Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2010

01-03-2010 | Hepatobiliary Tumors

Complete Necrosis After Transarterial Chemoembolization Could Predict Prolonged Survival in Patients with Recurrent Intrahepatic Hepatocellular Carcinoma After Curative Resection

Authors: Ju Hyun Shim, MD, Kang Mo Kim, MD, Young-Joo Lee, MD, Gi-Young Ko, MD, Hyun-Ki Yoon, MD, Kyu-Bo Sung, MD, Kwang-Min Park, MD, Sung-Gyu Lee, MD, Young-Suk Lim, MD, Han Chu Lee, MD, Young-Hwa Chung, MD, Yung Sang Lee, MD, Dong Jin Suh, MD

Published in: Annals of Surgical Oncology | Issue 3/2010

Login to get access

Abstract

Background

We explored the predictors of response to transarterial chemoembolization (TACE) in patients with recurrent intrahepatic hepatocellular carcinoma (HCC) after hepatectomy and investigated the survival of these patients according to the response to TACE.

Methods

We analyzed data from 199 consecutive HCC patients who underwent curative liver resection and who later received repeat TACE for intrahepatic HCC recurrence.

Results

Of 199 patients, 139 (69.8%) achieved complete necrosis (CN) of HCC after repeated TACE (mean TACE session number, 1.3) and the other 60 (30.2%) (non-CN group) did not achieve CN. At hepatectomy, the CN group showed significantly smaller proportions of tumor capsular invasion, microvascular invasion, and pathologic tumor–node–metastasis stage III or IV HCCs. At first TACE, the CN group showed a significantly greater proportion of patients with time to recurrence ≥ 1 year, Child–Pugh class A, serum alpha-fetoprotein (AFP) levels < 200 ng/mL, tumor size < 3 cm, solitary tumors, and nodular tumor types; portal vein invasion were less common than seen in the non-CN group. After multivariate analysis, tumor size < 3 cm and a single tumor at first TACE were independently related to attainment of CN after TACE. Median survival after first TACE was significantly longer in the CN group (48.9 versus 17.0 months). In a Cox regression model, CN after TACE was an independent predictor of favorable survival outcome after first TACE.

