Achieving Complete Remission of Hepatocellular Carcinoma: A Significant Predictor for Recurrence-Free Survival after Liver Transplantation

Bürger, Christin; Maschmeier, Miriam; Hüsing‐Kabar, Anna; Wilms, Christian; Köhler, Michael; Schmidt, Martina; Schmidt, Hartmut; Kabar, Iyad

doi:10.1155/2019/5796074

Cited by 4 publications

(4 citation statements)

References 47 publications

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“…Of note, young-onset HCC resulted in similar postoperative recurrence rate but presented a robust reduction in time to recurrence. The median time to recurrence ranges from 12.5 to 23 months based on previous reports (11,30). In the present study, 72.4% of HCC patients experienced recurrence, with a median recurrence−free survival of only 5.9 months (178 days).…”

Section: Discussionsupporting

confidence: 59%

A Clinicopathological Study of Young-onset Hepatocellular Carcinoma

Chan

2021

Anticancer Res

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Background/Aim: The aim of this study was to describe the clinicopathological features of hepatocellular carcinoma (HCC) diagnosed at 40 years of age or below. Materials and Methods: Expression of CK19, Glypican-3 and β-catenin was assessed in clinical samples by immunohistochemistry (IHC). IHC expression was correlated with clinicopathological parameters. Hotspot mutations in TP53 gene were analyzed by sequencing. Results: Thirty-six cases were included with a male to female ratio of 3:1. Eighty percent of cases were associated with chronic hepatitis B infection. CK19 and GPC3 were expressed in 61% and 56% of cases, respectively. Only one case demonstrated β-catenin over-expression. TP53 hotspot mutation was identified in 4 cases. Number of tumor nodules, vascular invasion, and preoperative serum AFP level were associated with prognosis. Conclusion: A higher CK19 expression rate was observed in our young-onset HCC cohort, whereas β-catenin pathway activation and TP53 gene mutation events were less frequent. Conventional clinicopathological parameters remain predictors of survival.Hepatocellular carcinoma (HCC) is a major cancer worldwide, showing a male predominance. Local data revealed a mean age of diagnosis at 65 years for men and 73 years for women (Hong Kong Cancer Registry, Hospital Authority, 2015). Occurrence of HCC in the younger age group is relatively rare. Pediatric and adolescent HCC (below 20 years of age) has been reported to constitute less than 1% of HCC (1). For chronic hepatitis B patients, youngonset HCC was defined as a diagnosis under 40 years of age for men and 50 years of age for women according to the American Association for the Study of Liver Diseases (AASLD) guidelines. In particular, clinicopathological features of HCC in the younger age group exhibit some differences compared to the older age group. Early-onset HCC (under 40 years of age) is largely related to ethnic factors (2) and encompasses a broader spectrum of etiological factors such as hepatitis B virus (HBV), hepatitis C virus, tyrosinemia, biliary atresia, Alagille syndrome, glycogen storage disease, etc. (3, 4). On histological examination, the fibrolamellar HCC subtype comprised 15-41% cases in a meta-analysis (4). In terms of prognosis, compared to adult HCC patients, pediatric patients present with longer overall survival (7.98 vs. 2.78 years) (5). While genomic changes in HCC including TERT, TP53, CTNNB1, TSC, ARID1A mutations have been reported in many studies (6), little is known about the subset of young-onset HCC. A recent study has reported on the genetic alterations in a cohort of 15 pediatric HCC patients, among which 6 were associated with nonhepatotropic virus diseases, while the remaining 9 had no underlying liver disease (7). Among these 15 patients, 4 were found to have CTNNB1 deletion. A TP53, TERT and APC mutation was identified in 1, 2, and 2 patients, respectively (7). This prompted us to examine the clinicopathological characteristics of our local young-onset HCC. Specifically, we focused on the expre...

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Section: Discussionsupporting

confidence: 59%

A Clinicopathological Study of Young-onset Hepatocellular Carcinoma

Chan

2021

Anticancer Res

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“…26 Surveillance for HCC is particularly germane as the incidence of recurrence can be high as 20%-40% in the first year following treatment. 27,28 The NCCN guidelines recommend follow-up imaging after resection, transplantation, or locoregional therapy with CT or MRI scans every 3 to 6 months for 2 years, and every 6 to 12 months thereafter. 8 While posttreatment surveillance may provide a benefit among patients with colorectal, breast, and prostate cancer, [10][11][12]21 the use of "intense" surveillance in the postoperative setting remains a controversial topic.…”

Section: Discussionmentioning

confidence: 99%

Postoperative imaging surveillance for hepatocellular carcinoma: How much is enough?

Mirdad

Hyer

Díaz

et al. 2021

Journal of Surgical Oncology

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Background:The objective of the current study was to define trends in postoperative surveillance imaging following liver-directed treatment of hepatocellular carcinoma (HCC), and characterize the impact of high-intensity surveillance on longterm survival.Methods: Patients who underwent liver-directed therapy for HCC between 2004 and 2016 were identified using the SEER-Medicare database. Trends in surveillance intensity over time, factors associated with high surveillance intensity and the impact of surveillance on long-term outcomes were examined.Results: Utilization of high-intensity surveillance abdominal imaging (≥6 scans over 2 years) following liver-directed therapy of HCC decreased over time (2004-2007:

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“…It has been shown that results of the therapy may be used to select LTx candidates more effectively. A positive response to treatment enables eligibility and decreases recurrence risk [ 16 , 30 , 51 – 53 ].…”

Section: Risk Factors Before Proceduresmentioning

confidence: 99%

“…In the present study, we discuss risk factors influencing the frequency of recurrence, including both those that may be assessed before and after transplantation. These include factors to help determine transplantation eligibility among patients that have the lowest recurrence risk, as well as classification and duration of follow-up of liver recipients to aid in the early diagnosis of possible recurrence, which may allow for more prompt and effective treatment ( Table 1 ) [ 7 , 19 , 20 , 27 – 30 ].…”

Section: Introductionmentioning

confidence: 99%

Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive Models

et al. 2022

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Liver transplantation (LTx) is the best treatment for patients with early-stage hepatocellular carcinoma (HCC). The Milan criteria positively influenced results of liver transplantation and were adopted by the majority of cancer centers, becoming the criterion standard treatment for early-stage HCC. Despite the use of restrictive criteria, recurrence is still high, affecting between 8% and 20% of cases, and is a significant predictor of survival after LTx. The diagnosis of both micro-and macro-invasion of vessels, which are significant factors in determining the frequency of recurrence and overall survival, significantly decreases the success of transplantation, causing an increase in mortality of 50% in comparison to recipients with no vascular invasion. The risk of recurrence depends on several factors, which are discussed in this review. The authors also discuss the clinical presentation and treatment methods of recurrence and its prognosis. In addition, the role of different models developed to identify groups of patients with high versus low risk of recurrence is discussed, enabling the planning of recommendations and screening protocols after transplantation to help early diagnosis and guide effective treatment. In the era of an increasing numbers of liver transplants due to HCC, the need to create robust screening tools is urgent.

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Achieving Complete Remission of Hepatocellular Carcinoma: A Significant Predictor for Recurrence-Free Survival after Liver Transplantation

Cited by 4 publications

References 47 publications

A Clinicopathological Study of Young-onset Hepatocellular Carcinoma

A Clinicopathological Study of Young-onset Hepatocellular Carcinoma

Postoperative imaging surveillance for hepatocellular carcinoma: How much is enough?

Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive Models

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