Clinical practice guidelines for hepatocellular carcinoma: The Japan Society of Hepatology 2017 (4th JSH‐HCC guidelines) 2019 update

Kokudo, Norihiro; Takemura, Nobuyuki; Hasegawa, Kiyoshi; Takayama, Tadatoshi; Kubo, Shoji; Shimada, Mitsuo; Nagano, Hiroaki; Hatano, Etsuro; Izumi, Namiki; Kaneko, Shuichi; Kudo, Masatoshi; Iijima, Hiroko; Genda, Takuya; Tateishi, Ryosuke; Torimura, Takuji; Igaki, Hiroshi; Kobayashi, Satoshi; Sakurai, Hideyuki; Murakami, Takamichi; Watadani, Takeyuki; Matsuyama, Yutaka

doi:10.1111/hepr.13411

Cited by 440 publications

(445 citation statements)

References 17 publications

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“…Treatment with LEN is a recommended therapy for unresectable HCC, according to the clinical guidelines for HCC in the United States, Europe, and Japan [3,5,6,32]. In our study, the MST was 17.6 months in patients with HCC treated with LEN.…”

Section: Discussionmentioning

confidence: 52%

Controlling Nutritional Status (CONUT) Score is Associated with Overall Survival in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib: A Multicenter Cohort Study

et al. 2020

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We aimed to investigate the impact of the controlling nutritional status (CONUT) score, an immuno-nutritional biomarker, on the prognosis of patients with hepatocellular carcinoma (HCC) treated with lenvatinib (LEN). This retrospective study enrolled 164 patients with HCC and treated with LEN (median age 73 years, Barcelona Clinic Liver Cancer (BCLC) stage B/C 93/71). Factors associated with overall survival (OS) were evaluated using multivariate and decision tree analyses. OS was calculated using the Kaplan–Meier method and analyzed using the log–rank test. Independent factors for OS were albumin–bilirubin grade 1, BCLC stage B, and CONUT score <5 (hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.58–5.31, p < 0.001). The CONUT score was the most important variable for OS, with OS rates of 70.0% and 29.0% in the low and high CONUT groups, respectively. Additionally, the median survival time was longer in the low CONUT group than in the high CONUT group (median survival time not reached vs. 11.3 months, p < 0.001). The CONUT score was the most important prognostic variable, rather than albumin–bilirubin grade and BCLC stage, in patients with HCC treated with LEN. Accordingly, immuno-nutritional status may be an important factor in the management of patients with HCC treated with LEN.

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Section: Discussionmentioning

confidence: 52%

Controlling Nutritional Status (CONUT) Score is Associated with Overall Survival in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib: A Multicenter Cohort Study

et al. 2020

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“…HCC was screened using imaging modalities such as abdominal ultrasonography, computed tomography, and/or magnetic resonance imaging. When HCC was diagnosed, all patients were treated, whenever possible, according to the practical guidelines for HCC [15].…”

Section: Clinical Care and Follow-upmentioning

confidence: 99%

Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

Hanai

Shiraki

Imai

et al. 2020

JCM

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The clinical efficacy of a late evening snack (LES) is well documented in patients with cirrhosis, but its effect on survival remains unclear. This cohort study aimed to compare the overall survival between LES-treated patients and untreated patients. We conducted a retrospective cohort study to determine the effect of LES, which is defined as an oral intake of a branched-chain amino acids (BCAA)-enriched nutrient before bedtime, on survival in 523 patients with cirrhosis seen at a tertiary referral center in Japan from March 2004 to April 2019. The association between LES and all-cause mortality was evaluated using propensity score matching and inverse probability of treatment weighting analyses. The median age of the 523 participants was 66 years; 286 (55%) patients were men and 87 (17%) received LES therapy. Of the 231 propensity-matched patients, 20 (26%) LES-treated patients and 72 (47%) untreated patients died during a median follow-up of 2.0 years (interquartile range, 0.5–4.8). Propensity score matching analysis showed that the overall survival was significantly higher in LES-treated patients than in untreated patients (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34–0.93). The survival benefit of LES therapy was most prominent in patients with Child–Pugh C cirrhosis (HR, 0.40; 95% CI, 0.20–0.81). Inverse probability of treatment weighting analysis also revealed that LES significantly improved the prognosis of patients with cirrhosis (HR, 0.57; 95% CI, 0.33–0.99). In this retrospective study of patients with cirrhosis, we found that nocturnal BCAA supplementation was associated with a significant reduction in the risk of death in patients with liver cirrhosis.

