Up‐to‐seven criteria as a useful predictor for tumor downstaging to within Milan criteria and Child–Pugh grade deterioration after initial conventional transarterial chemoembolization

Yasui, Yutaka; Tsuchiya, Kaoru; Kurosaki, Masayuki; Takeguchi, Takaya; Takeguchi, Yuko; Okada, Mao; Wang, Wan; Kubota, Yohei; Gotō, Tomoyuki; Komiyama, Yasuyuki; Higuchi, Masakazu; Takaura, Kenta; Hayashi, Tsuguru; Takada, Hitomi; Tamaki, Nobuharu; Nakanishi, Hiroyuki; Itakura, Jun; Takahashi, Yuka; Asahina, Yasuhiro; Enomoto, Nobuyuki; Himeno, Yoshiro; Izumi, Namiki

doi:10.1111/hepr.13048

Cited by 63 publications

(53 citation statements)

References 32 publications

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“…classified patients with intermediate‐stage HCC into subgroups based on the tumor burden with the up‐to‐seven criteria, and patients out of the up‐to‐seven criteria were presumed to respond poorly to TACE . Several studies have verified the usefulness of the up‐to‐seven criteria for the classification of patients with intermediate‐stage HCC who received TACE . The present study also found that the TTTR was significantly shorter for patients out of the up‐to‐seven criteria than that for the other patients.…”

Section: Discussionsupporting

confidence: 81%

“…32 Several studies have verified the usefulness of the up-to-seven criteria for the classification of patients with intermediate-stage HCC who received TACE. [33][34][35] The present study also found that the TTTR was significantly shorter for patients out of the up-to-seven criteria than that for the other patients. Other subgrouping risk predictors, such as tumor number alone and other scoring systems (the maximum tumor diameter plus tumor number, and tumor factors plus laboratory values), have been proposed to identify ideal candidates for TACE.…”

Section: Discussionsupporting

confidence: 75%

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Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma

Maesaka

Sakamori

Yamada

et al. 2019

Hepatology Research

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Aim Intermediate‐stage hepatocellular carcinoma (HCC) targeted for transcatheter arterial chemoembolization (TACE) corresponds to a highly heterogeneous population for whom the factors predicting TACE efficacy have not been established. This study aimed to evaluate the impact of hypovascular hepatic nodules coexisting with intermediate‐stage HCC as a significant predictive factor for TACE refractoriness. Methods A total of 66 patients with intermediate‐stage HCC who received initial TACE were retrospectively analyzed. Hypovascular hepatic nodules were detected by dynamic computed tomography or magnetic resonance imaging, as well as angiography, before all initial TACE. The time to TACE refractoriness (TTTR) was defined as the period from initial TACE until the diagnosis of TACE refractoriness. Results Hypovascular hepatic nodules were detected in 36 patients (54.5%), 15 (41.7%) of whom had a single nodule, whereas 21 (58.3%) had multiple nodules, and the median size of the maximum nodule was 10 mm (range 5–80 mm). The median TTTR was 17.4 months for all patients, and 7.3 and 33.1 months for patients with and without hypovascular hepatic nodules, respectively. The TTTR was significantly shorter for patients with hypovascular hepatic nodules than that for the other patients. In the multivariate analysis, the presence of hypovascular hepatic nodules (HR 7.016, 95% CI 3.534–13.930; P < 0.001) and being out of the up‐to‐seven criteria (HR 2.861, 95% CI 1.493–5.486; P = 0.002) were independent risk factors for a short TTTR. Conclusions The presence of hypovascular hepatic nodules with intermediate‐stage HCC represents a significant predictive risk factor for TACE refractoriness.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 75%

Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma

Maesaka

Sakamori

Yamada

et al. 2019

Hepatology Research

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“…In B2 substage HCC, the early onset of TACE refractoriness is responsible for the shorter survival than that of patients with B1 substage HCC [10,31]. In another retrospective study [33], multivariate analysis revealed that beyond the up-to-seven criteria is an independent factor associated with Child-Pugh class deterioration (HR, 1.9; p=0.005). These findings are large Japanese cohorts [34,35], consistent to the OS initially treated with TACE in the present study.…”

Section: Efficacy and Safetymentioning

confidence: 98%

Lenvatinib as an Initial Treatment in Patients with Intermediate-stage Hepatocellular Carcinoma Beyond up-to-seven Criteria and Child-Pugh A Liver Function: A Proof-of-Concept Study

