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      Prognostic role of ABO blood group in patients with unresectable hepatocellular carcinoma after transarterial chemoembolization

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          Abstract

          Background

          The association of ABO blood group with prognosis of several malignancies has been established. However, its role in hepatocellular carcinoma (HCC) remains unclear.

          Patients and methods

          In this study, we investigated the prognostic role of ABO blood group in unresectable HCC patients receiving transarterial chemoembolization (TACE) as an initial treatment. Medical records of 2,611 HCC patients were collected, and clinical data of 282 unresectable HCC patients receiving TACE were ultimately analyzed retrospectively. A prognostic nomogram was generated for predicting 1-, 2-, and 3-year overall survival (OS) probability. A total of 114 (40.4%), 69 (24.5%), 64 (22.7%), and 35 (12.4%) HCC patients had blood groups O, A, B, and AB, respectively.

          Results

          The median OS times for patients with blood groups O, A, B, and AB were 24, 23, 20, and 20 months, respectively. Patients with blood group AB (hazard ratio [HR]=2.050, 95% confidence interval [CI], 1.331–3.157, P=0.001) or group non-O (HR=1.479, 95% CI, 1.110–1.972, P=0.008) had a poorer OS than those with blood group O. The prognostic nomogram, with a c-index of 0.701, was modest in predicting OS of unresectable HCC patients.

          Conclusion

          Patients with non-O blood group, particularly blood group AB, had a worse OS compared with those having blood type O. ABO blood group can predict the prognosis in patients with unresectable HCC undergoing TACE as an initial therapy. Further external validation in larger cohorts is necessary to confirm their usefulness in clinical practice.

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          Most cited references 34

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          Transcatheter Arterial Chemoembolization Plus Radiotherapy Compared With Chemoembolization Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis.

           Ya Huo,  Guy D Eslick (2015)
          Hepatocellular carcinoma (HCC) has the second-highest cancer-related mortality rate in the world because most patients are diagnosed at an intermediate to advanced stage when surgery is not suitable. Transcatheter arterial chemoembolization (TACE) is currently considered a first-line therapy for unresectable HCC. However, advancements in radiotherapy (RT) have resulted in some studies identifying a significant therapeutic benefit of TACE plus RT for unresectable HCC compared with TACE alone.
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            Endothelial cell adhesion molecules and cancer progression.

            The role of cell adhesion molecules (CAMs), such as intercellular cell adhesion molecule-1 (ICAM-1), vascular endothelial cell adhesion molecule-1 (VCAM-1), E-selectin, and P-selectin, has been studied extensively in the process of inflammation. These molecules are responsible for recruiting leukocytes onto the vascular endothelium before extravasation to the injured tissues. Some circulating cancer cells have been shown to extravasate to a secondary site using a process similar to inflammatory cells. The most studied ligands for CAMs expressed on cancer cells, sialyl Lewis (a/x) antigens, are shown to be involved in adhesion to endothelial cells by binding to E-selectin. This process, shared by inflammatory cells and cancer cells, may partially explain the link between inflammation and tumorigenesis. Furthermore, this process may elucidate the therapeutic benefit of anti-inflammatory drugs in cancer treatment. The complexity of the tumor microenvironment has been revealed in the past decade. Currently, intense investigation is aimed at various aspects of the tumor microenvironment in addition to the tumor cells themselves. Here, we review the role of CAMs in extravasation of circulating cancer cells, a key step in metastasis.
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              Surgical and Locoregional Therapy of HCC: TACE

              Transcatheter arterial chemoembolization (TACE) is performed worldwide for patients with intermediate-stage hepatocellular carcinoma (HCC). TACE has produced survival advantages in two randomized controlled trials and a meta-analysis, and is currently the mainstay of treatment for this stage of HCC. However, there are currently no global guidelines regarding the dose, choice or combination of cytotoxic agents for TACE; therefore, it is difficult to compare data from different TACE studies. In Japan, most of the TACE procedures have been based on iodized oil as conventional TACE, utilizing the microembolic and drug-carrying characteristic of iodized oil. Superselective TACE with lipiodol is the primary TACE procedure that has reported satisfactory levels of local control associated with a lower risk of complications. Conversely, TACE performed using drug-eluting beads has been widely used in western countries, and this has shown similar tumor response and median survival compared to conventional TACE. Moreover, the combination of TACE and molecular targeted agents is now ongoing to evaluate the synergistic effect. In this review, the indication, technical issues, and complications of TACE are reviewed.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2018
                29 May 2018
                : 14
                : 991-998
                Affiliations
                [1 ]Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
                [2 ]Department of General Surgery, Xi’an Central Hospital, Xi’an, Shaanxi, People’s Republic of China
                [3 ]Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
                Author notes
                Correspondence: Li-Li Han, Department of Medical Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, No 157 West 5 Street, Xi’an, Shaanxi 710004, People’s Republic of China, Tel +86 153 3239 6006, Email 61439376@ 123456qq.com
                Hui Guo, Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, No 277 Yanta West Road, Xi’an, Shaanxi 710061, People’s Republic of China, Tel/fax +86 29 8532 4086, Email guohuihappy97@ 123456163.com
                [*]

                These authors contributed equally to this work

                Article
                tcrm-14-991
                10.2147/TCRM.S160089
                5985783
                © 2018 Li et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                transarterial chemoembolization, prognosis, liver cancer, overall survival, abo blood group

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