Impact of local tumor lesion treatments and preoperative indicators on the survival of patients with small hepatocellular carcinomas

Wei,Yanyan; Dai,Feng; Yi,Yongxiang; Ye,Wei; Zhao,Wei

doi:10.3892/ol.2018.9263

Impact of local tumor lesion treatments and preoperative indicators on the survival of patients with small hepatocellular carcinomas

Authors:
- Yanyan Wei
- Feng Dai
- Yongxiang Yi
- Wei Ye
- Wei Zhao
View Affiliations

Affiliations: Department of Liver Disease, The Second Hospital of Nanjing, Medical School of Southeast University, Nanjing, Jiangsu 210000, P.R. China
Published online on: August 3, 2018 https://doi.org/10.3892/ol.2018.9263
Pages: 5050-5058
Copyright: © Wei et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The prognosis for small hepatocellular carcinomas (SHCC) remains uncertain. The aim of the present study was to compare three local tumor lesion treatments and identify the prognostic factors in patients with SHCC by analyzing preoperative indicators. A retrospective study was performed using data from 206 patients with SHCC from 2006‑2015. All of the patients had undergone transarterial chemoembolization (TACE) alone, TACE plus percutaneous microwave coagulation therapy (PMCT) or surgical resection (SR). The Kaplan‑Meier method was used to calculate the survival rates. Multivariate analysis was conducted using Cox regression analysis. The median survival time of patients with SHCC was 27 (range, 14‑49) months in the TACE group, 29.5 (range, 16‑52) months in the TACE‑PMCT group and 36.5 (range, 26‑52) months in the SR group (P=0.091). The 1, 3 and 5‑year survival rates for patients with SHCC were 82.4, 64.9 and 46.8% in the TACE group; 89.0, 72.6 and 58.3% in the TACE‑PMCT group and 88.8, 72.3 and 58.6% in the SR group (P=0.181), respectively. Analysis from the Cox regression model demonstrated that preoperative α‑fetoprotein (AFP; <400 ng/ml vs. ≥400 ng/ml; HR=0.548; P=0.036) was an independent predictor of the survival time of patients with SHCC. Analysis of patients with preoperative AFP levels of ≥400 ng/ml revealed that the median survival time in the SR group was 36 (range, 28.25‑52) months, significantly longer than the TACE (17 months; range, 12‑44 months) and TACE‑PMCT group (27 months; range, 14‑55 months; P=0.035). The 1, 2 and 3‑year survival rates for patients with SHCC with ≥400 ng/ml AFP were: 70.8, 55.5 and 49.9% in the TACE group; 83.7, 68.0 and 60.8% in the TACE‑PMCT group; and 90.9, 81.8 and 61.0% in SR group, respectively (P=0.664). However, there was no significant difference among the three groups in the survival time of patients with SHCC with <400 ng/ml preoperative AFP. The observations indicated that SR is not significantly different for overall survival time in the patients with SHCC between the two groups; this method can be employed for patients with SHCC. This was based on the median survival time of patients with ≥400 ng/ml AFP in the SR group who had a longer survival time and a higher survival rate than in the TACE and TACE‑PMCT group.