Conclusions

CN after repeat TACE for postresection intrahepatic recurrence was attained more commonly in patients with smaller tumor size and lower tumor number at first TACE and favored longer survival in recurrent patients.
Literature
1.
Bruix J, Sala M, Llovet JM. Chemoembolization for hepatocellular carcinoma. Gastroenterology. 2004;127(5 Suppl 1):S179–88.CrossRefPubMed
2.
Park KW, Park JW, Choi JI, et al. Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus-endemic area. J Gastroenterol Hepatol. 2008;23(3):467–73.CrossRefPubMed
3.
Esnaola NF, Mirza N, Lauwers GY, et al. Comparison of clinicopathologic characteristics and outcomes after resection in patients with hepatocellular carcinoma treated in the United States, France, and Japan. Ann Surg. 2003;238(5):711–9.CrossRefPubMed
4.
Pawlik TM, Delman KA, Vauthey JN, et al. Tumor size predicts vascular invasion and histologic grade: Implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl. 2005;11(9):1086–92.CrossRefPubMed
5.
Cha C, Fong Y, Jarnagin WR, et al. Predictors and patterns of recurrence after resection of hepatocellular carcinoma. J Am Coll Surg. 2003;197(5):753–8.CrossRefPubMed
6.
Llovet JM, Schwartz M, Mazzaferro V. Resection and liver transplantation for hepatocellular carcinoma. Semin Liver Dis. 2005;25(2):181–200.CrossRefPubMed
7.
Shah SA, Greig PD, Gallinger S, et al. Factors associated with early recurrence after resection for hepatocellular carcinoma and outcomes. J Am Coll Surg. 2006;202(2):275–83.CrossRefPubMed
8.
Poon RT, Fan ST, O’Suilleabhain CB, Wong J. Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma by combined resection and locoregional therapy. J Am Coll Surg. 2002;195(3):311–8.CrossRefPubMed
9.
Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg. 2003;238(5):703–10.CrossRefPubMed
10.
Poon RT, Fan ST, Lo CM, et al. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg. 1999;229(2):216–22.CrossRefPubMed
11.
Shimada M, Saitoh A, Kano T, et al. The effect of a perioperative steroid pulse on surgical stress in hepatic resection. Int Surg. 1996;81(1):49–51.PubMed
12.
Shimada K, Sakamoto Y, Esaki M, et al. Analysis of prognostic factors affecting survival after initial recurrence and treatment efficacy for recurrence in patients undergoing potentially curative hepatectomy for hepatocellular carcinoma. Ann Surg Oncol. 2007;14(8):2337–47.CrossRefPubMed
13.
El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132(7):2557–76.CrossRefPubMed
14.
Lee PH, Lin WJ, Tsang YM, et al. Clinical management of recurrent hepatocellular carcinoma. Ann Surg. 1995;222(5):670–6.CrossRefPubMed
15.
Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology. 2003;37(2):429–42.CrossRefPubMed
16.
Shim JH, Park JW, Choi JI, et al. Does postembolization fever after chemoembolization have prognostic significance for survival in patients with unresectable hepatocellular carcinoma? J Vasc Interv Radiol. 2009;20(2):209–16.CrossRefPubMed
17.
Han K, Lee J, Seong J. Treatment of non-resectable hepatocellular carcinoma. J Gastroenterol Hepatol. 2002;17 Suppl 3:S424–7.CrossRefPubMed
18.
Yu JS, Kim KW, Sung KB, et al. Small arterial-portal venous shunts: a cause of pseudolesions at hepatic imaging. Radiology. 1997;203(3):737–42.PubMed
19.
20.
Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693–9.CrossRefPubMed
21.
Jang MK, Lee HC, Kim IS, et al. Role of additional angiography and chemoembolization in patients with hepatocellular carcinoma who achieved complete necrosis following transarterial chemoembolization. J Gastroenterol Hepatol. 2004;19(9):1074–80.CrossRefPubMed
22.
Park JW. [Practice guideline for diagnosis and treatment of hepatocellular carcinoma]. Korean J Hepatol. 2004;10(2):88–98.PubMed
23.
Sobin LH, Wittekind Ch, eds. TMN classification of malignat tumors, 5th ed. New York: Wiley;1997.
24.
Tung-Ping Poon R, Fan ST, Wong J. Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg. 2000;232(1):10–24.CrossRefPubMed
25.
Choi GH, Kim DH, Kang CM, et al. Prognostic factors and optimal treatment strategy for intrahepatic nodular recurrence after curative resection of hepatocellular carcinoma. Ann Surg Oncol. 2008;15(2):618–29.CrossRefPubMed
26.
Poon RT, Ngan H, Lo CM, et al. Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol. 2000;73(2):109–14.CrossRefPubMed
27.
Okazaki M, Yamasaki S, Ono H, et al. Chemoembolotherapy for recurrent hepatocellular carcinoma in the residual liver after hepatectomy. Hepatogastroenterology. 1993;40(4):320–3.PubMed
28.
Ouchi K, Matsubara S, Fukuhara K, et al. Recurrence of hepatocellular carcinoma in the liver remnant after hepatic resection. Am J Surg. 1993;166(3):270–3.CrossRefPubMed
29.
Takayasu K, Arii S, Matsuo N, et al. Comparison of CT findings with resected specimens after chemoembolization with iodized oil for hepatocellular carcinoma. AJR Am J Roentgenol. 2000;175(3):699–704.PubMed
