Postoperative prediction of and strategy for metastatic recurrent hepatocellular carcinoma according to histologic activity of hepatitis

Ueno, Satoko; Tanabe, Gen; Yoshida, Aichi; Yoshidome, Shinrou; Takao, Sonshin; Aikou, Takashi

doi:10.1002/(sici)1097-0142(19990715)86:2<248::aid-cncr8>3.3.co;2-t

Cited by 16 publications

(35 citation statements)

References 13 publications

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“…It also must be noted that the histologic status of the noncancerous regions of the liver influence tumor recurrence, especially secondary growths of HCC. 30,[33][34][35] Interestingly, 2 recent articles dealing with the prognosis of patients with HCC have been correlated with physical parameters such as performance status and the presence or absence of symptoms. 36,37 However, we did not compare those classifications in this study, because the physical parameters would have been difficult to determine and organize retrospectively.…”

Section: Discussionmentioning

confidence: 99%

Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients

2001

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To reliably estimate the prognoses of patients with hepatocellular carcinoma (HCC), both liver function and tumorrelated factors should be accounted for. However, there are few worldwide staging systems that assess prognostic value in the context of selecting individual patients for randomized stratification in therapeutic and clinical trials. We investigated the value of known prognostic systems and verified the usefulness of the new scoring system proposed by the Cancer of the Liver Italian Program (CLIP), as determined from 662 Japanese patients. A retrospective analysis of the HCC diagnoses at 4 Japanese institutions from 1990 and 1998 was performed. Overall survival was the only end point used in the analysis. Discriminatory ability and predictive power of the CLIP score were compared with those of Okuda stage and AJCC TNM stage. Compared with the Okuda and AJCC staging systems, the CLIP score's enhanced discriminatory capacity, which was tested by the linear trend test and Harrels' c-index, revealed a class of patients with an impressively more favorable prognosis and another class with a relatively shorter life expectancy. Moreover, the likelihood ratio test showed that the CLIP score had additional homogeneity of survival within each score above that of the Okuda stage or the AJCC stage. This was true for 3 subgroups of patients who received surgery, transcatheter arterial chemoembolizations, and percutaneous ethanol injections. Collectively, these findings indicate that the CLIP score has the highest stratification ability with regard to prognosis in patients with HCC. The CLIP score could be used internationally to stratify randomization groups in therapeutic and clinical trials. (HEPATOLOGY 2001; 34:529-534.) Hepatocellular carcinoma (HCC) is a relatively common malignant tumor worldwide, accounting for almost one million deaths annually. In the past 2 decades, some newly developed therapeutic options have been applied with varying degrees of success (i.e., liver resection and transplantation, transcatheter arterial chemoembolization [TACE], and percutaneous ethanol injection [PEI]). To reliably estimate the prognoses of patients with HCC, both liver function and tumor-related factors should be accounted for 1-3 ; however, there are few data collection systems that include both. 4 In fact, the well-known UICC and AJCC staging (TNM) criteria do not define the relative prognostic weight of variables, in terms of residual liver function. 5 Although several studies have examined predictive factors for prognosis in relation to treatment, 1,6-16 most of these have been performed in Asian institutions. Accordingly, these facilities and patient populations possess early detection plans, risk factors for primary liver cancer, a high proportion of expanding tumors, and differing rates of resectability, respectively, with regard to those in Western countries. 2,9,12

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Section: Discussionmentioning

confidence: 99%

Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients

2001

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“…Some liver functional markers, such as alanine transaminase (ALT), gamma-glutamyl transpeptidase (GGT), serum albumin level, the preoperative indocyanine green (ICG) retention value at 15 minutes after injection, particularly the Child-Pugh classification, are important predictive markers for DFS of HCC patients [23][24][25] . According to the scoring of hepatitis activity index (HAI), the histologic activity of hepatitis was closely related to the HCC recurrence, the HCC patients with middle hepatitis activity (HAI score of 6-9) in the non-tumor liver tissue had a higher 2-year intrahepatic recurrent rate [26] . Recurrence hardly could be avoided in the patients with liver dysfunction [27,28] .…”

Section: Co-existing Hepatitis Status and Liver Cirrhosismentioning

confidence: 99%

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

Qin¹,

Tang²

2002

WJG

159

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The prognosis of patients with HCC still remains dismal. The life expectancy of HCC patients is hard to predict because of the high possibility of postoperative recurrence. Many factors, s u c h a s p a t i e n t ' s g e n e r a l c o n d i t i o n s , macroscopic tumor morphology, as well as tumor hitopathology features, have been proven of prognostic significance. Female HCC patient often has a better prognosis than male patient, which might be due to the receptor of sex hormones. Younger patients often have tumors with higher invasiveness and metastatic potentials, and their survival and prognosis are w o r s e t h a n t h e o l d e r o n e s . C o -e x i s t i n g hepatitis status and hepatic functional reserve h a v e b e e n c o n f i r m e d a s r i s k f a c t o r s f o r recurrence. Serum alpha-fetoprotein (AFP) is useful not only for diagnosis, but also as a prognostic indicator for HCC patients. AFP mRNA has been proposed as a predictive marker of HCC cells disseminated into the circulation and for metastatic recurrence. Many pathologic features, such as tumor size, number, capsule state, cell differentiation, venous invasion, intrahepatic spreading, and a d v a n c e d p T N M s t a g e , a r e t h e b e s testablished risk factors for recurrence and important aspects affecting the prognosis of patients with HCC. Marked inflammatory cell infiltration in the tumor could predict a better prognosis. Clinical stage is still the most important factor influencing on the prognosis. E x t r a t u m o r s p r e a d i n g a n d l y m p h n o d a l metastasis are independent predictors for poor outcome. Some new predictive systems h a v e r e c e n t l y b e e n p r o p o s e d . D i f f e r e n t strategies of treatment might have significant different effects on the patients' prognosis. To date, surgical resection is still the only p o t e n t i a l l y c u r a t i v e t r e a t m e n t f o r H C C , including localized postoperative recurrences. Extent of resection, blood transfusion, occlusion of porta hepatis, and blood loss affect the survival and prognosis of HCC patients. Regional therapies provide alternative ways to improve the prognosis of HCC patients who have no opportunity to receive surgical treatment or postoperative recurrence. The combination of these treatment modalities is hopeful to further improve the prognosis. The efficacies of neoadjuvant (preoperative) or adjuvant (postoperative) chemotherapy or chemoembolization in preventing recurrence and on the HCC prognosis still remain great controversy, and deserves further evaluation. Biotherapy, including IFN-alpha therapy, will play more important role in preventing recurrence and metastasis of HCC after operation.Qin LX,Tang ZY.The prognostic significance of clinical and pathological features in hepatocellular carcinoma.

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“…15 Zendejas-Ruiz and associates, in their study of 53 patients, showed that HAI > 4 at 4 49 months was significantly associated with HCC recurrence, but they did not study the effects of rate of fibrosis on HCC recurrence. 16 Kubo and associates suggested that HAI > 4 was significantly associated with HCC recurrence after resection.…”

Section: Resultsmentioning

confidence: 99%

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2015

Exp Clin Transplant

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Postoperative prediction of and strategy for metastatic recurrent hepatocellular carcinoma according to histologic activity of hepatitis

Cited by 16 publications

References 13 publications

Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients

Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

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