Comparison of resection, liver transplantation and transcatheter oily chemoembolization in treatment of hepatocellular carcinoma

doi:10.1016/S0168-8278(96)80007-9

Journal of Hepatology

Volume 24, Issue 3, March 1996, Pages 293-300

https://doi.org/10.1016/S0168-8278(96)80007-9 Get rights and content

Abstract

Background/Aims: Resection and liver transplantation are currently considered as the most useful treatments for hepatocellular carcinoma. However, transcatheter oily chemoembolization may be favourably compared with these two surgical treatments in patients with anatomically operable tumors.

Methods: Between 1985 and 1991, 122 patients with an Okuda stage I tumor were hospitalized in two French hospitals. Among these patients, 33 remained untreated, 42 were treated by transcatheter oily chemoembolization, 30 by resection and 17 by liver transplantation. The four groups were closely comparable except for age, the patients in the two surgical groups being significantly younger. Moreover, the frequency of pTNM II tumor was significantly higher in the resection group.

Results: The 5-year probability of survival was close to 45% in each of the three treated groups and was significantly higher than in the untreated group (0% at 4 years, p<0.0001). The probability of cancer recurrence and/or metastatic dissemination was lower after transcatheter oily chemoembolization than after surgery.

Conclusion: Thus, transcatheter oily chemoembolization seems comparable at 5 years with resection or transplantation for the treatment of resectable hepatocellular carcinoma.

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Cited by (97)

