Clinical Implication of the Body Composition in Old Adults Patients with Hepatocellular Carcinoma Treated with Trans-Arterial Chemoembolization

( Lim Jihye ),( Yung Sang Lee ),( Young-hwa Chung ),( Han Chu Lee ),( Young-suk Lim ),( Kang Mo Kim ),( Ju Hyun Shim ),( Jonggi Choi ),( Danbi Lee ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: As aging is worldwide phenomenon, the elderly patients with hepatocellular carcinoma (HCC) have been increased. However, little is known about the prognosis of trans-arterial chemoembolization (TACE) in elderly HCC patients. As the body composition reflects frailty and geriatric conditions in older adults, its clinical significance has been emphasized. So, we investigated the prognostic factors of elderly HCC patients treated with TACE including body composition and clarify its clinical significance. Methods: A total of 237 patients with HCC, aged 65 or older, who received TACE as initial treatment were included [age (years, mean ± SD: 70.0 ± 4.5); sex (M/F: 168/69); etiology (HBV/HCV/NBNC: 139/51/47); Barcelona Clinic Liver Cancer (BCLC) stage (A/B: 136/101)]. They were followed up regularly for a median of 44 months (range, 22.6 - 69.2). When diagnosed with HCC, we analyzed skeletal muscle index (SMI), calculated as the total abdominal muscle area divided by height squared in meters, and visceral to subcutaneous fat ratio (VSR) around third lumbar vertebra using CT scan. We defined muscle depletion with visceral adiposity (MDVA) as SMI less than 50 percentile and VSR more than 50 percentile, sex specifically. We analyzed the survival rates in relation to the presence of MDVA and other clinical factors. Results: The medians of SMI were 49.5 ㎠/㎡ (range 45.3 - 54.9) and 43.6 ㎠/㎡ (range 38.4 - 48.1) and those of VSR were 1.0 (range 0.7 - 1.4) and 0.5 (range 0.4 - 0.7) for men and women, respectively. About 60.8% patients had multiple HCCs, and average size of maximal diameter of tumor was 3.9 ± 2.9 cm. The Model for end stage liver disease (MELD) score was 8.4 ± 2.3. During the follow-up periods, 170 patients (71.7%) died and overall cumulative survival rates were 88.9% at 1 year and 59.8% at 3 years after TACE. The mortality was not quite different from BCLC stage (the survival rate of BCLC A vs. B; 89.5% vs. 88.1% at 1 year; 61.1% vs. 58.1% at 3 years, P=0.653). The MDVA group showed significantly lower survival rates compared with those without MDVA. (85.1% vs. 90.4% at 1 year and 47.8% vs. 64.7% at 3 years, P=0.016). Also, multivariate analysis revealed that in addition to older age (HR 1.077, P<0.001), presence of ascites (HR 2.364, P=0.009), and higher MELD score(HR 1.104, P<0.001), the presence of MDVA (HR 1.448, P=0.026) was an important prognostic factor to predict mortality after TACE in elderly patients with HCC. Conclusions: Our data indicate that body composition, especially MDVA, might be a crucial factor for clinical outcome in aged 65 years or more HCC patients treated with TACE along with age, presence of ascites, and liver function.

Prediction Model of Quality of Life in Patients with Hepatocellular Carcinoma Treated with Trans-arterial chemoembolization

Mi Kyong Chong,Sohyune Sok 한국간호과학회 2019 한국간호과학회 학술대회 Vol.2019 No.10

Application of Lobaplatin in Trans-catheter Arterial Chemoembolization for Primary Hepatic Carcinoma

Wang, Nan,Lv, Yin-Zhang,Xu, An-Hui,Huang, Yan-Rong,Peng, Ling,Li, Jia-Rui Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.2

Objective: To explore the efficiency of single application of lobaplatin in tran-scatheter arterial chemoembolization (TACE) for patients with a primary hepatic carcinoma who were unable or unwilling to undergo surgery. Methods: 173 patients with primary hepatic carcinoma diagnosed by imaging or pathology were randomly divided into experimental and control groups and respectively treated with lobaplatin and pirarubicin hydrochloride as chemotherapeutic drugs for TACE. The amount of iodipin was regulated according to the tumor number and size, and then gelatin sponge or polyvinyl alcohol particles were applied for embolisms. The efficiency of treatment in the two groups was compared with reference to survival time and therapeutic response. Results: The experimental group (single lobaplatin as chemotherapy drug) was superior to control group (single pirarubicin hydrochloride as chemotherapy drug) in the aspects of survival time and therapeutic response, with statistical significance. Conclusions: Single lobaplatin can be as a chemotherapy drug in TACE and has better efficiency in the aspects of mean survival time and therapeutic response, deserving to be popularized in the clinic.

