Tyrosine kinase inhibitors are considered for use in patients with hepatocellular carcinoma (HCC) refractory to transarterial chemoembolization (TACE). The aim of the present retrospective study was to identify factors associated with progression-free survival (PFS) and to evaluate the indications for lenvatinib treatment in patients with intermediate-stage HCC refractory to TACE using a data-mining analysis. A total of 171 patients with intermediate-stage HCC refractory to TACE were included. All patients were classified into three groups according to their HCC treatment: Lenvatinib (n=45), sorafenib (n=53) and TACE (n=73) groups. PFS time was calculated using the Kaplan-Meier method and analyzed using a log-rank test. Factors associated with PFS time were evaluated using multivariate and decision-tree analyses. The median PFS time was 5.8, 3.2 and 2.4 months in the lenvatinib, sorafenib and TACE groups, respectively (P<0.001). In the Cox regression analysis, lenvatinib treatment and being within the up-to-seven criteria were identified as independent factors for PFS (lenvatinib, P<0.0001; within up-to-seven, P=0.001). The decision-tree analysis revealed that patients beyond the up-to-seven criteria, treated with lenvatinib and with albumin-bilirubin (ALBI) grade 1 had a longer PFS time (245.2±107.9 days) than patients beyond the up-to-seven criteria, treated with lenvatinib and with ALBI grade 2 (147.1±78.6 days). Additionally, lenvatinib was independently associated with longer PFS time in patients with intermediate-stage HCC refractory to TACE. Therefore, lenvatinib may be recommended for patients who have intermediate-stage HCC refractory to TACE, ALBI grade 1 and who are within the up-to-seven criteria.
We report two cases of a nonparasitic solitary huge liver cyst. The first case, that of a 42-year-old woman, was admitted with a chief complaint of upper abdominal pain. Computed tomography (CT) scans revealed a huge cyst, 10 cm in diameter, in segments 4 and 5 of the liver, and spontaneous rupture of the cyst with intracystic hemorrhage. Her general condition was improved by transcatheter arterial embolization (TAE). Percutaneous cystic needle aspiration cytological examination revealed no malignant cells, so she was discharged. After 3 weeks, however, the cyst had increased in size, and simple cystectomy was performed. Histological examination proved the cyst to be benign. The patient in the second case, a 70-year-old man, was admitted with epigastric discomfort and obstructive jaundice. CT scans revealed a huge liver cyst, 18 x 15 cm, in the right lobe of the liver, with dilation of the bile duct in the lateral segment. Magnetic resonance cholangiopancreatography showed compression of the left hepatic duct by the cyst and dilation of the bile duct in the lateral segment. Endoscopic retrograde cholangiopancreatography disclosed no communication between the bile duct and the cyst. Percutaneous transhepatic cyst drainage was performed, and minocycline hydrochloride was infused. The cyst was reduced in size, and the reduction has been maintained for 20 months since treatment.
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