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Keshavarz P, Nezami N, Yazdanpanah F, Khojaste-Sarakhsi M, Mohammadigoldar Z, Azami M, Hajati A, Ebrahimian Sadabad F, Chiang J, McWilliams JP, Lu DSK, Raman SS. Prediction of treatment response and outcome of transarterial chemoembolization in patients with hepatocellular carcinoma using artificial intelligence: A systematic review of efficacy. Eur J Radiol 2025; 184:111948. [PMID: 39892373 DOI: 10.1016/j.ejrad.2025.111948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 01/10/2025] [Accepted: 01/22/2025] [Indexed: 02/03/2025]
Abstract
PURPOSE To perform a systematic literature review of the efficacy of different AI models to predict HCC treatment response to transarterial chemoembolization (TACE), including overall survival (OS) and time to progression (TTP). METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines until May 2, 2024. RESULTS The systematic review included 23 studies with 4,486 HCC patients. The AI algorithm receiver operator characteristic (ROC) area under the curve (AUC) for predicting HCC response to TACE based on mRECIST criteria ranged from 0.55 to 0.97. Radiomics-models outperformed non-radiomics models (AUCs: 0.79, 95 %CI: 0.75-0.82 vs. 0.73, 0.61-0.77, respectively). The best ML methods used for the prediction of TACE response for HCC patients were CNN, GB, SVM, and RF with AUCs of 0.88 (0.79-0.97), 0.82 (0.71-0.89), 0.8 (0.60-0.87) and 0.8 (0.55-0.96), respectively. Of all predictive feature models, those combining clinic-radiologic features (ALBI grade, BCLC stage, AFP level, tumor diameter, distribution, and peritumoral arterial enhancement) had higher AUCs compared with models based on clinical characteristics alone (0.79, 0.73-0.89; p = 0.04 for CT + clinical, 0.81, 0.75-0.88; p = 0.017 for MRI + clinical versus 0.6, 0.55-0.75 in clinical characteristics alone). CONCLUSION Integrating clinic-radiologic features enhances AI models' predictive performance for HCC patient response to TACE, with CNN, GB, SVM, and RF methods outperforming others. Key predictive clinic-radiologic features include ALBI grade, BCLC stage, AFP level, tumor diameter, distribution, and peritumoral arterial enhancement. Multi-institutional studies are needed to improve AI model accuracy, address heterogeneity, and resolve validation issues.
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Affiliation(s)
- Pedram Keshavarz
- Department of Radiological Sciences, David Geffen School of Medicine at The University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
| | - Nariman Nezami
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC 20007, USA; Georgetown University School of Medicine, Washington, DC 20007, USA; Lombardi Comprehensive Cancer Center, Washington, DC 20007, USA
| | | | | | - Zahra Mohammadigoldar
- Department of Radiological Sciences, David Geffen School of Medicine at The University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Mobin Azami
- Department of Diagnostic & Interventional Radiology, New Hospitals Ltd., Tbilisi 0114, Georgia
| | - Azadeh Hajati
- Department of Radiology, Division of Abdominal Imaging, Harvard Medical School, Boston, MA 02114, USA
| | | | - Jason Chiang
- Department of Radiological Sciences, David Geffen School of Medicine at The University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Justin P McWilliams
- Department of Radiological Sciences, David Geffen School of Medicine at The University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - David S K Lu
- Department of Radiological Sciences, David Geffen School of Medicine at The University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine at The University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Wang W, Zhang Q, Cui Y, Zhang S, Li B, Xia T, Song Y, Zhou S, Ye F, Xiao W, Cao K, Chi Y, Qu J, Zhou G, Chen Z, Zhang T, Chen X, Ju S, Wang YC. TRACE Model: Predicting Treatment Response to Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma. J Hepatocell Carcinoma 2025; 12:193-203. [PMID: 39896274 PMCID: PMC11787783 DOI: 10.2147/jhc.s490226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 01/23/2025] [Indexed: 02/04/2025] Open
Abstract
Purpose To develop and validate a predictive model for predicting six-month outcome by integrating pretreatment MRI features and one-month treatment response after TACE. Methods A total of 108 patients with 160 hCCs from a single-arm, multicenter clinical trial (NCT03113955) were analyzed and served as the training cohort. An external multicenter dataset (ChiCTR2100046020) consisting of 63 patients with 99 hCCs served as the test dataset. Radiomics model was constructed based on the selected features from pretreatment MR images. Univariate and multivariate logistic regression analysis of clinical and radiological factors were used to identify the independent predictors for the 6-month treatment response. A combined model was further constructed by incorporating one-month treatment response, selected clinical and radiological factors and radiomics signature. Results Among all the clinical and radiological features, only corona enhancement and one-month treatment response were selected. The combined model, named TRACE model (Treatment response at 1 month, RAdiomics and Corona Enhancement), with AUCs of 0.91 (training cohort) and 0.84 (test cohort). The TRACE model demonstrated a significantly higher AUC than the radiomics model (P = 0.001). High-risk and low-risk groups stratified by using the TRACE model also exhibited significant differences in overall survival (OS) (P < 0.001). In contrast, none of the published scoring systems, including ART, SNACOR or ABCR score, demonstrated significant differences between the risk groups in OS prediction. Conclusion The TRACE model exhibited favorable predictive capability for six-month TACE response, and holds potential as a marker for long-term survival outcomes.
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Affiliation(s)
- Weilang Wang
- Department of Radiology, Zhongda Hospital, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Qi Zhang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, People’s Republic of China
| | - Ying Cui
- Department of Radiology, Zhongda Hospital, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Shuhang Zhang
- Department of Radiology, Zhongda Hospital, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Binrong Li
- Department of Radiology, Zhongda Hospital, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Tianyi Xia
- Department of Radiology, Zhongda Hospital, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Yang Song
- MR Scientific Marketing, Siemens Healthineers Ltd, Shanghai, People’s Republic of China
| | - Shuwei Zhou
- Department of Radiology, Zhongda Hospital, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Feng Ye
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Wenbo Xiao
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Kun Cao
- Department of Radiology, Peking University Cancer Hospital and Institute, Beijing, People’s Republic of China
| | - Yuan Chi
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Jinrong Qu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Guofeng Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, People’s Republic of China
| | - Zhao Chen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Teng Zhang
- Institute for Artificial Intelligence in Medicine, School of Artificial Intelligence, Nanjing University of Information Science and Technology, Nanjing, People’s Republic of China
| | - Xunjun Chen
- Department of Radiology, The People's Hospital of Xuyi County, Huaian, Jiangsu, People’s Republic of China
| | - Shenghong Ju
- Department of Radiology, Zhongda Hospital, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Yuan-Cheng Wang
- Department of Radiology, Zhongda Hospital, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
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Alhaddad O, Gomaa A, Shamandy ME, Kohla M, Edrees A, Ashour R. Evaluation of different scoring systems for repeating Transarterial Chemoembolization in Egyptian patients with Hepatocellular Carcinoma. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:430-439. [PMID: 39217454 DOI: 10.2478/rjim-2024-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE) have a diverse range of outcomes due to their high degree of heterogeneity. Therefore, different predictive scoring systems have been created to assist in decision-making regarding retreatment with TACE. We compared the predictive capabilities of different scoring systems, such as ART, ABCR, and SNACOR, for prediction of the outcome of subsequent TACE in HCC patients. METHOD In this retrospective study, the three scoring systems were compared for their capability of predicting the outcome of repeating TACE in 149 HCC patients treated at the National Liver Institute, Egypt, between January 2017 and December 2019. We used the likelihood ratio to select the model with the highest predictive capability for overall survival (OS). RESULTS According to our data, the amount of tumor, the change in Barcelona Clinic Liver Cancer (BCLC) stage following TACE, and the SNACOR score (with a 95% confidence range for HR 1.0305-1.256 and p-value = 0.0106) were the most predictive variables. It was also shown that the ABCR score was a good predictor of survival (90 patients had an ABCR score ≤ 0 with a P- value <0.0001, 56 patients had 0 < ABCR < 4 with a P-value <0.0001, and the ART score was not useful in predicting OS (P-value = 0.18). CONCLUSION The SNACOR score is the most predictive score for OS and would be the most helpful scoring system in decision-making regarding retreatment with TACE.
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Affiliation(s)
- Omkolsoum Alhaddad
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt
| | - Asmaa Gomaa
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt
| | - Merhan El Shamandy
- Department of Hepatology and Gastroenterology, Ahmad Maher Teaching Hospital, Cairo 11511, Egypt
| | - Mohamed Kohla
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt
| | - Ahmed Edrees
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt
| | - Reham Ashour
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, 32511, Egypt
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Feng J, Bin JL, Liao XW, Wu Y, Tang Y, Lu PZ, Zhu GZ, Cui QR, Dan YY, Yang GH, Li LX, Deng JH, Peng T, Hooi SC, Zhou J, Lu GD. The prognostic role of ACSL4 in postoperative adjuvant TACE-treated HCC: implications for therapeutic response and mechanistic insights. J Exp Clin Cancer Res 2024; 43:306. [PMID: 39563427 PMCID: PMC11575417 DOI: 10.1186/s13046-024-03222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 11/01/2024] [Indexed: 11/21/2024] Open
Abstract
BACKGROUND The response of hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE) treatment and its underlying mechanisms remain elusive. This study investigates the role of enzymes involved in fatty acid activation, specifically Acyl-CoA synthetase long chain 4 (ACSL4), in HCC patients treated with postoperative adjuvant TACE (PA-TACE) and in nutrient-deprived HCC cells. METHODS We examined the expression of ACSL4 and its family members in HCC clinical samples and cell lines. The clinical significance of ACSL4, particularly regarding the prognosis of patients treated with PA-TACE, was assessed using two independent HCC cohorts. We further explored the role of ACSL4 in glucose starvation-induced cell death in HCC cells and xenograft mouse models. RESULTS Among the family members, ACSL4 is the most up-regulated enzyme, associated with poor survival in HCC patients, particularly in post-recurrent TACE-treated patients in a Singapore cohort. ACSL4 is essential for HCC cell survival in response to glucose starvation, rather than to hypoxia or to the combination of hypoxia with doxorubicin or cisplatin. ACSL4-mediated arachidonic acid (AA) metabolism supports mitochondrial β-oxidation and energy production. CCAAT/enhancer binding protein α (CEBPA) transcriptionally regulates ACSL4 by binding 3 motifs (-623 to -613, -1197 to -1187 and -1745 to -1735) of ACSL4 upstream promoter region, enhancing its pro-survival effects. Furthermore, canagliflozin (Cana), a clinical-approved drug for type 2 diabetes, mimics glucose starvation and inhibits the growth of ACSL4-low xenograft tumors. Moreover, high ACSL4 or CEBPA expressions correlate with increased recurrence susceptibility after PA-TACE in the China-Guangxi HCC cohort. CONCLUSIONS The CEBPA-ACSL4 pathway is critical in protecting HCC cells from glucose starvation-induced cell death, suggesting that ACSL4 and CEBPA could serve as valuable prognostic indicators and potential therapeutic targets in the context of PA-TACE treatment for HCC.
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Affiliation(s)
- Ji Feng
- School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032, China
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Key Laboratory of Basic Research On Regional Diseases (Guangxi Medical University), Education Department of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, China
| | - Jin-Lian Bin
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Xi-Wen Liao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, China
| | - Yong Wu
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Yue Tang
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Pei-Zhi Lu
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Guang-Zhi Zhu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, China
| | - Qian-Ru Cui
- Department of Physiology, School of Preclinical Medicine, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, 530021, China
| | - Yock Young Dan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Guo-Huan Yang
- Department of Liver Surgery and Transplantation, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Li-Xin Li
- Department of Hepato-Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jing-Huan Deng
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Tao Peng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, China.
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education; Guangxi Key Laboratory of High-Incidence-Tumor Prevention & Treatment, (Guangxi Medical University), Nanning, Guangxi, 530021, China.
| | - Shing Chuan Hooi
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, 2 Medical Drive MD9, Singapore, 117593, Singapore.
| | - Jing Zhou
- Department of Physiology, School of Preclinical Medicine, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, 530021, China.
| | - Guo-Dong Lu
- School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032, China.
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education; Guangxi Key Laboratory of High-Incidence-Tumor Prevention & Treatment, (Guangxi Medical University), Nanning, Guangxi, 530021, China.
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Yang C, Yang HC, Luo YG, Li FT, Cong TH, Li YJ, Ye F, Li X. Predicting Survival Using Whole-Liver MRI Radiomics in Patients with Hepatocellular Carcinoma After TACE Refractoriness. Cardiovasc Intervent Radiol 2024; 47:964-977. [PMID: 38750156 DOI: 10.1007/s00270-024-03730-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/07/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE To develop a model based on whole-liver radiomics features of pre-treatment enhanced MRI for predicting the prognosis of hepatocellular carcinoma (HCC) patients undergoing continued transarterial chemoembolization (TACE) after TACE-resistance. MATERIALS AND METHODS Data from 111 TACE-resistant HCC patients between January 2014 and March 2018 were retrospectively collected. At a ratio of 7:3, patients were randomly assigned to developing and validation cohorts. The whole-liver were manually segmented, and the radiomics signature was extracted. The tumor and liver radiomics score (TLrad-score) was calculated. Models were trained by machine learning algorithms and their predictive efficacies were compared. RESULTS Tumor stage, tumor burden, body mass index, alpha-fetoprotein, and vascular invasion were revealed as independent risk factors for survival. The model trained by Random Forest algorithms based on tumor burden, whole-liver radiomics signature, and clinical features had the highest predictive efficacy, with c-index values of 0.85 and 0.80 and areas under the ROC curve of 0.96 and 0.83 in the developing cohort and validation cohort, respectively. In the high-rad-score group (TLrad-score > - 0.34), the median overall survival (mOS) was significantly shorter than in the low-rad-score group (17 m vs. 37 m, p < 0.001). A shorter mOS was observed in patients with high tumor burden compared to those with low tumor burden (14 m vs. 29 m, p = 0.007). CONCLUSION The combined radiomics model from whole-liver signatures may effectively predict survival for HCC patients continuing TACE after TACE refractoriness. The TLrad-score and tumor burden are potential prognostic markers for TACE therapy following TACE-resistance.
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Affiliation(s)
- Chao Yang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Hong-Cai Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yin-Gen Luo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Fu-Tian Li
- Huiying Medical Technology (Beijing) Co., Ltd, Beijing, 100192, China
| | - Tian-Hao Cong
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yu-Jie Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Feng Ye
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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Zeng ZX, Wu JY, Wu JY, Li YN, Fu YK, Zhang ZB, Liu DY, Li H, Ou XY, Zhuang SW, Yan ML. The TAE score predicts prognosis of unresectable HCC patients treated with TACE plus lenvatinib with PD-1 inhibitors. Hepatol Int 2024; 18:651-660. [PMID: 38040945 DOI: 10.1007/s12072-023-10613-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/29/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND AND AIMS Transcatheter arterial chemoembolization combined with lenvatinib and PD-1 inhibitors (triple therapy) exhibits promising efficacy for unresectable hepatocellular carcinoma (uHCC). We aimed to evaluate the prognosis of patients with uHCC who received triple therapy and develop a prognostic scoring model to identify patients who benefit the most from triple therapy. METHODS A total of 246 patients with uHCC who received triple therapy at eight centers were included and assigned to the training and validation cohorts. Prognosis was evaluated by the Kaplan-Meier curves. The prognostic model was developed by utilizing predictors of overall survival (OS), which were identified through the Cox proportional hazards model. RESULTS In the training cohort, the 3-year OS was 52.0%, with a corresponding progression-free survival (PFS) of 30.6%. The median PFS was 13.2 months [95% confidence interval, 9.7-16.7]. Three variables (total bilirubin ≥ 17 μmol/L, alpha-fetoprotein ≥ 400 ng/mL, and extrahepatic metastasis) were predictors of poor survival and were used for developing a prognostic model (TAE score). The 2-year OS rates in the favorable (0 points), intermediate (1 point), and dismal groups (2-3 points) were 96.9%, 61.4%, and 11.4%, respectively (p < 0.001). The PFS was also stratified according to the TAE score. These findings were confirmed in an external validation cohort. CONCLUSIONS Triple therapy showed encouraging clinical outcomes, and the TAE score aids in identifying patients who would benefit the most from triple therapy.
