Impact of Tumor Factors on Survival in Patients with Hepatocellular Carcinoma Classified Based on Kinki Criteria Stage B2

2017 ◽  
Vol 35 (6) ◽  
pp. 583-588 ◽  
Author(s):  
Tadaaki Arizumi ◽  
Tomohiro Minami ◽  
Hirokazu Chishina ◽  
Masashi Kono ◽  
Masahiro Takita ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Group Size ◽  
University Hospital ◽  
Tumor Diameter ◽  
Group Comparison ◽  
Targeted Agents ◽  
Time To Progression ◽  
Tumor Number ◽  
Homogeneous Subgroup ◽  
Maximum Tumor Diameter

Background: Tumors classified based on the Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are heterogeneous in nature. Previously, the Kinki criterion was proposed for a more precise subclassification of tumors in BCLC-stage B. However, tumors in sub-stage B2 include various size and number of HCCs even with the Kinki criteria, which could lead to heterogeneity for overall survival (OS). In this study, we assessed how the size and number of tumors affect the OS and time to progression (TTP) in patients with Kinki criteria stage B2 tumors and treated with transarterial chemoembolization (TACE). Methods: Of 906 HCC patients treated with TACE at Kindai University Hospital, 236 patients with HCC considered as Kinki criteria stage B2 were examined. They were classified into the following 4 groups according to the maximum tumor diameter and number of tumors: B2a group, tumor size ≤6 cm and total number of tumors ≤6; B2b group, size ≤6 cm and number >6; B2c group, size >6 cm and number ≤6; and B2d group, size >6 cm and number >6. The OS and TTP of patients in each group were compared. Results: There were 131 patients (55.5%) in the B2a group, 58 (24.6%) in the B2b group, 41 (17.4%) in the B2c group, and 6 (0.03%) in the B2d group. Comparison of the survivals revealed that the median OS was 2.8 years (95% CI 2.0-3.5) in the B2a group, 2.8 years (95% CI 2.0-3.3) in the B2b group, 1.9 years (95% CI 0.8-4.0) in the B2c group, and 2.3 years (95% CI 1.2-ND [no data]) in the B2d group, respectively (p = 0.896). The median TTP in B2a, B2b, B2c, and B2d sub-substage HCC were13.2, 12.1, 13.8, and 11.5 months, respectively (p = 0.047). The median TTP in B2a + B2c sub-substage patients was longer than that in B2b + B2d sub-substage HCC patients (14.0 months and 10.4 months; p = 0.002). Conclusion: No significant differences were observed in the OS among HCC patients subclassified based on the maximum tumor diameter and tumor number in Kinki criteria stage B2. Consequently, Kinki criteria stage B2 HCC is a homogeneous subgroup in terms of OS prediction. However, shorter TTP in B2b+B2c sub-substage HCC patients than that in B2a + B2c sub-substage HCC patients suggests that different treatment strategy, such as systemic therapy with targeted agents instead of TACE, may be suitable to preserve the liver function.

scholarly journals FXYD6 overexpression in HBV-related hepatocellular carcinoma with cirrhosis

2020 ◽  
Vol 15 (1) ◽  
pp. 259-266
Author(s):  
Xiongfei Chen ◽  
Lishuang Ding ◽  
Deshuai Kong ◽  
Xiulei Zhao ◽  
Lili Liao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Normal Liver ◽  
Early Recurrence ◽  
Tumor Diameter ◽  
Tumor Number ◽  
B Virus ◽  
Expression Rate ◽  
Polymerase Chain ◽  
And Gender ◽  
Liver Tissues

AbstractObjectiveThe aim of this study was to investigate the expression of FXYD domain-containing ion transport regulator 6 (FXYD6) mRNA and protein in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) tissues with cirrhosis, the corresponding paracancerous tissues and the normal liver tissues, and to explore the clinical significance of FXYD6 expression in HBV-related HCC with cirrhosis.MethodsThe FXYD6 mRNA and protein were examined by semi-quantitative reverse transcription polymerase chain reaction and immunohistochemistry, respectively.ResultsThe FXYD6 mRNA in HBV-related HCC tissues was significantly higher than that in the cirrhosis tissues or that in the normal liver tissues. The positive expression rate of FXYD6 protein was statistically higher in HBV-related HCC tissues than that in HBV-related cirrhosis or that in normal liver tissues. There was no significant correlation between the expression of FXYD6 protein and gender, age, histological differentiation, tumor diameter, tumor number, integrity of tumor capsule or not and alpha fetoprotein (AFP) concentration in serum, but the protein expression was associated with microvascular invasion, pathological stage, and early recurrence after operation within 1 year.ConclusionFXYD6 might be involved in hepatocyte carcinogenesis and tumor progression in HBV-related HCC with cirrhosis and indicated a poor prognosis.

