Hepatocellular Carcinoma

Treatment of patients with hepatocellular carcinoma (HCC) requires a multidisciplinary approach. This month we will review articles that analyze outcomes after liver resection compared to percutaneous ablation, prediction of immunotherapy efficacy based on observed treatment-related side effects, and the risk of subsequent malignancies in patients with HCC.

Xie et al. reported their retrospective review of outcomes of 67 adults with resectable caudate HCC within Milan criteria. Out of these, 46 underwent hepatic resection and 21 underwent percutaneous ablation. Overall survival at 1, 3, and 5 years was 97.6%, 83.6%, and 71.5%, respectively, for the hepatic resection patients, vs 89.4%, 58.5%, and 48.8%, respectively, for the percutaneous ablation patients (P = 0.032). Recurrence-free survival at these time points was 77.6%, 47.9%, and 42.6%, respectively, for the hepatic resection group, and 40.5%, 23.2%, and 15.4%, respectively, for the percutaneous ablation group (P = 0.010). The investigators concluded that HCC patients who underwent hepatic resection had significantly higher rates of recurrence-free and overall survival compared to those who underwent percutaneous ablation.

For those patients with unresectable HCC, systemic immune checkpoint inhibitor therapy is now part of the standard of care. Treatment-associated adverse events occur in over half of patients treated with immunotherapy. Pinato et al. reviewed the outcomes of a cohort of 406 adults with unresectable or advanced HCC who were receiving immune checkpoint inhibitor therapy while enrolled in clinical trials that were submitted to the Food and Drug Administration. the development of adverse events was associated with longer overall survival and progression-free survival rates compared to patients who did not develop treatment-related adverse events (16.7 months vs 11.2 months; 5.5 months vs 2.2 months, respectively).  The authors concluded that the development of treatment-related adverse events was significantly correlated with improve overall and progression-free survival in HCC patients treated with ICI monotherapy in clinical trials.

Finally, Kong et al. retrospectively looked at a cohort of 40,314 adult patients diagnosed with HCC between 2000 and 2014 in the SEER database, identifying the incidence of second primary cancers. Overall, the patients were followed for a median of 19 months following their HCC diagnosis. A total of 1,593 HCC patients (3.95%) developed secondary primary malignancies starting at 2 months after their initial HCC diagnosis. The 3-, 5-, and 10-year cumulative incidence of developing second primary malignancies were 2.35%, 3.12%, and 4.51%. The top five sites of the second primary malignancies were lung and bronchus, prostate, non-Hodgkin lymphoma, colon, and breast. The patients with poorer tumor-related characteristics such as larger tumor size, vascular invasion, positive AFP level, poorer tumor grade, and distant extension were associated with a decreased risk of developing second primary cancers, most probably because of their higher risk of dying from HCC. The authors developed a competing-risk nomogram for the purpose of improving guideline surveillance and further management of HCC survivors, concluding that HCC survivors should be monitored for evidence of secondary primary cancers.

Treatment of patients with hepatocellular carcinoma (HCC) requires a multidisciplinary approach. This month we will review articles that analyze outcomes after liver resection compared to percutaneous ablation, prediction of immunotherapy efficacy based on observed treatment-related side effects, and the risk of subsequent malignancies in patients with HCC.

Xie et al. reported their retrospective review of outcomes of 67 adults with resectable caudate HCC within Milan criteria. Out of these, 46 underwent hepatic resection and 21 underwent percutaneous ablation. Overall survival at 1, 3, and 5 years was 97.6%, 83.6%, and 71.5%, respectively, for the hepatic resection patients, vs 89.4%, 58.5%, and 48.8%, respectively, for the percutaneous ablation patients (P = 0.032). Recurrence-free survival at these time points was 77.6%, 47.9%, and 42.6%, respectively, for the hepatic resection group, and 40.5%, 23.2%, and 15.4%, respectively, for the percutaneous ablation group (P = 0.010). The investigators concluded that HCC patients who underwent hepatic resection had significantly higher rates of recurrence-free and overall survival compared to those who underwent percutaneous ablation.

For those patients with unresectable HCC, systemic immune checkpoint inhibitor therapy is now part of the standard of care. Treatment-associated adverse events occur in over half of patients treated with immunotherapy. Pinato et al. reviewed the outcomes of a cohort of 406 adults with unresectable or advanced HCC who were receiving immune checkpoint inhibitor therapy while enrolled in clinical trials that were submitted to the Food and Drug Administration. the development of adverse events was associated with longer overall survival and progression-free survival rates compared to patients who did not develop treatment-related adverse events (16.7 months vs 11.2 months; 5.5 months vs 2.2 months, respectively).  The authors concluded that the development of treatment-related adverse events was significantly correlated with improve overall and progression-free survival in HCC patients treated with ICI monotherapy in clinical trials.

