Prognostic factors for survival in patients with compensated cirrhosis and small hepatocellular carcinoma after percutaneous ethanol injection therapy

Pompili, Maurizio; Rapaccini, Gian Ludovico; Covino, Marcello; Pignataro, Giulia; Caturelli, Eugenio; Siena, D.; Villani, M; Cedrone, A; Gasbarrini, Giovanni

doi:10.1002/1097-0142(20010701)92:1<126::aid-cncr1300>3.0.co;2-v

Cited by 78 publications

(41 citation statements)

References 109 publications

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“…As mentioned earlier, the other factor was a platelet count of <100 Â 10 9 /L. Thrombocytopenia, indicating advanced liver cancer, has been reported to be a poor prognostic factor of curative treatments, such as resection (29), radiofrequency ablation (30), and percutaneous ethanol injection therapy (31). Besides the HCC itself, hepatic failure is another major cause of death among HCC patients.…”

Section: Discussionmentioning

confidence: 92%

Community-Based Mass Ultrasonographic Screening of Hepatocellular Carcinoma among Thrombocytopenic Adults

Wang

Chen

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Thrombocytopenia has been reported as a valid surrogate for liver cirrhosis and could be used to identify groups at high risk of hepatocellular carcinoma (HCC) for ultrasonographic (US) screening. We designed this two-stage community-based screening for HCC. In 2004, subjects (ages z40 years) were invited to undergo comprehensive health examinations, with 17,551 men (ages 63.0 F 11.5 years) and 39,151 women (ages 59.9 F 11.7 years) participating. Subjects with platelet counts <150 Â 10 9 /L or A-fetoprotein (AFP) >20 ng/mL were enrolled for the second-stage US screening; 3,242 subjects (5.7%; male/ female, 1,415/1,827; age 66 F 10 years) were candidates for US screening and 2,983 (92.2%) responded. Of 137 suspected cases, 124 (90.5%) complied with referral for confirmation and 72 (58.1%) were confirmed to be HCC cases (male/female, 41/31; age 68.1 F 8.8 years). Screening with AFP, thrombocytopenia, or both could identify 0.64% (n = 364), 5.33% (n = 3,205), and 5.7% (n = 3,242) of the high-risk subjects from the population, estimated to include 50.5%, 54.5%, and 71.3% of all HCC cases. Among confirmed patients, tumor diameters were <3 cm for the 27 (37.5%) patients and 3 to 5 cm for the 23 (31.9%) patients. Only 5 (6.9%) patients' conditions were too advanced to be actively treated. This study enrolled only 5.7% of the participants for US, which cover 64.7% to 71.3% of the HCC cases. Most (93%) of the detected cases were caught early enough to undergo effective treatment modalities. This HCC screening protocol should be feasible, economical, and effective. (Cancer Epidemiol Biomarkers Prev 2008;17(7):1813 -21)

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Section: Discussionmentioning

confidence: 92%

Community-Based Mass Ultrasonographic Screening of Hepatocellular Carcinoma among Thrombocytopenic Adults

Wang

Chen

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…It has been reported that thrombocytopenia is a poor prognostic factor of achieving curative treatment, such as resection, 38 radiofrequency ablation, 39 and percutaneous ethanol injection, 40 although there are differing opinions. 41 However, 19 detected tumors (76%) measured 5 cm in the current study and were detected early enough to allow the patients receive curative treatment.…”

Section: Discussionmentioning

confidence: 99%

Thrombocytopenia as a surrogate for cirrhosis and a marker for the identification of patients at high‐risk for hepatocellular carcinoma

