Indication of Liver Transplantation for Hepatocellular Carcinoma Should Be Reconsidered in Case of Microvascular Invasion and Multilocular Tumor Occurrence

Liver transplantation (LT) is routinely performed for hepatocellular carcinoma (HCC) in cirrhosis without major vascular invasion. Although the adverse influence of microvascular invasion is recognized, its occurrence does not contraindicate LT. We retrospectively analyzed in our LT cohort the significance of microvascular invasion on survival and demonstrate bridging procedures. At our hospital, 346 patients were diagnosed with HCC, 171 patients were evaluated for LT, and 153 were listed at Eurotransplant during a period of 11 years. Among these, 112 patients received LT and were included in this study. Overall survival after 1, 3 and 5 years was 86.3%, 73.9%, and 67.9%, respectively. Microvascular invasion led to significantly reduced overall (p = 0.030) and disease-free survival (p = 0.002). Five-year disease-free survival with microvascular invasion was 10.5%. Multilocular tumor occurrence with simultaneous microvascular invasion revealed the worst prognosis. In our LT cohort, predominant bridging treatment was transarterial chemoembolization (TACE) and the number of TACE significantly correlated with poorer overall survival after LT (p = 0.028), which was confirmed in multiple Cox regression analysis for overall and disease-free survival (p = 0.015 and p = 0.011). Microvascular tumor invasion is significantly associated with reduced prognosis after LT, which is aggravated by simultaneous occurrence of multiple lesions. Therefore, indication strategies for LT should be reconsidered.

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Value of HCC-MELD Score in Patients With Hepatocellular Carcinoma Undergoing Liver Transplantation

Progress in Transplantation ◽

10.1177/1526924817746686 ◽

2017 ◽

Vol 28 (1) ◽

pp. 63-69 ◽

Cited By ~ 3

Author(s):

Gian Piero Guerrini ◽

Domenico Pinelli ◽

Elena Marini ◽

Vittorio Corno ◽

Michela Guizzetti ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Overall Survival ◽

Cox Regression ◽

Prognostic Score ◽

Disease Free Survival ◽

Meld Score ◽

Poor Overall Survival ◽

Cox Regression Analysis ◽

Improve Risk Stratification

Context: Liver transplantation (LT) is considered the ideal therapy for patients with hepatocellular carcinoma (HCC) having cirrhosis but the shortage of liver donors and the risk of dropout from the wait list due to tumor progression severely limit transplantation. A new prognostic score, the HCC-model for end-stage liver disease (HCC-MELD), was developed by combining α-fetoprotein (AFP), MELD, and tumor size, to improve risk stratification of dropout in patients with HCC. Objectives: In this study, we investigated the ability of the HCC-MELD score in predicting the posttransplant for patients fulfilling Milan criteria (MC). Design: Two hundred patients with stage II tumor were retrospectively reviewed from a total of 1290 transplants performed at our institution from October 1997 through April 2015. Cox regression analysis was performed to identify the prognostic factors impacting the posttransplant survival. Results: Overall survival at 1, 5, and 10 years was 89.3%, 71.1%, and 67.2%, whereas disease-free survival was 86.4%, 66.5%, and 52.4%, respectively. Multivariate analysis showed HCC-MELD score (hazard ratio [HR] 39.6, P < .001) and microvascular invasion (HR 2.41, P = .002) to be independent risk factors for recurrence, whereas HCC diameter (HR 1.15, P = .041), HCC-MELD (HR 15.611, P = .006), and grading (HR 2.17, P = .03) proved to be predictive factors of poor overall survival. Conclusion: Our study showed the validity of the HCC-MELD equation in the evaluation of patients undergoing LT for HCC. This score offers a reliable method to assess the risk of waiting list dropout and predict posttransplantation outcomes.