Finally, Kong et al. retrospectively looked at a cohort of 40,314 adult patients diagnosed with HCC between 2000 and 2014 in the SEER database, identifying the incidence of second primary cancers. Overall, the patients were followed for a median of 19 months following their HCC diagnosis. A total of 1,593 HCC patients (3.95%) developed secondary primary malignancies starting at 2 months after their initial HCC diagnosis. The 3-, 5-, and 10-year cumulative incidence of developing second primary malignancies were 2.35%, 3.12%, and 4.51%. The top five sites of the second primary malignancies were lung and bronchus, prostate, non-Hodgkin lymphoma, colon, and breast. The patients with poorer tumor-related characteristics such as larger tumor size, vascular invasion, positive AFP level, poorer tumor grade, and distant extension were associated with a decreased risk of developing second primary cancers, most probably because of their higher risk of dying from HCC. The authors developed a competing-risk nomogram for the purpose of improving guideline surveillance and further management of HCC survivors, concluding that HCC survivors should be monitored for evidence of secondary primary cancers.

Treatment of patients with hepatocellular carcinoma (HCC) requires a multidisciplinary approach. This month we will review articles that analyze outcomes after liver resection compared to percutaneous ablation, prediction of immunotherapy efficacy based on observed treatment-related side effects, and the risk of subsequent malignancies in patients with HCC.

Xie et al. reported their retrospective review of outcomes of 67 adults with resectable caudate HCC within Milan criteria. Out of these, 46 underwent hepatic resection and 21 underwent percutaneous ablation. Overall survival at 1, 3, and 5 years was 97.6%, 83.6%, and 71.5%, respectively, for the hepatic resection patients, vs 89.4%, 58.5%, and 48.8%, respectively, for the percutaneous ablation patients (P = 0.032). Recurrence-free survival at these time points was 77.6%, 47.9%, and 42.6%, respectively, for the hepatic resection group, and 40.5%, 23.2%, and 15.4%, respectively, for the percutaneous ablation group (P = 0.010). The investigators concluded that HCC patients who underwent hepatic resection had significantly higher rates of recurrence-free and overall survival compared to those who underwent percutaneous ablation.

For those patients with unresectable HCC, systemic immune checkpoint inhibitor therapy is now part of the standard of care. Treatment-associated adverse events occur in over half of patients treated with immunotherapy. Pinato et al. reviewed the outcomes of a cohort of 406 adults with unresectable or advanced HCC who were receiving immune checkpoint inhibitor therapy while enrolled in clinical trials that were submitted to the Food and Drug Administration. the development of adverse events was associated with longer overall survival and progression-free survival rates compared to patients who did not develop treatment-related adverse events (16.7 months vs 11.2 months; 5.5 months vs 2.2 months, respectively).  The authors concluded that the development of treatment-related adverse events was significantly correlated with improve overall and progression-free survival in HCC patients treated with ICI monotherapy in clinical trials.

Finally, Kong et al. retrospectively looked at a cohort of 40,314 adult patients diagnosed with HCC between 2000 and 2014 in the SEER database, identifying the incidence of second primary cancers. Overall, the patients were followed for a median of 19 months following their HCC diagnosis. A total of 1,593 HCC patients (3.95%) developed secondary primary malignancies starting at 2 months after their initial HCC diagnosis. The 3-, 5-, and 10-year cumulative incidence of developing second primary malignancies were 2.35%, 3.12%, and 4.51%. The top five sites of the second primary malignancies were lung and bronchus, prostate, non-Hodgkin lymphoma, colon, and breast. The patients with poorer tumor-related characteristics such as larger tumor size, vascular invasion, positive AFP level, poorer tumor grade, and distant extension were associated with a decreased risk of developing second primary cancers, most probably because of their higher risk of dying from HCC. The authors developed a competing-risk nomogram for the purpose of improving guideline surveillance and further management of HCC survivors, concluding that HCC survivors should be monitored for evidence of secondary primary cancers.

Key clinical point: Among hepatitis B virus-positive HCC patients, the 2-year recurrence-free survival rate was higher in those with negative expression of cytokeratin 19 compared to those who were CK19-positive. 

Major finding: In a multivariate analysis, CK19 expression was significantly associated with poor recurrence-free survival (hazard ratio 1.586, P = 0.042); other independent predictors were postoperative platelet > 300/L (HR 2.82), satellite nodule (HR = 1.71), 95 microvascular invasion (HR = 1.61), and tumor without capsule (HR 1.87).