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Affiliation(s)
- Zhen-Xin Zeng
- The Shengli Clinical Medical College of Fujian Medical University, Dongjie Road 134, Fuzhou, 350001, Fujian, China
| | - Jia-Yi Wu
- The Shengli Clinical Medical College of Fujian Medical University, Dongjie Road 134, Fuzhou, 350001, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Jun-Yi Wu
- The Shengli Clinical Medical College of Fujian Medical University, Dongjie Road 134, Fuzhou, 350001, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Yi-Nan Li
- The Shengli Clinical Medical College of Fujian Medical University, Dongjie Road 134, Fuzhou, 350001, Fujian, China
| | - Yang-Kai Fu
- The Shengli Clinical Medical College of Fujian Medical University, Dongjie Road 134, Fuzhou, 350001, Fujian, China
| | - Zhi-Bo Zhang
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - De-Yi Liu
- The Shengli Clinical Medical College of Fujian Medical University, Dongjie Road 134, Fuzhou, 350001, Fujian, China
| | - Han Li
- The Shengli Clinical Medical College of Fujian Medical University, Dongjie Road 134, Fuzhou, 350001, Fujian, China
| | - Xiang-Ye Ou
- The Shengli Clinical Medical College of Fujian Medical University, Dongjie Road 134, Fuzhou, 350001, Fujian, China
| | - Shao-Wu Zhuang
- Department of Interventional Radiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Shengli Road 59, Zhangzhou, 363000, Fujian, China.
| | - Mao-Lin Yan
- The Shengli Clinical Medical College of Fujian Medical University, Dongjie Road 134, Fuzhou, 350001, Fujian, China.
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China.
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Asano K, Kageyama K, Yamamoto A, Jogo A, Uchida-Kobayashi S, Sohgawa E, Murai K, Kawada N, Miki Y. Transcatheter Arterial Chemoembolization for Treatment-Naive Hepatocellular Carcinoma Has Different Treatment Effects Depending on Central or Peripheral Tumor Location. Liver Cancer 2023; 12:576-589. [PMID: 38058422 PMCID: PMC10697731 DOI: 10.1159/000530441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/27/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction The purpose of this study was to evaluate the treatment efficacy of transcatheter arterial chemoembolization (TACE) for treatment-naive hepatocellular carcinoma (HCC) according to tumor location and burden. Methods Between 2010 and 2019, consecutive patients who underwent TACE as the first treatment were enrolled. Tumors were classified into two categories based on their location, as central or peripheral tumors. Tumors in the central zone, which is within 1 cm of the main trunk or the first branch of the portal vein, were classified as central tumors, while those located in the peripheral zone were classified as peripheral tumors. Patients were grouped according to the HCC location and up-to-7 criteria. Patients with central tumors were classified into the central arm and those with only peripheral tumors were classified into the peripheral arm. Patients within and beyond the up-to-7 criteria were classified into the up-to-7 in and up-to-7 out-groups, respectively. Local recurrence-free survival (LRFS) and progression-free survival (PFS) were compared per nodule (central tumor vs. peripheral tumor) and per patient (central arm vs. peripheral arm), respectively. The prognostic factors of LRFS and PFS were analyzed by univariate and multivariate analyses. Results A total of 174 treatment-naive patients with 352 HCCs were retrospectively enrolled. Ninety-six patients and 130 lesions were selected by propensity score matching. Median LRFS was longer for peripheral tumors than central tumors (not reached vs. 3.3 months, p < 0.001). Median PFS was 17.1 months (8.3-24.9) in the peripheral arm and up-to-7 in, 7.0 months (3.3-12.7) in the peripheral arm and up-to-7 out, 8.4 months (4.0-12.6) in the central arm and up-to-7 in, and 3.0 months (1.2-4.9) in the central arm and up-to-7 out-groups. The peripheral arm and up-to-7 in-groups had significantly longer PFS than the other three groups (p = 0.013, p = 0.015, p < 0.001, respectively). Multivariate analysis confirmed that the central zone and central arm were associated with high adjusted hazard ratios for tumor recurrence or death (2.87, p < 0.001; 2.89, p < 0.001, respectively). Conclusion Treatment-naive HCCs in the peripheral zone had a longer LRFS and PFS following TACE compared to those in the central zone.
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Affiliation(s)
- Kazuo Asano
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Ken Kageyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Atsushi Jogo
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Sawako Uchida-Kobayashi
- Department of Premier Preventive Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Etsuji Sohgawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kazuki Murai
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Norifumi Kawada
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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8
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Ninomiya M, Tsuruoka M, Inoue J, Hiraoka A, Iwata T, Sano A, Sato K, Onuki M, Sawahashi S, Kuroda H, Oikawa T, Fujita M, Abe K, Katsumi T, Sato W, Igarashi G, Iino C, Endo T, Tanabe N, Numao H, Iijima K, Matsumoto T, Ohira H, Ueno Y, Masamune A. A new model to estimate duration of survival in patients with hepatocellular carcinoma with BCLC intermediate stage. Sci Rep 2023; 13:20739. [PMID: 38007597 PMCID: PMC10676419 DOI: 10.1038/s41598-023-48068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023] Open
Abstract
It is difficult to determine whether an individual therapy contributes to the elongation of survival because of the difficulty of organizing clinical research in patients who receive multiple treatments in HCC. We aimed to establish a new model of survival prediction in patients with intermediate stage HCC to establish standards in the recent and coming multi-MTA era. This analysis was prepared using a data set of 753 patients diagnosed HCC prior to 2017. Multiple regression analysis showed age, naïve or recurrence, the size of the largest tumor nodule, the number of nodules, total bilirubin, albumin and α-fetoprotein as independent predictors of survival. A Weibull model had the best fit and, based on these predictors, we established a new predicted survival model. The survival duration can be predicted the proposed model; EXP (4.02580 + (- 0.0086253) × age + (- 0.34667) × (naïve/recurrence) + (- 0.034962) × (number of nodules) + (- 0.079447) × (the size of the largest nodule) + (- 0.21696) × (total bilirubin) + 0.27912 × (albumin) + (- 0.00014741) × (α-fetoprotein)) × (- natural logarithm(0.5))^0.67250. This model is useful for the planning and evaluating the efficacy of recent sequential therapies in multi-MTA era.
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Affiliation(s)
- Masashi Ninomiya
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 9808574, Japan.
| | - Mio Tsuruoka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 9808574, Japan
| | - Jun Inoue
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 9808574, Japan
| | - Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Tomoaki Iwata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 9808574, Japan
| | - Akitoshi Sano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 9808574, Japan
| | - Kosuke Sato
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 9808574, Japan
| | - Masazumi Onuki
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 9808574, Japan
| | - Satoko Sawahashi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 9808574, Japan
| | - Hidekatsu Kuroda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Shiwa, Iwate, Japan
| | - Takayoshi Oikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Shiwa, Iwate, Japan
| | - Masashi Fujita
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kazumichi Abe
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tomohiro Katsumi
- Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Wataru Sato
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Go Igarashi
- Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Iino
- Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tetsu Endo
- Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Nobukazu Tanabe
- Department of Gastroenterology, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hiroshi Numao
- Department of Gastroenterology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Shiwa, Iwate, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshiyuki Ueno
- Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 9808574, Japan
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9
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Zhong JW, Nie DD, Huang JL, Luo RG, Cheng QH, Du QT, Guo GH, Bai LL, Guo XY, Chen Y, Chen SH. Prediction model of no-response before the first transarterial chemoembolization for hepatocellular carcinoma: TACF score. Discov Oncol 2023; 14:184. [PMID: 37847433 PMCID: PMC10581972 DOI: 10.1007/s12672-023-00803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023] Open
Abstract
Previous clinic models for patients with hepatocellular carcinoma (HCC) receiving transarterial chemoembolization (TACE) mainly focused on the overall survival, whereas a simple-to-use tool for predicting the response to the first TACE and the management of risk classification before TACE are lacking. Our aim was to develop a scoring system calculated manually for these patients. A total of 437 patients with hepatocellular carcinoma (HCC) who underwent TACE treatment were carefully selected for analysis. They were then randomly divided into two groups: a training group comprising 350 patients and a validation group comprising 77 patients. Furthermore, 45 HCC patients who had recently undergone TACE treatment been included in the study to validate the model's efficacy and applicability. The factors selected for the predictive model were comprehensively based on the results of the LASSO, univariate and multivariate logistic regression analyses. The discrimination, calibration ability and clinic utility of models were evaluated in both the training and validation groups. A prediction model incorporated 3 objective imaging characteristics and 2 indicators of liver function. The model showed good discrimination, with AUROCs of 0.735, 0.706 and 0.884 and in the training group and validation groups, and good calibration. The model classified the patients into three groups based on the calculated score, including low risk, median risk and high-risk groups, with rates of no response to TACE of 26.3%, 40.2% and 76.8%, respectively. We derived and validated a model for predicting the response of patients with HCC before receiving the first TACE that had adequate performance and utility. This model may be a useful and layered management tool for patients with HCC undergoing TACE.
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Affiliation(s)
- Jia-Wei Zhong
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Dan-Dan Nie
- Department of Gastroenterology, Fengcheng People's Hospital, Fengcheng, Jiangxi, China
| | - Ji-Lan Huang
- Medical Imaging Department, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Rong-Guang Luo
- Department of Interventional Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qing-He Cheng
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qiao-Ting Du
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Gui-Hai Guo
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Liang-Liang Bai
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xue-Yun Guo
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yan Chen
- Department of Interventional Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Si-Hai Chen
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
- Postdoctoral Innovation Practice Base, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
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10
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Feng L, Chen Q, Huang L, Long L. Radiomics features of computed tomography and magnetic resonance imaging for predicting response to transarterial chemoembolization in hepatocellular carcinoma: a meta-analysis. Front Oncol 2023; 13:1194200. [PMID: 37519801 PMCID: PMC10374837 DOI: 10.3389/fonc.2023.1194200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To examine the methodological quality of radiomics-related studies and evaluate the ability of radiomics to predict treatment response to transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods A systematic review was performed on radiomics-related studies published until October 15, 2022, predicting the effectiveness of TACE for HCC. Methodological quality and risk of bias were assessed using the Radiomics Quality Score (RQS) and Quality Assessment of Diagnostic Accuracy Studies-2 tools, respectively. Pooled sensitivity, pooled specificity, and area under the curve (AUC) were determined to evaluate the utility of radiomics in predicting the response to TACE for HCC. Results In this systematic review, ten studies were eligible, and six of these studies were used in our meta-analysis. The RQS ranged from 7-21 (maximum possible score: 36). The pooled sensitivity and specificity were 0.89 (95% confidence interval (CI) = 0.79-0.95) and 0.82 (95% CI = 0.64-0.92), respectively. The overall AUC was 0.93 (95% CI = 0.90-0.95). Conclusion Radiomics-related studies evaluating the efficacy of TACE in patients with HCC revealed promising results. However, prospective and multicenter trials are warranted to make radiomics more feasible and acceptable.
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Affiliation(s)
- Lijuan Feng
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qianjuan Chen
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Linjie Huang
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Liling Long
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Gaungxi Medical University, Ministry of Education, Nanning, Guangxi, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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11
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Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea. 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. JOURNAL OF LIVER CANCER 2023; 23:1-120. [PMID: 37384024 PMCID: PMC10202234 DOI: 10.17998/jlc.2022.11.07] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/30/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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Affiliation(s)
- Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea
- Corresponding author: KLCA-NCC Korea Practice Guideline Revision Committee (KPGRC) (Committee Chair: Joong-Won Park) Center for Liver and Pancreatobiliary Cancer, Division of Gastroenterology, Department of Internal Medicine, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea Tel. +82-31-920-1605, Fax: +82-31-920-1520, E-mail:
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12
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Moawad AW, Morshid A, Khalaf AM, Elmohr MM, Hazle JD, Fuentes D, Badawy M, Kaseb AO, Hassan M, Mahvash A, Szklaruk J, Qayyum A, Abusaif A, Bennett WC, Nolan TS, Camp B, Elsayes KM. Multimodality annotated hepatocellular carcinoma data set including pre- and post-TACE with imaging segmentation. Sci Data 2023; 10:33. [PMID: 36653372 PMCID: PMC9849450 DOI: 10.1038/s41597-023-01928-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver neoplasm, and its incidence has doubled over the past two decades owing to increasing risk factors. Despite surveillance, most HCC cases are diagnosed at advanced stages and can only be treated using transarterial chemo-embolization (TACE) or systemic therapy. TACE failure may occur with incidence reaching up to 60% of cases, leaving patients with a financial and emotional burden. Radiomics has emerged as a new tool capable of predicting tumor response to TACE from pre-procedural computed tomography (CT) studies. This data report defines the HCC-TACE data collection of confirmed HCC patients who underwent TACE and have pre- and post-procedure CT imaging studies and available treatment outcomes (time-to-progression and overall survival). Clinically curated segmentation of pre-procedural CT studies was done for the purpose of algorithm training for prediction and automatic liver tumor segmentation.
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Affiliation(s)
- Ahmed W Moawad
- Departments of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
- Department of radiology, Mercy catholic medical center, Darby, PA, 19023, USA.
| | - Ali Morshid
- Departments of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Ahmed M Khalaf
- Departments of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Mohab M Elmohr
- Departments of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
- Department of radiology, Baylor college of medicine, TX, 77030, Houston, USA.
| | - John D Hazle
- Departments of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - David Fuentes
- Departments of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Mohamed Badawy
- Departments of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ahmed O Kaseb
- Departments of Gastrointestinal Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Manal Hassan
- Departments of Gastrointestinal Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Armeen Mahvash
- Departments of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Janio Szklaruk
- Departments of Body Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Aliyya Qayyum
- Departments of Body Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Abdelrahman Abusaif
- Departments of Body Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - William C Bennett
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
| | - Tracy S Nolan
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
| | - Brittney Camp
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
| | - Khaled M Elsayes
- Departments of Body Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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13
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2022 KLCA-NCC Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Korean J Radiol 2022; 23:1126-1240. [PMID: 36447411 PMCID: PMC9747269 DOI: 10.3348/kjr.2022.0822] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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14
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Mokhria RK, Singh J. Role of artificial intelligence in the diagnosis and treatment of hepatocellular carcinoma. Artif Intell Gastroenterol 2022; 3:96-104. [DOI: 10.35712/aig.v3.i4.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/30/2022] [Accepted: 09/14/2022] [Indexed: 02/07/2023] Open
Abstract
Artificial intelligence (AI) evolved many years ago, but it gained much advancement in recent years for its use in the medical domain. AI with its different subsidiaries, i.e. deep learning and machine learning, examine a large amount of data and performs an essential part in decision-making in addition to conquering the limitations related to human evaluation. Deep learning tries to imitate the functioning of the human brain. It utilizes much more data and intricate algorithms. Machine learning is AI based on automated learning. It utilizes earlier given data and uses algorithms to arrange and identify models. Globally, hepatocellular carcinoma is a major cause of illness and fatality. Although with substantial progress in the whole treatment strategy for hepatocellular carcinoma, managing it is still a major issue. AI in the area of gastroenterology, especially in hepatology, is particularly useful for various investigations of hepatocellular carcinoma because it is a commonly found tumor, and has specific radiological features that enable diagnostic procedures without the requirement of the histological study. However, interpreting and analyzing the resulting images is not always easy due to change of images throughout the disease process. Further, the prognostic process and response to the treatment process could be influenced by numerous components. Currently, AI is utilized in order to diagnose, curative and prediction goals. Future investigations are essential to prevent likely bias, which might subsequently influence the analysis of images and therefore restrict the consent and utilization of such models in medical practices. Moreover, experts are required to realize the real utility of such approaches, along with their associated potencies and constraints.