Initial Treatment Response is Significantly Associated Survival Outcomes in Patients Treated with TACE for Recurrent HCC after Curative Resection

( Jae Seung Lee ),( Beom Kyung Kim ),( Jun Yong Park ),( Do Young Kim ),( Sang Hoon Ahn ),( Kwang-hyub Han ),( Seung Up Kim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Trans-arterial chemoembolization (TACE) prolongs the survival of patients with hepatocellular carcinoma (HCC). We evaluated whether the initial treatment response by TACE for recurrent HCC after curative resection is associated with better survival. Methods: Between 2003 and 2015, 385 patients with recurrent HCC after curative resection who were treated with TACE were recruited for this retrospective study. Modified Response Evaluation Criteria in Solid Tumor (mRECIST) was used for response evaluation. Results: After the first TACE, 266 (69.1%), 75 (19.5%), 18 (5.7%), and 26 (6.7%) showed complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD), respectively. Patients with CR achievement after the first TACE had significantly better survival than those with PR/SD and PD (median 83.7 vs. 45.6 and 13.7 months; all P<0.05, log-rank tests). Similarly, patients with CR achievement as the best response during repeated TACE showed significantly better survival than those with PR/SD and PD (median 78.8 vs. 28.2 and 7.8 months; all P<0.05, log-rank tests). On multivariate analysis, CR achievement after the first TACE (hazard ratio [HR]=0.629; 95% confidence interval [CI], 0.454-0.872; P=0.005) or during repeated TACE (HR=0.354; 95% CI, 0.237-0.528; P<0.001) was independently associated with the reduced risk of mortality, whereas multiple tumors, BCLC stage C (vs. A-B), and Child- Pugh class B liver function (vs. A) were associated with the increased risk of poor outcomes (all P<0.05). Conclusions: CR achievement after the first TACE or during repeated TACE strongly predicted favorable survival outcome in patients with recurrent HCC after curative resection.

Different Survival Outcomes between Patients with Treatment-Naive HCC versus Recurrent HCC after Curative Resection Undergoing TACE

( David S. Kim ),( Beom Kyung Kim ),( Jun Yong Park ),( Do Young Kim ),( Sang Hoon Ahn ),( Kwang Hyub Han ),( Seung Up Kim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Trans-arterial chemoembolization (TACE) improves survival of patients with hepatocellular carcinoma (HCC). However, the treatment outcomes of TACE in patients with treatment-naive HCC versus recurrent HCC after curative resection has not been compared. Methods: A total of 448 patients with treatment-naive HCC and 275 patients with recurrent HCC after curative resection treated with TACE as the first-line anti-cancer treatment were recruited. Cox regression analysis was used to identify independent factors affecting overall mortality. Results: Patients with treatment-naive HCC at the time of TACE showed a significantly higher proportion of liver cirrhosis (61.9% vs. 49.3%), higher aspartate aminotransferase level (median 48 vs. 31 IU/L), higher alanine aminotransferase level (median 38 vs. 26 IU/L), higher alpha-fetoprotein level (median 96.6 vs. 7.7 ng/mL), higher total bilirubin level (mean 0.97 vs. 0.84 mg/ dL), longer prothrombin time (1.05 vs. 1.01 INR), higher tumor number (mean 2.1 vs. 1.7), larger tumor size (3.1 vs. 1.6 cm), and lower proportion of BCLC stage 0-B (vs stage C) (55.6% vs. 71.9%) (all P<0.05). Multivariate analysis showed that TACE for treatment-naive HCC (vs. recurrent HCC after curative resection) was one of independent risk factors of mortality (hazard ratio, 1.328; 95% confidence interval, 1.038-1.700; P=0.024), together with higher alpha-fetoprotein level and higher tumor number (all P<0.05). Conclusions: Patients with treatment-naive HCC showed poorer clinical characteristics than those with recurrent HCC after curative resection at the time of TACE and TACE for treatment-naive HCC (vs. TACE for recurrent HCC after curative resection) was independently associated with the increased risk of mortality.

Conventional versus Drug-eluting Beads Trans-arterial Chemoembolization for Treatment of Hepatocellular Carcinoma at Very Early and Early Stages

이광훈,주승문,염태준,정상훈 대한간암학회 2017 대한간암학회지 Vol.17 No.2

Background/Aims: To retrospectively compare conventional and drug-eluting beads transarterial chemoembolization (C-TACE and DEB-TACE) for treatment of hepatocellular carcinoma (HCC) at very early and early stages. Methods: We retrospectively compared patients treated with C-TACE (n=115) or DEB-TACE (n=103) from September 2009 to May 2016. All patients were in a very early (stage 0) or early stage (stage A) of the Barcelona Clinic Liver Cancer (BCLC) staging system, and all had Child– Pugh class A and ≤B7 liver status. Approval by the institutional review board was waived because the study was retrospective. The following parameters were evaluated: severe pain and bradycardia during TACE, post-embolization syndrome (PES), liver function change, complications, target tumor response, and conversion to another treatment modality. Numeric differences were assessed by the independent Student’s t-test for continuous variables and by chi-square test for categorical variables. Results: Severe intractable pain and bradycardia during the TACE procedure were significantly more frequent in the C-TACE group than in the DEB-TACE group (P<0.001). The incidence and duration of PES were significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The increase in liver enzymes was significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The deterioration of the Child-Pugh class was significantly higher in the C-TACE group than in the DEB-TACE group (P =0.006). There was no significant difference in serious complications except localized bile duct dilatation between the groups. There was no significant difference between the groups in tumor response at both immediate and 1-year assessment. The conversion rate to other treatment modalities was significantly higher in the DEB-TACE group than in the C-TACE group (P<0.001). Conclusions: DEB-TACE is better than C-TACE in terms of procedural safety as initial treatment in a very early or early stage of HCC.

