Resubclassification and clinical management for Barcelona Clinic Liver Cancer Stage C hepatocellular carcinoma

Lin, Cheng-Wei; Chen, Yaw Sen; Lo, Gin Ho; Wu, Tsung Chin; Yeh, Jen Hao; Yeh, Ming Lun; Dai, Chia Yen; Huang, Jiun-Chi; Chuang, Wan‐Long; Roberts, Lewis R.; Jun, Dae Won; Toyoda, Hidenori; Yasuda, Satoshi; Nguyen, Mindie H.; Yu, Ming

doi:10.1007/s12072-021-10169-8

Cited by 11 publications

(3 citation statements)

References 30 publications

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“…To the best of our knowledge, PVTT and EHS reflect the aggressiveness of HCC and have been deemed as negative prognostic predictors in different staging systems (24)(25)(26)(27). Beyond the guideline recommendation, TACE-S has been widely used to manage uHCC patients with PVTT and EHS in real-world clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Identify optimal HAP series scores for unresectable HCC patients undergoing TACE plus sorafenib: A Chinese multicenter observational study

Zhu

Wang²,

Zhao

et al. 2023

Front. Oncol.

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BackgroundHepatoma arterial-embolization prognostic (HAP) series scores have been proposed for prognostic prediction in patients with unresectable hepatocellular carcinoma (uHCC) undergoing transarterial chemoembolization (TACE). However, their prognostic value in TACE plus sorafenib (TACE-S) remains unknown. Here, we aim to evaluate their prognostic performance in such conditions and identify the best model for this combination therapy.MethodsBetween January 2012 and December 2018, consecutive patients with uHCC receiving TACE-S were recruited from 15 tertiary hospitals in China. Cox regression analyses were used to investigate the prognostic values of baseline factors and every scoring system. Their prognostic performance and discriminatory performance were evaluated and confirmed in subgroup analyses.ResultsA total of 404 patients were enrolled. In the whole cohort, the median follow-up period was 44.2 (interquartile range (IQR), 33.2–60.7) months, the median overall survival (OS) time was 13.2 months, and 336 (83.2%) patients died at the end of the follow-up period. According to multivariate analyses, HAP series scores were independent prognostic indicators of OS. In addition, the C-index, Akaike information criterion (AIC) values, and time-dependent area under the receiver operating characteristic (ROC) curve (AUC) indicated that modified HAP (mHAP)-III had the best predictive performance. Furthermore, the results remained consistent in most subsets of patients.ConclusionHAP series scores exhibited good predictive ability in uHCC patients accepting TACE-S, and the mHAP-III score was found to be superior to the other HAP series scores in predicting OS. Future prospective high-quality studies should be conducted to confirm our results and help with treatment decision-making.

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Section: Discussionmentioning

confidence: 99%

Identify optimal HAP series scores for unresectable HCC patients undergoing TACE plus sorafenib: A Chinese multicenter observational study

Zhu

Wang²,

Zhao

et al. 2023

Front. Oncol.

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“…In advanced stages, HCC tends to invade main vascular structures (macroscopic vascular invasion): principally the portal vein system, but also hepatic veins and the inferior vena cava. Advanced stage HCC represents more than 35% of newly diagnosed HCCs [3] and is characterized by vascular invasion or extrahepatic spread; it is included in stages C and D of the Barcelona Clinic Liver Cancer (BCLC) staging system and is often associated with portal vein tumor thrombosis (PVTT), which heavily affects patients' prognosis, with a median survival of 2.7-4 months without therapy, prolonged to 5 months up to 5 years by different treatments and according to liver functional conditions [4][5][6]. Performance status is poor, ranging from Eastern Cooperative Oncology Group (ECOG) 1-2 in BCLC stage C to 3-4 in BCLC stage D [4].…”

Section: Introductionmentioning

confidence: 99%

The Role of Contrast-Enhanced Ultrasound (CEUS) in the Detection of Neoplastic Portal Vein Thrombosis in Patients with Hepatocellular Carcinoma

