A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization

Lladó, Laura; Virgili, J.; Figueras, Joan; Valls, Carme; Domínguez, Joan; Rafecas, Antoni; Torras, Jaume; Fabregat, Joan; Guardiola, Jordi; Jaurrieta, Eduardo

doi:10.1002/(sici)1097-0142(20000101)88:1<50::aid-cncr8>3.0.co;2-i

Cited by 162 publications

(99 citation statements)

References 31 publications

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“…Many pathologic factors of tumor itself, such as tumor size, number, capsule state, cell differentiation, venous invasion, presence of satellite nodules, and advanced pTNM stage, are the best-established risk factors for recurrence and important aspects affecting the prognosis of patients with HCC [43][44][45][46] . Assal et al proposed an invasiveness scoring system to predict recurrence and survival after curative HCC resection, which consists of six variables including portal venous invasion, intrahepatic spreading, hepatic venous invasion, membrane invaded, and no tumor capsule, or capsule invaded.…”

Section: Pathological Features Of Tumormentioning

confidence: 99%

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

Qin¹,

Tang²

2002

WJG

161

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The prognosis of patients with HCC still remains dismal. The life expectancy of HCC patients is hard to predict because of the high possibility of postoperative recurrence. Many factors, s u c h a s p a t i e n t ' s g e n e r a l c o n d i t i o n s , macroscopic tumor morphology, as well as tumor hitopathology features, have been proven of prognostic significance. Female HCC patient often has a better prognosis than male patient, which might be due to the receptor of sex hormones. Younger patients often have tumors with higher invasiveness and metastatic potentials, and their survival and prognosis are w o r s e t h a n t h e o l d e r o n e s . C o -e x i s t i n g hepatitis status and hepatic functional reserve h a v e b e e n c o n f i r m e d a s r i s k f a c t o r s f o r recurrence. Serum alpha-fetoprotein (AFP) is useful not only for diagnosis, but also as a prognostic indicator for HCC patients. AFP mRNA has been proposed as a predictive marker of HCC cells disseminated into the circulation and for metastatic recurrence. Many pathologic features, such as tumor size, number, capsule state, cell differentiation, venous invasion, intrahepatic spreading, and a d v a n c e d p T N M s t a g e , a r e t h e b e s testablished risk factors for recurrence and important aspects affecting the prognosis of patients with HCC. Marked inflammatory cell infiltration in the tumor could predict a better prognosis. Clinical stage is still the most important factor influencing on the prognosis. E x t r a t u m o r s p r e a d i n g a n d l y m p h n o d a l metastasis are independent predictors for poor outcome. Some new predictive systems h a v e r e c e n t l y b e e n p r o p o s e d . D i f f e r e n t strategies of treatment might have significant different effects on the patients' prognosis. To date, surgical resection is still the only p o t e n t i a l l y c u r a t i v e t r e a t m e n t f o r H C C , including localized postoperative recurrences. Extent of resection, blood transfusion, occlusion of porta hepatis, and blood loss affect the survival and prognosis of HCC patients. Regional therapies provide alternative ways to improve the prognosis of HCC patients who have no opportunity to receive surgical treatment or postoperative recurrence. The combination of these treatment modalities is hopeful to further improve the prognosis. The efficacies of neoadjuvant (preoperative) or adjuvant (postoperative) chemotherapy or chemoembolization in preventing recurrence and on the HCC prognosis still remain great controversy, and deserves further evaluation. Biotherapy, including IFN-alpha therapy, will play more important role in preventing recurrence and metastasis of HCC after operation.Qin LX,Tang ZY.The prognostic significance of clinical and pathological features in hepatocellular carcinoma.

