Background & Aims Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) and it is the most commonly used treatment for HCC worldwide. ...However, no prognostic indices, designed to select appropriate candidates for repeat conventional TACE, have been incorporated in the guidelines. Methods From January 2007 to April 2012, 139 consecutive HCC patients, mainly with an alcohol- or viral-induced disease, were treated with TACE. Using a regression model on the prognostic variables of our population, we determined a score designed to help for repeat TACE and we validated it in two cohorts. We also compared it to the ART score. Results In the multivariate analysis, four prognostic factors were associated with overall survival: BCLC and AFP (>200 ng/ml) at baseline, increase in Child-Pugh score by ⩾2 from baseline, and absence of radiological response. These factors were included in a score (ABCR, ranging from −3 to +6), which correlates with survival and identifies three groups. The ABCR score was validated in two different cohorts of 178 patients and proofed to perform better than the ART score in distinguishing between patients’ prognosis. Conclusions The ABCR score is a simple and clinically relevant index, summing four prognostic variables endorsed in HCC. An ABCR score ⩾4 prior to the second TACE identifies patients with dismal prognosis who may not benefit from further TACE sessions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The Entry, Descent and Landing Demonstrator Module (EDM) named Schiaparelli, was the ESA-led Mars lander element of the ESA-Roscosmos ExoMars 2016 mission. Following launch on 14 March 2016 with the ...ExoMars Trace Gas Orbiter (TGO) and cruise to Mars, Schiaparelli separated for encounter with Mars to demonstrate entry, descent and landing technologies. Although on 19 October 2016 the final touchdown and surface operation were not achieved, other aspects were demonstrated and reported via real-time telemetry transmitted at 8 kbps in UHF during entry and descent.
This paper presents a technical description of the elements of the Schiaparelli EDM system and its operation, plus reference to published post-flight analyses of the data obtained.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The ExoMars programme is pursued as part of a broad cooperation between ESA and Roscosmos with significant contribution from NASA. Two missions compose the ExoMars programme with launches in 2016 and ...2020. The ExoMars 2016 mission, led by ESA, has been launched by the Russian Proton on March 14th, 2016. The mission includes the Trace Gas Orbiter (TGO) and the Entry, Descent, and Landing Demonstrator Module (EDM, named Schiaparelli), both supplied by ESA. Thales Alenia Space Italia (TASI) acted as prime contractor for the ExoMars2016 Mission, leading the Spacecraft Composite development and verification, including system design and verification of the EDM and key GNC/EDL technologies. DEIMOS Space has been involved in Exomars since 2004 providing more than 12 years of technical activities in Mission Engineering (from launch to landing) and GNC.
Schiaparelli separated from TGO on October 16th, 2016, and reached Mars 3 days later: it successfully entered with a pre-defined FPA and performed a nominal hypersonic entry, decreasing its velocity until reaching subsonic regime under the parachute. During the descent phase an anomaly occurred, and the EDM separated from the backshell earlier than expected, compromising the landing phase. During the EDL, Schiaparelli was able to communicate with the TGO and with the Mars Reconnaissance Orbiter, transmitting its real time on-board telemetry. Data collected is extremely valuable in preparation to the 2020 mission.
This paper focuses on the level 0/1 post-flight analyses of the Schiaparelli mission, presenting the activities performed by DEIMOS Space in strict collaboration with TASI and ESA, aimed to assess the main flight performance from the mission analysis perspective, and determine and compare the actual flight with the predicted one. The analyses covered: trajectory reconstruction, entry aerodynamic and flying qualities analyses, EDL performance reconstruction and assessment, descent data analysis and trajectory reconstruction.
Post-flight results contributed to validate key technologies and design tools, including the DEIMOS Space Planetary Entry Toolbox (PETBox) for Mission Engineering and the related design methodology for Atmospheric Flight, now Flight Qualified for both missions on Earth and Mars.
•Schiaparelli end to end trajectory reconstructed from separation to touchdown.•Very accurate targeting of Mars arrival, steep entry due to MSA over-performance.•Capsule dynamics during parachute inflation and descent reconstructed.•Large deviations in chute riser angle identified as likely cause of IMU saturation.•Actual flight performance demonstrated the validity of mission analysis predictions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
BACKGROUNDDirect-acting antivirals (DAAs) therapy against hepatitis C viral (HCV) infection has markedly improved the sustained viral response. However, recent studies have suggested an unsuspected ...high rate of hepatocellular carcinoma (HCC) recurrence.
PATIENTS AND METHODSA retrospective case–control study was carried out to investigate the impact of DAAs on tumor recurrence in patients with complete response to HCC treatment within our HCV-related cirrhosis cohort. Patients who received group 1 (G1), n=22 or not group 2 (G2), n=49 a DAAs therapy were matched 1 : 2 for age, sex, liver function, HCC stage, and treatment.