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Affiliation(s)
- Rajesh Kumar Mokhria
- Government Model Sanskriti Senior Secondary School, Chulkana, 132101, Panipat, Haryana, India
| | - Jasbir Singh
- Department of Biochemistry, Kurukshetra University, Kurukshetra, 136119, Haryana, India
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15
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2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Clin Mol Hepatol 2022; 28:583-705. [PMID: 36263666 PMCID: PMC9597235 DOI: 10.3350/cmh.2022.0294] [Citation(s) in RCA: 174] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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16
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Yang C, Luo YG, Yang HC, Yao ZH, Li X. Effects of Early TACE Refractoriness on Survival in Patients with Hepatocellular Carcinoma: A Real-World Study. J Hepatocell Carcinoma 2022; 9:621-631. [PMID: 35903756 PMCID: PMC9317376 DOI: 10.2147/jhc.s373112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the effect of early transarterial chemoembolization (TACE) refractoriness on hepatocellular carcinoma (HCC) patient survival and to explore whether viable lesions > 50% after two consecutive TACE treatments negatively affect the prognosis of HCC patients. Patients and Methods From January 2014 to August 2017, 323 HCC patients who received TACE as the initial treatment were analyzed. TACE refractoriness was diagnosed according to the Japan Society of Hepatology 2021 version. Propensity score matching (PSM) was used to create a 1:1 matched group (nonrefractoriness vs refractoriness). To determine survival outcomes and prognostic factors, the Kaplan-Meier method and Cox proportional hazards model were used. Results In total, 51.1% of patients developed early TACE refractoriness (n = 165). After PSM, 120 patients from each group were matched and analyzed. The median overall survival (OS) time of the early TACE refractoriness group was significantly shorter than that of the nonrefractory group [21 months (95% CI: 15.7–26.3) vs 34 months (95% CI: 27.5–40.5), p = 0.002]. Thirty-eight patients with viable lesions >50% after two consecutive TACE procedures were identified and matched with patients of non-refractoriness. No significant difference in median OS was observed [35 months (95% CI: 21.6–48.5) vs 31 months (95% CI: 25.4–36.6), p = 0.611]. Multivariate analysis revealed that the BCLC stage, tumor size, tumor capsule, tumor distribution, α-fetoprotein level (AFP), and early TACE refractoriness were independent risk factors for prognosis in HCC patients. Conclusion Early TACE refractoriness may shorten the OS of HCC patients. However, viable lesions >50% after two consecutive TACE treatments did not impair the survival of patients. It may be inappropriate to consider these patients as having developed TACE refractoriness.
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Affiliation(s)
- Chao Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yin-Gen Luo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hong-Cai Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhi-Hang Yao
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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17
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Garg T, Shrigiriwar A, Habibollahi P, Cristescu M, Liddell RP, Chapiro J, Inglis P, Camacho JC, Nezami N. Intraarterial Therapies for the Management of Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14143351. [PMID: 35884412 PMCID: PMC9322128 DOI: 10.3390/cancers14143351] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 12/11/2022] Open
Abstract
Image-guided locoregional therapies play a crucial role in the management of patients with hepatocellular carcinoma (HCC). Transarterial therapies consist of a group of catheter-based treatments where embolic agents are delivered directly into the tumor via their supplying arteries. Some of the transarterial therapies available include bland embolization (TAE), transarterial chemoembolization (TACE), drug-eluting beads-transarterial chemoembolization (DEB-TACE), selective internal radioembolization therapy (SIRT), and hepatic artery infusion (HAI). This article provides a review of pre-procedural, intra-procedural, and post-procedural aspects of each therapy, along with a review of the literature. Newer embolotherapy options and future directions are also briefly discussed.
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Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (T.G.); (R.P.L.)
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Peiman Habibollahi
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Mircea Cristescu
- Vascular and Interventional Radiology Division, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Robert P. Liddell
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (T.G.); (R.P.L.)
| | - Julius Chapiro
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06510, USA;
| | - Peter Inglis
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Juan C. Camacho
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL 34239, USA
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
- Correspondence:
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18
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He C, Yang J, Jin Z, Zhu Y, Hu W, Zeng L, Li X. An ALBI- and Ascites-Based Model to Predict Survival for BCLC Stage B Hepatocellular Carcinoma. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:1801230. [PMID: 35845571 PMCID: PMC9283054 DOI: 10.1155/2022/1801230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/06/2022] [Accepted: 06/10/2022] [Indexed: 01/27/2023]
Abstract
Background We aimed to develop a predictive model constituted with the ALBI grade, the ascites, and tumor burden related parameters in patients with BCLC stage B HCC. Methods Patients diagnosed as the BCLC stage B HCC were collected from a retrospective database. Construction and validation of the predictive model were performed based on multivariate Cox regression analysis. Predictive accuracy, discrimination (c-index), and fitness performance (calibration curve) of the model were compared with the other eight models. The decision curve analysis (DCA) was used to evaluate the clinical utility. Results A total of 1773 patients diagnosed as BCLC stage B HCC between 2007 and 2016 were included in the present study. The ALBI-AS grade, the AFP level, and the 8-and-14 grade were used for the development of a prognostic prediction model after multivariate analysis. The area under the receiver operator characteristic curve (AUROC) for overall survival at 1, 2, and 3 years predicted by the present model were 0.73, 0.69, and 0.67 in the training cohort. The concordance index (c-index) and the Aiken information criterion (AIC) were 0.68 and 6216.3, respectively. In the internal and external validation cohorts, the present model still revealed excellent predictive accuracy, discrimination, and fitness performance. Then the ALBI-AS based model was evaluated to be superior to other prognostic models with the highest AUROC, c-index, and lowest AIC values. Moreover, DCA also demonstrated that the present model was clinically beneficial. Conclusion The ALBI-AS grade is a novel predictor of survival for patients with BCLC stage B HCC.
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Affiliation(s)
- Cheng He
- Department of Hepatobiliary Surgery, Affiliated Hospital of Xiangnan University, Chenzhou, Hunan, China
| | - Jing Yang
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zheng Jin
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ying Zhu
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei Hu
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingfeng Zeng
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Xiaocheng Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan, China
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Bannangkoon K, Hongsakul K, Tubtawee T, Janjindamai P, Akkakrisee S, Piratvisuth T, Geater A. Decision-Making Scoring System for the Repetition of Conventional Transarterial Chemoembolization in Patients With Inoperable Hepatocellular Carcinoma. Clin Transl Gastroenterol 2022; 13:e00506. [PMID: 35905418 PMCID: PMC10476822 DOI: 10.14309/ctg.0000000000000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/18/2022] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Patients with unresectable hepatocellular carcinoma treated with conventional transarterial chemoembolization (cTACE) have heterogeneous tumor burden and liver function. Therefore, the selection of patients for repeated cTACE is challenging owing to different outcomes. This study aimed to establish a decision-making scoring system for repeated cTACE to guide further treatment. METHODS All patients with hepatocellular carcinoma who underwent cTACE between 2008 and 2019 were included and randomly assigned into training (n = 324) and validation (n = 162) cohorts. Tumor Size, number of Masses, Albumin-bilirubin score, baseline Alpha-fetoprotein level, and Response to initial cTACE session were selected to generate a "SMAART" score in the training cohort. Patients were stratified according to the SMAART score: low risk, 0-2; medium risk, 3-4; and high risk, 5-8. Prediction error curves based on the integrated Brier score and the Harrell C-index validated the SMAART scores and compared them with the Assessment for Retreatment with Transarterial chemoembolization (ART) score. RESULTS The low-risk group had the longest median overall survival of 39.0 months, followed by the medium-risk and high-risk groups of 21.2 months and 10.5 months, respectively, with significant differences (P < 0.001). The validation cohort had similar results. The high-risk group had 63.1% TACE refractory cases. The Harrell C-indexes were 0.562 and 0.665 and the integrated Brier scores were 0.176 and 0.154 for ART and SMAART scores, respectively. DISCUSSION The SMAART score can aid clinicians in selecting appropriate candidates for subsequent cTACE. A SMAART score of ≥5 after the first cTACE session identified patients with poor prognosis who may not benefit from additional cTACE sessions.
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Affiliation(s)
- Kittipitch Bannangkoon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand;
| | - Keerati Hongsakul
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand;
| | - Teeravut Tubtawee
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand;
| | - Phurich Janjindamai
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand;
| | - Surasit Akkakrisee
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand;
| | - Teerha Piratvisuth
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand;
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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20
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Hatzidakis A, Müller L, Krokidis M, Kloeckner R. Local and Regional Therapies for Hepatocellular Carcinoma and Future Combinations. Cancers (Basel) 2022; 14:cancers14102469. [PMID: 35626073 PMCID: PMC9139740 DOI: 10.3390/cancers14102469] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Percutaneous interventional radiological techniques offer many alternatives for treatment of Hepatocellular Carcinoma (HCC) using local anesthesia and sedation. These methods aim to destroy the malignant tumors locally without affecting the non-malignant liver. In this way, complications are kept low and patient recovery is quick. Indications depend on tumor size, type and stage, as well as patient’s condition, liver function and co-morbidities. In recent years, a lot of research has been made in combining such approaches with immune therapy, but there is still much work to be done. This manuscript tries to analyze where we stand today and explain, using a comprehensive algorithm, the treatment options for each different clinical condition. Abstract Background: Hepatocellular carcinoma (HCC) can be treated by local and regional methods of percutaneous interventional radiological techniques. Indications depend on tumor size, type and stage, as well as patient’s condition, liver function and co-morbidities. According to international classification systems such as Barcelona Clinic Liver Cancer (BCLC) classification, very early, early or intermediate staged tumors can be treated either with ablative methods or with transarterial chemoembolization (TACE), depending on tumor characteristics. The combination of both allows for individualized forms of treatment with the ultimate goal of improving response and survival. In recent years, a lot of research has been carried out in combining locoregional approaches with immune therapy. Although recent developments in systemic treatment, especially immunotherapy, seem quite promising and have expanded possible combined treatment options, there is still not enough evidence in their favor. The aim of this review is to provide a comprehensive up-to-date overview of all these techniques, explaining indications, contraindications, technical problems, outcomes, results and complications. Moreover, combinations of percutaneous treatment with each other or with immunotherapy and future options will be discussed. Use of all those methods as down-staging or bridging solutions until surgery or transplantation are taken into consideration will also be reviewed. Conclusion: Local and regional therapies remain a mainstay of curative and palliative treatment of patients with HCC. Currently, evidence on potential combination of the local and regional treatment options with each other as well as with other treatment modalities is growing and has the potential to further individualize HCC therapy. To identify the most suitable treatment option out of these new various options, a repeated interdisciplinary discussion of each case by the tumor board is of utmost importance.
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Affiliation(s)
- Adam Hatzidakis
- Department of Radiology, AHEPA University Hospital of Thessaloniki, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence:
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (R.K.)
| | - Miltiadis Krokidis
- 1st Department of Radiology, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (R.K.)
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21
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Lin PT, Teng W, Jeng WJ, Chen WT, Hsieh YC, Huang CH, Lui KW, Hung CF, Wang CT, Chai PM, Lin CC, Lin CY, Lin SM, Sheen IS. Dynamic Change of Albumin-Bilirubin Score Is Good Predictive Parameter for Prognosis in Chronic Hepatitis C-hepatocellular Carcinoma Patients Receiving Transarterial Chemoembolization. Diagnostics (Basel) 2022; 12:665. [PMID: 35328217 PMCID: PMC8947376 DOI: 10.3390/diagnostics12030665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 02/08/2023] Open
Abstract
Background and Aims: The Albumin-Bilirubin (ALBI) grade is a good index for liver function evaluation and is also associated with the outcomes of hepatocellular carcinoma patients receiving TACE. However, the correlation between the dynamic change to the ALBI score and clinical outcome is seldom discussed. Therefore, this study aimed to investigate the application of ALBI grade and dynamic change of ALBI grade (delta ALBI grade) after first TACE for prognosis prediction in HCC patients with chronic hepatitis C infection. Method: From January 2005 to December 2015, newly diagnosed naive chronic hepatitis C-hepatocellular carcinoma (CHC-HCC) patients who were treated with TACE as the initial treatment at the Chang Gung Memorial Hospital, Linkou Medical Center, were retrospectively recruited. The pre-treatment host factors, tumor status and noninvasive markers were collected. The Cox regression model was used to identify independent predictors of overall survival and tumor recurrence. Results: Among 613 treatment-naive CHC-HCC patients, 430 patients died after repeated TACE during a median follow-up of 26.9 months. Complete remission after repeated TACE occurred in 46.2% patients, and 208 patients (33.9%) had tumor recurrence, with a median recurrence-free interval of 8.5 months. In Cox regression analysis, ALBI grade II/III (aHR: 1.088, p = 0.035) and increased delta ALBI grade (aHR: 1.456, p = 0.029) were independent predictive factors for tumor recurrence. Furthermore, ALBI grade II/III (aHR: 1.451, p = 0.005) and increased delta ALBI grade during treatment (aHR: 1.436, p = 0.006) were predictive factors for mortality, while achieving complete response after repeated TACE (aHR: 0.373, p < 0.001) and anti-viral therapy (aHR: 0.580, p = 0.002) were protective factors for mortality. Conclusion: Both ALBI and delta ALBI grade are independent parameters to predict survival and tumor recurrence of CHC-HCC patients receiving TACE treatment.
