Response to transarterial chemoembolization as a selection criterion for resection of hepatocellular carcinomas

Lei, Jianyong; Zhong, Jing; Yan, Lü-Nan; Zhu, Junquan; Wang, W. T.; Zeng, Yong; Li, B.; Wen, Tianfu; Yang, Jiayin

doi:10.1002/bjs.9864

Cited by 13 publications

(11 citation statements)

References 31 publications

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“…This revealed that segmental or wedge liver resection is generally a better choice for elderly patients above 69 years with Stage I-II HCC when liver transplantation is not available. This is somewhat different from some other research findings (4,16,22,23). After PSM, in Cohort 2, there were no statistical differences (P > 0.05) between the Non-surgery and the Surgery groups in nearly all variables, so the effects of different surgeries could be more clearly compared.…”

Section: Discussioncontrasting

confidence: 90%

Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

Zhang

Albahde

et al. 2020

Front. Oncol.

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Background and Aims: The best treatment modalities for elderly patients with stage I-II HCC (hepatocellular carcinoma) remain controversial in an era of a shortage of liver donors.Methods: From the SEER database (Surveillance, Epidemiology, and End Results program), 2,371 elderly patients were sampled as Cohort 1. OS (Overall Survival) and CSS (Cancer-Specific Survival) were compared between the Non-surgery and Surgery groups. A stratification analysis in a CSS Cox model was also conducted among sub-groups, and propensity score matching was performed to generate Cohort 2 (746 pairs), reducing the influences of confounders.Results: For Cohort 1, the median follow-up times of the Non-surgery and Surgery groups were 11 months (95% CI, confidence interval: 9.74-12.26) vs. 49 months (44.80-53.21) in OS, and 14 months (12.33-15.67) vs. 74 months (64.74-83.26) in CSS, respectively. In the stratification analysis, for the elderly patients (age >= 70 years), Larger Resection was associated with a higher HR (hazard ratio) than Segmental Resection: 0.30 (95% CI, confidence interval: 0.22-0.41) vs. 0.29 (0.21-0.38) in 70-74 year-olds; 0.26 (0.18-0.38) vs. 0.23 (0.16-0.32) in 75-79 year-olds; 0.32 (0.21-0.49) vs. 0.21 (0.13-0.32) in those 80+ years old. For Cohort 2, a similar result could be seen in the CSS Cox forest plot. The HRs of Larger Resection and Segmental Resection were 0.27 (0.21-0.33) and 0.25 (0.20-0.31), respectively.Conclusions: It is cautiously recommended that, when liver transplantation is not available, segmental or wedge liver resection is the better treatment choice for elderly patients with stage I-II HCC (AJCC edition 6), especially those over 70 years old, compared with other surgeries, based on the SEER data.

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Section: Discussioncontrasting

confidence: 90%

Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

Zhang

Albahde

et al. 2020

Front. Oncol.

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“…mRECIST is correlated with long-term survival [29, 30], and it was used to determine the amount of tumor necrosis induced by TACE. Furthermore, Lei's study [31] suggested that mRECIST may represent selection criterion for intermedian-HCC for resection. Adachi E et al [32] reported that preoperative TACE resulted in better disease-free survival rates when complete tumor necrosis was induced.…”

Section: Discussionmentioning

confidence: 99%

Hepatic resection after transarterial chemoembolization increases overall survival in large/multifocal hepatocellular carcinoma: a retrospective cohort study

Lai

Huang

et al. 2016

Oncotarget

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To investigate the prognosis of transarterial chemoembolization (TACE) followed by hepatic resection (HR) in large/multifocal hepatocellular carcinoma (HCC), the medical records of consecutive HCC patients who underwent TACE between January 2006 and December 2010 were retrospectively analyzed. Patients who received TACE alone comprised the T group (61 patients), while those who received HR after TACE comprised the T+R group (49 patients). All the resections were successfully performed, and only one class V complication occurred. While liver function was altered from baseline within 1 week after HR, it recovered within 1 month. Overall survival (OS) of the T+R and T groups were compared, and sub-group analyses were performed based on baseline α-fetoprotein (AFP) levels, the reduction of AFP, and tumor response before HR. Overall survival (OS) in the T+R group was longer than in the T group (47.00 ± 2.87 vs. 20.00 ± 1.85 months, P < 0.001). OS in the T+R group with AFP reduction was less than 50%, and OS among those with a poor tumor response before HR did not differ from the T group (P > 0.05). These patients may not benefit from the combined treatment. Our findings suggest HR after TACE is safe and effective for large/multifocal HCC, and prolongs OS when compared to TACE alone.

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“…Although transarterial chemoembolization (TACE) is recommended as the standard treatment for BCLC‐B HCC, various other treatments including liver resection have been used in clinical settings. Recent studies have provided evidence supporting the survival benefit of resection for BCLC‐B HCC, but the issue remains controversial. Well designed studies comparing liver resection with non‐surgical treatments such as TACE are sparse.…”

Section: Introductionmentioning

confidence: 99%

Survival benefit of liver resection for Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma

Kim

Ahn

Hong

et al. 2017

British Journal of Surgery

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Response to transarterial chemoembolization as a selection criterion for resection of hepatocellular carcinomas

Abstract: mRECIST may represent selection criterion for intermediate HCC for surgical treatment.

Cited by 13 publications

References 31 publications

Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

Hepatic resection after transarterial chemoembolization increases overall survival in large/multifocal hepatocellular carcinoma: a retrospective cohort study

Survival benefit of liver resection for Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma

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