View Figures

View References

1	Wang X, Wang ZS and Wu LQ: Combined measurements of tumor number and size helps estimate the outcome of resection of Barcelona clinic liver cancer stage B hepatocellular carcinoma. Bmc Surg. 16:2016. View Article : Google Scholar
2	Qin SK, Bai YX, Lim HY, Thongprasert S, Chao Y, Fan J, Yang TS, Bhudhisawasdi V, Kang WK, Zhou Y, et al: Randomized, multicenter, open-label study of oxaliplatin plus fluorouracil/leucovorin versus doxorubicin as palliative chemotherapy in patients with advanced hepatocellular carcinoma from Asia. J Clin Oncol. 31:3501–3508. 2013. View Article : Google Scholar : PubMed/NCBI
3	França AV, Elias Junior J, Lima BL, Martinelli AL and Carrilho FJ: Diagnosis, staging and treatment of hepatocellular carcinoma. Braz J Med Biol Res. 37:1689–1705. 2004. View Article : Google Scholar : PubMed/NCBI
4	Llovet JM, Fuster J and Bruix J; Barcelona-Clinic Liver Cancer G, : The Barcelona approach: Diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl. 10:S115–S120. 2004. View Article : Google Scholar : PubMed/NCBI
5	Yang LY, Fang F, Ou DP, Wu W, Zeng ZJ and Wu F: Solitary large hepatocellular carcinoma a specific subtype of hepatocellular carcinoma with good outcome after hepatic resection. Ann Surg. 249:118–123. 2009. View Article : Google Scholar : PubMed/NCBI
6	Ochiai T, Sonoyama T, Ichikawa D, Fujiwara H, Okamoto K, Sakakura C, Ueda Y, Otsuji E, Itoi H, Hagiwara A and Yamagishi H: Poor prognostic factors of hepatectomy in patients with resectable small hepatocellular carcinoma and cirrhosis. J Cancer Res Clin Oncol. 130:197–202. 2004. View Article : Google Scholar : PubMed/NCBI
7	Cong WM and Wu MC: Small hepatocellular carcinoma: Current and future approaches. Hepatol Int. 7:805–812. 2013. View Article : Google Scholar : PubMed/NCBI
8	Kaneko H, Takagi S and Shiba T: Laparoscopic partial hepatectomy and left lateral segmentectomy: Technique and results of a clinical series. Surgery. 120:468–475. 1996. View Article : Google Scholar : PubMed/NCBI
9	Seki T, Tamai T, Nakagawa T, Imamura M, Nishimura A, Yamashiki N, Ikeda K and Inoue K: Combination therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation therapy for hepatocellular carcinoma. Cancer. 89:1245–1251. 2000. View Article : Google Scholar : PubMed/NCBI
10	Shiozawa K, Watanabe M, Wakui N, Ikehara T, Iida K and Sumino Y: Risk factors for the local recurrence of hepatocellular carcinoma after single-session percutaneous radiofrequency ablation with a single electrode insertion. Mol Med Rep. 2:89–95. 2009.PubMed/NCBI
11	Terzi E, Piscaglia F, Forlani L, Mosconi C, Renzulli M, Bolondi L and Golfieri R; BLOG-Bologna Liver Oncology Group, ; S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy, : TACE performed in patients with a single nodule of hepatocellular carcinoma. BMC Cancer. 14:6012014. View Article : Google Scholar : PubMed/NCBI
12	Yang WZ, Jiang N, Huang N, Huang JY, Zheng QB and Shen Q: Combined therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation for small hepatocellular carcinoma. World J Gastroenterol. 15:748–752. 2009. View Article : Google Scholar : PubMed/NCBI
13	Fu CC, Liu NZ, Deng QS, Li XW, Ma KS and Bie P: Radiofrequency ablation vs. surgical resection on the treatment of patients with small hepatocellular carcinoma: A system review and meta-analysis sf five randomized controlled trials. Hepato-Gastroenterol. 61:1722–1729. 2014.
14	De Carlis L, Giacomom A, Pirotta V, Lauterio A, Slim AO, Sammartino C, Cardillo M and Forti D: Surgical treatment of hepatocellular cancer in the era of hepatic transplantation. J Am Coll Surgeons. 196:887–897. 2003. View Article : Google Scholar
15	Kamo N, Kaido T, Yagi S, Okajima H and Uemoto S: Liver transplantation for small hepatocellular carcinoma. Hepatol Surg Nutr. 5:391–398. 2016. View Article : Google Scholar
16	Hsu HC, Wu TT, Wu MZ, Sheu JC, Lee CS and Chen DS: Tumor invasiveness and prognosis in resected hepatocellular carcinoma. Clinical and pathogenetic implications. Cancer. 61:2095–2099. 1988. View Article : Google Scholar : PubMed/NCBI
17	Huang G, Lau WY, Wang ZG, Pan ZY, Yuan SX, Shen F, Zhou WP and Wu MC: Antiviral therapy improves postoperative survival in patients with hepatocellular carcinoma: A randomized controlled trial. Ann Surg. 261:56–66. 2015. View Article : Google Scholar : PubMed/NCBI
