Wait Time for Curative Intent Radio Frequency Ablation is Associated with Increased Mortality in Patients with Early Stage Hepatocellular Carcinoma

Brahmania, Mayur; Ahmed, Osman; Kelley, Melissa; Wong, David; Kowgier, Matthew; Khalili, Korosh; Beecroft, R.; Renner, Eberhard L.; Shah, Hemant; Feld, Jordan J.; Janssen, Harry L A; Sherman, Morris

doi:10.5604/01.3001.0010.2776

Cited by 12 publications

(25 citation statements)

References 10 publications

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“…In one US study, treatment delays were associated with worse survival. 19 Smaller studies in Taiwan 29,48 and Canada 49 have also shown the adverse impact of delays in locoregional therapy on treatment response and survival. In contrast, studies have found that delays in surgical therapy have no impact 50 or are associated with improved survival compared with no delays.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and Therapeutic Delays in Patients With Hepatocellular Carcinoma

Rao¹,

Rich²,

Marrero³

et al. 2021

Journal of the National Comprehensive Cancer Network

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Background: Delays in diagnosis and treatment have been reported for many cancers, with resultant stage migration and worse survival; however, few data exist in patients with hepatocellular carcinoma (HCC). These data are of particular importance in light of the COVID-19 pandemic, which has caused disruptions in healthcare processes and may continue to impact cancer care for the foreseeable future. The aim of our study was to characterize the prevalence and clinical significance of diagnostic and treatment delays in patients with HCC. Methods: We performed a retrospective cohort study of consecutive patients diagnosed with HCC between January 2008 and July 2017 at 2 US health systems. Diagnostic and treatment delays were defined as >90 days between presentation and HCC diagnosis and between diagnosis and treatment, respectively. We used multivariable logistic regression to identify factors associated with diagnostic and treatment delays and Cox proportional hazard models to identify correlates of overall survival. Results: Of 925 patients with HCC, 39.0% were diagnosed via screening, 33.1% incidentally, and 27.9% symptomatically. Median time from presentation to diagnosis was 37 days (interquartile range, 18–94 days), with 120 patients (13.0%) experiencing diagnostic delays. Median time from HCC diagnosis to treatment was 46 days (interquartile range, 29–74 days), with 17.2% of patients experiencing treatment delays. Most (72.5%) diagnostic delays were related to provider-level factors (eg, monitoring indeterminate nodules), whereas nearly half (46.2%) of treatment delays were related to patient-related factors (eg, missed appointments). In multivariable analyses, treatment delays were not associated with increased mortality (hazard ratio, 0.90; 95% CI, 0.60–1.35); these results were consistent across subgroup analyses by Barcelona Clinic Liver Cancer stage and treatment modality. Conclusions: Diagnostic and therapeutic delays exceeding 3 months are common in patients with HCC; however, observed treatment delays do not seem to significantly impact overall survival.

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Section: Discussionmentioning

confidence: 99%

Diagnostic and Therapeutic Delays in Patients With Hepatocellular Carcinoma

Rao¹,

Rich²,

Marrero³

et al. 2021

Journal of the National Comprehensive Cancer Network

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“…Hepatocellular carcinoma (HCC) is the fifth most frequently occurring cancer and the third leading cause of cancer-related death. 1 , 2 Most patients are found in the advanced stage, and the prognosis of HCC is extremely poor due to the frequent metastasis, relapse, and chemotherapy resistance. 3 – 5 Therefore, understanding the molecular mechanisms underlying the initiation and development of HCC may lead to the improvement of clinical treatment.…”

