Aim:Survival in patients with hepatocellular carcinoma(HCC)is impacted by stage of liver disease,tumor characteristics,and HCC surveillance in high-risk individuals.Factors associated with HCC tumor growth rate(TGR)an...Aim:Survival in patients with hepatocellular carcinoma(HCC)is impacted by stage of liver disease,tumor characteristics,and HCC surveillance in high-risk individuals.Factors associated with HCC tumor growth rate(TGR)and its influence on recurrence-free survival after treatment was investigated.Methods:TGR was calculated in 164 HCC patients with chronic viral hepatitis who had two consecutive magnetic resonance imaging or computed tomography scans≥30 days apart prior to treatment and who were followed prospectively to determine the rates of recurrence-free survival.Results:The median TGR in 164 patients was 17.8%per month(mean 33.3%per month).Regression tree analysis indicated that the top three predictors of TGR were alpha-fetoprotein(AFP)levels(≥16.7 ng/mL),platelet counts(≥140,000 mm3),and serum albumin level(<3.55 g/dL).The regression tree identified patient groups with TGRs ranging from 0.65%to 39.4%per month.At a median follow-up of 22 months,the overall recurrence-free survival was 53.8%.The Cox model with backwards AIC search identified TGR(HR=1.34,P=0.029),age>56 years(HR=1.08,P=0.072),hepatitis C virus(HR=1.44,P=0.091),macrovascular invasion(HR=1.94,P=0.092),and the most definitive treatments(orthotopic liver transplantation,HR 0.14,P<0.001;surgical resection,HR=0.54,P=0.072;radiofrequency ablation,HR=0.58,P=0.060)as independent predictors of recurrence-free survival.For all treatment modalities,slow ;TGR was significant for prolonged survival(P=0.029).The poorest survival rates were observed in patients with fast TGRs treated by transarterial chemoembolization.Conclusion:The TGR correlated with AFP,platelet count,and albumin level.Patients with fast TGRs had shorter recurrence-free survival after HCC treatments.TGR is a potential imaging biomarker to predict clinical outcomes in HCC.展开更多
Aim:Nonalcoholic fatty liver disease(NAFLD)-associated hepatocellular carcinoma(HCC)is projected to become the leading indication for liver transplantation.Previous studies indicate that tumor growth rates(TGR)may pre...Aim:Nonalcoholic fatty liver disease(NAFLD)-associated hepatocellular carcinoma(HCC)is projected to become the leading indication for liver transplantation.Previous studies indicate that tumor growth rates(TGR)may predict survival and were helpful in determining HCC surveillance intervals.Therefore,we aimed to determine its usefulness in predicting clinical outcomes and treatments.Methods:We conducted a retrospective study of hepatitis B,C and NAFLD-HCC cases.TGR was measured using 2-consecutive pre-treatment contrast-enhanced imaging studies≥25 days apart.A multivariate regression model was used to determine predictors of TGR.In addition,the Cox regression model was used to evaluate the relationship between TGR and overall survival.Results:From 2000-2019,the study cohort comprised 38,60,and 47 HBV,HCV,and NAFLD patients,respectively,with TGRs.NAFLD-HCC tumor size was inversely correlated to the extent of liver disease as measured by Child-Pugh score(7.2 cm in non-cirrhosis;3.7 cm,2.6 cm,and 2.1 cm in Child A,B,and C,respectively;P<0.001).After adjusting for baseline characteristics,the TGR per month was fastest in HBV(9.4%,95%CI:6.3%-12.5%)compared to HCV(4.9%,95%CI:2.8%-7%)and NAFLD patients(3.6%,95%CI:1.6%-6.7%).Predictors of TGR included elevated AFP,low albumin,and smaller tumor size.Fast TGR in viral etiologies had higher mortality[adj.hazard ratio(HR)=2.6,95%CI:1.2-5.7,P=0.02]than slow TGRs,independent of treatments.Fast TGR in NAFLD had a trend towards higher mortality(HR=3.6,95%CI:0.95-13.3,P=0.059).Conclusion:NAFLD-HCC patients have more indolent growths than viral-related HCC TGRs.The addition of TGR as a biomarker may assist in stratifying treatment options.展开更多
The prevalence of nonalcoholic fatty liver disease(NAFLD)is increasing worldwide and is projected to become a major etiology of cirrhosis and hepatocellular carcinoma(HCC).HCC occurs more commonly in NAFLD patients wh...The prevalence of nonalcoholic fatty liver disease(NAFLD)is increasing worldwide and is projected to become a major etiology of cirrhosis and hepatocellular carcinoma(HCC).HCC occurs more commonly in NAFLD patients who develop cirrhosis,though HCC is known to occur in the setting of noncirrhotic NAFLD as well.This is of particular importance given that the American College of Radiology(ACR)CT/MRI Liver Reporting and Data System(LI-RADS)algorithm may only be applied to a certain population of patients,and this population does not include those with noncirrhotic NAFLD.Conventional ultrasound(US)has long been in use for HCC surveillance,but contrast-enhanced US(CEUS)is a relatively newer modality,growing in use for assessment of liver lesions,and its use in HCC diagnosis has been formalized with CEUS LI-RADS.The use of US and CEUS in the assessment of liver lesions in NAFLD patients involves the consideration of certain particular nuances,and familiarity with these considerations will continue increasing in importance as the disease becomes more common.展开更多
