Background The role of adjuvant transarterial chemoembolisation(TACE)to reduce postoperative recurrence varies widely among patients undergoing hepatectomy with curative intent for hepatocellular carcinoma(HCC).Person...Background The role of adjuvant transarterial chemoembolisation(TACE)to reduce postoperative recurrence varies widely among patients undergoing hepatectomy with curative intent for hepatocellular carcinoma(HCC).Personalised predictive tool to select which patients may benefit from adjuvant TACE is lacking.This study aimed to develop and validate an online calculator for estimating the reduced risk of early recurrence from adjuvant TACE for patients with HCC.Methods From a multi-institutional database,2590 eligible patients undergoing curative-intent hepatectomy for HCC were enrolled,and randomly assigned to the training and validation cohorts.Independent predictors of early recurrence within 1 year of surgery were identified in the training cohort,and subsequently used to construct a model and corresponding prediction calculator.The predictive performance of the model was validated using concordance indexes(C-indexes)and calibration curves,and compared with conventional HCC staging systems.The reduced risk of early recurrence when receiving adjuvant TACE was used to estimate the expected benefit from adjuvant TACE.Results The prediction model was developed by integrating eight factors that were independently associated with risk of early recurrence:alpha-fetoprotein level,maximum tumour size,tumour number,macrovascular and microvascular invasion,satellite nodules,resection margin and adjuvant TACE.The model demonstrated good calibration and discrimination in the training and validation cohorts(C-indexes:0.799 and 0.778,respectively),and performed better among the whole cohort than four conventional HCC staging systems(C-indexes:0.797 vs 0.562–0.673,all p<0.001).An online calculator was built to estimate the reduced risk of early recurrence from adjuvant TACE for patients with resected HCC.Conclusions The proposed calculator can be adopted to assist decision-making for clinicians and patients to determine which patients with resected HCC can significantly benefit from adjuvant TACE.WHAT IS ALREADY KNOWN ON THIS TOPIC⇒Previous studies have indicated that adjuvant transarterial chemoembolisation(TACE)may im-prove long-term survival in certain subgroups of patients with hepatocellular carcinoma(HCC)after hepatectomy.⇒However,these studies did not provide personalised risk assessment or net benefit estimation for indi-vidual patients,highlighting the need for a more refined prediction model.WHAT THIS STUDY ADDS⇒This study developed a risk prediction model in-corporating eight independent factors associat-ed with early recurrence after hepatectomy for HCC,demonstrating good predictive accuracy and discrimination.⇒The model outperformed four commonly used con-ventional HCC staging systems and facilitated the development of an online calculator to estimate in-dividual patient’s reduced risk of early recurrence using adjuvant TACE.HOW THIS STUDY MIGHT AFFECT RESEARCH,PRACTICE OR POLICY⇒The study’s findings may assist clinicians in decid-ing whether to use adjuvant TACE after hepatectomy for HCC,potentially improving patient outcomes.⇒Further research should validate the model with larger cohorts or those from other centres to assess its broader applicability.展开更多
Aim:Transarterial chemoembolisation(TACE)is recommended therapy for intermediate-stage hepatocellular carcinoma(HCC).However,the wide variations in outcomes reflect significant heterogeneity of this patient group.We e...Aim:Transarterial chemoembolisation(TACE)is recommended therapy for intermediate-stage hepatocellular carcinoma(HCC).However,the wide variations in outcomes reflect significant heterogeneity of this patient group.We evaluated the prognostic factors associated with survival in a real-world setting to identify those at high risk of a poor outcome.Methods:Patients with HCC who underwent initial TACE at six tertiary hospitals between 2009 to 2014 were included via an extensive search of hospital databases and electronic medical records.Overall survival(OS)was measured from the date of initial treatment to the date of death or last follow-up.Univariate and multivariate Cox regression analyses were used to assess the effects of baseline variables on post-TACE survival.Results:The majority of the 431 eligible patients were Caucasian(80%),male(87%),with a mean age of 66 years and had alcohol-related cirrhosis(43%).Most were Child-Pugh A(69%)with BCLC stage A(59%)or B(35%)disease,with a median OS of 28 months.On multivariate analysis,pre-treatment ascites(P=0.001)and larger HCC(P<0.001)were associated with worse overall survival,while higher serum albumin(P<0.001)and HBV(P=0.005)were associated with improved survival.Conclusion:Patients with advanced liver disease,including the presence of ascites and lower serum albumin,as well as those with greater tumour burden,have poorer outcomes following TACE treatment.Such findings provide a better understanding of the variation in survival after TACE and are helpful in facilitating selection and timely stage migration of patients undergoing this therapy.展开更多
