A new prognostic model for hepatocellular carcinoma based on total tumor volume: The Taipei Integrated Scoring system

Hsu, Chia Yang; Huang, Yi Hsiang; Hsia, Cheng Yuan; Su, Chien Wei; Lin, Han Chieh; Loong, Che Chuan; Chiou, Yi You; Chiang, Jen–Huey; Lee, Pui Ching; Huo, Teh Ia; Lee, Shou Dong

doi:10.1016/j.jhep.2010.01.038

Cited by 156 publications

(116 citation statements)

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“…[2][3][4] In our study, only 27.2% of patients overall survived for 5 years. However, around 35% of the patients were found at an earlystage HCC.…”

Section: Discussioncontrasting

confidence: 57%

“…With marked improvement in the early detection and management of HCC during recent decades; however, up to around 60% of early-stage HCC patients may survive without recurrence for 5 or even 7 years. [2][3][4] Established prognostic predictors include the degrees of liver damage, tumor burden and serum a-fetoprotein values. [2][3][4] Although many studies have addressed these and other prognostic factors, [2][3][4][5] there has been limited exploration of the influence of modifiable lifestyle factors on HCC prognosis.…”

mentioning

confidence: 99%

“…[6][7][8][9][10][11][12] Heavy drinking is a major cause of liver cirrhosis, 13,14 which underlies HCC and contributes to poor prognosis of HCC. [2][3][4]11 Tobacco-related carcinogens can initiate liver tumor formation and inactivate tumor suppressor genes via promoter hypermethylation or mutation in animal models, [15][16][17][18][19] yet the information on the role of prediagnostic smoking in HCC survival is limited. 20 Whether smoking cessation can improve survival rates remains unclear.…”

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confidence: 99%

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Influences of tobacco and alcohol use on hepatocellular carcinoma survival

Shih

Chang

Liaw

et al. 2012

Intl Journal of Cancer

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Prognosis of hepatocellular carcinoma (HCC) is generally poor. The role of modifiable lifestyle factors on HCC survival has been less studied. To examine whether prediagnosis smoking and alcohol affected HCC survival stratified by viral etiology, we conducted a prospective cohort study of 2,273 (1990 with viral hepatitis and 283 without) incident HCC cases aged 20-75 years who were enrolled between 1997 and 2004 from a Taiwanese multicenter study, and followed up through 2007. Information on habitual smoking and alcohol consumption was obtained at baseline through personal interview. After follow-up to a maximum of 10 years, 1,757 participants died and 1,488 (84.7%) were attributed to HCC. Prediagnosis smoking and alcohol worsened prognosis independent of each other and clinical predictors. The effects of both risky behaviors were limited to viral hepatitis-related HCC and more profound among those with early-stage HCC. Risk for HCC-specific mortality increased with increasing pack-years smoked and ethanol intake (all p < 0.001 for trend), with an additive effect shown for the two habits [hazard ratio (HR) for alcohol 46.2 g/day and 10 pack-years 5 1.72, 95% confidence interval (CI) 5 1.45-2.05]. For either habit, cessation reduced HCC-specific mortality, but a significant mortality benefit occurred 10 years after abstinence (quitting smoking 10 years vs. continuing smokers: HR 5 0.77, 95% CI 5 0.61-0.97; quitting drinking 10 years vs. continuing drinkers: HR 5 0.74, 95% CI 5 0.56-0.98). In conclusion, among patients with viral hepatitis-related HCC, prediagnosis smoking and alcohol have a deleterious effect on HCC survival. Quitting smoking or drinking alcohol could reduce the excess risk, but only after a long interval of cessation.Hepatocellular carcinoma (HCC) is one of the world's leading cancer threats associated with death.1 The prognosis of advanced HCC remains poor. With marked improvement in the early detection and management of HCC during recent decades; however, up to around 60% of early-stage HCC patients may survive without recurrence for 5 or even 7 years.2-4 Established prognostic predictors include the degrees of liver damage, tumor burden and serum a-fetoprotein values.2-4 Although many studies have addressed these and other prognostic factors, 2-5 there has been limited exploration of the influence of modifiable lifestyle factors on HCC prognosis.Both alcohol consumption and cigarette smoking have been associated with increased risk of HCC in many epidemiological studies, although the results are somewhat inconsistent.6-12 Heavy drinking is a major cause of liver cirrhosis, 13,14 which underlies HCC and contributes to poor prognosis of HCC.2-4,11 Tobacco-related carcinogens can initiate liver tumor formation and inactivate tumor suppressor genes via promoter hypermethylation or mutation in animal models, [15][16][17][18][19] yet the information on the role of prediagnostic smoking in HCC survival is limited. 20 Whether smoking cessation can improve survival rates remains unclear.Using a multic...

