Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy: Comparative effectiveness of treatment modalities

Ho, Cheng-Maw; Lee, Po‐Huang; Shau, Wen–Yi; Ho, Ming-Chih; Wu, Yao‐Ming; Hu, Rey‐Heng

doi:10.1016/j.surg.2011.12.015

Cited by 93 publications

(98 citation statements)

References 43 publications

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“…In countries (such as Egypt) with a high incidence of HCC owing to endemic viral hepatitis, low organ donation rates and lack of deceased liver transplantation, primary hepatic resection is the first line of treatment for HCC patients with sufficient liver reserve [4].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Recurrence in Hepatitis C Virus Related Hepatocellular Carcinoma after Hepatic Resection: A Retrospective Cohort Study

Wahab

Shehta

Hamed

et al. 2014

EAJM

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Objective: Egypt is one of the hot spots in the international map of Hepatocellular carcinoma (HCC), which is where hepatitis C virus (HCV) infection is the major risk factor in development of HCC (80%). Due to low organ donation rates and lack of deceased liver transplantation, hepatic resection is the main line of treatment for HCC patients with sufficient liver reserve. We introduce our experience with patients who had HCV related HCC who underwent hepatic resection to determine various predictors of tumour recurrence in this group. This is the first study to come from a country where chronic HCV hepatitis is endemic. Materials and Methods:This is a retrospective cohort study of 208 cases of HCC in hepatitis C virus positive patients with cirrhotic livers who underwent first-time liver resection, in Gastroenterology Surgical Centre, Mansoura University, Egypt during the period from January 2002 to December 2011. Shapiro-Wilk test was used to assess normality of data. Predictors of HCC recurrence were assessed by bivariate correlation tests, univariate analysis using the chi-square and t-test and binary logistic regression analysis. A P value <0.05 was considered statistically significant.Results: Tumour recurrence occurred in 88 patients (42.3%). Most of the recurrences occurred within the first year 55 patients (62.5%). The most common site for recurrence was the liver (n=68, 77.3%). Based on the univariate analysis; significant variables predicting tumor recurrence were alpha feto-protein (AFP), blood transfusion, multifocality, cut margin, microvascular invasion, lack of capsule, tumour grade and stage. Based on multivariate analysis, the main variables predicting tumor recurrence were blood transfusion, cut margin, tumour capsule and microvascular invasion. Conclusion:Although the predictors of recurrence are the same for both HBV and HCV related HCC, the rate and aggressiveness of recurrence are higher in HCV related HCC.Key Words: HCV related HCCs, liver resection, recurrent HCC Özet Amaç: Mısır; hepatit C virüsü (HCV) enfeksiyonunun Hepatocellular karsinomun (HCC) görülmesinde önemli (% 80) bir risk faktörü olduğu, uluslararası HCC haritasındaki sıcak noktalardan biridir. Organ bağışı oranlarının düşük olması ve kadavradan karaciğer nakli eksikliği sebebiyle, karaciğer rezeksiyonu, yeterli karaciğer rezervi olan HCC hastalarının tedavisinde ana yöntemdir. Bu grupta HCV'ye bağlı HCC'si olan hastalarda tümör nüksünün çeşitli faktörlerini araştırmak için karaciğer rezeksiyonu deneyimimizi aktarmak amacındayız. Bu, kronik HCV hepatitinin endemik olduğu bir ülkeden gelen ilk çalış-madır. Gereç ve Yöntem:Bu, Ocak 2002-Aralık 2011 süresince Mısır'ın Mansoura Üniversitesi, Gastroenterolojik Cerrahi Merkezinde ilk kez karaciğer rezeksiyonu yapılan sirotik karaciğerli HCC, hepatit C virüsü pozitif hastalarda 208 vakanın retrospektif kohort çalışmasıdır. Verilerin normalliğini değerlendirmek için Shapiro-Wilk testi kullanılmıştır. HCC nüks prediktörleri ikili korelasyon testleri, tek değişkenli ki-kare ve...