Background: Transarterial chemoembolization(TACE) is the most commonly used adjuvant therapy for hepatocellular carcinoma(HCC) after curative resection. Responses to TACE are variable due to tumor and patient heteroge...Background: Transarterial chemoembolization(TACE) is the most commonly used adjuvant therapy for hepatocellular carcinoma(HCC) after curative resection. Responses to TACE are variable due to tumor and patient heterogeneity. We had previously demonstrated that expression of Granulin-epithelin precursor(GEP) and ATP-dependent binding cassette(ABC)B5 in liver cancer stem cells was associated with chemoresistance. The present study aimed to evaluate the association between GEP/ABCB5 expression and response to adjuvant TACE after curative resection for HCC. Methods: Patients received adjuvant TACE after curative resection for HCC and patients received curative resection alone were identified from a prospectively collected database. Clinical samples were retrieved for biomarker analysis. Patients were categorized into 3 risk groups according to their GEP/ABCB5 status for survival analysis: low(GEP-/ABCB5-), intermediate(either GEP +/ABCB5-or GEP-/ABCB5 +) and high(GEP +/ABCB5 +). Early recurrence(recurrence within 2 years after resection) and disease-free survival were analyzed. Results: Clinical samples from 44 patients who had followed-up for more than 2 years were retrieved for further biomarker analysis. Among them, 18 received adjuvant TACE and 26 received surgery alone. Patients with adjuvant TACE in the intermediate risk group was associated with significantly better overall survival and 2-year disease-free survival than those who had surgery alone( P = 0.036 and P = 0.011, respectively). Adjuvant TACE did not offer any significant differences in the early recurrence rate, 2-year disease-free survival and overall survival for patients in low and high risk groups. Conclusions: Adjuvant TACE can only provide survival benefits for patients in the intermediate risk group(either GEP +/ABCB5-or GEP-/ABCB5 +). A larger clinical study is warranted to confirm its role in patient selection for adjuvant TACE.展开更多
In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using networ...In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using network metaanalysis methodology.We focus specifically on the potential advantages and role of HAIC in the treatment algorithm for advanced HCC.However,there remains numerous knowledge gaps before the role of HAIC can be established.There is significant heterogeneity of HAIC regimes with difficult interpretation of the clinical outcomes.Additionally,there is a lack of direct comparative data between HAIC,systemic chemotherapy,novel immunotherapies and targeted therapies.The underlying biochemical mechanisms that might explain the efficacy of HAIC and its effect on the HCC microenvironment requires further research.In the developing era of nanotechnology and targeted drug delivery systems,there is potential for integration of HAIC with novel technologies to effectively treat advanced HCC whilst minimising systemic complications.展开更多
基金supported by the National Natural Science Foundation of China(no.82273074)Dawn Project Foundation of Shanghai(no.21SG36)+2 种基金Adjunct Talent Fund of Zhejiang Provincial People’s Hospital(no.2021-YT)the Natural Science Foundation of Shanghai(no.22ZR1477900)Shanghai Science and Technology Committee Rising-Star Programme(no.22QA1411600).
文摘Background The role of adjuvant transarterial chemoembolisation(TACE)to reduce postoperative recurrence varies widely among patients undergoing hepatectomy with curative intent for hepatocellular carcinoma(HCC).Personalised predictive tool to select which patients may benefit from adjuvant TACE is lacking.This study aimed to develop and validate an online calculator for estimating the reduced risk of early recurrence from adjuvant TACE for patients with HCC.Methods From a multi-institutional database,2590 eligible patients undergoing curative-intent hepatectomy for HCC were enrolled,and randomly assigned to the training and validation cohorts.Independent predictors of early recurrence within 1 year of surgery were identified in the training cohort,and subsequently used to construct a model and corresponding prediction calculator.The predictive performance of the model was validated using concordance indexes(C-indexes)and calibration curves,and compared with conventional HCC staging systems.The reduced risk of early recurrence when receiving adjuvant TACE was used to estimate the expected benefit from adjuvant TACE.Results The prediction model was developed by integrating eight factors that were independently associated with risk of early recurrence:alpha-fetoprotein level,maximum tumour size,tumour number,macrovascular and microvascular invasion,satellite nodules,resection margin and adjuvant TACE.The model demonstrated good calibration and discrimination in the training and validation cohorts(C-indexes:0.799 and 0.778,respectively),and performed better among the whole cohort than four conventional HCC staging systems(C-indexes:0.797 vs 0.562–0.673,all p<0.001).An online calculator was built to estimate the reduced risk of early recurrence from adjuvant TACE for patients with resected HCC.Conclusions The proposed calculator can be adopted to assist decision-making for clinicians and patients to determine which patients with resected HCC can significantly benefit from adjuvant TACE.WHAT IS ALREADY KNOWN ON THIS TOPIC⇒Previous studies have indicated that adjuvant transarterial chemoembolisation(TACE)may im-prove long-term survival in certain subgroups of patients with hepatocellular carcinoma(HCC)after hepatectomy.⇒However,these studies did not provide personalised risk assessment or net benefit estimation for indi-vidual patients,highlighting the need for a more refined prediction model.WHAT THIS STUDY ADDS⇒This study developed a risk prediction model in-corporating eight independent factors associat-ed with early recurrence after hepatectomy for HCC,demonstrating good predictive accuracy and discrimination.⇒The model outperformed four commonly used con-ventional HCC staging systems and facilitated the development of an online calculator to estimate in-dividual patient’s reduced risk of early recurrence using adjuvant TACE.HOW THIS STUDY MIGHT AFFECT RESEARCH,PRACTICE OR POLICY⇒The study’s findings may assist clinicians in decid-ing whether to use adjuvant TACE after hepatectomy for HCC,potentially improving patient outcomes.⇒Further research should validate the model with larger cohorts or those from other centres to assess its broader applicability.
