Page 7 - Read Online

Page 2 of 13 Tong et al. Hepatoma Res 2019;5:36 I http://dx.doi.org/10.20517/2394-5079.2019.005

TGR was significant for prolonged survival (P = 0.029). The poorest survival rates were observed in patients with fast
TGRs treated by transarterial chemoembolization.

Conclusion: The TGR correlated with AFP, platelet count, and albumin level. Patients with fast TGRs had shorter
recurrence-free survival after HCC treatments. TGR is a potential imaging biomarker to predict clinical outcomes in HCC.

Keywords: Liver cancer, growth rates, hepatitis B, hepatitis C, hepatocellular carcinoma treatments

INTRODUCTION
Worldwide, hepatocellular carcinoma (HCC) is the fifth most frequently encountered malignancy and is the
[1]
third leading cause of cancer-related deaths . In the United States, the incidence of HCC has significantly
[2]
increased and is projected to be among the top three causes of cancer-related deaths by 2030 . In addition,
[3]
the financial burden of HCC in the United States has continued to increase over the last decade . Numerous
studies showed that the most common etiologies are chronic infection with hepatitis B virus (HBV) and
hepatitis C virus (HCV), with HBV accounting for at least 42% and HCV accounting for at least 27% of
HCC cases globally . The remaining cases are associated with excessive alcohol intake and non-alcoholic
[4]
steatohepatitis.

Over the last two decades, improvements in HCC survival have been made by advances in HCC treatments
in surgery and interventional radiology. Furthermore, the implementation of surveillance protocols in high-
[5]
risk populations has resulted in early HCC detection and improved post-treatment survival . Additional
factors that predict HCC survival include the degree of liver dysfunction as well as the initial tumor size and
number of tumors.

Another potential factor is the tumor volume doubling time (TVDT) which is assessed by two serial
radiologic imaging studies prior to HCC treatments. Initially, TVDT was used to determine suitable
screening intervals for early HCC detection. Previous imaging studies reported TVDTs ranging from a
median of 117 days to a mean of 127 days, and suggested intervals of 4 to 5 months for HCC screening .
[6,7]
Other reports showed that shorter TVDTs were correlated with earlier deaths after hepatectomies as well as
higher recurrence rates after surgical resection and radiofrequency ablation [8-10] .

These papers on TVDT highlight its potential value as a prognostic tool for predicting HCC survival rates.
Nevertheless, some of these studies were limited by early imaging technology, variations in screening
intervals, and small sample sizes. Further, a recent report indicated that the TVDT is a less suitable variable
for tumor growth rate because (1) mean TVDT estimates are not accurate if the time interval measurements
are short; (2) the TVDT is not defined if the consecutively estimated volumes are similar; and (3) the
[11]
asymmetrical frequency distribution of the TVDT makes it less suitable for statistical analysis . In contrast,
the mean tumor growth rate (TGR) gives a more correct value for average growth rate and has a symmetrical
frequency distribution. Thus, an improved understanding of tumor growth, as measured by TGR, may help
in guiding prognostic evaluations and aid in determining treatment options for patients with HCC. In the
report herein, we assessed factors associated with TGR in 164 patients with chronic viral hepatitis and HCC.
In addition, we evaluated the potential value of TGR as a factor in predicting recurrence-free survival after
HCC treatment in these patients.

METHODS
Patient population
Between 1984 and 2014, 357 patients with HCC were evaluated at the Liver Center in Pasadena, California.
A database was created to collate and anonymize patient records, including laboratory tests, tumor size,