Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;9(1):41-49.
doi: 10.1159/000502479. Epub 2019 Oct 22.

Treatment of Intermediate-Stage Hepatocellular Carcinoma in Japan: Position of Curative Therapies

Kazuya Kariyama  1 , Kazuhiro Nouso  1 , Akiko Wakuta  1 , Ayano Oonishi  1 , Hidenori Toyoda  2 , Toshifumi Tada  2 , Atsushi Hiraoka  3 , Kunihiko Tsuji  4 , Ei Itobayashi  5 , Toru Ishikawa  6 , Koichi Takaguchi  7 , Akemi Tsutsui  7 , Noritomo Shimada  8 , Takashi Kumada  2
Affiliations

Treatment of Intermediate-Stage Hepatocellular Carcinoma in Japan: Position of Curative Therapies

Kazuya Kariyama et al. Liver Cancer. 2020 Jan.

Abstract

Background: Transcatheter arterial chemoembolization (TACE) is the standard therapy for intermediate-stage (IM) hepatocellular carcinoma (HCC). However, IM-HCC includes various clinical conditions, and various therapies were conducted in practice. In this study, we retrospectively analyzed the actually conducted treatments for IM-HCC and their efficacies to elucidate the treatment strategies suitable for IM-HCC.

Methods: This study included 627 IM-HCC of 5,260 HCC from 9 hospitals. We examined the treatment strategies of these patients and analyzed the efficacy of each therapy with the Cox proportional hazard model and propensity score-matched analysis.

Results: Liver resection, radiofrequency ablation (RFA), and TACE were performed in 165, 108, and 351 patients, respectively. Liver resection and RFA were preferably selected in cases of Barcelona Clinic Liver Cancer (BCLC)-B1/B2, and patient survival was significantly longer than in those treated with TACE (p< 0.0001). However, no beneficial effect of these active therapies was observed in cases of BCLC-B3/B4. Multivariate analysis revealed that surgical resection (hazard ratio = 0.384) and RFA (hazard ratio = 0.597) were negative risk factors for survival. Propensity score-matching analysis revealed that -survival of RFA-treated patients was longer than that of TACE-treated patients (p = 0.036).

Conclusion: RFA and surgical resection were effective for IM-HCC, particularly in BCLC-B1/B2 cases.

Keywords: Intermediate-stage hepatocellular carcinoma; Radiofrequency ablation; Surgical resection.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Treatment selection based on BCLC-B substages. In BCLC-B1, the most prevalent therapy was liver resection (LR; 67 patients, 46.9%), followed by RFA (42 ­patients, 29.4%), and TACE (32 patients, 22.4%). The number of TACE increased in BCLC-B2 (84 patients, 40.2%); however, more than half of the patients underwent LR or RFA (121 patients, 57.9%). In BCLC-B3/B4, TACE was preferably selected (86 patients, 59.7%).
Fig. 2
Fig. 2
Overall survival of the patients stratified by BCLC-B substages. In BCLC-B1, overall survival of liver resection (LR; median survival time [MST], 6.43 years) and RFA (MST, 6.96 years) was significantly better than that of TACE (MST, 3.16 years; p< 0.0001). The same relationship was observed in BCLC-B2: MST of LR, RFA, and TACE were 5.28, 3.83, and 2.76 years, respectively (p< 0.0001). No significant difference in survival was observed in BCLC-B3/B4 (data not shown).
Fig. 3
Fig. 3
Overall survival (after propensity score-matching analysis). The overall survival of patients in the RFA group was significantly longer than that in the TACE group (p = 0.036).
See this image and copyright information in PMC

References

    1. Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, et al. Global Burden of Disease Cancer Collaboration Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol. 2017;3:524–48. - PMC - PubMed
    1. Keen WW., IV Report of a Case of Resection of the Liver for the Removal of a Neoplasm, with a table of seventy-six cases of resection of the liver for hepatic tumors. Ann Surg. 1899 Sep;30((3)):267–83. - PMC - PubMed
    1. Shiina S, Teratani T, Obi S, Hamamura K, Koike Y, Omata M. Nonsurgical treatment of hepatocellular carcinoma: from percutaneous ethanol injection therapy and percutaneous microwave coagulation therapy to radiofrequency ablation. Oncology. 2002;62((1 Suppl 1)):64–8. - PubMed
    1. Tateishi R, Shiina S, Teratani T, Obi S, Sato S, Koike Y, et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer. 2005 Mar;103((6)):1201–9. - PubMed
    1. Shiina S, Teratani T, Obi S, Sato S, Tateishi R, Fujishima T, et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology. 2005 Jul;129((1)):122–30. - PubMed

LinkOut - more resources