Clinical Values and Markers of Radiation-Induced Liver Disease for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus Treated With Stereotactic Body Radiotherapy

BackgroundInformation about radiation-induced liver disease (RILD) in hepatocellular carcinoma (HCC) patients preexisting hepatitis B cirrhosis with portal vein tumor thrombus (PVTT) extended to the main portal vein treated with stereotactic body radiotherapy (SBRT) is still inadequate and the predictive markers for RILD have not been cleared in these patients. The aim of the study is to identify factors that can be used to predict RILD and to evaluate the influence of RILD in these patients.MethodsIn our study, 59 patients were analyzed and evaluated from December 2015 to June 2019, according to the entry criteria. After treatment, 59 patients were followed up within the first month and then every 3 months. Hematology test, tumor markers, three-phasic CT scan of the lungs, and CT or MRI scan of the liver were performed at each follow up.ResultsMedian overall survival time was 10.7 months (range, 5.8 to 14.9). RILD appeared in 17 of the 59 patients (28.8%) at the 3rd month after SBRT. In the univariate analysis, not only the CP score class (A or B) but also each different pretreatment CP score (p < 0.05) was a significant predictive factor of RILD. More RILD cases were detected with the increase of CP score. The recovery rate decreased as the baseline CP score increased (p < 0.05). It was found that the overall survival time was affected by only baseline CP score and RILD (p < 0.05).ConclusionsThe development of RILD has a dependency on the CP score in these patients. CP scores before treatment and RILD are significantly associated with overall survival. SBRT is an effective and safe method for patients with CP ≤ B7. For patients with CP-B8, liver function should be monitored more frequently. It is not safe enough for the SBRT treatment in CP-B9 patients.

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Transarterial Chemoembolization (TACE) Combined with Sorafenib in Treatment of HBV Background Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Propensity Score Matching Study

BioMed Research International ◽

10.1155/2019/2141859 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Jia Yuan ◽

Xin Yin ◽

Bei Tang ◽

Hui Ma ◽

Lan Zhang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Propensity Score ◽

Combination Therapy ◽

Portal Vein ◽

Propensity Score Matching ◽

Transarterial Chemoembolization ◽

Tumor Thrombus ◽

Portal Vein Tumor Thrombus ◽

Rank Test

Objectives. Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remains a challenge in management. Transarterial chemoembolization (TACE) has been used for patients with PVTT but efficiency was limited with a median overall survival of 4 to 6.1 months. The aim of this study is to evaluate the efficiency of TACE combined with sorafenib in HBV background HCC with PVTT. Methods. A total of 498 patients were enrolled in the study including 69 patients who received TACE combined with sorafenib and 429 patients treated with TACE alone between January 1st, 2008, and April 30st, 2014. Using the 1:2 propensity score matching, 138 well-balanced patients were enrolled. Overall survival (OS) was compared between the two groups. The Kaplan-Meier method was used to evaluate the OS, and the differences between groups were analyzed with a log-rank test. Results. TACE combined with sorafenib improved the OS of the patients compared with TACE alone (13.0 vs 6.0 months, p<0.001). After propensity score matching, the median OS of combination therapy and TACE were 13.0 and 7.0 months, respectively (p=0.001). Subgroup analysis revealed that the patients younger than 60 years old, male patients, AFP more than 400ng/ml, tumor size more than 5cm, or type III/IV PVTT had OS benefits from TACE combined with sorafenib. Conclusions. Compared with TACE therapy alone, TACE combined with sorafenib could improve OS in HBV background HCC patients with PVTT. The patients who are younger, male, or with more tumor burden may benefit more from combination therapy.

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Distant survival for patients undergoing surgery using volatile versus IV anesthesia for hepatocellular carcinoma with portal vein tumor thrombus: a retrospective study

BMC Anesthesiology ◽

10.1186/s12871-020-01111-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xiao-Yan Meng ◽

Xiu-Ping Zhang ◽

Zhe Sun ◽

Hong-Qian Wang ◽

Wei-Feng Yu

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Portal Vein ◽

Tumor Thrombus ◽

Cox Regression ◽

Cancer Recurrence ◽

Portal Vein Tumor Thrombus ◽

Cox Regression Analysis ◽

The Impact ◽

Underlying Pathophysiology

Abstract Background Whether anesthesia type is associated with the surgical outcome of Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) remains to be determined. This study aims to investigate the impact of volatile inhalational anesthesia (INHA) versus total IV anesthesia (TIVA) on the survival outcomes in HCC patients with PVTT. Methods A cohort of in-patients whom were diagnosed of HCC with PVTT in Eastern Hepatobiliary Surgery Hospital, Shanghai, China, from January 1, 2008 to December 24, 2012 were identified. Surgical patients receiving the INHA and TIVA were screened out. The overall survival (OS), recurrence-free survival (RFS) and several postoperative adverse events were compared according to anesthesia types. Results A total of 1513 patients were included in this study. After exclusions are applied, 263 patients remain in the INHA group and 208 in the TIVA group. Patients receiving INHA have a lower 5-year overall survival rate than that of patients receiving TIVA [12.6% (95% CI, 9.0 to 17.3) vs. 17.7% (95% CI, 11.3 to 20.8), P = 0.024]. Results of multivariable Cox-regression analysis also identify that INHA anesthesia is significantly associated with mortality and cancer recurrence after surgery compare to TIVA, with HR (95%CI) of 1.303 (1.065, 1.595) and 1.265 (1.040, 1.539), respectively. Subgroup analysis suggested that in more severe cancer patients, the worse outcome related to INHA might be more significant. Conclusion This retrospective analysis identifies that TIVA is associated with better outcomes compared with INHA. Future prospective studies clinical and translational studies are required to verify this difference and investigate underlying pathophysiology.