Section: Introductionmentioning

confidence: 99%

miR-517a promotes Warburg effect in HCC by directly targeting FBP1

Zhang

Zhu

et al. 2018

OTT

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PurposeHepatocellular carcinoma (HCC) is one of the most aggressive malignancies worldwide. Our aim is to explore the expression and biological function of miR-517a in HCC.Materials and methodsWe performed qRT-PCR to detect the expression of miR-517a in clinical samples and cell lines. CKK-8 assay and colony formation assay were employed to detect the miR-517a regulated cell proliferation. Glucose uptake and lactate production were examined to determine the Warburg effect. We also performed ECAR assay using Seahorse system. Luciferase acitivy assay was used to examine the binding of FBP1 3′UTR by miR-517a.ResultsmiR-517a was upregulated in HCC samples in both genomic and mRNA levels. Moreover, overexpression of miR-517a promoted cell proliferation and Warburg effect. Mechanically, miR-517a could directly target the 3′-UTR of FBP1. In addition, restoring the expression of FBP1 inhibited cell growth.ConclusionWe demonstrated that miR-517a acts as an oncogene to promote Warburg effect in HCC, favoring tumor growth, and miR-517a/FBP1 could be a novel target for HCC treatment.

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“…The pathological results showed that 9.5% of the patients had cirrhosis, 27.6% had microvascular invasion, 12.1% had venous thromboembolism, and 88.4% were highly differentiated. Severe complications occurred in 2.6% of the patients, with a median hospital stay of 18 (14)(15)(16)(17)(18)(19)(20)(21)(22) days. The median OS of patients was 37 (23.4-57.6) months (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Besides, several studies have shown that delayed treatment increases the risk of residual tumor and death, and delayed treatment of HCC is associated with shortened OS, and signi cantly delayed treatment leads to worse survival rates, especially in patients with delayed treatment of more than 3 months [3,[13][14][15][16] . This is contrary to the results obtained in this study.…”

Section: Discussionmentioning

confidence: 99%

Effect of Delayed Surgical Resection of Primary Hepatocellular Carcinoma on Survival Outcomes In Elderly Patients and Prediction of Clinical Models

Liang

et al. 2021

Preprint

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Background: The effect of time delay from diagnosis to surgery on the prognosis of elderly patients with liver cancer is not well known. We investigated the effect of surgical timing on the prognosis of elderly hepatocellular carcinoma patients undergoing surgical resection and constructed a Nomogram model to predict the overall survival of patients.Methods: A retrospective analysis was performed on elderly patients with primary liver cancer after hepatectomy from 2012 to 2018. The effect of surgical timing on the prognosis of elderly patients with liver cancer was analyzed using the cut-off times of 18 days, 30 days, and 60 days. Cox was used to analyze the independent influencing factors of overall survival in patients, and a prognostic model was constructed.Results: A total of 232 elderly hepatocellular carcinoma patients who underwent hepatectomy were enrolled in this study. The cut-off times of 18, 30, and 60 days were used. The duration of surgery had no significant effect on overall survival. Body Mass Index, Child-Pugh classification, Tumor size Max, and Length of stay were independent influencing factors for overall survival in the elderly Liver cancer patients after surgery. These factors combined with Liver cirrhosis and Venous tumor emboli were incorporated into a Nomogram. The nomogram was validated using the clinical data of the study patients, and exhibited better prediction for 1-year, 3-year, and 5-year overall survival.Conclusion: We demonstrated that the operative time has no significant effect on delayed operation in the elderly patients with hepatocellular carcinoma, and a moderate delay may benefit some patients. The constructed Nomogram model is a good predictor of overall survival in elderly patients with hepatectomy.

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Wait Time for Curative Intent Radio Frequency Ablation is Associated with Increased Mortality in Patients with Early Stage Hepatocellular Carcinoma

Cited by 12 publications

References 10 publications

Diagnostic and Therapeutic Delays in Patients With Hepatocellular Carcinoma

Diagnostic and Therapeutic Delays in Patients With Hepatocellular Carcinoma

miR-517a promotes Warburg effect in HCC by directly targeting FBP1

Effect of Delayed Surgical Resection of Primary Hepatocellular Carcinoma on Survival Outcomes In Elderly Patients and Prediction of Clinical Models

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