Study details: The data come from a retrospective study of 674 adults with hepatitis B virus (HBV) positive hepatocellular carcinoma who underwent resection between January 2010 and May 2020. Researchers used a multivariate analysis to create a nomogram of 2-year recurrence-free survival.

Disclosures: The study was supported by the Gansu Science and Technology Department. The researchers had no financial conflicts to disclose.

Source: Shuyao W et al. J Gastrointest Surg. 2021 Sep 10. doi: 10.1007/s11605-021-05107-w.

Key clinical point: Among hepatitis B virus-positive HCC patients, the 2-year recurrence-free survival rate was higher in those with negative expression of cytokeratin 19 compared to those who were CK19-positive. 

Major finding: In a multivariate analysis, CK19 expression was significantly associated with poor recurrence-free survival (hazard ratio 1.586, P = 0.042); other independent predictors were postoperative platelet > 300/L (HR 2.82), satellite nodule (HR = 1.71), 95 microvascular invasion (HR = 1.61), and tumor without capsule (HR 1.87).

Study details: The data come from a retrospective study of 674 adults with hepatitis B virus (HBV) positive hepatocellular carcinoma who underwent resection between January 2010 and May 2020. Researchers used a multivariate analysis to create a nomogram of 2-year recurrence-free survival.

Disclosures: The study was supported by the Gansu Science and Technology Department. The researchers had no financial conflicts to disclose.

Source: Shuyao W et al. J Gastrointest Surg. 2021 Sep 10. doi: 10.1007/s11605-021-05107-w.

Key clinical point: Among hepatitis B virus-positive HCC patients, the 2-year recurrence-free survival rate was higher in those with negative expression of cytokeratin 19 compared to those who were CK19-positive. 

Major finding: In a multivariate analysis, CK19 expression was significantly associated with poor recurrence-free survival (hazard ratio 1.586, P = 0.042); other independent predictors were postoperative platelet > 300/L (HR 2.82), satellite nodule (HR = 1.71), 95 microvascular invasion (HR = 1.61), and tumor without capsule (HR 1.87).

Study details: The data come from a retrospective study of 674 adults with hepatitis B virus (HBV) positive hepatocellular carcinoma who underwent resection between January 2010 and May 2020. Researchers used a multivariate analysis to create a nomogram of 2-year recurrence-free survival.

Disclosures: The study was supported by the Gansu Science and Technology Department. The researchers had no financial conflicts to disclose.

Source: Shuyao W et al. J Gastrointest Surg. 2021 Sep 10. doi: 10.1007/s11605-021-05107-w.

Key clinical point: The development of treatment-related adverse events was significantly correlated with improve overall and progression-free survival in HCC patients treated with ICI monotherapy in clinical trials.

Major finding: Treatment-related adverse events were reported in 56% of patients with unresectable or advanced HCC; the development of adverse events was associated with longer overall survival and progression-free survival rates compared to patients who did not develop treatment-related adverse events (16.7 months vs 11.2 months; 5.5 months vs 2.2 months, respectively).

Study details: The data come from a cohort of 406 adults with unresectable or advanced HCC who were receiving immune checkpoint inhibitor (ICI) therapy while enrolled in clinical trials submitted to the Food and Drug Administration.

Disclosures: The study received no outside funding. Lead author Dr. Pinato disclosed lecture fees from ViiV Healthcare, and Bayer Healthcare; travel expenses from BMS and Bayer Healthcare; consulting fees for Mina Therapeutics, EISAI, Roche, AstraZeneca; and research funding (to his institution) from MSD and BMS.

Source: Pinato DJ et al. Eur J Cancer. 2021 Sep 8. doi: 10.1016/j.ejca.2021.08.020. 

Key clinical point: The development of treatment-related adverse events was significantly correlated with improve overall and progression-free survival in HCC patients treated with ICI monotherapy in clinical trials.

Major finding: Treatment-related adverse events were reported in 56% of patients with unresectable or advanced HCC; the development of adverse events was associated with longer overall survival and progression-free survival rates compared to patients who did not develop treatment-related adverse events (16.7 months vs 11.2 months; 5.5 months vs 2.2 months, respectively).

Study details: The data come from a cohort of 406 adults with unresectable or advanced HCC who were receiving immune checkpoint inhibitor (ICI) therapy while enrolled in clinical trials submitted to the Food and Drug Administration.

