Outcomes of reduction hepatectomy combined with postoperative multidisciplinary therapy for advanced hepatocellular carcinoma

Background. Sorafenib is a first-line treatment option for advanced hepatocellular carcinoma (HCC) patients; however, survival predictors upon progression have not been well characterized. In the present study, we aimed to show the efficacy of multidisciplinary therapy for patients who had failed to respond to sorafenib treatment. Methods. Among 146 BCLC stage B or C HCC patients treated with sorafenib monotherapy between July 2009 and August 2014, the first radiological progression according to the modified RECIST was identified in 71 patients; factors predicting overall survival (OS) and survival postprogression (SPP) were analyzed in these patients. Results. The median OS and SPP for patients who failed to respond to sorafenib treatment were 10.5 and 6.2 months, respectively, and the SPP was strongly correlated with the OS (r=0.982, P<0.01, and R2=0.965). The independent predictors of OS and SPP were identical. The predictors of SPP were des-gamma-carboxy prothrombin, progression of portal vein thrombosis, and subsequent second-line or additional treatment. Conclusions. SPP is closely associated with OS and might be notable in patients who have failed to respond to initial sorafenib treatment. Furthermore, interventions consisting of other treatment options upon the appearance of progression might prolong OS.

Download Full-text

Long-term complete response of advanced hepatocellular carcinoma treated with multidisciplinary therapy including reduced dose of sorafenib: case report and review of the literature

World Journal of Surgical Oncology ◽

10.1186/s12957-015-0559-9 ◽

2015 ◽

Vol 13 (1) ◽

Cited By ~ 7

Author(s):

Masahiro Shinoda ◽

Norihiro Kishida ◽

Osamu Itano ◽

Shigenori Ei ◽

Akihisa Ueno ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Case Report ◽

Complete Response ◽

Advanced Hepatocellular Carcinoma ◽

Review Of The Literature ◽

Multidisciplinary Therapy ◽

Reduced Dose

Download Full-text

Outcomes of reduction hepatectomy and postoperative multidisciplinary therapy for 30 unresectable advanced hepatocellular carcinomas

10.21203/rs.3.rs-131096/v1 ◽

2020 ◽

Author(s):

Yoh Asahi ◽

Toshiya Kamiyama ◽

Tatsuhiko Kakisaka ◽

Tatsuya Orimo ◽

Shingo Shimada ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Survival Rate ◽

Combined Treatment ◽

Postoperative Treatment ◽

Survival Outcomes ◽

Advanced Hepatocellular Carcinoma ◽

Remnant Liver ◽

Overall Survival Rate ◽

Multidisciplinary Therapy

Abstract Background The role of volume reduction hepatectomy in the treatment of unresectable advanced hepatocellular carcinoma remains unclear. This study aimed to examine the outcomes of combination treatment with reduction hepatectomy and multidisciplinary postoperative treatment for unresectable advanced hepatocellular carcinoma. Methods Thirty cases of unresectable advanced hepatocellular carcinoma, in which reduction hepatectomy was performed between 2000 and 2018 at the Department of Gastroenterological Surgery I, were divided into POCR(+) and POCR(-) groups, depending on whether postoperative complete remission (POCR) of the evaluable lesions was achieved through postoperative treatment. The cases in the POCR(-) group were subdivided into POCR(-)TKI(+) and POCR(-)TKI(-) groups, depending on whether tyrosine kinase inhibitors (TKIs) were administered postoperatively. Results The 5-year overall survival rate and mean survival time (MST) after reduction hepatectomy were 15.7% and 28.40 months, respectively, for all cases; 37.5% and 56.55 months, respectively, in the POCR(+) group; and 6.3% and 14.84 months, respectively, in the POCR(-) group (p = 0.0041). Tumor size, vascular invasion, and the number of tumors in the remnant liver after the reduction hepatectomy were also found to be related to survival outcomes. The number of tumors in the remnant liver was the only factor that differed significantly between the POCR(+) group and POCR(-) group, and POCR was achieved significantly more frequently when ≤ 3 tumors remained in the remnant liver (p = 0.0025). The MST was 33.52 months in the POCR(-)TKI(+) group, which was superior to the MST of 10.74 months seen in the POCR(-)TKI(-) group (p = 0.0473). Conclusions Reduction hepatectomy and multidisciplinary postoperative treatment for unresectable advanced hepatocellular carcinoma resulted in a 5-year overall survival rate of 15.70% and an MST of 28.40 months. The treatment strategy was effective when POCR was achieved via multidisciplinary postoperative therapy. To achieve POCR, reduction hepatectomy should aim to ensure that ≤ 3 tumors remain in the remnant liver. Even in cases in which POCR is not achieved, combined treatment with reduction hepatectomy and multidisciplinary therapy can improve survival outcomes when TKIs are administered.

Download Full-text