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This article aims to evaluate the prognostic significance of pretreatment serum ɣ-glutamyl transpeptidase (GGT) levels in patients with intermediate (BCLC B) and advanced stage (BCLC C) hepatocellular carcinoma receiving transarterial chemoembolization (TACE) as first-line treatment. In this single-center retrospective study, a total of 608 patients with BCLC B and BCLC C class were included who received TACE as first-line treatment modality. Patients were divided into low and high GGT groups based on a cutoff value of pretreatment serum GGT levels calculated by receiver operating curve. Overall survival was evaluated with Kaplan–Meier method, and intergroup significance was calculated by log-rank test for overall patients, each BCLC B and BCLC C group. Univariate and multivariate analysis were used for significance for prognostic factors. Median follow-up time was 20, 22, and 9 months for overall patients, BCLC B, and BCLC C group, respectively. Optimal cut value for GGT was calculated at 90.5 U/L. One-year and 3-year survival rates were 84.2% and 27.9% in low GGT, 49.4% and 8.6% in high-GGT group for overall patients. Multivariate analysis in overall patients showed Child–Pugh B (HR,1.801; 95%CI, 1.373–2.362, P <.001), ascites (1.393, 1.070–1.812; P =.014), multiple tumors (1.397, 1.137–1.716; P =.001), AST >40 (1.407, 1.095–1.808; P =.008), albumin <3.2 (.735,.612–.884; P =.001), AFP > 400 (1.648, 1.351–2.011; P <.001), high GGT (2.009, 1.631–2.475; P <.001), or receipt of chemo/ablation (.463,.377–.569; P <.001) as independent risk factors for overall survival. Serum GGT levels and AFP showed significant correlation in between with significance coefficient of.155 (P <.001). Elevated pretreatment serum GGT level was feasible and promising independent prognostic marker for overall survival in intermediate and advanced stage hepatocellular carcinoma patients treated with TACE. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to compare SURG vs SOR regarding the OS and progression-free survival (PFS) in a real-world clinical scenario. Background data: The treatment for advanced nonmetastatic HCC belonging to the Barcelona Clinic Liver Cancer stage C (BCLC C) is still controversial. Methods: BCLC C patients without extrahepatic spread and tumoral invasion of the main portal trunk were considered. Surgical patients were obtained from the HE.RC.O.LE.S. Register, whereas sorafenib patients were obtained from the ITA.LI.CA register The inverse probability weighting (IPW) method was adopted to balance the confounders between the 2 groups. Results: Between 2008 and 2019, 478 patients were enrolled: 303 in SURG and 175 in SOR group. Eastern Cooperative Oncological Group Performance Status (ECOG-PS), presence of cirrhosis, steatosis, Child-Pugh grade, hepatitis B virus and hepatitis C virus, alcohol intake, collateral veins, bilobar disease, localization of the tumor thrombus, number of nodules, alpha-fetoprotein, age, and Charlson Comorbidity index were weighted by IPW to create two balanced pseudo-populations: SURG = 374 and SOR = 263. After IPW, 1-3-5 years OS was 83.6%, 68.1%, 55.9% for SURG, and 42.3%, 17.8%, 12.8% for SOR (P < 0.001). Similar trends were observed after subgrouping patients by ECOG-PS = 0 and ECOG-PS >0, and by the intrahepatic location of portal vein invasion. At Cox regression, sorafenib treatment (hazard ratio 4.436; 95% confidence interval 3.19-6.15; P < 0.001) and Charlson Index (hazard ratio 1.162; 95% confidence interval 1.06-1.27; P = 0.010) were the only independent predictors of mortality. PFS at 1-3-5 years were 65.9%, 40.3%, 24.3% for SURG and 21.6%, 3.5%, 2.9% for SOR (P = 0.007). Conclusions: In BCLC C patients without extrahepatic spread but with intrahepatic portal invasion, liver resection, if feasible, was followed by better OS and PFS compared with sorafenib. [ABSTRACT FROM AUTHOR]

