Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma

Ó'Súilleabháin, Críostóir; Poon, Ronnie Tung‐Ping; Yong, Jamy L; Ooi, G. C.; Tso, WK; Fan, Sheung Tat

doi:10.1002/bjs.4045

Cited by 104 publications

(65 citation statements)

References 28 publications

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“…In the current study, the factors that were significant in multivariate analysis were similar to the factors that constitute the CLIP score, and they also were similar to the factors determined in previous studies of TACE. 28,29 The most powerful prognostic factor of poor survival was vascular invasion in this study, and similar results were reported in patients who underwent liver resection or transplantation. 1,[30][31][32] Although the BCLC system was validated as the most suitable prognostic system for patients with HCC in Italy and the United States, it was not considered a suitable prognostic system in the Eastern countries until now.…”

Section: Discussionsupporting

confidence: 88%

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Cho

Chung

Kim

et al. 2007

Cancer

110

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BACKGROUND.Many liver staging systems have been proposed for patients with hepatocellular carcinoma after locoregional therapy; however, controversies persist regarding which system is the best. In this study, the authors compared the performance of 7 staging systems in a cohort of patients with hepatocellular carcinoma who underwent transarterial chemoembolization.METHODS.In total, 131 patients with hepatocellular carcinoma who underwent transarterial chemoembolization between August 1998 and February 2005 were included in the study. Demographic, laboratory, and tumor characteristics were determined at diagnosis and before therapy. At the time of censorship, 109 patients had died (83.2%). Predictors of survival were identified by using the Cox proportional hazards model. The likelihood‐ratio chi‐square statistic and the Akaike Information Criterion were calculated for 7 prognostic systems to evaluate their discriminatory ability. Comparisons of the survival rate between each stage were performed to evaluate the monotonicity of the gradients using Kaplan‐Meier estimation and the log‐rank test.RESULTS.The 5‐year survival rate for the entire cohort was 13.6%. The independent predictors of survival were serum albumin level (≤3.4 g/dL), the presence of ascites, serum α‐fetoprotein level (>60 ng/mL), and portal or hepatic vein tumor thrombosis (P = .001, P = .001, P = .004, and P = .000, respectively). The Cancer of the Liver Italian Program classification system was superior to the other 6 prognostic systems regarding discriminatory ability and the monotonicity of the gradients.CONCLUSIONS.In this comparison of many staging systems, the Cancer of Liver Italian Program system provided the best prognostic stratification for a cohort the patients with hepatocellular carcinoma who underwent transarterial chemoembolization. Cancer 2008. © 2007 American Cancer Society.

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Section: Discussionsupporting

confidence: 88%

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Cho

Chung

Kim

et al. 2007

Cancer

110

View full text Add to dashboard Cite

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“…As expected these patients had lower survival rates. However, with minor differences depending on the group of patients selected and treatment modalities chosen, similar results were reported by others (Stuart et al, 1996;Allgaier et al, 1998;Bruix and Llovet, 2002;Herold et al, 2002;O'Suilleabhain et al, 2003).…”

Section: Discussionsupporting

confidence: 87%

“…In contrast to a series of other published studies (Chevret et al, 1999;Llovet et al, 1999; The Cancer of the Liver Italian Program, 2000; Villa et al, 2000;Rabe et al, 2001;Herold et al, 2002), this study included a high number of patients treated by TACE and PEI, which have become the most frequently used treatments in the Western World. No patient was excluded from our retrospective analysis in contrast to those studies, who investigated only the effect of surgery or local ablative therapy (Tanaka et al, 1998;Schlitt et al, 1999;O'Suilleabhain et al, 2003;Jaeck et al, 2004). Therefore, this data reflects the current situation, for unselected patients with HCC similar to a different study published 9 years ago (Stuart et al, 1996).…”

Section: Discussionmentioning

confidence: 76%

Survival rate in patients with hepatocellular carcinoma: a retrospective analysis of 389 patients

Greten¹,

Papendorf

Bleck³

et al. 2005

Br J Cancer

176

101

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Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. However, treatment options are limited and often inefficient. The aim of this study was to determine current survival rates for patients diagnosed with HCC and to identify prognostic factors, which will help in choosing optimal therapies for individual patients. A retrospective analysis of medical records was performed on 389 patients who were identified through the central tumour registry at our institution from 1998 to 2003. Clinical parameters, treatments received and survival curves from time of diagnosis were analysed. Overall median survival was 11 months. Liver cirrhosis was diagnosed in 80.5% of all patients. A total of 170 patients received transarterial chemoembolisation (TACE) and/or percutaneous ethanol injections (PEI) with a median survival rate of 16 months for patients receiving TACE, 11 months for patients receiving PEI and 24 months for patients receiving TACE followed by PEI. Independent negative prognostic parameters for survival were the presence of portal vein thrombosis, advanced liver cirrhosis (Child -Pugh score B or C) and a score of 42. This study will help to estimate survival rates for patients with HCC according to their clinical status at diagnosis and the treatments received.

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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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Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma

Abstract: Five-year survival is possible with TACE for inoperable HCC, even in some patients with advanced tumours. Unilobar tumours, alpha-fetoprotein level below 1000 ng/ml and albumin concentration greater than 35 g/l were factors predictive of 5-year survival.

Cited by 104 publications

References 28 publications

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Survival rate in patients with hepatocellular carcinoma: a retrospective analysis of 389 patients

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

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