RESULTSInitial HCC were mostly Barcelona Clinic Liver Cancer stage A (95% G1, 94% G2). Sustained viral response with DAAs was achieved in 86% of patients. After a similar median overall follow-up time with similar radiologic surveillance after HCC treatment, 41% of patients developed radiologic tumor recurrence in G1 versus 35% of patients in G2 (P=0.7904). There was no significant difference in time to progression between the two groups 12 (9–16) months G1 vs. 14 (8–21) months G2, P=0.7688, or Barcelona Clinic Liver Cancer stage at recurrence. However, the interval between HCC treatment and antiviral therapy was significantly different among DAAs patients with recurrence and those without recurrence 7.0 (2.5–9.0) months vs. 36.0 (9.0–58.0) months, P=0.0235, respectively.
CONCLUSIONIn our case–control study, HCV therapy with DAAs does not accelerate or prevent early HCC recurrence compared with untreated patients. The rate of recurrence, time to progression, and HCC pattern are similar. Early DAAs treatment (<12 months) after HCC cure should be discouraged considering the HCC recurrence rate during this period.
BACKGROUNDAdvanced hepatocellular carcinoma (HCC) includes a wide spectrum of tumors and patients’ prognosis after treatment is highly variable. Moreover, therapeutic options based on the Barcelona ...Clinic Liver Cancer (BCLC) staging system algorithm are restricted to one systemic therapy.
AIM OF THE STUDYTo refine the stratification among BCLC C HCC patients by establishing a new simple prognostic score.
PATIENTS AND METHODSA regression model based on a BCLC stage C population and validated with an external cohort of BCLC C HCC patients defined the score. It was therefore validated among three external cohorts of BCLC C HCC patients treated with sorafenib.
RESULTSFive variables had independent prognostic valuesthe number of nodules, the infiltrating nature of the HCC, α-fetoprotein serum level, Child–Pugh score, and Eastern Cooperative Oncology Group Performance Status grade. They were integrated into a new score named NIACE ranging from 0 to 7, well correlated with survival. With the use of one threshold value, this score enables defining of two populations with different survivals among BCLC C patients and specifically among those treated with sorafenib.
CONCLUSIONThe NIACE score defines different prognostic subgroups after palliative treatment of HCC. It could be an additional tool for BCLC C HCC before inclusion in clinical trials or for the management of patients. These results must be validated in a prospective study.
To compare the performances of the Barcelona clinic liver cancer (BCLC) nomogram and others systems (BCLC, HKLC, CLIP, NIACE) for survival prediction in a large hepatocellular carcinoma (HCC) French ...cohort.
Data were collected retrospectively from 01/2007 to 12/2013 in five French centers. Newly diagnosed HCC patients were analyzed. The discriminatory ability, homogeneity ability, prognostic stratification ability Akaike information criterion (AIC) and C-index were compared among scoring systems.
The cohort included 1102 patients, mostly men, median age 68 60-74 years with cirrhosis (81%), child-Pugh A (73%), alcohol-related (41%), HCV-related (27%). HCC were multinodular (59%) and vascular invasion was present in 41% of cases. At time of HCC diagnosis BCLC stages were A (17%), B (16%), C (60%) and D (7%). First line HCC treatment was curative in 23.5%, palliative in 59.5%, BSC in 17% of our population. Median OS was 10.8 mo 4.9-28.0. Each system distinguished different survival prognosis groups (
< 0.0001). The nomogram had the highest discriminatory ability, the highest C-index value. NIACE score had the lowest AIC value. The nomogram distinguished sixteen different prognosis groups. By classifying unifocal large HCC into tumor burden 1, the nomogram was less powerful.
In this French cohort, the BCLC nomogram and the NIACE score provided the best prognostic information, but the NIACE could even help treatment strategies.
BACKGROUNDConventional transarterial chemoembolization (cTACE) with lipiodol is widely performed in patients with hepatocellular carcinoma (HCC) unsuitable for curative treatment. Additional tumor ...parameters such as HCC macroscopic appearance based on imaging might be helpful for transarterial chemoembolization prognostication and management.
PATIENTS AND METHODSA total of 405 patients with HCC who underwent cTACE between 2008 and 2016 from a real-life multicenter French cohort were retrospectively reviewed. Tumors were classified into two macroscopic types according to HCC gross appearance on imagingnodular versus non-nodular. The study population was stratified into two groupsderivation and validation cohorts. Independent prognostic factors of survival based on multivariate cox regression models were determined and then assessed in the validation set. Thereafter, time to progression (TTP) and radiological response rate were investigated for each prognostic factors of survival.
RESULTSMedian overall survival (OS) was 35 months for Barcelona Clinic Liver Cancer (BCLC) stage A, 22 months for BCLC stage B and 12 months for BCLC stage C patients (P < 0.0001). The corresponding TTP for these patients was 12 (7–17) months, 5 (3–6) months and 1.2 (1.2–3) months (P < 0.0001). Multivariate analysis revealed that tumors size and number, non-nodular type, alpha-fetoprotein, aspartate aminotransferase serum levels and impairment of performance status-1 were independent predictors of survival among the study groups. Non-nodular type was the most powerful factor that influences OS, TTP and radiological response rate for the recommended transarterial chemoembolization candidates. TTP was consistent with OS within each stage.
CONCLUSIONHCC macroscopic appearance on imaging is a determinant predictor of outcome after cTACE in a real-life multicenter cohort.
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