Backgrounds/Aims Systemic therapy is the current standard treatment for hepatocellular carcinoma (HCC) with extrahepatic metastasis (EHM). However, some patients with HCC and EHM undergo transarterial chemoembolization (TACE) to manage intrahepatic tumors. Herein, we aimed to explore the appropriateness of TACE in patients with HCC and EHM in an era of advanced systemic therapy.
Methods This study analyzed 248 consecutive patients with HCC and EHM (median age, 58.5 years; male, 83.5%; Child-Pugh A, 88.7%) who received TACE or systemic therapy (83 sorafenib, 49 lenvatinib, 28 immunotherapy-based) between January 2018 and January 2021.
Results Among the patients, 196 deaths were recorded during a median follow-up of 8.9 months. Patients who received systemic therapy had a higher albumin-bilirubin grade, elevated tumor markers, an increased number of intrahepatic tumors, larger-sized tumors, and more frequent portal vein invasion than those who underwent TACE. TACE was associated with longer median overall survival (OS) than sorafenib (15.1 vs. 4.7 months; 95% confidence interval [CI], 11.1-22.2 vs. 3.7-7.3; hazard ratio [HR], 1.97; P<0.001). After adjustment for potential confounders, TACE was associated with statistically similar survival outcomes to those of lenvatinib (median OS, 8.0 months; 95% CI, 6.5-11.0; HR, 1.21; P=0.411) and immunotherapies (median OS, 14.3 months; 95% CI, 9.5-27.0; HR, 1.01; P=0.973), demonstrating survival benefits equivalent to these treatments.
Conclusions In patients with HCC and EHM, TACE can provide a survival benefit comparable to that of newer systemic therapies. Accordingly, TACE remains a valuable option in this era of new systemic therapies.
Management of hepatocellular carcinoma (HCC) is challenging due to the complex relationship between underlying liver disease, tumor burden, and liver function. HCC is also notorious for its high recurrence rate even after curative treatment for early-stage tumor. Liver transplantation can substantially alter patient prognosis, but donor availability varies by each patient which further complicates treatment decision. Recent advancements in HCC treatments have introduced numerous potentially efficacious treatment modalities. However, high level evidence comparing the risks and benefits of these options is limited. In this complex situation, multidisciplinary approach or multidisciplinary team care has been suggested as a valuable strategy to help cope with escalating complexity in HCC management. Multidisciplinary approach involves collaboration among medical and health care professionals from various academic disciplines to provide comprehensive care. Although evidence suggests that multidisciplinary care can enhance outcomes of HCC patients, robust data from randomized controlled trials are currently lacking. Moreover, the implementation of a multidisciplinary approach necessitates increased medical resources compared to conventional cancer care. This review summarizes the current evidence on the role of multidisciplinary approach in HCC management and explores potential future directions.
Jun Sik Yoon, Han Ah Lee, Hwi Young Kim, Dong Hyun Sinn, Dong Ho Lee, Suk Kyun Hong, Ju-Yeon Cho, Jonggi Choi, Young Chang, Hyun-Joo Kong, Eunyang Kim, Young-Joo Won, Jeong-Hoon Lee
J Liver Cancer. 2021;21(1):58-68. Published online March 31, 2021
Background/Aims Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer-related death in Korea. This study evaluated the characteristics of Korean patients newly diagnosed with HCC in 2015.
Methods Data from the Korean Primary Liver Cancer Registry (KPLCR), a representative sample of patients newly diagnosed with HCC in Korea, were analyzed. A total of 1,558 patients with HCC registered in the KPLCR in 2015 were investigated.
Results The median age was 61.0 years (interquartile range, 54.0-70.0 years), and men accounted for 79.7% of the subjects. Hepatitis B virus infection was the most common underlying liver disease (58.1%). According to the Barcelona Clinic Liver Cancer (BCLC) staging system, stage 0, A, B, C, and D HCCs accounted for 14.2%, 31.5%, 7.6%, 39.0%, and 7.8% of patients, respectively. Transarterial therapy (32.1%) was the most commonly performed initial treatment, followed by surgical resection (23.2%), best supportive care (20.2%), and local ablation therapy (10.7%). Overall, 34.5% of patients were treated in accordance with the BCLC guidelines: 59.2% in stage 0/A, 48.4% in stage B, 18.1% in stage C, and 71.6% in stage D. The 1-, 3-, and 5-year OS rates were 67.1%, 50.9%, and 27.0%, respectively.
Conclusions In 2015, approximately 45% of Korean HCC cases were diagnosed at a very early or early stage, and 35% of patients underwent potentially curative initial treatment. BCLC guidance was followed in 34.5% of patients; in patients with stage B or C disease, there was relatively low adherence.
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Transarterial radioembolization (TARE) with yttrium-90 microspheres has become widely utilized in managing hepatocellular carcinoma (HCC). The utility of TARE is expanding with new insights through experiences from real-world practice and clinical trials, and recently published data suggest that TARE in combination with sorafenib may improve the overall survival in selected patients. Here, we report a case of advanced stage HCC that was successfully treated with TARE and sorafenib. The patient achieved complete response (CR) at 12 months after the initial treatment with TARE and sorafenib, followed by additional transarterial chemoembolization and proton beam therapy for local tumor recurrence at 19-month post-TARE. The patient was followed up every 3 months thereafter and still achieved CR both biochemically and radiologically for the following 12 months. A combination strategy of TARE and systemic therapy may be a useful alternative treatment option for selected patients with advanced stage HCC.
