A total of 48 and 32 patients were treated with PVA and ME, respectively. There were no significant differences in survival (P=0.679) or tumoral response (P=0.369) between groups (PVA or ME). Overall survival rates at 12, 18, 24, 36, and 48 months were 97.9, 88.8, 78.9, 53.4, and 21.4% in the PVA-TAE group and 100, 92.9, 76.6, 58.8, and 58% in the ME-TAE group (P=0.734). Patients submitted to TAE with ME presented postembolization syndrome more frequently when compared with the PVA group (P=0.02). According to our cohort, the choice of ME or PVA as embolizing agent had no significant impact on overall survival.

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The outcome of definitive or salvage radiotherapy for locally advanced hepatocellular carcinoma: A retrospective cohort study of 822 patients from a single institution.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.248 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 248-248

Author(s):

J. Seong

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Cohort Study ◽

Retrospective Cohort ◽

Locally Advanced ◽

Survival Rates ◽

Advanced Hcc ◽

Overall Survival Rates ◽

Better Than ◽

3D Crt

248 Background: With technological development and awareness of efficacy, radiotherapy (RT) is more frequently adopted in management of hepatocellular carcinoma (HCC). To assess the efficacy of RT, we conducted this retrospective cohort study from a single institute. Methods: The analysis involved 822 patients who underwent definitive or salvage RT for locally advanced HCC from January 1997 to August 2009. Two-dimensional RT, 3-dimensional conformal RT (3D-CRT), and intensity-modulated RT including tomotherapy (IMRT) were carried out for 186 (22.6%), 579 (70.4%), and 57 (6.9%) patients, respectively. In a majority of patients, RT was done either concurrently with intra-arterial 5-FU (500 mg/m2) chemotherapy (CCRT group; 326 patients, 39.7%), or following transarterial chemoembolization (TACE+RT group; 244 patients, 29.7%). Total radiation dose was 30 to 64.8 Gy (median dose 45 Gy) in 1.8-2 Gy fraction. Results: The median age of total 822 patients was 55 and 84.3% was male. The 2, 3, and 4-year overall survival rates of total patients were 21.2, 13.1, and 10.1%, respectively. In 2-year survival, the patients with Child-Pugh class A did better than B or C (23% vs 10.9%, p<0.001), without portal vein thrombosis (PVT) did better than with PVT (26.8% vs 14.3%, p<0.001), and without lymph node metastasis (LNM) did better than with LNM (22.9% vs 11.7%, p<0.001). Patients with total dose higher than 45 Gy did better than those with less than 45 Gy (30.1% vs. 15.6%, p<0.001). The best outcome was shown in patients received higher than 45 Gy using 3D-CRT or IMRT, with 2-year overall survival rates of 25.9% (CCRT) and 41.3% (TACE+RT). Conclusions: This study showed a substantial effect of RT in locally advanced HCC. Further analysis will be continued to provide the best option of radiotherapy for locally advanced HCC. No significant financial relationships to disclose.

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Intra-Procedural CT/MR-Ultrasound Fusion Imaging Helps to Improve Outcomes of Thermal Ablation for Hepatocellular Carcinoma: Results in 502 Nodules

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1021-1616 ◽

2019 ◽

Cited By ~ 1

Author(s):

Erjiao Xu ◽

Kai Li ◽

Yinglin Long ◽

Liping Luo ◽

Qingjing Zeng ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Thermal Ablation ◽

Survival Rates ◽

Major Complication ◽

Fusion Imaging ◽

Milan Criteria ◽

Efficacy Rate ◽

Institutional Review ◽

Overall Survival Rates

Abstract Purpose The aim was to assess the value of intra-procedural CT/MR-ultrasound (CT/MR-US) fusion imaging in the management of thermal ablation for hepatocellular carcinoma (HCC). Materials and Methods This retrospective study was approved by the institutional review board. From May 2010 to October 2016, 543 HCC nodules in 440 patients (387 men and 53 women; age range: 25–84 years) that met the Milan Criteria were treated by percutaneous thermal ablation using intra-procedural CT/MR-US fusion imaging. The HCC nodules were divided into subgroups and compared (≤ 3 cm and > 3 cm, or high-risk and low-risk location, or inconspicuous and conspicuous, respectively). Technique efficacy and major complication were calculated. Cumulative local tumor progression (LTP), tumor-free and overall survival rates were estimated with the Kaplan-Meier method. Results CT/MR-US fusion imaging was successfully registered in 419 patients with 502 nodules. The technique efficacy rate of thermal ablation was 99.4 %. The major complication rate was 1.9 %. The cumulative LTP rates were 3.2 %, 5.6 % and 7.2 % at 1, 3, and 5 years, respectively. There were no significant differences for the comparisons of cumulative LTP rates between different subgroups (P = 0.541, 0.314, 0.329). The cumulative tumor-free survival rates were 74.8 %, 54.0 % and 37.5 % at 1, 3, and 5 years, respectively. The cumulative overall survival rates were 97.8 %, 87.1 % and 81.7 % at 1, 3, and 5 years, respectively. Conclusion Intra-procedural CT/MR-ultrasound fusion imaging is a useful technique for percutaneous liver thermal ablation. It could help to achieve satisfying survival outcomes for HCC patients who meet the Milan Criteria.