scholarly journals Platelet-to-Lymphocyte Ratio and C-Reactive Protein as Markers for Colorectal Polyp Histological Type

2020 ◽  
Author(s):  
Rui Chen ◽  
Liguang Wang ◽  
Qi Zhao ◽  
Zhen Li ◽  
Man Chen ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Colorectal Polyp ◽  
Colorectal Polyps ◽  
Histological Type ◽  
Endoscopic Polypectomy ◽  
Tumor Diameter ◽  
Reactive Protein ◽  
Tumor Number ◽  
Maximum Tumor Diameter

Abstract Background: The PLR and CRP level are markers that have been reported to predict the histological type of various tumors, and here, we evaluated their utility in predicting colorectal polyp histological types.Methods: We retrospectively reviewed 172 patients with colorectal polyps who underwent endoscopic polypectomy. The associations between histological type and clinicopathologic parameters were assessed by multivariate analysis. Results: The optimal PLR and CRP cut-off values were 113.32 and 0.39, respectively. The PLR (P=0.002) and CRP (P= 0.009) values were associated with the histological type according to the univariate analysis, whereas low PLR (P ≤0.001) and CRP (P =0.017) values were independent risk factors in the multivariate analysis together with maximum tumor diameter (P ≤0.001) and tumor number (P =0.0014).Conclusions: Preoperative PLR and CRP are correlated with the colorectal polyp histological type.

scholarly journals Development of a Prognostic Scoring System for Hepatocellular Carcinoma Patients With Main Portal Vein Tumor Thrombus Undergoing Conventional Transarterial Chemoembolization: An Analysis of 173 Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Jing-huan Li ◽  
Xin Yin ◽  
Wen-shuai Fan ◽  
Lan Zhang ◽  
Rong-xin Chen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Tumor Thrombus ◽  
Portal Vein Tumor Thrombus ◽  
Ratio Test ◽  
Tumor Diameter ◽  
Main Portal Vein ◽  
Cox Regression Analysis ◽  
Tumor Number ◽  
Prognostic Stratification

BackgroundPatients with hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (mPVTT) have poor prognosis. Promising systemic therapies, such as target therapies, have limited benefits. The purpose of this study is to retrospectively evaluate the benefits of conventional TACE (c-TACE) and to establish a prognostic stratification of HCC patients with mPVTT.MethodsThis is a single center retrospective study conducted over 5 years (duration of performing c-TACE), on consecutive HCC patients with mPVTT receiving c-TACE. Univariable and multivariable analysis were used to explore factors independently associated with overall survival (OS). Based on Cox-regression analysis, prognostic models were developed and internally validated by bootstrap methods. Discrimination and performance were measured by Akaike information criterion, concordance index, and likelihood ratio test.ResultsA total of 173 patients were included. Median OS was 6.0 months (95%CI: 3.92~8.08). The independent variables correlated with survival were largest tumor diameter, tumor number, mPVTT extension, and AFP. In the final model, patients were assigned 2 points if largest tumor diameter ≥8 cm, or tumor number ≥2, 1point if main trunk was complete obstructed, or AFP ≥400 ng/ml. By summing up these points, patients were divided into three risk groups according to the score at the 15rd and 85th percentiles, in which median OS were 18, 7, and 3.5months, respectively (p<0.001). The model shown optimal discrimination, performance, and calibration.Conclusionsc-TACE could provide survival benefits in HCC patients with mPVTT and the proposed prognostic stratification may help to identify good candidates for the treatment, and those for whom c-TACE may be futile.

scholarly journals Preoperative Risk Stratification for Early Recurrence of HBV-related Hepatocellular Carcinoma After Deceased Donor Liver Transplantation:A Five-Eight Model Development and Validation