18	Ko CJ, Chien SY, Chou CT, Chen LS, Chen ML and Chen YL: Factors affecting prognosis of small hepatocellular carcinoma in Taiwanese patients following hepatic resection. Can J Gastroenterol. 25:485–491. 2011. View Article : Google Scholar : PubMed/NCBI
19	Shimozawa N and Hanazaki K: Longterm prognosis after hepatic resection for small hepatocellular carcinoma. J Am Coll Surg. 198:356–365. 2004. View Article : Google Scholar : PubMed/NCBI
20	Sugimachi K, Shirabe K, Taketomi A, Soejima Y, Iguchi T, Takeishi K, Toshima T, Aishima S, Tajima T and Maehara Y: Prognostic significance of preoperative imaging in recipients of living donor liver transplantation for hepatocellular carcinoma. Transplantation. 91:570–574. 2011. View Article : Google Scholar : PubMed/NCBI
21	Hakamada K, Kimura N, Miura T, Morohashi H, Ishido K, Nara M, Toyoki Y, Narumi S and Sasaki M: Des-gamma-carboxy prothrombin as an important prognostic indicator in patients with small hepatocellular carcinoma. World J Gastroentero. 14:1370–1377. 2008. View Article : Google Scholar
22	Hernández-Guerra M, Hernández-Camba A, Turnes J, Ramos LM, Arranz L, Mera J, Crespo J and Quintero E: Application of the Barcelona clinic liver cancer therapeutic strategy and impact on survival. United European Gastroenterol J. 3:284–293. 2015. View Article : Google Scholar : PubMed/NCBI
23	Prajapati HJ and Kim HS: Treatment algorithm based on the multivariate survival analyses in patients with advanced hepatocellular carcinoma treated with trans-arterial chemoembolization. PLoS One. 12:e01707502017. View Article : Google Scholar : PubMed/NCBI
24	Lok AS: Prevention of hepatitis B virus-related hepatocellular carcinoma. Gastroenterology. 127:S303–S309. 2004. View Article : Google Scholar : PubMed/NCBI
25	Zhou XD, Tang ZY, Yang BH, Lin ZY, Ma ZC, Ye SL, Wu ZQ, Fan J, Qin LX and Zheng BH: Experience of 1000 patients who underwent hepatectomy for small hepatocellular carcinoma. Cancer. 91:1479–1486. 2001. View Article : Google Scholar : PubMed/NCBI
26	Zhao JH, Zhang H, Wei LS, Xie SP and Suo ZM: Comparing the long-term efficacy of standard and combined minimally invasive procedures for unresectable HCC: A mixed treatment comparison. Oncotarget. 8:15101–15113. 2017.PubMed/NCBI
27	Takuma Y, Takabatake H, Morimoto Y, Toshikuni N, Kayahara T, Makino Y and Yamamoto H: Comparison of combined transcatheter arterial chemoembolization and radiofrequency ablation with surgical resection by using propensity score matching in patients with hepatocellular carcinoma within milan criteria. Radiology. 269:927–937. 2013. View Article : Google Scholar : PubMed/NCBI
28	Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, Kudo M, Lee JM, Choi BI, Poon RT, et al: Asian Pacific Association for the study of the liver consensus recommendations on hepatocellular carcinoma. Hepatol Int. 4:439–474. 2010. View Article : Google Scholar : PubMed/NCBI
29	Poon RT, Fan ST, Lo CM, Liu CL and Wong J: Difference in tumor invasiveness in cirrhotic patients with hepatocellular carcinoma fulfilling the Milan criteria treated by resection and transplantation: Impact on long-term survival. Ann Surg. 245:51–58. 2007. View Article : Google Scholar : PubMed/NCBI
30	Nagashima I, Hamada C, Naruse K, Osada T, Nagao T, Kawano N and Muto T: Surgical resection for small hepatocellular carcinoma. Surgery. 119:40–45. 1996. View Article : Google Scholar : PubMed/NCBI
31	Segawa T, Izawa K, Tsunoda T, Kanematsu T, Shima M, Matsunaga N and Hayashi K: Evaluation of hepatectomy in small hepatocellular carcinoma-comparison with transcatheter arterial embolization therapy. Nihon Geka Gakkai Zasshi. 93:1095–1099. 1992.(In Japanese). PubMed/NCBI
32	Huang J, Yan L, Cheng Z, Wu H, Du L, Wang J, Xu Y and Zeng Y: A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg. 252:903–912. 2010. View Article : Google Scholar : PubMed/NCBI
33	Shi J, Sun Q, Wang Y, Jing X, Ding J, Yuan Q, Ren C, Shan S, Wang Y and Du Z: Comparison of microwave ablation and surgical resection for treatment of hepatocellular carcinomas conforming to Milan criteria. J Gastroenterol Hepatol. 29:1500–1507. 2014. View Article : Google Scholar : PubMed/NCBI
