Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus–endemic area

Park, Kyung Woo; Park, Joong-Won; Choi, Jun Il; Kim, Tae Hyun; Kim, Seong Hoon; Park, Hong Suk; Lee, Woojin; Park, Sang Jae; Hong, Eun Kyung; Kim, In Soo

doi:10.1111/j.1440-1746.2007.05112.x

Cited by 108 publications

(108 citation statements)

References 29 publications

(63 reference statements)

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“…PVTT can also decrease portal flow that may lead to ascites, jaundice, hepatic encephalopathy, or liver failure. Therefore, the presence of PVTT is one of the most significant prognostic factors of poor prognosis [21,22] , and it has been reported that these patients survive only 2.7-4 mo if left untreated [22,23] . In advanced HCC patients with PVTT, standard treatments have not been established, especially in the Asia-Pacific region.…”

Section: Discussionmentioning

confidence: 99%

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis

Song

Bae²,

Song³

et al. 2013

WJG

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AIM:To evaluate the prognostic factors and efficacy of hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis. METHODS:Fifty hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) were treated using hepatic arterial infusion chemotherapy (HAIC) via a subcutaneously implanted port. The epirubicin-cisplatin-5-fluorouracil (ECF) chemotherapeutic regimen consisted of 35 mg/m 2 epirubicin on day 1, 60 mg/m 2 cisplatin for 2 h on day 2, and 500 mg/m 2 5-fluorouracil for 5 h on days 1-3. The treatments were repeated every 3 or 4 wk. RESULTS:Three (6%) of the 50 patients achieved a complete response (CR), 13 (26%) showed partial responses (PR), and 22 (44%) had stable disease (SD).The median survival and time to progression were 7 and 2 mo, respectively. After 2 cycles of HAIC, CR was achieved in 1 patient (2%), PR in 10 patients (20%) and SD in 26 patients (52%). Significant pre-treatment prognostic factors were a tumor volume of < 400 cm 3 (P = 0.01) and normal levels of protein induced by vitamin K absence or antagonist (PIVKA)-Ⅱ (P = 0.022). After 2 cycles of treatment, disease control (CR + PR + SD) (P = 0.001), PVTT response (P = 0.003) and α-fetoprotein reduction of over 50% (P = 0.02) were independent factors for survival. Objective response (CR + PR), disease control, PVTT response, and combination therapy during the HAIC were also significant prognostic factors. Adverse events were tolerable and successfully managed. CONCLUSION: HAIC may be an effective treatment modality for advanced HCC with PVTT in patients with tumors < 400 cm 3 and good prognostic factors.© 2013 Baishideng. All rights reserved. Key words: Hepatocellular carcinoma; Hepatic arterial infusion chemotherapy; Portal vein tumor thrombosisCore tip: The aim of this study was to investigate the prognostic factors of hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma patients with portal vein tumor thrombosis. The primary findings of this study were as follows: (1) The median survival and time to progression were 7 and 2 mo, respectively; (2) A tumor volume of < 400 cm 3 and protein induced by vitamin K absence or antagonist-Ⅱ were independent pre-treatment prognostic factors; (3) Disease control and ≥ 50% tumor marker reduction were significant prognostic factors after the second cycle of hepatic arterial infusion chemotherapy (HAIC); and (4) Objective tumor response, disease control and portal vein tumor thrombosis response were independent post-treatment prognostic factors at the end of the HAIC. ORIGINAL ARTICLE

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Section: Discussionmentioning

confidence: 99%

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis

Song

Bae²,

Song³

et al. 2013

WJG

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“…Serum a-fetoprotein level and tumor stage (by the modified UICC and the BCLC systems) affected uptake only of 18 F-FDG. For analyzing accuracy in the detection of small tumors or extrahepatic metastases, we prospectively enrolled more patients who had modified UICC stage I, II, and IVb, compared with the patient population of our previous report (27). A high rate of positive findings on 18 F-FDG PET has been reported in patients with elevated serum a-fetoprotein levels (7) and in patients with poorly differentiated HCC (28).…”

