Effect of repeated transcatheter arterial embolization on the survival time in patients with hepatocellular carcinoma: an analysis by the Cox proportional hazard model

Article Abstract:

Hepatocellular carcinoma is a form of liver cancer; it is more common in Asian nations than it is in the United States, and is often associated with liver cirrhosis. When the cancer exists as only one cluster of cancerous cells, surgery may be a practical treatment. However, in many cases, there are already many clusters of cancer cells sprinkled throughout the liver by the time that the disease is first discovered. In more than 80 percent of all cases, surgery is thus impractical. An alternative form of treatment may be transcatheter arterial embolization. In this technique, tiny gelatin sponge particles are injected into an artery of the liver; these particles then clog smaller arteries, temporarily occluding the flow of blood. In some cases, significant cell death in the starved tumor masses is the result. Often, however, a single such treatment fails to produce the desired effect. Some specialists have suggested that the procedure may be repeated. A study was conducted in which the transcatheter arterial embolization was repeated again and again if an acceptable response was not obtained. This study, conducted on 142 patients with hepatocellular carcinoma, found that many patients who did not achieve complete necrosis (death of cells) within their tumor on the first treatment did so on subsequent treatments. Only 12 percent of patients achieved complete necrosis on first treatment, but 27.5 percent achieved complete necrosis with repeated treatment. Some patients received as many as 15 treatments. The survival rates for the patients in this study were 76.5, 54.5, and 41.1 percent at the end of one, two, and three years, respectively. Statistical analysis revealed that successful complete necrosis was an important determinant of survival. Analysis also revealed, however, that patients with larger cancers, patients with cirrhosis, and patients whose cancer had invaded the portal vein had worse survival rates. It should be mentioned, however, that while transcatheter arterial embolization may result in increased survival, the technique should be considered as a palliative, and that the treatment cannot be expected to result in long-term survival or cure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment

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Flow cytometric DNA analysis of hepatocellular carcinoma

Article Abstract:

In recent years, considerable interest on the part of researchers has been directed towards using modern techniques to identify new prognostic indicators for cancer, to be used in addition to traditional prognostic factors such as cancer stage and histological (pertaining to cells) grade. One method that is becoming popular is the use of flow cytometry (cell counting and analysis) to measure the DNA content of cancer cells. In many cases, but not all, abnormal DNA content, which is indicative of aneuploidy (an abnormal chromosome complement), is associated with a worse outcome than is a DNA content that is indicative of the normal diploid chromosome complement. The method of flow cytometry has now been applied to hepatocellular carcinoma. Hepatocellular carcinoma, a form of liver cancer, is especially common in Asia and Africa, and is the third most common cause of cancer deaths among Japanese men. The analysis of cell ploidy was performed on 203 patients using flow cytometry; 46 specimens could not be completely processed due to technical difficulties. Half the remaining patients had DNA measurements indicating aneuploidy. These patients has a significantly worse outcome than did the patients with diploid tumors; the aneuploid and diploid patients had five-year survival rates of 12 and 54 percent, respectively. Furthermore, it was observed that among patients with aneuploid cancer, those with a DNA index of less than 1.5 survived for a shorter period than those who had a greater DNA index. The DNA index is simply the ratio of quantity of DNA to that of a normal diploid cell. (The DNA index for a diploid cell is therefore 1.0). For some cancers, aneuploidy might correlate with traditional variables such as histologic grade, and therefore not add anything new to the prognosis. However, a multivariate analysis of the data for hepatocellular carcinoma revealed that DNA content, vascular invasion, and metastatic spread within the liver served as both useful and mutually independent predictors of outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Development and progression, DNA, Flow cytometry, Composition, Cancer cells

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