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Affiliation(s)
- Po-Ting Lin
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-T.L.); (W.-J.J.); (W.-T.C.); (Y.-C.H.); (C.-H.H.); (C.-C.L.); (S.-M.L.); (I.-S.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
| | - Wei Teng
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-T.L.); (W.-J.J.); (W.-T.C.); (Y.-C.H.); (C.-H.H.); (C.-C.L.); (S.-M.L.); (I.-S.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei City 11265, Taiwan
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-T.L.); (W.-J.J.); (W.-T.C.); (Y.-C.H.); (C.-H.H.); (C.-C.L.); (S.-M.L.); (I.-S.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei City 11265, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Ting Chen
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-T.L.); (W.-J.J.); (W.-T.C.); (Y.-C.H.); (C.-H.H.); (C.-C.L.); (S.-M.L.); (I.-S.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
| | - Yi-Chung Hsieh
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-T.L.); (W.-J.J.); (W.-T.C.); (Y.-C.H.); (C.-H.H.); (C.-C.L.); (S.-M.L.); (I.-S.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
| | - Chien-Hao Huang
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-T.L.); (W.-J.J.); (W.-T.C.); (Y.-C.H.); (C.-H.H.); (C.-C.L.); (S.-M.L.); (I.-S.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
| | - Kar-Wai Lui
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
- Department of Radiology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chen-Fu Hung
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
- Department of Radiology, Tucheng Composite Municipal Hospital, New Taipei City 236, Taiwan
| | - Ching-Ting Wang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
- Department of Nursing, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Pei-Mei Chai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
- Department of Nursing, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-T.L.); (W.-J.J.); (W.-T.C.); (Y.-C.H.); (C.-H.H.); (C.-C.L.); (S.-M.L.); (I.-S.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-T.L.); (W.-J.J.); (W.-T.C.); (Y.-C.H.); (C.-H.H.); (C.-C.L.); (S.-M.L.); (I.-S.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.L.); (C.-F.H.); (C.-T.W.); (P.-M.C.)
| | - Shi-Ming Lin
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-T.L.); (W.-J.J.); (W.-T.C.); (Y.-C.H.); (C.-H.H.); (C.-C.L.); (S.-M.L.); (I.-S.S.)
- Department of Radiology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - I-Shyan Sheen
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (P.-T.L.); (W.-J.J.); (W.-T.C.); (Y.-C.H.); (C.-H.H.); (C.-C.L.); (S.-M.L.); (I.-S.S.)
- Department of Radiology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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22
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Müller L, Hahn F, Auer TA, Fehrenbach U, Gebauer B, Haubold J, Zensen S, Kim MS, Eisenblätter M, Diallo TD, Bettinger D, Steinle V, Chang DH, Zopfs D, Pinto dos Santos D, Kloeckner R. Tumor Burden in Patients With Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Head-to-Head Comparison of Current Scoring Systems. Front Oncol 2022; 12:850454. [PMID: 35280804 PMCID: PMC8904349 DOI: 10.3389/fonc.2022.850454] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/28/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives Recently, several scoring systems for prognosis prediction based on tumor burden have been promoted for patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). This multicenter study aimed to perform the first head-to-head comparison of three scoring systems. Methods We retrospectively enrolled 849 treatment-naïve patients with HCC undergoing TACE at six tertiary care centers between 2010 and 2020. The tumor burden score (TBS), the Six-and-Twelve score (SAT), and the Seven-Eleven criteria (SEC) were calculated based on the maximum lesion size and the number of tumor nodes. All scores were compared in univariate and multivariate regression analyses, adjusted for established risk factors. Results The median overall survival (OS) times were 33.0, 18.3, and 12.8 months for patients with low, medium, and high TBS, respectively (p<0.001). The median OS times were 30.0, 16.9, and 10.2 months for patients with low, medium, and high SAT, respectively (p<0.001). The median OS times were 27.0, 16.7, and 10.5 for patients with low, medium, and high SEC, respectively (p<0.001). In a multivariate analysis, only the SAT remained an independent prognostic factor. The C-Indexes were 0.54 for the TBS, 0.59 for the SAT, and 0.58 for the SEC. Conclusion In a direct head-to-head comparison, the SAT was superior to the TBS and SEC in survival stratification and predictive ability. Therefore, the SAT can be considered when estimating the tumor burden. However, all three scores showed only moderate predictive power. Therefore, tumor burden should only be one component among many in treatment decision making.
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Affiliation(s)
- Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Timo Alexander Auer
- Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany
| | - Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sebastian Zensen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Moon-Sung Kim
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michel Eisenblätter
- Department of Diagnostic and Interventional Radiology, Freiburg University Hospital, Freiburg, Germany
| | - Thierno D. Diallo
- Department of Diagnostic and Interventional Radiology, Freiburg University Hospital, Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Verena Steinle
- Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany
| | - De-Hua Chang
- Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany
| | - David Zopfs
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | | | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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23
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Müller L, Hahn F, Jungmann F, Mähringer-Kunz A, Stoehr F, Halfmann MC, Pinto Dos Santos D, Hinrichs J, Auer TA, Düber C, Kloeckner R. Quantitative washout in patients with hepatocellular carcinoma undergoing TACE: an imaging biomarker for predicting prognosis? Cancer Imaging 2022; 22:5. [PMID: 35016731 PMCID: PMC8753936 DOI: 10.1186/s40644-022-00446-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/31/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The delayed percentage attenuation ratio (DPAR) was recently identified as a novel predictor of an early complete response in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). In this study, we aimed to validate the role of DPAR as a predictive biomarker for short-, mid-, and long-term outcomes after TACE. METHODS We retrospectively reviewed laboratory and imaging data for 103 treatment-naïve patients undergoing initial TACE treatment at our tertiary care center between January 2016 and November 2020. DPAR and other washin and washout indices were quantified in the triphasic computed tomography performed before the initial TACE. The correlation of DPAR and radiologic response was investigated. Furthermore, the influence of DPAR on the 6-, 12-, 18-, and 24-month survival rates and the median overall survival (OS) was compared to other established washout indices and estimates of tumor burden and remnant liver function. RESULTS The DPAR was significantly of the target lesions (TLs) with objective response to TACE after the initial TACE session was significantly higher compared to patients with stable disease (SD) or progressive disease (PD) (125 (IQR 118-134) vs 110 (IQR 103-116), p < 0.001). Furthermore, the DPAR was significantly higher in patients who survived the first 6 months after TACE (122 vs. 115, p = 0.04). In addition, the number of patients with a DPAR > 120 was significantly higher in this group (n = 38 vs. n = 8; p = 0.03). However, no significant differences were observed in the 12-, 18-, and 24-month survival rates after the initial TACE. Regarding the median OS, no significant difference was observed for patients with a high DPAR compared to those with a low DPAR (18.7 months vs. 12.7 months, p = 0.260). CONCLUSIONS Our results confirm DPAR as the most relevant washout index for predicting the short-term outcome of patients with HCC undergoing TACE. However, DPAR and the other washout indices were not predictive of mid- and long-term outcomes.
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Affiliation(s)
- Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Florian Jungmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Aline Mähringer-Kunz
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Fabian Stoehr
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Daniel Pinto Dos Santos
- Department of Radiology, University Hospital Cologne, Cologne, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jan Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Timo A Auer
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckst. 1, 55131, Mainz, Germany.
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Cheng S, Yu X, Liu S, Jin Z, Xue H, Wang Z, Xie P. Development of a Prognostic Nomogram in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus Following Trans-Arterial Chemoembolization with Drug-Eluting Beads. Cancer Manag Res 2022; 13:9367-9377. [PMID: 34992462 PMCID: PMC8713724 DOI: 10.2147/cmar.s341672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/10/2021] [Indexed: 12/16/2022] Open
Abstract
Objective To develop and validate a prognostic nomogram in eastern patients with hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) receiving trans-arterial chemoembolization with drug-eluting beads (DEB-TACE). Methods This retrospective study included 200 patients with training cohort (n = 118) from institution 1 and test cohort (n = 82) from institution 2. All these patients received first-line DEB-TACE between October 2016 and October 2018. Multivariate Cox proportional hazard regression analysis was performed on the training cohort to reveal the independent prognostic factors, and then prognostic nomograms were developed. In order to evaluate the performance of the nomogram comprehensively in both the training and test cohorts, C-index, Kaplan–Meier curve with Log rank test, receiver operating characteristic curve (ROC), calibration plot, and decision curve analysis (DCA) were performed. Results Tumor number, serum γ-glutamyl transferase (GGT) level, and level of PVTT were independent risk factors of prognosis. A nomogram was constructed to predict 6-, 12- and 18-month overall survival (OS) based on these identified prognostic factors. C-indexes of the nomogram were 0.88 (95% confidence interval [CI], 0.79–0.97) in the training cohort and 0.87 (95% CI, 0.75–0.99) in the test cohort. The Kaplan–Meier curve analysis showed that the nomogram was able to separate patients into low- and high-risk subgroups. ROC curves for the nomogram at 6-, 12- and 18-month showed satisfied discrimination, with an AUC of 0.765, 0.803 and 0.809 in the training cohort, respectively, and 0.772, 0.724 and 0.746 in the test cohort, respectively. The calibration curve demonstrated good agreement between predicted and actual survival rates in the training and test cohorts. The decision curve showed good performance of the nomogram in terms of clinical application. Conclusion We developed and validated a nomogram that was accurate and clinically useful in eastern patients with HBV-associated HCC with PVTT who underwent DEB-TACE.
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Affiliation(s)
- Sihang Cheng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Department of Radiology, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, People's Republic of China
| | - Xiang Yu
- Department of Radiology, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, People's Republic of China
| | - Siyun Liu
- Pharmaceutical Diagnostics, GE Healthcare, Beijing, People's Republic of China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhiwei Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Ping Xie
- Department of Radiology, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, People's Republic of China
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Kim DS, Kim BK, Lee JS, Lee HW, Park JY, Kim DY, Ahn SH, Kim SU. Validation of Pre-/Post-TACE-Predict Models among Patients with Hepatocellular Carcinoma Receiving Transarterial Chemoembolization. Cancers (Basel) 2021; 14:67. [PMID: 35008231 PMCID: PMC8750487 DOI: 10.3390/cancers14010067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022] Open
Abstract
This study attempted to validate the prognostic performance of the proposed Pre- and Post-TACE (transarterial chemoembolization)-Predict models, in comparison with other models for prognostication. One-hundred-and-eighty-seven patients with HCC who underwent TACE were recruited. Regarding overall survival (OS), the predictive performance of the Pre-TACE-Predict model (one-year integrated area under the curve (iAUC) 0.685 (95% confidence interval (CI) 0.593-0.772)) was better than that of the Post-TACE-Predict model (iAUC 0.659 (95% CI 0.580-0.742)). However, there was no significant statistical difference between two models at any time point. For comparison between models using pre-treatment factors, the modified hepatoma arterial embolization prognostic (mHAP)-II model demonstrated significantly better predictive performance at one year (iAUC 0.767 (95% CI 0.683-0.847)) compared with Pre-TACE-Predict. For comparison between models using first TACE response, the SNACOR model was significantly more predictive at one year (iAUC 0.778 (95% CI 0.687-0.866) vs. 0.659 (95% CI 0.580-0.742), respectively) and three years (iAUC 0.707 (95% CI 0.646-0.770) vs. 0.624 (95% CI 0.564-0.688), respectively) than the Post-TACE-Predict model. mHAP-II and SNACOR may be preferred over the Pre- and Post-TACE-Predict models, respectively, considering their similar or better performance and the ease of application.
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Affiliation(s)
- David Sooik Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (D.S.K.); (B.K.K.); (J.S.L.); (H.W.L.); (J.Y.P.); (D.Y.K.); (S.H.A.)
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (D.S.K.); (B.K.K.); (J.S.L.); (H.W.L.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
- Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea
| | - Jae Seung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (D.S.K.); (B.K.K.); (J.S.L.); (H.W.L.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
- Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (D.S.K.); (B.K.K.); (J.S.L.); (H.W.L.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
- Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (D.S.K.); (B.K.K.); (J.S.L.); (H.W.L.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
- Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (D.S.K.); (B.K.K.); (J.S.L.); (H.W.L.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
- Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (D.S.K.); (B.K.K.); (J.S.L.); (H.W.L.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
- Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (D.S.K.); (B.K.K.); (J.S.L.); (H.W.L.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
- Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea
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Hu S, Gan W, Qiao L, Ye C, Wu D, Liao B, Yang X, Jiang X. A New Prognostic Algorithm Predicting HCC Recurrence in Patients With Barcelona Clinic Liver Cancer Stage B Who Received PA-TACE. Front Oncol 2021; 11:742630. [PMID: 34745962 PMCID: PMC8566809 DOI: 10.3389/fonc.2021.742630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/27/2021] [Indexed: 01/05/2023] Open
Abstract
Background Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) is effective in preventing the recurrence of hepatocellular carcinoma (HCC) in patients treated with surgery. However, there is a lack of reports studying the risk factors associated with recurrence in HCC patients who received PA-TACE. In this study, we identified the independent risk factors for recurrence of HCC patients who received PA-TACE. We also developed a novel, effective, and valid nomogram to predict the individual probability of recurrence, 1, 3, and 5 years after PA-TACE. Methods A retrospective study was performed to identify the independent risk factors for recurrence of HCC in a group of 502 patients diagnosed in stage B based on the Barcelona Clinic Liver Cancer (BCLC) evaluation system for HCC that underwent curative resections. Then, subgroup analysis was performed for 184 patients who received PA-TACE, who were included in the training cohort. The other 147 HCC patients were included in a validation cohort. A recurrence-free survival (RFS)-predicting nomogram was constructed, and results were assessed using calibration and decision curves and a time-dependent AUC diagram. Results PA-TACE was shown to be a significant independent prognostic value for patients with BCLC stage B [p < 0.001, hazard ratio (HR) = 0.508, 95% CI = 0.375–0.689 for OS, p = 0.002; HR = 0.670, 95%CI = 0.517–0.868 for RFS]. Alpha fetoprotein (AFP), tumor number, tumor size, microvascular invasion (MVI), and differentiation were considered as independent risk factors for RFS in the training cohort, and these were further confirmed in the validation cohort. Next, a nomogram was constructed to predict RFS. The C-index for RFS in the nomogram was 0.721 (95% CI = 0.718–0.724), which was higher than SNACOR, HAP, and CHIP scores (0.587, 0.573, and 0.607, respectively). Calibration and decision curve analyses and a time-dependent AUC diagram were used. Our nomogram showed stronger performance than these other nomograms in both the training and validation cohorts. Conclusions HCC patients diagnosed as stage B according to BCLC may benefit from PA-TACE after surgery. The RFS nomogram presented here provides an accurate and reliable prognostic model to monitor recurrence. Patients with a high recurrence score based on the nomogram should receive additional high-end imaging exams and shorter timeframes in between follow-up visits.
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Affiliation(s)
- Shuyang Hu
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Wei Gan
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Liver Cancer Institute, Zhongshan Hospital and Shanghai Medical School, Fudan University, Key Laboratory for Carcinogenesis & Cancer Invasion, The Chinese Ministry of Education, Shanghai, China
| | - Liang Qiao
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Cheng Ye
- Medical Center of Fudan University, Shanghai, China
| | - Demin Wu
- Department of Health Physical Examination, Shanghai Electric Power Hospital, Shanghai, China
| | - Boyi Liao
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Xiaoyu Yang
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Xiaoqing Jiang
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
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Kim GH, Kim JH, Shim JH, Ko HK, Chu HH, Shin JH, Yoon HK, Ko GY, Gwon DI. Chemoembolization for Single Large Hepatocellular Carcinoma with Preserved Liver Function: Analysis of Factors Predicting Clinical Outcomes in a 302 Patient Cohort. Life (Basel) 2021; 11:840. [PMID: 34440584 PMCID: PMC8400325 DOI: 10.3390/life11080840] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to define the role of transcatheter arterial chemoembolization (TACE) in patients with a single large hepatocellular carcinoma (HCC) and define the patient groups benefiting from TACE. Treatment-naïve patients with preserved liver function who received TACE as the first-line treatment for single large (>5 cm) HCC without macrovascular invasion and extrahepatic metastasis between 2007 and 2019 were retrospectively analyzed. Overall survival, progression-free survival, radiologic tumor response, complications, and predictors of survival were analyzed using multivariate analysis, and then a pretreatment risk-prediction model was created using the four predictive factors of tumor size, tumor type, ALBI grade, and ECOG performance status. Patients with scores of 0 (n = 54), 1-2 (n = 170), and 3-6 (n = 78) according to the model were classified as low-, intermediate-, and high-risk, respectively. The corresponding median OS values were 141, 55, and 28 months, respectively. The percentage of major complications increased as tumor size increased (4-21%). Asymptomatic, nodular HCC patients with a tumor size of 5-7 cm and ALBI grade 1 benefited the most from TACE. By contrast, the value of TACE in the treatment of single huge HCC (>10 cm) with high complication rates remains unclear.