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“…In addition, systemic therapy was also recommended for intermediate‐stage HCC patients for whom TACE showed a poor response due to its higher tumor burden or for patients who met the TACE failure/refractoriness proposed by the Japan Society of Hepatology and the Liver Cancer Study Group of Japan . According to the fourth version of the Japan Society of Hepatology HCC Guidelines, systemic therapy is recommended as first‐line treatment for patients with extrahepatic spread (EHS) or macroscopic vascular invasion (MVI) . It is also recommended as second‐line treatment for patients with four or more tumors in the liver without both EHS and MVI .…”

Section: Introductionmentioning

confidence: 99%

“…According to the fourth version of the Japan Society of Hepatology HCC Guidelines, systemic therapy is recommended as first‐line treatment for patients with extrahepatic spread (EHS) or macroscopic vascular invasion (MVI) . It is also recommended as second‐line treatment for patients with four or more tumors in the liver without both EHS and MVI . Nowadays, regorafenib improves the overall survival of patients with progressive disease receiving sorafenib treatment, and ramucirumab also provides a better survival benefit in patients with serum levels of α‐fetoprotein ≥400 ng/mL who previously received sorafenib compared with placebo .…”

Section: Introductionmentioning

confidence: 99%

Analyses of objective response rate, progression‐free survival, and adverse events in hepatocellular carcinoma patients treated with lenvatinib: A multicenter retrospective study

Hatanaka

Kakizaki

Nagashima

et al. 2019

Hepatology Research

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Aim The aim of this study was to investigate the predictive factors of objective response rate (ORR) and progression‐free survival (PFS), and the correlation of albumin‐bilirubin (ALBI) grade with decreased appetite and fatigue in hepatocellular carcinoma patients treated with lenvatinib. Methods From March 2018 to December 2018, a total of 94 patients was included in this retrospective multicenter study. Results The median age of all patients was 73 years (interquartile range 66–79.3 years), and approximately 78% patients were men. The ALBI grade was 1, 2, and 3 in 27 (28.7%), 64 (68.1%), and three patients (3.2%), respectively. The Barcelona Clinic Liver Cancer stage was early, intermediate, and advanced in one (1.1%), 22 (23.4%), and 71 patients (75.5%), respectively. Best radiological response was determined to complete response, partial response, stable disease, and progressive disease in 0 (0.0%), 24 (30.4%), 38 (48.1%), and 17 patients (21.5%), respectively, giving the ORR of 30.4%. The 3‐, 6‐, and 12‐month PFS was calculated to be 78.7% (95% CI 70.3–87.1%), 46.7% (95% CI 36.1–57.3%), and 17.4% (95% CI 6.6–28.2%). Multivariate analysis showed that the Barcelona Clinic Liver Cancer intermediate stage was shown to be the only significant factor affecting the ORR (odds ratio 3.78, 95% CI 1.14–12.5, P = 0.030) and PFS (hazard ratio 0.49, 95% CI 0.26–0.94, P = 0.030). The incidence of all grades of decreased appetite and fatigue was significantly less in patients with ALBI grade 1 compared with ALBI grade 2 + 3. Conclusions The Barcelona Clinic Liver Cancer intermediate stage was the predictive factor affecting the ORR and PFS, and ALBI grade was a good predictive factor affecting the incidence of fatigue and decreased appetite.

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Clinical practice guidelines for hepatocellular carcinoma: The Japan Society of Hepatology 2017 (4th JSH‐HCC guidelines) 2019 update

Cited by 440 publications

References 17 publications

Controlling Nutritional Status (CONUT) Score is Associated with Overall Survival in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib: A Multicenter Cohort Study

Controlling Nutritional Status (CONUT) Score is Associated with Overall Survival in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib: A Multicenter Cohort Study

Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

Analyses of objective response rate, progression‐free survival, and adverse events in hepatocellular carcinoma patients treated with lenvatinib: A multicenter retrospective study

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