Application of the Barcelona Clinic Liver Cancer therapeutic strategy and impact on survival

Hernández‐Guerra, Manuel; Hernández-Camba, Alejandro; Turnés, Juan; Ramos, Luis Martín; Arranz, Laura; Mera, J.; Crespo, Javier; Quintero, Enrique

doi:10.1177/2050640615575971

Cited by 6 publications

(7 citation statements)

References 45 publications

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“…In the last couple of years, a debate has taken place about the necessity of adherence to such staging systems [ 27 , 28 , 29 , 30 , 31 ]. In fact, most of these systems have been conceived by experts attending patients affected with HCC in a clinical context where cirrhotic liver represents the very large majority of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…This is why we are convinced that the authority of such prescribed guidelines should be discussed and their contextual applications should be explicitly addressed. In fact, the adherence to international guidelines has been already questioned in real-life practice by some physicians [ 29 , 30 , 31 ], while a more contextualist approach has been suggested by others [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

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Hepatocellular carcinoma surgery outcomes in the developing world: A 20-year retrospective cohort study at the National Cancer Institute of Peru

Ruíz

Rojas

Berrospi

et al. 2016

Heliyon

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In the developing world, most patients with hepatocellular carcinoma present with advanced-stage disease, considered to be incurable based on current therapeutic algorithms. Here, we demonstrate that curative liver resection is achievable in a portion of Peruvian patients not addressed by these treatment algorithms. We conducted a retrospective cohort study of 253 hepatocellular carcinoma patients that underwent a curative hepatectomy between 1991 and 2011 at the National Cancer Institute of Peru. The median age of the cohort was 36 years, and merely 15.4% of the patients displayed cirrhosis. The average tumor size was over 14 cm in diameter, resulting in 76.3% of major hepatectomies performed. The 5-and 10-year survival probability estimates were 37.5% and 26.2%, respectively. Age (>44 vs. ≤44 years old; P = 0.005), tumor size (>10 cm vs. ≤10 cm in diameter; P = 0.009), cirrhosis (P < 0.001), satellite lesions (P < 0.001), macroscopic vascular invasion (P < 0.001), allogeneic blood transfusion (P = 0.011), and spontaneous rupture of the tumor (P = 0.006) were independent predictive factors for prognosis. Hepatocellular carcinomas in Peru are characterized by a distinct clinical presentation with notable features compared with those typically described throughout relevant literature. Despite a large number of advanced-stage hepatocellular carcinomas, the outcomes of liver resection observed in the present study were in good standing with the results previously described in other series.It thus appears that staging systems and associated therapeutic algorithms designed for use in the developed world remain inadequate in certain populations, especially in the context of Peruvian patients. Our findings suggest that clinicians in the developing world should reconsider management guidelines pertaining to hepatocellular carcinoma. Indeed, we hypothesize that, in developing countries, a strict adherence to these therapeutic algorithms might create a selection bias resulting in the dismissal of patients who could eventually be treated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma surgery outcomes in the developing world: A 20-year retrospective cohort study at the National Cancer Institute of Peru

Ruíz

Rojas

Berrospi

et al. 2016

Heliyon

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“…These patients underwent contrast enhanced MRI at four weeks after the embolization, as part of their follow-up management protocol. None of the patients were candidates for other minimally invasive procedures such as radiofrequency ablation or microwave ablation due to the presence of multinodular or intermediate stage HCC, which directs the treatment towards TACE, exclusively [11].…”

Section: Methodsmentioning

confidence: 99%

Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization – a Multiparametric Magnetic Resonance Imaging Study