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Affiliation(s)
- Gun Ha Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (G.H.K.); (H.-K.K.); (H.H.C.); (J.H.S.); (H.-K.Y.); (G.-Y.K.); (D.I.G.)
| | - Jin Hyoung Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (G.H.K.); (H.-K.K.); (H.H.C.); (J.H.S.); (H.-K.Y.); (G.-Y.K.); (D.I.G.)
| | - Ju Hyun Shim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea;
| | - Heung-Kyu Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (G.H.K.); (H.-K.K.); (H.H.C.); (J.H.S.); (H.-K.Y.); (G.-Y.K.); (D.I.G.)
| | - Hee Ho Chu
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (G.H.K.); (H.-K.K.); (H.H.C.); (J.H.S.); (H.-K.Y.); (G.-Y.K.); (D.I.G.)
| | - Ji Hoon Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (G.H.K.); (H.-K.K.); (H.H.C.); (J.H.S.); (H.-K.Y.); (G.-Y.K.); (D.I.G.)
| | - Hyun-Ki Yoon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (G.H.K.); (H.-K.K.); (H.H.C.); (J.H.S.); (H.-K.Y.); (G.-Y.K.); (D.I.G.)
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (G.H.K.); (H.-K.K.); (H.H.C.); (J.H.S.); (H.-K.Y.); (G.-Y.K.); (D.I.G.)
| | - Dong Il Gwon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (G.H.K.); (H.-K.K.); (H.H.C.); (J.H.S.); (H.-K.Y.); (G.-Y.K.); (D.I.G.)
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Müller L, Hahn F, Mähringer-Kunz A, Stoehr F, Gairing SJ, Foerster F, Weinmann A, Galle PR, Mittler J, Pinto dos Santos D, Pitton MB, Düber C, Kloeckner R. Refining Prognosis in Chemoembolization for Hepatocellular Carcinoma: Immunonutrition and Liver Function. Cancers (Basel) 2021; 13:3961. [PMID: 34439116 PMCID: PMC8392843 DOI: 10.3390/cancers13163961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 02/08/2023] Open
Abstract
A combination of albumin-bilirubin (ALBI) grading and the Prognostic Nutritional Index (PNI) was identified recently as a highly predictive tool for patients with hepatocellular carcinoma (HCC) undergoing tumor ablation. The present study evaluated this combination in patients undergoing transarterial chemoembolization (TACE). Between 2010 and 2020, 280 treatment-naïve patients were retrospectively identified. The influence of ALBI grade, PNI and the novel ALBI-PNI on the median overall survival (OS) was assessed. In the next step, the prognostic ability of the combined approach was compared to established scoring systems. Both ALBI grade 2-3 and a low PNI were highly predictive for median OS (ALBI grade 1-3: 39.0 vs. 16.3 vs. 5.4 months, p < 0.001; high vs. low PNI: 21.4 vs. 7.5, p < 0.001). The combination of both resulted in a median OS of 39.0, 20.1, 10.3, and 5.4 months (p < 0.001). With a Concordance Index (C-Index) of 0.69, ALBI-PNI outperformed each individual score (ALBI 0.65, PNI 0.64) and was also better than BCLC, HAP, mHAP-II, and the Six-and-Twelve score (C-Indices 0.66, 0.60, 0.59, and 0.55). Thus, the easy-to-calculate ALBI-PNI may be a promising stratification tool for patients with HCC undergoing TACE, reflecting both immunonutritive status and liver function.
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Affiliation(s)
- Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.H.); (A.M.-K.); (F.S.); (M.B.P.); (C.D.)
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.H.); (A.M.-K.); (F.S.); (M.B.P.); (C.D.)
| | - Aline Mähringer-Kunz
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.H.); (A.M.-K.); (F.S.); (M.B.P.); (C.D.)
| | - Fabian Stoehr
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.H.); (A.M.-K.); (F.S.); (M.B.P.); (C.D.)
| | - Simon Johannes Gairing
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.J.G.); (F.F.); (A.W.); (P.R.G.)
| | - Friedrich Foerster
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.J.G.); (F.F.); (A.W.); (P.R.G.)
| | - Arndt Weinmann
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.J.G.); (F.F.); (A.W.); (P.R.G.)
| | - Peter Robert Galle
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.J.G.); (F.F.); (A.W.); (P.R.G.)
| | - Jens Mittler
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany;
| | | | - Michael Bernhard Pitton
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.H.); (A.M.-K.); (F.S.); (M.B.P.); (C.D.)
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.H.); (A.M.-K.); (F.S.); (M.B.P.); (C.D.)
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.H.); (A.M.-K.); (F.S.); (M.B.P.); (C.D.)
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Chu HH, Kim JH, Shim JH, Gwon DI, Ko HK, Shin JH, Ko GY, Yoon HK, Kim N. Neutrophil-to-Lymphocyte Ratio as a Biomarker Predicting Overall Survival after Chemoembolization for Intermediate-Stage Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:2830. [PMID: 34204125 PMCID: PMC8201147 DOI: 10.3390/cancers13112830] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/23/2022] Open
Abstract
The clinical impact of neutrophil-to-lymphocyte ratio (NLR) in predicting outcomes in hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) remain unclear, and additional large-scale studies are required. This retrospective study evaluated outcomes in treatment-naïve patients who received TACE as first-line treatment for intermediate-stage HCC between 2008 and 2017. Patients who underwent TACE before and after 2013 were assigned to the development (n = 495) and validation (n = 436) cohorts, respectively. Multivariable Cox analysis identified six factors predictive of outcome, including NLR, which were used to create models predictive of overall survival (OS) in the development cohort. Risk scores of 0-3, 4-7, and 8-12 were defined as low, intermediate, and high risk, respectively. Median OS times in the low-, medium-, and high-risk groups in the validation cohort were 48.1, 24.3, and 9.7 months, respectively (p < 0.001). Application to the validation cohort of time-dependent ROC curves for models predictive of OS showed AUC values of 0.72 and 0.70 at 3 and 5 years, respectively. Multivariable logistic regression analysis found that NLR ≥ 3 was a significant predictor (odds ratio, 3.4; p < 0.001) of disease progression 6 months after TACE. Higher baseline NLR was predictive of poor prognosis in patients who underwent TACE for intermediate-stage HCC.
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Affiliation(s)
- Hee Ho Chu
- Asan Medical Center, Department of Radiology, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.H.C.); (D.I.G.); (H.-K.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Jin Hyoung Kim
- Asan Medical Center, Department of Radiology, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.H.C.); (D.I.G.); (H.-K.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Ju Hyun Shim
- Liver Center, Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Dong Il Gwon
- Asan Medical Center, Department of Radiology, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.H.C.); (D.I.G.); (H.-K.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Heung-Kyu Ko
- Asan Medical Center, Department of Radiology, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.H.C.); (D.I.G.); (H.-K.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Ji Hoon Shin
- Asan Medical Center, Department of Radiology, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.H.C.); (D.I.G.); (H.-K.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Gi-Young Ko
- Asan Medical Center, Department of Radiology, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.H.C.); (D.I.G.); (H.-K.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Hyun-Ki Yoon
- Asan Medical Center, Department of Radiology, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.H.C.); (D.I.G.); (H.-K.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Nayoung Kim
- Asan Medical Center, Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea;
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30
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Müller L, Stoehr F, Mähringer-Kunz A, Hahn F, Weinmann A, Kloeckner R. Current Strategies to Identify Patients That Will Benefit from TACE Treatment and Future Directions a Practical Step-by-Step Guide. J Hepatocell Carcinoma 2021; 8:403-419. [PMID: 34012930 PMCID: PMC8128497 DOI: 10.2147/jhc.s285735] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 12/11/2022] Open
Abstract
Treatment of hepatocellular carcinoma (HCC) depends on the stage of disease. In the Western Hemisphere, the Barcelona Clinic Liver Cancer classification (BCLC) is the preferred staging system. Approximately one-third of patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. However, the intermediate-stage comprises a heterogeneous subgroup of patients with considerable differences in tumor burden and liver function. In addition, differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate further evaluation of these patients. Due to these differences, not all patients benefit equally from TACE. Several tools and scoring systems have been devised to provide decision-making support. All of these have shown promising initial results but failed external evaluation and have not been translated to the clinic. Nevertheless, criteria for objectifying treatment decisions in daily clinical practice are needed in all stages of disease. Therefore, this review provides a concise practical step-by-step guide on current strategies for patient selection and decision-making, with a focus on TACE, to critically evaluate the existing decision-support tools and provide a summary of the latest updates in the field.
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Affiliation(s)
- Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Fabian Stoehr
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Aline Mähringer-Kunz
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Chang K, Chi C, Lee R, Hou M, Huang Y, Lee I. Efficacy and predictors of survival in patients with solitary hepatocellular carcinoma larger than 5 cm undergoing transarterial chemoembolization. ADVANCES IN DIGESTIVE MEDICINE 2021. [DOI: 10.1002/aid2.13278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ke‐Bin Chang
- Division of Gastroenterology and Hepatology, Department of Medicine Keelung Hospital, Ministry of Health and Welfare Keelung Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
- Faculty of Medicine National Yang Ming Chiao Tung University School of Medicine Taipei Taiwan
| | - Chen‐Ta Chi
- Division of Gastroenterology and Hepatology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
- Faculty of Medicine National Yang Ming Chiao Tung University School of Medicine Taipei Taiwan
| | - Rheun‐Chuan Lee
- Department of Radiology Taipei Veterans General Hospital Taipei Taiwan
| | - Ming‐Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
- Faculty of Medicine National Yang Ming Chiao Tung University School of Medicine Taipei Taiwan
| | - Yi‐Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
- Faculty of Medicine National Yang Ming Chiao Tung University School of Medicine Taipei Taiwan
- Institute of Clinical Medicine National Yang Ming Chiao Tung University Taipei Taiwan
| | - I‐Cheng Lee
- Division of Gastroenterology and Hepatology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
- Faculty of Medicine National Yang Ming Chiao Tung University School of Medicine Taipei Taiwan
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Chen L, Yu CX, Zhong BY, Zhu HD, Jin ZC, Zhu GY, Zhang Q, Ni CF, Teng GJ. Development of TACE Refractoriness Scores in Hepatocellular Carcinoma. Front Mol Biosci 2021; 8:615133. [PMID: 33981722 PMCID: PMC8109267 DOI: 10.3389/fmolb.2021.615133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/27/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose: To identify the independent risk factors for transarterial embolization (TACE) refractoriness and to develop a novel TACE refractoriness score and nomogram for predicting TACE refractoriness in patients with hepatocellular carcinoma (HCC). Methods: Between March 2006 and March 2016, HCC patients who underwent TACE monotherapy as initial treatment at two hospitals formed the study cohort and validation cohort. The criteria of TACE refractoriness followed the Japan Society of Hepatology 2014 version of TACE refractoriness. In the study cohort, the independent risk factors for TACE refractoriness were identified, and TACE refractoriness score and nomogram were then developed. The accuracy of the systems was validated externally in the validation cohort. Results: In total, 113 patients from hospital A formed the study cohort and 122 patients from hospital B formed the validation cohort. In the study cohort, 82.3% of the patients (n = 93) developed TACE refractoriness with a median overall survival (OS) of 540 days (95% CI, 400.8–679.1), and the remaining 20 patients in the TACE-non-refractory group had a median OS of 1,257 days (95% CI, 338.8–2,175.2) (p = 0.019). The median time for developing TACE refractoriness was 207 days (95% CI, 134.8–279.2), and a median number of two TACE procedures were performed after refractoriness developed. The independent risk factors for TACE refractoriness were the number of tumors and bilobular invasion of HCC. TACE refractoriness scores <3.5 indicated a lower incidence of TACE refractoriness, whereas scores >3.5 points indicated a higher incidence (p < 0.001). In the validation cohort, 77.9% of the patients (n = 95) developed TACE refractoriness with a median OS of 568 days (95% CI, 416.3–719.7), and a median OS of 1,324 days was observed in the TACE-non-refractory group (n = 27; 95% CI, 183.5–2,464.5). Conclusions: TACE refractoriness impairs the OS of HCC patients. The number of tumors and bilobular invasion status were independent risk factors for TACE refractoriness. The TACE refractoriness score can be an effective tool and easy approach to predict the risk of TACE refractoriness status.
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Affiliation(s)
- Li Chen
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Chen-Xi Yu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Bin-Yan Zhong
- Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hai-Dong Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Zhi-Cheng Jin
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Guang-Yu Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Qi Zhang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Cai-Fang Ni
- Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Prince D, Liu K, Xu W, Chen M, Sun JY, Lu XJ, Ji J. Management of patients with intermediate stage hepatocellular carcinoma. Ther Adv Med Oncol 2020; 12:1758835920970840. [PMID: 33224278 PMCID: PMC7649909 DOI: 10.1177/1758835920970840] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) causes a significant health burden globally and its impact is expected to increase in the coming years. Intermediate stage HCC, as defined by the Barcelona Clinic Liver Cancer (BCLC) system stage B, represents up to 30% of patients at diagnosis and encompasses a broad spectrum of tumor burden. Several attempts have been made to further subclassify this heterogenous group. The current standard of care recommended by BCLC for intermediate stage HCC patients is transarterial chemoembolization (TACE), with modest outcomes reported. While refinements have been made to TACE technique and patient selection, it remains non-curative. In the real-world setting, only 60% of patients with intermediate stage HCC receive TACE, with the remainder deviating to a range of other therapies that have shown promise in select patient subgroups. These include curative treatments (resection, ablation, and liver transplantation), radiotherapy (stereotactic and radioembolization), systemic therapies, and their combination. In this review, we summarize the classifications and current management for patients with intermediate stage HCC as well as highlight recent key developments in this space.
