Survival of infiltrative hepatocellular carcinoma patients with preserved hepatic function after treatment with transarterial chemoembolization

Jang, Eun Sun; Yoon, Jeesun; Chung, Jin Wook; Cho, Eun Ju; Yu, Su Jong; Lee, Jeong-Hoon; Kim, Yoon Jun; Lee, Hyo‐Suk; Kim, Chung Yong

doi:10.1007/s00432-012-1364-2

Cited by 33 publications

(32 citation statements)

References 24 publications

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“…For this reason, although TACE is generally accepted as the only available treatment option, its efficacy for the treatment of infiltrative HCC has rarely been studied. However, Kneuertz et al (5) and Jang et al (23) have recently reported that TACE is both safe and feasible in selected patients with infiltrative HCC.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Arterial Chemoembolization for Infiltrative Hepatocellular Carcinoma: Clinical Safety and Efficacy and Factors Influencing Patient Survival

et al. 2014

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ObjectiveTo evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) in patients with infiltrative hepatocellular carcinoma (HCC) and to identify the prognostic factors associated with patient survival.Materials and MethodsFifty two patients who underwent TACE for infiltrative HCC were evaluated between 2007 and 2010. The maximum diameter of the tumors ranged from 7 cm to 22 cm (median 15 cm). Of 46 infiltrative HCC patients with portal vein tumor thrombosis, 32 patients received adjuvant radiation therapy for portal vein tumor thrombosis after TACE.ResultsThe tumor response by European Association for the Study of the Liver criteria was partial in 18%, stable in 47%, and progressive in 35% of the patients. The median survival time was 5.7 months (Kaplan-Meier analysis). The survival rates were 48% at six months, 25% at one year, and 12% at two years. In the multivariable Cox regression analysis, Child-Pugh class (p = 0.02), adjuvant radiotherapy (p = 0.003) and tumor response after TACE (p = 0.004) were significant factors associated with patient survival. Major complications occurred in nine patients. The major complication rate was significantly higher in patients with Child-Pugh B than in patients with Child-Pugh A (p = 0.049, χ2 test).ConclusionTranscatheter arterial chemoembolization can be a safe treatment option in infiltrative HCC patients with Child Pugh class A. Child Pugh class A, radiotherapy for portal vein tumor thrombosis after TACE and tumor response are good prognostic factors for an increased survival after TACE in patients with infiltrative HCCs.

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Section: Discussionmentioning

confidence: 99%

Transcatheter Arterial Chemoembolization for Infiltrative Hepatocellular Carcinoma: Clinical Safety and Efficacy and Factors Influencing Patient Survival

et al. 2014

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“…Sorafenib is recommended for the treatment of advanced and unresectable HCC (12). However, other modalities, such as transarterial chemoembolization (TACE) or transarterial radioembolization using yttrium-90 microspheres are also used to treat infiltrating HCC due to the modest efficacy and high cost of sorafenib treatment (13)(14)(15). TACE is currently considered to be one of the standard treatments for patients with unresectable HCC.…”

Section: Introductionmentioning

confidence: 99%

Transarterial chemoembolization vs. conservative treatment for unresectable infiltrating hepatocellular carcinoma: A retrospective comparative study

Dai

et al. 2014

Molecular and Clinical Oncology

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This study was conducted to compare long-term survival between patients with unresectable infiltrating hepatocellular carcinoma (HCC) who were treated with transarterial chemoembolization (TACE) and those who received conservative treatment (best supportive care). Between January, 2007 and January, 2012, a total of 131 consecutive patients with unresectable infiltrating HCC underwent TACE in a cancer center (TACE group), while 156 similar consecutive HCC patients received conservative treatment in another cancer center (conservative treatment group). The diagnosis of unresectable infiltrating HCC was established by agreement between two radiologists coming from the two centers, who performed an independent review of all the cross-sectional imagings of the patients. The two groups were comparable regarding patient characteristics, preoperative liver function, tumor burden and general condition. In the TACE group, 52 patients received one session and 79 patients received more than one session of TACE (mean, 1.5 and range, 1-4 sessions). There was no reported TACE-related mortality. The 1-month mortality rate was 0.8 and 3.8% in the TACE and the conservative groups, respectively (P=0.134). The median survival for the TACE and conservative treatment groups was 7.0 and 3.0 months, respectively. The 6-, 12- and 24-month overall survival rates for the TACE and conservative treatment groups were 61.7, 18.5 and 2.3% vs. 22.7, 12.1 and 0%, respectively (P<0.001). On multivariate analysis, treatment allocation [odds ratio (OR)=1.777; 95% confidence interval (CI): 1.499-2.107; P<0.001] and portal vein tumor thrombosis (OR=1.721; 95% CI: 1.504-1.907; P<0.001) were independent predictors of overall survival. In conclusion, TACE was found to be a safe and feasible treatment option for patients with unresectable infiltrating HCC and it conferred survival benefit over conservative treatment.