Section: Discussionmentioning

confidence: 99%

A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

Park¹,

Kim²,

Kim³

et al. 2008

J Nucl Med

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252

237

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Because 18 F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), 11 C-acetate PET has been proposed as another technique for this use. We prospectively evaluated the value of PET/CT using these 2 tracers for the detection of primary and metastatic HCC. Methods: One hundred twelve patients (99 with HCC, 13 with cholangiocellular carcinoma) underwent biopsy and 18 F-FDG and 11 C-acetate PET/CT. Results: The overall sensitivities of 18 F-FDG, 11 C-acetate, and dual-tracer PET/CT in the detection of 110 lesions in 90 patients with primary HCC were 60.9%, 75.4%, and 82.7%, respectively. Elevated serum a-fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive 18 F-FDG PET/CT results. Uptake of 11 C-acetate was associated with large and multiple tumors. For 18 F-FDG, the sensitivities according to tumor size (1-2, 2-5, and $5 cm) were 27.2%, 47.8%, and 92.8%, respectively; for 11 C-acetate, these respective values were 31.8%, 78.2%, and 95.2%. 18 F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with 18 F-FDG PET/CT positive for all indexed lesions than in those with FDG negative or partially positive through the entire follow-up period. In analysis based on biopsied lesions, the sensitivity of 18 F-FDG PET/CT was 64.4% for primary HCC and 84.4% for 11 C-acetate PET/CT. The overall sensitivities of 18 F-FDG, 11 C-acetate, and dual-tracer PET/CT for 35 metastatic HCCs were 85.7%, 77.0%, and 85.7%, respectively. There was no significant difference in the sensitivity of tracers according to metastatic tumor size, location, or differentiation. Conclusion: The addition of 11 C-acetate to 18 F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. 18 F-FDG, 11 C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but 18 F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.

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“…Therapeutic options are stage-dependent (6,7). Only approximately 30% of patients who present with early stage tumors undergo resection, liver transplantation and percutaneous ablation, due to various factors, such as multifocal tumor and poor liver function resulting from underlying cirrhosis (8)(9)(10). Until recently, no effective treatment was available for these conditions (11).…”

Section: Introductionmentioning

confidence: 99%

Cryotherapy is associated with improved clinical outcomes of sorafenib for the treatment of advanced hepatocellular carcinoma

Yang

Wang

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. Sorafenib may prolong survival in patients with advanced hepatocellular carcinoma (HCC), but with limited efficacy. The present study aimed to assess the safety and efficacy of sorafenib combined with cryotherapy (cryoRx) for the treatment of advanced HCC. A total of 104 patients met the following criteria: advanced HCC without distant metastasis, presence of portal vein thrombosis, Child-Pugh class A or B and life expectancy of at least 12 weeks. All patients were randomly assigned to sorafenib and cryoRx (n=52) or sorafenib-alone (n=52) treatment groups. The primary end-point of the study was overall survival (OS). The secondary end-points included time to progression (TTP) and tolerability. Microvessel density (MVD) was assessed following immunostaining for CD34. In a median of 10.5 (4-26) months follow-up, the median OS was 12.5 months (95% CI 10.6-16.4) in the combination therapy vs. 8.6 months (7.3-10.4) in the sorafenib-alone (P= 0.01) group. The median TTP was 9.5 months (8.4-13.5) in the combination therapy vs. 5.3 months (3.8-6.9) in the sorafenib alone (P=0.02) group. CryoRx was an independent factor associated with improved clinical outcomes of sorafenib for the treatment of advanced HCC. Patients with low intratumoral MVD receiving the combination therapy exhibited a significantly longer median TTP and OS compared to those receiving sorafenib. High intratumoral MVD was an independent predictor of poor responses to sorafenib for advanced HCC. Compared with previous reports of sorafenib-related adverse drug reactions (ADRs), cryoRx did not further increase the frequency and degree of sorafenib-related ADRs. In conclusion, compared to sorafenib alone, the addition of cryoRx to sorafenib significantly improves the clinical outcomes of sorafenib for the treatment of advanced HCC with acceptable tolerance and similar safety profiles as previously reported. High intratumoral MVD is predictive of poor responses to sorafenib in advanced HCC patients.

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Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus–endemic area

Abstract: The results of this study will be helpful in determining the survival outcomes and treatment strategies for HCC patients in HBV-endemic areas.

Cited by 108 publications

References 29 publications

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis

A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

Cryotherapy is associated with improved clinical outcomes of sorafenib for the treatment of advanced hepatocellular carcinoma

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Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus–endemic area

Abstract: The results of this study will be helpful in determining the survival outcomes and treatment strategies for HCC patients in HBV-endemic areas.

Cited by 108 publications

References 29 publications

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis

A Prospective Evaluation of18F-FDG and11C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

Cryotherapy is associated with improved clinical outcomes of sorafenib for the treatment of advanced hepatocellular carcinoma

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Product

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A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma