Evidence map›Paper›PMID 28944072›Full record

ArticleBMJ open gastroenterology2017

Close observation versus upfront treatment in hepatocellular carcinoma: are the exception points worth the risk?

Danielle M Tholey, Ben Hornung, Charles K Enestvedt, Yiyi Chen, Willscott S Naugler, Khashayar Farsad, Nima Nabavizadeh, Barry Schlansky, Joseph Ahn, Janice H Jou

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open gastroenterology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.1field-weighted citation impact, top 48% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 2 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 1 institution in 1 country.

Danielle M TholeyDepartment of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA.
Ben HornungDepartment of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Charles K EnestvedtDepartment of Abdominal Transplantation Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Yiyi ChenDivision of Biostatistics, Oregon Health and Science University, Portland, Oregon, USA.
Willscott S NauglerDepartment of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA.
Khashayar FarsadDepartment of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA.
Nima NabavizadehDepartment of Radiation Oncology, Oregon Health and Science University, Portland, Oregon, USA.
Barry SchlanskyDepartment of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA.
Joseph AhnDepartment of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA.
Janice H JouDepartment of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA.
Oregon Health & Science University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionTo assess the outcomes of immediate LDT versus observation strategies for T1 hepatocellular carcinoma (HCC) with respect to progression beyond Milan and survival.

methodT1 HCCs were retrospectively reviewed from a multidisciplinary tumour board database between September 2007 and May 2015. In the observation group, T1 lesions were observed until the tumour grew to meet T2 criteria (=2 cm). The treatment group consisted of T1 lesions treated at diagnosis with liver directed therapy (LDT). Kaplan-Meier plots were constructed for tumour progression beyond Milan and overall survival.

results87 patients (observation n=56; LDT n=31) were included in the study. A total of 22% (n=19) of patients progressed beyond Milan with no difference in progression between treatment and observation groups (19% vs 23%, p=0.49). Median time to progression beyond Milan was 16 months. Overall transplantation rate was 22% (observation group n=16; treatment group n=3, p=0.04). Median survival was 55 months with LDT versus 36 months in the observation group (p=0.22). In patients who progressed to T2 (n=60), longer time to T2 progression was a predictor of improved survival (HR=0.94, 95% CI 0.88 to 0.99, p=0.03).

conclusionsImmediate LDT of T1 lesions was not associated with increased risk of progression beyond Milan criteria when compared with an observation approach. Longer time to T2 progression was associated with increased survival and may be a surrogate for favourable tumour biology.

Indexed as

hepatocellular carcinomahepatomaliver cirrhosisliver transplantationorthotopic liver transplantation

Identifiers

PMID28944072
PMCPMC5596865
OpenAlexW2754427625

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.