Abstract
BackgroundThe size and number of tumors are important prognostic indicators for hepatocellular carcinoma (HCC). However, it is difficult to assess the prognosis for patients with a variable number and size of tumors. By combining these two factors, we investigated the role and prognostic accuracy of total tumor volume (TTV) for HCC.MethodsA total of 786 patients undergoing locoregional therapy (transarterial chemoembolization, percutaneous radiofrequency ablation and acetic acid or ethanol injection) for HCC were prospectively evaluated.ResultsThe mean and median TTV was 177 cm3 (range, 0.1-3,591 cm3) and 21 cm3, respectively. Of all, 38%, 29%, 15%, 7% and 11% of patients had TTV of <10 cm3, 10-50 cm3, 50-200 cm3, 200-500 cm3 and >500 cm3, respectively. TTV was significantly larger in patients with higher serum α-fetoprotein (AFP) levels or with vascular invasion. The Child-Turcotte-Pugh score, performance status, vascular invasion, AFP level and TTV were significant independent prognostic predictors in the Cox proportional hazards model. After adjustment, patients with TTV 50-200 cm3 (relative risk [RR]: 1.74, p = 0.009), 200-500 cm3 (RR: 2.15, p = 0.006) and >500 cm3 (RR: 3.92, p < 0.001) had a significantly increased mortality risk in comparison to patients with TTV <10 cm3.ConclusionsTTV is a feasible prognostic predictor across a wide gradient and can be used to predict the mortality risk of HCC. Selecting appropriate cutoffs of TTV may help refine the design of cancer staging system and treatment planning. Future clinical trials of HCC may include this parameter for mortality risk stratification.
Highlights
The size and number of tumors are important prognostic indicators for hepatocellular carcinoma (HCC)
We have investigated the feasibility of total tumor volume (TTV), its association with other clinical parameters and its predictive accuracy in patients with HCC undergoing locoregional therapy
The underlying etiology of liver disease was attributed to hepatitis B virus (HBV) infection if patients were seropositive for hepatitis B surface antigen (HBsAg, RIA kits, Abbott Laboratories, North Chicago, IL, USA) and attributed to hepatitis C virus (HCV) infection if patients were seropositive for an antibody against HCV by a second-generation enzyme immunoassay (Abbott Laboratories, IL)
Summary
The size and number of tumors are important prognostic indicators for hepatocellular carcinoma (HCC). It is difficult to assess the prognosis for patients with a variable number and size of tumors By combining these two factors, we investigated the role and prognostic accuracy of total tumor volume (TTV) for HCC. It is difficult to assess the prognosis for patients with a variable number and size of tumor nodules, and this difficulty may make the application of the currently used prognostic models for HCC less practical and clinically feasible. By combining the factor of size and number of tumor nodule, we aimed to define the tumor burden by using TTV in assessing the long-term outcome of patients with HCC. We have investigated the feasibility of TTV, its association with other clinical parameters and its predictive accuracy in patients with HCC undergoing locoregional therapy
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