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Long-term outcomes of synchronous splenectomy and hepatectomy or radiofrequency ablation for hepatocellular carcinoma and esophagogastric variceal bleeding

10.21203/rs.3.rs-367796/v1 ◽

2021 ◽

Author(s):

Jia-li Ma ◽

Li Jiang ◽

Ping Li ◽

Ling-ling He ◽

Hong-shan Wei

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Variceal Bleeding ◽

Survival Rates ◽

Recurrence Free Survival ◽

Long Term Outcomes ◽

Survival Curves ◽

Free Survival ◽

Overall Survival Rates

Abstract Aim: This study aimed to compare the long-term outcomes of hepatectomy and radiofrequency ablation (RFA) combined with pericardial devascularization (PCDV) plus splenectomy for patients with cirrhosis having hepatocellular carcinoma and esophagogastric variceal bleeding.Materials and Methods: Between October 2008 and March 2018, 46 patients with cirrhosis having hepatocellular carcinoma and esophagogastric variceal bleeding for portal hypertension were included in this study. The overall survival curves, recurrence-free survival curves, and rebleeding-free survival curves were plotted using Kaplan–Meier analysis. The log-rank test was used to compare time-to-event curves between groups.Results: The median follow-up time was 38 months. Among 20 patients undergoing RFA, the 1-, 3-, and 5-year overall survival rates were 95.00%,60.00%, and 35.00%, respectively. The 1-, 3- and 5-year recurrence-free survival rates were 35.00%, 25.00%, and 10.00%, respectively. The 1,3- and 5-year rebleeding-free survival rates were 85.00%, 60.00%, and 40.00%, respectively. Among 26 patients undergoing hepatectomy, the 1-, 3-, and 5-year overall survival rates were 96.15%,50.00%, and 34.62%, respectively. The 1-, 3-, and 5-year recurrence-free survival rates were 65.38%, 19.23%, and 11.54%, respectively. The 1-, 3-, and 5-year rebleeding-free survival rates were 73.08%, 42.31%, and 26.92%, respectively. No significant differences were found in overall, recurrence-free, and rebleeding-free survival rates.Conclusions: Hepatectomy or RFA with PCDV plus splenectomy might be a safe and effective treatment for patients with cirrhosis having hepatocellular carcinoma and esophagogastric variceal bleeding. “Hepatectomy first” strategy may be considered due to its lower and later recurrence. More attention should be paid to background liver diseases after surgery.

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Postoperative adjuvant transarterial chemoembolization improves the prognosis of hepatocellular carcinoma patients with microvascular invasion: a systematic review and meta-analysis

Acta Radiologica ◽

10.1177/0284185119878357 ◽

2019 ◽

Vol 61 (6) ◽

pp. 723-731

Author(s):