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Predictive Effects of Inflammatory Scores in Patients with BCLC 0-A Hepatocellular Carcinoma after Hepatectomy

Journal of Clinical Medicine ◽

10.3390/jcm8101676 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1676 ◽

Cited By ~ 5

Author(s):

Pao-Yuan Huang ◽

Chih-Chi Wang ◽

Chih-Che Lin ◽

Sheng-Nan Lu ◽

Jing-Houng Wang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Hepatocellular Carcinoma ◽

Overall Survival ◽

Prognostic Factors ◽

Disease Free Survival ◽

Microvascular Invasion ◽

Poor Overall Survival ◽

Free Survival ◽

Lymphocyte Ratio ◽

Disease Free

Background: Inflammatory markers are regarded as prognostic factors of the outcomes of hepatocellular carcinoma (HCC). Examples include the neutrophil-to-lymphocyte ratio (NLR); platelet to lymphocyte ratio (PLR); the albumin and lymphocyte counts used in the prognostic nutritional index (PNI); and the neutrophil, lymphocyte, and platelet counts used in the systemic immune-inflammation index (SII). This study evaluates the effects of PNI, NLR, PLR, and SII to predict recurrence and survival in patients with Barcelona Clinic Liver Cancer (BCLC) stages 0-A of HCC after hepatectomy. Methods: This retrospective study was conducted at Kaohsiung Chung-Gung Memorial Hospital, Taiwan. The study enrolled 891 patients (77.9% males; mean age 58.53 ± 11.60 years) with BCLC stage 0/A HCC undergoing hepatectomy between 2001 and 2016. PNI, NLR, PLR and SII were measured before hepatectomy. Results: High NLR (>1.8) was adversely associated with overall survival (p = 0.032). Low PNI (≤45) was adversely associated with overall survival and disease-free survival (p < 0.001). Low SII (≤45) also had an adverse association with overall survival (p = 0.008) and disease-free survival (p < 0.001). Diabetes mellitus, cirrhosis, microvascular invasion, low PNI (≤45), and low SII (≤160) were independently associated with poor overall survival in a multivariate analysis. HCV infection, diabetes mellitus, cirrhosis, microvascular invasion, low PNI, and low SII were independent prognostic factors of recurrent HCC. The combined use of PNI and SII provided improved prognostic information. Conclusions: Low PNI and low SII are significantly poor prognostic factors for overall survival and recurrence in patients with BCLC 0-A hepatocellular carcinoma after hepatectomy.

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Carbohydrate Antigen 19-9 Increases the Predictive Efficiency of a-Fetoprotein for Prognosis of Resected Hepatocellular Carcinoma

The American Surgeon ◽

10.1177/000313481808400126 ◽

2018 ◽

Vol 84 (1) ◽

pp. 80-85 ◽

Cited By ~ 1

Author(s):

Li Zhou ◽

Jing-An Rui ◽

Shao-Bin Wang ◽

Shu-Guang Chen ◽

Qiang Qu

Keyword(s):

Hepatocellular Carcinoma ◽

Large Scale ◽

Cox Regression ◽

Prognostic Significance ◽

Disease Free Survival ◽

Carbohydrate Antigen ◽

Free Survival ◽

Cox Regression Analysis ◽

Disease Free ◽

Predictive Efficiency

Serum α-fetoprotein (AFP) is a classical biomarker for both diagnosis and prognosis of hepatocellular carcinoma (HCC). However, its predictive efficiency for prognosis remains unsatisfactory. This study explores whether integrating AFP and carbohydrate antigen (CA) 19-9/carcinoembryonic antigen (CEA) increase its prognostic efficiency in HCC. A total of 67 HCC patients with complete record of AFP, CA19-9, and CEA, who underwent radical hepatectomy, were included. The sole and combined evaluations for prognostic significance of the three markers were performed. In the first, it was found by one-factor analysis that AFP was a univariate prognostic indicator for disease-free survival, but not overall survival, whereas CEA and CA19-9 were not statistically significant, although the latter was of marginally predictive significance for disease-free survival. Subsequently, it was revealed that combined evaluation of AFP and CA19-9, rather than AFP and CEA, distinguished overall and disease-free survival more effectively, compared with single ones. However, this combination was not significant in multivariate Cox regression analysis, thus needing further validation, especially in large-scale prospective investigations. The addition of vascular invasion to AFP/CA19-9 combination might provide enhanced predictive power for disease-free survival. Collectively, these results preliminarily suggest that CA19-9 increases the predictive efficiency of AFP for prognosis of HCC after resection.

