scholarly journals Treatment allocation in patients with hepatocellular carcinoma: Need for a paradigm shift?

2021 ◽  
Author(s):  
Alessandro Vitale ◽  
Michele Finotti ◽  
Franco Trevisani ◽  
Fabio Farinati ◽  
Edoardo G. Giannini
Keyword(s):  
Hepatocellular Carcinoma ◽  
Paradigm Shift ◽  
Treatment Allocation

Radiofrequency Ablation With or Without Transcatheter Arterial Chemoembolization in the Treatment of Hepatocellular Carcinoma: A Prospective Randomized Trial

2013 ◽  
Vol 31 (4) ◽  
pp. 426-432 ◽  
Author(s):  
Zhen-Wei Peng ◽  
Yao-Jun Zhang ◽  
Min-Shan Chen ◽  
Li Xu ◽  
Hui-Hong Liang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Transcatheter Arterial Chemoembolization ◽  
Recurrence Free Survival ◽  
Treatment Allocation ◽  
Free Survival ◽  
End Point ◽  
Tumor Number ◽  
Arterial Chemoembolization

Purpose To compare radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC). Patients and Methods A randomized controlled trial was conducted on 189 patients with HCC less than 7 cm at a single tertiary referral center between October 2006 and June 2009. Patients were randomly asssigned to receive TACE combined with RFA (TACE-RFA; n = 94) or RFA alone (n = 95). The primary end point was overall survival. The secondary end point was recurrence-free survival, and the tertiary end point was adverse effects. Results At a follow-up of 7 to 62 months, 34 patients in the TACE-RFA group and 48 patients in the RFA group had died. Thirty-three patients and 52 patients had developed recurrence in the TACE-RFA group and RFA group, respectively. The 1-, 3-, and 4-year overall survivals for the TACE-RFA group and the RFA group were 92.6%, 66.6%, and 61.8% and 85.3%, 59%, and 45.0%, respectively. The corresponding recurrence-free survivals were 79.4%, 60.6%, and 54.8% and 66.7%, 44.2%, and 38.9%, respectively. Patients in the TACE-RFA group had better overall survival and recurrence-free survival than patients in the RFA group (hazard ratio, 0.525; 95% CI, 0.335 to 0.822; P = .002; hazard ratio, 0.575; 95% CI, 0.374 to 0.897; P = .009, respectively). There were no treatment-related deaths. On logistic regression analyses, treatment allocation, tumor size, and tumor number were significant prognostic factors for overall survival, whereas treatment allocation and tumor number were significant prognostic factors for recurrence-free survival. Conclusion TACE-RFA was superior to RFA alone in improving survival for patients with HCC less than 7 cm.

scholarly journals Treatment allocation in hepatocellular carcinoma: Assessment of the BCLC algorithm

2016 ◽  
Vol 15 (1) ◽  
pp. 82-90 ◽  
Author(s):  
Mandy Richani ◽  
Philippe Kolly ◽  
Marina Knoepfli ◽  
Evelyn Herrmann ◽  
Martin Zweifel ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Treatment Allocation

Impact of direct-acting antivirals and 12-week sustained viral response on clinical outcomes in patients with hepatitis C and hepatocellular carcinoma.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 397-397
Author(s):  
William M Kamp ◽  
Cortlandt Sellers ◽  
Stacey Stein ◽  
Joseph K Lim ◽  
Hyun S. Kevin Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Hepatitis C ◽  
Sustained Viral Response ◽  
Tumor Location ◽  
Care Hospital ◽  
Direct Acting Antivirals ◽  
Treatment Allocation ◽  
Viral Response ◽  
Direct Acting

397 Background: To investigate the impact of direct-acting antivirals (DAA) and 12-week sustained viral response (SVR12) in patients with hepatocellular carcinoma (HCC) and hepatitis C viral infections (HCV). Methods: Retrospective analysis of HCC patients diagnosed from 2005 to 2016 at an urban tertiary-care hospital. Kaplan-Meier curves and multivariable Cox proportional hazards models were used to assess survival. Results: Nine hundred ninety-six patients met inclusion criteria (mean age 62.8±10.2 yrs, 79% male). Four hundred seventy-eight (50%) patients received interventional oncology (catheter-based therapies, ablation and combination locoregional therapies), 141 (15%) received supportive care (palliative or no treatment), 125 (13%) received a transplant, 112 (14%) had tumor resection and 94 (12%) received chemotherapy or radiation as their primary treatment. Median overall survival (OS) of the entire cohort was 24.2 months (95% CI: 20.9-27.9). Transplant patients were excluded from further analysis. Four hundred seventy patients had HCV (56%). One hundred twenty-three patients received one or more DAA therapies for HCV (26.2%), 83 of whom achieved SVR12 (68%). HCC occurrence and recurrence were reported in 29 (26%) and 38 (45%) patients, respectively, after DAA therapy. HCV-positive and HCV-negative patients had similar survival (OS 20.7 mo vs 17.4 mo, p=0.22). Patients receiving DAA therapy had a higher OS of 71.8 mo (CI: 39.5-not reached) vs 11.6 mo (CI: 9.8-14.5) for patients without DAA therapy (p<0.0001). DAA patients who achieved SVR12 had a higher OS of 75.6 mo (CI: 49.2-not reached) vs the non-SVR12 group (26.7 mo, CI: 13.7-31.1, p<0.0001). Multivariable analysis (MVA) showed that AJCC, Child-Pugh Score, MELD, tumor size, tumor location and treatment allocation had independent influence on survival for the cohort (p<0.05). In HCV patients, AJCC, MELD, tumor location, treatment allocation and DAA were significant (p<0.05). In patients receiving DAA, only MELD score and SVR12 remained significant factors (p<0.05). Conclusions: DAA therapy and achieving SVR12 is associated with increased overall survival in HCC patients with HCV. This analysis supports the importance of treating HCV to SVR12 as part of HCC management.

scholarly journals Preoperative immunotherapy for resectable hepatocellular carcinoma: Toward a paradigm shift?

2020 ◽  
Vol 73 (6) ◽  
pp. 1588-1590
Author(s):  
Florian Seckler ◽  
Alexandre Doussot ◽  
Prudence Colpart ◽  
Célia Turco ◽  
Paul Calame ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Paradigm Shift
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