Current Treatment for Small (&lt;5 cm) Hepatocellular Carcinoma

Pugalenthi, Amudhan; Cutter, Calvin; Fong, Yuman

doi:10.1016/j.yasu.2014.05.012

Cited by 3 publications

(3 citation statements)

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“…[ 1 ] In stage I (AJCC 6 th and 7 th ) HCC, all 3 surgical methods were utilized for selected patients. However, the long-term prognosis for patients in this stage after different surgical procedures was controversial, [ 8 , 10 , 17 – 21 ] thus a comprehensive analyses is needed to illustrate the prognostic effect of these treatment methods. Using LR as a reference, we compared the long-term prognosis among SI-HCC patients after LR, LT, LTD, or none treatment.…”

Section: Discussionmentioning

confidence: 99%

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Management and survival for patients with stage-I hepatocellular carcinoma

Wu¹,

Chen²,

Ouyang³

et al. 2020

Medicine

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It is controversial regarding the treatment allocation for patients with stage I hepatocellular carcinoma (SI-HCC). The aim of the present study was to compare the long-term survival in SI-HCC patients undergoing liver transplantation (LT), liver resection (LR), local tumor destruction (LTD), or none. SI-HCC patients diagnosed between 2004 and 2015 were extracted from the SEER 18 registry database. Multivariable Cox models and propensity score matching (PSM) method were used to explore the association between surgical methods and long-term prognosis. A total of 5165 patients with stage I (AJCC, 6th or 7th) HCC were included in the study. Only 36.9% of patients diagnosed with HCC in stage I received surgical therapy. The incidence of LT was decreased over time ( P < .001). In the multivariable-adjusted cohort (n = 5165), after adjusting potential confounding factors, a clear prognostic advantage of LT was observed in OS ( P < .0001) compared with patients after LR. Patients undergoing LTD had a worse OS in comparison with patients who underwent LR ( P < .0001). Patients who received no surgical treatment had the worst OS ( P < .0001) among 4 treatment groups. In stratified analyses, the salutary effects of LT vs LR on OS were consistent across all subgroups except for a similar result in the noncirrhotic subgroup ( P = .4414). The inferior survival effects of LTD vs LR on OS were consistent across all subgroups, and even in the subgroup with tumor size < 3 cm ( P = .0342). In the PSM cohort, patients in LT group showed a better OS ( P < .001) than patients in LR group ( P < .0001) and patients undergoing LTD had a worse OS compared with patients who underwent LR ( P = .00059). In conclusion, LT offered a survival advantage compared with LR among patients with Stage I HCC. LT is the best surgical treatment for stage I HCC in patients with advanced fibrosis, whereas LR provides comparable long-term outcomes to LT in patients without advanced fibrosis and should be considered as the first-line surgical option. LTD can be used as an alternative method when LR and LT are unavailable.

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Section: Discussionmentioning

confidence: 99%

“…[ 2 – 7 ] For patients with stage-I (American Joint Committee on Cancer pathological TNM stage, 6 th or 7 th ) HCC (SI-HCC), surgical treatments, including liver resection (LR), liver transplantation (LT), and local tumor destruction (LTD) can be performed to achieve potentially curative treatments. [ 8 – 10 ]…”

Section: Introductionmentioning

confidence: 99%

Management and survival for patients with stage-I hepatocellular carcinoma

Wu¹,

Chen²,

Ouyang³

et al. 2020

Medicine

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“…Hepatocellular cancer (HCC) is the sixth most common type of cancer and the third in cancer-associated death. It has been traditionally managed by either surgical intervention [1] or by other approaches such as transcatheter arterial tumor chemoembolization, drug-eluting bead embolization and radiofrequency ablation [2], while the systemic anticancer therapy of HCC is limited to a few drugs including, doxorubicin or paclitaxel [3][4]. Their clinical efficacy however has not been verified by controlled clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Enhancement of the Cytotoxic Effect of Anticancer Agent by Cytochrome c Functionalised Hybrid Nanoparticles in Hepatocellular Cancer Cells