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Affiliation(s)
- David Prince
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Liver Injury and Cancer Program, The Centenary Institute, Sydney, NSW, Australia
| | - Weiqi Xu
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Minjiang Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University/Affiliated Lishui Hospital of Zhejiang University/The Central Hospital of Zhejiang Lishui, Lishui, China
- Department of Radiology, the Fifth Affiliated Hospital of Wenzhou Medical University/Affiliated Lishui Hospital of Zhejiang University/The Central Hospital of Zhejiang Lishui, Lishui, China
| | - Jin-Yu Sun
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Sparkfire Scientific Research Group, Nanjing Medical University, Nanjing, China
| | - Xiao-Jie Lu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University/Affiliated Lishui Hospital of Zhejiang University/The Central Hospital of Zhejiang Lishui, Lishui 323000, China
- Department of Radiology, the Fifth Affiliated Hospital of Wenzhou Medical University/Affiliated Lishui Hospital of Zhejiang University/The Central Hospital of Zhejiang Lishui, Lishui, 323000, China
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Chang Y, Jeong SW, Young Jang J, Jae Kim Y. Recent Updates of Transarterial Chemoembolilzation in Hepatocellular Carcinoma. Int J Mol Sci 2020; 21:E8165. [PMID: 33142892 PMCID: PMC7662786 DOI: 10.3390/ijms21218165] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 12/24/2022] Open
Abstract
Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC). In this review, we summarize recent updates on the use of TACE for HCC. TACE can be performed using two techniques; conventional TACE (cTACE) and drug-eluting beads using TACE (DEB-TACE). The anti-tumor effect of the two has been reported to be similar; however, DEB-TACE carries a higher risk of hepatic artery and biliary injuries and a relatively lower risk of post-procedural pain than cTACE. TACE can be used for early stage HCC if other curative treatments are not feasible or as a neoadjuvant treatment before liver transplantation. TACE can also be considered for selected patients with limited portal vein thrombosis and preserved liver function. When deciding to repeat TACE, the ART (Assessment for Retreatment with TACE) score and ABCR (AFP, BCLC, Child-Pugh, and Response) score can guide the decision process, and TACE refractoriness needs to be considered. Studies on the combination therapy of TACE with other treatment modalities, such as local ablation, radiation therapy, or systemic therapy, have been actively conducted and are still ongoing. Recently, new prognostic models, including analysis of the neutrophil-lymphocyte ratio, radiomics, and deep learning, have been developed to help predict survival after TACE.
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Affiliation(s)
- Young Chang
- Department of Internal Medicine, Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul 04401, Korea; (Y.C.); (J.Y.J.)
| | - Soung Won Jeong
- Department of Internal Medicine, Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul 04401, Korea; (Y.C.); (J.Y.J.)
| | - Jae Young Jang
- Department of Internal Medicine, Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul 04401, Korea; (Y.C.); (J.Y.J.)
| | - Yong Jae Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Seoul 04401, Korea;
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Jiménez Pérez M, Grande RG. Application of artificial intelligence in the diagnosis and treatment of hepatocellular carcinoma: A review. World J Gastroenterol 2020; 26:5617-5628. [PMID: 33088156 PMCID: PMC7545389 DOI: 10.3748/wjg.v26.i37.5617] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/01/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
Although artificial intelligence (AI) was initially developed many years ago, it has experienced spectacular advances over the last 10 years for application in the field of medicine, and is now used for diagnostic, therapeutic and prognostic purposes in almost all fields. Its application in the area of hepatology is especially relevant for the study of hepatocellular carcinoma (HCC), as this is a very common tumor, with particular radiological characteristics that allow its diagnosis without the need for a histological study. However, the interpretation and analysis of the resulting images is not always easy, in addition to which the images vary during the course of the disease, and prognosis and treatment response can be conditioned by multiple factors. The vast amount of data available lend themselves to study and analysis by AI in its various branches, such as deep-learning (DL) and machine learning (ML), which play a fundamental role in decision-making as well as overcoming the constraints involved in human evaluation. ML is a form of AI based on automated learning from a set of previously provided data and training in algorithms to organize and recognize patterns. DL is a more extensive form of learning that attempts to simulate the working of the human brain, using a lot more data and more complex algorithms. This review specifies the type of AI used by the various authors. However, well-designed prospective studies are needed in order to avoid as far as possible any bias that may later affect the interpretability of the images and thereby limit the acceptance and application of these models in clinical practice. In addition, professionals now need to understand the true usefulness of these techniques, as well as their associated strengths and limitations.
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Affiliation(s)
- Miguel Jiménez Pérez
- UGC de Aparato Digestivo, Unidad de Hepatología-Trasplante Hepático, Hospital Regional Universitario de Málaga, Málaga 29010, Spain
| | - Rocío González Grande
- UGC de Aparato Digestivo, Unidad de Hepatología-Trasplante Hepático, Hospital Regional Universitario de Málaga, Málaga 29010, Spain
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Lin PT, Teng W, Jeng WJ, Hsieh YC, Hung CF, Huang CH, Lui KW, Chen YC, Lin CC, Lin CY, Sheen IS, Lin SM. Add-on sorafenib is beneficial for hepatocellular carcinoma patients with transarterial chemoembolization refractoriness: a real-world experience. Eur J Gastroenterol Hepatol 2020; 32:1192-1199. [PMID: 31851084 DOI: 10.1097/meg.0000000000001637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Sorafenib is the first proved target therapy that shows significant survival benefit in advanced hepatocellular carcinoma. This study was aimed to investigate whether add-on sorafenib be beneficial for those experienced transarterial chemoembolization refractoriness. METHODS From 2005 to 2016, a total of 656 treatment-naive hepatocellular carcinoma patients receiving transarterial chemoembolization treatment were recruited. Transarterial chemoembolization refractoriness was defined as progressive disease after two consecutive of transarterial chemoembolization treatment within 6 months. Patient's baseline characteristics, tumor burden, and parameters for liver function evaluation during treatment were analyzed. All the variables were compared between patients with and without transarterial chemoembolization refractoriness, as well as with and without add-on sorafenib. RESULTS Among the 656 patients, the median age was 62.5 (range 27.3-91.5) years old, and 74.5% were male. Transarterial chemoembolization refractoriness events were documented in 202 patients (30.8%). After multivariate logistic regression analysis, tumor size ≧5 cm, baseline alpha-fetoprotein level ≧200 mg/dl, elevation of alpha-fetoprotein ≧20%, and elevation of Child-Turcotte-Pugh score ≧2 points after first transarterial chemoembolization were the independent predictive factors for transarterial chemoembolization refractoriness. Twenty-two patients (10.9%) received add-on sorafenib treatment and 146 (72.3%) patients continued transarterial chemoembolization treatment alone. After 1:2 propensity score matching, patients with add-on sorafenib therapy had significantly longer median overall survival than transarterial chemoembolization treatment alone (23.1 vs. 11.0 months, log-rank P = 0.001). CONCLUSION The tumor size, baseline alpha-fetoprotein, and elevation of alpha-fetoprotein and Child-Turcotte-Pugh score after first transarterial chemoembolization were the predictors for transarterial chemoembolization refractoriness. For patients with transarterial chemoembolization refractoriness, add-on sorafenib achieved better survival benefit than transarterial chemoembolization treatment alone.
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Affiliation(s)
- Po-Ting Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch
| | - Wei Teng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch
- Chang Gung University College of Medicine
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch
- Chang Gung University College of Medicine
| | - Yi-Chung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch
- Chang Gung University College of Medicine
| | - Chen-Fu Hung
- Chang Gung University College of Medicine
- Department of Radiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chien-Hao Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch
- Chang Gung University College of Medicine
| | - Kar-Wai Lui
- Chang Gung University College of Medicine
- Department of Radiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Yi-Cheng Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch
- Chang Gung University College of Medicine
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch
- Chang Gung University College of Medicine
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch
- Chang Gung University College of Medicine
| | - I-Shyan Sheen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch
- Chang Gung University College of Medicine
| | - Shi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch
- Chang Gung University College of Medicine
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Jeon MY, Kim BK, Park JY, Kim DY, Ahn SH, Han KH, Lee JH, Yu SJ, Kim YJ, Yoon JH, Cho EJ, Kim SU. Proposal of a New Risk Score for Patients Treated with Transarterial Chemoembolization due to Recurrent Hepatocellular Carcinoma after Curative Resection: A Multicenter Study. Gut Liver 2020; 14:477-485. [PMID: 31640304 PMCID: PMC7366139 DOI: 10.5009/gnl19111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/09/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Prognostic models are lacking for patients with recurrent hepatocellular carcinoma (HCC) following surgical resection. This study devised and validated a new hepatoma arterial-embolization prognostic (HAP) score optimized for use in patients undergoing treatment with transarterial chemoembolization (TACE) for recurrence subsequent to surgical resection of HCC. METHODS Training cohort (n=424) and validation cohort (n=350) patients with recurrent HCC after resection treated with TACE between 2003 and 2016 were enrolled. Cox regression and area under the receiver operating characteristic curve (AUC) analyses were used to identify risk factors for survival and to calculate the predictive performance of risk scores, respectively. RESULTS The median age of the study population was 59.2 years. α-Fetoprotein >400 ng/mL (hazard ratio [HR]=1.815), serum albumin ≤3.5 g/dL (HR=1.966), tumor number ≥2 (HR=1.425), tumor size >5 cm at resection or recurrence (HR=1.356), segmental portal vein invasion at resection or recurrence (HR=2.032), and time from resection to recurrence ≤1 years (HR=1.849) independently predicted survival (all p<0.05). The postoperative HAP (pHAP) model based on the rounded HRs of these variables showed an AUC of 0.723 for predicting survival at 3 years, which was significantly higher than AUCs of other HAP-based models, including HAP, modified HAP, and modified HAP-II scores (0.578-0.621) (all p<0.05). The accuracy of pHAP was maintained in the entire cohort (n=774; AUC=0.776 at 3 years). CONCLUSIONS A new pHAP score optimized for patients treated with TACE due to recurrent HCC after resection showed acceptable accuracy and was externally validated. Further studies of means by which to select treatment options other than TACE for high-risk patients according to pHAP scores are warranted.
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Affiliation(s)
- Mi Young Jeon
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
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Han G, Berhane S, Toyoda H, Bettinger D, Elshaarawy O, Chan AWH, Kirstein M, Mosconi C, Hucke F, Palmer D, Pinato DJ, Sharma R, Ottaviani D, Jang JW, Labeur TA, van Delden OM, Pirisi M, Stern N, Sangro B, Meyer T, Fateen W, García‐Fiñana M, Gomaa A, Waked I, Rewisha E, Aithal GP, Travis S, Kudo M, Cucchetti A, Peck‐Radosavljevic M, Takkenberg R, Chan SL, Vogel A, Johnson PJ. Prediction of Survival Among Patients Receiving Transarterial Chemoembolization for Hepatocellular Carcinoma: A Response-Based Approach. Hepatology 2020; 72:198-212. [PMID: 31698504 PMCID: PMC7496334 DOI: 10.1002/hep.31022] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/28/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS The heterogeneity of intermediate-stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable. APPROACH AND RESULTS Clinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological responses (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) were also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A pre-TACE model ("Pre-TACE-Predict") and a post-TACE model ("Post-TACE-Predict") that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. The median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha-fetoprotein, albumin, bilirubin, vascular invasion, cause, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared with existing models (the hepatoma arterial embolization prognostic score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years. CONCLUSIONS A TACE-specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient-level prognostication.
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Affiliation(s)
- Guohong Han
- Department of Liver Disease and Digestive Interventional RadiologyXijing Hospital of Digestive DiseaseFourth Military Medical UniversityXi’anChina
| | - Sarah Berhane
- Department of BiostatisticsUniversity of LiverpoolLiverpoolUnited Kingdom
| | - Hidenori Toyoda
- Department of Gastroenterology and HepatologyOgaki Municipal HospitalOgakiJapan
| | - Dominik Bettinger
- Department of Medicine IIFaculty of MedicineMedical Center University of FreiburgUniversity of FreiburgFreiburgGermany
| | - Omar Elshaarawy
- National Liver InstituteMenoufia UniversityShebeen El‐KomEgypt
| | | | - Martha Kirstein
- Department of Gastroenterology, Hepatology and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Cristina Mosconi
- Radiology UnitDepartment of SpecializedDiagnostic and Experimental MedicineAlma Mater Studiorum ‐ University of BolognaItaly University Hospital of Bologna Sant'Orsola‐Malpighi PolyclinicBolognaItaly
| | - Florian Hucke
- Department of Internal Medicine and GastroenterologyKlinikum Klagenfurt am WörtherseeKlagenfurtAustria
| | - Daniel Palmer
- Department of Molecular and Clinical Cancer MedicineUniversity of LiverpoolLiverpoolUnited Kingdom
| | - David J. Pinato
- Department of Surgery and CancerImperial College LondonLondonUnited Kingdom
| | - Rohini Sharma
- Department of Surgery and CancerImperial College LondonLondonUnited Kingdom
| | - Diego Ottaviani
- UCL Cancer InstituteUniversity College LondonLondonUnited Kingdom
| | - Jeong W. Jang
- Department of Internal MedicineThe Catholic University of KoreaSeoul St. Mary’s HospitalSeoulRepublic of Korea
| | - Tim A. Labeur
- Department of Gastroenterology and HepatologyAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Otto M. van Delden
- Department of RadiologyAmsterdam University Medical CentersAmsterdamthe Netherlands
| | - Mario Pirisi
- Department of Translational MedicineUniversità del Piemonte OrientaleNovaraItaly
| | - Nick Stern
- Department of Gastroenterology and HepatologyAintree University HospitalLiverpoolUnited Kingdom
| | - Bruno Sangro
- Liver UnitClínica Universidad de Navarra IDISNA and CIBEREHDPamplonaSpain
| | - Tim Meyer
- Research Department of OncologyUCL Cancer InstituteUniversity College LondonLondonUnited Kingdom
| | - Waleed Fateen
- National Institute for Health Research Nottingham Biomedical Research CentreNottingham University Hospitals National Health Service Trust and the University of NottinghamNottinghamUnited Kingdom
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUnited Kingdom
| | | | - Asmaa Gomaa
- National Liver InstituteMenoufia UniversityShebeen El‐KomEgypt
| | - Imam Waked
- National Liver InstituteMenoufia UniversityShebeen El‐KomEgypt
| | - Eman Rewisha
- National Liver InstituteMenoufia UniversityShebeen El‐KomEgypt
| | - Guru P. Aithal
- National Institute for Health Research Nottingham Biomedical Research CentreNottingham University Hospitals National Health Service Trust and the University of NottinghamNottinghamUnited Kingdom
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUnited Kingdom
| | - Simon Travis
- Department of RadiologyNottingham University Hospitals National Health Service TrustNottinghamUnited Kingdom
| | - Masatoshi Kudo
- Department of Gastroenterology and HepatologyKinki University School of MedicineOsaka‐SayamaOsakaJapan
| | | | - Markus Peck‐Radosavljevic
- Department of Internal Medicine and GastroenterologyKlinikum Klagenfurt am WörtherseeKlagenfurtAustria
| | - R.B. Takkenberg
- Department of Gastroenterology and HepatologyAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Stephen L. Chan
- Department of Clinical OncologyChinese University of Hong KongShatinHong Kong
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Philip J. Johnson
- Department of Molecular and Clinical Cancer MedicineUniversity of LiverpoolLiverpoolUnited Kingdom
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Wang H, Lin C, Fan W, Zhang J, Zhang Y, Yao W, Li J. Dynamic Changes in the Neutrophil-to-Lymphocyte Ratio Predict the Prognosis of Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization. Cancer Manag Res 2020; 12:3433-3444. [PMID: 32523374 PMCID: PMC7234956 DOI: 10.2147/cmar.s245396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/21/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To examine the effect of dynamic changes in neutrophil-to-lymphocyte ratio (NLR) on tumor response and overall survival (OS) in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). Patients and Methods Data from 181 patients with HCC were retrospectively collected. White blood cell, neutrophil and lymphocyte counts, and the NLR were obtained 1–3 days before as well as 3–6 weeks and 3 months after TACE. Patients were divided into two groups at each time point according to the mean value of NLR, and also divided into continuous decrease, fluctuating increase-decrease (I-D), fluctuating decrease-increase (D-I), and continuous increase groups according to the dynamic changes in the NLR. The dynamic changes in blood counts and NLR were analyzed using repeated-measures ANOVA. The odds ratios (ORs) for tumor response in different NLR groups were examined using a multivariate logistic regression model. Finally, the prognostic value of the dynamic changes in the NLR was examined using Cox regression models. Results Continuous decline of white blood cell counts, neutrophil counts and lymphocyte counts were observed at 3–6 weeks and 3 months after TACE treatment. The NLR increased slightly and then decreased substantially in responders, while it increased slightly and then significantly in non-responders, with a significant interaction effect of Time × Tumor response (P = 0.005). NLR grouping before TACE, 3–6 weeks and 3 months after TACE was not associated with tumor response, and only 3 months after TACE did, it shows a significant difference in univariate survival analyses (NLR > 2.5 vs NLR ≤ 2.5, hazard ratio [HR] = 2.442, 95% confidence interval (CI): 1.545, 3.860). The changes in the NLR were significantly correlated with tumor response and OS. Non-responders for TACE were more common in the continuous NLR increase group (OR = 6.230, 95% CI: 1.848–21.001) and in the fluctuating D-I group (OR = 5.702, 95% CI: 1.480–21.957). Multivariate analyses revealed that these two patient groups also showed poorer OS (HR = 2.351, 95% CI: 1.120–4.605 and HR = 2.320, 95% CI: 1.187–4.533, respectively). Conclusion Dynamic changes in the NLR may be better predictors of tumor response and OS than static NLR values, but more data are needed.