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The Efficacy and Prognostic Factors of the Combination of TACE and Apatinib for the Treatment of BCLC Stage C Hepatocellular Carcinoma

Frontiers in Medicine ◽

10.3389/fmed.2021.774345 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shun Liu ◽

Kai-Cai Liu ◽

Wei-Fu Lv ◽

Dong Lu ◽

Xian-Hai Zhu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Adverse Events ◽

Portal Vein ◽

Survival Time ◽

Tumor Size ◽

Tumor Thrombus ◽

Portal Vein Tumor Thrombus ◽

Cox Regression Analysis ◽

Pugh Class

Objective: Apatinib is a inhibitor of vascular endothelial growth factor receptor-2. To explore the efficacy and prognostic factors of transarterial chemoembolization (TACE) combined with apatinib in the treatment of Barcelona Clinic Liver Cancer stage C (BCLC C) hepatocellular carcinoma (HCC).Methods: Clinical data of 146 HCC patients with BCLC stage C admitted to our hospital were collected and analyzed retrospectively, of which 76 cases were treated with TACE combined with apatinib (TACE-apatinib) and 70 with TACE alone. The tumor response, survival time, and adverse events were compared between the two groups, and the factors affecting the prognosis were analyzed.Results: The objective response rate (ORR) and disease control rate (DCR) in the TACE-apatinib group were higher than in the TACE-alone group (ORR: 42.10 vs. 25.71%, P = 0.03; DCR: 84.21 vs. 55.71%, P = 0.001). The median time to progression (TTP) and overall survival (OS) in the TACE-apatinib group were longer than in the TACE-alone group (TTP: 5.5 vs. 3.7 months, P = 0.02; OS: 10.0 vs. 6.2 months, P = 0.01). Univariate and multivariate Cox regression analysis showed that tumor size, Child-Pugh class, and the presence of the portal vein tumor thrombus affect the prognosis of patients. Subgroup analysis revealed that TACE-apatinib therapy resulted in a higher OS in patients with tumor size <10 cm, without portal vein tumor thrombus, and with Child-Pugh class A (P < 0.05). The likelihood of adverse events (hand-foot syndrome, hypertension, oral ulcer) was significantly higher in the increased in the TACE-apatinib group than in the TACE alone group (P < 0.05).Conclusion: TACE-apatinib is an effective and safe method for the treatment of BCLC stage C HCC. Tumor size, Child-Pugh class, and portal vein tumor thrombus affect survival time in HCC patients with BCLC stage C.

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Response To Pretransplant Downstaging Therapy Predicts Patient Outcome After Liver Transplantation For Hepatocellular Carcinoma With Portal Vein Tumor Thrombus

10.21203/rs.3.rs-41646/v1 ◽

2020 ◽

Author(s):

Zhe Yang ◽

Shuo Wang ◽

Jingqi Sun ◽

Li Zhuang ◽

Qiyong Li ◽

...

Keyword(s):

Patient Outcome ◽

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Overall Survival ◽

Portal Vein ◽

Tumor Necrosis ◽

Tumor Thrombus ◽

Poor Response ◽

Portal Vein Tumor Thrombus ◽

Tumor Viability

Abstract Background: Tumor viability and areas of necrosis after pretransplant downstaging therapy is predictive of patient outcome, but has not been evaluated in hepatocellular carcinoma (HCC) recipients with portal vein tumor thrombus (PVTT). Methods: Recurrence-free survival (RFS) and overall survival (OS) were compared among PVTT-HCC patients receiving pretransplant downstaging therapy with and without well response (radiographic tumor necrosis >50%). Multivariable predictors of well response to downstaging were identified.Results: Of 107 patients, downstaging was attempted in 48, and 15 had well response to pretransplant therapy. Compared with poor response and non-downstaged patients, well response patients had significantly superior 1-, 2-, and 3-year RFS (72%, 72%, and 72% vs 30.4%, 22.6%, and 22.6%; P = 0.002) and OS (100%, 90.9%, and 90.9% vs 66.3%, 47.7%, and 47.7%; P = 0.008). Pre-transplant alpha-fetoprotein (AFP) level <1000ng/mL and radiographic tumor necrosis >50% were independent favorable factors for lower HCC recurrence rate and better overall survival after liver transplantation (LT). Multivariable predictors of well response to downstage included well-moderate differentiated tumor on explant and multiple combined pretransplant locoregional and systematic therapies. Conclusions: For HCC patients with PVTT and receive pretransplant downstaging therapy, achieving well response is predictive of significantly better posttransplant outcomes and patients can have acceptable survival with LT after successful downstaging. Combined locoregional and systematic therapies may help to improve the responsiveness to downstaging.

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