Disclosures: The study received no outside funding. Lead author Dr. Pinato disclosed lecture fees from ViiV Healthcare, and Bayer Healthcare; travel expenses from BMS and Bayer Healthcare; consulting fees for Mina Therapeutics, EISAI, Roche, AstraZeneca; and research funding (to his institution) from MSD and BMS.

Source: Pinato DJ et al. Eur J Cancer. 2021 Sep 8. doi: 10.1016/j.ejca.2021.08.020. 

Key clinical point: The development of treatment-related adverse events was significantly correlated with improve overall and progression-free survival in HCC patients treated with ICI monotherapy in clinical trials.

Major finding: Treatment-related adverse events were reported in 56% of patients with unresectable or advanced HCC; the development of adverse events was associated with longer overall survival and progression-free survival rates compared to patients who did not develop treatment-related adverse events (16.7 months vs 11.2 months; 5.5 months vs 2.2 months, respectively).

Study details: The data come from a cohort of 406 adults with unresectable or advanced HCC who were receiving immune checkpoint inhibitor (ICI) therapy while enrolled in clinical trials submitted to the Food and Drug Administration.

Disclosures: The study received no outside funding. Lead author Dr. Pinato disclosed lecture fees from ViiV Healthcare, and Bayer Healthcare; travel expenses from BMS and Bayer Healthcare; consulting fees for Mina Therapeutics, EISAI, Roche, AstraZeneca; and research funding (to his institution) from MSD and BMS.

Source: Pinato DJ et al. Eur J Cancer. 2021 Sep 8. doi: 10.1016/j.ejca.2021.08.020. 

Key clinical point: Risk factors for secondary primary malignancies in HCC patients included older age at diagnosis, localized disease, smaller tumor size, and treatment with local tumor destruction, hepatectomy, and transplantation.   

Major finding: A total of 1,593 HCC patients (3.95%) developed secondary primary malignancies starting at 2 months after their initial HCC diagnoses; the top five sites were lung and bronchus; prostate, non-hodgkin lymphoma, colon, and breast.

Study details: The data come from a retrospective study of 40,314 adults with hepatocellular carcinoma who were diagnosed between 2000 and 2014 and identified through the SEER database who were followed for a median of 19 months from their initial HCC diagnoses.

Disclosures: The study was supported by the National Natural Science Foundation of China. The researchers had no financial conflicts to disclose.

Source: Kong J et al. Front Oncol. 2021 Aug 23. doi: 10.3389/fonc.2021.713637. 

Key clinical point: Risk factors for secondary primary malignancies in HCC patients included older age at diagnosis, localized disease, smaller tumor size, and treatment with local tumor destruction, hepatectomy, and transplantation.   

Major finding: A total of 1,593 HCC patients (3.95%) developed secondary primary malignancies starting at 2 months after their initial HCC diagnoses; the top five sites were lung and bronchus; prostate, non-hodgkin lymphoma, colon, and breast.

Study details: The data come from a retrospective study of 40,314 adults with hepatocellular carcinoma who were diagnosed between 2000 and 2014 and identified through the SEER database who were followed for a median of 19 months from their initial HCC diagnoses.

Disclosures: The study was supported by the National Natural Science Foundation of China. The researchers had no financial conflicts to disclose.

Source: Kong J et al. Front Oncol. 2021 Aug 23. doi: 10.3389/fonc.2021.713637. 

Key clinical point: Risk factors for secondary primary malignancies in HCC patients included older age at diagnosis, localized disease, smaller tumor size, and treatment with local tumor destruction, hepatectomy, and transplantation.   

Major finding: A total of 1,593 HCC patients (3.95%) developed secondary primary malignancies starting at 2 months after their initial HCC diagnoses; the top five sites were lung and bronchus; prostate, non-hodgkin lymphoma, colon, and breast.

Study details: The data come from a retrospective study of 40,314 adults with hepatocellular carcinoma who were diagnosed between 2000 and 2014 and identified through the SEER database who were followed for a median of 19 months from their initial HCC diagnoses.

Disclosures: The study was supported by the National Natural Science Foundation of China. The researchers had no financial conflicts to disclose.

Source: Kong J et al. Front Oncol. 2021 Aug 23. doi: 10.3389/fonc.2021.713637. 

Key clinical point: Raltitrexed-based transcatheter arterial chemoembolization (TACE) extended the overall survival of intermediate and advanced HCC patients in a real-world clinical setting.

Major finding: After propensity score matching, the overall survival rates at 6 months, 1 year, and 2 years were significantly higher in patients given raltitrexed compared to controls (78.2% vs 60.9%; 43.5% vs 22.8%; and 17.4% vs 2.2%, respectively).

