Liver resection for hepatocellular carcinoma in 313 Western patients: Tumor biology and underlying liver rather than tumor size drive prognosis

Kluger, Michael D.; Salceda, Juan; Laurent, Alexis; Tayar, Claude; Duvoux, Christophe; Decaens, Thomas; Luciani, Alain; Nhieu, Jeanne Tran Van; Azoulay, Daniel; Cherqui, Daniel

doi:10.1016/j.jhep.2014.12.018

Cited by 104 publications

(87 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although these results were in the lower range of 5-year OS reported after resection of HCC > 5 cm: 34% [14] and 33.8% [15], it must be pointed out that in our patients resection was contraindicated mainly because of too advanced cirrhosis and/ or insufficient general condition. For instance, in comparison with western HCC patients resected by Kluger et al [14], in our study twice more had cirrhosis, and their median age was 10 years older. That emphasized the main advantages of mbp-RFA over resection in the setting of cirrhosis by offering a curative option in a larger number of less selected patients.…”

Section: Discussioncontrasting

confidence: 71%

Multibipolar Radiofrequency Ablation for the Treatment of Mass-Forming and Infiltrative Hepatocellular Carcinomas > 5 cm: Long-Term Results

et al. 2018

View full text Add to dashboard Cite

Aims and Background: Only few patients with cirrhosis and hepatocellular carcinoma (HCC) larger than 5 cm are amenable to resection or straight liver transplantation, and in such circumstances, multibipolar radiofrequency ablation (mbp-RFA) could be a reliable alternative. This study was aimed to assess the long-term outcome in patients treated with mbp-RFA for unresectable HCC > 5 cm. Methods: Eighty-three consecutive patients with cirrhosis (median age 70 years [37–93 years], 67 males, BCLC A/B/C: 54/21/8, 74 naive) with up to three HCCs, the largest > 5 cm in diameter (median: 6.2 cm, 5.1–9 cm, 22 infiltrative forms, 12 with segmental portal invasion of which 10 were infiltrative forms) were treated with mbp-RFA. Overall (OS) and recurrence-free (RFS) survival and their associated predictive factors were assessed. Results: Complete ablation was observed in 78/83 (94%) patients. Thirty-one side effects occurred, including 6 (7%) severe complications. After a median follow-up of 26.1 months (1–112 months), in naive patients the 3- and 5-year OS was 51% (38–62) and 24% (13–36), 63 and 30% for mass-forming and 25 and 6% for infiltrative form, respectively. Infiltrative form (HR: 2.5 [1.33–4.69], p = 0.004) was the only independent OS predictor. In naive patients with mass-forming and infiltrative form, the 3- and 5-year RFS were 47 and 17 and 18 and 18%, respectively. Alpha-fetoprotein (HR: 2.86 [1.32–6.21], p = 0.008), multinodular form (HR: 2.74 [1.4–5.38], p = 0.003) and infiltrative form (HR: 3.43 [1.67–7.01], p = 0.0007) were independent RFS predictors. Conclusions: mbp-RFA offers good OS in inoperable patients with cirrhosis and large HCC, with acceptable safety profile. For infiltrative forms, although mbp-RFA leads to complete responses in more than 80% cases, few only remain tumor progression-free in long-term.

show abstract

Section: Discussioncontrasting

confidence: 71%

Multibipolar Radiofrequency Ablation for the Treatment of Mass-Forming and Infiltrative Hepatocellular Carcinomas > 5 cm: Long-Term Results

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Microvascular invasion (MVI) is an important determinant for HCC recurrence and prognosis [26, 36]. However, MVI could not be diagnosed before liver resection or transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…This concept was based on several studies which showed that tumor size was not an independent risk factor for long-term survival and tumor recurrence after curative resection of single HCC. Instead, tumor biology and underlying liver disease were better prognostic factors than tumor size [36]. …”

Section: Discussionmentioning

confidence: 99%

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

Fang

Kao

et al. 2018

Liver Cancer

View full text Add to dashboard Cite

Background/Aims: Whether single large hepatocellular carcinoma (SLHCC) is classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B is still controversial. We aimed to compare the clinical manifestations, treatment modalities, and prognoses among patients with SLHCC and those in BCLC stage A and B. Methods: We enrolled 2,285 treatment-naive hepatocellular carcinoma (HCC) patients with BCLC stage A or B from October 2007 to December 2015. Factors in terms of prognoses were analyzed by multivariate analysis. Results: We enrolled 1,210, 466, and 609 patients in a BCLC-A, SLHCC, and BCLC-B group, respectively. After a median follow-up duration of 21.2 months, 898 patients had died. The cumulative 5-year survival rates were 57.0, 42.6, and 27.3% for patients in the BCLC-A, SLHCC, and BCLC-B groups, respectively, which were significantly different (p < 0.001). Multivariate analysis indicated that the following independent risk factors were associated with poor prognosis: age > 65 years, alkaline phosphatase > 100 U/L, creatinine > 1.0 mg/dL, alpha-fetoprotein > 20 mg/mL, noncurative treatment, albumin-bilirubin (ALBI) grade, and HCC staging. Subgroup analysis also confirmed that patients in the SLHCC group had a survival rate intermediate to those in the BCLC-A and BCLC-B groups. However, for patients in the SLHCC group and with ALBI grade 1, outcomes were close to those in the BCLC-A group, especially in the setting of curative treatment. For those with ALBI grades 2 or 3, the prognoses were similar to those of the SLHCC and BCLC-B groups. Conclusion: Patients in the SLHCC group had an overall survival rate intermediate to those of the BCLC-A and BCLC-B groups. It is suggested that the SLHCC group could be classified as occupying a different stage from the BCLC stages A and B. The ALBI grade could help to stratify SLHCC into a different prognostic group. However, the results need to be validated externally in other regions of the world.

show abstract

“…In another study, Kluger et al concluded that tumor biology and NTLP rather than tumor size are the main prognostic factors for recurrence and survival after resection of HCC. 29 Microvascular invasion was one of the factors that negatively affected the DFS. A subgroup analysis to study the impact of mVI on outcome of each modality may be helpful, but the small patient numbers in SLT and RR group made this analysis difficult.…”

mentioning

confidence: 99%

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

Ali

Wang

et al. 2016

HPB

View full text Add to dashboard Cite

show abstract

Liver resection for hepatocellular carcinoma in 313 Western patients: Tumor biology and underlying liver rather than tumor size drive prognosis

Cited by 104 publications

References 60 publications

Multibipolar Radiofrequency Ablation for the Treatment of Mass-Forming and Infiltrative Hepatocellular Carcinomas > 5 cm: Long-Term Results

Multibipolar Radiofrequency Ablation for the Treatment of Mass-Forming and Infiltrative Hepatocellular Carcinomas > 5 cm: Long-Term Results

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

Contact Info

Product

Resources

About