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Affiliation(s)
- Hongyu Wang
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Chuyang Lin
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou 510080, People's Republic of China
| | - Wenzhe Fan
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Jiang Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Yingqiang Zhang
- Department of Interventional Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, People's Republic of China
| | - Wang Yao
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Jiaping Li
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
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Nam JY, Choe AR, Sinn DH, Lee JH, Kim HY, Yu SJ, Kim YJ, Yoon JH, Lee JM, Chung JW, Choi SY, Lee JK, Baek SY, Lee HA, Kim TH, Yoo K. A differential risk assessment and decision model for Transarterial chemoembolization in hepatocellular carcinoma based on hepatic function. BMC Cancer 2020; 20:504. [PMID: 32487089 PMCID: PMC7268402 DOI: 10.1186/s12885-020-06975-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The decision of transarterial chemoembolization (TACE) initiation and/or repetition remains challenging in patients with unresectable hepatocellular carcinoma (HCC). The aim was to develop a prognostic scoring system to guide TACE initiation/repetition. METHODS A total of 597 consecutive patients who underwent TACE as their initial treatment for unresectable HCC were included. We derived a prediction model using independent risk factors for overall survival (OS), which was externally validated in an independent cohort (n = 739). RESULTS Independent risk factors of OS included Albumin-bilirubin (ALBI) grade, maximal tumor size, alpha-fetoprotein, and tumor response to initial TACE, which were used to develop a scoring system ("ASAR"). C-index values for OS were 0.733 (95% confidence interval [CI] = 0.570-0.871) in the derivation, 0.700 (95% CI = 0.445-0.905) in the internal validation, and 0.680 (95% CI = 0.652-0.707) in the external validation, respectively. Patients with ASAR< 4 showed significantly longer OS than patients with ASAR≥4 in all three datasets (all P < 0.001). Among Child-Pugh class B patients, a modified model without TACE response, i.e., "ASA(R)", discriminated OS with a c-index of 0.788 (95% CI, 0.703-0.876) in the derivation, and 0.745 (95% CI, 0.646-0.862) in the internal validation, and 0.670 (95% CI, 0.605-0.725) in the external validation, respectively. Child-Pugh B patients with ASA(R) < 4 showed significantly longer OS than patients with ASA(R) ≥ 4 in all three datasets (all P < 0.001). CONCLUSIONS ASAR provides refined prognostication for repetition of TACE in patients with unresectable HCC. For Child-Pugh class B patients, a modified model with baseline factors might guide TACE initiation.
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Affiliation(s)
- Joon Yeul Nam
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985 Republic of Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - A Reum Choe
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985 Republic of Korea
| | - Dong Hyun Sinn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Hwi Young Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985 Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Young Choi
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jeong Kyong Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Seung Yon Baek
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Tae Hun Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985 Republic of Korea
| | - Kwon Yoo
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985 Republic of Korea
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Vogeler M, Mohr I, Pfeiffenberger J, Sprengel SD, Klauss M, Teufel A, Chang DH, Springfeld C, Longerich T, Merle U, Mehrabi A, Weiss KH, Mieth M. Applicability of scoring systems predicting outcome of transarterial chemoembolization for hepatocellular carcinoma. J Cancer Res Clin Oncol 2020; 146:1033-1050. [PMID: 32107625 PMCID: PMC7085483 DOI: 10.1007/s00432-020-03135-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/20/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Several scoring systems have been proposed to predict the outcome of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). However, the application of these scores to a bridging to transplant setting is poorly validated. Evaluation of the applicability of prognostic scores for patients undergoing TACE in palliative intention vs. bridging therapy to liver transplantation (LT) is necessary. METHODS Between 2008 and 2017, 148 patients with HCC received 492 completed TACE procedures (158 for bridging to transplant; 334 TACE procedures in palliative treatment intention at our center and were analyzed retrospectively. Scores (ART, CLIP, ALBI, APRI, SNACOR, HAP, STATE score, Child-Pugh, MELD, Okuda and BCLC) were calculated and evaluated for prediction of overall survival. ROC analysis was performed to assess prediction of 3-year survival and treatment discontinuation. RESULTS In patients receiving TACE in palliative intention most scores predicted OS in univariate analysis but only mSNACOR score (p = 0.006), State score (p < 0.001) and Child-Pugh score (p < 0.001) revealed statistical significance in the multivariate analysis. In the bridging to LT cohort only the BCLC score revealed statistical significance (p = 0.002). CONCLUSIONS Clinical usability of suggested scoring systems for TACE might be limited depending on the individual patient cohorts and the indication. Especially in patients receiving TACE as bridging to LT none of the scores showed sufficiently applicability. In our study Child-Pugh score, STATE score and mSNACOR score showed the best performance assessing OS in patients with TACE as palliative therapy.
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Affiliation(s)
- Marie Vogeler
- Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany
| | - Isabelle Mohr
- Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Pfeiffenberger
- Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany
| | | | - Miriam Klauss
- Department of Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Teufel
- Division of Hepatology, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany
| | - De-Hua Chang
- Department of Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Springfeld
- Department of Medical Oncology, Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Longerich
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany
| | - Uta Merle
- Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, INF 110, 69120, Heidelberg, Germany
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany
| | - Karl Heinz Weiss
- Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Mieth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, INF 110, 69120, Heidelberg, Germany.
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany.
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Mähringer-Kunz A, Wagner F, Hahn F, Weinmann A, Brodehl S, Schotten S, Hinrichs JB, Düber C, Galle PR, Pinto Dos Santos D, Kloeckner R. Predicting survival after transarterial chemoembolization for hepatocellular carcinoma using a neural network: A Pilot Study. Liver Int 2020; 40:694-703. [PMID: 31943703 DOI: 10.1111/liv.14380] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS Deciding when to repeat and when to stop transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) can be difficult even for experienced investigators. Our aim was to develop a survival prediction model for such patients undergoing TACE using novel machine learning algorithms and to compare it to conventional prediction scores, ART, ABCR and SNACOR. METHODS For this retrospective analysis, 282 patients who underwent TACE for HCC at our tertiary referral centre between January 2005 and December 2017 were included in the final analysis. We built an artificial neural network (ANN) including all parameters used by the aforementioned risk scores and other clinically meaningful parameters. Following an 80:20 split, the first 225 patients were used for training; the more recently treated 20% were used for validation. RESULTS The ANN had a promising performance at predicting 1-year survival, with an area under the ROC curve (AUC) of 0.77 ± 0.13. Internal validation yielded an AUC of 0.83 ± 0.06, a positive predictive value of 87.5% and a negative predictive value of 68.0%. The sensitivity was 77.8% and specificity 81.0%. In a head-to-head comparison, the ANN outperformed the aforementioned scoring systems, which yielded lower AUCs (SNACOR 0.73 ± 0.07, ABCR 0.70 ± 0.07 and ART 0.54 ± 0.08). This difference reached significance for ART (P < .001); for ABCR and SNACOR significance was not reached (P = .143 and P = .201). CONCLUSIONS Artificial neural networks could be better at predicting patient survival after TACE for HCC than traditional scoring systems. Once established, such prediction models could easily be deployed in clinical routine and help determine optimal patient care.
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Affiliation(s)
- Aline Mähringer-Kunz
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Franziska Wagner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Clinical Registry Unit (CRU), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sebastian Brodehl
- Institute for Informatics, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sebastian Schotten
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jan B Hinrichs
- Department of Interventional and Diagnostic Radiology, Hannover Medical School, Hanover, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Peter R Galle
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Kim DS, Lim TS, Jeon MY, Kim BK, Park JY, Kim DY, Ahn SH, Han KH, Baatarkhuu O, Kim SU. Transarterial Chemoembolization in Treatment-Naïve and Recurrent Hepatocellular Carcinoma: A Propensity-Matched Outcome Analysis. Dig Dis Sci 2019; 64:3660-3668. [PMID: 31187326 DOI: 10.1007/s10620-019-05701-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/04/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Transarterial chemoembolization (TACE) improves the survival of patients with hepatocellular carcinoma (HCC); however, TACE treatment outcomes of patients with treatment-naïve HCC (TN-HCC) and those with recurrent HCC after curative resection (R-HCC) have not yet been compared. METHODS We recruited 448 patients with TN-HCC, and 275 patients with R-HCC treated with TACE as first-line anti-cancer treatment. RESULTS At first TACE, patients with TN-HCC showed a significantly lower proportion of male gender (74.9% vs. 84.3%), higher proportion of liver cirrhosis (61.9% vs. 49.3%), higher aspartate aminotransferase (median 48 vs. 31 IU/L), alanine aminotransferase (median 38 vs. 26 IU/L), alpha-fetoprotein (AFP) (median 96.6 vs. 7.7 ng/mL), and total bilirubin (mean 1.0 vs. 0.8 mg/dL) levels, longer prothrombin time (median 1.05 vs. 1.01 international normalized ratio), higher tumor number (mean 2.1 vs. 1.7), larger tumor size (median 3.1 vs. 1.6 cm), and lower proportion of Barcelona Clinic Liver Cancer stage 0-A (55.6% vs. 71.9%) than patients with R-HCC (all P < 0.05). Multivariate analysis showed that TACE for TN-HCC (vs. R-HCC) was an independent predictor of mortality (hazard ratio, 1.328; P = 0.024) with AFP level and tumor number (all P < 0.05). However, treatment outcomes between TN-HCC and R-HCC became statistically similar after propensity score-matched (PSM) analysis using liver cirrhosis, tumor size, and multiple tumors (P < 0.05). CONCLUSIONS Based on the similar TACE treatment outcomes observed with the PSM analysis, the current TACE treatment guideline for patients with TN-HCC might similarly be applied for patients with R-HCC.
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MESH Headings
- Aged
- Alanine Transaminase/metabolism
- Antineoplastic Agents/administration & dosage
- Aspartate Aminotransferases/metabolism
- Bilirubin/metabolism
- Carcinoma, Hepatocellular/epidemiology
- Carcinoma, Hepatocellular/metabolism
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/therapy
- Case-Control Studies
- Chemoembolization, Therapeutic
- Doxorubicin/administration & dosage
- Ethiodized Oil/administration & dosage
- Female
- Humans
- Iodized Oil/administration & dosage
- Kaplan-Meier Estimate
- Liver Cirrhosis/epidemiology
- Liver Neoplasms/epidemiology
- Liver Neoplasms/metabolism
- Liver Neoplasms/pathology
- Liver Neoplasms/therapy
- Male
- Middle Aged
- Mortality
- Multivariate Analysis
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Neoplasms, Multiple Primary/epidemiology
- Neoplasms, Multiple Primary/metabolism
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Propensity Score
- Proportional Hazards Models
- Prothrombin Time
- Sex Distribution
- Treatment Outcome
- Tumor Burden
- alpha-Fetoproteins/metabolism
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Affiliation(s)
- David Sooik Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Tae Seop Lim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
- Yonsei Liver Center, Severance Hospital, Seoul, South Korea
| | - Mi Young Jeon
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
- Yonsei Liver Center, Severance Hospital, Seoul, South Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
- Yonsei Liver Center, Severance Hospital, Seoul, South Korea
| | - Jun Yong Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
- Yonsei Liver Center, Severance Hospital, Seoul, South Korea
| | - Do Young Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
- Yonsei Liver Center, Severance Hospital, Seoul, South Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
- Yonsei Liver Center, Severance Hospital, Seoul, South Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
- Yonsei Liver Center, Severance Hospital, Seoul, South Korea
| | - Oidov Baatarkhuu
- Department of Infectious Diseases, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
- Yonsei Liver Center, Severance Hospital, Seoul, South Korea.
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Adhoute X, Pénaranda G, Raoul JL, Pietri O, Bronowicki JP, Castellani P, Perrier H, Monnet O, Bayle O, Oules V, Pol B, Beaurain P, Muller C, Cassagneau P, Bourlière M. Hepatocellular carcinoma macroscopic gross appearance on imaging: predictor of outcome after transarterial chemoembolization in a real-life multicenter French cohort. Eur J Gastroenterol Hepatol 2019; 31:1414-1423. [PMID: 31045613 DOI: 10.1097/meg.0000000000001420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Conventional transarterial chemoembolization (cTACE) with lipiodol is widely performed in patients with hepatocellular carcinoma (HCC) unsuitable for curative treatment. Additional tumor parameters such as HCC macroscopic appearance based on imaging might be helpful for transarterial chemoembolization prognostication and management. PATIENTS AND METHODS A total of 405 patients with HCC who underwent cTACE between 2008 and 2016 from a real-life multicenter French cohort were retrospectively reviewed. Tumors were classified into two macroscopic types according to HCC gross appearance on imaging: nodular versus non-nodular. The study population was stratified into two groups: derivation and validation cohorts. Independent prognostic factors of survival based on multivariate cox regression models were determined and then assessed in the validation set. Thereafter, time to progression (TTP) and radiological response rate were investigated for each prognostic factors of survival. RESULTS Median overall survival (OS) was 35 months for Barcelona Clinic Liver Cancer (BCLC) stage A, 22 months for BCLC stage B and 12 months for BCLC stage C patients (P < 0.0001). The corresponding TTP for these patients was 12 (7-17) months, 5 (3-6) months and 1.2 (1.2-3) months (P < 0.0001). Multivariate analysis revealed that tumors size and number, non-nodular type, alpha-fetoprotein, aspartate aminotransferase serum levels and impairment of performance status-1 were independent predictors of survival among the study groups. Non-nodular type was the most powerful factor that influences OS, TTP and radiological response rate for the recommended transarterial chemoembolization candidates. TTP was consistent with OS within each stage. CONCLUSION HCC macroscopic appearance on imaging is a determinant predictor of outcome after cTACE in a real-life multicenter cohort.
