Management of patients with intermediate stage hepatocellular carcinoma

Prince, David; Liu, Ken; Xu, Weiqi; Chen, Minjiang; Sun, Jin‐Yu; Lu, Xiao‐Jie; Ji, Jiansong

doi:10.1177/1758835920970840

Cited by 27 publications

(26 citation statements)

References 143 publications

(232 reference statements)

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“…Because of the heterogeneity of intermediate-stage HCC, the outcomes of TACE in these patients also vary [ 31 , 32 , 33 ]. Attempts have been made to stratify these patients by subgroup, both for prognostic reasons and to develop optimal treatment strategies for each subgroup.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil-to-Lymphocyte Ratio as a Biomarker Predicting Overall Survival after Chemoembolization for Intermediate-Stage Hepatocellular Carcinoma

Chu

Kim

Shim

et al. 2021

Cancers

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The clinical impact of neutrophil-to-lymphocyte ratio (NLR) in predicting outcomes in hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) remain unclear, and additional large-scale studies are required. This retrospective study evaluated outcomes in treatment-naïve patients who received TACE as first-line treatment for intermediate-stage HCC between 2008 and 2017. Patients who underwent TACE before and after 2013 were assigned to the development (n = 495) and validation (n = 436) cohorts, respectively. Multivariable Cox analysis identified six factors predictive of outcome, including NLR, which were used to create models predictive of overall survival (OS) in the development cohort. Risk scores of 0–3, 4–7, and 8–12 were defined as low, intermediate, and high risk, respectively. Median OS times in the low-, medium-, and high-risk groups in the validation cohort were 48.1, 24.3, and 9.7 months, respectively (p < 0.001). Application to the validation cohort of time-dependent ROC curves for models predictive of OS showed AUC values of 0.72 and 0.70 at 3 and 5 years, respectively. Multivariable logistic regression analysis found that NLR ≥ 3 was a significant predictor (odds ratio, 3.4; p < 0.001) of disease progression 6 months after TACE. Higher baseline NLR was predictive of poor prognosis in patients who underwent TACE for intermediate-stage HCC.

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Section: Discussionmentioning

confidence: 99%

Neutrophil-to-Lymphocyte Ratio as a Biomarker Predicting Overall Survival after Chemoembolization for Intermediate-Stage Hepatocellular Carcinoma

Chu

Kim

Shim

et al. 2021

Cancers

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“…Keywords: cancer driver genes, prognostic signature, hepatocellular carcinoma, TCGA, ICGC BACKGROUND Liver cancer is the sixth most common malignancy, with a high mortality rate and a five-year survival rate of less than 18 percent (Jemal et al, 2017;Villanueva, 2019;Siegel et al, 2020). Hepatocellular carcinoma (HCC) accounts for over 80 percent of liver cancer and is highly malignant, heterogeneity, and recurrent (Yi et al, 2018;Prince et al, 2020). Alpha-fetoprotein (AFP) is the most common biomarker for HCC, though with insufficient specificity.…”

Section: Discussionmentioning

confidence: 99%

Large-Scale Transcriptome Analysis Identified a Novel Cancer Driver Genes Signature for Predicting the Prognostic of Patients With Hepatocellular Carcinoma

Gao

et al. 2021

Front. Pharmacol.

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Background: Hepatocellular carcinoma (HCC) is a common malignant tumor with high mortality and heterogeneity. Genetic mutations caused by driver genes are important contributors to the formation of the tumor microenvironment. The purpose of this study is to discuss the expression of cancer driver genes in tumor tissues and their clinical value in predicting the prognosis of HCC.Methods: All data were sourced from The Cancer Genome Atlas (TCGA), International Cancer Genome Consortium (ICGC), and Gene Expression Omnibus (GEO) public databases. Differentially expressed and prognostic genes were screened by the expression distribution of the cancer driver genes and their relationship with survival. Candidate genes were subjected to functional enrichment and transcription factor regulatory network. We further constructed a prognostic signature and analyzed the survival outcomes and immune status between different risk groups.Results: Most cancer driver genes are specifically expressed in cancer tissues. Driver genes may influence HCC progression through processes such as transcription, cell cycle, and T-cell receptor-related pathways. Patients in different risk groups had significant survival differences (p < 0.05), and risk scores showed high predictive efficacy (AUC>0.69). Besides, risk subgroups were also associated with multiple immune functions and immune cell content.Conclusion: We confirmed the critical role of cancer driver genes in mediating HCC progression and the immune microenvironment. Risk subgroups contribute to the assessment of prognostic value in different patients and explain the heterogeneity of HCC.

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“…For patients with a limited tumor burden, namely oligo-nodular disease with a tumor diameter <5 cm, liver resection has to be considered as a treatment option. 103 However, the most common limitation for curative resection beyond early stages is the impaired liver function, which has repeatedly been identified as an independent predictor for a reduced median OS. 104 In this case, thermal ablation offers another feasible curative treatment option.…”

Section: Introductionmentioning

confidence: 99%

Current Strategies to Identify Patients That Will Benefit from TACE Treatment and Future Directions a Practical Step-by-Step Guide

Müller¹,

Stoehr²,

Mähringer‐Kunz³

et al. 2021

JHC

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Treatment of hepatocellular carcinoma (HCC) depends on the stage of disease. In the Western Hemisphere, the Barcelona Clinic Liver Cancer classification (BCLC) is the preferred staging system. Approximately one-third of patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. However, the intermediate-stage comprises a heterogeneous subgroup of patients with considerable differences in tumor burden and liver function. In addition, differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate further evaluation of these patients. Due to these differences, not all patients benefit equally from TACE. Several tools and scoring systems have been devised to provide decision-making support. All of these have shown promising initial results but failed external evaluation and have not been translated to the clinic. Nevertheless, criteria for objectifying treatment decisions in daily clinical practice are needed in all stages of disease. Therefore, this review provides a concise practical step-by-step guide on current strategies for patient selection and decisionmaking, with a focus on TACE, to critically evaluate the existing decision-support tools and provide a summary of the latest updates in the field.

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Management of patients with intermediate stage hepatocellular carcinoma

Cited by 27 publications

References 143 publications

Neutrophil-to-Lymphocyte Ratio as a Biomarker Predicting Overall Survival after Chemoembolization for Intermediate-Stage Hepatocellular Carcinoma

Neutrophil-to-Lymphocyte Ratio as a Biomarker Predicting Overall Survival after Chemoembolization for Intermediate-Stage Hepatocellular Carcinoma

Large-Scale Transcriptome Analysis Identified a Novel Cancer Driver Genes Signature for Predicting the Prognostic of Patients With Hepatocellular Carcinoma

Current Strategies to Identify Patients That Will Benefit from TACE Treatment and Future Directions a Practical Step-by-Step Guide

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