Prognostic factors and treatment effects for hepatocellular carcinoma in Child C cirrhosis

Nouso, Kazuhiro; Ito, Yoichi M.; Kuwaki, Kenji; Kobayashi, Yohnosuke; Nakamura, Shinichiro; Ohashi, Yasuo; Yamamoto, Kazuhide

doi:10.1038/sj.bjc.6604282

Cited by 51 publications

(42 citation statements)

References 24 publications

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“…Despite the poor prognosis of Child-Pugh C disease, the present results show that treatment might improve prognosis in patients with low Child-Pugh scores, which is in agreement with the results reported by Nouso et al [15]. …”

Section: Discussionsupporting

confidence: 83%

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Hepatocellular Carcinoma in Child-Pugh C Cirrhosis: Prognostic Factors and Survival Benefit of Nontransplant Treatments

Kudo

Osaki²,

Matsunaga³

et al. 2013

Dig Dis

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A retrospective multicenter study was conducted to clarify the survival benefit of nontransplant treatments for patients with hepatocellular carcinoma (HCC) associated with Child-Pugh C cirrhosis. Data on 436 patients, including 203 treated patients with HCC, were collected from 20 institutions in Japan. Cox's proportional hazards model corrected for bias by propensity score analysis clearly showed the following as significant independent prognostic factors, including all four nontransplant treatments examined: transarterial chemoembolization, hepatic arterial infusion chemotherapy, percutaneous ethanol injection therapy, radiofrequency ablation, hepatitis B virus, number of tumors, log α-fetoprotein, encephalopathy, ascites and prothrombin time. The cumulative survival rate was significantly higher in the treated group than in the untreated group. The present findings suggest that prognosis can be improved by nontransplant treatments in patients with low Child-Pugh scores. Since this study was retrospective, the possibility of selection bias cannot be ruled out. Therefore, verification by a prospective controlled study is warranted.

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Section: Discussionsupporting

confidence: 83%

“…This may be attributed to the frequent use of superselective TACE even in multinodular HCC patients in Japan, which does not cause deterioration of liver function. A previous report also described that superselective TACE was identified as having survival benefit in HCC patients with Child-Pugh C [15]. …”

Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma in Child-Pugh C Cirrhosis: Prognostic Factors and Survival Benefit of Nontransplant Treatments

Kudo

Osaki²,

Matsunaga³

et al. 2013

Dig Dis

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“…Nouso et al [19] reported that RFA had no effects on the prognosis of patients with Child-Pugh C liver cirrhosis. However, our data showed that the survival rate after 1 year in Child-Pugh C patients with HCC was 68.0%.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma with Decompensated Cirrhosis

et al. 2011

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Background: Radiofrequency ablation (RFA) is used to treat early-stage hepatocellular carcinoma (HCC), but is sometimes avoided in patients with decompensated liver cirrhosis because of the possible side effect of deterioration of liver function. Aims: In this study, we report the safety and effects of RFA for treating HCC patients with Child-Pugh B/C liver cirrhosis. Methods: Sixty-six consecutive HCC patients with Child-Pugh B/C cirrhosis, who were treated by RFA, were enrolled in this study. We analyzed patient outcomes, the complications of RFA, and changes in liver function and tumor markers. Results: Fifty-six patients were classified as Child-Pugh class B, and 10 were classified as class C. The overall survival rates in patients with Child-Pugh B and C cirrhosis were 82 and 83% at 1 year and 47 and 31% at 3 years, respectively. Serum total bilirubin (T.Bil), albumin, prothrombin time, ascites, and encephalopathy were unchanged at 1, 3, and 6 months after RFA in patients with Child-Pugh B cirrhosis; however, serum T.Bil levels increased significantly at 6 months after RFA in 6/10 (60%) patients with Child-Pugh C cirrhosis. Hemothorax and rupture of esophageal varices were observed in 2 patients; however, there were no complications related to poor liver function. Conclusion: RFA is a useful modality for treating HCC in patients with poor liver function such as Child-Pugh B and C, but careful monitoring after RFA must be needed.

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“…The choice of the treatment modality depends on the number of tumors and their size, the stage and the cause of cirrhosis and the availability of various modalities in each center [7]. The effect of different associated risk factors including number, size and location of tumor, serum alpha fetoprotein level, portal involvement, vascularity and Child-Pugh score have been previously studied [11,12,29,30]. These studies have also evaluated the response of males compared with females [12,29].…”

Section: Discussionmentioning

confidence: 99%

“…Although the effect of associated risk factors including the number and location of lesions, tumor size, ChildPugh score, vascularity, portal involvement and alpha fetoprotein value on tumor response using TACE have already been studied [10][11][12], the effect of CLD using multivariate logistic analysis of associated risk factors is still unclear. The aim of this study is to evaluate the effect of CLD on tumor response in HCC patients treated with TACE using multivariate regression model while regarding associated risk factor analysis.…”

Section: Introductionmentioning

confidence: 99%

Effect of chronic liver disease using a multivariate analysis of associated risk factors in patients with hepatocellular carcinoma treated with transarterial chemoembolization

Farshid¹,

Bazrafshan²,

Azizi³

et al. 2014

J Cancer Res Ther

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Purpose: To evaluate the effect of chronic liver disease (CLD) in a multivariate analysis of associated risk factors in patients with hepatocellular carcinoma (HCC) using transarterial chemoembolization (TACE). Materials and methods: A total of 145 patients with HCC (99 men, 46 women; mean age: 63 years  8.1; age range: 46-84 years) underwent 598 TACE procedures. The presence of CLD, number and location of lesions, tumor size, Child-Pugh score, vascularity, portal involvement and alpha fetoprotein value were analyzed using the multivariate regression model. Cox regression was used for survival analysis. Results: The median survival time was 26.7 months, and 78.6% of all treated lesions showed tumor responses. The presence of CLD (OR 2.12, P0.004), Child-Pugh score B (OR 2.24, P0.002), alpha fetoprotein 100ng/dl (OR 1.18, P0.001), multinodularity (3 lesions) (OR 4.41, P0.003), lesion size 5cm (OR 4.12, P0.002) and hypervascularity (OR 7.94, P0.003) were significant effective factors for a local response when analyzed using a multivariate logistic model. Multivariate survival analysis using Cox's regression model during the median follow-up period of 25 months (range: 1-42 months) demonstrated a significant difference in survival rates (P values 0.05). No significant difference in responses was noted for males, locations of lesions and portal involvements statistically. Conclusion: The presence of chronic liver disease as well as associated risk factors including Child-Pugh score B, alpha fetoprotein 100ng/dl, multinodularity (3 lesions), lesion size 5cm and hypervascularity statistically led to a significant effect in tumor response in HCC patients treated with TACE. Patient gender, location of lesion and involvement of portal vein showed no significant difference in response.

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Prognostic factors and treatment effects for hepatocellular carcinoma in Child C cirrhosis

Cited by 51 publications

References 24 publications

Hepatocellular Carcinoma in Child-Pugh C Cirrhosis: Prognostic Factors and Survival Benefit of Nontransplant Treatments

Hepatocellular Carcinoma in Child-Pugh C Cirrhosis: Prognostic Factors and Survival Benefit of Nontransplant Treatments

Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma with Decompensated Cirrhosis

Effect of chronic liver disease using a multivariate analysis of associated risk factors in patients with hepatocellular carcinoma treated with transarterial chemoembolization

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