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Prognostic factors and curative radiotherapy results in patients with octogenarian bladder cancer

Medical Science and Discovery ◽

10.36472/msd.v7i6.386 ◽

2020 ◽

Vol 7 (6) ◽

pp. 515-519

Author(s):

Berrin Inanc ◽

Ozlem Mermut

Keyword(s):

Overall Survival ◽

Bladder Cancer ◽

Prognostic Factors ◽

Cox Regression ◽

Disease Free Survival ◽

Free Survival ◽

Cox Regression Analysis ◽

Curative Radiotherapy ◽

Co Morbidity ◽

Disease Free

Objective: In this retrospective research, we aimed to evaluate the survival outcomes and survival-related prognostic factors in octogenarian (>80 years) bladder cancer patients. Material and Methods: A total of 17 patients receiving radiotherapy or chemoradiotherapy treatment for bladder cancer in octogenarian patients were included in the study. Results: In total 17 patients, 13 patients (76.5%) had Stage II, 2 patients (11.8.%) had Stage III and stage IVa. Median follow-up was 23 months (6-72 months).While median overall survival (OS) was 14 months, median disease-free survival (DFS) was 13 months.Overall survival and disease-free survival rates for 6 months and 1st years were 70.6%, 35% and 64.3%, 24.1%, respectively. No prognostic factors were found in the univariate Cox regression analysis for overall survival. In multivariate Cox regression analysis, we found stage (hazard ratio [HR] = 3.009. 95% confidence interval [CI] = 1.003–9.029, p = 0.049), radiotherapy doses (HR = 241,226, 95% CI = 5.421–107.679, p = 0.005) and Charlson co-morbidity index (HR = 0.161 95% CI = 0.035–0.748, p = 0.020) as independent prognostic factors for overall survival. Conlusion: Curative radiotherapy can be used for older ( >80 years) patients with invasive bladder cancer. Nonetheless, the co-morbidity disease should be a consideration before radiotherapy and chemoradiotherapy administration

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Expression of EEF1A1 Is Associated with Prognosis of Patients with Colon Adenocarcinoma

Journal of Clinical Medicine ◽

10.3390/jcm8111903 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1903 ◽

Cited By ~ 3

Author(s):

Eun kyo Joung ◽

Jiyoung Kim ◽

Nara Yoon ◽

Lee-so Maeng ◽

Ji Hoon Kim ◽

...

Keyword(s):

Colon Cancer ◽

Multivariate Analysis ◽

Prognostic Factor ◽

Cox Regression ◽

Disease Free Survival ◽

Colon Adenocarcinoma ◽

Independent Prognostic Factor ◽

Free Survival ◽

Cox Regression Analysis ◽

Disease Free

Background: The prognostic role of the translational factor, elongation factor-1 alpha 1 (EEF1A1), in colon cancer is unclear. Objectives: The present study aimed to investigate the expression of EEF1A in tissues obtained from patients with stage II and III colon cancer and analyze its association with patient prognosis. Methods: A total of 281 patients with colon cancer who underwent curative resection were analyzed according to EEF1A1 expression. Results: The five-year overall survival in the high-EEF1A1 group was 87.7%, whereas it was 65.6% in the low-EEF1A1 expression group (hazard ratio (HR) 2.47, 95% confidence interval (CI) 1.38–4.44, p = 0.002). The five-year disease-free survival of patients with high EEF1A1 expression was 82.5%, which was longer than the rate of 55.4% observed for patients with low EEF1A1 expression (HR 2.94, 95% CI 1.72–5.04, p < 0.001). Univariate Cox regression analysis indicated that age, preoperative carcinoembryonic antigen level, adjuvant treatment, total number of metastatic lymph nodes, and EEF1A1 expression level were significant prognostic factors for death. In multivariate analysis, expression of EEF1A1 was an independent prognostic factor associated with death (HR 3.01, 95% CI 1.636–5.543, p < 0.001). EEF1A1 expression was also an independent prognostic factor for disease-free survival in multivariate analysis (HR 2.54, 95% CI 1.459–4.434, p < 0.001). Conclusions: Our study demonstrated that high expression of EEF1A1 has a favorable prognostic effect on patients with colon adenocarcinoma.

