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

  • Hepatobiliary Tumors
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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.

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Acknowledgment

The authors are grateful to Dong-Su Jang (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, South Korea) for his help with the figures.

Conflict of interest

All authors have no conflict of interest, financial or otherwise.

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Authors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hyung Soon Lee MD, Gi Hong Choi MD, Jin Sub Choi MD & Kyung Sik Kim MD

  2. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Kwang-Hyub Han MD, Sang Hoon Ahn MD, Do Young Kim MD, Jun Yong Park MD, Seung Up Kim MD & Beom Kyung Kim MD

  3. Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jinsil Seong MD

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  1. Hyung Soon Lee MD
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Correspondence to Jin Sub Choi MD.

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Lee, H.S., Choi, G.H., Choi, J.S. et al. Surgical Resection After Down-Staging of Locally Advanced Hepatocellular Carcinoma by Localized Concurrent Chemoradiotherapy. Ann Surg Oncol 21, 3646–3653 (2014). https://doi.org/10.1245/s10434-014-3652-3

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