Changes of long-term survival of resection and liver transplantation in hepatocellular carcinoma throughout the years: A meta-analysis
2024, European Journal of Surgical Oncology
Hepatocellular Carcinoma (HCC) still is one of the most detrimental malignant diseases in the world. As two curative surgical therapies exist, the discussion whether to opt for liver resection (LR) or transplantation (LT) is ongoing, especially as novel techniques to improve outcome have emerged for both. The aim of the study was to investigate how the utilization and outcome of the respective modalities changed through time.
We searched Medline and PubMed for relevant publications comparing LT and LR in HCC patients during the time period from 1990 to 2022, prior to March 31, 2023. A total of 63 studies involving 19,804 patients – of whom 8178 patients received a liver graft and 11,626 underwent partial hepatectomy - were included in this meta-analysis.
LT is associated with significantly better 5-year overall survival (OS) (64.83%) and recurrence-free survival (RFS) (70.20%) than LR (OS: 50.83%, OR: 1.79, p < 0.001; RFS: 34.46%, OR: 5.32, p < 0.001). However, these differences are not as evident in short-term intervals. Older cohorts showed comparable disparities between the outcome of the respective modalities, as did newer cohorts after 2005. This might be due to the similar improvement in survival rates that were observed for both, LT (15–23%) and LR (12–20%) during the last 30 years.
LT still outperforms LR in the therapy of HCC in terms of long-term survival rates. Yet, LR outcome has remarkably improved which is of major importance in reference to the well-known limitations that occur in LT.
Volume perfusion computed tomography (VPCT) - Based evaluation of response to TACE using two different sized drug eluting beads in patients with nonresectable hepatocellular carcinoma: Impact on tumor and liver parenchymal vascularisation
2015, European Journal of Radiology
Citation Excerpt :
Different particle sizes have been tested so far as well as different drugs and variable doses in order to optimize this technique [7,9,10]. One major limitation to repeated TACE is severe hepatic dysfunction due to the higher risk for post-interventional complications and poor prognosis in patients with Child-Pugh class C disease [11]. Post-TACE liver atrophy, lobar or focal, depends on the extent of the embolization area and was described in patients undergoing TACE.
Response monitoring of transarterial chemoembolization (TACE) with the help of volume perfusion computed tomography (VPCT) at day one post-TACE and analysis of TACE-impact on tumor and uninvolved liver parenchymal perfusion by using different particles sizes and epirubicin dose.
Institutional review board approved this prospective study. VPCT was performed in the baseline, post-interventional (FU₁; 24 h post-TACE) and at follow-up (FU₂; median, 81 days) in 45 consecutive patients. 100–300 μm (n = 17) and 300–500 μm (n = 28) drug eluting beads (DEB) using an epirubicin dose of (< = 25 vs. >25) were administered. VPCT was performed for 40-s using 80 kV, 100/120 mAs, 64 × 0.6 mm collimation, 26 consecutive measurements, IV injection (50 ml iodinated contrast), flow rate (5 ml/s). Blood flow (BF), blood volume (BV) and k-trans were registered as average and max values in the tumor. Arterial liver perfusion (ALP), portal-venous perfusion (PVP) and the hepatic perfusion index (HPI) were registered both in tumor and non-involved liver parenchyma. Response to TACE was classified by VPCT as complete (CR), partial (PR) or no response (NR).
A significant reduction of viable tumor tissue was found in all patients between baseline and FU₁ (p < 0.001) being independent on particle size and epirubicin dose (p > 0.05). PPV/NPV/sensitivity/specificity of post-interventional VPCT (FU₁) results for prediction of the mid-term tumor course (FU₂) were 100%/70%/76%/100%. There was generally a significant increase of the ALP between baseline and FU₁ in the liver parenchyma coupled by a significant subsequent decrease (normalization) of ALP and HPI between FU₁ and FU_2.
VPCT accurately measures impact of TACE on liver tumor and hepatic parenchymal perfusion. The former proved not to be significantly dependent on particle size and epirubicin dose. There was no persistent perfusion deficit in the liver after TACE.
Transarterial embolization therapies for the treatment of hepatocellular carcinoma: CEPO review and clinical recommendations
2015, HPB
Citation Excerpt :
Although some of these therapies have been used for many years as standard, their efficacy is still being questioned. Results from prospective studies comparing TACE with absence of treatment were not consistent across studies,6-12 whereas all retrospective studies reported a survival benefit with TACE.13-15,17 However, the level of evidence of the latter studies is lower.
Hepatocellular carcinoma (HCC) is one of the most deadly cancers in the world and its incidence rate has consistently increased over the past 15 years in Canada. Although transarterial embolization therapies are palliative options commonly used for the treatment of HCC, their efficacy is still controversial. The objective of this guideline is to review the efficacy and safety of transarterial embolization therapies for the treatment of HCC and to develop evidence-based recommendations.
A review of the scientific literature published up to October 2013 was performed. A total of 38 studies were included.
Considering the evidence available to date, the CEPO recommends the following: (i) transarterial chemoembolization therapy (TACE) be considered a standard of practice for the palliative treatment of HCC in eligible patients; (ii) drug-eluting beads (DEB)-TACE be considered an alternative and equivalent treatment to conventional TACE in terms of oncological efficacy (overall survival) and incidence of severe toxicities; (iii) the decision to treat with TACE or DEB-TACE be discussed in tumour boards; (iv) bland embolization (TAE) not be considered for the treatment of HCC; (v) radioembolization (TARE) not be considered outside of a clinical trial setting; and (vi) sorafenib combined with TACE not be considered outside of a clinical trial setting.
Liver transplantation versus liver resection for hepatocellular carcinoma: A meta-analysis
2014, Hepatobiliary and Pancreatic Diseases International
Liver transplantation (LT) and liver resection (LR) are currently considered the standard treatment of patients with hepatocellular carcinoma (HCC). However, the outcomes of LT and LR are still inconclusive.
MEDLINE, EMBASE, and Cochrane Library were searched for relevant studies. Surgical safety indices such as treatment-related morbidity and mortality, and efficacy indices such as overall and tumor-free survival outcomes were evaluated. Weighted mean differences and odds ratios (ORs) were calculated using a random-effects model.
Seventeen studies were included in this meta-analysis. LT achieved significantly higher rates of surgery-related morbidity (OR=1.47; 95% CI: 1.02-2.13) and mortality (OR=2.12; 95% CI: 1.11-4.05). Likewise, the 1-year survival rate was lower in LT (OR=0.86; 95% CI: 0.61-1.20). However, the 3- and 5-year survival rates were significantly higher in LT than in LR and the ORs were 1.12 (95% CI: 0.96-1.30) in 3 years and 1.84 (95% CI: 1.49-2.28) in 5 years. Furthermore, the tumor-free survival rate in LT was significantly higher than that in LR in 1, 3, 5 years after surgery, with the ORs of 1.72 (95% CI: 1.24-2.41), 3.75 (95% CI: 2.94-4.78) and 5.64 (95% CI: 4.35-7.31), respectively.
One-year morbidity and mortality are higher in LT than in LR for patients with HCC. However, long-term survival and tumor-free survival rates are higher in patients treated with LT than those treated with LR.
Superselective transarterial chemoembolization vs hepatic resection for resectable early-stage hepatocellular carcinoma in patients with Child-Pugh class a liver function
2012, European Journal of Radiology
Citation Excerpt :
Bronowicki et al., Yoshimi et al., and Huang et al. retrospectively compared the result of TACE and with that of surgical resection for resectable HCC. The 5-year overall survival rates were not significantly different between 2 groups (34%–47% for TACE and 28%–43% for surgical resection) [21–23]. In this study, we collected a large sample of patients and focused on resectable early-stage HCC patients with Child-Pugh A liver function.
In contrast to hepatic resection (HR) for resectable early-stage HCC, the efficacy of transarterial chemoembolization (TACE) is controversial. This study is designed to compare the long-term outcome of TACE using superselective technique with hepatic resection for the treating resectable early-stage HCC and Child-Pugh class A liver function.
In total, 185 consecutive patients with resectable early-stage HCC and Child-Pugh class A liver function were included: 73 patients received superselective TACE (group I) and 112 patients underwent HR (group II). We evaluated the therapy-related recurrence and long-term outcome and in both groups. The risk factors of recurrence and mortality were assessed by Cox's model.
The mean survival time of group 1 patient was similar to that of group 2 patient (40.8 ± 19.8 vs 46.7 ± 24.6 months respectively, p = 0.91). The 1-, 3-, and 5-year overall survival rates after TACE (group I)and HR (group II) were 91%, 66%, and 52% and 93%, 71%, and 57%, respectively (p = 0.239). The 1-, 3-, and 5-year recurrence-free survival rates in groups 1 and 2 were 68%, 28%, and 17% and 78%, 55%, and 35%, respectively (p < 0.0001). Serum albumin, tumour size, tumour number and recurrence interval were independent risk factors for mortality. Serum albumin level, tumour size, tumour number, and treatment modality of TACE or HR could predict HCC recurrence.
TACE is an efficient and safe treatment for resectable early-stage HCC with overall survival rates similar to that of HR. Thus, TACE is indicated in selected patients with resectable early-stage HCC.
Stereotactic body radiotherapy for primary hepatocellular carcinoma
2011, International Journal of Radiation Oncology Biology Physics
Citation Excerpt :
Equally notable, and perhaps more clinically relevant, is the median TTP of 4 years for the entire cohort and 3 years for the nontransplanted population. These rates are comparable to those obtained with percutaneous ablation and surgical resection, and they exceed the quoted rate of 10 to 27 months after transarterial chemoembolization or radioembolization for similarly sized lesions (19, 23, 24). The impact on overall survival relative to other liver-directed therapies remains to be determined.
To evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) for the treatment of primary hepatocellular carcinoma (HCC).
From 2005 to 2009, 60 patients with liver-confined HCC were treated with SBRT at the Indiana University Simon Cancer Center: 36 Child-Turcotte-Pugh (CTP) Class A and 24 CTP Class B. The median number of fractions, dose per fraction, and total dose, was 3, 14 Gy, and 44 Gy, respectively, for those with CTP Class A cirrhosis and 5, 8 Gy, and 40 Gy, respectively, for those with CTP Class B. Treatment was delivered via 6 to 12 beams and in nearly all cases was prescribed to the 80% isodose line. The records of all patients were reviewed, and treatment response was scored according to Response Evaluation Criteria in Solid Tumors v1.1. Toxicity was graded according to the Common Terminology Criteria for Adverse Events v4.0. Local control (LC), time to progression (TTP), progression-free survival (PFS), and overall survival (OS) were calculated according to the method of Kaplan and Meier.
The median follow-up time was 27 months, and the median tumor diameter was 3.2 cm. The 2-year LC, PFS, and OS were 90%, 48%, and 67%, respectively, with median TTP of 47.8 months. Subsequently, 23 patients underwent transplant, with a median time to transplant of 7 months. There were no ≥Grade 3 nonhematologic toxicities. Thirteen percent of patients experienced an increase in hematologic/hepatic dysfunction greater than 1 grade, and 20% experienced progression in CTP class within 3 months of treatment.
SBRT is a safe, effective, noninvasive option for patients with HCC ≤6 cm. As such, SBRT should be considered when bridging to transplant or as definitive therapy for those ineligible for transplant.