2019 ◽  
Author(s):  
Abdulahad Abdulrab Mohammed Al-Ameri ◽  
Xuyong Wei ◽  
Lidan Lin ◽  
Zhou Shao ◽  
Haijun Guo ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Model Development ◽  
Deceased Donor ◽  
Early Recurrence ◽  
Individual Risk ◽  
Tumor Diameter ◽  
Tumor Number ◽  
Serum Alpha Fetoprotein ◽  
Transplant Registry ◽  
Development And Validation

Abstract Background: Early recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is associated with poor surgical outcomes. This study aims to construct a preoperative model to predict individual risk of post-LT HCC recurrence. Methods: Data of 748 adult patients who underwent deceased donor LT for HCC between January 2015, and February 2019 were collected retrospectively from the China Liver Transplant Registry database and randomly divided into training (n=486) and validation(n=262) cohorts. A multivariate analysis was performed and the five-eight model was developed. Results: A total of 748 patients were included in the study; of them, 96% had hepatitis B virus (HBV) and 84 % had cirrhosis. Pre-LT serum alpha-fetoprotein (AFP), tumor number and largest tumor diameter were incorporated to construct the 5-8 model which can stratify patients accurately according to their risk of recurrence into three prognostic subgroups; low-(0-5 points), medium-(6–8 points) and high-risk (>8 points) with 2-year post-LT recurrence rate of (5%,20% and 51%,p<0.001) respectively.The 5-8 model was better than Milan, Hangzhou, and AFP-model for prediction of HCC early recurrence. These findings were confirmed by the results of the validation cohort. Conclusions: The 5-8 model is a simple validated and accurate tool for preoperative stratification of early recurrence of HCC after LT.

scholarly journals Changes in hepatocellular carcinoma aggressiveness characteristics with an increase in tumor diameter

2021 ◽  
pp. 172460082199637
Author(s):  
Brian I. Carr ◽  
Vito Guerra ◽  
Rossella Donghia ◽  
Fabio Farinati ◽  
Edoardo G. Giannini ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Survival Data ◽  
Alpha Fetoprotein ◽  
Tumor Diameter ◽  
Vein Thrombosis ◽  
Tumor Multifocality ◽  
Maximum Tumor Diameter ◽  
Tumor Sampling

Background: Hepatocellular carcinoma prognosis depends on both liver and tumor determinants, especially on maximum tumor diameter, multifocality, and presence of portal vein thrombosis, despite apparently complete tumor removal by resection or liver transplantation. Aims: To examine parameters of hepatocellular carcinoma aggressiveness as tumor size increases. Methods: A large hepatocellular carcinoma database was examined for trends in serum alpha-fetoprotein and the percentage of patients with macroscopic portal vein thrombosis or tumor multifocality. Results: A total of 13,016 hepatocellular carcinoma patients were identified having full tumor and survival data. Of these, 76.56% were male and 23.44% were female, with a median age of 64.4 years. We found that as the maximum tumor diameter increased, there was a significant trend for increased alpha-fetoprotein levels ( P<0.001) and an increased percentage of patients with either portal vein thrombosis or tumor multifocality, each P<0.0001. Furthermore, the increases of both alpha-fetoprotein and portal vein thrombosis were proportionately greater than the related maximum tumor diameter increases. These trends of increased alpha-fetoprotein, portal vein thrombosis, and multifocality with increasing maximum tumor diameter had non-linear patterns. Within alpha-fetoprotein and multifocality trends, there were identifiable sub-trends associated with specific maximum tumor diameter ranges. Conclusions: The greater fold-increases in alpha-fetoprotein and portal vein thrombosis compared with increases in maximum tumor diameter imply that hepatocellular carcinoma characteristics may change with increasing size to a more aggressive phenotype, suggesting that follow-up tumor sampling might be useful, in addition to baseline tumor sampling, for optimal therapeutic choices to be made.

scholarly journals Preoperative and Postoperative Nomograms in Predicting Early Recurrence of Hepatocellular Carcinoma Without Macrovascular Invasion After Curative Resection