30.
Choi BI, Kim HC, Han JK, et al. Therapeutic effect of transcatheter oily chemoembolization therapy for encapsulated nodular hepatocellular carcinoma: CT and pathologic findings. Radiology. 1992;182(3):709–13.PubMed
31.
Taura K, Ikai I, Hatano E, et al. Implication of frequent local ablation therapy for intrahepatic recurrence in prolonged survival of patients with hepatocellular carcinoma undergoing hepatic resection: an analysis of 610 patients over 16 years old. Ann Surg. 2006;244(2):265–73.CrossRefPubMed
32.
Takayasu K, Wakao F, Moriyama N, et al. Postresection recurrence of hepatocellular carcinoma treated by arterial embolization: analysis of prognostic factors. Hepatology. 1992;16(4):906–11.CrossRefPubMed
33.
Jinno K, Moriwaki S, Tanada M, et al. Clinicopathological study on combination therapy consisting of arterial infusion of lipiodol-dissolved SMANCS and transcatheter arterial embolization for hepatocellular carcinoma. Cancer Chemother Pharmacol. 1992;31 Suppl:S7–12.CrossRefPubMed
34.
Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001;35(3):421–30.
35.
Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Liver Cancer Study Group of Japan. Ann Surg. 1990;211(3):277–87.
36.
Ernst O, Sergent G, Mizrahi D, et al. Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization: comparison of planned periodic chemoembolization and chemoembolization based on tumor response. AJR Am J Roentgenol. 1999;172(1):59–64.PubMed
37.
Tanaka K, Inoue S, Numata K, et al. Color Doppler sonography of hepatocellular carcinoma before and after treatment by transcatheter arterial embolization. AJR Am J Roentgenol. 1992;158(3):541–6.PubMed
38.
Lee JK, Chung YH, Song BC, et al. Recurrences of hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization. J Gastroenterol Hepatol. 2002;17(1):52–8.CrossRefPubMed
39.
Bismuth H, Morino M, Sherlock D, et al. Primary treatment of hepatocellular carcinoma by arterial chemoembolization. Am J Surg. 1992;163(4):387–94.CrossRefPubMed
40.
Huang YS, Chiang JH, Wu JC, et al. Risk of hepatic failure after transcatheter arterial chemoembolization for hepatocellular carcinoma: predictive value of the monoethylglycinexylidide test. Am J Gastroenterol. 2002;97(5):1223–7.CrossRefPubMed
41.
Cheng BQ, Jia CQ, Liu CT, et al. Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm: a randomized controlled trial. JAMA. 2008;299(14):1669–77.CrossRefPubMed
42.
Ishii H, Okada S, Sato T, et al. Effect of percutaneous ethanol injection for postoperative recurrence of hepatocellular carcinoma in combination with transcatheter arterial embolization. Hepatogastroenterology. 1996;43(9):644–50.PubMed
43.
Sato M, Watanabe Y, Iseki N, et al. Chemoembolization and percutaneous ethanol injection for intrahepatic recurrence of hepatocellular carcinoma after hepatic resection. Hepatogastroenterology. 1996;43(12):1421–6.PubMed
44.
Choi BO, Choi IB, Jang HS, et al. Stereotactic body radiation therapy with or without transarterial chemoembolization for patients with primary hepatocellular carcinoma: preliminary analysis. BMC Cancer 2008;8:351.CrossRefPubMed
45.
Yamada K, Izaki K, Sugimoto K, et al. Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2003;57(1):113–9.PubMed
46.
Poon RT, Fan ST, Ng IO, et al. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer. 2000;89(3):500–7.CrossRefPubMed
Metadata
Title
Complete Necrosis After Transarterial Chemoembolization Could Predict Prolonged Survival in Patients with Recurrent Intrahepatic Hepatocellular Carcinoma After Curative Resection
Authors
Ju Hyun Shim, MD
Kang Mo Kim, MD
Young-Joo Lee, MD
Gi-Young Ko, MD
Hyun-Ki Yoon, MD
Kyu-Bo Sung, MD
Kwang-Min Park, MD
Sung-Gyu Lee, MD
Young-Suk Lim, MD
Han Chu Lee, MD
Young-Hwa Chung, MD
Yung Sang Lee, MD
Dong Jin Suh, MD
Publication date
01-03-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 3/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0788-7

Other articles of this Issue 3/2010

Annals of Surgical Oncology 3/2010 Go to the issue

Translational Research and Biomarkers

Clinicopathologic Features of Non-Small-Cell Lung Cancer with EML4–ALK Fusion Gene

Colorectal Cancer

Clinically-Staged T3N0 Rectal Cancer: Is Preoperative Chemoradiotherapy the Optimal Treatment?

Thoracic Oncology

How Does the Number of Resected Lymph Nodes Influence TNM Staging and Prognosis for Esophageal Carcinoma?

Endocrine Tumors

The Adrenal Mass: Correlation of Histopathology with Imaging

Translational Research and Biomarkers

Hypoxic Single-Pass Isolated Hepatic Perfusion of Hypotonic Cisplatin: Safety Study in the Pig

Gastrointestinal Oncology

Emphasis on Preventing Microscopic Positive Margins in Gastric Cancer