Interventional treatment for unresectable hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization(TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidatesfor systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies(TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC.

Postoperative outcomes and recurrence patterns of intermediatestage hepatocellular carcinoma dictated by the sum of tumor size and number

BACKGROUND The selection criteria for Barcelona Clinic Liver Cancer(BCLC)intermediate-stage hepatocellular carcinoma(HCC)patients who would truly benefit from liver resection(LR)remain undefined.AIM To identify BCLC-B HCC patients more suitable for LR.METHODS We included patients undergoing curative LR for BCLC stage A or B multinodular HCC(MNHCC)and stratified BCLC-B patients by the sum of tumor size and number(N+S).Overall survival(OS),recurrence-free survival(RFS),recurrence-to-death survival(RTDS),recurrence patterns,and treatments after recurrence in BCLC-B patients in each subgroup were compared with those in BCLC-A patients.RESULTS In total,143 patients who underwent curative LR for MNHCC with BCLC-A(n=25)or BCLC-B(n=118)were retrospectively analyzed.According to the N+S,patients with BCLC-B HCC were divided into two subgroups:BCLC-B1(N+S≤10,n=83)and BCLC-B2(N+S>10,n=35).Compared with BCLC-B2 patients,those with BCLC-B1 had a better OS(5-year OS rate:67.4%vs 33.6%;P<0.001),which was comparable to that in BCLC-A patients(5-year OS rate:67.4%vs 74.1%;P=0.250),and a better RFS(median RFS:19 mo vs 7 mo;P<0.001),which was worse than that in BCLC-A patients(median RFS:19 mo vs 48 mo;P=0.022).Further analysis of patients who developed recurrence showed that both BCLC-B1 and BCLC-A patients had better RTDS(median RTDS:Not reached vs 49 mo;P=0.599),while the RTDS in BCLC-B2 patients was worse(median RTDS:16 mo vs not reached,P<0.001;16 mo vs 49 mo,P=0.042).The recurrence patterns were similar between BCLC-B1 and BCLC-A patients,but BCLC-B2 patients had a shorter recurrence time and a higher proportion of patients had recurrence with macrovascular invasion and/or extrahepatic metastasis,both of which were independent risk factors for RTDS.CONCLUSION BCLC-B HCC patients undergoing hepatectomy with N+S≤10 had mild recurrence patterns and excellent OS similar to those in BCLC-A MNHCC patients,and LR should be considered in these patients.