Background:The Barcelona Clinic Liver Cancer(BCLC)system has been endorsed by international guidelines as a staging algorithm of hepatocellular carcinoma.This analysis was performed to assess the outcome of liver tran...Background:The Barcelona Clinic Liver Cancer(BCLC)system has been endorsed by international guidelines as a staging algorithm of hepatocellular carcinoma.This analysis was performed to assess the outcome of liver transplantation in patients treated against the BCLC recommendations.Methods:The data of 198 patients who underwent liver transplantation for hepatocellular carcinoma were extracted from a prospectively maintained database to classify the patients according to the BCLC system.Results:BCLC staging was as follows:0,n=5;A,n=77;B,n=41;C,n=53;and D,n=22.Accordingly,liver transplantation was performed in the majority of patients against BCLC recommendations.Surgery(n=16),radiofrequency ablation(n=15)and transarterial chemoembolization(n=151)preceded liver transplantation in 182 patients.Sixteen patients were transplanted without pretreatment.The 1-,5-and 10-year survival rates were 83.8%,62.4%and 45.9%,and 1-,5-,and 10-year recurrence rates were 7.7%,22.7%and 26.7%.The BCLC classification did neither impact survival(P=0.796)nor recurrence(P=0.693).In the Cox analysis,RECIST tumor progression and initial alpha fetoprotein were independent predictors of outcome.Conclusions:Neither the oncological nor the functional stratification imposed by the BCLC system was of importance for outcome.Lack of flexibility and disregard of biological parameters hamper its clinical applicability in liver transplantation.展开更多
Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of e...Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of effectiveness and safety, as reported in recent research articles, systematic reviews and meta-analyses. In this report, we summarized for the first time the results of proton therapy treatment for HCC according with respect to the Barcelona Clinic Liver Cancer Staging System, the most adopted classification system for HCC which provides information on both prognostic prediction and treatment allocation.展开更多
Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a signific...Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a significant clinical challenge.However,transarterial chemoembolization(TACE)is the only recommended treatment option.Therefore,we aimed to investigate the patient characteristics and outcomes of living donor liver transplantation(LDLT)for BCLC stage B HCC.Methods:A total of 516 patients with BCLC stage B HCC who underwent LDLT(n=104)or did not undergo LDLT(non-LDLT;n=412)between 2004 to 2018 were analyzed by propensity score matching(PSM;1:4)analysis.Factors influencing overall survival(OS)and recurrence were analyzed using Cox’s proportional hazards models.Results:Patients treated with LDLT achieved better OS than the non-LDLT group,including liver-and non-liver related survival(all P<0.001).Multivariate Cox regression analysis showed age>60 years(P=0.006),a neutrophil-lymphocyte ratio(NLR)>4(P=0.016)and>3 locoregional therapies(LRT)before LDLT(P<0.001)were independent risk factors for HCC recurrence.In addition,age>60 years(P<0.001)and>3 LRT before LDLT(P=0.001)were independent risk factors for OS.Using a combination of age,NLR,and LRT before liver transplantation(LT),the patients can be divided into low-risk(none of risk),intermediate-risk(one of risk),and high risk(more than two of risk)groups.There were significant differences in the cumulative HCC recurrence(P<0.001)and mortality(P<0.001)rates among the three groups.Conclusions:LDLT may represent a valuable therapeutic option for selected patients with BCLC stage B HCC.展开更多
文摘Background:The Barcelona Clinic Liver Cancer(BCLC)system has been endorsed by international guidelines as a staging algorithm of hepatocellular carcinoma.This analysis was performed to assess the outcome of liver transplantation in patients treated against the BCLC recommendations.Methods:The data of 198 patients who underwent liver transplantation for hepatocellular carcinoma were extracted from a prospectively maintained database to classify the patients according to the BCLC system.Results:BCLC staging was as follows:0,n=5;A,n=77;B,n=41;C,n=53;and D,n=22.Accordingly,liver transplantation was performed in the majority of patients against BCLC recommendations.Surgery(n=16),radiofrequency ablation(n=15)and transarterial chemoembolization(n=151)preceded liver transplantation in 182 patients.Sixteen patients were transplanted without pretreatment.The 1-,5-and 10-year survival rates were 83.8%,62.4%and 45.9%,and 1-,5-,and 10-year recurrence rates were 7.7%,22.7%and 26.7%.The BCLC classification did neither impact survival(P=0.796)nor recurrence(P=0.693).In the Cox analysis,RECIST tumor progression and initial alpha fetoprotein were independent predictors of outcome.Conclusions:Neither the oncological nor the functional stratification imposed by the BCLC system was of importance for outcome.Lack of flexibility and disregard of biological parameters hamper its clinical applicability in liver transplantation.
文摘Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of effectiveness and safety, as reported in recent research articles, systematic reviews and meta-analyses. In this report, we summarized for the first time the results of proton therapy treatment for HCC according with respect to the Barcelona Clinic Liver Cancer Staging System, the most adopted classification system for HCC which provides information on both prognostic prediction and treatment allocation.
基金This work was supported by grants from the Health and Welfare Surcharge of Tobacco Products,Ministry of Health and Welfare,Taiwan(Nos.MOHW107-TDU-B-212-114022,MOHW108-TDU-B-212-124022,MOHW109-TDU-B-212-134022 to Chen CL).
文摘Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a significant clinical challenge.However,transarterial chemoembolization(TACE)is the only recommended treatment option.Therefore,we aimed to investigate the patient characteristics and outcomes of living donor liver transplantation(LDLT)for BCLC stage B HCC.Methods:A total of 516 patients with BCLC stage B HCC who underwent LDLT(n=104)or did not undergo LDLT(non-LDLT;n=412)between 2004 to 2018 were analyzed by propensity score matching(PSM;1:4)analysis.Factors influencing overall survival(OS)and recurrence were analyzed using Cox’s proportional hazards models.Results:Patients treated with LDLT achieved better OS than the non-LDLT group,including liver-and non-liver related survival(all P<0.001).Multivariate Cox regression analysis showed age>60 years(P=0.006),a neutrophil-lymphocyte ratio(NLR)>4(P=0.016)and>3 locoregional therapies(LRT)before LDLT(P<0.001)were independent risk factors for HCC recurrence.In addition,age>60 years(P<0.001)and>3 LRT before LDLT(P=0.001)were independent risk factors for OS.Using a combination of age,NLR,and LRT before liver transplantation(LT),the patients can be divided into low-risk(none of risk),intermediate-risk(one of risk),and high risk(more than two of risk)groups.There were significant differences in the cumulative HCC recurrence(P<0.001)and mortality(P<0.001)rates among the three groups.Conclusions:LDLT may represent a valuable therapeutic option for selected patients with BCLC stage B HCC.