Malekigorji

Hoskins

Curtis

et al. 2014

jnmr

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cell death could be an ideal solution for controlling and reducing tumor volume [8]. Numerous proteins are involved in apoptosis and thus serve as both potential targets as well as therapeutic tools in cancer treatment. A crucial event during apoptosis is the release of intra-mitochondrial pro-apoptotic proteins into the cytosol, which marks the point of no return in the process [9]. One of the proteins translocated from the mitochondria to the cytosol is Cytochrome c (Cyt c), a 12.7 kDa protein that is also involved in the transport of electrons in the mitochondrial respiratory chain, shuttling electrons between respiratory complex III and IV [10]. Following an apoptotic stimuli, Cyt c released from the mitochondria facilitates the assembly of the apoptosome which comprises of apoptosis activating factor 1 (Apaf-1), pro-caspase 9 and dATP and initiates the activation of the caspase cascade [11]. This mechanism can be exploited in practice by introducing Cyt c into tumor cells which can trigger apoptosis and lead to cell death. However, the intracellular targeting of proteins exhibits significant challenges and it requires the application of specific drug delivery systems. There have previously been attempts to introduce Cyt c into cells using lipid-apolipoprotein particles [12], biodegradable chimeric polymersomes [13], mesoporous silica nanoparticles with a pore surface that undergoes charge conversion intracellularly [14], biodegradable polymersomes containing Abbreviations

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Combined Ablation and Resection (CARe) as an Effective Parenchymal Sparing Treatment for Extensive Colorectal Liver Metastases

et al. 2014

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BackgroundCombined intra-operative ablation and resection (CARe) is proposed to treat extensive colorectal liver metastases (CLM). This multicenter study was conducted to evaluate overall survival (OS), local recurrence-free survival (LRFS), hepatic recurrence-free survival (HRFS) and progression-free survival (PFS), to identify factors associated with survival, and to report complications.Materials and MethodsFour centers combined retropectively their clinical experiences regarding CLM treated by CARe. CLM characteristics, pre- and post-operative chemotherapy regimens, surgical procedures, complications and survivals were analyzed.ResultsOf the 288 patients who received CARe, 210 (73%) had synchronous and 255 (88%) had bilateral CLM. Twenty-two patients (8%) had extrahepatic disease. Median follow-up was 3.17 years (95%CI 2.83–4.08). Median OS was 3.33 years (95%CI 3.08–4.17) and 5-year OS was 37% (95%CI 29–45). One- and 5-year LRFS from ablated lesions were 87.9% (95%CI 83.3–91.2) and 78.0% (95%CI 71–83), respectively. Median HRFS and PFS were 14 months (95%CI 11–18) and 9 months (95%CI 8–11), respectively. One hundred patients experienced complications: 29 grade I, 68 grade II–III–IV, and three deaths. In the multivariate models adjusted for center, the occurrence of complications was confirmed as a major independent factor associated with 3-year OS (HR 1.80; P = 0.008). Five-year OS was 25.6% (95%CI 14.9–37.6) for patients with complications and 45% (95%CI 33.3–53.4) for patients without.ConclusionsRecent strategies facing advanced CLM include non-anatomic resections, portal-induced hypertrophy of the future remnant liver and aggressive medical preoperative treatments. CARe has the qualities of an approach that allows effective tumor clearance while maintaining good tolerance for the patient.

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Current Treatment for Small (<5 cm) Hepatocellular Carcinoma

Cited by 3 publications

References 83 publications

Management and survival for patients with stage-I hepatocellular carcinoma

Management and survival for patients with stage-I hepatocellular carcinoma

Enhancement of the Cytotoxic Effect of Anticancer Agent by Cytochrome c Functionalised Hybrid Nanoparticles in Hepatocellular Cancer Cells

Combined Ablation and Resection (CARe) as an Effective Parenchymal Sparing Treatment for Extensive Colorectal Liver Metastases

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