Hepatocellular Carcinoma—How to Determine Therapeutic Options

Mehta, Neil

doi:10.1002/hep4.1481

Cited by 16 publications

(11 citation statements)

References 120 publications

(189 reference statements)

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“…Применение неоадъювантного лечения в различных формах позволяет улучшить отдаленный прогноз и расширить когорту пациентов, которым возможно выполнить ТП с прогнозируемым результатом. Дальнейшее изучение проблемы требует акцентированного внимания к биологическим маркерам опухоли, в том числе PIVKAII, BALAD, GALAD [5,18,37], а также более широкой имплементации подробных современных моделей классификации, таких как Metro-ticket 2.0, TRAIN и других [1,29,38].…”

Section: Discussionunclassified

Outcomes of liver transplantation in hepatocellular carcinoma: a single-center experience

et al. 2020

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Aim. To evaluate the long-term results of liver transplantation for hepatocellular carcinoma. To perform an analysis of risk factors for tumor recurrence.Materials and methods. A retrospective analysis of 63 deceased donor liver transplantations, which were performed from January 2010 to February 2020. Patients were divided into three groups according to the Milan and California criteria – within the Milan criteria, outside the Milan criteria, but within the California criteria, outside the California criteria.Results. There were 33 recipients within the Milan criteria, 5 within the California criteria, and 25 outside the California criteria. The 5-years recurrence rate was 9.1%, 40% and 52%, respectively (p = 0.002), five-year survival rate of – 93.2%, 66.7% and 54.7% (p = 0.041). Factors associated with an increased risk of recurrence: five and more tumor nodes (OR = 3.675; 95% CI (1.35–9.97); p = 0.011), macroscopic vascular invasion (OR = 5.97; 95% CI (2.06–17.31); p = 0.001) and inconsistency with California criteria (OR = 4.00; 95% CI (1.49–10.74); p = 0.006). The factors associated with a lower recurrence rate: one or two tumor nodes (p = 0.014 and 0.042, respectively), a high grade of histological differentiation (RR = 0.24; 95% CI (0.06–0.93); p = 0.039), compliance with Milanese criteria (RR = 0.18; 95% CI (0.06–0.58); p = 0.004).Conclusion. Liver transplantation can be performed in a number of patients beyond the Milan and California criteria. The morphological and biological characteristics of the tumor and a multidisciplinary differentiated approach to treatment have an important role in the success of treatment.

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Section: Discussionunclassified

Outcomes of liver transplantation in hepatocellular carcinoma: a single-center experience

et al. 2020

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“…In this section, we discuss the most commonly used locoregional therapies in bridging and downstaging prior to transplant; TACE, radioembolization with yttrium-90 (Y-90), thermal ablative therapy and stereotactic body radiation therapy (Table 2). Factors that affect decision-making when formulating an optimal treatment strategy include tumor stage, performance status, tumor location, severity of liver disease, organ availability and tumor biology/behavior (22).…”

Section: Locoregional Therapiesmentioning

confidence: 99%

“…The complication rate was also lower in the TARE group. Ettore et al (55) performed TARE in a small cohort of patients (22) with the majority being outside the Milan criteria, and successfully bridged all patients and down staged 79% of patients outside Milan criteria. More recently, the TRACE trial (56) compared Y-90 to DEB-TACE and included patients with BCLC A/B, ECOG 1 and segmental portal vein thrombosis.…”

Section: Transcatheter Arterial Radioembolizationmentioning

confidence: 99%

Locoregional Therapies for Bridging and Downstaging Hepatocellular Carcinoma Prior to Liver Transplant

2021

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Hepatocellular carcinoma is the most common primary liver malignancy and is a common indication for liver transplantation. To qualify for liver transplantation, the size and number of tumors must be within established criteria. The Milan criteria is the most well-established of these criteria, however there is evidence these criteria can be safely expanded without affecting outcomes. While awaiting liver transplantation, locoregional therapy can be used as bridging therapy to maintain the tumor burden within criteria. Locoregional therapy can also be used to decrease tumor burden within transplant criteria, a process called downstaging. For tumors <3 cm, thermal ablation-most commonly using a radio-frequency probe-is preferred when feasible and offers tumor control approaching that of resection. Larger or multifocal lesions are usually treated with either trans-arterial chemoembolization or yttrium-90 trans-arterial radioembolization. The choice between these two interventions is generally based on institutional preference as neither has demonstrated survival advantage in the transplant population. However, single center trials show longer time to progression, improved downstaging success, and less microvascular invasion in patients treated

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“…Among various treatment modalities transarterial chemoembolization (TACE) is frequently used as the initial treatment in patients with unresectable HCC (Llovet et al 2002;Marrero et al 2018). To correctly evaluate treatment response, experienced health care providers are needed, which almost always need to be supported by a series of imaging examinations and laboratory tests (Mehta 2020). In order to standardize interpretation, several treatment response algorithms are available including the WHO and mRECIST criteria (Bruix et al 2001;Forner et al 2009; Lencioni and Llovet 2010).…”

Section: Introductionmentioning

confidence: 99%

Performance of initial LI-RADS 2018 treatment response in predicting survival of patients with hepatocellular carcinoma following TACE: a retrospective, single-center cohort study

Bartnik

Podgórska

Rosiak

et al. 2021

Preprint

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Purpose Treatment response following transarterial chemoembolization (TACE) is frequently evaluated with Liver Imaging Reporting and Data System Treatment Response (LR-TR) algorithm, but its association with patients outcomes is not supported in the literature. The purpose of this study was to provide such data. Methods A retrospective analysis of 99 TACE patients with stage A/B hepatocellular carcinoma according to Barcelona Clinic Liver Cancer staging system was performed. Two radiologists assessed LR-TR, while a third radiologist re-assessed divergent results. Overall survival (OS) and time to disease progression (TTP) were the primary endpoints of the study, while the Cox proportional hazard model was used for outcome analyses. Results Interobserver agreement was substantial between the two readers with κ = 0.69 (95% CI: 0.58–0.81). The median OS in viable, equivocal and non-viable groups were 27, 27 and 73 months, respectively (p < 0.001). However, after adjustment for confounding factors, there was no significant association between initial viable response and OS (HR 0.98 [95% CI: 0.37–2.63], p = 0.97), while equivocal response remained statistically significant (HR 3.52. [95% CI: 1.27–9.71], p = 0.015). No significant association was noted when viable and equivocal groups were analyzed in aggregate (HR 1.03 [95% CI: 0.4–2.4], p = 0.96). The median TTP did not differ between non-viable and viable groups (23 vs 18 months, respectively; p = 0.98). None of the analyzed predictors was associated with TTP. Conclusion Initial LR-TR response was not an independent predictor for OS nor TTP. The preliminary results suggest the necessity for more aggressive management of equivocal patients.

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Hepatocellular Carcinoma—How to Determine Therapeutic Options

Cited by 16 publications

References 120 publications

Outcomes of liver transplantation in hepatocellular carcinoma: a single-center experience

Outcomes of liver transplantation in hepatocellular carcinoma: a single-center experience

Locoregional Therapies for Bridging and Downstaging Hepatocellular Carcinoma Prior to Liver Transplant

Performance of initial LI-RADS 2018 treatment response in predicting survival of patients with hepatocellular carcinoma following TACE: a retrospective, single-center cohort study

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