scholarly journals Surgery versus radiofrequency ablation in patients with Child- Pugh class-A/single small (≤3cm) hepatocellular carcinoma

2021 ◽  
Author(s):  
Jungnam Lee ◽  
Young-Joo Jin ◽  
Seung Kak Shin ◽  
Jung Hyun Kwon ◽  
Sang Gyune Kim ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Class A ◽  
Pugh Class

scholarly journals Percutaneous Ablation for Hepatocellular Carcinoma: Comparison of Various Ablation Techniques and Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Shuichiro Shiina ◽  
Koki Sato ◽  
Ryosuke Tateishi ◽  
Motonori Shimizu ◽  
Hideko Ohama ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Microwave Ablation ◽  
Irreversible Electroporation ◽  
Percutaneous Ablation ◽  
Term Survival ◽  
Ethanol Injection ◽  
Class A ◽  
Pugh Class

Image-guided percutaneous ablation is considered best in the treatment of early-stage hepatocellular carcinoma (HCC). Ablation is potentially curative, minimally invasive, and easily repeatable for recurrence. Ethanol injection used to be the standard in ablation. However, radiofrequency ablation has recently been the most prevailing ablation method for HCC. Many investigators have reported that radiofrequency ablation is superior to ethanol injection, from the viewpoints of treatment response, local tumor curativity, and overall survival. New-generation microwave ablation can create a larger ablation volume in a shorter time period. Further comparison studies are, however, mandatory between radiofrequency ablation and microwave ablation, especially in terms of complications and long-term survival. Irreversible electroporation, which is a non-thermal ablation method that delivers short electric pulses to induce cell death due to apoptosis, requires further studies, especially in terms of long-term outcomes. It is considerably difficult to compare outcomes in ablation with those in surgical resection. However, radiofrequency ablation seems to be a satisfactory alternative to resection for HCC 3 cm or smaller in Child-Pugh class A or B cirrhosis. Furthermore, radiofrequency ablation may be a first-line treatment in HCC 2 cm or smaller in Child-Pugh class A or B cirrhosis. Various innovations would further improve outcomes in ablation. Training programs may be effective in providing an excellent opportunity to understand basic concepts and learn cardinal skills for successful ablation. Sophisticated ablation would be more than an adequate alternative of surgery for small- and possibly middle-sized HCC.

Analysis of Post-Progression Survival in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib

Oncology ◽  
2020 ◽  
Vol 98 (11) ◽  
pp. 787-797 ◽  
Author(s):  
Yuwa Ando ◽  
Tomokazu Kawaoka ◽  
Yosuke Suehiro ◽  
Kenji Yamaoka ◽  
Yumi Kosaka ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Multivariate Analysis ◽  
Liver Function ◽  
Second Line ◽  
First Line ◽  
Second Line Therapy ◽  
Class A ◽  
Line Therapy ◽  
Pugh Class ◽  
Ecog Ps

<b><i>Background:</i></b> Although a strong antitumor effect of lenvatinib (LEN) has been noted for patients with unresectable hepatocellular carcinoma (HCC), there are still no reports on the prognosis for patients with disease progression after first-line LEN therapy. <b><i>Methods:</i></b> Patients (<i>n</i> = 141) with unresectable HCC, Child-Pugh class A liver function, and an Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0 or 1 who were treated with LEN from March 2018 to December 2019 were enrolled. <b><i>Results:</i></b> One hundred and five patients were treated with LEN as first-line therapy, 53 of whom had progressive disease (PD) at the radiological evaluation. Among the 53 patients with PD, there were 27 candidates for second-line therapy, who had Child-Pugh class A liver function and an ECOG-PS of 0 or 1 at progression. After progression on first-line LEN, 28 patients were treated with a molecular targeted agent (MTA) as second-line therapy (sorafenib: <i>n</i> = 26; ramucirumab: <i>n</i> = 2). Multivariate analysis identified modified albumin-bilirubin grade 1 or 2a at LEN initiation (odds ratio 5.18, 95% confidence interval [CI] 1.465–18.31, <i>p</i> = 0.011) as a significant and independent factor for candidates. The median post-progression survival after PD on first-line LEN was 8.3 months. Cox hazard multivariate analysis showed that a low alpha-fetoprotein level (&#x3c;400 ng/mL; hazard ratio [HR] 0.297, 95% CI 0.099–0.886, <i>p</i> = 0.003), a relative tumor volume &#x3c;50% at the time of progression (HR 0.204, 95% CI 0.07–0.592, <i>p</i> = 0.03), and switching to MTAs as second-line treatment after LEN (HR 0.299, 95% CI 0.12–0.746, <i>p</i> = 0.01) were significant prognostic factors. <b><i>Conclusion:</i></b> Among patients with PD on first-line LEN, good liver function at introduction of LEN was an important and favorable factor related to eligibility for second-line therapy. In addition, post-progression treatment with MTAs could improve the prognosis for patients who had been treated with first-line LEN.

scholarly journals Sorafenib in patients with Child-Pugh class A and B advanced hepatocellular carcinoma: a prospective feasibility analysis

2013 ◽  
Vol 24 (2) ◽  
pp. 406-411 ◽  
Author(s):  
T. Pressiani ◽  
C. Boni ◽  
L. Rimassa ◽  
R. Labianca ◽  
S. Fagiuoli ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Feasibility Analysis ◽  
Advanced Hepatocellular Carcinoma ◽  
Class A ◽  
Pugh Class

scholarly journals The Combination of Albumin–Bilirubin Score and Prothrombin Time Is a Useful Tool for Predicting Liver Dysfunction after Transcatheter Arterial Chemoembolization in Child–Pugh Class A Patients with Hepatocellular Carcinoma within Up-to-Seven Criteria

