Ventura Y, Carr BI, Kori I, Guerra V, Shibolet O. Analysis of aggressiveness factors in hepatocellular carcinoma patients undergoing transarterial chemoembolization. World J Gastroenterol 2018; 24(15): 1641-1649 [PMID: 29686471 DOI: 10.3748/wjg.v24.i15.1641]
Corresponding Author of This Article
Oren Shibolet, MD, Liver Unit, Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, 14 Weizman Street, Tel-Aviv 62431, Israel. orensh@tlvmc.gov.il
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 21, 2018; 24(15): 1641-1649 Published online Apr 21, 2018. doi: 10.3748/wjg.v24.i15.1641
Analysis of aggressiveness factors in hepatocellular carcinoma patients undergoing transarterial chemoembolization
Yossi Ventura, Brian I Carr, Issac Kori, Vito Guerra, Oren Shibolet
Yossi Ventura, Oren Shibolet, Liver Unit, Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Tel-Aviv 62431, Israel
Yossi Ventura, Oren Shibolet, Sackler faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
Brian I Carr, Izmir Biomedicine and Genome Center, Dokuz Eylul University, Izmir 35340, Turkey
Issac Kori, Interventional Radiology, Division of Imaging Tel Aviv Medical Center, Tel-Aviv 62431, Israel
Vito Guerra, Department of Clinical Trials and Epidemiology, IRCCS de Bellis, Castellana Grotte 70013, Italy
Author contributions: All authors equally contributed to this manuscript.
Institutional review board statement: The Tel-Aviv medical center database management conforms to Israeli legislation on privacy and this study was approved by the institutional research committee in Tel-Aviv Medical Center (Approval number: 0528-16-TLV) in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent statement: Our manuscript is a retrospective study, therefore an informed consent waver was given by the IRB. Data was anonymized to prevent identification.
Conflict-of-interest statement: Professor Shibolet has nothing to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at orensh@tlvmc.gov.il. Consent was not obtained but the presented data are anonymized and there is no risk of patient identification. The potential benefits of sharing these data outweigh the potential harms because of its possible application in improving future identification and treatment of HCC.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Oren Shibolet, MD, Liver Unit, Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, 14 Weizman Street, Tel-Aviv 62431, Israel. orensh@tlvmc.gov.il
Telephone: +972-3-6973984 Fax: +972-3-6974622
Received: January 3, 2018 Peer-review started: January 4, 2018 First decision: January 16, 2018 Revised: March 10, 2018 Accepted: March 25, 2018 Article in press: March 25, 2018 Published online: April 21, 2018 Processing time: 105 Days and 13.1 Hours
ARTICLE HIGHLIGHTS
Research background
Hepatocellular carcinoma (HCC) is a common and deadly cancer. Transterial chemoembolization (TACE) is the treatment of choice for non-operable, intermediate stage HCC.
Research motivation
There is a need to identify prognostic indices in HCC patients undergoing TACE. An “HCC aggressiveness index (AgI)” incorporates 4 tumor-related parameters: maximum tumor diameter (MTD), number of tumor nodules, portal vein thrombosis (PVT) and serum alpha fetoprotein (AFP) levels. This score predicts survival in HCC patients.
Research objective
To identify novel biomarkers to predict survival following TACE and combine them with the AgI.
Research methods
We retrospectively analyzed data from 167 patients with HCC that underwent TACE at Tel-Aviv Medical center from 2000 to 2015. Baseline tumor parameters including: maximum tumor diameter, number of tumor nodules and presence of PVT; labs including: blood count; routine liver function tests and plasma AFP levels; demographics and overall survival information were all collected. The Cox proportional hazards model was applied to identify the correlation of AgI with overall survival and analyze laboratory factors’ associated with the AgI.
Research results
The AgI was correlated with survival. The 3-year survival probability for AgI of > 4 vs < 4 was 42.4% vs 61.8%; P < 0.0863, from the time of diagnosis by Kaplan-Meier plot. Moreover, According to the univariate Cox proportional hazard model for mortality with AgI score of > 4, there was a HR of 2.18 (95%CI: 1.108-4.310, P < 0.024). We found that only GGTP levels and the AgI were independently associated with survival of the HCC patients following TACE.
Research conclusions
AgI was validated as a useful predictor of survival in HCC patients undergoing TACE. Combining the AgI with liver function parameters may improve its prognostic yield in this patient population.
Research prospective
This novel score can be used to assess prognosis in HCC undergoing TACE.
