BCLC stage B hepatocellular carcinoma and transcatheter arterial chemoembolization: a 20‐year survey by the Italian Liver Cancer group

Farinati, Fabio; Vanin, V.; Giacomin, A.; Pozzan, C.; Cillo, Umberto; Vitale, Alessandro; Nolfo, Anna M. Di; Poggio, P. Del; Benvegnù, Luisa; Rapaccini, Gianludovico; Zoli, Marco; Borzio, Franco; Giannini, Edoardo G.; Caturelli, Eugenio; Trevisani, Franco

doi:10.1111/liv.12649

Cited by 44 publications

(30 citation statements)

References 37 publications

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“…As it is recently stated in a study from the Italian Liver Cancer Group in which TACE for BCLC-B was analysed on 405 patients, "TACE cannot be considered the best approach for BCLC stage B patients who represent a heterogeneous population and are often suitable for more aggressive therapies, which lead to a better survival". 24 An important matter of debate would be the impact that pretreatment biopsy could have for a biopsy-guided protocol. 22,25,26 It has been recently reported that biopsy for microvascular invasion is not as accurate as it should be.…”

Section: Discussionmentioning

confidence: 99%

Optimizing the management of patients with BCLC stage-B hepatocellular carcinoma: Modern surgical resection as a feasible alternative to transarterial chemoemolization

Ciria

López‐Cillero

Gallardo

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Section: Discussionmentioning

confidence: 99%

Optimizing the management of patients with BCLC stage-B hepatocellular carcinoma: Modern surgical resection as a feasible alternative to transarterial chemoemolization

Ciria

López‐Cillero

Gallardo

et al. 2015

European Journal of Surgical Oncology (EJSO)

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“…A close relationship exists between the level of serum AFP and HCC recurrence/metastasis [38, 39]. AFP values have been considered a significant independent predictor of large/multifocal patients [40]. We presumed that a reduction in the AFP level after TACE might indicate the preoperative TACE had reduced tumor activity, which in turn might lead to better results in the following resection procedure.…”

Section: Discussionmentioning

confidence: 99%

Hepatic resection after transarterial chemoembolization increases overall survival in large/multifocal hepatocellular carcinoma: a retrospective cohort study

Lai

Huang

et al. 2016

Oncotarget

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To investigate the prognosis of transarterial chemoembolization (TACE) followed by hepatic resection (HR) in large/multifocal hepatocellular carcinoma (HCC), the medical records of consecutive HCC patients who underwent TACE between January 2006 and December 2010 were retrospectively analyzed. Patients who received TACE alone comprised the T group (61 patients), while those who received HR after TACE comprised the T+R group (49 patients). All the resections were successfully performed, and only one class V complication occurred. While liver function was altered from baseline within 1 week after HR, it recovered within 1 month. Overall survival (OS) of the T+R and T groups were compared, and sub-group analyses were performed based on baseline α-fetoprotein (AFP) levels, the reduction of AFP, and tumor response before HR. Overall survival (OS) in the T+R group was longer than in the T group (47.00 ± 2.87 vs. 20.00 ± 1.85 months, P < 0.001). OS in the T+R group with AFP reduction was less than 50%, and OS among those with a poor tumor response before HR did not differ from the T group (P > 0.05). These patients may not benefit from the combined treatment. Our findings suggest HR after TACE is safe and effective for large/multifocal HCC, and prolongs OS when compared to TACE alone.

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“…In this patient subgroup where overall survival (OS) often extends beyond 2 years [2], guidelines recommend trans-arterial chemoembolization (TACE) with the intent of prolonging OS by achieving local disease control [3]. …”

Section: Introductionmentioning

confidence: 99%

Combined sequential use of HAP and ART scores to predict survival outcome and treatment failure following chemoembolization in hepatocellular carcinoma: a multi-center comparative study

et al. 2016

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BackgroundThe prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) is variable, despite a myriad of prognostic markers. We compared and integrated the established prognostic models, HAP and ART scores, for their accuracy of overall survival (OS) prediction.ResultsIn both training and validation sets, HAP and ART scores emerged as independent predictors of OS (p<0.01) with HAP achieving better prognostic accuracy (c-index: 0.68) over ART (0.57). We tested both scores in combination to evaluate their combined ability to predict OS. Subgroup analysis of BCLC-C patients revealed favorable HAP stage (p<0.001) and radiological response after initial TACE (p<0.001) as positive prognostic factors.Patients and MethodsPrognostic scores were studied using multivariable Cox regression and c-index analysis in 83 subjects with Barcelona Clinic Liver Cancer (BCLC) A/B stage from UK and Italy (training set), and 660 from Korea and Japan (validation set), all treated with conventional TACE. Scores were further validated in an separate analysis of patients with BCLC-C stage disease (n=63) receiving initial TACE.ConclusionART and HAP scores are validated indices in patients with intermediate stage HCC undergoing TACE. The HAP score is best suited for screening patients prior to initial TACE, whilst sequential ART assessment improves early detection of chemoembolization failure. BCLC-C patients with low HAP stage may be a subgroup where TACE should be explored in clinical studies.

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BCLC stage B hepatocellular carcinoma and transcatheter arterial chemoembolization: a 20‐year survey by the Italian Liver Cancer group

Abstract: In clinical practice, TACE cannot be considered the best approach for BCLC stage B patients who represent a heterogeneous population and are often suitable for more aggressive therapies, which lead to a better survival.

Cited by 44 publications

References 37 publications

Optimizing the management of patients with BCLC stage-B hepatocellular carcinoma: Modern surgical resection as a feasible alternative to transarterial chemoemolization

Optimizing the management of patients with BCLC stage-B hepatocellular carcinoma: Modern surgical resection as a feasible alternative to transarterial chemoemolization

Hepatic resection after transarterial chemoembolization increases overall survival in large/multifocal hepatocellular carcinoma: a retrospective cohort study

Combined sequential use of HAP and ART scores to predict survival outcome and treatment failure following chemoembolization in hepatocellular carcinoma: a multi-center comparative study

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