Study details: The data come from HCC patients seen at multiple centers in Chongqing, China, between January 2013 and December 2019. Cases were divided into two groups based on treatment: the raltitrexed group (raltitrexed plus lobaplatin + pirarubicin) and the control group (lobaplatin + pirarubicin).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: He J et al. Hepatol Res. 2021 Sep 7. doi: 10.1111/hepr.13708. 

Key clinical point: Raltitrexed-based transcatheter arterial chemoembolization (TACE) extended the overall survival of intermediate and advanced HCC patients in a real-world clinical setting.

Major finding: After propensity score matching, the overall survival rates at 6 months, 1 year, and 2 years were significantly higher in patients given raltitrexed compared to controls (78.2% vs 60.9%; 43.5% vs 22.8%; and 17.4% vs 2.2%, respectively).

Study details: The data come from HCC patients seen at multiple centers in Chongqing, China, between January 2013 and December 2019. Cases were divided into two groups based on treatment: the raltitrexed group (raltitrexed plus lobaplatin + pirarubicin) and the control group (lobaplatin + pirarubicin).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: He J et al. Hepatol Res. 2021 Sep 7. doi: 10.1111/hepr.13708. 

Key clinical point: Raltitrexed-based transcatheter arterial chemoembolization (TACE) extended the overall survival of intermediate and advanced HCC patients in a real-world clinical setting.

Major finding: After propensity score matching, the overall survival rates at 6 months, 1 year, and 2 years were significantly higher in patients given raltitrexed compared to controls (78.2% vs 60.9%; 43.5% vs 22.8%; and 17.4% vs 2.2%, respectively).

Study details: The data come from HCC patients seen at multiple centers in Chongqing, China, between January 2013 and December 2019. Cases were divided into two groups based on treatment: the raltitrexed group (raltitrexed plus lobaplatin + pirarubicin) and the control group (lobaplatin + pirarubicin).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: He J et al. Hepatol Res. 2021 Sep 7. doi: 10.1111/hepr.13708. 

Key clinical point: The postoperative controlling nutritional status (PoCONUT) score was an independent predictor of both overall survival and recurrence-free survival in small HCC patients who underwent liver resection; higher scores were associated with decreased survival.

Major finding: Overall survival at 1, 3, and 5 years was 95.4 %, 81.2, and 63.3 %, respectively, in the low PoCONUT group, vs 88.7 %, 63.0, and 44.2 %, respectively, in the high PoCONUT group (P = 0.009). Similarly, recurrence-free survival at 1, 3, and 5 years was 80.4 %, 57.5, and 49.5 %, respectively, vs 66.1 %, 40.3%, and 31.0 %, respectively, in the low and high groups.

Study details: The data come from a retrospective, case-control study including 547 consecutive adult patients with small HCC who underwent liver resection between February 2007 and December 2015; patients were divided into low (382 patients) and high (165 patients) groups according to postoperative controlling nutritional status (PoCONUT) scores (2 or less; 3 or greater).

Disclosures: The study was supported by the National Natural Science Foundation of China. The researchers had no financial conflicts to disclose.

Source: Peng W et al. BMC Surg. 2021 Sep 7. doi: 10.1186/s12893-021-01334-9.

Key clinical point: The postoperative controlling nutritional status (PoCONUT) score was an independent predictor of both overall survival and recurrence-free survival in small HCC patients who underwent liver resection; higher scores were associated with decreased survival.

Major finding: Overall survival at 1, 3, and 5 years was 95.4 %, 81.2, and 63.3 %, respectively, in the low PoCONUT group, vs 88.7 %, 63.0, and 44.2 %, respectively, in the high PoCONUT group (P = 0.009). Similarly, recurrence-free survival at 1, 3, and 5 years was 80.4 %, 57.5, and 49.5 %, respectively, vs 66.1 %, 40.3%, and 31.0 %, respectively, in the low and high groups.

Study details: The data come from a retrospective, case-control study including 547 consecutive adult patients with small HCC who underwent liver resection between February 2007 and December 2015; patients were divided into low (382 patients) and high (165 patients) groups according to postoperative controlling nutritional status (PoCONUT) scores (2 or less; 3 or greater).

Disclosures: The study was supported by the National Natural Science Foundation of China. The researchers had no financial conflicts to disclose.

Source: Peng W et al. BMC Surg. 2021 Sep 7. doi: 10.1186/s12893-021-01334-9.

Key clinical point: The postoperative controlling nutritional status (PoCONUT) score was an independent predictor of both overall survival and recurrence-free survival in small HCC patients who underwent liver resection; higher scores were associated with decreased survival.