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Efficacy trend of hepatic resection for hepatocellular carcinoma with large multinodular tumor or macrovascular invasion.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.427 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 427-427 ◽

Cited By ~ 1

Author(s):

Jian-Hong Zhong ◽

Le-Qun Li ◽

Xin-Ping Ye ◽

Yang Ke ◽

Lin Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Liver Function ◽

Hepatic Resection ◽

Tertiary Care ◽

Disease Free Survival ◽

Recent Decade ◽

Free Survival ◽

Disease Free

427 Background: Official guidelines and retrospective studies have different view on the role of hepatic resection (HR) for patients with large (≥5 cm) multinodular (≥2) hepatocellular carcinoma (HCC) and those involving macrovascular invasion (MVI). We aim to evaluate the efficacy and its variation trend and the safety of HR for these patients in three tertiary care settings. Methods: A consecutive sample of 1,824 patients with Child-Pugh A liver function and large/multinodular HCC or involving MVI and who underwent initial HR were divided into four groups: large/multinodular HCC of the previous (2000-2004, n = 496) and recent five years (2005-2010, n = 765), involving MVI of the previous (n = 242) and recent five years (n = 321). Results: Among our patient sample, the hospital mortality was less than 5% and had a downward trend. Moreover, patients in recent five years have statistically significant longer survival time. Among patients with large/multinodular HCC, patients in recent five years showed a significantly better overall survival than those in previous five years at 1-year (92% vs. 84%), 3-year (69% vs. 61%), and 5-year (45% vs. 40%) (P = 0.004). Moreover, among patients involving MVI, overall survival in recent five years was significantly higher at 1-year (83% vs. 78%), 3-year (50% vs. 41%), and 5-year (25% vs. 17%) (P= 0.033). However, the disease-free survival of recent five years was only slightly higher than that of the previous five years in the two subgroups. Conclusions: HR offers good overall survival for patients with resectable large/multinodular HCC or those involving MVI and with preserved liver function. Outcomes have tended to improve in recent decade.

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Prognosis of hepatic failure with the albumin-bilirubin model for hepatocellular carcinoma after stereotactic body radiotherapy with and without transplant.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.384 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 384-384

Author(s):

Shaakir Hasan ◽

Alexander V. Kirichenko ◽

Paul Renz ◽

Vijay Kudithipudi ◽

Molly Vincent ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Hepatic Failure ◽

Stereotactic Body Radiotherapy ◽

Disease Free Survival ◽

Median Dose ◽

Free Survival ◽

Prognostic Assessment ◽

Disease Free

384 Background: The Albumin-Bilirubin (ALBI) model is a validated prognostic assessment of cirrhosis in hepatocellular carcinoma (HCC), stratifying patients to grades 1(ALBI-1), 2(ALBI-2), or 3(ALBI-3). We reported that ALBI distinguishes patients at higher risk for hepatic failure(HF) after stereotactic body radiotherapy (SBRT) within the Child Pugh(CP) A population. We now apply the ALBI model to both CP-A and CP-B patients after SBRT with or without orthotropic liver transplant (OLT), and assess its prognostic capability of overall survival (OS) and HF relative to the CP model. Methods: From 2009-2017, 68 patients with 81 HCC lesions and CP-A (45) or CP-B (23) cirrhosis completed SBRT in this IRB approved study. The median dose was 45 Gy (35 - 57 Gy) in 4-7 fractions. Initial ALBI and CP scores were measured against OS and progression of CP class, which was recorded every 3-4 months. Median follow-up = 18 months. Results: The median age = 62 and tumor size = 3.5 cm (1.1 Ð 11 cm). 26 patients were ALBI-1, 31 ALBI-2, and 11 ALBI-3 prior to SBRT. For all patients, 2-year local control was 96%. 1 and 2 year OS was 77% and 54%, disease free survival was 71% and 40%, and freedom from CP progression was 71% and 56%, respectively. OS was significantly different between ALBI-1, ALBI-2, and ALBI-3 patients (P = 0.01), as was progression of CP class (P<0.001). When stratified by initial CP class, there were no significant differences in survival or CP progression [Table 1]. In a subset of 37 CP-A and 15 CP-B without OLT, rates of progressive cirrhosis were better predicted by ALBI (P<0.001) than CP class (P=0.09). Conclusions: Compared to the CP model, the ALBI index more precisely predicted HF and OS in HCC patients for both early and intermediate cirrhosis. Its application may help better select candidates for OLT after SBRT, who may be at higher risk for HF than initially predicted. [Table: see text]

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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.