Background/Aims To reduce the cancer burden, the Korean government initiated the National Cancer Control Plan including the National Liver Cancer Screening Program (NLCSP). Ultrasonography examinations and α-fetoprotein tests at six-month intervals are currently offered for high-risk individuals. High-risk individuals are identified by reviewing the National Health Insurance Service claims data for medical use for the past two years using International Classification of Diseases Codes for specific liver disease. We surveyed the attitudes and opinions towards the NLCSP to understand the issues surrounding the NLCSP in Korea.
Methods Altogether, 90 Korean Liver Cancer Association members participated in online and offline surveys between November and December 2019.
Results Approximately one-quarter (27%) of the survey participants rated the NLCSP as very contributing and about two-thirds (68%) as contributing to some extent toward reducing hepatocellular carcinoma (HCC)-related deaths in Korea. Most (87.8%) responded that the current process of identifying high-risk individuals needs improvement. Many (78.9%) were concerned that the current process identifies individuals who use medical services and paradoxically misses those who do not. When asked for the foremost priority for improvement, solving ‘duplication issues between the NLCSP and private clinic HCC screening practices’ was the most commonly selected choice (23.3%).
Conclusions The survey participants positively rated the role of the NLCSP in reducing liver cancer deaths. However, many participants rated the NCLSP as needing improvement in all areas. This survey can be a relevant resource for future health policy decisions regarding the NLCSP in Korea.
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A prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal
that the median survival is 2 to 4 months without treatment. Sorafenib, the standard regimen of
advanced HCC, can prolong median survival only 1.5 months. A 50-year-old man with a history
of chronic hepatitis B was diagnosed advanced HCC with PVTT. By a multidisciplinary medical
team approach, the combination of 3-demensional conformal radiation therapy with sequential
sorafenib was challenged. 4 months after initiation of treatment, he achieved partial response
as modified response evaluation criteria in solid tumors criteria. Sorafenib was continued so
far, and stable disease has been maintained up to now, without significant adverse effect.
Background/Aims Hepatocellular carcinoma (HCC) is a unique condition where the cause of
death might not only be due to progressive cancer, but also from liver failure. We evaluated
specific causes of death for HCC patients who were initially diagnosed within the Milan criteria. Methods A retrospective cohort of 147 patients with mortality who were initially diagnosed
with HCC within the Milan criteria between January 2008 and December 2012 at a single
institution was reviewed. Results During follow-up, 104 patients (70.7%) experienced one or more cirrhotic complications,
such as ascites, variceal bleeding, or hepatic encephalopathy. Near mortality, cancer progression
(exceeding the Milan criteria) was recorded for 102 patients (69.3%), while cirrhosis progression
(greater than two-point increase in Child-Pugh score) was noted in 110 (74.8%) patients. Alphafetoprotein,
protein-induced by vitamin K antagonist-II levels and treatment modality were
associated with cancer progression, while age and Child-Pugh class were associated with
cirrhosis progression. There were 61 patients with in-hospital mortality; cancer progression
plus liver failure was noted in 34 patients (55.7%), liver failure without cancer progression was
seen in 20 patients (32.8%), and only four patients (6.6%) showed mortality from extrahepatic
metastasis without liver failure. Conclusions Among HCC patients who were diagnosed within the Milan criteria, most of them
had cirrhosis progression near mortality, and significant proportion died without uncontrolled
cancer growth, mainly due to liver failure. These findings show the importance of liver function
that should be considered in managing HCC patients.
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This paper (“A case of rapid progression of hepatocellular carcinoma after radiofrequency ablation” by Lee K, et al from
Journal of Liver Cancer 2015;15(2):118-121) has been retracted because of the several figures (Fig. 1A, Fig. 3A, and Fig. 4) of
the paper1 were identical to those of the previous published original article2 without agreement of the copyright holder.
The authors informed that they will take full responsibility for this unintended duplicate publication of figures caused by
lack of communication, and wish to apologize to readers of the journal for any convenience.
To preserve scientific integrity, Journal of Liver Cancer agreed with the authors that this paper be retracted.
Background/Aims Cirrhosis has generally been considered a prerequisite for hepatitis C
virus (HCV)-infected livers to develop hepatocellular carcinoma (HCC), but HCCs that arise
in absence of cirrhosis has been reported. We assessed the prevalence and significance of
cirrhosis in HCV-related HCC patients who underwent surgical resection. Methods A total of 78 HCC patients (65 male [83.3%]; mean age, 64.2 ± 8.6 years) were
evaluated for the presence of cirrhosis. Cirrhosis was assessed based on histology, aspartate
aminotransferase-to-platelet ratio index (APRI) as well as clinical criteria, such as ascites,
varices, thrombocytopenia, splenomegaly, and radiographic configuration of cirrhosis. Results Based on histology, cirrhosis, septal fibrosis, periportal fibrosis and no fibrosis
was noticed in 33.3%, 60.3%, 5.1% and 1.3% of patients, respectively. The clinical criteria of
cirrhosis were present in 76.9% of patients. APRI > 1.0 was seen in 47.4% of patients. There
was no evidence of cirrhosis in 18 patients (23.1%), either by histology or clinically. Cirrhosis
by histology was an independent factor for overall survival [hazard ratio: 3.87 (95% CI: 1.24 –
12.00), P=0.019]. Conclusions Quite proportion of HCC patients had no evidence of cirrhosis, either by
histology or clinically. Careful follow-up for HCC may be necessary even for non-cirrhotic HCVinfected
Korean patients. (J Liver Cancer 2014;14:108-114)