Marginal survival benefit in the treatment of early hepatocellular carcinoma

Midorikawa, Yutaka; Takayama, Tadatoshi; Shimada, Kazuaki; Nakayama, Hisashi; Higaki, Tokio; Moriguchi, Masamichi; Nara, Satoshi; Tsuji, Shingo; Tanaka, Masatoshi

doi:10.1016/j.jhep.2012.09.026

Cited by 53 publications

(52 citation statements)

References 27 publications

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“…A few studies have investigated the natural history of these lesions showing that HGDN are the most advanced HCC precursors [4] [5] and that eHCC can transform at a variable rate into small, pHCC [6]. Of importance is a recent report demonstrating that eHCC rarely shows microvascular invasion and intrahepatic metastasis, with marginal survival benefit after the surgical treatment [7]. A detailed clinico-pathological study of the sequence dysplasia-HCC is expected to provide important information with potential impact on nodule management and treatment.…”

Section: Introductionmentioning

confidence: 99%

Morphophenotypic changes in human multistep hepatocarcinogenesis with translational implications

Sciarra

Tommaso

Nakano

et al. 2016

Journal of Hepatology

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Section: Introductionmentioning

confidence: 99%

Morphophenotypic changes in human multistep hepatocarcinogenesis with translational implications

Sciarra

Tommaso

Nakano

et al. 2016

Journal of Hepatology

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“…These findings were attributed to the fact that treatment of early HCC does not contribute to patient survivals due to the long lead time from early to classical HCC (25). That is, the survival benefit of patients undergoing liver resection for early HCC is too marginal to justify the procedure.…”

Section: Discussionmentioning

confidence: 99%

Clinical correspondence to hepatocellular carcinoma-related lesions with atypical radiological pattern

Higaki

Midorikawa

Nakashima

et al. 2017

BST

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“…On the other hand, even small classical HCCs are associated with a high rate of vascular invasion and can easily relapse (8). It is therefore difficult to determine whether recurrent tumors represent 'relapse' or 'second primary HCC' after resection of classical HCC.…”

Section: Discussionmentioning

confidence: 99%

“…Briefly, on macroscopic examination, the tumor contained Glisson's triad and was a distinctive nodule from the surrounding lobules in terms of size or color but did not substantially destroy the preexisting hepatic framework. Microscopically, early HCC showed hypercellularity (>2.0) with minimal cellular or nuclear atypia but definite structural atypia (8).…”

Section: Pathologymentioning

confidence: 99%

“…However, we have recently demonstrated that prolonged survival after treatment of early HCC includes a long lead time, and resection of early HCC could offer only marginal survival benefits, suggesting that early HCC is in a preclinical phase (8). Similarly, several researchers have reported that preclinical phase HCC could be observed because of bias in length of time (9), that other classical HCC may appear even after complete removal of early HCC (10,11) and that the outcomes of early HCC depend on the underlying liver disease or the subsequent development of classical HCC (12,13).…”

Section: Introductionmentioning

confidence: 99%

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Early hepatocellular carcinoma as a signaling lesion for subsequent malignancy

Midorikawa¹,

Takayama²,

Higaki³

et al. 2016

Japanese Journal of Clinical Oncology

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Objective: Early diagnosis and treatment of cancer may contribute substantially to complete cure, but it remains unknown whether treatment of early hepatocellular carcinoma can actually result in cure. This study was performed to clarify the cancer risk of the background liver after treating early hepatocellular carcinoma. Methods: Early hepatocellular carcinoma is defined as very well-differentiated cancer containing Glisson's triad. The cumulative incidence of classical hepatocellular carcinoma, hypervascular liver cancer detected on imaging studies, after resection of early hepatocellular carcinoma positive for anti-hepatitis C antibody (early hepatocellular carcinoma group, n = 105) was compared with that in patients with chronic liver disease positive for anti-hepatitis C antibody (control group, n = 751) and propensity score-matched patients after resection of classical hepatocellular carcinoma (classical hepatocellular carcinoma group, n = 105). Results: After a median follow-up of 4.8 years (range, 0.3-15.0), the cumulative incidence of classical hepatocellular carcinoma at 5 years was 56.9% (95% confidence interval, 44.2-67.7%) in the early hepatocellular carcinoma group and 70.6% (52.5-81.8%) in the classical hepatocellular carcinoma group as compared with 4.6% (2.8-6.4%) in the control group. The risk of the development of classical hepatocellular carcinoma in the early hepatocellular carcinoma group was significantly higher than that in the control group (hazard ratio, 17.5; 95% confidence interval, 12.1-25.3; P < 0.001) and significantly lower than that in the classical hepatocellular carcinoma group (hazard ratio, 0.60; 0.41-0.89; P = 0.010). However, the cumulative incidence of second primary hepatocellular carcinoma in patients with one early hepatocellular carcinoma did not differ significantly from that in patients with two or more early hepatocellular carcinoma lesions (hazard ratio, 1.50; 0.85-2.65; P = 0.157). Conclusions: Treatment of early hepatocellular carcinoma cannot provide complete cure due to the substantial risk of developing classical hepatocellular carcinoma.

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Marginal survival benefit in the treatment of early hepatocellular carcinoma

Cited by 53 publications

References 27 publications

Morphophenotypic changes in human multistep hepatocarcinogenesis with translational implications

Morphophenotypic changes in human multistep hepatocarcinogenesis with translational implications

Clinical correspondence to hepatocellular carcinoma-related lesions with atypical radiological pattern

Early hepatocellular carcinoma as a signaling lesion for subsequent malignancy

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