Major finding: Overall survival at 1, 3, and 5 years was 95.4 %, 81.2, and 63.3 %, respectively, in the low PoCONUT group, vs 88.7 %, 63.0, and 44.2 %, respectively, in the high PoCONUT group (P = 0.009). Similarly, recurrence-free survival at 1, 3, and 5 years was 80.4 %, 57.5, and 49.5 %, respectively, vs 66.1 %, 40.3%, and 31.0 %, respectively, in the low and high groups.

Study details: The data come from a retrospective, case-control study including 547 consecutive adult patients with small HCC who underwent liver resection between February 2007 and December 2015; patients were divided into low (382 patients) and high (165 patients) groups according to postoperative controlling nutritional status (PoCONUT) scores (2 or less; 3 or greater).

Disclosures: The study was supported by the National Natural Science Foundation of China. The researchers had no financial conflicts to disclose.

Source: Peng W et al. BMC Surg. 2021 Sep 7. doi: 10.1186/s12893-021-01334-9.

Key clinical point: HCC patients who underwent hepatic resection had significantly higher rates of overall survival and recurrence-free survival compared to those who underwent percutaneous ablation.

Major finding: Overall survival at 1, 3, and 5 years was 97.6%, 83.6%, and 71.5%, respectively, for the hepatic resection patients, vs 89.4%, 58.5%, and 48.8%, respectively, for the percutaneous ablation patients (P = 0.032). Recurrence-free survival at these time points was 77.6%, 47.9%, and 42.6%, respectively, for the hepatic resection group, and 40.5%, 23.2%, and 15.4%, respectively, for the percutaneous ablation group (P = 0.010). 

Study details: The data come from a retrospective study of 67 adults with resectable caudate HCC within Milan criteria at three centers; 46 underwent hepatic resection and 21 underwent percutaneous ablation.

Disclosures: The study was supported by the National Science Fund for Distinguished Young Scholars, the National Natural Science Foundation of China, and the Natural Science Foundation of Guangdong, China.

Source: Xie W et al. J Gastrointest Surg. 2021 Sep 7. doi: 10.1007/s11605-021-05111-0.

Key clinical point: HCC patients who underwent hepatic resection had significantly higher rates of overall survival and recurrence-free survival compared to those who underwent percutaneous ablation.

Major finding: Overall survival at 1, 3, and 5 years was 97.6%, 83.6%, and 71.5%, respectively, for the hepatic resection patients, vs 89.4%, 58.5%, and 48.8%, respectively, for the percutaneous ablation patients (P = 0.032). Recurrence-free survival at these time points was 77.6%, 47.9%, and 42.6%, respectively, for the hepatic resection group, and 40.5%, 23.2%, and 15.4%, respectively, for the percutaneous ablation group (P = 0.010). 

Study details: The data come from a retrospective study of 67 adults with resectable caudate HCC within Milan criteria at three centers; 46 underwent hepatic resection and 21 underwent percutaneous ablation.

Disclosures: The study was supported by the National Science Fund for Distinguished Young Scholars, the National Natural Science Foundation of China, and the Natural Science Foundation of Guangdong, China.

Source: Xie W et al. J Gastrointest Surg. 2021 Sep 7. doi: 10.1007/s11605-021-05111-0.

Key clinical point: HCC patients who underwent hepatic resection had significantly higher rates of overall survival and recurrence-free survival compared to those who underwent percutaneous ablation.

Major finding: Overall survival at 1, 3, and 5 years was 97.6%, 83.6%, and 71.5%, respectively, for the hepatic resection patients, vs 89.4%, 58.5%, and 48.8%, respectively, for the percutaneous ablation patients (P = 0.032). Recurrence-free survival at these time points was 77.6%, 47.9%, and 42.6%, respectively, for the hepatic resection group, and 40.5%, 23.2%, and 15.4%, respectively, for the percutaneous ablation group (P = 0.010). 

Study details: The data come from a retrospective study of 67 adults with resectable caudate HCC within Milan criteria at three centers; 46 underwent hepatic resection and 21 underwent percutaneous ablation.

Disclosures: The study was supported by the National Science Fund for Distinguished Young Scholars, the National Natural Science Foundation of China, and the Natural Science Foundation of Guangdong, China.

Source: Xie W et al. J Gastrointest Surg. 2021 Sep 7. doi: 10.1007/s11605-021-05111-0.

Key clinical point: A total of 84% of HCC patients had at least one emergency department visit within 12 months of therapy.

Major finding: Patients with HCC experienced an average of 3.2 adverse events over a median of 9 months; the most common was pain (75%), followed by infection (39%). Infection was the most costly adverse event ($50,374), and up to 90% of costs were associated with inpatient admissions.