34	Maluccio M and Covey A: Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA Cancer J Clin. 62:394–399. 2012. View Article : Google Scholar : PubMed/NCBI
35	Kim JY, Sinn DH, Gwak GY, Choi GS, Saleh AM, Joh JW, Cho SK, Shin SW, Carriere KC, Ahn JH, et al: Transarterial chemoembolization versus resection for intermediate-stage (BCLC B) hepatocellular carcinoma. Clin Mol Hepatol. 22:250–258. 2016. View Article : Google Scholar : PubMed/NCBI
36	Boutros C, Somasundar P, Garrean S, Saied A and Espat NJ: Microwave coagulation therapy for hepatic tumors: Review of the literature and critical analysis. Surg Oncol. 19:e22–e32. 2010. View Article : Google Scholar : PubMed/NCBI
37	Tamai T, Oshige A, Tabu K, Tabu E, Ijyuin S, Sakae H, Onishi H, Muromachi K, Saisyoji A, Oda K, et al: Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma. Oncol Lett. 14:3199–3206. 2017. View Article : Google Scholar : PubMed/NCBI
38	Nomura F, Ohnishi K and Tanabe Y: Clinical features and prognosis of hepatocellular carcinoma with reference to serum alpha-fetoprotein levels. Analysis of 606 patients. Cancer. 64:1700–1707. 1989. View Article : Google Scholar : PubMed/NCBI
39	Choi D, Lim HK, Rhim H, Kim YS, Yoo BC, Paik SW, Joh JW and Park CK: Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: Long-term results and prognostic factors. Ann Surg Oncol. 14:2319–2329. 2007. View Article : Google Scholar : PubMed/NCBI
40	Carr BI, Guerra V, Giannini EG, Farinati F, Ciccarese F, Rapaccini GL, Di Marco M, Benvegnù L, Zoli M, Borzio F, et al: Low alpha-fetoprotein HCC and the role of GGTP. Int J Biol Markers. 29:e395–e402. 2014. View Article : Google Scholar : PubMed/NCBI
41	Blank S, Wang Q, Fiel MI, Luan W, Kim KW, Kadri H, Mandeli J and Hiotis SP: Assessing prognostic significance of preoperative alpha-fetoprotein in hepatitis B-associated hepatocellular carcinoma: Normal is not the new normal. Ann Surg Oncol. 21:986–994. 2014. View Article : Google Scholar : PubMed/NCBI
42	Terentiev AA and Moldogazieva NT: Alpha-fetoprotein: A renaissance. Tumour Biol. 34:2075–2091. 2013. View Article : Google Scholar : PubMed/NCBI
43	Giannini EG, Marenco S, Borgonovo G, Savarino V, Farinati F, Del Poggio P, Rapaccini GL, Anna Di Nolfo M, Benvegnù L, Zoli M, et al: Alpha-fetoprotein has no prognostic role in small hepatocellular carcinoma identified during surveillance in compensated cirrhosis. Hepatology. 56:1371–1379. 2012. View Article : Google Scholar : PubMed/NCBI
44	Graham JA, Melancon JK, Shetty K and Johnson LB: Liver transplantation should be offered to patients with small solitary hepatocellular carcinoma and a positive serum alpha fetoprotein rather than resection. Am J Surg. 205:374–380. 2013. View Article : Google Scholar : PubMed/NCBI
45	Bholee AK, Peng K, Zhou Z, Chen J, Xu L, Zhang Y and Chen M: Radiofrequency ablation combined with transarterial chemoembolization versus hepatectomy for patients with hepatocellular carcinoma within Milan criteria: A retrospective case-control study. Clin Transl Oncol. 19:844–852. 2017. View Article : Google Scholar : PubMed/NCBI
46	Choi D, Lim HK, Rhim H, Kim YS, Lee WJ, Paik SW, Koh KC, Lee JH, Choi MS and Yoo BC: Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: Long-term results and prognostic factors in a large single-institution series. Eur Radiol. 17:684–692. 2007. View Article : Google Scholar : PubMed/NCBI
47	Kim BK, Ahn SH, Seong JS, Park JY, Kim DY, Kim JK, Lee DY, Lee KH and Han KH: Early α-fetoprotein response as a predictor for clinical outcome after localized concurrent chemoradiotherapy for advanced hepatocellular carcinoma. Liver Int. 31:369–376. 2011. View Article : Google Scholar : PubMed/NCBI
48	Khan MM, Saito S, Takagi S, Ohnishi H, Izumi H, Sakauchi F, Washio M, Sonoda T, Nagata Y, Asakura S, et al: Relationship between hepatocellular carcinoma and impaired glucose tolerance among Japanese. Hepatogastroenterology. 53:742–746. 2006.PubMed/NCBI
49	Singal AK and Ayoola AE: Prevalence and factors affecting occurrence of type 2 diabetes mellitus in Saudi patients with chronic liver disease. Saudi J Gastroenterol. 14:118–121. 2008. View Article : Google Scholar : PubMed/NCBI