Survival benefit of transarterial chemoembolization in patients with metastatic hepatocellular carcinoma: a single center experience

Bettinger, Dominik; Spode, Renan; Glaser, Nicolas; Buettner, Nico; Böettler, Tobias; Brunner, Thomas; Gkika, Eleni; Maruschke, Lars; Thimme, Robert; Schultheiß, Michael

doi:10.1186/s12876-017-0656-z

Cited by 21 publications

(23 citation statements)

References 32 publications

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“…Another study involving 240 patients with HCC found intrahepatic tumor status as a significant predictor of survival [20]; however, it was composed of a heterogeneous population (141 patients with EHM at diagnosis and 99 patients who developed EHM during follow-up) who underwent a variety of treatment. Another study from Germany analyzed 215 patients with metastatic HCC and reported that treatment with intrahepatic TACE (n = 42) and a combination of TACE and sorafenib (n = 23) were associated with improved survival [15]. However, the reference group comprised those without therapy (n = 102), and not those that received sorafenib (n = 48) as initial treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The controllability of intrahepatic lesions was identified as an important prognostic factor for survival in HCC patients with EHM [11]. Hence, in real-life practice, some patients with HCC and EHM have been treated for intrahepatic HCC using locoregional treatments, usually transarterial chemoembolization (TACE) [12–15], without robust evidence to support. Moreover, these data were derived from an era when sorafenib and other immunotherapic agents were not widely available.…”

Section: Introductionmentioning

confidence: 99%

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Hepatocellular carcinoma with extrahepatic metastasis: Are there still candidates for transarterial chemoembolization as an initial treatment?

et al. 2019

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Background and aim Currently, sorafenib is indicated for hepatocellular carcinoma (HCC) with extrahepatic metastasis (EHM), and many other systemic agents are becoming available. However, a few HCC patients with EHM still undergo transarterial chemoembolization (TACE) for intrahepatic tumor control. We aimed to investigate whether TACE is appropriate for patients with EHM, and if so, which subgroup may benefit from TACE. Methods A total of 186 consecutive HCC patients (median: 55 years, male: 86.0%, hepatitis B virus: 81.7%, Child-Pugh Class A: 83.3%) with EHM (nodal metastasis: 60.8%, distant metastasis: 39.2%) between 2010 and 2014 were analyzed. Initial treatment included sorafenib in 69 patients, and TACE in 117 patients. Results During a median follow-up of 6.6 months (range: 0.2–94.6 months), mortality was observed in 90.3% (168/186). The median survival was better for patients who received TACE than those treated with sorafenib (8.2 months vs. 4.6 months, p < 0.001). However, baseline characteristics varied between patients initially treated with TACE and sorafenib, and the treatment modality was not an independent factor associated with overall survival (hazard ratio: 1.19, 95% confidence interval: 0.81–1.75, p = 0.36). In sub-group analysis, TACE was associated with better survival only among younger patients and those with segmental/lobar portal vein invasion. Conclusion In HCC patients with EHM, TACE was not an independent favorable prognostic factor compared to sorafenib. The concept of intrahepatic control in HCC patients with EHM may need to be reevaluated in the era of promising systemic therapies, although there can be specific subgroups who still benefit from TACE.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hepatocellular carcinoma with extrahepatic metastasis: Are there still candidates for transarterial chemoembolization as an initial treatment?

et al. 2019

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“…Vascular invasion or extrahepatic tumor spread lead to no curative treatment options available. Metastatic HCC (MHC) is mainly determined by progression of the underlying liver disease rather than by the extrahepatic metastases . In China and Africa patients who present with symptoms usually die within 4 months but longer survival is possible in western countries .…”

Section: Introductionmentioning

confidence: 99%

The diagnostic value of PIVKA‐II, AFP, AFP‐L3, CEA, and their combinations in primary and metastatic hepatocellular carcinoma

