Predisposing Factors of Hepatocellular Carcinoma Recurrence Following Complete Remission in Response to Transarterial Chemoembolization

Jin, Young–Joo; Chung, Young–Hwa; Kim, Jeong‐A; Park, Wonhyung; Lee, Don; Shim, Ju Hyun; Lee, Danbi; Kim, Kang Mo; Lim, Young‐Suk; Lee, Han Chu; Lee, Yung Sang; Kim, Pyo Nyun; Sung, Kyu Bo

doi:10.1007/s10620-013-2562-8

Cited by 30 publications

(23 citation statements)

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“…The fi ndings of the present study demonstrated an inverse association between tumor number and DFS time following initial TACE. Consistent with the present study, several previous studies have identified tumor number as a predictor of intrahepatic recurrence following initial TACE for HCC (27)(28)(29)(30)(31). Recurrence following initial remission by TACE has been more often reported in patients with multinodular-type HCC and with portal vein thrombosis (32).…”

Section: Discussionsupporting

confidence: 90%

“…The distribution of lipiodol uptake determined by tumor differentiation and the blood vessel network have been shown to affect the local recurrence rate and long-term outcome in patients with HCC (37,38). Furthermore, consistent with the present study, a previous study showed that local recurrence developed more frequently in patients with early recurrence (≤1 year) compared with those with late recurrence (>1 year) (27). These results indicated that early recurrence is associated with local recurrence arising from limitations of the radiological evaluation of tumor response, and remnant tumors can develop and be recognizable by imaging modalities over time.…”

Section: Discussionsupporting

confidence: 90%

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Predisposing factors for hepatocellular carcinoma recurrence following initial remission after transcatheter arterial chemoembolization

et al. 2017

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Abstract. Hepatocellular carcinoma (HCC) is prone to recurrence following curative treatment. The purpose of the present study was to identify the predisposing factors of HCC recurrence following complete remission achieved by transarterial chemoembolization (TACE). A retrospective cohort study of 70 consecutive patients with HCC who underwent TACE as the initial treatment was conducted. The patients were divided into two groups according to their 1-year disease-free survival (DFS) status; the early recurrence group (ER group; n=32), with HCC recurring within 1 year of initial TACE; and the non-early recurrence group (NER group; n=38), who did not experience recurrence within 1 year. The parameters identified as significantly associated with DFS time on univariate analysis were aspartate aminotransferase (AST), alanine aminotransferase and α-fetoprotein levels, as well as the tumor number (P=0.003, P=0.027, P=0.002 and P=0.005, respectively). Multivariate analysis revealed that AST levels and tumor number were significantly associated with a shorter DFS period (P=0.009 and P=0.038, respectively). The Mantel-Haenszel test revealed a significant trend of decreasing DFS with increasing tumor number. Among the patients with HCC in the ER group, locoregional recurrence occurred more frequently in those who received TACE alone compared with those treated with TACE combined with radiofrequency ablation treatment. In summary, multinodularity of HCC is the most potent predictive factor for the recurrence of HCC within 1 year of initial TACE.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Predisposing factors for hepatocellular carcinoma recurrence following initial remission after transcatheter arterial chemoembolization

et al. 2017

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“…Out of 32 patients without recurrence after CR, all except 1 survived during the follow up period (1 died of hepatic failure about 19 months after CR); in contrast, 1, 2 and 3 year survival rates of those with recurrence were 97%, 82% and 67%, respectively. (p = 0.003) In another study, recurred HCC was found in 169 patients (77%) out of 220 consecutive HCC patients who had achieved CR by TACE followed for a median period of 72 months (12). Thus, the recurrences of HCC are very common even after the achievement of CR by TACE, and the recurrences of HCC are closely associated with shorter survival periods compared with patients without recurrence after CR by TACE.…”

Section: Tcs22-02mentioning

confidence: 95%

“…In our recent study, among the recurred 169 HCCs, 91 (54%) were found adjacent to the primary sites which were considered as being controlled well by TACE; 61 (36%) at the other site separated from original tumors, 17 (10%) both. Early recurrences were found in 45 cases out of 169 patients (27%; local recurrences/Secondary tumors/ both = 28/13/4); late recurrence in the remaining 124 cases (73%; local recurrences/secondary tumors/both = 63/48/13) (12). Compared with those with radiofrequency ablation (RFA), HCC patients treated with TACE present local recurrences more frequently in cases who achieved CR.…”

Section: Tcs22-02mentioning

confidence: 98%

“…The administration of of neuropeptide Y elicited an increase in splanchnic resistance and thereby decreased portal pressure (11). Also, the inhibition of the vasodilative urotensin II receptor increased spanchnic vascular resistance and decreased portal pressure in cirrhotic animals, and could restore the Rho-kinase activity in the splanchnic vasculature (12). …”

Section: University Of Bonnmentioning

confidence: 99%

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The 22nd Conference of the Asian Pacific Association for the Study of the Liver

2012

Hepatol Int

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Acute esophageal variceal hemorrhage is a dreadful complication of portal hypertension. With the advancement of treatment, the mortality has decreased to around 20%. This could be ascribed to use of prophylactic antibiotics, use of vasoconstrictors prior to endoscopy and endoscopic modality evolved from endoscopic injection sclerotherapy (EIS) to endoscopic variceal ligation (EVL). Vasoconstrictors have been shown to be able to control approximately 80% of bleeding episodes, are generally used as a first line therapy. The use of vasoconstrictors has been demonstrated to reduce the incidence of active variceal bleeding during endoscopy and make endoscopic therapy easier to perform. Following the use of vasoconstrictor, endoscopic therapy is often employed to arrest the bleeding varices as well as preventing early rebleeding. A meta-analysis showed that the combination of vasoconstrictor and endoscopic therapy is superior to endoscopic therapy alone in the control of acute esophageal variceal hemorrhage. During endoscopic examination, active variceal bleeding is believed to account for one-third of acute esophageal variceal hemorrhage. The presence of active variceal bleeding with exanguination of fresh blood is a great challenge for endoscopists. Owing to decrease of visual field, there is technical difficulty to perform EVL under such a circumstance. The optimal method to treat these lesions is disputed. Our study showed that EVL is superior to EIS in the arresting of active variceal bleeding. On rare occasions, EIS could replace EVL as a feasible tool in the arresting of variceal hemorrhage. Early use of transjugular intrahepatic porto-systemic stent shunt (TIPS) for patients with hepatic venous pressure gradient (HVPG) [ 20 mmHG or Child-Pugh's class B or C with active bleeding has been proven to improve survival in a European study. The use of TIPS is not popular in the Asia-Pacific region. Approximately 60% of patients achieving hemostasis may encounter variceal rebleeding if esophageal varices were left untreated. Combination of EVL and beta blockers has been documented to be the therapy of choice to prevent variceal rebeeding. If a patient could be proven to be a responder to beta blockers as shown by measurement of HVPG, repeated endoscopic therapy may be obviated. Meta-analysis did not favor the combination of EVL and EIS to prevent variceal rebleeding. TIPS may be indicated for endoscopic and pharmacological therapy failure cases. It is well established that individuals with high risk esophageal varices which has never bled should receive primary prophylaxis. Either beta blockers or EVL could be employed to prevent first variceal bleeding. Currently, studies with the combination of beta blockers and EVL do not show enhanced efficacy in the prophylaxis of first bleeding. Endoscopic obturation with histoacryl is highly effective in the arresting of acute gastric variceal bleeding as well as in the prevention of variceal rebleeding. Histoacryl injection is more effective than EVL in prevention of gastric va...

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Survival in Patients With Recurrent Intermediate-Stage Hepatocellular Carcinoma

Fan,

Zhu,

Chen

et al. 2024

JAMA Oncol

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ImportanceTransarterial chemoembolization (TACE) is commonly used to treat patients with recurrent intermediate-stage hepatocellular carcinoma (HCC) and positive microvascular invasion (MVI); however, TACE alone has demonstrated unsatisfactory survival benefits. A previous retrospective study suggested that TACE plus sorafenib (SOR-TACE) may be a better therapeutic option compared with TACE alone.ObjectiveTo investigate the clinical outcomes of SOR-TACE vs TACE alone for patients with recurrent intermediate-stage HCC after R0 hepatectomy with positive MVI.Design, Setting, and ParticipantsIn this phase 3, open-label, multicenter randomized clinical trial, patients with recurrent intermediate-stage HCC and positive MVI were randomly assigned in a 1:1 ratio via a computerized minimization technique to either SOR-TACE treatment or TACE alone. This trial was conducted at 5 hospitals in China, and enrolled patients from October 2019 to December 2021, with a follow-up period of 24 months. Data were analyzed from June 2023 to September 2023.InterventionsRandomization to on-demand TACE (conventional TACE: doxorubicin, 50 mg, mixed with lipiodol and gelatin sponge particles [diameter: 150-350 μm]; drug-eluting bead TACE: doxorubicin, 75 mg, mixed with drug-eluting particles [diameter: 100-300 μm or 300-500 μm]) (TACE group) or sorafenib, 400 mg, twice daily plus on-demand TACE (SOR-TACE group) (conventional TACE: doxorubicin, 50 mg, mixed with lipiodol and gelatin sponge particles [diameter, 150-350 μm]; drug-eluting bead TACE: doxorubicin, 75 mg, mixed with drug-eluting particles [diameter: 100-300 μm or 300-500 μm]).Main Outcomes and MeasuresThe primary end point was overall survival by intention-to-treat analysis. Safety was assessed in patients who received at least 1 dose of study treatment.ResultsA total of 162 patients (median [range] age, 55 [28-75] years; 151 males [93.2%]), were randomly assigned to be treated with either SOR-TACE (n = 81) or TACE alone (n = 81). The median overall survival was significantly longer in the SOR-TACE group than in the TACE group (22.2 months vs 15.1 months; hazard ratio [HR], 0.55; P &lt; .001). SOR-TACE also prolonged progression-free survival (16.2 months vs 11.8 months; HR, 0.54; P &lt; .001), and improved the objective response rate when compared with TACE alone based on the modified Response Evaluation Criteria in Solid Tumors criteria (80.2% vs 58.0%; P = .002). Any grade adverse events were more common in the SOR-TACE group, but all adverse events responded well to treatment. No unexpected adverse events or treatment-related deaths occurred in this study.Conclusions and RelevanceThe results of this randomized clinical trial demonstrated that SOR-TACE achieved better clinical outcomes than TACE alone. These findings suggest that combined treatment should be used for patients with recurrent intermediate-stage HCC after R0 hepatectomy with positive MVI.Trial RegistrationClinicalTrials.gov Identifier: NCT04103398

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Predisposing Factors of Hepatocellular Carcinoma Recurrence Following Complete Remission in Response to Transarterial Chemoembolization

Abstract: Early recurrences following CR by TACE may be due mainly to undetectable remaining tumors, whereas late recurrences may be caused by newly appearing tumors in patients with a background of advanced cirrhotic liver.

Cited by 30 publications

References 26 publications

Predisposing factors for hepatocellular carcinoma recurrence following initial remission after transcatheter arterial chemoembolization

Predisposing factors for hepatocellular carcinoma recurrence following initial remission after transcatheter arterial chemoembolization

The 22nd Conference of the Asian Pacific Association for the Study of the Liver

Survival in Patients With Recurrent Intermediate-Stage Hepatocellular Carcinoma

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