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.
Citations
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The position of loco-regional therapy in the management of hepatocellular carcinoma with extrahepatic metastases Beom Kyung Kim Journal of Liver Cancer.2024; 24(2): 129. CrossRef
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 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.
Citations
Citations to this article as recorded by
2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma
Clinical Outcomes of Hepatitis B Virus–Related Hepatocellular Carcinoma Patients with Undetectable Serum HBV DNA Levels Jong-In Chang, Dong Hyun Sinn, Hyun Cho, Seonwoo Kim, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik Digestive Diseases and Sciences.2022; 67(9): 4565. CrossRef
2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma
Clinical and Molecular Hepatology.2022; 28(4): 583. CrossRef
2022 KLCA-NCC Korea Practice Guidelines for the Management of Hepatocellular Carcinoma
Korean Journal of Radiology.2022; 23(12): 1126. CrossRef
Stereotactic Ablative Radiotherapy for Oligometastatic Hepatocellular Carcinoma: A Multi-Institutional Retrospective Study (KROG 20-04) Tae Hyung Kim, Taek-Keun Nam, Sang Min Yoon, Tae Hyun Kim, Young Min Choi, Jinsil Seong Cancers.2022; 14(23): 5848. CrossRef
Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients Dong Hyun Sinn, Gyu-Seong Choi, Hee Chul Park, Jong Man Kim, Honsoul Kim, Kyoung Doo Song, Tae Wook Kang, Min Woo Lee, Hyunchul Rhim, Dongho Hyun, Sung Ki Cho, Sung Wook Shin, Woo Kyoung Jeong, Seong Hyun Kim, Jeong Il Yu, Sang Yun Ha, Su Jin Lee, Ho Yeon PLOS ONE.2019; 14(1): e0210730. CrossRef
Hepatocellular carcinoma with extrahepatic metastasis: Are there still candidates for transarterial chemoembolization as an initial treatment? Jihye Kim, Dong-Hyun Sinn, Moon Seok Choi, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik, Enzo Tagliazucchi PLOS ONE.2019; 14(3): e0213547. CrossRef
Treatment of hepatocellular carcinoma is often very challenging when the underlying liver
function is decompensated. Recent experimental and clinical studies showed that some
chelating agents, including deferoxamine, display anti-proliferative actions against tumor
cells, thereby exhibiting anti-cancer effect in certain cancers, including hepatocellular
carcinoma. Based on previous studies, we herein offer our experience of positive tumor
marker response after intra-arterial deferoxamine infusion in a patient presenting with
advanced hepatocellular carcinoma with decompensated hepatic function. Validation of
the efficacy of intra-arterial deferoxamine therapy in the setting of advanced hepatocellular
carcinoma with underlying decompensated hepatic function is warranted. (J Liver Cancer
2014;14:127-130)
Most patients with advanced hepatocellular carcinoma (HCC) are not suitable candidates for surgical treatment
at the time of diagnosis because of poor liver function, extensive tumor involvement of the liver, vascular
involvement, and/or intra/extrahepatic metastasis. We attempted localized concurrent chemo-radiation therapy
(CCRT) followed by hepatic arterial infusion chemotherapy (HAIC) in patients having locally advanced HCC with
vascular involvement and preserved hepatic function. We report a case of locally advanced HCC patient who
became surgically resectable by downstaging after localized CCRT followed by HAIC. Localized CCRT was
performed with a total radiation dose of 4,500 cGy (180 cGy × 25 times) and hepatic arterial infusion of
5-fluorouracil (5-FU, 500 mg/day) via implantable port system during the first and the last weeks of the
radiotherapy. Following localized CCRT, the patient was scheduled to receive HAIC with 5-FU (500 mg/m2 for
5 hours, days 1~3) and cisplatin (60 mg/m2 for 2 hours, day 2) every 4 weeks. Marked contraction of HCC was
noted on follow up computerized tomography (CT) and positron emission tomography (PET) after localized CCRT
and HAIC, and subsequently surgical resection with curative aim was performed. The patient is in complete
remission status without recurrence to date.