Zhou

et al. 2019

Clinical Laboratory Analysis

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Background: Early diagnosis decreases the mortality of hepatocellular carcinoma (HCC). We aimed to investigate the usefulness of PIVKA-II, AFP, AFP-L3, CEA, and their combinations in the diagnosis of primary and metastatic HCC. Methods: One hundred and twenty patients with primary HCC (PHC), 115 with metastatic HCC (MHC), 89 with chronic liver disease (CLD), and 116 healthy volunteers were included. The diagnostic values of each marker and their combinations for HCC diagnosis were represented by ROC curve analyses.Results: PIVKA-II, AFP, and AFP-L3 levels in PHC group were higher than that in normal control, CLD, and MHC groups. CEA levels in MHC group were higher than that in the other three groups. When the four markers were analyzed individually, PIVKA-II showed the highest positive rate in PHC group (76.7%) and CEA showed the highest positive rate in MHC group (69.6%). PIVKA-II showed the largest area under ROC curve (AUC = 0.835) to discriminate PHC group from CLD group. Combined PIVKA-II with AFP-L3 increased the AUC to 0.910. CEA showed the highest AUC (0.849) to discriminate MHC group from CLD group. Combined CEA with PIVKA-II increased the AUC to 0.866. AFP-L3 alone showed the highest AUC (0.890) to discriminate MHC group from PHC group. Combined PIVKA-II with AFP-L3, and CEA increased the AUC to 0.957. Conclusion: PIVKA-II, AFP-L3, AFP, and CEA are effective biomarkers for the diagnosis of PHC and MHC. Their combinations could improve the diagnostic performance compared with each marker used alone in detecting PHC and MHC. K E Y W O R D S AFP, AFP-L3, CEA, hepatocellular carcinoma, PIVKA-II

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“…8 However, patients with HCC are often diagnosed in advanced stages, and even after complete HCC tumor resection or ablation, the carcinogenic tissue microenvironment in the remnant liver can give rise to recurrent de novo HCC tumors, which progress into incurable, advanced-stage disease in the majority of patients. 9 The recent alarming increase in the incidence of HCC in thalassemias, prompted us to overview the most common risk factors involved in the development of HCC, to briefly describe the frequency and the clinical and diagnostic characteristics, and to discuss the recommendations for HCC surveillance in high-risk patients with β-thalassemias. The preliminary data of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescent Medicine (ICET-A) on HCC survey in thalassemia major (transfusion-dependent thalassemia:TDT) and intermedia patients (transfusion-dependent thalassemia: NTDT) are also presented.…”

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confidence: 99%

Concise Review on the Frequency, Major Risk Factors and Surveillance of Hepatocellular Carcinoma (Hcc) in Β-Thalassemias: Past, Present and Future Perspectives

Sanctis¹,

Soliman

Daar

et al. 2020

Mediterr J Hematol Infect Dis

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Due to the recent alarming increase in the incidence of hepatocellular carcinoma (HCC) in thalassemias, the aim of the present report is to review briefly the frequency, the major risk factors and the surveillance of HCC in β-thalassemias. Over the past 33 years, 153 cases of HCC were reported in patients with thalassemia, mainly in Italy, and Greece. Among HCV-infected patients additional factors promoting development of HCC, included: advanced age, male sex, chronic hepatitis B (CHB) coinfection, and iron overload. For early diagnosis of HCC sequential ultrasound screening is recommended especially for thalassemia patients with chronic hepatitis C (CHC), that coincide with (one or more) additional risk factors for HCC. Here we report also the preliminary data of thalassemic patients, above the age of 30 years, followed in 13 different centers. The total number of enrolled patients was 1,313 (males: 612 and 701 females). The prevalence of HCC in thalassemia major patients [characterized by transfusion-dependency (TDT)] and thalassemia intermedia [characterized by nontransfusion dependency (NTDT)] was 1.68 % and 1.98 % ,respectively The lowest age at diagnosis was 36 years in TDT and 47 years in NTDT patients.We hope that our review can be used to develop more refined and prospective analyses of HCC magnitude and risk in patients with thalassemia, and to define specific international guidelines to support clinicians for an early diagnosis and treatment of HCC in thalassemic patients.

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Survival benefit of transarterial chemoembolization in patients with metastatic hepatocellular carcinoma: a single center experience

Cited by 21 publications

References 32 publications

Hepatocellular carcinoma with extrahepatic metastasis: Are there still candidates for transarterial chemoembolization as an initial treatment?

Hepatocellular carcinoma with extrahepatic metastasis: Are there still candidates for transarterial chemoembolization as an initial treatment?

The diagnostic value of PIVKA‐II, AFP, AFP‐L3, CEA, and their combinations in primary and metastatic hepatocellular carcinoma

Concise Review on the Frequency, Major Risk Factors and Surveillance of Hepatocellular Carcinoma (Hcc) in Β-Thalassemias: Past, Present and Future Perspectives

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