Study details: The data come from 322 adults with HCC who had 12 months of follow-up data available after treatment with tyrosine kinase inhibitor (TKI) monotherapy; immune checkpoint inhibitor (ICI) monotherapy; or FOLFOX combination therapy.

Disclosures: The study was supported by AstraZeneca and some coauthors are AstraZeneca employees. Lead author Dr. Lal had no financial conflicts to disclose.

Source: Lal LS et al. Cancer Rep. 2021 Sep 7. doi: 10.1002/cnr2.1504.

Key clinical point: A total of 84% of HCC patients had at least one emergency department visit within 12 months of therapy.

Major finding: Patients with HCC experienced an average of 3.2 adverse events over a median of 9 months; the most common was pain (75%), followed by infection (39%). Infection was the most costly adverse event ($50,374), and up to 90% of costs were associated with inpatient admissions.

Study details: The data come from 322 adults with HCC who had 12 months of follow-up data available after treatment with tyrosine kinase inhibitor (TKI) monotherapy; immune checkpoint inhibitor (ICI) monotherapy; or FOLFOX combination therapy.

Disclosures: The study was supported by AstraZeneca and some coauthors are AstraZeneca employees. Lead author Dr. Lal had no financial conflicts to disclose.

Source: Lal LS et al. Cancer Rep. 2021 Sep 7. doi: 10.1002/cnr2.1504.

Key clinical point: A total of 84% of HCC patients had at least one emergency department visit within 12 months of therapy.

Major finding: Patients with HCC experienced an average of 3.2 adverse events over a median of 9 months; the most common was pain (75%), followed by infection (39%). Infection was the most costly adverse event ($50,374), and up to 90% of costs were associated with inpatient admissions.

Study details: The data come from 322 adults with HCC who had 12 months of follow-up data available after treatment with tyrosine kinase inhibitor (TKI) monotherapy; immune checkpoint inhibitor (ICI) monotherapy; or FOLFOX combination therapy.

Disclosures: The study was supported by AstraZeneca and some coauthors are AstraZeneca employees. Lead author Dr. Lal had no financial conflicts to disclose.

Source: Lal LS et al. Cancer Rep. 2021 Sep 7. doi: 10.1002/cnr2.1504.

Key clinical point: Arsenic trioxide (ATO)/lipiodol emulsion in the transcatheter arterial chemoembolization (TACE) combined with apatinib was safe and effective in patients with advanced HCC.

Major finding: At one week after the aTACE plus apatinib procedure, levels of AST and ALT were significantly elevated compared with pre-treatment levels, indicating treatment response (65.84 U/L vs 54.15 U/L and 63.44 U/L vs 51.60 U/L, respectively). Median progression-free survival was 10.2 months, and median overall survival was 23.3 months, with longer survival in patients without portal vein tumor thrombus. 

Study details: The data come from 87 consecutive adults with advanced hepatocellular carcinoma who underwent arsenic trioxide (ATO)/lipiodol emulsion in the transcatheter arterial chemoembolization (TACE) combined with apatinib for advanced hepatocellular carcinoma between December 2015 and February 2017.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.  

Source: Li Z et al. Can J Gastroenterol Hepatol. 2021 Aug 19. doi: 10.1155/2021/5565793.

Key clinical point: Arsenic trioxide (ATO)/lipiodol emulsion in the transcatheter arterial chemoembolization (TACE) combined with apatinib was safe and effective in patients with advanced HCC.

Major finding: At one week after the aTACE plus apatinib procedure, levels of AST and ALT were significantly elevated compared with pre-treatment levels, indicating treatment response (65.84 U/L vs 54.15 U/L and 63.44 U/L vs 51.60 U/L, respectively). Median progression-free survival was 10.2 months, and median overall survival was 23.3 months, with longer survival in patients without portal vein tumor thrombus. 

Study details: The data come from 87 consecutive adults with advanced hepatocellular carcinoma who underwent arsenic trioxide (ATO)/lipiodol emulsion in the transcatheter arterial chemoembolization (TACE) combined with apatinib for advanced hepatocellular carcinoma between December 2015 and February 2017.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.  

Source: Li Z et al. Can J Gastroenterol Hepatol. 2021 Aug 19. doi: 10.1155/2021/5565793.

Key clinical point: Arsenic trioxide (ATO)/lipiodol emulsion in the transcatheter arterial chemoembolization (TACE) combined with apatinib was safe and effective in patients with advanced HCC.