10.21203/rs.2.15935/v2 ◽

2020 ◽

Author(s):

Xiao-Yan Meng ◽

Xiu-Ping Zhang ◽

Hong-Qian Wang ◽

Weifeng Yu

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Portal Vein ◽

Cox Regression ◽

Cancer Recurrence ◽

Survival Outcomes ◽

Free Survival ◽

Cox Regression Analysis ◽

Underlying Causes ◽

The Impact

Abstract Background Whether anesthesia type is associate 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 has better survival outcomes compare to INHA in HCC patients with PVTT. Future prospective researches are urgent to verify this difference and figure out underlying causes of it.

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FAM83D is associated with gender, AJCC stage, overall survival and disease-free survival in hepatocellular carcinoma

Bioscience Reports ◽

10.1042/bsr20181640 ◽

2019 ◽

Vol 39 (5) ◽

Cited By ~ 2

Author(s):

Xuling Liu ◽

Hong Gao ◽

Jie Zhang ◽

Dongying Xue

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Sequence Similarity ◽

Prognostic Significance ◽

Disease Free Survival ◽

High Expression ◽

Mrna Levels ◽

Free Survival ◽

Ajcc Stage ◽

Disease Free

AbstractPrognostic significance of family with sequence similarity 83, member D (FAM83D) in hepatocellular carcinoma (HCC) patients has not been well-investigated using Gene Expression Omnibus (GEO) series and TCGA database, we compared FAM83D expression levels between tumor and adjacent tissues, and correlated FAM83D in tumors with outcomes and clinico-pathological features in HCC patients. Validated in GSE33006, GSE45436, GSE84402 and TCGA, FAM83D was significantly overexpressed in tumor tissues than that in adjacent tissues (all P<0.01). FAM83D up-regulation was significantly associated with worse overall survival (OS) and disease-free survival (DFS) in HCC patients (Log rank P=0.00583 and P=4.178E-04, respectively). Cox analysis revealed that FAM83D high expression was significantly associated with OS in HCC patients [hazard ratio (HR) = 1.44, 95% confidence interval (CI) = 1.005–2.063, P=0.047]. Additionally, patients deceased or recurred/progressed had significantly higher FAM83D mRNA levels than those living or disease-free (P=0.0011 and P=0.0238, respectively). FAM83D high expression group had significantly more male patients and advanced American Joint Committee on Cancer (AJCC) stage cases (P=0.048 and P=0.047, respectively). FAM83D mRNA were significantly overexpressed in male (P=0.0193). Compared with patients with AJCC stage I, those with AJCC stage II and stage III–IV had significantly higher FAM83D mRNA levels (P = 0.0346 and P=0.0045, respectively). In conclusion, overexpressed in tumors, FAM83D is associated with gender, AJCC stage, tumor recurrence and survival in HCC.

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Elevated Preoperative Neutrophil-Lymphocyte Ratio Is Associated with Poor Prognosis in Hepatocellular Carcinoma Patients Treated with Liver Transplantation: A Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2016/4743808 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 13

Author(s):

Xiao-Dong Sun ◽

Xiao-Ju Shi ◽

Yu-Guo Chen ◽

Chuan-Lei Wang ◽

Qiang Ma ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Poor Prognosis ◽

Meta Analysis ◽

Disease Free Survival ◽

Clinical Work ◽

Free Survival ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Disease Free

This study aims to investigate the prognostic value of neutrophil to lymphocyte ratio (NLR) in hepatocellular carcinoma (HCC) patients treated with liver transplantation (LT) through meta-analysis. Relevant articles were sought in PubMed, Embase, and Wangfang databases up to July 2015. A total of 1687 patients from 10 studies were included in this meta-analysis. Meta-analysis results showed that elevated NLR was significantly associated with poorer overall survival (OS) (HR = 2.71, 95% CI: 1.91–3.83) and poorer disease-free survival (DFS) (HR = 3.61, 95% CI: 2.23–5.84) in HCC patients treated with LT. Moreover, subgroup analysis showed the significant association between elevated preoperative NLR and poor prognosis was not altered by cutoff values of NLR or types of LT. Therefore, elevated preoperative NLR is associated with poor prognosis in HCC patients treated with LT. Preoperative NLR should be used to predict the prognosis of HCC after LT in our clinical work.

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