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“…[2][3][4] In our study, only 27.2% of patients overall survived for 5 years. However, around 35% of the patients were found at an earlystage HCC.…”

Section: Discussioncontrasting

confidence: 57%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Influences of tobacco and alcohol use on hepatocellular carcinoma survival

Shih

Chang

Liaw

et al. 2012

Intl Journal of Cancer

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“…However, few studies (with the exception of Hsu et al) have analyzed survival according to tumor volume [35] . In the current study, multivariate analysis of the pre-treatment parameters showed that a tumor volume < 400 cm 3 was an independent pretreatment prognostic factor, while the maximal tumor diameter was not.…”

Section: Discussionmentioning

confidence: 99%

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis

Song

Bae²,

Song³

et al. 2013

WJG

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AIM:To evaluate the prognostic factors and efficacy of hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis. METHODS:Fifty hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) were treated using hepatic arterial infusion chemotherapy (HAIC) via a subcutaneously implanted port. The epirubicin-cisplatin-5-fluorouracil (ECF) chemotherapeutic regimen consisted of 35 mg/m 2 epirubicin on day 1, 60 mg/m 2 cisplatin for 2 h on day 2, and 500 mg/m 2 5-fluorouracil for 5 h on days 1-3. The treatments were repeated every 3 or 4 wk. RESULTS:Three (6%) of the 50 patients achieved a complete response (CR), 13 (26%) showed partial responses (PR), and 22 (44%) had stable disease (SD).The median survival and time to progression were 7 and 2 mo, respectively. After 2 cycles of HAIC, CR was achieved in 1 patient (2%), PR in 10 patients (20%) and SD in 26 patients (52%). Significant pre-treatment prognostic factors were a tumor volume of < 400 cm 3 (P = 0.01) and normal levels of protein induced by vitamin K absence or antagonist (PIVKA)-Ⅱ (P = 0.022). After 2 cycles of treatment, disease control (CR + PR + SD) (P = 0.001), PVTT response (P = 0.003) and α-fetoprotein reduction of over 50% (P = 0.02) were independent factors for survival. Objective response (CR + PR), disease control, PVTT response, and combination therapy during the HAIC were also significant prognostic factors. Adverse events were tolerable and successfully managed. CONCLUSION: HAIC may be an effective treatment modality for advanced HCC with PVTT in patients with tumors < 400 cm 3 and good prognostic factors.© 2013 Baishideng. All rights reserved. Key words: Hepatocellular carcinoma; Hepatic arterial infusion chemotherapy; Portal vein tumor thrombosisCore tip: The aim of this study was to investigate the prognostic factors of hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma patients with portal vein tumor thrombosis. The primary findings of this study were as follows: (1) The median survival and time to progression were 7 and 2 mo, respectively; (2) A tumor volume of < 400 cm 3 and protein induced by vitamin K absence or antagonist-Ⅱ were independent pre-treatment prognostic factors; (3) Disease control and ≥ 50% tumor marker reduction were significant prognostic factors after the second cycle of hepatic arterial infusion chemotherapy (HAIC); and (4) Objective tumor response, disease control and portal vein tumor thrombosis response were independent post-treatment prognostic factors at the end of the HAIC. ORIGINAL ARTICLE

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“…Finally, the Taipei Integrated Scoring system defends the use of the total tumor volume as the best tool for assessing the tumor burden. 12 In almost all instances, the currently used systems focus on assessments of the liver function and the tumor burden. The tumor burden is assessed by radiological or pathological criteria.…”

Section: Formentioning

confidence: 99%