Trans-arterial chemoembolization + radiofrequency ablation versus surgical resection in hepatocellular carcinoma – A meta-analysis

Gui, Chuan Hao; Baey, Samantha; D'cruz, Reuban Toby; Shelat, Vishal G

doi:10.1016/j.ejso.2020.01.004

Cited by 64 publications

(69 citation statements)

References 35 publications

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“…To reduce mortality and improve outcomes, these patients can be recommended for non-hepatectomy approaches, such as ablation, TACE, Y90, or the combination. 27 As both thrombocytosis and thrombocytopenia are unfavorable prognostic factors for HCC, the prognostic value of PALBI may be different across different levels of PLT. However, all the previous studies did not take into account the effect of PLT in the significance of PALBI.…”

Section: Discussionmentioning

confidence: 99%

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The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count

Pang¹,

Liu²,

Wang³

et al. 2020

CMAR

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Background Platelet–albumin–bilirubin (PALBI) has been demonstrated to be superior to conventional Child–Pugh (C-P) grade in evaluating liver function and prognosis of HCC patients. However, both thrombocytosis and thrombocytopenia are unfavorable for HCC survival. The aim of this study was to preliminarily investigate the prognostic value of PALBI in HCC patients with thrombocytopenia and excluding thrombocytopenia. Methods In this retrospective cohort study, we reviewed 465 cases of HCC patients who underwent radical surgery. PALBI grade was calculated based on preoperative serological examinations. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS), which were assessed by Kaplan–Meier method and Cox regression. The prognostic performances of PALBI and other models were estimated by using the concordance index (C-index). Results During a median follow-up time of 28 months, 31.6% (147/465) of patients died and 33.5% (156/465) experienced recurrence. Multivariate analyses revealed that both thrombocytosis and thrombocytopenia were independently associated with poor OS and RFS compared with normal platelet count (PLT) in HCC patients. Stratified analysis further revealed that PALBI was a significant predictor for HCC survival in patients excluding thrombocytopenia but not in patients with thrombocytopenia. In particular, in HCC patients excluding thrombocytopenia, the combination of tumor size with PALBI (C-index = 0.730, 95% CI: 0.674–0.786) may be superior to the classical Barcelona Clinic Liver Cancer (BCLC) and Cancer of Liver Italian Program (CLIP) staging systems in predicting survival. Conclusion In conclusion, PALBI grade, in particular the combination with tumor size, is an effective model for discriminating survival in HCC patients excluding thrombocytopenia but not in thrombocytopenic HCC patients.

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Section: Discussionmentioning

confidence: 99%

“…39 In addition, the combination of TACE and ablation offers comparable clinical outcomes but reduces peri-operative-related mortality. 27 As patients with liver disfunction had worse outcomes in cases who received liver transplantation or ALPPS, 40,41 the two therapies should be used with caution.…”

Section: Discussionmentioning

confidence: 99%

The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count

Pang¹,

Liu²,

Wang³

et al. 2020

CMAR

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“…27 Furthermore, the application of different staging standards also has an impact on the prognosis of HCC patients. 28 The current international staging standards include Barcelona Clinic Liver Cancer (BCLC) staging system, Hong Kong Liver Cancer (HKLC) staging system, TNM staging system, etc. Medical institutions should select a more suitable staging system for their HCC patients.…”

Section: Discussionmentioning

confidence: 99%

Fibrinogen/Lymphocyte Count Ratio Can Be Used as a New Indicator of Prognosis in Patients with Hepatocellular Carcinoma After Radical Resection

Yi-cheng¹,

Zheng-li²,

Deng³

et al. 2020

CMAR

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Preoperative fibrinogen levels are associated with the development, recurrence and metastasis of malignant tumors. This study was designed to investigate the clinical value of preoperative fibrinogen/lymphocyte count ratio (FLR) index in hepatocellular carcinoma (HCC). Patients and Methods: The clinical data of 479 patients with HCC who underwent radical resection were retrospectively analyzed. The correlation between FLR and clinicopathological features was analyzed by chi-square test or non-parametric test. The overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier method. Results: The optimal cutoff value of FLR was determined as 1.6 according to the receiver operating characteristic curve (ROC) analysis, in order to predict prognosis for HCC patients after radical resection. It was further found that FLR level was correlated with tumor size, TNM stage, microvascular invasion and prognosis. Multivariate Cox regression analyses found that FLR was an independent predictor for postoperative OS (overall survival) (p = 0.002) and PFS (progression-free survival) (p = 0.001) in patients with HCC; and the 1-, 3and 5-year OS and PFS of HCC patients in the FLR ≤1.6 level group were significantly higher than those in the FLR >1.6 level group. Conclusion: Preoperative FLR level is a novel and effective predictor of prognosis in patients with HCC, and elevated FLR level is associated with poor prognosis in patients with HCC.

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“…In contrast, high-risk patients may need to combine more adjuvant treatments to obtain optimal prognosis, particularly in younger patients. A recent meta-analysis showed that TACE + RFA can provide comparable therapeutic outcomes in HCC patients compared with hepatectomy and have the advantage of reducing morbidity [56]. This result is important for clinical decision making in high-risk patients, and it is worth considering whether a patient who is deemed to be high risk of PHER should not undergo a hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

Artificial Neural Network Model to Predict Post-Hepatectomy Early Recurrence of Hepatocellular Carcinoma without Macroscopic Vascular Invasion

Mai

Zeng

Meng

et al. 2020

Preprint

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Background: The accurate prediction of post-hepatectomy early recurrence (PHER) for hepatocellular carcinoma (HCC) is of great significance in determining postoperative adjuvant treatment and monitoring. This research aimed to develop and validate an artificial neural network (ANN) model to predict PHER in HCC patients without macroscopic vascular invasion.Methods: 903 patients who underwent curative liver resection for HCC were collected. They were randomly divided into a derivation cohort (n = 679) and a validation cohort (n = 224). The ANN model was then developed in the derivation cohort and verified in the validation cohort.Results: The morbidity of PHER in the derivation and validation cohorts was 34.8% and 39.2%, respectively. Multivariate analysis revealed that hepatitis B virus DNA load, γ-glutamyl transpeptadase, α-fetoprotein, tumor diameter, tumor differentiation, microvascular invasion, satellite nodules and blood loss were significantly associated with PHER. Incorporating these factors, the ANN model had greater discriminatory abilities than conventional Cox model, existing recurrence models and commonly used staging systems for predicting PHER. Stratification into two risk groups indicated a statistically significant discrepancy in recurrence-free survival curves. Conclusion: The ANN model has a significant advantage in predicting PHER for HCC patients without macroscopic vascular invasion when compared to other models and staging systems.

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Trans-arterial chemoembolization + radiofrequency ablation versus surgical resection in hepatocellular carcinoma – A meta-analysis

Cited by 64 publications

References 35 publications

<p>The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count</p>

<p>The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count</p>

<p>Fibrinogen/Lymphocyte Count Ratio Can Be Used as a New Indicator of Prognosis in Patients with Hepatocellular Carcinoma After Radical Resection</p>

Artificial Neural Network Model to Predict Post-Hepatectomy Early Recurrence of Hepatocellular Carcinoma without Macroscopic Vascular Invasion

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