BACKGROUND AND AIM: Hepatocellular carcinoma (HCC) is one of the most prevalent and lethal cancers. Several local and systemic therapies are available for patients with HCC depending on the stage of the disease. In clinical practice, treatment decision-making, and sequencing may be very heterogeneous. METHODS: In this study, we retrospectively analyzed treatment algorithms in 2101 patients with HCC treated from 2000 to 2015 at Hannover Medical School, Germany. RESULTS: Transarterial chemoembolization was the most common initial treatment (n = 545; 25.9%), followed by resection (n = 435, 20.7%), local-ablative procedures (n = 283, 13.5%), systemic therapies (n = 275, 13.1%), and liver transplantation (n = 52; 2.5%). Most patients were treated only once (n = 960; 59.6%). A total of 433 (26.9%) and 160 (9.9%) patients received a second line and third line treatment after recurrent or progressive disease. Patients with more than one treatment line were diagnosed at significantly earlier disease stages (P < 0.001). Using binary logistic regression, AFP ≤ 200 μg/L, albumin > 36 g/L, and small tumor size (≤50 mm) were identified as predictors of achieving more than one treatment line. Subsequent treatment stage migration to a therapy suggested for the next advanced stage occurred only in 56.9%, whereas 43.1% received treatments suggested for earlier disease stages. Only 16% of all treated patients received systemic therapy in the salvage setting. CONCLUSION: Most patients were treated only once, and only a minority of patients received systemic treatment. The high dropout rate for subsequent therapies needs to be considered within therapy decision-making. There is an urgent need for prospective studies to define the best time point when to switch patients from local to systemic therapies.
BACKGROUND AND AIM: Hepatocellular carcinoma (HCC) is one of the most prevalent and lethal cancers. Several local and systemic therapies are available for patients with HCC depending on the stage of the disease. In clinical practice, treatment decision-making, and sequencing may be very heterogeneous. METHODS: In this study, we retrospectively analyzed treatment algorithms in 2101 patients with HCC treated from 2000 to 2015 at Hannover Medical School, Germany. RESULTS: Transarterial chemoembolization was the most common initial treatment (n = 545; 25.9%), followed by resection (n = 435, 20.7%), local-ablative procedures (n = 283, 13.5%), systemic therapies (n = 275, 13.1%), and liver transplantation (n = 52; 2.5%). Most patients were treated only once (n = 960; 59.6%). A total of 433 (26.9%) and 160 (9.9%) patients received a second line and third line treatment after recurrent or progressive disease. Patients with more than one treatment line were diagnosed at significantly earlier disease stages (P < 0.001). Using binary logistic regression, AFP ≤ 200 μg/L, albumin > 36 g/L, and small tumor size (≤50 mm) were identified as predictors of achieving more than one treatment line. Subsequent treatment stage migration to a therapy suggested for the next advanced stage occurred only in 56.9%, whereas 43.1% received treatments suggested for earlier disease stages. Only 16% of all treated patients received systemic therapy in the salvage setting. CONCLUSION: Most patients were treated only once, and only a minority of patients received systemic treatment. The high dropout rate for subsequent therapies needs to be considered within therapy decision-making. There is an urgent need for prospective studies to define the best time point when to switch patients from local to systemic therapies.
Authors: Martha M Kirstein; Steffen Marquardt; Nils Jedicke; Silke Marhenke; Wolfgang Koppert; Michael P Manns; Frank Wacker; Arndt Vogel Journal: J Cancer Res Clin Oncol Date: 2017-06-20 Impact factor: 4.553
Authors: Cyrill Wehling; Daniel Hornuss; Pasquale Schneider; Christoph Springfeld; Katrin Hoffmann; De-Hua Chang; Patrick Naumann; Markus Mieth; Thomas Longerich; Clemens Kratochwil; Arianeb Mehrabi; Annika Gauss; Karl Heinz Weiss; Jan Pfeiffenberger Journal: J Cancer Res Clin Oncol Date: 2019-08-19 Impact factor: 4.553
Authors: Cyrill Wehling; Michael T Dill; Alexander Olkus; Christoph Springfeld; De-Hua Chang; Patrick Naumann; Thomas Longerich; Clemens Kratochwil; Arianeb Mehrabi; Uta Merle; Jan Pfeiffenberger; Christian Rupp; Karl Heinz Weiss; Markus Mieth Journal: J Cancer Res Clin Oncol Date: 2021-02-04 Impact factor: 4.553
Authors: Martha M Kirstein; Torsten Voigtländer; Nora Schweitzer; Jan B Hinrichs; Jens Marquardt; Marcus-Alexander Wörns; Roman Kloeckner; Thorben W Fründt; Harald Ittrich; Frank Wacker; Thomas Rodt; Michael P Manns; Henning Wege; Arndt Weinmann; Arndt Vogel Journal: United European Gastroenterol J Date: 2017-06-20 Impact factor: 4.623