2021 ◽  
Author(s):  
Yanfang Zhang ◽  
Liangliang Xu ◽  
Mingqing Xu ◽  
Hong Tang
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Validation Cohort ◽  
Predictive Performance ◽  
Early Recurrence ◽  
Tumor Diameter ◽  
Training Cohort ◽  
Factors Associated ◽  
Tumor Number ◽  
Before And After

Abstract This study aimed to establish pre- and postoperative nomograms in predicting postoperative early recurrence (ER) for hepatocellular carcinoma (HCC) without macrovascular invasion. The patients who underwent curative LR for HCC from January 2012 to December 2016 in our center were divided into training and internal prospective validation cohorts. Nomograms were constructed based on the independent risk factors derived from multivariate logistic regression analyses in training cohort. The predictive performance of nomograms was validated by internal prospective validation cohort. A total of 698 patients fulfilled with eligible criteria. Among them, 265 out of 482 patients (55.0%) in training cohort and 120 out 216 (55.6%) patients in validation cohort developed ER. The preoperative risk factors associated with ER were age, alpha fetoprotein (AFP), tumor diameter, tumor number; the postoperative risk factors associated with ER were age, tumor diameter, tumor number, microvasular invasion (MVI) and differentiation. The pre- and postoperative nomograms based on these factors showed good accuracy with C-indices of 0.712 and 0.850 in training cohort, and 0.754 and 0.857 in validation cohort, respectively. The calibration curves showed optimal agreement between the prediction by the nomograms and actual observation. The area under the receiver operating characteristic curves of pre- and postoperative nomograms were 0.721 and 0.848 in training cohort, and 0.754 and 0.844 in validation cohort, respectively. Present nomograms showed good performance in predicting ER for HCC without macrovascular invasion before and after surgery, which were helpful for doctors in designation of treatments and selection of patients for regularly surveillance or administration of neoadjuvant therapies.

scholarly journals Macroscopic Portal Vein Thrombosis in HCC Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Hikmet Akkiz ◽  
Brian I. Carr ◽  
Sedef Kuran ◽  
Ümit Karaoğullarından ◽  
Oguz Üsküdar ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Odds Ratio ◽  
Logistic Regression Model ◽  
Tumor Diameter ◽  
Portal Vein Invasion ◽  
Vein Thrombosis ◽  
Tumor Multifocality ◽  
Maximum Tumor Diameter ◽  
Low Levels

Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD <5cm to 56.4% with tumors of MTD >10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumor multifocality. A logistic regression model that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD>5.0cm plus tumor multifocality plus elevated AFP, compared to low levels of these 3 parameters. The presence or absence of macroscopic PVT may therefore represent different HCC aggressiveness phenotypes, as judged by a significant increase in tumor multifocality and AFP levels in the PVT positive patients. Factors in addition to MTD and AFP must also contribute to PVT development.

scholarly journals Preoperative Risk Stratification for Early Recurrence of HBV-related Hepatocellular Carcinoma After Deceased Donor Liver Transplantation:A Five-Eight Model Development and Validation

2019 ◽  
Author(s):  
Abdulahad Abdulrab Mohammed Al-Ameri ◽  
Xuyong Wei ◽  
Lidan Lin ◽  
Zhou Shao ◽  
Haijun Guo ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Model Development ◽  
Deceased Donor ◽  
Early Recurrence ◽  
Individual Risk ◽  
Tumor Diameter ◽  
Tumor Number ◽  
Serum Alpha Fetoprotein ◽  
Transplant Registry ◽  
Development And Validation

Abstract Background Early recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is associated with poor surgical outcomes. Objectives To construct a preoperative model to predict individual risk of post-LT HCC recurrence. Methods Data of 748 adult patients who underwent deceased donor LT for HCC between January 2015, and February 2019 were collected retrospectively from the China Liver Transplant Registry database and randomly divided into training (n=486) and validation(n=262) cohorts. A multivariate analysis was performed and the five-eight model was developed. Results A total of 748 patients were included in the study; of them, 96% had hepatitis B virus (HBV) and 84 % had cirrhosis. Pre-LT serum alpha-fetoprotein (AFP), tumor number and largest tumor diameter were incorporated to construct the 5-8 model which can stratify patients accurately according to their risk of recurrence into three prognostic subgroups; low-(0-5 points), medium-(6–8 points) and high-risk (>8 points) with 2-year post-LT recurrence rate of (5%,20% and 51%,p<0.001) respectively.The 5-8 model was better than Milan, Hangzhou, and AFP-model for prediction of HCC early recurrence. These findings were confirmed by the results of the validation cohort. Conclusions The 5-8 model is a simple validated and accurate tool for preoperative stratification of early recurrence of HCC after LT.