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“…In their series, the majority of patients receiving intraarterial therapy had a Child-Pugh score of A or B, and better results were obtained for patients with a bilirubin level less than 2 mg/dL and an AFP level less than 400 ng/mL at presentation. Similarly, in a recent study, Jang et al (15) suggested that when given to well-selected patients with infiltrative HCC and preserved hepatic function, transarterial chemoembolization is safe and leads to increased survival (>2 years). Overall, systemic chemotherapy is ineffective for patients with HCC (60,61).…”

Section: Treatment and Prognosis For Patients With Infiltrative Hccmentioning

confidence: 92%

“…It has an aggressive course and is associated with a substantially worse prognosis, compared with the nodular HCC subtype (9,10). Infiltrative HCC accounts for approximately 7%-20% of HCC cases (9,(11)(12)(13)(14)(15) and is reported to be commonly associated with hepatitis B virus infection, particularly in Asia (9,16). Patients with infiltrative HCC may have markedly elevated a-fetoprotein (AFP) values (>10,000 ng/mL) (10,13,17).…”

Section: Imaging Modalities For Diagnosis Of Hccmentioning

confidence: 98%

Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know

Reynolds¹,

Furlan²,

Fetzer³

et al. 2015

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Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. The macroscopic growth pattern of HCC is subdivided into three categories: nodular, massive, and infiltrative. Infiltrative HCC accounts for 7%-20% of HCC cases and is confirmed at pathologic analysis on the basis of the spread of minute tumor nodules throughout large regions of the liver. Infiltrative HCC may represent a diagnostic challenge because it is often difficult to distinguish from background changes in cirrhosis at imaging. Infiltrative HCC usually spreads over multiple hepatic segments, occupying an entire hepatic lobe or the entire liver, and it is frequently associated with portal vein tumor thrombosis. The tumor is usually ill defined at ultrasonography and shows minimal and inconsistent arterial enhancement and heterogeneous washout at contrast material-enhanced computed tomography and magnetic resonance (MR) imaging. The tumor may be more visible among the surrounding liver parenchyma at diffusion-, T1-, and T2-weighted MR imaging. Several liver diseases can mimic the infiltrative appearance of this malignancy, including focal confluent fibrosis, hepatic fat deposition, hepatic microabscesses, intrahepatic cholangiocarcinoma, and diffuse metastatic disease (pseudocirrhosis). The prognosis for patients with infiltrative HCC is poor because the tumor is often markedly advanced and associated with vascular invasion at presentation. Survival after surgical resection is decreased; thus, infiltrative HCC is a contraindication for resection and transplantation. Knowledge of the key tumor characteristics and imaging findings will help radiologists formulate a correct and timely diagnosis to improve patient management.

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Survival of infiltrative hepatocellular carcinoma patients with preserved hepatic function after treatment with transarterial chemoembolization

Cited by 33 publications

References 24 publications

Transcatheter Arterial Chemoembolization for Infiltrative Hepatocellular Carcinoma: Clinical Safety and Efficacy and Factors Influencing Patient Survival

Transcatheter Arterial Chemoembolization for Infiltrative Hepatocellular Carcinoma: Clinical Safety and Efficacy and Factors Influencing Patient Survival

Transarterial chemoembolization vs. conservative treatment for unresectable infiltrating hepatocellular carcinoma: A retrospective comparative study

Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know

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