A New Prognostic Algorithm Predicting HCC Recurrence in Patients With Barcelona Clinic Liver Cancer Stage B Who Received PA-TACE

BackgroundPostoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) is effective in preventing the recurrence of hepatocellular carcinoma (HCC) in patients treated with surgery. However, there is a lack of reports studying the risk factors associated with recurrence in HCC patients who received PA-TACE. In this study, we identified the independent risk factors for recurrence of HCC patients who received PA-TACE. We also developed a novel, effective, and valid nomogram to predict the individual probability of recurrence, 1, 3, and 5 years after PA-TACE.MethodsA retrospective study was performed to identify the independent risk factors for recurrence of HCC in a group of 502 patients diagnosed in stage B based on the Barcelona Clinic Liver Cancer (BCLC) evaluation system for HCC that underwent curative resections. Then, subgroup analysis was performed for 184 patients who received PA-TACE, who were included in the training cohort. The other 147 HCC patients were included in a validation cohort. A recurrence-free survival (RFS)-predicting nomogram was constructed, and results were assessed using calibration and decision curves and a time-dependent AUC diagram.ResultsPA-TACE was shown to be a significant independent prognostic value for patients with BCLC stage B [p < 0.001, hazard ratio (HR) = 0.508, 95% CI = 0.375–0.689 for OS, p = 0.002; HR = 0.670, 95%CI = 0.517–0.868 for RFS]. Alpha fetoprotein (AFP), tumor number, tumor size, microvascular invasion (MVI), and differentiation were considered as independent risk factors for RFS in the training cohort, and these were further confirmed in the validation cohort. Next, a nomogram was constructed to predict RFS. The C-index for RFS in the nomogram was 0.721 (95% CI = 0.718–0.724), which was higher than SNACOR, HAP, and CHIP scores (0.587, 0.573, and 0.607, respectively). Calibration and decision curve analyses and a time-dependent AUC diagram were used. Our nomogram showed stronger performance than these other nomograms in both the training and validation cohorts.ConclusionsHCC patients diagnosed as stage B according to BCLC may benefit from PA-TACE after surgery. The RFS nomogram presented here provides an accurate and reliable prognostic model to monitor recurrence. Patients with a high recurrence score based on the nomogram should receive additional high-end imaging exams and shorter timeframes in between follow-up visits.

Vascular Endothelial Growth Factor Levels Difference among Hepatocellular Cancer Patients Based on Barcelona Clinic Liver Cancer Staging

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. It depends on angiogenesis for growth and metastasis. Vascular endothelial growth factor (VEGF), a growth factor for angiogenesis, is hoped to be a biomarker for the diagnosis of HCC and its development. AIM: The objective of the study is to determine the difference of VEGF levels among HCC patients based on barcelona clinic liver cancer (BCLC) staging. METHODS: A cross-sectional study was conducted at Haji Adam Malik General Hospital Medan, Indonesia between January and December 2018. Patients aged 18 years or older with HCC were enrolled using consecutive sampling method. Patients with cholangiocarcinoma, hemangioma, and liver metastasis were excluded from the study. The diagnosis of HCC was confirmed by triphasic computed tomography-scanning. Circulating VEGF levels were determined from serum specimen using Quantikine Human VEGF-enzyme-linked immunosorbent assay. All patients were grouped based on BCLC staging. Kruskal Wallis-H test was applied at 95% confidence interval. p < 0.05 was considered significant. RESULTS: Of 60 patients, 47 (78.3%) were male. Mean age of patients was 61.4 (SD11.7) years. Hepatitis B was the most common etiology (70.0%) of HCC. Based on BCLC staging, 25 (41.7%) patients were in stage C. Median VEGF level was 951.25 pg/mL. There was a statistically significant difference in VEGF levels (p = 0.006) where patients in Stage C (1,009.6 pg/mL) and D (1,189.7 pg/mL) had higher VEGF levels compared to those in Stage A (578 pg/mL). CONCLUSION: There was a statistically significant difference of VEGF levels among HCC patients based on BCLC staging.

Hepatocellular Carcinoma Treatment by Using TACE: a literature review

Hepatocellular Carcinoma (HCC) is the most prevalent liver malignancy. Trans arterial chemoembolization (TACE) is the gold standard treatment for Barcelona Clinic Liver Cancer (BCLC) stage B patients, who are considered to have unresectable HCC. In the following review it is shown that BCLC stage B group is too heterogenous, at the same time some patient may present a better outcome by receiving a more aggressive procedure, while others may benefit from systemic therapy. Those methods suggest which is the optimal treatment for BCLC stage B patients and when to apply it. Apart from alternatives to TACE, this review has highlighted other situations when TACE may be used – BCLC stage A or C.

Unresectable hepatocellular carcinoma treatment with doxorubicin-eluting polyethylene glycol microspheres: a single-center experience

Background: Transarterial chemoembolization (TACE) is indicated for unresectable hepatocellular carcinoma. Methods: This was a retrospective study of 50 hepatocellular carcinoma patients treated with TACE using doxorubicin-loaded LifePearl™ to investigate the safety and efficacy of TACE. Results: There was no 30-day mortality, and limited adverse events were reported. At best tumor response, complete response and disease control were 58% and 94%, respectively, with a median of 4.5 months of follow-up. Median overall survival was 33.8 months. Patients with Barcelona Clinic Liver Cancer stage 0 and stage A at best tumor response showed a higher complete response rate (83%) than patients with Barcelona Clinic Liver Cancer stage B (complete response: 50%; p = 0.0414). Conclusion: Doxorubicin-loaded LifePearl™ TACE might be an effective treatment, with a good safety profile, for patients with early/intermediate-stage hepatocellular carcinoma. Further prospective data, especially with a small cohort of selected patients, are required to confirm these results.

A novel sub-staging system for prognosis prediction of Barcelona clinic liver cancer C stage hepatocellular carcinoma: 10 years observational study.

e16139 Background: This study sought to propose a novel sub-staging system which could predict prognosis of patients with Barcelona clinic liver cancer (BCLC) C stage Hepatocellular carcinoma (HCC). Methods: Between January 2008 and September 2018, 806 patients with BCLC-C stage HCC were assessed retrospectively. The significance of clinical variables in predicting prognosis were statistical analysis. A prognostic sub-staging system of BCLC-C stage HCC was developed according to prognosis-related factors. The predictive performance was subsequently validated. Results: In training set, tumor burden (TB) >50%, type III/IV portal vein tumor thrombus (PVTT), extrahepatic metastasis (M) and Child-Pugh (CP) B class were independently associated with overall survival (OS). According to those prognosis-related factors, a novel sub-staging system of BCLC-C stage was “linear predictor= TB+PVTT+M+CP”, which had good performance in predicting OS in both training and validation set. The thirtieth percentile and the third quartile of the linear predictor, namely 6 and 12, were selected as cut-off values, stratifying patients into different OS after interventional therapy (IT) or sorafenib therapy (ST), specifically, ≤6: 43.7 months for IT, 32.0 month for ST;＞6 but＜12: 43.7 months for IT, 32.0 month for ST; ≥12: 43.7 months for IT, 32.0 month for ST. Conclusions: The novel sub-staging system of BCLC-C stage HCC may stratify patients for suitable therapy and predict individual survival with favorable performance and discrimination.