Growth Rate of Locally Recurrent Hepatocellular Carcinoma After Transcatheter Arterial Chemoembolization: Comparing the Growth Rate of Locally Recurrent Tumor with That of Primary Hepatocellular Carcinoma

Abstract

We compared the growth rate of locally recurrent hepatocellular carcinoma (HCC) with that of primary HCC. After the first treatment by transcatheter arterial chemoembolization (TACE), 60 locally recurrent HCC nodules were reviewed. The tumor volume doubling time (DT) of locally recurrent HCC was significantly shorter than that of primary HCC. The 95% lower threshold value was 17.7 days. The 6-, 12-, and 36-month recurrence-free rates of the tumors having DTs more than 70 days after the second TACE (77.7%, 53.8%, and 40.4%) were significantly higher than those of the tumors having DTs less than 70 days (26.7%, 26.7%, and 17.8%). Locally recurrent HCCs cannot double in diameter in less than 53 days. In the case that an equivocal lesion smaller than the section collimation depicted during a contrast-enhanced computed tomography (CECT) screening cannot be ruled out as local recurrence, the next CECT screening should be performed 2 months later.

Hypoxia After Liver Surgery Imposes an Aggressive Cancer Stem Cell Phenotype on Residual Tumor Cells

“…Interestingly, a recent study investigated the growth speed of 60 HCC tumors before and after transarterial chemoembolization. 51,52 This procedure induces high levels of hypoxia due to the embolization spheres. 53,54 After transarterial chemoembolization, the mean tumor doubling time was significantly shorter, suggesting hypoxia-associated acceleration of tumor growth.…”

A novel prognostic factor for hepatocellular carcinoma: protein disulfide isomerase

“…Locally recurrent HCC nodules that survive hypoxic insults after transarterial chemoembolization sometimes have significantly shorter doubling times than those in neighboring nodules [17]. Moreover, HCC sometimes undergoes an infiltrating rather than a mass-forming growth pattern; these advanced infiltrative HCCs seldom show hypervascularity, grow more rapidly, and have a poorer prognosis than the mass-forming hypervascular types.…”

Prognostic implications of tumor vascularity and its relationship to cytokeratin 19 expression in patients with hepatocellular carcinoma

“…However, advanced infiltrative HCCs seldom show hypervascularity, though they are more rapidly growing than the mass-forming types [24]. In addition, we often encounter recurrent hypovascular HCCs following several sessions of TACE or other treatments and they progress rapidly resulting in a poorer outcome compared to hypervascular HCCs [25]. However, the prognostic implications of tumor vascularity in HCC remain unknown.…”