scholarly journals Correlationship between Ki67, VEGF, and p53 and Hepatocellular Carcinoma Recurrence in Liver Transplant Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Xia Zhang ◽  
Zhixian Wu ◽  
Yonghai Peng ◽  
Dongliang Li ◽  
Yi Jiang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Recurrence ◽  
Independent Predictor ◽  
Clinicopathological Characteristics ◽  
Tumor Diameter ◽  
Node Metastasis ◽  
Transplant Patients ◽  
Tumor Number ◽  
Hepatocellular Carcinoma Recurrence ◽  
Hcc Recurrence

Background and Aims. Patients with hepatocellular carcinoma (HCC) who undergo orthotopic liver transplantation (OLT) are at risk for posttransplant tumor recurrence. The aim of this study was to evaluate the correlation between the expression of Ki67, VEGF, and p53 in HCC and clinicopathological characteristics of HCC patients, as well as their predictive value for HCC recurrence after OLT. Methods. 60 patients who underwent OLT and were found to have HCC in the liver explant. The expression of Ki67, VEGF, and p53 in HCC was detected by immunohistochemistry. Results. Ki67 was associated with the tumor number and the grade of differentiation at baseline. VEGF was associated with the diameter and number of tumors, tumor differentiation, and lymph node metastasis. p53 was associated with the tumor diameter and tumor encapsulation. The expression of Ki67, VEGF, and p53 in HCC was correlated with the tumor recurrence after OLT, respectively. Among them, VEGF was an independent predictor for tumor recurrence after OLT. Conclusion. Ki67, VEGF, and p53 are associated with the recurrence of HCC after OLT. VEGF independently predicts the recurrence of HCC.

scholarly journals The effect of tumor necrosis on postoperative survival of patients with solitary small hepatocellular carcinoma

2019 ◽  
Author(s):  
Yi-hong Ling ◽  
Jie-wei Chen ◽  
Shi-hong Wen ◽  
Chao-yun Huang ◽  
Peng Li ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Tumor Necrosis ◽  
Primary Treatment ◽  
Hazard Ratio ◽  
Tumor Diameter ◽  
Small Hepatocellular Carcinoma ◽  
Cancer Aggressiveness ◽  
Maximum Tumor Diameter

Abstract Background: Small hepatocellular carcinoma (sHCC) is a special subtype of HCC with the maximum tumor diameter ≤ 3 cm and favorable long-term outcomes. Surgical resection or radiofrequency ablation offer the greatest chance for cure; however, many patients still undergo tumor recurrence after primary treatment. So far, there is no clinical applicable method to assess biological aggressiveness in solitary sHCC.Methods: In the present study, we retrospectively evaluated tumor necrosis of 335 patients with solitary sHCC treated with hepatectomy between December 1998 and 2010 from Sun Yat-sen University Cancer Center.Results: In the current study, the presence of tumor necrosis was observed in 157 of 335 (46.9%). Further correlation analysis showed that the presence of tumor necrosis in sHCC was significantly correlated with tumor size and vascular invasion (P = 0.026, 0.003, respectively). The presence of tumor necrosis was associated closely with poorer cancer-specific overall survival (OS) and recurrence-free survival (RFS) as evidenced by univariate (P < 0.001; hazard ratio, 2.821; 95% CI, 1.643-4.842) and multivariate analysis (P = 0.005; hazard ratio, 2.208; 95% CI, 1.272-3.833). More importantly, the combined model by tumor necrosis, vascular invasion and tumor size can significantly stratify the risk for RFS and OS and improve the ability to discriminate sHCC patients’ outcomes (P < 0.0001 for both).Conclusions: Our findings provide evidence that tumor necrosis has the potential to be a parameter for cancer aggressiveness in solitary sHCC. The combined prognostic model may be a useful tool for identifying solitary sHCC patients with worse outcomes.

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