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

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Abstract

Purpose

Transarterial chemoembolization (TACE) is highly effective and safe therapeutic modality for unresectable hepatocellular carcinoma (HCC). However, the role of TACE for infiltrative HCC has never been elucidated owing to the concern about hepatic failure and subsequent mortality after the procedure. In this study, we aimed to document whether patients with infiltrative HCC would benefit from TACE.

Methods

Child-Pugh class A/B patients who were newly diagnosed as infiltrative HCC and treated with curative-intent TACE were enrolled. All radiological images were reviewed by a radiologist with more than 20 years of experience in TACE.

Results

Among 1,184 patients newly diagnosed as HCC, 233 (19.7 %) had infiltrative-type tumors and 128 (54.9 %) underwent curative-intent TACE. Although the median overall survival was 5.4 months (IQR 3.1–13.9 months) and 16 (12.5 %) patients had experienced significant complications, 19 (15.9 %) patients survived more than 2 years after the first diagnosis. In multivariable analysis, age >60 years old (HR 0.54, 95 % CI 0.31–0.92), Child-Pugh class A (HR 0.48, 95 % CI 0.30–0.76), and a major PVT without parasitic supply (HR 0.66, 95 % CI 0.44–0.99) were independent favorable prognostic factors. Development of significant complication after TACE was a significant hazard factor of survival (HR 1.99, 95 % CI 1.09–3.62).

Conclusions

In carefully selected patients with preserved hepatic function and good performance, TACE may achieve long-term survival of infiltrative HCC patients with major PVT without parasitic supply. However, the risk of morbidity and immediate mortality after TACE should be considered to select subjects for the procedure.

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Abbreviations

HCC:

Hepatocellular carcinoma

TACE:

Transarterial chemoembolization

PVT:

Portal vein thrombosis

BCLC:

Barcelona Clinic Liver Cancer

ECOG:

Eastern Cooperative Oncology Group

HBV:

Hepatitis B virus

AFP:

α-Fetoprotein

ALP:

Alkaline phosphatase

IQR:

Interquartile range

CT:

Computed tomography

References

  • Baer HU, Gertsch P, Matthews JB, Schweizer W, Triller J, Zimmermann A, Blumgart LH (1989) Resectability of large focal liver lesions. Br J Surg 76(10):1042–1044

    Article  PubMed  CAS  Google Scholar 

  • Benvegnu L, Noventa F, Bernardinello E, Pontisso P, Gatta A, Alberti A (2001) Evidence for an association between the aetiology of cirrhosis and pattern of hepatocellular carcinoma development. Gut 48(1):110–115

    Article  PubMed  CAS  Google Scholar 

  • Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53(3):1020–1022. doi:10.1002/hep.24199

    Article  PubMed  Google Scholar 

  • Choi SH, Chung JW, Lee HS (2003) Hepatocellular carcinoma supplied by portal flow after repeated transcatheter arterial chemoembolization. AJR Am J Roentgenol 181(3):889–890

    Article  PubMed  Google Scholar 

  • Chung JW, Park JH, Han JK, Choi BI, Han MC, Lee HS, Kim CY (1996) Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology 198(1):33–40

    PubMed  CAS  Google Scholar 

  • Chung GE, Lee JH, Kim HY, Hwang SY, Kim JS, Chung JW, Yoon JH, Lee HS, Kim YJ (2011) Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology 258(2):627–634. doi:10.1148/radiol.10101058

    Article  PubMed  Google Scholar 

  • Conill C, Verger E, Salamero M (1990) Performance status assessment in cancer patients. Cancer 65(8):1864–1866

    Article  PubMed  CAS  Google Scholar 

  • Demirjian A, Peng P, Geschwind JF, Cosgrove D, Schutz J, Kamel IR, Pawlik TM (2011) Infiltrating hepatocellular carcinoma: seeing the tree through the forest. J Gastrointest Surg 15(11):2089–2097. doi:10.1007/s11605-011-1614-7

    Article  PubMed  Google Scholar 

  • Forner A, Reig ME, de Lope CR, Bruix J (2010) Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 30(1):61–74. doi:10.1055/s-0030-1247133

    Article  PubMed  CAS  Google Scholar 

  • Geschwind JF, Ramsey DE, Choti MA, Thuluvath PJ, Huncharek MS (2003) Chemoembolization of hepatocellular carcinoma: results of a metaanalysis. Am J Clin Oncol 26(4):344–349. doi:10.1097/01.COC.0000020588.20717.BB

    PubMed  CAS  Google Scholar 

  • Goseki N, Nosaka T, Endo M, Koike M (1995) Nourishment of hepatocellular carcinoma cells through the portal blood flow with and without transcatheter arterial embolization. Cancer 76(5):736–742

    Article  PubMed  CAS  Google Scholar 

  • Kanematsu M, Semelka RC, Leonardou P, Mastropasqua M, Lee JK (2003) Hepatocellular carcinoma of diffuse type: MR imaging findings and clinical manifestations. J Magn Reson Imaging 18(2):189–195. doi:10.1002/jmri.10336