2021 ◽  
Vol 10 (21) ◽  
pp. 4838
Author(s):  
Hiroaki Takaya ◽  
Tadashi Namisaki ◽  
Soichi Takeda ◽  
Kosuke Kaji ◽  
Hiroyuki Ogawa ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Prothrombin Time ◽  
Liver Dysfunction ◽  
Transcatheter Arterial Chemoembolization ◽  
Predictive Ability ◽  
Recurrence Rates ◽  
Class A ◽  
Pugh Class ◽  
Arterial Chemoembolization

Mortality and recurrence rates of hepatocellular carcinoma (HCC) are high. Recent studies show that for patients with HCC beyond up-to-seven criteria, treatment with molecular-targeted agents (MTAs) is recommended because the treatment efficiency of transcatheter arterial chemoembolization (TACE) is poor; further, TACE increases decline in liver function. However, the relationship between TACE and liver function decline in patients with HCC within up-to-seven criteria has not been clarified. Hence, we aimed to investigate this relationship. This retrospective observational study included 189 HCC tumors within up-to-seven criteria in 114 Child–Pugh class A patients. Twenty-four (12.7%) tumors were changed from Child–Pugh class A to B after TACE, and 116 (61.4%) tumors exhibited recurrence within 6 months after TACE. Prothrombin time (PT) and albumin–bilirubin (ALBI) score before TACE were significantly associated with liver dysfunction from Child–Pugh class A to B. The combination of PT and ALBI score before TACE had high predictive ability for liver dysfunction from Child–Pugh class A to B after TACE (specificity = 100%, sensitivity = 91.7%). The combined use of pre-TACE PT and ALBI score has a high predictive ability for liver dysfunction after TACE for Child–Pugh class A patients with HCC within up-to-seven criteria.

scholarly journals HEPATOCELLULAR CARCINOMA;

2014 ◽  
Vol 21 (06) ◽  
pp. 1222-1226
Author(s):  
Muhammad Amjad Kalhoro ◽  
Irfan Murtaza Shahwani ◽  
Mashooque Ali Dasti ◽  
Syed Zulfiquar Ali Shah ◽  
Faisal Shahab ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Decompensated Cirrhosis ◽  
Outcome Variable ◽  
Medical Unit ◽  
Class A ◽  
Case Series Study ◽  
Class B ◽  
Child Class ◽  
Pugh Class ◽  
The Mean

Objective: To determine the frequency of hepatocellular carcinoma in different Child-Pugh classes based on Alfa fetoprotein level. Study design: Case series study. Period: Six months Setting: Medical Unit-I of Liaquat University Hospital, Hyderabad Sindh Pakistan. Patients & Methods: A total of 100 patients admitted (inpatients) in Medical Unit I with the diagnosis of cirrhosis were enrolled in the study. Patients with cirrhosis of liver (more than six month duration) of either gender were included. If patients had metastatic lesion of the liver, liver abscess, or acute liver failure then they were excluded. Child-Pugh score was calculated which included ascites, encephalopathy, prothrombin time, albumin and serum bilirubin. The levels of α-fetoprotein were measured and HCC was diagnosed. The primary outcome variable was presence of HCC in cirrhotic patients. Results: The proportion of males (53%) was higher as compared to females (47%). The mean age of the study patients was 40.47 years with a standard deviation of 11.5. At the beginning patients were categorized according to Child Pugh Classes (A= up to 6, B=7-9 and C=10-11), age groups (15-30 years, 31-50 years and 51-70 years respectively). The mean Child Pugh score was 6.83 with ± 1.8 S.D. The majority of the cases of HCC (75.61%) occurred in the Child Class A, whereas 21.95% occurred in Child Class B and finally only one case of HCC (2.44%) was present in Child Class C. Conclusions: This study comprehensively demonstrated that hepatocellular carcinoma (HCC) is far more common in compensated cirrhosis (Child Pugh Class A) vs. decompensated cirrhosis (Child Pugh Class B and C).

scholarly journals Prognostic Factors after Percutaneous Radiofrequency Ablation in the Treatment of Hepatocellular Carcinoma. Impact of Incomplete Ablation on Recurrence and Overall Survival Rates

2018 ◽  
Vol 27 (4) ◽  
pp. 399-407 ◽  
Author(s):  
Zeno Sparchez ◽  
Tudor Mocan ◽  
Pompilia Radu ◽  
Lavinia Patricia Mocan ◽  
Mihaela Sparchez ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Local Recurrence ◽  
Histological Grade ◽  
Survival Rates ◽  
Distant Recurrence ◽  
Ethanol Injection ◽  
Pugh Class ◽  
Poor Outcomes ◽  
Long Term Impact

Aims: To report on the long-term impact of tumor and non-tumor related parameters on local recurrence, distant recurrence and survival in patients with naïve or recurrent type hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA).Methods: We performed 240 RFA sessions on 133 patients with 156 HCC nodules developed on a background of liver cirrhosis and analyzed the outcomes.Results: Contrast-enhanced ultrasound performed one month after RFA showed complete ablation in 119 out of 133 (89.65%) patients. With a median follow-up of 46 months, 3-, 5- and 7-year survival rates were 61.7%, 35.7%, and 22.6%, respectively. Previous ethanol injection and histological grade were significantly related to local tumor progression. Child-Pugh class, incomplete ablation, histological grade, previous ethanol injection, alpha-fetoprotein level before the treatment, and local recurrence were all significantly related to distant recurrence. Multivariate analysis demonstrated that age, Child-Pugh class, distant recurrence and multiple incomplete ablations were significantly related to survival.Conclusion: Radiofrequency ablation could be locally curative for HCC, resulting in a survival longer than 7 years. Previous ethanol injection and incomplete ablations were strongly associated with poor outcomes.

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