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Section: Pathological Features Of Tumormentioning

confidence: 99%

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

Qin¹,

Tang²

2002

WJG

161

View full text Add to dashboard Cite

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“…However, in the US, where there is no national screening program, the majority of HCC patients present at an advanced phase of their disease, either due to the severity of the underlying cirrhosis or the extent of their HCC. There has not so far, to our knowledge, been a large prospective study of these advanced unresectable HCC patients; although, several small series having evaluated prognostic factors in these patients [8,20,[24][25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Tumor and liver determinants of prognosis in unresectable hepatocellular carcinoma: a large case cohort study

2009

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Objectives 967 patients with unresectable and untransplantable, biopsy-proven hepatocellular carcinoma (HCC) were prospectively evaluated at baseline and followed up till death. Survival was the end point. Results We found that male gender, ascites, cirrhosis, portal vein thrombosis (PVT), elevated AFP or bilirubin, or alkaline phosphatase, were each statistically significant adverse prognostic factors. Patients with normal AFP survived longer than those with elevated AFP, even in the presence of PVT, large or bilobar tumors or cirrhosis. We used a bivariate analysis to separate patient sub groups based on liver function and tumor characteristics and found clear discrimination in survival between subsets; in addition both cirrhosis and presence of PVT were significant factors. We also used a purely mathematical approach to derive subgroups and a prognostic model for individual patients. Interestingly, the two approaches gave similar predictive information, which opens the possibility of a more detailed mathematical analysis in the future. The results of this large dataset show that amongst non-surgical HCC patients, there are clear subsets with longer survival. Conclusion The data supports the concept of heterogeneity of HCC. The three factors, bilirubin, AFP, and PVT predominate in prognosis.

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“…Furthermore high number of HCC foci means more TACE sessions or selective embolization, thus the tumor response and patient outcome can be affected negatively. Llad et al (28) defined a significant relationship between the AFP level (cutoff level, 400 ng/mL) and survival in 143 HCC patients; a similar relationship was also observed in our study, where patients with AFP ≤400 ng/mL had better survival than those with AFP >400 ng/mL. Llovet et al (5) stated that tumor response affects the survival.…”

Section: Discussionmentioning

confidence: 93%

“…Llovet et al (5) stated that tumor response affects the survival. Llad et al (28) reported a positive relationship between the reduced tumor size and survival. We also determined a significant effect of tumor response on survival; thus, complete response should be the main goal in TACE for an effective treatment and better survival.…”

Section: Discussionmentioning

confidence: 99%

The effect of using different embolic agents on survival in transarterial chemoembolization of hepatocellular carcinoma: gelfoam versus polyvinyl alcohol

Koçyi̇ği̇t

Dıcle²,

Göktay³

et al. 2014

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to compare the effect of using different embolic agents such as gelfoam and polyvinyl alcohol (PVA) on survival, tumor response, and complications in transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) patients. MATERIALS AND METHODSWe retrospectively reviewed the medical records of 38 inoperable HCC patients who underwent TACE between August 1998 and April 2007. A total of 50 TACE sessions were performed using PVA (n=18) or gelfoam particles (n=20), following the application of 60 mg doxorubicin with 10-20 mL lipiodol emulsion. The PVA and gelfoam groups were compared based on clinical, laboratory, and demographic variables. Survival rates were calculated starting from the first TACE session using the Kaplan-Meier analysis. RESULTSThere was no significant difference between the survival rates of PVA and gelfoam groups (P = 0.235). Overall survival rates at 12, 24, 36, 48, and 60 months were 55%, 36%, 15%, 7%, and 5%, respectively. Tumor response, age, lipiodol accumulation type, number of HCC foci, complications, and serum alpha-fetoprotein level were significant factors for survival in all patients. CONCLUSIONUse of gelfoam or PVA as the embolic agent did not have a significant impact on survival. Complete tumor response, intensive lipiodol accumulation in tumor, older age (>60 years), fewer (≤3) HCC foci, and low serum alpha-fetoprotein level (≤400 ng/mL) were found to improve cumulative survival significantly.

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A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization

Cited by 162 publications

References 31 publications

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

Tumor and liver determinants of prognosis in unresectable hepatocellular carcinoma: a large case cohort study

The effect of using different embolic agents on survival in transarterial chemoembolization of hepatocellular carcinoma: gelfoam versus polyvinyl alcohol

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