Transarterial chemoembolization versus resection for intermediate-stage (BCLC B) hepatocellular carcinoma

BACKGROUND/AIMS: Several studies have suggested that surgical resection (SR) can provide a survival benefit over transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) at the intermediate stage according to the Barcelona Clinic Liver Cancer (BCLC) staging system. However, the criteria for SR remain to be determined. This study compared the long-term outcome of intermediate-stage HCC patients treated by either TACE or SR as a primary treatment modality, with the aim of identifying the patient subgroup that gained a survival benefit by either modality. METHODS: In total, 277 BCLC intermediate-stage HCC patients treated by either TACE (N=225) or SR (N=52) were analyzed. RESULTS: The overall median survival time was significantly better for SR than TACE (61 vs. 30 months, P=0.002). Decision-tree analysis divided patients into seven nodes based on tumor size and number, serum alpha-fetoprotein (AFP) level, and Child-Pugh score, and these were then simplified into four subgroups (B1-B4) based on similarities in the overall hazard rate. SR provided a significant survival benefit in subgroup B2, characterized by ‘oligo' (2-4) nodules of intermediate size (5-10 cm) when the AFP levels was <400 ng/ml, or ‘oligo' (2-4) nodules of small to intermediate size (<10 cm) plus a Child-Pugh score of 5 when the AFP level was ≥400 ng/mL (median survival 73 vs. 28 months for SR vs. TACE respectively; P=0.014). The survival rate did not differ significantly between SR and TACE in the other subgroups (B1 and B3). CONCLUSIONS: SR provided a survival benefit over TACE in intermediate-stage HCC, especially for patients meeting certain criteria. Re-establishing the criteria for optimal treatment modalities in this stage of HCC is needed to improve survival rates.

Current treatment for intermediate-stage hepatocellular carcinoma / 中华消化外科杂志

Staging of hepatocellular carcinoma (HCC) need to consider tumor factors and functional status of liver,which is different from other solid tumors.Now there are many clinical staging and prognosis systems of HCC.Intermediate stage HCC is commonly occurred at disease diagnosis,with varied clinicopathological charactertics,therapeutic options and survival outcomes of patients.In this review,the definition,current therapeutic strategies,substaging model of intermediatestage HCC and the efficacy of liver resection for patients of intermediate-stage HCC are discussed for further improving feasibility of individualized surgical therapy.

Intermediate Stage Report about Change of Deep Venous Valve Function after Superficial Vein Surgery of Lower Extremity / 中国普外基础与临床杂志

Objective To evaluate improved effect for deep venous valve function after superficial vein surgery of lower extremity in the intermediate stage.Methods Totally 43 patients (55 limbs) with varicose veins of lower extremity were enrolled to accept surgical management of vein systems in our department from March 2006 to October 2006.All patients were respectively followed up after 6 months and 4 years about the changes of deep venous valve function with color Doppler ultrasonography.Results Thirty-nine patients’ deep venous valve function kept well up to now,and there was no significant difference between the two results.Four patients without proximal saphenous vein ligation recurred,and there was reflux in deep venous.Conclusion Endovenous laser treatment and ablation of varicose veins of lower extremity with deep venous insufficiency could improve deep venous valve function effectively.Proximal great saphenous vein ligation is important for successful operation.