scholarly journals Hepatic Resection Versus Transarterial Chemoembolization for the Intermediate Stage Hepatocellular Carcinoma: A Cohort Study

2020 ◽  
Author(s):  
Linbin Lu ◽  
Peichan Zheng ◽  
Lujun Shen ◽  
Zhixian Wu ◽  
Xiong Chen
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cohort Study ◽  
Hepatic Resection ◽  
Transarterial Chemoembolization ◽  
Intermediate Stage

scholarly journals Tumor Marker-Based Definition of the Transarterial Chemoembolization-Refractoriness in Intermediate-Stage Hepatocellular Carcinoma: A Multi-Cohort Study

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1721 ◽  
Author(s):  
Jun Sik Yoon ◽  
Dong Hyun Sinn ◽  
Jeong-Hoon Lee ◽  
Hwi Young Kim ◽  
Cheol-Hyung Lee ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cohort Study ◽  
Tumor Marker ◽  
Systemic Therapy ◽  
Transarterial Chemoembolization ◽  
External Validation ◽  
Intermediate Stage ◽  
Prognostic Impact ◽  
High Baseline ◽  
Definition Of

Background: For patients with hepatocellular carcinoma (HCC), the definition of refractoriness to transarterial chemoembolization (TACE), which might make them a candidate for systemic therapy, is still controversial. We aimed to derive and validate a tumor marker-based algorithm to define the refractoriness to TACE in patients with intermediate-stage HCC. Methods: This multi-cohort study was comprised of patients who underwent TACE for treatment-naïve intermediate-stage HCC. We derived a prediction model for overall survival (OS) using the pre- and post-TACE model to predict tumor recurrence after living donor liver transplantation (MoRAL) (i.e., MoRAL score = 11×√protein induced by vitamin K absence-II + 2×√alpha-fetoprotein), which was proven to reflect both tumor burden and biologic aggressiveness of HCC in the explant liver, from a training cohort (n = 193). These results were externally validated in both an independent hospital cohort (from two large-volume centers, n = 140) and a Korean National Cancer Registry sample cohort (n = 149). Results: The changes in MoRAL score (ΔMoRAL) after initial TACE was an independent predictor of OS (MoRAL-increase vs. MoRAL-non-increase: adjusted hazard ratio (HR) = 2.18, 95% confidence interval (CI) = 1.37–3.46, p = 0.001; median OS = 18.8 vs. 37.8 months). In a subgroup of patients with a high baseline MoRAL score (≥89.5, 25th percentile and higher), the prognostic impact of ΔMoRAL was more pronounced (MoRAL-increase vs. MoRAL-non-increase: HR = 3.68, 95% CI = 1.54–8.76, p < 0.001; median OS = 9.9 vs. 37.4 months). These results were reproduced in the external validation cohorts. Conclusion: The ΔMoRAL after the first TACE, a simple and objective index, provides refined prognostication for patients with intermediate-stage HCC. Proceeding to a second TACE may not provide additional survival benefits in cases of a MoRAL-increase after the first TACE in patients with a high baseline MoRAL score (≥89.5), who might be candidates for systemic therapy.

Hepatic resection is superior to transarterial chemoembolization for treating intermediate-stage hepatocellular carcinoma

2016 ◽  
Vol 37 (7) ◽  
pp. 1083-1084 ◽  
Author(s):  
Jian-Hong Zhong ◽  
Ning-Fu Peng ◽  
Xue-Mei You ◽  
Liang Ma ◽  
Le-Qun Li
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Resection ◽  
Transarterial Chemoembolization ◽  
Intermediate Stage

Sorafenib versus transarterial chemoembolization as adjuvant therapies for patients with hepatocellular carcinoma and microvascular invasion.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 244-244 ◽  
Author(s):  
Xinyu Bi ◽  
Jie Gao ◽  
Jianqiang Cai
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Resection ◽  
Transarterial Chemoembolization ◽  
Standard Of Care ◽  
Intermediate Stage ◽  
Microvascular Invasion ◽  
Rank Test ◽  
Control Group ◽  
Adjuvant Therapies ◽  
Sorafenib Group

244 Background: Microvascular invasion (MVI) is a risk factor for poor prognosis following curative resection in hepatocellular carcinoma (HCC). Currently, there is no standard of care for patients with HCC and MVI. The present study compared the effectiveness of sorafenib and transarterial chemoembolization (TACE) as adjuvant therapies following hepatic resection in patients with early and intermediate-stage HCC and MVI. Methods: This bi-center retrospective study examined 70 patients with HCC and MVI treated by hepatic resection between June 2009 and March 2018. Twenty-four patients received no postoperative adjuvant therapy (control), 19 received TACE and 27 received sorafenib. Recurrence-free survival (RFS) and overall survival (OS) were compared by the log-rank test. Results: Subjects consisted of 62 males and 8 females, with a median age of 53.5 (range, 28-82) years. The median follow-up was 26.0 (range, 4.1-103.1) months. RFS in the sorafenib group was significantly improved compared with the TACE group (P=0.048), but not with the control group. OS in the sorafenib group was significantly improved compared with both TACE (P=0.015; 2-year OS: 100% vs. 78.6%) and control (P=0.023; 2-year OS: 100% vs. 80.0%) groups. Conclusions: Adjuvant sorafenib following hepatic resection improved OS in patients with HCC and MVI and might be a better choice than adjuvant TACE.

scholarly journals Hepatic Resection Versus Transarterial Chemoembolization for Intermediate-Stage Hepatocellular Carcinoma: A Cohort Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Linbin Lu ◽  
Peichan Zheng ◽  
Zhixian Wu ◽  
Xiong Chen
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Resection ◽  
Transarterial Chemoembolization ◽  
Proportional Hazards ◽  
Intermediate Stage ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Real World Data ◽  
Risk Of Death ◽  
The Impact

BackgroundThe selection criteria for hepatic resection (HR) in intermediate-stage (IM) hepatocellular carcinoma (HCC) are still controversial. We used real-world data to evaluate the overall survival (OS) in treatment with HR or transarterial chemoembolization (TACE).MethodsIn total, 942 patients with IM-HCC were categorized into the HR group and the TACE group. OS was analyzed using the Kaplan–Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched (PSM) analysis. Curve smoothing was performed through the generalized additive model. The interaction test was performed to evaluate the impact of HR on OS concerning risk factors. Also, we used multiple imputation to deal with missing data.ResultsIn total, 23.0% (n = 225) of patients received HR. At a median OS of 23.7 months, HR was associated with improved OS in the multivariate analysis [hazard ratio (HzR) = 0.45, 95%CI = 0.35–0.58; after PSM: HzR = 0.56, 95%CI = 0.41–0.77]. Landmark analyses limited to long-term survivors of ≥6 months, ≥1 year, and ≥2 years demonstrated better OS with HR in all subsets (all p &lt; 0.05). After PSM analysis, however, HR increased the risk of death by 20% (HzR = 1.20, 95%CI = 0.67–2.15) in the subgroup of patients with lactate dehydrogenase (LDH) ≤192 U/L (p for interaction = 0.037). Furthermore, the significant interaction was robust between the LDH and HR with respect to the 1-, 3-, and 5-year observed survival rates (all p &lt; 0.05).ConclusionHR was superior to TACE for intermediate-stage HCC in patients with LDH levels &gt;192 U/L. Moreover, TACE might be suitable for patients with LDH levels ≤192 U/L.

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