Scheau

Lupescu

2017

JGLD

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Background & Aims: Emerging minimally invasive treatments for hepatocellular carcinoma (HCC) can significantly improve a patient’s prognosis, but they may alter the imaging features of the treated nodules. This study focuses on a series of patients presenting with a rare pathology, the nodule-in-nodule imaging pattern of HCC, analyzes the imaging features and discusses possible approaches for the diagnosis of tumoral recurrence.Method: Nine patients recruited over two years, having HCC with nodule-in-nodule imaging pattern on diagnosis, and treated by transarterial chemoembolization were monitored by magnetic resonance imaging (MRI). Nodule morphology, dynamic contrast behavior and size progression were followed in this study.Results: All patients showed tumor recurrence. In 7 nodules, a T2 weighted-imaging hyperintense signal of the HCC foci was found, with isointensity of the background nodule. Restricted diffusion within the HCC foci was found in 6 cases but with no statistical significance. Dynamic contrast images evaluation showed a “classical” enhancement pattern in five patients. All nodules had hypointense HCC foci in the hepatobiliary phase. Four patients demonstrated progressive disease according to the mRECIST criteria.Conclusions: Due to the particularly challenging nodule characteristics, the sensitivity in diagnosing HCC foci in these nodules is about 77% when using conventional imaging criteria related to nodule morphology. Contrast media uptake curves may be altered by changes in nodule hemodynamics caused by embolization. The diagnostic rate may be significantly increased by considering the tumoral size increase in follow-up studies and completing the study with a hepatobiliary phase using Acidum Gadoxeticum.Abbreviations. ADC: Apparent diffusion coefficient; CT: Computed tomography; DEB-TACE: drug-eluting beads transarterial chemoembolization; DWI: Diffusion-weighted imaging; Gd-EOB-DTPA: acidum gadoxeticum; HCC: hepatocellular carcinoma; HBV: hepatitis virus B; HCV: hepatitis virus C; HDV: hepatitis virus D; IN-OPP: in-phase and out-of-phase; mRECIST: modified Response Evaluation Criteria in Solid Tumors; MRI: Magnetic resonance imaging; ROI: region of interest; TACE: Transarterial chemoembolization; WI: weighted imaging.

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“…Treatment programs for 206 patients with SHCC were determined through the BCLC proposal and patients' informed consent ( 22 , 23 ). By comparing three local tumor lesion treatments, the appropriate treatment for patients with SHCC was elucidated.…”

Section: Introductionmentioning

confidence: 99%

Impact of local tumor lesion treatments and preoperative indicators on the survival of patients with small hepatocellular carcinomas

Yue

Dai

et al. 2018

Oncol Lett

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The prognosis for small hepatocellular carcinomas (SHCC) remains uncertain. The aim of the present study was to compare three local tumor lesion treatments and identify the prognostic factors in patients with SHCC by analyzing preoperative indicators. A retrospective study was performed using data from 206 patients with SHCC from 2006–2015. All of the patients had undergone transarterial chemoembolization (TACE) alone, TACE plus percutaneous microwave coagulation therapy (PMCT) or surgical resection (SR). The Kaplan-Meier method was used to calculate the survival rates. Multivariate analysis was conducted using Cox regression analysis. The median survival time of patients with SHCC was 27 (range, 14–49) months in the TACE group, 29.5 (range, 16–52) months in the TACE-PMCT group and 36.5 (range, 26–52) months in the SR group (P=0.091). The 1, 3 and 5-year survival rates for patients with SHCC were 82.4, 64.9 and 46.8% in the TACE group; 89.0, 72.6 and 58.3% in the TACE-PMCT group and 88.8, 72.3 and 58.6% in the SR group (P=0.181), respectively. Analysis from the Cox regression model demonstrated that preoperative α-fetoprotein (AFP; <400 ng/ml vs. ≥400 ng/ml; HR=0.548; P=0.036) was an independent predictor of the survival time of patients with SHCC. Analysis of patients with preoperative AFP levels of ≥400 ng/ml revealed that the median survival time in the SR group was 36 (range, 28.25–52) months, significantly longer than the TACE (17 months; range, 12–44 months) and TACE-PMCT group (27 months; range, 14–55 months; P=0.035). The 1, 2 and 3-year survival rates for patients with SHCC with ≥400 ng/ml AFP were: 70.8, 55.5 and 49.9% in the TACE group; 83.7, 68.0 and 60.8% in the TACE-PMCT group; and 90.9, 81.8 and 61.0% in SR group, respectively (P=0.664). However, there was no significant difference among the three groups in the survival time of patients with SHCC with <400 ng/ml preoperative AFP. The observations indicated that SR is not significantly different for overall survival time in the patients with SHCC between the two groups; this method can be employed for patients with SHCC. This was based on the median survival time of patients with ≥400 ng/ml AFP in the SR group who had a longer survival time and a higher survival rate than in the TACE and TACE-PMCT group.

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Application of the Barcelona Clinic Liver Cancer therapeutic strategy and impact on survival

Cited by 6 publications

References 45 publications

Hepatocellular carcinoma surgery outcomes in the developing world: A 20-year retrospective cohort study at the National Cancer Institute of Peru

Hepatocellular carcinoma surgery outcomes in the developing world: A 20-year retrospective cohort study at the National Cancer Institute of Peru

Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization – a Multiparametric Magnetic Resonance Imaging Study

Impact of local tumor lesion treatments and preoperative indicators on the survival of patients with small hepatocellular carcinomas

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