基金supported by an Australian Government Research Training Program(RTP)Scholarship,Monash University,Melbourne,Australia。
文摘Aim:Transarterial chemoembolisation(TACE)is recommended therapy for intermediate-stage hepatocellular carcinoma(HCC).However,the wide variations in outcomes reflect significant heterogeneity of this patient group.We evaluated the prognostic factors associated with survival in a real-world setting to identify those at high risk of a poor outcome.Methods:Patients with HCC who underwent initial TACE at six tertiary hospitals between 2009 to 2014 were included via an extensive search of hospital databases and electronic medical records.Overall survival(OS)was measured from the date of initial treatment to the date of death or last follow-up.Univariate and multivariate Cox regression analyses were used to assess the effects of baseline variables on post-TACE survival.Results:The majority of the 431 eligible patients were Caucasian(80%),male(87%),with a mean age of 66 years and had alcohol-related cirrhosis(43%).Most were Child-Pugh A(69%)with BCLC stage A(59%)or B(35%)disease,with a median OS of 28 months.On multivariate analysis,pre-treatment ascites(P=0.001)and larger HCC(P<0.001)were associated with worse overall survival,while higher serum albumin(P<0.001)and HBV(P=0.005)were associated with improved survival.Conclusion:Patients with advanced liver disease,including the presence of ascites and lower serum albumin,as well as those with greater tumour burden,have poorer outcomes following TACE treatment.Such findings provide a better understanding of the variation in survival after TACE and are helpful in facilitating selection and timely stage migration of patients undergoing this therapy.
文摘Background: Transarterial chemoembolization(TACE) is the most commonly used adjuvant therapy for hepatocellular carcinoma(HCC) after curative resection. Responses to TACE are variable due to tumor and patient heterogeneity. We had previously demonstrated that expression of Granulin-epithelin precursor(GEP) and ATP-dependent binding cassette(ABC)B5 in liver cancer stem cells was associated with chemoresistance. The present study aimed to evaluate the association between GEP/ABCB5 expression and response to adjuvant TACE after curative resection for HCC. Methods: Patients received adjuvant TACE after curative resection for HCC and patients received curative resection alone were identified from a prospectively collected database. Clinical samples were retrieved for biomarker analysis. Patients were categorized into 3 risk groups according to their GEP/ABCB5 status for survival analysis: low(GEP-/ABCB5-), intermediate(either GEP +/ABCB5-or GEP-/ABCB5 +) and high(GEP +/ABCB5 +). Early recurrence(recurrence within 2 years after resection) and disease-free survival were analyzed. Results: Clinical samples from 44 patients who had followed-up for more than 2 years were retrieved for further biomarker analysis. Among them, 18 received adjuvant TACE and 26 received surgery alone. Patients with adjuvant TACE in the intermediate risk group was associated with significantly better overall survival and 2-year disease-free survival than those who had surgery alone( P = 0.036 and P = 0.011, respectively). Adjuvant TACE did not offer any significant differences in the early recurrence rate, 2-year disease-free survival and overall survival for patients in low and high risk groups. Conclusions: Adjuvant TACE can only provide survival benefits for patients in the intermediate risk group(either GEP +/ABCB5-or GEP-/ABCB5 +). A larger clinical study is warranted to confirm its role in patient selection for adjuvant TACE.
文摘In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using network metaanalysis methodology.We focus specifically on the potential advantages and role of HAIC in the treatment algorithm for advanced HCC.However,there remains numerous knowledge gaps before the role of HAIC can be established.There is significant heterogeneity of HAIC regimes with difficult interpretation of the clinical outcomes.Additionally,there is a lack of direct comparative data between HAIC,systemic chemotherapy,novel immunotherapies and targeted therapies.The underlying biochemical mechanisms that might explain the efficacy of HAIC and its effect on the HCC microenvironment requires further research.In the developing era of nanotechnology and targeted drug delivery systems,there is potential for integration of HAIC with novel technologies to effectively treat advanced HCC whilst minimising systemic complications.