Major finding: At one week after the aTACE plus apatinib procedure, levels of AST and ALT were significantly elevated compared with pre-treatment levels, indicating treatment response (65.84 U/L vs 54.15 U/L and 63.44 U/L vs 51.60 U/L, respectively). Median progression-free survival was 10.2 months, and median overall survival was 23.3 months, with longer survival in patients without portal vein tumor thrombus. 

Study details: The data come from 87 consecutive adults with advanced hepatocellular carcinoma who underwent arsenic trioxide (ATO)/lipiodol emulsion in the transcatheter arterial chemoembolization (TACE) combined with apatinib for advanced hepatocellular carcinoma between December 2015 and February 2017.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.  

Source: Li Z et al. Can J Gastroenterol Hepatol. 2021 Aug 19. doi: 10.1155/2021/5565793.

Key clinical point: Serum Prothrombin Induced by Vitamin K Absence or Antagonist-II (PIVKA-II) and alpha-fetoprotein were significant predictors of hepatocellular carcionoma and death in patients with chronic hepatitis B-related cirrhosis.

Major finding: Alpha-fetoprotein levels greater than 7 ng/mL (hazard ratio [HR]: 2.84, 95% confidence interval [CI]: 1.73–4.67) and PIVKA-II levels greater than 50 mAU/mL at virological remission significantly predicted the development of HCC (hazard ratios 2.84 and 2.46, respectively).

Study details: The data come from 293 adults with chronic hepatitis B-related cirrhosis; after an average follow-up of 78 months, 76 patient developed HCC and 19 died.

Disclosures: The study was supported by the Ministry of Science and Technology, National Taiwan University Hospital, and the Liver Disease Prevention & Treatment Research Foundation, Taiwan. Lead author Dr. Su disclosed research grant from Gilead Sciences, and serving on speaker's bureaus for AbbVie, Bayer, Bristol-Myers Squibb, Gilead Sciences, Merck Sharp and Dohme, and Takeda.

Source: Su T-H et al. J Formos Med Assoc. 2021 Aug 24. doi: 10.1016/j.jfma.2021.08.003.

Key clinical point: Serum Prothrombin Induced by Vitamin K Absence or Antagonist-II (PIVKA-II) and alpha-fetoprotein were significant predictors of hepatocellular carcionoma and death in patients with chronic hepatitis B-related cirrhosis.

Major finding: Alpha-fetoprotein levels greater than 7 ng/mL (hazard ratio [HR]: 2.84, 95% confidence interval [CI]: 1.73–4.67) and PIVKA-II levels greater than 50 mAU/mL at virological remission significantly predicted the development of HCC (hazard ratios 2.84 and 2.46, respectively).

Study details: The data come from 293 adults with chronic hepatitis B-related cirrhosis; after an average follow-up of 78 months, 76 patient developed HCC and 19 died.

Disclosures: The study was supported by the Ministry of Science and Technology, National Taiwan University Hospital, and the Liver Disease Prevention & Treatment Research Foundation, Taiwan. Lead author Dr. Su disclosed research grant from Gilead Sciences, and serving on speaker's bureaus for AbbVie, Bayer, Bristol-Myers Squibb, Gilead Sciences, Merck Sharp and Dohme, and Takeda.

Source: Su T-H et al. J Formos Med Assoc. 2021 Aug 24. doi: 10.1016/j.jfma.2021.08.003.

Key clinical point: Serum Prothrombin Induced by Vitamin K Absence or Antagonist-II (PIVKA-II) and alpha-fetoprotein were significant predictors of hepatocellular carcionoma and death in patients with chronic hepatitis B-related cirrhosis.

Major finding: Alpha-fetoprotein levels greater than 7 ng/mL (hazard ratio [HR]: 2.84, 95% confidence interval [CI]: 1.73–4.67) and PIVKA-II levels greater than 50 mAU/mL at virological remission significantly predicted the development of HCC (hazard ratios 2.84 and 2.46, respectively).

Study details: The data come from 293 adults with chronic hepatitis B-related cirrhosis; after an average follow-up of 78 months, 76 patient developed HCC and 19 died.

Disclosures: The study was supported by the Ministry of Science and Technology, National Taiwan University Hospital, and the Liver Disease Prevention & Treatment Research Foundation, Taiwan. Lead author Dr. Su disclosed research grant from Gilead Sciences, and serving on speaker's bureaus for AbbVie, Bayer, Bristol-Myers Squibb, Gilead Sciences, Merck Sharp and Dohme, and Takeda.

Source: Su T-H et al. J Formos Med Assoc. 2021 Aug 24. doi: 10.1016/j.jfma.2021.08.003.