scholarly journals Utility of FIB4-T as a Prognostic Factor for Hepatocellular Carcinoma

Cancers ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 203 ◽  
Author(s):  
Kazuya Kariyama ◽  
Kazuhiro Nouso ◽  
Hidenori Toyoda ◽  
Toshifumi Tada ◽  
Atsushi Hiraoka ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Tumor Progression ◽  
Survival Rates ◽  
Staging System ◽  
Information Criteria ◽  
Prediction Ability ◽  
Jis Score ◽  
New Perspective ◽  
Prognostic Prediction

Background: Most integrated scores for predicting the prognosis of patients with hepatocellular carcinoma (HCC) comprise tumor progression factors and liver function variables. The FIB4 index is an indicator of hepatic fibrosis calculated on the basis of age, aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, and platelet count, but it does not include variables directly related to liver function. We propose a new staging system, referred to as “FIB4-T,” comprising the FIB4 index as well as tumor progression factors, and examine its usefulness. Method: Subjects included 3800 cases of HCC registered in multiple research centers. We defined grades 1, 2, and 3 as a Fibrosis-4 (FIB4) index of <3.25, 3.26–6.70, and >6.70 as FIB4, respectively, and calculated the FIB4-T in the same manner in which the JIS (Japan Integrated Staging Score) scores and albumin-bilirubin tumor node metastasis (ALBI-T) were calculated. We compared the prognostic prediction ability of FIB4-T with that of the JIS score and ALBI-T. Results: Mean observation period was 37 months. The 5-year survival rates (%) of JIS score (0/1/2/3/4/5), ALBI-T (0/1/2/3/4/5) and FIB4-T (0/1/2/3/4/5) were 74/60/36/16/0, 82/66/45/22/5/0 and 88/75/65/58/32/10, respectively. Comparisons of the Akaike information criteria among JIS scores, ALBI-T, and FIB4-T indicated that stratification using the FIB4-T system was comparable to those using ALBI-T and JIS score. The risk of mortality significantly increased (1.3–2.8 times/step) with an increase in FIB4-T, and clear stratification was possible regardless of the treatment. Conclusions: FIB4-T is useful in predicting the prognosis of patients with HCC from a new perspective.

Therapeutic Efficacy of Transcatheter Arterial Chemoembolization as Compared With Hepatic Resection in Hepatocellular Carcinoma Patients With Compensated Liver Function in a Hepatitis B Virus–Endemic Area: A Prospective Cohort Study

2002 ◽  
Vol 20 (22) ◽  
pp. 4459-4465 ◽  
Author(s):  
Hyo-Suk Lee ◽  
Kang Mo Kim ◽  
Jung-Hwan Yoon ◽  
Tae-Rim Lee ◽  
Kyung Suk Suh ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Survival Rate ◽  
Liver Function ◽  
Hepatic Resection ◽  
Transcatheter Arterial Chemoembolization ◽  
Survival Rates ◽  
Tumor Stage ◽  
Significant Difference ◽  
Tace Group ◽  
Arterial Chemoembolization

PURPOSE: Identifying a special subgroup of hepatocellular carcinoma (HCC) patients who may benefit from transcatheter arterial chemoembolization (TACE) when compared with the standard treatment of hepatic resection (HR) warrants research in Asian countries. PATIENTS AND METHODS: From January 1993 to December 1994, 182 patients with operable HCC (Child-Pugh class A and International Union Against Cancer [UICC] stage T1-3N0M0) were enrolled. After initial TACE and lipiodol computed tomography, 91 received HR and 91, who refused the operation, received repeated sessions of TACE. After stratification according to the tumor stage (UICC and Cancer of the Liver Italian Program [CLIP]) and lipiodol retention pattern, the survival rates of the two treatment groups were compared. The median follow-up period was 83 months. RESULTS: As of December 31, 2000, 48 patients who underwent HR and 68 patients who underwent TACE had died. In a subgroup analysis according to tumor stage, the HR group survival rate was significantly higher than the TACE group in both UICC T1-2N0M0 (P = .0058) and CLIP 0 (P = .0027) subgroups. However, there was no significant difference in either UICC T3N0M0 (P = .7512) or CLIP 1-2 (P = .5366) subgroups. Even in patients with UICC T1-2N0M0 HCC, when lipiodol was compactly retained, the survival rate of the HR group was comparable to that of the TACE group (P = .0596). CONCLUSION: TACE proved to be as effective as HR in the subpopulations with UICC T3N0M0 or CLIP 1-2 HCC and adequate liver function, and even with UICC T1-2N0M0 HCC when lipiodol was compactly retained in the tumor. In such cases, the choice of treatment modality between TACE and HR may be left to the patient’s preference.

