Treatment of Hepatocellular Carcinoma with Child-Pugh C Cirrhosis

Abstract

Background: In most guidelines, no other interventional therapy but liver transplantation is recommended for the treatment of hepatocellular carcinoma (HCC) with Child-Pugh C cirrhosis (CP-C). However, in Japan, patients were sometimes treated with expectation of benefit. Summary: A workshop was conducted to explore the state of treatments for CP-C HCC in Japan. After the workshop, a questionnaire on therapies was given to the panelists. Clinical data of 769 patients with CP-C HCC from 8 hospitals as well as analyses of data collected by the Liver Cancer Study Group of Japan (LCSGJ) consisting of 1,344 CP-C HCC cases were presented. Patients who underwent liver transplantation were excluded. In total, 424 out of the 769 patients (55.1%) from the 8 hospitals and 537 out of 828 CP-C HCC cases (64.8%) from the LCSGJ data received interventional therapies, such as local ablation and transcatheter arterial chemoembolization. All panelists agreed that there was a subgroup of CP-C patients who benefitted from the locoregional therapies. The major goals for the therapies were to prevent HCC rupture and avoid obstruction of major vessels by tumor growth, which can lead to a sudden deterioration of the patients' condition. Patient liver function and tumor stage are both important factors for the decision to undergo treatment; however, the inclusion criteria for the treatments varied among the centers. Key Message: There exists a subgroup of CP-C patients who benefit from interventions for HCC.

Management of Hepatocellular Carcinoma in Japan as a World-Leading Model

“…A follow-up survey by the Liver Cancer Study Group of Japan revealed that approximately half of Child-Pugh class C HCC patients in Japan receive locoregional therapy (resection, ablation, and TACE, or HAIC). Propensity score-matching analysis of data from this follow-up survey showed that local ablation therapies and TACE improve survival in patients with a Child-Pugh score of 10 or 11 [35], consistent with other multicenter or single-center studies [36][37][38][39]. In Japan, locoregional therapy is used in routine clinical practice for carefully selected patients with Child-Pugh C HCC within the Milan criteria, and TACE and ablation appear to be beneficial in such patients.…”

Is there a survival benefit in interventional radiology for hepatocellular carcinoma in patients with Child-Pugh C liver cirrhosis?: A multicenter study

“…Nouso et al. also showed that TACE for HCC in Child–Pugh C patients provided a survival benefit, whereas local ablation or TAI did not . In the present cohort, there were no significant differences between the prognosis of patients treated with ablative therapies and those with TACE in the patients with up to 7 criteria and with total bilirubin of less than 3 mg/dL, and there was no certain conclusion of survival benefit from treatment against HCC in Child–Pugh C LC patients beyond up to 7 criteria with total bilirubin of less than 3 mg/dL because of their heterogeneous characteristics.…”

“…It was reported that a high level of serum bilirubin (>3 mg/dL) was a prognostic factor shown in analyses of 157 Child–Pugh C patients with HCC . The average level of total bilirubin of the patients who were treated with some kind of method was 2.85 ± 1.9 mg/dL.…”

Recent Trends in the Management of Hepatocellular Carcinoma with Special Emphasis on Treatment with Regorafenib and Immune Checkpoint Inhibitors

“…Experimental treatments for Child-Pugh C patients without hepatic encephalopathy or refractory ascites and with a serum bilirubin concentration ≤3 mg/dl include ablation and subsegmental TACE. Retrospective studies using propensity score matching [45,46,47] showed a survival benefit in patients with Child-Pugh score 10 or 11; however, there have been no randomized clinical trials. Further prospective clinical studies are needed to address this issue.…”