Improved survival following transarterial radioembolization of infiltrative-appearance hepatocellular carcinoma

Nisiewicz, Michael J; Kapoor, Harit; Fowler, Kathryn J.; Furlan, Alessandro; Dugan, Adam; Owen, Joseph W.

doi:10.1007/s00261-020-02870-3

Cited by 7 publications

(8 citation statements)

References 23 publications

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“…Regarding the Child-Pugh class, it has been reported that the therapeutic outcomes of patients with HCC are associated with liver function by several previous studies (23,24) and the present study has shown a similar result. High AFP level represents a more aggressive nature of the tumor and has been associated with a poor therapeutic outcome in patients with HCC (25,26); the results of the present study have confirmed this finding. The present study also compared the therapeutic outcomes between patients with repeated ablation and TACE after a failed first attempt thermal ablation.…”

Section: Discussionsupporting

confidence: 87%

Initial Incomplete Thermal Ablation Is Associated With a High Risk of Tumor Progression in Patients With Hepatocellular Carcinoma

et al. 2021

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PurposeTo investigate whether incomplete thermal ablation is associated with a high risk of tumor progression in patients with hepatocellular carcinoma (HCC), and to compare the efficacy of repeated thermal ablation and transarterial chemoembolization (TACE) for residual tumor after incomplete ablation.MethodsThis retrospective study included 284 patients with unresectable HCC who underwent thermal ablation from June 2014 to September 2020. The response of the initially attempted ablation was classified into complete (n=236) and incomplete (n=48). The progression-free survival (PFS) and overall survival (OS) were compared between patients with complete and incomplete responses, before and after a one-to-one propensity score-matching (PSM), and between patients in whom repeated ablation or TACE was performed after a first attempt incomplete ablation.ResultsAfter PSM of the 284 patients, 46 pairs of patients were matched. The PFS was significantly higher in the complete response group than in the incomplete response group (P<0.001). No difference in OS was noted between two groups (P=0.181). After a first attempt incomplete ablation, 29 and 19 patients underwent repeated ablation and TACE, respectively. There were no significant differences in PFS (P=0.424) and OS (P=0.178) between patients who underwent repeated ablation and TACE. In multivariate Cox regression analysis, incomplete response (P<0.001) and Child-Pugh class B (P=0.017) were independent risk factors for tumor progression, while higher AFP level (P=0.011) and Child-Pugh class B (P=0.026) were independent risk factors for poor OS.ConclusionAlthough patients with incomplete ablation are associated with tumor progression compared with those with complete ablation, their OS is not affected by incomplete ablation. When patients present with residual tumors, TACE may be an alternative if repeated ablation is infeasible.

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Section: Discussionsupporting

confidence: 87%

Initial Incomplete Thermal Ablation Is Associated With a High Risk of Tumor Progression in Patients With Hepatocellular Carcinoma

et al. 2021

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“…Because of the nature of infiltrative HCC, including the large size, the diffuse nature, and the propensity for the involvement of blood vessels, the treatment options available are limited and exclude surgical resection, liver transplantation, and thermal ablation. Recently, intra-arterial therapy (IAT) [i.e., transarterial chemoembolization (TACE) and 90 Y radioembolization] summarized in ( Table E1 ) were applied in the infiltrative HCC and the median survival time varied from 5.7 to 16.2 months ( 9 – 14 ). Moreover, hepatic arterial infusion chemotherapy (HAIC) has been used increasingly in intermediate and advanced HCC as an effective and safe transcatheter chemotherapy ( 15 , 16 ), and our team has designed and confirmed that the HAIC of FOLFOX (oxaliplatin plus fluorouracil and leucovorin) regime (HAIF) for advanced HCC, which achieved satisfactory and better survival outcomes compared with sorafenib ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

Infiltrative Hepatocellular Carcinoma: Transcatheter Arterial Chemoembolization Versus Hepatic Arterial Infusion Chemotherapy

Zuo

et al. 2021

Front. Oncol.

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AimsTo compare the effectiveness, safety, and survival outcomes in patients with infiltrative hepatocellular carcinoma (HCC) who underwent hepatic arterial infusion chemotherapy (HAIC) and transarterial chemoembolization (TACE).MethodsA total of 160 patients with infiltrative HCCs who underwent initial TACE (n = 68) and HAIC (n = 92) treatment from January 2016 to March 2020. We applied the propensity score matching (PSM) to adjust for potential imbalances. The overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR) were compared between two groups. Multivariate analysis was evaluated through the forward stepwise Cox regression model and β coefficients was applied for the nomogram construction.ResultsThe median follow-up duration for the study population was 20.8 months. After PSM, the median OS and PFS in the HAIC group were significantly higher than those in the TACE group (OS, 13.3 vs 10.8 months; p = 0.043; PFS, 7.8 vs 4.0 months; p = 0.035) and the ORR and DCR in the HAIC group were significantly higher than those in the TACE group (ORR, 34.8% vs 11.8%; p = 0.001; DCR, 54.3% vs 36.8%; p = 0.028). A nomogram model comprising albumin-bilirubin grade, treatment responses, sessions, and treatment modalities, showed good predictive accuracy and discrimination (training set, concordance index [C-index] of 0.789; validation set, C-index of 0.757), which outperformed other staging systems and conventional indices.ConclusionHAIC improve significantly survival compared to TACE in patients with infiltrative HCC. A prospective randomized trial is ongoing to confirm this finding.

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“…Intra‐arterial therapy (IAT) has been consider as a nonoperative option for patients with infiltrating HCC. Patients who have received IAT have demonstrated higher absolute survival rates than patients receiving palliative care 24,25 . As such, IAT, primarily in the form of transarterial chemoembolization, may be an effective form of liver‐directed therapy for infiltrating HCC (Figure 3E).…”

Section: Introductionmentioning

confidence: 99%

“…Patients who have received IAT have demonstrated higher absolute survival rates than patients receiving palliative care. 24,25 As such, IAT, primarily in the form of transarterial chemoembolization, may be an effective form of liver-directed therapy for infiltrating HCC (Figure 3E). IAT involves the administration of cytotoxic chemicals into predetermined vessels that feed the tumor vasculature, promulgating the formation of emboli, which contribute to the emergence of ischemia in the tumor microenvironment.…”

Section: Introductionmentioning

confidence: 99%

Diffuse infiltrative hepatocellular carcinoma: Multimodality imaging manifestations

Madani

Mirza‐Aghazadeh‐Attari

Mohseni

et al. 2022

Journal of Surgical Oncology

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Hepatocellular carcinoma (HCC) is the most prevalent primary liver cancer, being the third most common cause of cancer-related death globally. HCC most frequently develops in the context of hepatic cirrhosis. HCC can manifest as various morphologic subtypes. Each pattern exhibits distinct behaviors in terms of imaging features, disease progression, response to therapy, and prognosis. While the nodular

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Improved survival following transarterial radioembolization of infiltrative-appearance hepatocellular carcinoma

Cited by 7 publications

References 23 publications

Initial Incomplete Thermal Ablation Is Associated With a High Risk of Tumor Progression in Patients With Hepatocellular Carcinoma

Initial Incomplete Thermal Ablation Is Associated With a High Risk of Tumor Progression in Patients With Hepatocellular Carcinoma

Infiltrative Hepatocellular Carcinoma: Transcatheter Arterial Chemoembolization Versus Hepatic Arterial Infusion Chemotherapy

Diffuse infiltrative hepatocellular carcinoma: Multimodality imaging manifestations

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