ABSTRACT
Objective: To investigate the necessity of sub-classification for Barcelona clinic liver cancer (BCLC) classification stage B hepatocellular carcinoma (HCC), and to analyze the curative effect and survival of patients with different substages HCC after TACE. Methods: Clinical and follow-up data of 133 patients with BCLC classification stage B HCC treated with TACE were retrospectively analyzed. There were 31 cases of substage B1, 77 of substage B2, 15 of substage B3 and 10 cases of substage B4. The curative effect and survival of patients were evaluated. Results: Totally 567 times of TACE treatments were performed on 133 patients. There was no statistical difference of the TACE treatment times among patients with different substages (F=1.702, P=0.170). One month after the first time TACE, partial response was achieved in 47 cases, while stable disease and progressive disease were found in 74 cases and 12 cases respectively according to modified response evaluation criteria in solid tumors criteria. No statistical difference of curative effect was detected among patients with different substages (χ2=2.121, P=0.908). The overall survival of patients with different substages HCC after TACE was statistically different (χ2=10.846, P=0.013). The survival time of patients with substage B1 was significantly longer than that of patients with substage B3 (P=0.020) and B4 (P=0.033), respectively. Conclusion: The overall survival of patients with BCLC classification stage B HCC after TACE are different. This sub-classification is beneficial for clinic to formulate specific treatment plan.
ABSTRACT
Objective: To investigate the influence of gelatin sponge microparticles-TACE (GSMs-TACE) on myeloid-derived suppressor cells (MDSCs) in peripheral blood of patients with Barcelona clinic liver cancer (BCLC) classification stage B hepatocellular carcinoma (HCC). Methods: Five patients with clinically diagnosed BCLC B-stage HCC (HCC group) underwent GSMs-TACE. Flow cytometry was used to detect the frequency of MDSCs (the proportion of MDSCs clusters to HLA-DR-cell) in the peripheral blood of patients before GSMs-TACE and 10 days as well as 30 days after operation, respectively. Seven healthy volunteers (normal control group) were enrolled. The MDSCs frequency of normal control group was detected simultaneously with HCC group before GSMs-TACE. Statistical analysis was performed to compare the differences of the frequency of MDSCs in HCC patients before and after GSMs-TACE. And the frequency of MDSCs of HCC group was compared with that of normal control group. Results: The frequency of MDSCs in peripheral blood of patients with HCC before GSMs-TACE was (30.26±12.12)%, which decreased to (10.22±3.79)% after 10 days and decreased to (7.33±3.38)% after 30 days (P<0.001). Pairwise comparison showed that the frequency of MDSCs at 30 days (P<0.001) and 10 days (P=0.011) after GSMs-TACE was lower than that before operation,respectively. The frequency of preoperative MDSCs of HCC group was statistically higher than that of normal control group ([30.26±12.12]% vs [3.41±1.89]%, t=5.876, P<0.001). Conclusion: The frequency of MDSCs in peripheral blood of patients with BCLC B-stage HCC significantly reduced after GSMs-TACE treatment. GSMs-TACE treatment has positive regulation effect on the immune function of patients.
ABSTRACT
PURPOSE: Transarterial chemoembolization (TACE) is indicated for Barcelona Clinic Liver Cancer (BCLC) B hepatocellular carcinoma (HCC). Whether TACE provides any long-term survival benefits remains unclear. We aimed to investigate micrometastases predictors with which to identify patients who would benefit from surgical resection (SR). MATERIALS AND METHODS: First, we analyzed risk factors of micrometastases, microvascular invasion, and poor histologic grade in 38 patients with newly diagnosed resectable BCLC stage B HCC limited to one or two segments with well-preserved liver function and who underwent SR between January 2006 and December 2013. Second, we validated identified risk factors in 54 newly diagnosed resectable BCLC B HCC patients with well-preserved liver function who underwent TACE during the same period to determine their influence on survival. RESULTS: Risk factors of micrometastases in SR patients were α-fetoprotein (AFP) ≥110 [hazard ratio (HR)=5.166; 95% confidence interval (CI), 1.031–25.897; p=0.046] and prothrombin induced by vitamin K absence-II (PIVKA-II) ≥800 (HR=5.166; 95% CI, 1.031–25.897; p=0.046). The cumulative probability of tumor recurrence (p=0.009) after SR differed according to levels of AFP and PIVKA-II. After validation of these risk factors in the TACE group, patients with SR and AFP <110 and PIVKA-II <800 had superior survival outcomes than other patients (HR=0.116; 95% CI, 0.027–0.497; p=0.004). CONCLUSION: AFP and PIVKA-II levels predict micrometastases and survival. Therefore, they should be considered when selecting SR for BCLC B HCC.