scholarly journals An Evidence-Based Multidisciplinary Approach to the Management of Hepatocellular Carcinoma (HCC): The Alberta HCC Algorithm

2010 ◽  
Vol 24 (11) ◽  
pp. 643-650 ◽  
Author(s):  
Kelly W Burak ◽  
Norman M Kneteman
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Liver Function ◽  
Potential Role ◽  
Staging System ◽  
Evidence Based ◽  
Transarterial Radioembolization ◽  
Bclc Staging ◽  
Tumour Characteristics

Hepatocellular carcinoma (HCC) is one of only a few malignancies with an increasing incidence in North America. Because the vast majority of HCCs occur in the setting of a cirrhotic liver, management of this malignancy is best performed in a multidisciplinary group that recognizes the importance of liver function, as well as patient and tumour characteristics. The Barcelona Clinic Liver Cancer (BCLC) staging system is preferred for HCC because it incorporates the tumour characteristics (ie, tumour-node-metastasis stage), the patient’s performance status and liver function according to the Child-Turcotte-Pugh classification, and then links the BCLC stage to recommended therapeutic interventions. However, the BCLC algorithm does not recognize the potential role of radiofrequency ablation for very early stage HCC, the expanding role of liver transplantation in the management of HCC, the role of transarterial chemoembolization in single large tumours, the potential role of transarterial radioembolization with90Yttrium and the limited evidence for using sorafenib in Child-Turcotte-Pugh class B cirrhotic patients. The current review article presents an evidence-based approach to the multidisciplinary management of HCC along with a new algorithm for the management of HCC that incorporates the BCLC staging system and the authors’ local selection criteria for resection, ablative techniques, liver transplantation, transarterial chemoembolization, transarterial radioembolization and sorafenib in Alberta.

scholarly journals Challenges in the Current Management of Hepatocellular Carcinoma

2021 ◽  
Vol 6 (04) ◽  
pp. 269-274
Author(s):  
Soumya Jogi ◽  
Radha Varanasi ◽  
Sravani S Bantu ◽  
Sudha Saduvala ◽  
Ashish Manne
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Kinase Inhibitors ◽  
Checkpoint Inhibitors ◽  
Performance Status ◽  
Staging System ◽  
Convincing Evidence ◽  
Locoregional Therapy ◽  
Vegf Inhibitors ◽  
Stereotactic Radiation

Management of hepatocellular carcinoma (HCC) is complicated. Barcelona Clinic Liver Cancer (BCLC) staging system is widely used in risk stratifying HCC. It is different from anatomic staging (TNM) used in other cancers and is based on the liver function (Child-Pugh Score) and performance status at diagnosis along with tumor characteristics like size/number of primary, vascular invasion, and distant metastasis. Guidelines proposed by various liver societies help the treating physician select first-line therapy, but there are many limitations to them. Lack of reliable biomarkers that give objective information to monitor the response other than alpha-fetoprotein or radiological response is hurting the management strategies. There are no ideal predictors for recurrence and residual microscopic disease, especially after locoregional therapy (LRT) like surgical resection, ablation, transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and stereotactic radiation therapy (SBRT). Also, there is no convincing evidence to use adjunct therapy along with LRT in localized HCC. There is a need to identify the subset of HCC that would benefit from peri-procedural therapy. Recommendations for treating advanced HCC with macrovascular invasion is not uniform across the guidelines. Some propose LRT (TACE and/or TARE) or recommend systemic therapy only like tyrosine-kinase inhibitors (TKI) or Immune-checkpoint inhibitors (ICI). A considerable portion of patients have poor liver function (Child-Pugh Score C) at diagnosis. In this era of medicine, we should give them options other than supportive care, but unfortunately, it is the preferred option. This population needs special attention in trials. In current practice, there only 2-3 classes of drugs available like TKI, ICI, and vascular endothelial growth factor (VEGF) inhibitors. There is a need to explore more classes of liver-friendly drugs in treating HCC, and the enrolment of patients in clinical trials must be advised in the guidelines.

scholarly journals A genomic-clinical nomogram predicting recurrence-free survival for patients diagnosed with hepatocellular carcinoma

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7942
Author(s):  
Junjie Kong ◽  
Tao Wang ◽  
Shu Shen ◽  
Zifei Zhang ◽  
Xianwei Yang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Risk Model ◽  
Cox Regression ◽  
Group Performance ◽  
Performance Status ◽  
Survival Rates ◽  
Eastern Cooperative Oncology Group ◽  
Staging System ◽  
Recurrence Free Survival ◽  
Free Survival

