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Surgical Resection After Down-Staging of Locally Advanced Hepatocellular Carcinoma by Localized Concurrent Chemoradiotherapy

Authors
 Hyung Soon Lee  ;  Gi Hong Choi  ;  Jin Sub Choi  ;  Kyung Sik Kim  ;  Kwang-Hyub Han  ;  Jinsil Seong  ;  Sang Hoon Ahn  ;  Do Young Kim  ;  Jun Yong Park  ;  Seung Up Kim  ;  Beom Kyung Kim 
Citation
 ANNALS OF SURGICAL ONCOLOGY, Vol.21(11) : 3646-3653, 2014 
Journal Title
ANNALS OF SURGICAL ONCOLOGY
ISSN
 1068-9265 
Issue Date
2014
MeSH
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/therapy* ; Chemoradiotherapy* ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Hepatectomy* ; Humans ; Infusions, Intra-Arterial ; Liver Neoplasms/mortality ; Liver Neoplasms/pathology ; Liver Neoplasms/therapy* ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Rate
Keywords
Overall Survival ; Curative Resection ; Portal Vein Embolization ; Biliary Complication ; Portal Vein Tumor Thrombus
Abstract
BACKGROUND:
This study evaluated the down-staging efficacy and impact on resectability of concurrent chemoradiotherapy (CCRT) followed by hepatic arterial infusion chemotherapy (HAIC) in locally advanced hepatocellular carcinoma, and identified prognostic factors of disease-free survival (DFS) and overall survival (OS) after curative resection.
METHODS:
DFS and OS were investigated using clinicopathologic variables. Functional residual liver volume (FRLV) was assessed before CCRT and again before surgery in patients with major hepatectomy. Tumor marker response was defined as elevated tumor marker levels at diagnosis but levels below cutoff values before surgery (α-fetoprotein < 20 ng/mL, protein induced by vitamin K absence or antagonist-II < 40 mAU/mL).
RESULTS:
Of 243 patients who received CCRT followed by HAIC between 2005 and 2011, 41 (16.9 %) underwent curative resection. Tumor down-staging was demonstrated in 32 (78 %) of the resected patients. FRLV significantly increased from 47.5 to 69.9 % before surgery in patients who underwent major hepatectomy. In addition, the OS of the curative resection group was significantly higher than the OS of the CCRT followed by HAIC alone group (49.6 vs. 9.8 % at 5-year survival; p < 0.001). By multivariate analysis, the poor prognostic factors for DFS after curative resection were tumor marker non-response and the presence of a satellite nodule; however, tumor marker non-response was the only independent poor prognostic factor of OS.
CONCLUSIONS:
CCRT followed by HAIC increased resectability by down-staging tumors and increasing FRLV. Curative resection may provide good long-term survival in tumor marker responders who undergo CCRT followed by HAIC.
Full Text
http://link.springer.com/article/10.1245%2Fs10434-014-3652-3
DOI
10.1245/s10434-014-3652-3
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyung Sik(김경식) ORCID logo https://orcid.org/0000-0001-9498-284X
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Hyung Soon(이형순)
Choi, Gi Hong(최기홍) ORCID logo https://orcid.org/0000-0002-1593-3773
Choi, Jin Sub(최진섭)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99647
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