1Department of Health Promotion Center, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
Copyright © 2020 by The Korean Liver Cancer Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
STATEMENT OF FINANCIAL SUPPORT
This study was supported by a grant from Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (grant number: 2017R1D1A1B03031499), and a grant and supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT) (grant number: 2020R1C1C1004112).
Conflicts of Interest
The authors declare no conflicts of interest relevant to this article.
Subclassification | B1 | B2 | B3 | |
---|---|---|---|---|
Child-Pugh score | 5–7 | 5–7 | 8–9 | |
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Beyond Milan within up-to-7 criteria | In | Out | Any | |
In (B3a) | Out (B3b) | |||
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Concept of treatment | Curative |
Palliative Non-curative |
Curative intent if within up-to-7 |
Palliative No treatment |
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Treatment option | Resection, ablation, c-TACE | DEB-TACE*, HAIC†, sorafenib‡ | Liver transplantation, ablation, c-TACE | HAIC†, DEB-TACE* |
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Alternative |
DEB-TACE* (if large HCC, Child-Pugh score 7) B-TACE§ |
c-TACE | DEB-TACE*, B-TACE§, HAIC† | Best supportive care |
c-TACE, conventional transarterial chemoembolization; DEB-TACE, drug-eluting beads transarterial chemoembolization; HAIC, hepatic arterial infusion chemotherapy; HCC, hepatocellular carcinoma; B-TACE, balloon-occluded TACE.
* DEB-TACE is recommended for tumor >6 cm;
† HAIC is recommended for multiple tumors >6;
‡ Sorafenib is recommended for Child-Pugh socre 5–6;
§ B-TACE is recommended for fewer tumors.
Year | Study design | Treatment group | Patients number | Tumor burden | Child-Pugh A/B (n) | Median OS (months) | 3-year OS (%) | 5-year OS (%) | P-value* |
---|---|---|---|---|---|---|---|---|---|
2014 | Randomized controlled trial | Surgery | 88 | Resectable outside Milan criteria (no vascular invasion and extrahepatic metastasis) | 87/1 | 41 | 51.5 | NR | <0.001 |
TACE | 85 | 80/5 | 14 | 18.1 | NR | ||||
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2011 | Prospective | Surgery | 85 | Intermediate stage and solitary tumor ≥5 cm | 81/4 | 22.5 | 35.3 | 23.9 | 0.26 |
TACE | 83 | 82/1 | 19.5 | 26.0 | 18.9 | ||||
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2017 | Retrospective | Surgery | 132 | Intermediate stage | 132/0 | 64 | 63.4 | 53.1 | 0.01 |
TACE | 132 | 132/0 | 41 | 53.0 | 34.1 | ||||
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2016 | Retrospective | Surgery | 52 | Intermediate stage | 51/1 | 61 | 65.0 | 51.8 | 0.02 |
TACE | 225 | 187/38 | 30 | 39.2 | 27.9 | ||||
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2016 | Retrospective | Surgery | 274 | Intermediate stage | 274/0 | 31.9 | 46 | 37 | <0.001 |
TACE | 169 | 169/0 | 14.3 | 15 | 12 | ||||
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2015 | Retrospective | Surgery | 36 | Intermediate stage | 32/4 | NR | 52.8 | 44.4 | 0.23 |
TACE | 44 | 29/15 | NR | 47.7 | 38.6 | ||||
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2014 | Retrospective | Surgery | 433 | Intermediate stage | 328/105 | 24.8 | 71.1 | 61.2 | <0.001 |
TACE | 490 | 381/109 | 26.9 | 62.2 | 45.1 |
Subclassification | B1 | B2 | B3 | B4 |
---|---|---|---|---|
Child-Pugh score | 5–7 | 5–6 | 7 | 8–9 |
Beyond Milan within up-to-7 criteria | In | Out | Out | Any |
ECOG-PS | 0 | 0 | 0 | 0–1 |
Portal vein thrombosis | No | No | No | No |
First treatment | TACE | TACE or TARE | (−) | Best supportive care |
Alternative option | Liver transplantation or TACE+ablation | Sorafenib | Research trials TACE+sorafenib | Liver transplantation |
Subclassification | B1 | B2 | B3 | |
---|---|---|---|---|
Child-Pugh score | 5–7 | 5–7 | 8–9 | |
| ||||
Beyond Milan within up-to-7 criteria | In | Out | Any | |
In (B3a) | Out (B3b) | |||
| ||||
Concept of treatment | Curative | Palliative Non-curative |
Curative intent if within up-to-7 | Palliative No treatment |
| ||||
Treatment option | Resection, ablation, c-TACE | DEB-TACE |
Liver transplantation, ablation, c-TACE | HAIC |
| ||||
Alternative | DEB-TACE B-TACE |
c-TACE | DEB-TACE |
Best supportive care |
Year | Study design | Treatment group | Patients number | Tumor burden | Child-Pugh A/B (n) | Median OS (months) | 3-year OS (%) | 5-year OS (%) | P-value |
---|---|---|---|---|---|---|---|---|---|
2014 | Randomized controlled trial | Surgery | 88 | Resectable outside Milan criteria (no vascular invasion and extrahepatic metastasis) | 87/1 | 41 | 51.5 | NR | <0.001 |
TACE | 85 | 80/5 | 14 | 18.1 | NR | ||||
| |||||||||
2011 | Prospective | Surgery | 85 | Intermediate stage and solitary tumor ≥5 cm | 81/4 | 22.5 | 35.3 | 23.9 | 0.26 |
TACE | 83 | 82/1 | 19.5 | 26.0 | 18.9 | ||||
| |||||||||
2017 | Retrospective | Surgery | 132 | Intermediate stage | 132/0 | 64 | 63.4 | 53.1 | 0.01 |
TACE | 132 | 132/0 | 41 | 53.0 | 34.1 | ||||
| |||||||||
2016 | Retrospective | Surgery | 52 | Intermediate stage | 51/1 | 61 | 65.0 | 51.8 | 0.02 |
TACE | 225 | 187/38 | 30 | 39.2 | 27.9 | ||||
| |||||||||
2016 | Retrospective | Surgery | 274 | Intermediate stage | 274/0 | 31.9 | 46 | 37 | <0.001 |
TACE | 169 | 169/0 | 14.3 | 15 | 12 | ||||
| |||||||||
2015 | Retrospective | Surgery | 36 | Intermediate stage | 32/4 | NR | 52.8 | 44.4 | 0.23 |
TACE | 44 | 29/15 | NR | 47.7 | 38.6 | ||||
| |||||||||
2014 | Retrospective | Surgery | 433 | Intermediate stage | 328/105 | 24.8 | 71.1 | 61.2 | <0.001 |
TACE | 490 | 381/109 | 26.9 | 62.2 | 45.1 |
ECOG-PS, Eastern Cooperative Oncology Group tumor-related performance status; TACE, transarterial chemoembolization; TARE, transarterial radioembolization.
c-TACE, conventional transarterial chemoembolization; DEB-TACE, drug-eluting beads transarterial chemoembolization; HAIC, hepatic arterial infusion chemotherapy; HCC, hepatocellular carcinoma; B-TACE, balloon-occluded TACE. DEB-TACE is recommended for tumor >6 cm; HAIC is recommended for multiple tumors >6; Sorafenib is recommended for Child-Pugh socre 5–6; B-TACE is recommended for fewer tumors.
TACE, transarterial chemoembolization; HCC, hepatocellular carcinoma; OS, overall survival; NR, not reported. Multivariate Cox regression models were used for