Initial response to percutaneous ablation predicts survival in patients with hepatocellular carcinoma

Sala, María; Llovet, Josep M.; Vilana, R.; Bianchi, L.; Solé, Manel; Ayuso, Carmen; Brú, Concepció; Bruix, Jordi

doi:10.1002/hep.20465

Cited by 419 publications

(333 citation statements)

References 36 publications

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“…Although this may have increased the number of treatment sessions, complete ablation is possibly associated with improved prognosis. 36 While there was no difference in early complication rates according to tumor location, the overall early complication rate of 4.2% in this study may be slightly higher than those reported in other studies. 21,37 The effort of thorough ablation increased the total number of electrode insertions, and this may have led to an increase in complications.…”

Section: Discussioncontrasting

confidence: 76%

Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations

et al. 2006

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We evaluated the efficacy and safety of radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) in presumably high-risk locations. Between February 1999 and December 2001, we performed RF ablation on 1,419 nodules in 636 consecutive HCC patients, of which 231 nodules in 207 patients were in high-risk locations, defined as less than 5 mm from a large vessel or an extrahepatic organ. Eighty-one patients had a nodule adjacent to a large vessel, 145 patients had a nodule adjacent to an extrahepatic organ, of whom 19 also had one adjacent to a large vessel. Early complications and local tumor progression were analyzed with regard to the location of each nodule. The mean nodule diameter and average number per patient were 27 mm and 2.3, respectively. Early complications, within 30 days after ablation, occurred in 12 of 207 patients (5.8 %) with a nodule in a high-risk location and in 15 of 429 patients (3.5 %) without (P ‫؍‬ .1776). There was no significant difference in local tumor progression rate between nodules in high-risk locations (1 year: 2.1%, 2 years: 3.1%, 3 years: 3.1%) and those elsewhere (1 year: 0.6%, 2 years: 1.7%, 3 years: 2.5%) (P ‫؍‬ .2745). In conclusion, HCC nodules adjacent to a large vessel or extrahepatic organ were treated with RF ablation without compromising the efficacy of the procedure. However, even though without significant difference, some complications occurred at risky locations and need to be carefully considered.

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Section: Discussioncontrasting

confidence: 76%

Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations

et al. 2006

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“…This therapeutic option is more commonly used in oriental countries. PEI achieves complete tumor necrosis in 90% of tumors < 2 cm, 70% in those of 2 cm -3 cm and 50% in those between 3 cm and 5 cm [44,61,62] . The fact that its action may be blocked either by the intra-tumoral fibrotic septa or the tumor capsule, undermines the curative capacity of this technique, particularly in tumors larger than 2 cm [1] .…”

Section: Percutaneous Ethanol Injectionmentioning

confidence: 95%

Hepatocellular carcinoma treatment strategies – a case-based review

Alves

Gomes

Macedo

et al. 2015

JST

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Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide and one of the fastest growing causes of cancer-related mortality, being mostly diagnosed in patients with cirrhosis. Despite the recent efforts regarding an earlier diagnosis, the majority of patients are at advanced stages at first presentation, when the potential for institution of curative strategies is scarce. This tumor is remarkable because it occurs mostly superimposed on chronic liver diseases, which entails the need to take special attention to liver function preservation and hepatotoxicity prevention when choosing a specific therapy. Major changes had occurred in the management of HCC in the last decade. The decision-making process must be based on an accurate staging of the patient, using the Barcelona Clinic Liver Cancer (BCLC) staging system, updated knowledge of the new therapeutic options, their contraindications and the potential local or systemic complications. The authors start from 4 clinical different scenarios, in order to objectively discuss the therapeutic options available and the decision-making-process based on the staging system.

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“…Similarly, although some tumoral markers (mainly AFP), have shown an indisputable prognostic power (60)(61)(62)(63)(64), there is no consensus in terms of determining a pathological cutoff value, and these markers do not have enough strength to evaluate patients in an individual way and in most clinical scenarios, they do not induce a change in therapeutic approach (7). Therefore, one of the current challenges in clinical research is to try to integrate gene expression data in the current evaluation systems and basing the survival prediction and treatment indication in the molecular profile of the patient.…”

Section: Refining Prognostic Assessment and Therapeutic Decisionmentioning

confidence: 99%

New challenges in clinical research on hepatocellular carcinoma

Díaz-González¹,

Forner²,

C³

et al. 2015

Rev Esp Enferm Dig

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This is an updated review of screening, early diagnosis and treatment of hepatocellular carcinoma, focusing on the advancements occurred in the last years and highlighting the challenges in clinical research.Hepatocellular carcinoma (HCC) is nowadays the sixth most frequent cancer worldwide with up to 740,000 new cases diagnosed each year, and it is the third most prevalent cause of cancer-relateddeath worldwide (1). This neoplasm usually appears linked to an underlying liver disease, being one of the most relevant causes of death in patients diagnosed of liver cirrhosis (2,3). In the last years, important advancements in terms of diagnosis, staging and treatment of HCC, improving the management and outcome of the disease, have been made (4-7). Despite the fact that these improvements have absolutely changed natural history of HCC, there are several areas that still need further advancements.The aim of this document is to discuss some controversial aspects, which in our opinion constitute real challenges in clinical research of HCC.Key words: Hepatocellular carcinoma. Hepatic oncology. Sorafenib. Transarterial chemoembolization. AFP. IMPROVING EARLY DIAGNOSISFrom the basis that the only possibility to offer and apply treatments with curative intention is being able to diagnose HCC at early stages, when there are not cancer related symptoms. Since this option is only feasible if screening is performed in population at risk, scientific guidelines recommend performing abdominal ultrasonography (US) in every patient with liver cirrhosis. Despite the recommendation of HCC screening by the Spanish guidelines (4), one registry study performed in Spain which included 62 centers and 705 patients diagnosed of HCC within a period of time of 4 months showed that just 47% of HCC patients were diagnosed in the setting of surveillance and less than a half were diagnosed at early stage (8).This data shows that early diagnosis, a key issue to be able to significantly reduce HCC-related mortality, is one of the most relevant issues that deserve further efforts from scientific community. Aiming to evaluate which were the causes of screening program fail in the United States of America, Singal et al. evaluated 1,005 patients included in the HALT-C prospective study. A third part of patients did not adhere to an adequate screening program and, in 70% of cases that were diagnosed at an advanced stage, the main reason was the absence of detection in US (9).With the aim of improving detection rate, it is crucial to establish formative programs in order to certify the capability of being able to carry on this activity and it is necessary to use up-to-date ultrasonography scans in order to perform an optimal liver exploration. Tumor markers could be a useful tool to overcome theoretical limitations of US: its evaluation is not subjective, does not depend on the operator and it may be reproducible, as well as it is relatively cheap and a tool easy to access in areas with low monetary income. Regrettably, different tumor markers ev...

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Initial response to percutaneous ablation predicts survival in patients with hepatocellular carcinoma

Cited by 419 publications

References 36 publications

Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations

Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations

Hepatocellular carcinoma treatment strategies – a case-based review

New challenges in clinical research on hepatocellular carcinoma

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