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Comparison of resection, liver transplantation and transcatheter oily chemoembolization in treatment of hepatocellular carcinoma

Abstract

Gastroenterology

J Hepatol

Gastroenterology

Am J Surg

Gastroentrology

Gastroenterology

Limited hepatic resection effective for selected cirrhotic patients with primary liver cancer

Ann Surg

Ultrasonically guided subsegmentectomy

Surg Gynecol Obstet

Liver resection in cirrhotic patients: a Western experience

World J Surg

Surgical treatment of 109 patients with symptomatic and asymptomatic hepatocellular carcinoma

Surgery

Clinical experience with 118 hepatic resections for hepatocellular carcinoma

Surgery

Hepatic resection for hepatocellular carcinoma. Clinical features and long term prognosis

Ann Surg

Clinical experience with hepatic resections for hepatocellular carcinoma in patients with cirrhosis

Surg Gynecol Obstet

Hepatic researction in 120 patients with hepatocellular carcinoma

Arch Surg

Surgery of smell hepatocellular carcinoma. Analysis of 144 cases

Cancer

Preoperative estimation of surgical risk of hepatectomy in cirrhotic patients

Hepatogastroenterology

Hepatic resection for hepatocellular carcinoma

Surgery

Associations Francaises de Recherche en Chirurgie. Résection des carcinomes hépatocellulaires. Analyse des facteurs pronostiques d'une série multicentrique de 153 malades

Gastroenterol Clin Biol

Liver transplantation for malignant disease. Results in 93 consecutive patients

Ann Surg

Primary hepatic malignancy: the role of liver transplantation

Br J Surg

Hepatic transplantation for primary and metastatic cancers of the liver

Surgery

Liver transplantation for primary hepatic cancer

Transplantation