Wang

Liu

et al. 2006

Cancer

148

136

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BACKGROUND.The objective of this study was to examine the usefulness of platelet counts in the diagnosis of cirrhosis and for identifying high‐risk individuals in a community‐based hepatocellular carcinoma (HCC) screening program.METHODS.Pilot Study 1 determined the correlation between platelet counts and pathologic hepatic fibrosis scores among individuals with chronic hepatitis B virus (HBV) infection (n = 122 patients) and hepatitis C virus (HCV) infection (n = 244 patients). Pilot Study 2 investigated proportions of individuals with thrombocytopenia (<150 × 103/mm3) among patients with HCC (n = 4042 patients). Pilot Study 3 demonstrated the correlation between platelet counts and ultrasonographic (US) parenchyma scores among anti‐HCV‐positive individuals (n = 75 patients). The core study was a 2‐stage, community‐based screening for HCC among residents age 40 years or older in townships with a high prevalence of anti‐HCV (n = 4616 individuals) and in townships with a low prevalence of anti‐HCV (n = 1694 individuals). Patients with thrombocytopenia were identified for US and α‐fetoprotein screening.RESULTS.Among the individuals who were positive for anti‐HCV, platelet counts decreased according to increased pathologic fibrosis scores or US scores for liver parenchyma disease: The best cutoff platelet count was 150 × 103/mm3 for a diagnosis of cirrhosis. The sensitivity and specificity were 68.2% and 76.4%, respectively, for pathologic cirrhosis and 76.2% and 87.8%, respectively, for US cirrhosis. Forty‐eight percent of patients with HCC were thrombocytopenic. The proportion of thrombocytopenia was significantly greater in patients with HCV‐related HCC (63%) than in patients with HBV‐related HCC (42%). In the townships with high and low anti‐HCV prevalence, the prevalence of thrombocytopenia was 17.9% and 6.1%, respectively, (P < .001), respectively. Twenty‐five patients were diagnosed with HCC, and all of those patients resided in the high‐prevalence township.CONCLUSIONS.Thrombocytopenia was a valid surrogate of cirrhosis and a valid marker for the identification of individuals at high‐risk for HCC, especially in areas that had a high prevalence of HCV. Cancer 2006. © 2006 American Cancer Society.

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“…Pompili et al evaluated the therapeutic efficacy of PEI for patients with Child-Pugh class A and tumors > 5 cm in diameter, and reported that alpha-fetoprotein level and liver function were factors which contributed to survival [21] . Ebara et al evaluated the therapeutic efficacy of PEI for patients with ≤ 3 lesions of small HCC, and found that alpha-fetoprotein level and liver function were factors contributed to the suvival [22] .…”

Section: Discussionmentioning

confidence: 99%

Successful initial ablation therapy contributes to survival in patients with hepatocellular carcinoma

Morimoto

Numata²,

Sugimori³

et al. 2007

WJG

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AIM:To evaluate the outcome predictors of percutaneous ablation therapy in patients with unresectable hepatocellular carcinoma (HCC), especially to identify whether the initial treatment response contributes to the survival of the patients. METHODS:The study cohort included 153 patients with single (102) and two or three (51) HCC nodules 5 cm or less in maximum diameter. As an initial treatment, 110 patients received radiofrequency ablation and 43 patients received percutaneous ethanol injection. RESULTS:The Kaplan-Meier estimates of overall 3-and 5-year survival rates were 75% and 59%, respectively. The log-rank test revealed statistically significant differences in the overall survivals according to ChildPugh class (P = 0.0275), tumor size (P = 0.0130), serum albumin level (P = 0.0060), serum protein induced by vitamin K absence or antagonist Ⅱ level (P = 0.0486), and initial treatment response (P = 0.0130). The independent predictors of survival were serum albumin level (risk ratio, 3.216; 95% CI, 1.407-7.353; P = 0.0056) and initial treatment response (risk ratio, 2.474; 95% CI, 1.076-5.692; P = 0.0330) based on the Cox proportional hazards regression models. The patients had a serum albumin level 3.5 g/dL and the 3-and 5-year survival rates of 86% and 82%. C O N C L U S I O N :I n H C C p a t i e n t s t r e a t e d w i t h percutaneous ablation therapy, serum albumin level and initial treatment response are the independent outcome predictors.

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Prognostic factors for survival in patients with compensated cirrhosis and small hepatocellular carcinoma after percutaneous ethanol injection therapy

Cited by 78 publications

References 109 publications

Community-Based Mass Ultrasonographic Screening of Hepatocellular Carcinoma among Thrombocytopenic Adults

Community-Based Mass Ultrasonographic Screening of Hepatocellular Carcinoma among Thrombocytopenic Adults

Thrombocytopenia as a surrogate for cirrhosis and a marker for the identification of patients at high‐risk for hepatocellular carcinoma

Successful initial ablation therapy contributes to survival in patients with hepatocellular carcinoma

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