Scheduled Interval Trans-Catheter Arterial Chemoembolization Followed by Radiation Therapy in Patients with Unresectable Hepatocellular Carcinoma

유정일,박희철,임도훈,김철진,Dongryul Oh,유병철,백승운,고광철,이준혁 대한의학회 2012 Journal of Korean medical science Vol.27 No.7

Combination treatment of trans-catheter arterial chemoembolization (TACE) and conformal radiation therapy (RT) reported promising results in patients with hepatocellular carcinoma (HCC), but, optimal interval was not determined. We hypothesized that a twoweek interval between TACE and RT would be optimal. Therefore, we designed this study to evaluate the safety and efficacy of scheduled interval TACE followed by RT. HCC patients who were not eligible for standard therapies were enrolled for scheduled interval TACE followed by RT (START). Patients received TACE on the first day of treatment, and then RT was delivered after 14 days. The entire course of treatment took between four and five weeks. In 81 patients (96.4%), START was completed in the planned treatment period. RT was delayed in the remaining three patients because of decreased liver function or poor performance status after TACE. Of the 81 patients, objective response was observed in 57 patients (70.4%). One unexpected death occurred after START due to hepatic failure. Other toxicities were manageable. The median survival was 14.7 months. There was a significant difference in overall survival according to the response to START (P < 0.001). In conclusion, START is safe and feasible.

초기단계의 간세포암의 고식적 및 약물방출 경동맥화학색전술의 비교

이광훈 ( Kwang-hun Lee ),주승문 ( Seung-moon Joo ),염태준 ( Tae Jun Yum ),정상훈 ( Sang Hoon Jung ) 대한간암학회 2017 대한간암학회지 Vol.17 No.2

Background/Aims: To retrospectively compare conventional and drug-eluting beads trans- arterial chemoembolization (C-TACE and DEB-TACE) for treatment of hepatocellular carcinoma (HCC) at very early and early stages. Methods: We retrospectively compared patients treated with C-TACE (n=115) or DEB-TACE (n=103) from September 2009 to May 2016. All patients were in a very early (stage 0) or early stage (stage A) of the Barcelona Clinic Liver Cancer (BCLC) staging system, and all had Child- Pugh class A and ≤B7 liver status. Approval by the institutional review board was waived because the study was retrospective. The following parameters were evaluated: severe pain and bradycardia during TACE, post-embolization syndrome (PES), liver function change, complications, target tumor response, and conversion to another treatment modality. Numeric differences were assessed by the independent Student`s t-test for continuous variables and by chi-square test for categorical variables. Results: Severe intractable pain and bradycardia during the TACE procedure were significantly more frequent in the C-TACE group than in the DEB-TACE group (P<0.001). The incidence and duration of PES were significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The increase in liver enzymes was significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The deterioration of the Child-Pugh class was significantly higher in the C-TACE group than in the DEB-TACE group (P =0.006). There was no significant difference in serious complications except localized bile duct dilatation between the groups. There was no significant difference between the groups in tumor response at both immediate and 1-year assessment. The conversion rate to other treatment modalities was significantly higher in the DEB-TACE group than in the C-TACE group (P<0.001). Conclusions: DEB-TACE is better than C-TACE in terms of procedural safety as initial treatment in a very early or early stage of HCC. (J Liver Cancer 2017;17:144-152)

TACE 및 Adjuvant Brivanib 치료로 완치된 뒤 21개월 후 재발성 간암으로 이식한 증례

이상헌 ( Sangheun Lee ),김미나 ( Mi Na Kim ),전영은 ( Young Eun Chon ),김범경 ( Beom Kyung Kim ),김승업 ( Seung Up Kim ),박준용 ( Jun Yong Park ),김도영 ( Do Young Kim ),안상훈 ( Sang Hoon Ahn ),전재윤 ( Chae Yoon Chon ),한광협 ( 대한간암학회 2013 대한간암학회지 Vol.13 No.1

Hepatocelluar carcinoma (HCC) is the most common primary liver cancer in the world and the most prevalent cancer among patients liver cirrhosis. The management of HCC depends on tumor stage and the degree of liver dysfunction. Patients with intermediate-stage HCC are ineligible for surgical or local ablative treatments. Current treatment guidelines recommend trans-arterial chemoembolization (TACE) for intermediate stage of HCC. However, tumor recurrence after TACE is universal and the survival benefit is relatively small. Hence, new strategies are needed to improve the outcome of HCC patients undergoing TACE. Recently, the combination of target agents with TACE has shown promising overall survival in advanced HCC. It is necessary to investigate new treat strategy how to increase treatment outcome of advanced HCC by new treat strategy.