Ali A Mokdad1, Amit G Singal2, Jorge A Marrero2, Hao Zhu3, Adam C Yopp1. 1. Department of Surgery, Division of Surgical Oncology 2. Department of Medicine, Division of Digestive and Liver Diseases 3. Children’s Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Abstract
Background: Patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) have variable long-term outcomes. Better delineation of prognosis is important for clinical trial enrollment and clinical practice in an era of precision medicine. We hypothesized that stratification of patients with BCLC stage C HCC by presence of vascular invasion and/or metastasis improves prognostic discrimination. Methods: Using a prospectively maintained database, we identified 234 patients diagnosed with BCLC stage C HCC between 2005 and 2015. Patients were stratified into 3 groups based on tumor characteristics: (1) vascular invasion alone, (2) metastasis alone, and (3) vascular invasion and metastasis. Overall survival (OS) was compared using a Cox model. A subgroup analysis was performed based on extent of vascular invasion and site of metastasis. Results: The cohort comprised 123 patients (53%) with vascular invasion alone, 34 (15%) with metastasis alone, and 77 (33%) with both vascular invasion and metastasis. Median survival was 5.7, 3.9, and 3.0 months, respectively (P<.01). Patients with vascular invasion or metastasis alone had significantly better survival compared with those with vascular invasion and metastasis (adjusted hazard ratio [HR],0.68; 95% CI, 0.49-0.94, and HR, 0.61; 95% CI, 0.39-0.96, respectively). Compared with tumoral invasion of branch portal veins, involvement of the main portal vein was associated with worse survival (HR, 2.13; 95% CI, 1.29-3.49). OS did not differ by site of metastasis. Conclusions: Stratification of patients within the BCLC stage C staging subgroup by vascular invasion and presence of metastasis further discriminates patient prognosis. This substratification may have implications for therapy and more accurate prognostic features.
Background: Patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) have variable long-term outcomes. Better delineation of prognosis is important for clinical trial enrollment and clinical practice in an era of precision medicine. We hypothesized that stratification of patients with BCLC stage C HCC by presence of vascular invasion and/or metastasis improves prognostic discrimination. Methods: Using a prospectively maintained database, we identified 234 patients diagnosed with BCLC stage C HCC between 2005 and 2015. Patients were stratified into 3 groups based on tumor characteristics: (1) vascular invasion alone, (2) metastasis alone, and (3) vascular invasion and metastasis. Overall survival (OS) was compared using a Cox model. A subgroup analysis was performed based on extent of vascular invasion and site of metastasis. Results: The cohort comprised 123 patients (53%) with vascular invasion alone, 34 (15%) with metastasis alone, and 77 (33%) with both vascular invasion and metastasis. Median survival was 5.7, 3.9, and 3.0 months, respectively (P<.01). Patients with vascular invasion or metastasis alone had significantly better survival compared with those with vascular invasion and metastasis (adjusted hazard ratio [HR],0.68; 95% CI, 0.49-0.94, and HR, 0.61; 95% CI, 0.39-0.96, respectively). Compared with tumoral invasion of branch portal veins, involvement of the main portal vein was associated with worse survival (HR, 2.13; 95% CI, 1.29-3.49). OS did not differ by site of metastasis. Conclusions: Stratification of patients within the BCLC stage C staging subgroup by vascular invasion and presence of metastasis further discriminates patient prognosis. This substratification may have implications for therapy and more accurate prognostic features.
Authors: Matthew J Ware; Lam P Nguyen; Justin J Law; Martyna Krzykawska-Serda; Kimberly M Taylor; Hop S Tran Cao; Andrew O Anderson; Merlyn Pulikkathara; Jared M Newton; Jason C Ho; Rosa Hwang; Kimal Rajapakshe; Cristian Coarfa; Shixia Huang; Dean Edwards; Steven A Curley; Stuart J Corr Journal: Sci Rep Date: 2017-09-12 Impact factor: 4.379
Authors: Hikmet Akkiz; Brian I Carr; Sedef Kuran; Ümit Karaoğullarından; Oguz Üsküdar; Salih Tokmak; Burcu Arslan; Figen Doran; Hüseyin Tugsan Balli; Abdulalh Ülkü; Tolga Atılgan Akçam; Halil İbrahim Bahçeci; Kamil Yalçın Polat; Necati Örmeci; Halis Şimşek; Abdullah Sonsuz; Ali Demir; Engin Altıntaş; Mehmet Demir; Kendal Yalçın; Nazım Ekinci; Ayşegül Harmancı Özakyol; Mehmet Yücesoy; Ahmet Uygun; Vito Guerra; Anıl Delik; Yaman Tokat; Sezai Yilmaz; Ahmet Bektaş; Murat Kılıç Journal: Can J Gastroenterol Hepatol Date: 2018-06-13