Liver resection surgery is the most commonly used treatment strategy for patients diagnosed with hepatocellular carcinoma (HCC). However, there is still a chance for recurrence in these patients despite the survival benefits of this procedure. This study aimed to explore recurrence-related genes (RRGs) and establish a genomic-clinical nomogram for predicting postoperative recurrence in HCC patients. A total of 123 differently expressed genes and three RRGs (PZP, SPP2, and PRC1) were identified from online databases via Cox regression and LASSO logistic regression analyses and a gene-based risk model containing RRGs was then established. The Harrell’s concordance index (C-index), receiver operating characteristic (ROC) curves and calibration curves showed that the model performed well. Finally, a genomic-clinical nomogram incorporating the gene-based risk model, AJCC staging system, and Eastern Cooperative Oncology Group performance status was constructed to predict the 1-, 2-, and 3-year recurrence-free survival rates (RFS) for HCC patients. The C-index, ROC analysis, and decision curve analysis were good indicators of the nomogram’s performance. In conclusion, we identified three reliable RRGs associated with the recurrence of cancer and constructed a nomogram that performed well in predicting RFS for HCC patients. These findings could enrich our understanding of the mechanisms for HCC recurrence, help surgeons predict patients’ prognosis, and promote HCC treatment.

scholarly journals Clinical Significance of Systemic Inflammation Markers in Newly Diagnosed, Previously Untreated Hepatocellular Carcinoma

Cancers ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1300 ◽  
Author(s):  
Jeong Il Yu ◽  
Hee Chul Park ◽  
Gyu Sang Yoo ◽  
Seung Woon Paik ◽  
Moon Seok Choi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Clinical Significance ◽  
Systemic Inflammation ◽  
Bootstrap Method ◽  
Staging System ◽  
Continuous Variables ◽  
Newly Diagnosed ◽  
Inflammation Markers ◽  
Lymphocyte Ratio

This study aimed to investigate the clinical significance of systemic inflammation markers (SIMs)—including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)—in patients with newly diagnosed, previously untreated hepatocellular carcinoma (HCC). The present study was performed using prospectively collected registry data of newly diagnosed, previously untreated HCC from a single institution. The training set included 6619 patients from 2005 to 2013 and the validation set included 2084 patients from 2014 to 2016. The SIMs as continuous variables significantly affected the overall survival (OS), and the optimal cut-off value of NLR, PLR, and LMR was 3.0, 100.0, and 3.0, respectively. There were significant correlations between SIMs and the albumin-bilirubin grade/Child-Turcotte-Pugh class (indicative of liver function status) and the staging system/portal vein invasion (indicative of the tumor burden). The OS curves were well stratified according to the prognostic model of SIMs and validated using the bootstrap method (1000 times, C-index 0.6367, 95% confidence interval (CI) 0.6274–0.6459) and validation cohort (C-index 0.6810, 95% CI 0.6570–0.7049). SIMs showed significant prognostic ability for OS, independent of liver function and tumor extent, although these factors were significantly correlated with SIMs in patients with newly diagnosed, previously untreated HCC.

scholarly journals The Short-Term Efficacy of Novel No-Touch Combined Directional Perfusion Radiofrequency Ablation in the Treatment of Small Hepatocellular Carcinoma With Cirrhosis.

2020 ◽  
Author(s):  
Chengming Qu ◽  
Xin-Qian Li ◽  
Feng Xia ◽  
Kai Feng ◽  
Kuansheng Ma
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Liver Function ◽  
Tumor Progression ◽  
New Technique ◽  
Long Term Results ◽  
Technical Failure ◽  
Short Term ◽  
Term Efficacy ◽  
Small Hcc

Abstract BackgroundNo-touch combined directed perfusion radiofrequency ablation (NTDP-RFA) is a new technique for the treatment of hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the short-term efficacy of this new technique for the treatment of small HCC with cirrhosis.MethodsFrom January 2017 to March 2018, 56 consecutive patients treated with NTDP-RFA at our center were enrolled in this retrospective study. All NTDP-RFA procedures involved the use of internally cooled wet electrodes with a directional injection function, which can perform both intraelectrode cooling and extraelectrode saline perfusion. Survival curves were analyzed using Kaplan-Meier methods, and Cox proportional hazards regression analyses were used to assess predictors of tumor progression and overall survival. Operative characteristics and complications were also assessed.ResultsNo technical failure occurred, and the complete ablation rate after single NTDP-RFA treatment was 98.2%. The median ablation time was only 8 (6-8) min. Only 5 patients (8.9%) experienced mild complications postoperation, and the median hospital stay was only 4 (3-5) days. In the 18 patients (32.1%) with poor liver function reserve (indocyanine green retention rate at 15 min > 15%), their liver function returned to normal on the third day after the postoperation. The 1-year and 2-year local and distant progression rates were 1.7%, 7.1%, 3.5% and 10.7%, respectively.ConclusionsNTDP-RFA in the treatment of small HCC with cirrhosis has a low incidence of complications and provides a high survival rate without local tumor progression. Further prospective randomized controlled studies are needed to investigate the long-term results.