Cerrito,

Ainora,

Di Francesco

et al. 2023

Tomography

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Hepatocellular carcinoma (HCC) is the principal primary liver cancer and one of the most frequent malignant tumors worldwide in patients with chronic liver disease. When diagnosed at an advanced stage, it is often associated with portal vein tumor thrombosis (PVTT), which heavily affects patients’ prognosis. Imaging evaluation is crucial in PVTT detection and staging; computed tomography and magnetic resonance are the principal diagnostic tools. Contrast-enhanced ultrasound (CEUS) is a non-invasive and easily repeatable method that can also be used in patients with impaired renal function. It represents an important means for the identification of PVTT, particularly differentiating neoplastic and non-neoplastic thrombosis through the analysis of ultrasound enhancement characteristics of the thrombosis (arterial hyperenhancement and portal washout), thus allowing more refined disease staging, appropriate treatment planning, and response evaluation, along with prognosis assessment.

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“…For patients with advanced disease or who have intermediate‐stage disease with refractory/poor response to TACE, systemic therapy is the main treatment method. 2 , 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

Regorafenib for Taiwanese patients with unresectable hepatocellular carcinoma after sorafenib failure: Impact of alpha‐fetoprotein levels

et al. 2021

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Background and Aims Regorafenib has demonstrated its survival benefit for unresectable hepatocellular carcinoma (uHCC) patients in a phase III clinical trial. We aimed to assess the efficacy and tolerability of regorafenib and the predictors of treatment outcomes in Taiwanese patients. Methods We analyzed the survival, best overall response, predictors of treatment outcomes, and safety for uHCC patients who had tumor progression on sorafenib therapy and received regorafenib as salvage therapy between March 2018 and November 2020. Results Eighty‐six patients with uHCC were enrolled (median age, 66.5 years; 76.7% male). The median regorafenib treatment duration was 4.0 months (95% confidence interval [CI], 3.6–4.6). The most frequently reported adverse events were hand‐foot skin reaction (44.2%), diarrhea (36.0%), and fatigue (29.1%). No unpredictable toxicity was observed during treatment. The median overall survival (OS) with regorafenib was 12.4 months (95% CI, 7.8–17.0) and the median progression‐free survival (PFS) was 4.2 months (95% CI, 3.7–4.7). Of 82 patients with regorafenib responses assessable, 4 patients (4.9%) achieved a partial response, and 33 (40.2%) had stable disease, leading to a disease control rate (DCR) of 45.1% (n = 37). Patients possessing baseline AFP < 400 ng/ml exhibited a markedly longer median OS, median PFS, and higher DCR compared with their counterparts (15.7 vs. 8.1 months, 4.6 vs. 3.7 months, 60.9% vs. 27.5%, respectively). Despite possessing high baseline AFP levels, patients with early AFP response (>10% reduction at 4 weeks or >20% reduction at 8 weeks after regorafenib administration) exhibited comparable treatment outcomes to those with baseline AFP < 400 ng/ml. Conclusions The results of this real‐world study verified the tolerability and efficacy of regorafenib treatment for uHCC patients who failed prior sorafenib therapy, especially for those with lower baseline AFP levels or with early AFP response.

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Resubclassification and clinical management for Barcelona Clinic Liver Cancer Stage C hepatocellular carcinoma

Cited by 11 publications

References 30 publications

Identify optimal HAP series scores for unresectable HCC patients undergoing TACE plus sorafenib: A Chinese multicenter observational study

Identify optimal HAP series scores for unresectable HCC patients undergoing TACE plus sorafenib: A Chinese multicenter observational study

The Role of Contrast-Enhanced Ultrasound (CEUS) in the Detection of Neoplastic Portal Vein Thrombosis in Patients with Hepatocellular Carcinoma

Regorafenib for Taiwanese patients with unresectable hepatocellular carcinoma after sorafenib failure: Impact of alpha‐fetoprotein levels

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