文摘Aim:Survival in patients with hepatocellular carcinoma(HCC)is impacted by stage of liver disease,tumor characteristics,and HCC surveillance in high-risk individuals.Factors associated with HCC tumor growth rate(TGR)and its influence on recurrence-free survival after treatment was investigated.Methods:TGR was calculated in 164 HCC patients with chronic viral hepatitis who had two consecutive magnetic resonance imaging or computed tomography scans≥30 days apart prior to treatment and who were followed prospectively to determine the rates of recurrence-free survival.Results:The median TGR in 164 patients was 17.8%per month(mean 33.3%per month).Regression tree analysis indicated that the top three predictors of TGR were alpha-fetoprotein(AFP)levels(≥16.7 ng/mL),platelet counts(≥140,000 mm3),and serum albumin level(<3.55 g/dL).The regression tree identified patient groups with TGRs ranging from 0.65%to 39.4%per month.At a median follow-up of 22 months,the overall recurrence-free survival was 53.8%.The Cox model with backwards AIC search identified TGR(HR=1.34,P=0.029),age>56 years(HR=1.08,P=0.072),hepatitis C virus(HR=1.44,P=0.091),macrovascular invasion(HR=1.94,P=0.092),and the most definitive treatments(orthotopic liver transplantation,HR 0.14,P<0.001;surgical resection,HR=0.54,P=0.072;radiofrequency ablation,HR=0.58,P=0.060)as independent predictors of recurrence-free survival.For all treatment modalities,slow ;TGR was significant for prolonged survival(P=0.029).The poorest survival rates were observed in patients with fast TGRs treated by transarterial chemoembolization.Conclusion:The TGR correlated with AFP,platelet count,and albumin level.Patients with fast TGRs had shorter recurrence-free survival after HCC treatments.TGR is a potential imaging biomarker to predict clinical outcomes in HCC.
文摘Aim:Nonalcoholic fatty liver disease(NAFLD)-associated hepatocellular carcinoma(HCC)is projected to become the leading indication for liver transplantation.Previous studies indicate that tumor growth rates(TGR)may predict survival and were helpful in determining HCC surveillance intervals.Therefore,we aimed to determine its usefulness in predicting clinical outcomes and treatments.Methods:We conducted a retrospective study of hepatitis B,C and NAFLD-HCC cases.TGR was measured using 2-consecutive pre-treatment contrast-enhanced imaging studies≥25 days apart.A multivariate regression model was used to determine predictors of TGR.In addition,the Cox regression model was used to evaluate the relationship between TGR and overall survival.Results:From 2000-2019,the study cohort comprised 38,60,and 47 HBV,HCV,and NAFLD patients,respectively,with TGRs.NAFLD-HCC tumor size was inversely correlated to the extent of liver disease as measured by Child-Pugh score(7.2 cm in non-cirrhosis;3.7 cm,2.6 cm,and 2.1 cm in Child A,B,and C,respectively;P<0.001).After adjusting for baseline characteristics,the TGR per month was fastest in HBV(9.4%,95%CI:6.3%-12.5%)compared to HCV(4.9%,95%CI:2.8%-7%)and NAFLD patients(3.6%,95%CI:1.6%-6.7%).Predictors of TGR included elevated AFP,low albumin,and smaller tumor size.Fast TGR in viral etiologies had higher mortality[adj.hazard ratio(HR)=2.6,95%CI:1.2-5.7,P=0.02]than slow TGRs,independent of treatments.Fast TGR in NAFLD had a trend towards higher mortality(HR=3.6,95%CI:0.95-13.3,P=0.059).Conclusion:NAFLD-HCC patients have more indolent growths than viral-related HCC TGRs.The addition of TGR as a biomarker may assist in stratifying treatment options.
文摘The prevalence of nonalcoholic fatty liver disease(NAFLD)is increasing worldwide and is projected to become a major etiology of cirrhosis and hepatocellular carcinoma(HCC).HCC occurs more commonly in NAFLD patients who develop cirrhosis,though HCC is known to occur in the setting of noncirrhotic NAFLD as well.This is of particular importance given that the American College of Radiology(ACR)CT/MRI Liver Reporting and Data System(LI-RADS)algorithm may only be applied to a certain population of patients,and this population does not include those with noncirrhotic NAFLD.Conventional ultrasound(US)has long been in use for HCC surveillance,but contrast-enhanced US(CEUS)is a relatively newer modality,growing in use for assessment of liver lesions,and its use in HCC diagnosis has been formalized with CEUS LI-RADS.The use of US and CEUS in the assessment of liver lesions in NAFLD patients involves the consideration of certain particular nuances,and familiarity with these considerations will continue increasing in importance as the disease becomes more common.