Jeongshim Lee,1,2 Won Sup Yoon,3 Woong Sub Koom,1 Chai Hong Rim3 1Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea; 2Department of Radiation Oncology, Inha University Hospital, Incheon, Republic of Korea; 3Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Republic of Korea On behalf of the Korean Liver Cancer Study Group Purpose: Sorafenib is recommended as the standard treatment for hepatocellular carcinoma (HCC) of Barcelona Clinic of Liver Cancer stage C (BCLC C). However, local treatment including radiation therapy (LRT) is also widely administered in practice. The aim of our study was to define the role of LRT among BCLC C patients. Patients and methods: Of the patients with HCC enrolled the Korean Central Cancer Registry from 2008 to 2014, the Korean Liver Cancer Study Group randomly extracted 10,580 patient data from ~50 hospitals nationwide. Among them, 3,401 patients were categorized to have BCLC C HCC. Among them, patients with information on initial treatments, defined as the first and secondary treatment within 60 days after the first treatment, were selected and classified into three initial treatment groups: LRT, sorafenib, and no treatment. Results: Among 3,401 BCLC C HCC patients, 1,486 were included in the study and the remaining patients were excluded as they did not meet the criteria (eg, underwent local treatments without radiotherapy [RT] or received chemotherapy other than sorafenib). Of these, 266 were assigned to LRT (17.9%), 316 to sorafenib (21.3%), and 904 to no treatment group (60.8%). Median survival time of the sorafenib group was shorter than that of the LRT group (3.8 vs 7.6 months, P

We aimed to identify the oncologic benefits of local treatment including radiotherapy (LRT) in hepatocellular carcinoma (HCC) invading the portal vein. We used clinical data of patients with HCC invading the portal vein from 2008 to 2014 provided by 50 hospitals nationwide. A total of 1163 patients were included in the analysis. The LRT group was younger than the best supportive care (BSC) group (p < 0.001). The mean Child-Pugh score of the LRT group (6.1) was significantly lower than that of the BSC group (7.7) (p < 0.001). Propensity score-matched analysis generated 222 pairs. The median survival of all patients, LRT, and BSC groups were 5.0, 8.0, and 2.0 months, respectively. The overall survival (OS) rates in the LRT and BSC groups were 34.2% and 16.2% at one year, and 12.6% and 6.8% at two years, respectively (p < 0.001). Multivariate analysis showed that LRT (HR 0.41, 95% CI 0.32–0.52), age >60 years, extrahepatic metastases, tumor size ≥10 cm, and Child-Pugh class (CPC) B or C were independent predictors of higher mortality (all p < 0.05). Statistical differences in survival were maintained in all CPC-albumin-bilirubin classes (all p < 0.05). LRT was significant in patients with HCC with portal invasion, valid for patients with CPC A and B.

Simple Summary: The benefit of local treatment for hepatocellular carcinoma (HCC) with portal invasion is unclear. Radiotherapy can technically palliate vessel-invasive HCC; however, the survival benefit has not been confirmed. Local treatment including radiotherapy showed a survival benefit in large propensity score-matched cohorts (median survival: 8 vs. 2 months, p < 0.001). The benefit persisted among patients with Child-Pugh class A and B liver function. Our results represent community-level data from all Korean administrative districts. We aimed to identify the oncologic benefits of local treatment including radiotherapy (LRT) in hepatocellular carcinoma (HCC) invading the portal vein. We used clinical data of patients with HCC invading the portal vein from 2008 to 2014 provided by 50 hospitals nationwide. A total of 1163 patients were included in the analysis. The LRT group was younger than the best supportive care (BSC) group (p < 0.001). The mean Child-Pugh score of the LRT group (6.1) was significantly lower than that of the BSC group (7.7) (p < 0.001). Propensity score-matched analysis generated 222 pairs. The median survival of all patients, LRT, and BSC groups were 5.0, 8.0, and 2.0 months, respectively. The overall survival (OS) rates in the LRT and BSC groups were 34.2% and 16.2% at one year, and 12.6% and 6.8% at two years, respectively (p < 0.001). Multivariate analysis showed that LRT (HR 0.41, 95% CI 0.32–0.52), age >60 years, extrahepatic metastases, tumor size ≥10 cm, and Child-Pugh class (CPC) B or C were independent predictors of higher mortality (all p < 0.05). Statistical differences in survival were maintained in all CPC-albumin-bilirubin classes (all p < 0.05). LRT was significant in patients with HCC with portal invasion, valid for patients with CPC A and B. [ABSTRACT FROM AUTHOR]