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Affiliation(s)
| | | | - Jean-Luc Raoul
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Nantes, Saint-Herblain
| | | | - Jean-Pierre Bronowicki
- Department of Gastroenterology and Hepatology, Centre Hospitalo-Universitaire de Nancy, Nancy, France
| | | | | | - Olivier Monnet
- Department of Interventional Radiology and Medical Imaging
| | - Olivier Bayle
- Department of Interventional Radiology and Medical Imaging
| | | | - Bernard Pol
- Department of Hepatobiliary Surgery, Hôpital Saint-Joseph Marseille
| | | | - Cyrille Muller
- Department of Interventional Radiology and Medical Imaging
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Loosen SH, Schulze-Hagen M, Bruners P, Tacke F, Trautwein C, Kuhl C, Luedde T, Roderburg C. Sarcopenia Is a Negative Prognostic Factor in Patients Undergoing Transarterial Chemoembolization (TACE) for Hepatic Malignancies. Cancers (Basel) 2019; 11:E1503. [PMID: 31597337 PMCID: PMC6827165 DOI: 10.3390/cancers11101503] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022] Open
Abstract
: Background and Aims: While transarterial chemoembolization (TACE) represents a standard of therapy for intermediate-stage hepatocellular carcinoma (HCC) and is also routinely performed in patients with liver metastases, it is still debated which patients represent the ideal candidates for TACE therapy in terms of overall survival. Sarcopenia, the degenerative loss of skeletal muscle mass and strength, has been associated with an adverse outcome for various malignancies, but its role in the context of TACE has largely remained unknown. Here, we evaluated the role of sarcopenia on the outcome of patients undergoing TACE for primary and secondary liver cancer. METHODS The patients' psoas muscle size was measured on axial computed tomography (CT) scans and normalized for the patients' height squared. This value was referred to as the psoas muscle index (PMI). The PMI was correlated with clinical and laboratory markers. RESULTS While pre-interventional sarcopenia had no impact on the direct tumor response to TACE, sarcopenic patients with a pre-interventional PMI below our ideal cut-off value of 13.39 mm/m2 had a significantly impaired long-term outcome with a median overall survival of 491 days compared to 1291 days for patients with a high PMI. This finding was confirmed by uni- and multivariate Cox-regression analyses. Moreover, a progressive rapid decline in muscle mass after TACE was a predictor for an unfavorable prognosis. CONCLUSION Our data suggest that sarcopenia represents a previously unrecognized prognostic factor for patients undergoing TACE therapy which might yield important information on the patients' post-interventional outcome and should therefore be implemented into clinical stratification algorithms.
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Affiliation(s)
- Sven H Loosen
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Frank Tacke
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Augustenburger Platz 1, 10117 Berlin, Germany.
| | - Christian Trautwein
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Tom Luedde
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
- Division of Gastroenterology, Hepatology and Hepatobiliary Oncology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - Christoph Roderburg
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Augustenburger Platz 1, 10117 Berlin, Germany.
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Khalaf AM, Fuentes D, Morshid A, Kaseb AO, Hassan M, Hazle JD, Elsayes KM. Hepatocellular carcinoma response to transcatheter arterial chemoembolisation using automatically generated pre-therapeutic tumour volumes by a random forest-based segmentation protocol. Clin Radiol 2019; 74:974.e13-974.e20. [PMID: 31521326 DOI: 10.1016/j.crad.2019.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/31/2019] [Indexed: 01/03/2023]
Abstract
AIM To demonstrate the feasibility of correlating pre-therapeutic volumes and residual liver volume (RLV) with clinical outcomes: time to progression (TTP) and overall survival (OS) in hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolisation (TACE). MATERIALS AND METHODS TTP was calculated from a database of 105 patients, receiving first-line treatment with TACE. TTP cut-off for stratifying patients into responders and non-responders was 28 weeks. Pre-treatment tumour and liver volumes were correlated with the TTP and OS following treatment. Univariate cox-regression model was used to assess whether these volumes could predict TTP and/or OS. Kaplan-Meier analysis with log-rank test was used to compare the TTP between high and low volume groups for viable, necrotic, and total tumour. Kaplan-Meier analysis was performed comparing the OS of 10 patients with the longest TTP (mean=122 weeks) in the responder group and 10 patients with the shortest TTP (mean=7 weeks) in the non-responder group. RESULTS HCC in high tumour volume groups had a shorter TTP than lesions in low tumour volume groups (p=0.05, p=0.04, p=0.02, for enhancing, non-enhancing, total tumour groups, respectively). A negative (correlation coefficient [CC] 0.3) linear correlation between TTP and tumour volumes, and a positive linear correlation between TTP and residual liver volumes were also demonstrated (CC 0.3). Patients with the longest TTP had a higher OS than with the shortest TTP (p=0.03). CONCLUSION This demonstrates the feasibility of predicting treatment response of HCC to TACE using volumetric measurements of pre-treatment lesion and the feasibility of correlating RLV with TACE outcome data in HCC patients.
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Affiliation(s)
- A M Khalaf
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - D Fuentes
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - A Morshid
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - A O Kaseb
- Department of Gastrointestinal Oncology, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - M Hassan
- Department of Gastrointestinal Oncology, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - J D Hazle
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - K M Elsayes
- Department of Diagnostic Radiology, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA.
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Lee IC, Hung YW, Liu CA, Lee RC, Su CW, Huo TI, Li CP, Chao Y, Lin HC, Hou MC, Huang YH. A new ALBI-based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma. Liver Int 2019; 39:1704-1712. [PMID: 31319016 DOI: 10.1111/liv.14194] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/29/2019] [Accepted: 07/07/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Transarterial chemoembolization (TACE) is a standard treatment for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), but the outcome varied. This study aimed to develop a model to predict the outcome of TACE in HCC patients. METHODS Consecutive 570 treatment-naïve BCLC stage B HCC patients undergoing TACE as the initial treatment from 2007 to 2016 were retrospectively enrolled. Factors associated with survival were analysed. Patients undergoing TACE from 2007 to 2011 constituted the training cohort (n = 293), while patients undergoing TACE from 2012 to 2016 constituted the validation cohort (n = 277). Homogeneity and corrected Akaike information criterion (AICc) were compared between each prognostic model. RESULTS A total of 1796 TACE sessions were performed for the 570 patients during the median follow-up period of 18.3 months. By multivariate analysis, beyond up-to-11 criteria (hazard ratio [HR] = 1.694, P < .001), alpha-foetoprotein >200 ng/mL (HR = 1.771, P < .001) and albumin-bilirubin (ALBI) grade 2 or 3 (HR = 1.817, P < .001) were independent predictors of overall survival (OS) in the training cohort. An ALBI-TAE model based on the three independent predictors of OS from the training cohort was developed to classify HCC patients into four subgroups. The performance of the ALBI-TAE model was superior to other prognostic models with lowest AICc values and highest homogeneity in both the training and validation datasets as well as the overall cohort. CONCLUSIONS Albumin-bilirubin grade is an important factor associated with survival in BCLC stage B HCC patients undergoing TACE. ALBI-TAE model can be applied to select patients who can get most benefit from TACE.
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Affiliation(s)
- I-Cheng Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ya-Wen Hung
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Wei Su
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Teh-Ia Huo
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chung-Pin Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yee Chao
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Development of a prognostic score for recommended TACE candidates with hepatocellular carcinoma: A multicentre observational study. J Hepatol 2019; 70:893-903. [PMID: 30660709 DOI: 10.1016/j.jhep.2019.01.013] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 12/27/2018] [Accepted: 01/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Previous prognostic scores for transarterial chemoembolization (TACE) were mainly derived from real-world settings, which are beyond guideline recommendations. A robust model for outcome prediction and risk stratification of recommended TACE candidates is lacking. We aimed to develop an easy-to-use tool specifically for these patients. METHODS Between January 2010 and May 2016, 1,604 treatment-naïve patients with unresectable hepatocellular carcinoma (HCC), Child-Pugh A5-B7 and performance status 0 undergoing TACE were included from 24 tertiary centres. Patients were randomly divided into training (n = 807) and validation (n = 797) cohorts. A prognostic model was developed and subsequently validated. Predictive performance and discrimination were further evaluated and compared with other prognostic models. RESULTS The final presentation of the model was "linear predictor = largest tumour diameter (cm) + tumour number", which consistently outperformed other currently available models in both training and validation datasets as well as in different subgroups. The thirtieth percentile and the third quartile of the linear predictor, namely 6 and 12, were further selected as cut-off values, leading to the "six-and-twelve" score which could divide patients into 3 strata with the sum of tumour size and number ≤6, >6 but ≤12, and >12 presenting significantly different median survival of 49.1 (95% CI 43.7-59.4) months, 32.0 (95% CI 29.9-37.5) months, and 15.8 (95% CI 14.1-17.7) months, respectively. CONCLUSIONS The six-and-twelve score may prove an easy-to-use tool to stratify recommended TACE candidates (Barcelona Clinic Liver Cancer stage-A/B) and predict individual survival with favourable performance and discrimination. Moreover, the score could stratify these patients in clinical practice as well as help design clinical trials with comparable criteria involving these patients. Further external validation of the score is required. LAY SUMMARY There is currently no prognostic model specifically developed for recommended or ideal transarterial chemoembolization (TACE) candidates with hepatocellular carcinoma, despite these patients being frequently identified as the best target population in pivotal randomized controlled trials. The six-and-twelve score provides patient survival prediction, especially in ideal candidates of TACE, outperforming other currently available models in both training and validation sets, as well as different subgroups. With cut-off values of 6 and 12, the score can stratify ideal TACE candidates into 3 strata with significantly different outcomes and may shed light on risk stratification of these patients in clinical practice as well as in clinical trials.
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Park Y, Kim BK, Park JY, Kim DY, Ahn SH, Han KH, Yeon JE, Byun KS, Kim HS, Kim JH, Kim SU. Feasibility of dynamic risk assessment for patients with repeated trans-arterial chemoembolization for hepatocellular carcinoma. BMC Cancer 2019; 19:363. [PMID: 30991968 PMCID: PMC6469056 DOI: 10.1186/s12885-019-5495-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/20/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hepatoma arterial-embolization prognostic (HAP) score and its modifications (modified HAP [mHAP] and mHAP-II), consisting of some or all of the following factors of tumor size, number, alpha-fetoprotein, bilirubin, and serum albumin, have been found to predict outcomes after trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). We investigated the feasibility of using HAP-related risk scores for dynamic risk assessment during repeated TACE. METHODS A total of 619 HCC patients treated with TACE from two institutions between 2003 and 2010 were included. RESULTS Patients with A-B class risk scores showed significantly better survival than those with C-D class risk scores at the first (median 43.7 vs. 21.5 months for mHAP-II, 35.2 vs. 10.2 months for mHAP, and 39.8 vs. 18.6 months for HAP; all P < 0.001) and the second rounds of TACE (38.6 vs. 17.2 months for mHAP-II, 30.0 vs. 8.5 months for mHAP, and 32.6 vs. 17.3 months for HAP; all P < 0.001). Sequential assessment of risk scores at the second TACE round was applied for patients with A-B class risk scores at the first TACE round, which further identified two subgroups of A-B and C-D class risk scores with different outcomes (median survival 40.6 vs. 19.6 months for mHAP-II, 31.2 vs. 16.9 months for mHAP, and 35.8 vs. 21.0 months for HAP; all P < 0.001). Compared with mHAP and HAP, mHAP-II showed the highest likelihood ratio (22.61 vs. 14.67 and 13.97, respectively), highest linear trend (24.43 vs. 19.67 and 14.19, respectively), and lowest Akaike information criteria value (1432.51 vs. 3412.29 and 2296.98, respectively). CONCLUSIONS All HAP-related risk scores dynamically predicted outcomes during repeated TACE. Sequential risk assessment using mHAP-II best identified optimal candidates for repeated TACE.
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Affiliation(s)
- Yehyun Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun–gu, Seoul, 120–752 South Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun–gu, Seoul, 120–752 South Korea
- Liver Cirrhosis Clinical Research Center, Seoul, South Korea
| | - Jun Yong Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun–gu, Seoul, 120–752 South Korea
- Liver Cirrhosis Clinical Research Center, Seoul, South Korea
| | - Do Young Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun–gu, Seoul, 120–752 South Korea
- Liver Cirrhosis Clinical Research Center, Seoul, South Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun–gu, Seoul, 120–752 South Korea
- Liver Cirrhosis Clinical Research Center, Seoul, South Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun–gu, Seoul, 120–752 South Korea
- Liver Cirrhosis Clinical Research Center, Seoul, South Korea
| | - Jong Eun Yeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Kwan Soo Byun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Hye Soo Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun–gu, Seoul, 120–752 South Korea
| | - Ji Hoon Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun–gu, Seoul, 120–752 South Korea
- Liver Cirrhosis Clinical Research Center, Seoul, South Korea
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50
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Chon YE, Park H, Hyun HK, Ha Y, Kim MN, Kim BK, Lee JH, Kim SU, Kim DY, Ahn SH, Hwang SG, Han KH, Rim KS, Park JY. Development of a New Nomogram Including Neutrophil-to-Lymphocyte Ratio to Predict Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization. Cancers (Basel) 2019; 11:509. [PMID: 30974843 PMCID: PMC6520830 DOI: 10.3390/cancers11040509] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/29/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) has recently been reported to predict the prognosis of hepatocellular carcinoma (HCC). We explored whether NLR predicted the survival of patients with HCC undergoing transarterial chemoembolization (TACE), and developed a predictive model. In total, 1697 patients with HCC undergoing TACE as first-line therapy at two university hospitals were enrolled (derivation set n = 921, internal validation set n = 395, external validation set n = 381). The tumor size, tumor number, AFP level, vascular invasion, Child-Pugh score, objective response after TACE, and NLR, selected as predictors of overall survival (OS) via multivariate Cox's regression model, were incorporated into a 14-point risk prediction model (SNAVCORN score). The time-dependent areas under the receiver-operating characteristic curves for OS at 1, 3, and 5 years predicted by the SNAVCORN score were 0.812, 0.734, and 0.700 in the derivation set. Patients were stratified into three risk groups by SNAVCORN score (low, 0-4; intermediate, 5-9; high, 10-14). Compared with the low-risk group, the intermediate-risk (HR 3.10, p < 0.001) and high-risk (HR 7.37, p < 0.001) groups exhibited significantly greater mortality. The prognostic performance of the SNAVCORN score including NLR in patients with HCC treated with TACE was remarkable, much better than those of the conventional scores. The SNAVCORN score will guide future HCC treatment decisions.
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Affiliation(s)
- Young Eun Chon
- Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea.
- CHA Bundang Liver Center, CHA Bundang Hospital, Seongnam 13496, Korea.
| | - Hana Park
- Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea.
- CHA Bundang Liver Center, CHA Bundang Hospital, Seongnam 13496, Korea.
| | - Hye Kyung Hyun
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Yeonjung Ha
- Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea.
- CHA Bundang Liver Center, CHA Bundang Hospital, Seongnam 13496, Korea.
| | - Mi Na Kim
- Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea.
- CHA Bundang Liver Center, CHA Bundang Hospital, Seongnam 13496, Korea.
| | - Beom Kyung Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea.
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea.
| | - Joo Ho Lee
- Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea.
- CHA Bundang Liver Center, CHA Bundang Hospital, Seongnam 13496, Korea.
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea.
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea.
| | - Do Young Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea.
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea.
| | - Sang Hoon Ahn
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea.
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea.
| | - Seong Gyu Hwang
- Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea.
- CHA Bundang Liver Center, CHA Bundang Hospital, Seongnam 13496, Korea.
| | - Kwang-Hyub Han
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea.
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea.
| | - Kyu Sung Rim
- Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea.
- CHA Bundang Liver Center, CHA Bundang Hospital, Seongnam 13496, Korea.
| | - Jun Yong Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea.
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea.
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