Lian Li ◽

Bo Li ◽

Ming Zhang

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Recurrence Rate ◽

Transarterial Chemoembolization ◽

Meta Analysis ◽

Survival Rates ◽

Microvascular Invasion ◽

Recurrence Rates ◽

The One ◽

Overall Survival Rates

Background Microvascular invasion has been widely accepted as a major risk factor of hepatocellular carcinoma prognoses after surgery. It is still controversial whether postoperative adjuvant transarterial chemoembolization could improve the survival of hepatocellular carcinoma patients with microvascular invasion. Purpose To evaluate the effect of postoperative adjuvant transarterial chemoembolization for postoperative hepatocellular carcinoma patients with microvascular invasion. Material and Methods PubMed, Web of Science, and Embase databases were searched for eligible studies, and the one-, three-, and five-year recurrence rates and overall survival rates were extracted for meta-analysis. Results A total of eight studies were included in this study. The results showed that the one-, three-, and five-year recurrence rate of the postoperative adjuvant transarterial chemoembolization group were better than those of the hepatectomy alone group, with a pooled risk ratio (RR) of 0.66 (95% confidence interval [CI] 0.58–0.75, P < 0.00001), 0.82 (95% CI 0.76–0.88, P < 0.00001), and 0.89 (95% CI 0.82–0.97, P = 0.007), respectively. The overall survival rates with one-, three-, and five-year pooled RR were 0.34 (95% CI 0.25–0.47, P < 0.00001), 0.69 (95% CI 0.60–0.79, P < 0.00001), and 0.78 (95% CI 0.69–0.89, P = 0.0001), respectively. No serious side effects have been reported, indicating that postoperative intervention is safe. Conclusion For hepatocellular carcinoma patients with microvascular invasion confirmed by postoperative pathology, postoperative adjuvant transarterial chemoembolization is a safe treatment, which could reduce the tumor recurrence rate and improve the patient’s overall survival.

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Superselective Radioembolization of Hepatocellular Carcinoma: 5-Year Results of a Prospective Study

Nuklearmedizin ◽

10.1055/s-0038-1629756 ◽

1994 ◽

Vol 33 (05) ◽

pp. 206-214 ◽

Cited By ~ 1

Author(s):

J. Triller ◽

H. U. Baer ◽

Livia Geiger ◽

H. F. Beer ◽

C. Becker ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Survival Rates ◽

Absorbed Dose ◽

Pulmonary Complications ◽

Pulmonary Shunt ◽

Recurrent Tumour ◽

Activity Distribution ◽

A Prospective Study ◽

Overall Survival Rates

SummaryTwenty patients with unresectable hepatocellular carcinoma (HCC) were followed up to 5 years after transarterial radiotherapy with 90Y-resin particles. Diagnostic radioembolizations of 99mTc-macroaggregates facilitated scintigraphic assessment of activity distribution, dose evaluation and final procedural verification. The overall survival rates were 56, 38 and 14% (after 1, 2 and 3 years, resp.). Patients with unifocal HCC and a single feeding artery (n = 7) even presented 83, 67 and 40% (2 alive after 2.75 and 4 years). With multiple arteries (n = 7), the longest survival was 26 months. Patients with multifocal HCC survived up to 33 months after selective radioembolization. Quality of life was improved in all. Survival was positively correlated with absorbed dose but residual/recurrent tumour occurred even after ≥300 Gy. Post-treatment symptoms were minimal (35 applications), pulmonary shunt rates were correctly predicted and pulmonary complications avoided.

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Effect of timing of surgical resection of primary hepatocellular carcinoma on survival outcomes in elderly patients and prediction of clinical models

BMC Gastroenterology ◽

10.1186/s12876-021-01815-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yongfei He ◽

Tianyi Liang ◽

Shutian Mo ◽

Zijun Chen ◽

Shuqi Zhao ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Liver Cancer ◽

Elderly Patients ◽

Surgical Resection ◽

Influencing Factors ◽

The Elderly ◽

Primary Hepatocellular Carcinoma ◽

Surgical Timing ◽

Duration Of Surgery

Abstract Background The effect of time delay from diagnosis to surgery on the prognosis of elderly patients with liver cancer is not well known. We investigated the effect of surgical timing on the prognosis of elderly hepatocellular carcinoma patients undergoing surgical resection and constructed a Nomogram model to predict the overall survival of patients. Methods A retrospective analysis was performed on elderly patients with primary liver cancer after hepatectomy from 2012 to 2018. The effect of surgical timing on the prognosis of elderly patients with liver cancer was analyzed using the cut-off times of 18 days, 30 days, and 60 days. Cox was used to analyze the independent influencing factors of overall survival in patients, and a prognostic model was constructed. Results A total of 232 elderly hepatocellular carcinoma patients who underwent hepatectomy were enrolled in this study. The cut-off times of 18, 30, and 60 days were used. The duration of surgery had no significant effect on overall survival. Body Mass Index, Child-Pugh classification, Tumor size Max, and Length of stay were independent influencing factors for overall survival in the elderly Liver cancer patients after surgery. These factors combined with Liver cirrhosis and Venous tumor emboli were incorporated into a Nomogram. The nomogram was validated using the clinical data of the study patients, and exhibited better prediction for 1-year, 3-year, and 5-year overall survival. Conclusions We demonstrated that the operative time has no significant effect on delayed operation in the elderly patients with hepatocellular carcinoma, and a moderate delay may benefit some patients. The constructed Nomogram model is a good predictor of overall survival in elderly patients with hepatectomy.

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