scholarly journals Radiogenomics-based Risk Prediction of Glioblastoma Multiforme with Clinical Relevance

2018 ◽  
Author(s):  
Xiaohua Qian ◽  
Hua Tan ◽  
Wei Chen ◽  
Weiling Zhao ◽  
Michael D. Chan ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tumor Progression ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Risk Groups ◽  
Resection Margins ◽  
Survival Prediction ◽  
High Survival ◽  
Imaging Features ◽  
Prediction Ability

AbstractGBM is the most common and aggressive primary brain tumor. Although the TMZ-based radiochemotherapy improves overall GBM patients’ survival, it also increases the frequency of false positive post-treatment magnetic resonance imaging (MRI) assessments for tumor progression. Pseudoprogression is a treatment-related reaction with an increase in contrast-enhancing lesion size at the tumor site or resection margins which mimics tumor recurrence on MRI. Accurate and reliable prognostication of GBM progression is urgently needed in the clinical management of GBM patients. Clinical data analysis indicates that the patients with PsP had superior overall and progression-free survival rates. In this study, we aimed to develop a prognostic model to evaluate tumor progression potential of GBM patients following standard therapies. We applied a dictionary learning scheme to obtain imaging features of GBM patients with PsP or TTP from the Wake dataset. Based on these radiographic features, we then conducted radiogenomics analysis to identify the significantly associated genes. These significantly associated genes were then used as features to construct a 2YS logistic regression model. GBM patients were classified into low-and high-survival risk groups based on the individual 2YS scores derived from this model. We tested our model using an independent TCGA dataset and found that 2YS scores were significantly associated with the patients’ overall survival. We further used two cohorts of the TCGA data to train and test our model. Our results show that 2YS scores-based classification results from the training and testing TGCA datasets were significantly associated with the overall survival of patients. We also analyzed the survival prediction ability of other clinical factors (gender, age, KPS, normal cell ratio) and found that these factors were not related or weakly correlated with patients’ survival. Overall, our studies have demonstrated the effectiveness and robustness of the 2YS model in predicting clinical outcomes of GBM patients after standard therapies.

Validation of the postneoadjuvant therapy pathological stage of the American Joint Committee on Cancer (AJCC) 8th Edition for predicting outcomes of esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant chemoradiotherapy (CRT) followed by esophagectomy.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 138-138
Author(s):  
Tsung-hao Liu ◽  
Hung-Yang Kuo ◽  
Jhe-Cyuan Guo ◽  
Chia-Chi Lin ◽  
Ta-Chen Huang ◽  
...  
Keyword(s):  
Cox Regression ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Staging System ◽  
Information Criteria ◽  
University Hospital ◽  
Phase Ii Trials ◽  
Prognostic Prediction

138 Background: The AJCC 8th edition staging system introduces a new postneoadjuvant therapy staging category (ypTNM-8th) for ESCC patients receiving neoadjuvant treatment followed by esophagectomy. Whether this new staging category has better prognostic prediction than the pathological staging category of AJCC 7th edition (ypTNM-7th) needs validation. Methods: We enrolled ESCC patients receiving neoadjuvant paclitaxel/cisplatin-based CRT (RT = 40Gy) followed by esophagectomy from three phase II trials conducted in the National Taiwan University Hospital. The prognostic prediction abilities of the ypTNM-8th and the ypTNM-7th on patients’ survivals were compared using Cox regression, concordance index (C-index), R-square, and Akaike information criteria (AIC). Results: A total 135 patients (M:F = 127: 8, median age:53.0 years) were enrolled. With a median follow-up of 31.3 months, the median PFS and OS of all patients were 24.4 months (95% CI: 15.4-33.5) and 33.9 months (95% CI: 22.6-45.1), respectively. In univariate analysis, both ypTNM-8th and ypTNM-7th had statistically significant prognostic effects for PFS and OS. In multivariate analysis on OS, the ypTNM-8th demonstrated a statistically significant predicting effect (P = 0.015) while the ypTNM-7th did not (P = 0.051). Although there is no statistically different between ypTNM-8th and ypTNM-7th by R-square analysis, the ypTNM-8th had lower AIC and C-index for both PFS and OS, meaning an better efficiency of predicting survivals, than ypTNM-7th. Conclusions: The new ypTNM-8th may have better prognostic prediction for OS of locally advanced ESCC patients receiving neoadjuvant CRT than the ypTNM-7th. (Granted by 106-HCH029)

Sign in / Sign up

Export Citation Format

Share Document