The effect of preoperative transarterial chemoembolization of resectable hepatocellular carcinoma on clinical and economic outcomes

Lee, King‐Teh; Lu, Yiwei; Wang, Shen‐Nien; Chen, Hong-Yaw; Chuang, Shih‐Chang; Chang, Wai Hoong; Shi, Hon-Yi; Ker, Chen‐Guo; Chiu, Herng‐Chia

doi:10.1002/jso.21248

Cited by 45 publications

(43 citation statements)

References 34 publications

(35 reference statements)

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“…The cut-off points for these variables were based on those used in previous clinical studies [5], [7], [36]–[40]. Low and high risk were coded as 0 and 1, respectively.…”

Section: Methodsmentioning

confidence: 99%

Disease-Free Survival after Hepatic Resection in Hepatocellular Carcinoma Patients: A Prediction Approach Using Artificial Neural Network

Lee

Chen

et al. 2012

PLoS ONE

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BackgroundA database for hepatocellular carcinoma (HCC) patients who had received hepatic resection was used to develop prediction models for 1-, 3- and 5-year disease-free survival based on a set of clinical parameters for this patient group.MethodsThe three prediction models included an artificial neural network (ANN) model, a logistic regression (LR) model, and a decision tree (DT) model. Data for 427, 354 and 297 HCC patients with histories of 1-, 3- and 5-year disease-free survival after hepatic resection, respectively, were extracted from the HCC patient database. From each of the three groups, 80% of the cases (342, 283 and 238 cases of 1-, 3- and 5-year disease-free survival, respectively) were selected to provide training data for the prediction models. The remaining 20% of cases in each group (85, 71 and 59 cases in the three respective groups) were assigned to validation groups for performance comparisons of the three models. Area under receiver operating characteristics curve (AUROC) was used as the performance index for evaluating the three models.ConclusionsThe ANN model outperformed the LR and DT models in terms of prediction accuracy. This study demonstrated the feasibility of using ANNs in medical decision support systems for predicting disease-free survival based on clinical databases in HCC patients who have received hepatic resection.

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“…The cut-off points for these variables were based on those used in previous clinical studies [5], [7], [36]–[40]. Low and high risk were coded as 0 and 1, respectively.…”

Section: Methodsmentioning

confidence: 99%

Disease-Free Survival after Hepatic Resection in Hepatocellular Carcinoma Patients: A Prediction Approach Using Artificial Neural Network

Lee

Chen

et al. 2012

PLoS ONE

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“…The main limitation is related to the time required to organize and perform TACE, which delays resection by 2-10 weeks and prevents up to 10% of patients from reaching surgery because of tumour progression or liver failure [5,6]. In addition, resection may be more challenging after TACE (requiring longer operative times, often in association with significant inflammatory reaction in the hilum and around the area of parenchymal treatment), TACE does not provide a measurable survival benefit, and has even been associated with increased mortality in two studies [5][6][7][8][9][10]. This said, some of us do consider that one (and sometimes two) sessions of TACE should always be attempted prior to surgery, giving a chance of achieving tumour necrosis, which has been associated with higher rates of disease-free survival [8].…”

Section: Treatment Of Hcc Prior To Resectionmentioning

confidence: 99%

The place of downstaging for hepatocellular carcinoma

Toso

Mentha

Kneteman

et al. 2010

Journal of Hepatology

122

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In the treatment of hepatocellular carcinomas, therapies such as trans-arterial chemo-embolisation, trans-arterial radioembolisation, percutaneous ethanol injection and radio-frequency ablation can decrease the size (and overall viability) of the tumours, thus potentially increasing the proportion of patients qualifying for resection and transplantation. While the use of such downstaging therapies is straightforward when resection is the aim, in a similar way to other neo-adjuvant treatments in the surgery of tumours that are too large or awkwardly placed to be primarily resected the issues related to transplantation are more complex. In the context of transplantation the word "downstaging" designates not only a neo-adjuvant treatment, but also a selection strategy to allow patients who are initially outside accepted listing criteria to benefit from transplantation should the neo-adjuvant therapy be successful in reducing tumour burden. The effectiveness of downstaging as a selection strategy, at first questioned because of methodological bias in the studies that described it, has been recently demonstrated by more solid prospective investigations. Several issues however remain open, such as inclusion criteria before the strategy is implemented (size/number, surrogate markers of differentiation/vascular invasion such as alpha-fetoprotein), the choice of which downstaging therapy, the end-points of treatment, and the need and duration of a period of observation proving disease response or stabilisation before the patient can be listed. The present review discusses which treatments and strategies are available for downstaging HCC on the basis of the published literature.

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“…Dimensions decrease leads to a safer liver resection, reducing the amount of peritumoral liver tissue resected and the opportunity to bring in a resectable stage tumors initially declared inoperable [14,15].…”

Section: Discussionmentioning

confidence: 99%

Left bisegmentectomy for liver cirrhosis associated primary hepatic carcinoma with preoperative chemoembolization

Molnar

Silaghi

Roşca

et al. 2014

Acta Medica Marisiensis

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Introduction: Hepatocellular carcinoma is the most frequent primary malignant tumor of the liver, being linked in 80% of cases with viral hepatitis "B" or "C". Treatment remains a challenge especially in cases with associated hepatic cirrhosis, where preoperative arterial chemoembolization followed by liver resection is recommended. Case report: We discuss the case of a 64 years old cirrhotic patient, diagnosed by echography, computed tomography, magnetic resonance cholangiography with hepatocellular carcinoma (64x52x46 mm). Preoperative chemoembolization was performed with Lipiodol and 5-FU by supra-selective catheterization of left hepatic artery, followed by favorable radiologic response. Two weeks after embolization, the patient was admitted in Surgical Clinic No. 1 Targu Mures where an atypical resection of the left hepatic lobe (bisegmentectomy II-III) was performed with Harmonic Scalpel. Early and late postoperative evolution was favorable. Discussions: The principle of arterial chemoembolization is based on the fact that vasculature of primary hepatic tumors is predominantly arterial. Arterial obstruction may lead to ischemic necrosis while tumor embolization combination with a chemotherapeutic agent significantly improves its local concentration. Decrease in tumor size and its vasculature allows for safe hepatic resection especially in the cirrhotic liver. Conclusion: In case of tumoral cirrhotic liver preoperative chemoembolization decreases intra and postoperative bleeding risk, providing a safe and oncological resection.

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The effect of preoperative transarterial chemoembolization of resectable hepatocellular carcinoma on clinical and economic outcomes

Cited by 45 publications

References 34 publications

Disease-Free Survival after Hepatic Resection in Hepatocellular Carcinoma Patients: A Prediction Approach Using Artificial Neural Network

Disease-Free Survival after Hepatic Resection in Hepatocellular Carcinoma Patients: A Prediction Approach Using Artificial Neural Network

The place of downstaging for hepatocellular carcinoma

Left bisegmentectomy for liver cirrhosis associated primary hepatic carcinoma with preoperative chemoembolization

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