    Article  PubMed  Google Scholar 

  • Kiely JM, Rilling WS, Touzios JG, Hieb RA, Franco J, Saeian K, Quebbeman EJ, Pitt HA (2006) Chemoembolization in patients at high risk: results and complications. J Vasc Interv Radiol 17(1):47–53. doi:10.1097/01.RVI.0000195074.43474.2F

    Article  PubMed  Google Scholar 

  • Llovet JM, Real MI, Montana X, Planas R, Coll S, Aponte J, Ayuso C, Sala M, Muchart J, Sola R, Rodes J, Bruix J (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359(9319):1734–1739. doi:10.1016/S0140-6736(02)08649-X

    Article  PubMed  Google Scholar 

  • Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, Schwartz M, Porta C, Zeuzem S, Bolondi L, Greten TF, Galle PR, Seitz JF, Borbath I, Haussinger D, Giannaris T, Shan M, Moscovici M, Voliotis D, Bruix J (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359(4):378–390. doi:10.1056/NEJMoa0708857

    Article  PubMed  CAS  Google Scholar 

  • Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, Fan ST, Wong J (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35(5):1164–1171. doi:10.1053/jhep.2002.33156

    Article  PubMed  CAS  Google Scholar 

  • Lopez RR, Jr, Pan SH, Hoffman AL, Ramirez C, Rojter SE, Ramos H, McMonigle M, Lois J (2002) Comparison of transarterial chemoembolization in patients with unresectable, diffuse vs focal hepatocellular carcinoma. Arch Surg 137(6):653–657; discussion 657–658

    Google Scholar 

  • Marrero JA, Fontana RJ, Barrat A, Askari F, Conjeevaram HS, Su GL, Lok AS (2005) Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology 41(4):707–716. doi:10.1002/hep.20636

    Article  PubMed  Google Scholar 

  • Myung SJ, Yoon JH, Kim KM, Gwak GY, Kim YJ, Yu JW, Chung JW, Lee HS (2006) Diffuse infiltrative hepatocellular carcinomas in a hepatitis B-endemic area: diagnostic and therapeutic impediments. Hepatogastroenterology 53(68):266–270

    PubMed  Google Scholar 

  • Okuda K, Noguchi T, Kubo Y, Shimokawa Y, Kojiro M, Nakashima T (1981) A clinical and pathological study of diffuse type hepatocellular carcinoma. Liver 1(4):280–289

    PubMed  CAS  Google Scholar 

  • Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, Nakajima Y, Ohnishi K (1985) Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 56(4):918–928

    Article  PubMed  CAS  Google Scholar 

  • Sakar B, Ustuner Z, Karagol H, Aksu G, Camlica H, Aykan NF (2004) Prognostic features and survival of inoperable hepatocellular carcinoma in Turkish patients with cirrhosis. Am J Clin Oncol 27(5):489–493

    Article  PubMed  Google Scholar 

  • Savastano S, Miotto D, Casarrubea G, Teso S, Chiesura-Corona M, Feltrin GP (1999) Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with child’s grade A or B cirrhosis: a multivariate analysis of prognostic factors. J Clin Gastroenterol 28(4):334–340

    Article  PubMed  CAS  Google Scholar 

  • Stroffolini T, Andreone P, Andriulli A, Ascione A, Craxi A, Chiaramonte M, Galante D, Manghisi OG, Mazzanti R, Medaglia C, Pilleri G, Rapaccini GL, Albanese M, Taliani G, Tosti ME, Villa E, Gasbarrini G (1999) Gross pathologic types of hepatocellular carcinoma in Italy. Oncology 56(3):189–192

    Article  PubMed  CAS  Google Scholar 

  • Trevisani F, Caraceni P, Bernardi M, D’Intino PE, Arienti V, Amorati P, Stefanini GF, Grazi G, Mazziotti A, Fornale L et al (1993) Gross pathologic types of hepatocellular carcinoma in Italian patients. Relationship with demographic, environmental, and clinical factors. Cancer 72(5):1557–1563

    Article  PubMed  CAS  Google Scholar 

  • Yoon HJ, Kim JH, Kim KA, Lee IS, Ko GY, Song HY, Gwon DI (2010) Transcatheter arterial chemo-lipiodol infusion for unresectable hepatocellular carcinoma in 96 high-risk patients. Clin Radiol 65(4):271–277. doi:10.1016/j.crad.2010.01.018

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A102065) and by a grant from the Liver Research Foundation of Korea.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnamsi, Gyeonggido, Republic of Korea

    Eun Sun Jang

  2. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yungun-dong, Chongno-gu, Seoul, 110-744, Republic of Korea

    Jung-Hwan Yoon, Eun Ju Cho, Su Jong Yu, Jeong-Hoon Lee, Yoon Jun Kim, Hyo-Suk Lee & Chung Yong Kim

  3. Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea

    Jin Wook Chung

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  1. Eun Sun Jang
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Correspondence to Jung-Hwan Yoon.

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Jang, E.S., Yoon, JH., Chung, J.W. et al. Survival of infiltrative hepatocellular carcinoma patients with preserved hepatic function after treatment with transarterial chemoembolization. J Cancer Res Clin Oncol 139, 635–643 (2013). https://doi.org/10.1007/s00432-012-1364-2

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  • DOI: https://doi.org/10.1007/s00432-012-1364-2

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