Kudo¹,

Ueshima²,

Chan³

et al. 2019

Preprint

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Background: Although transcatheter arterial chemoembolisation (TACE) is the standard of care for intermediate-stage hepatocellular carcinoma (HCC), this is a largely heterogeneous disease that includes a subgroup of patients who do not benefit from TACE. The treatment strategy for this subgroup of patients currently remains an unmet need in clinical practice. Here, we performed a proof-of-concept study that lenvatinib may be more favourable treatment option over TACE as an initial treatment in intermediate-stage HCC patients with large or multinodular tumours exceeding the up-to-seven criteria. Methods: This proof-of-concept study included 642 consecutive patients with HCC initially treated with lenvatinib or conventional TACE (cTACE) between January 2006 and December 2018. Of these patients, 176 who received lenvatinib or cTACE as an initial treatment and met the eligibility criteria [unresectable, beyond the up-to-seven criteria, no prior TACE/systemic therapy, no vascular invasion, no extrahepatic spread and Child-Pugh A liver function] were selected for the study. Propensity score matching was used to adjust for patient demographics. Results: After propensity-score matching, outcome of 30 patients prospectively treated with lenvatinib (14 in clinical trials, 1 in early access program and 15 in real world setting) and 60 patients treated with cTACE as the initial treatment was compared. The change of ALBI score from baseline to the end of treatment were -2.61 to -2.61 for 30 patients in lenvatinib group (p = 0.254) and -2.66 to -2.09 in cTACE group (p < 0.01), respectively. The lenvatinib group showed a significantly higher objective response rate (73.3% vs. 33.3%; p < 0.001) and significantly longer median progression-free survival than the cTACE group (16.0 vs. 3.0 months; p < 0.001). Overall survival was significantly longer in the lenvatinib group than in the cTACE group (37.9 vs. 21.3 months; hazard ratio: 0.48, p < 0.01). Conclusion: In patients with large or multinodular intermediate-stage HCC exceeding the up-to-seven criteria with Child-Pugh A liver function, who usually do not benefit from TACE, lenvatinib provides more favorable outcome than TACE.

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“…Hepatocellular carcinoma (HCC) is one of the most common causes of cancer‐related death worldwide . The survival of HCC patients depends on several prognostic factors that are either host related, such as liver function and general patient status, or tumor related . The Barcelona Clinic Liver Cancer (BCLC) classification is the most widely used classification to predict prognoses and determine treatment methods .…”

Section: Introductionmentioning

confidence: 99%

“…1 The survival of HCC patients depends on several prognostic factors that are either host related, such as liver function and general patient status, or tumor related. [2][3][4][5][6] The Barcelona Clinic Liver Cancer (BCLC) classification is the most widely used classification to predict prognoses and determine treatment methods. 7 Guidelines from the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases consider patients with stage 0 (very early stage BCLC) and stage A (early stage) suitable for curative treatment.…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma: Comparison with TACE alone using decision‐tree analysis after propensity score matching

Shimose

Tanaka

Iwamoto

et al. 2019

Hepatology Research

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Aims The prognosis of hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE) is still poor. We aimed to evaluate the impact of TACE combined with radiofrequency ablation (TACE+RFA) on the prognosis of HCC patients using decision‐tree analysis after propensity score matching. Methods This was a retrospective study. We enrolled 420 patients with HCC treated with TACE alone (n = 311) or TACE+RFA (n = 109) between 1998 and 2016 (median age, 72 years; male / female, 272/148; Barcelona Clinic Liver Cancer (BCLC) stage A / B, 215/205). The prognosis of patients who underwent TACE+RFA was compared to patients who underwent TACE alone after propensity score matching. Decision‐tree analysis was used to investigate the profile for prognosis of the patients. Results After propensity score matching, there was no significant difference in age, sex, BCLC stage, or albumin–bilirubin (ALBI) score between both groups. The survival rate of the TACE+RFA group was significantly higher than the TACE alone group (median survival time [MST] 57.9 months vs. 33.1 months, P < 0.001). In a stratification analysis according to BCLC stage, the overall survival rate of the TACE+RFA group was significantly higher than the TACE alone group in BCLC stage A and B (MST 57.9 and 50.7 months vs. 39.8 and 24.5 months [P = 0.007 and 0.001], respectively). Decision‐tree analysis showed that TACE+RFA was the third distinguishable factor for survival in patients with α‐fetoprotein level >7 ng/mL and ALBI <−2.08. Conclusion Decision‐tree analysis after propensity score matching showed that TACE+RFA could prolong the survival of HCC patients compared to TACE alone.

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Up‐to‐seven criteria as a useful predictor for tumor downstaging to within Milan criteria and Child–Pugh grade deterioration after initial conventional transarterial chemoembolization

Abstract: The up-to-seven criteria had prognostic value and could predict non-critical recurrence and maintenance of Child-Pugh grade in patients who underwent initial conventional TACE.

Cited by 63 publications

References 32 publications

Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma

Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma

Lenvatinib as an Initial Treatment in Patients with Intermediate-stage Hepatocellular Carcinoma Beyond up-to-seven Criteria and Child-Pugh A Liver Function: A Proof-of-Concept Study

Prognostic impact of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma: Comparison with TACE alone using decision‐tree analysis after propensity score matching

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