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Section: Introductionmentioning

confidence: 99%

Predictors of Recurrence in Hepatitis C Virus Related Hepatocellular Carcinoma after Hepatic Resection: A Retrospective Cohort Study

Wahab

Shehta

Hamed

et al. 2014

EAJM

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“…However, this only applies to new primary HCCs, and antiviral therapy is unlikely able to prevent intra-or extra-hepatic disease due to metastasis. To this end, it is likely that antiviral therapy can help to prevent late rather than early HCC recurrences [50,51] . HBV replication and high viral load has been associated with vascular invasion, although this has not been consistently shown [52] .…”

Section: Antiviral Therapy For Hcc Patients Undergoing Surgical Resecmentioning

confidence: 99%

The role of oral antiviral therapy in hepatitis B-related hepatocellular carcinoma

Fung¹,

Chok²

2017

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Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) in places where chronic hepatitis B infection is endemic. Oral nucleos(t)ide analog (NA) therapy can reduce the risk of HCC, but cannot completely prevent its development. For HBV-related HCCs, viral inhibition by NAs can preserve or improve liver function, thereby increasing the chance of therapeutic intervention. After surgical resection, NAs can prevent reactivation of HBV, and also reduce the chance of de novo development of HCC in the remnant liver. For those who undergo liver transplantation, NAs are essential to prevent reactivation and graft hepatitis, but is not likely to prevent HCC recurrence, which is due to metastatic disease. The role of NAs for non-curable advanced HCC is less well defined. These include patients undergoing locoregional therapy, chemotherapy, or palliation. Although antiviral therapy can preserve liver function, which may be compromised by HBV, it is unable to prevent disease progression from HCC. At the time of HCC diagnosis, most patients will already be receiving NAs, and these patients should be maintained on therapy. For patients not on antiviral therapy at the time of HCC diagnosis, the decision to commence therapy is often determined by the stage of HCC and life expectancy. Patients undergoing curative therapy, or locoregional therapy/chemotherapy with reasonable life expectancy, should be commenced on antiviral therapy. Key words:Antiviral therapy, hepatitis B virus, hepatocellular carcinoma ABSTRACTArticle history:

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“…Administration of antiviral therapy after HCC surgery cannot prevent intrahepatic early recurrence, or recurrence outside of the liver, both of which account for at least 70 and 10% of HCC recurrences after resection, respectively [68].…”

Section: Recurrence Of Hccmentioning

confidence: 99%

Current clinical evidence for nucleos(t)ide analogues in patients with HBV-related hepatocellular carcinoma

Zhang

2017

Expert Review of Gastroenterology & Hepatology

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Introduction: Hepatocellular carcinoma (HCC) is a leading cause of death globally and is frequently seen following Hepatitis B virus (HBV) or Hepatitis C virus infection. Areas with high HBV infection rates, such as Asia and sub-Saharan Africa, are therefore also high-risk areas for HCC. Areas covered: This review identifies and discusses the current evidence from robust clinical trials which have investigated the benefits of Nucleos(t)ide analogue (NA) antiviral therapy in HBV-related HCC patients, including HCC patients that underwent liver transplantation and HCC patients with or without curative treatment. In addition, we assess how this evidence has influenced current clinical practice, with a particular focus on those areas of high HBV infection rates. Expert commentary: A number of studies have assessed whether NA antiviral treatment can improve the prognosis of HBV-related HCC patients. In this review we evaluate the current evidence, including that from trials in Asia, for antiviral NA treatments in HBV-related HCC patients. We also focus on those NAs with a high genetic barrier to resistance (i.e. ETV or TDF), on different therapeutic approaches, and on the future evidence that is required in this field. ARTICLE HISTORY

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Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy: Comparative effectiveness of treatment modalities

Cited by 93 publications

References 43 publications

Predictors of Recurrence in Hepatitis C Virus Related Hepatocellular Carcinoma after Hepatic Resection: A Retrospective Cohort Study

Predictors of Recurrence in Hepatitis C Virus Related Hepatocellular Carcinoma after Hepatic Resection: A Retrospective Cohort Study

The role of oral antiviral therapy in hepatitis B-related hepatocellular carcinoma

Current clinical evidence for nucleos(t)ide analogues in patients with HBV-related hepatocellular carcinoma

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