Prognostic Factors for Patients With a Large Number of Hepatocellular Carcinoma Nodules

Yutaro Abe, Kazuyoshi Ohkawa, Mitsuru Sakakibara, Takatoshi Nawa, Nobuyasu Fukutake, Kenji Ikezawa, Ryoji Takada, Akira Kusakabe, Toshihiro Imai, Katsuyuki Nakanishi, Takahiro Tabuchi, Hayato Hikita, Ryotaro Sakamori, Tomohide Tatsumi, Tetsuo Takehara, Kazuhiro Katayama


Background: The prognostic factors and treatment strategies for hepatocellular carcinoma (HCC) patients with a large number of tumor nodules have not been fully elucidated. Clinical factors influencing prognosis were investigated in HCC patients with 30 or more tumor nodules.

Methods: Forty-six HCC patients with 30 or more tumor nodules participated in this study. None of them had vascular invasion and extrahepatic metastasis. Kaplan-Meier curve and Cox proportional hazard model were used for analysis.

Results: The median survival time of our patients was no more than 15 months, suggesting that patients with 30 or more tumor nodules may be regarded as a progressive subgroup showing poorer prognosis. In multivariate analysis, presence of between 30 and 59 tumor nodules (P = 0.002), male gender (P = 0.002), lower total bilirubin (total bilirubin < 1.0 mg/dL) (P = 0.011), transarterial chemoembolization (TACE) as an initial therapy (P = 0.027) and higher prothrombin time (P = 0.049) were significant independent factors for better overall survival. Among 39 patients who underwent TACE as an initial therapy, patients who received sorafenib therapy during follow-up showed better overall survival than those who did not (P = 0.026). Efficacy of sorafenib appeared to be more evident in patients who needed repeated transarterial treatment.

Conclusions: In HCC patients with 30 or more tumor nodules, TACE as an initial therapy may be correlated with better prognosis. Sorafenib administration after the prior transarterial treatment may improve antitumor efficacy.

J Clin Med Res. 2020;12(1):26-35


A large number of hepatocellular carcinoma nodules; Overall survival; Transarterial chemoembolization; Sorafenib

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