Child-Pugh A Hepatitis B-Related Cirrhotic Patients with a Single Hepatocellular Carcinoma Up to 5 cm: Liver Transplantation vs. Resection

Li, Chuan; Zhu, Wen-Jiang; Wen, Tianfu; Dai, Yan; Yan, Lü-Nan; Li, Bo; Yang, Jiayin; Wang, Wentao; Xu, Meiqing

doi:10.1007/s11605-014-2550-0

Cited by 15 publications

(10 citation statements)

References 36 publications

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“…Our previous study reported that HR of patients with intermediate- and advanced-stage HCC and PHT gave better survival than transarterial chemoembolization [4] , and another study reported that HR was associated with longer survival and time to recurrence than radiofrequency ablation [31] . For Child-Pugh A cirrhotic patients with a single HCC up to 5 cm, HR offers a similar 5-year OS to liver transplantation, even for patients with PHT [32] , [33] . However, the liver donation is shortage in most countries.…”

Section: Discussionmentioning

confidence: 98%

Hepatic Resection Is Safe and Effective for Patients with Hepatocellular Carcinoma and Portal Hypertension

Zhong

Xiao

et al. 2014

PLoS ONE

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Background & AimsOfficial guidelines do not recommend hepatic resection (HR) for patients with hepatocellular carcinoma (HCC) and portal hypertension (PHT). This study aims to investigate the safety and efficacy of HR for patients with HCC and PHT.MethodsMortality and survival after HR were analyzed retrospectively in a consecutive sample of 1738 HCC patients with PHT (n = 386) or without it (n = 1352). To assess the robustness of findings, we repeated the analysis using propensity score-matched analysis. We also comprehensively searched the PubMed database for studies evaluating the efficacy and safety of HR for patients with HCC and PHT.ResultsThe 90-day mortality rate was 6.7% among those with PHT and 2.1% among those without it (P<.001). Patients without PHT had a survival benefit over those with PHT at 1, 3, and 5 years (96% vs 90%, 75% vs 67%, 54% vs 45%, respectively; P = .001). In contrast, PHT was not associated with worse short- or long-term survival when only propensity score-matched pairs of patients and those with early-stage HCC or those who underwent minor hepatectomy were included in the analysis (all P>.05). Moreover, the recurrence rates were similar between the two groups. Consistent with our findings, all 9 studies identified in our literature search reported HR to be safe and effective for patients with HCC and PHT.ConclusionsHR is safe and effective in HCC patients with PHT and preserved liver function. This is especially true for patients who have early-stage HCC or who undergo minor hepatectomy.

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Section: Discussionmentioning

confidence: 98%

Hepatic Resection Is Safe and Effective for Patients with Hepatocellular Carcinoma and Portal Hypertension

Zhong

Xiao

et al. 2014

PLoS ONE

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“…87,88 While 10-year overall survival is better with LT for resectable HCC, 89 many studies have shown similar 5-year overall survival for resection compared to LT in patients with a single <3 cm HCC. 89,90 Patients with a single <3 cm HCC have improved outcome compared to those with larger tumor burden regardless of resection versus LT. [91][92][93] More recently, a large multinational study 94 reported a ~40% cure rate with resection (compared to 75% with LT) in patients with single <3 cm HCC and MELD <11 with similar intention-to-treat survival given the expected 10%-20% waitlist dropout rate in those awaiting LT.…”

Section: Management Of Single Small Hcc Liver Transplantation Versusmentioning

confidence: 99%

Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference

et al. 2020

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Liver transplantation (LT) offers excellent long-term outcome for certain patients with hepatocellular carcinoma (HCC), with a push to not simply rely on tumor size and number. Selection criteria should also consider tumor biology (including alpha-fetoprotein), probability of waitlist and post-LT survival (ie, transplant benefit), organ availability, and waitlist composition. These criteria may be expanded for live donor LT (LDLT) compared to deceased donor LT though this should not adversely affect the double equipoise in LDLT, namely ensuring both acceptable recipient outcomes and donor safety. HCC patients with compensated liver disease and minimal tumor burden have low urgency for LT, especially after local-regional therapy with complete response, and do not appear to derive the same benefit from LT as other waitlist candidates. These guidelines were developed to assist in selecting appropriate HCC patients for both deceased donor LT and LDLT.

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“…There was 73 (34.9%) HCC patients undergoing LDLT. Many studies including our previous study demenstrated there was no statistically difference between the HCC patients after DCD and LDLT [28,29].…”

Section: Discussionmentioning

confidence: 88%

Nomograms to predict prognosis of hepatocelluar carcinoma without major vascular invasion after primary liver transplantation

Shen¹,

Li²,

Wen³

et al. 2018

Oncotarget

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Background: A model to predict individual prognosis after liver transplantation (LT) has not been clearly established. We aimed to create nomograms for prediction of individual survival after LT for hepatocelluar carcinoma (HCC).Results: There were 128(61.2%) patients within the Milan criteria. Before transplantation, 43 (20.6%) patients received transcatheter arterial chemoembolization (TACE) and 22 (10.5%) received radiofrequency ablation(RFA). Multivariate predictors of survival included tumor size, tumor number and tumor differentiation. Nomograms for OS and recurrence free survival (RFS) have been created. Discrimination and calibration of the nomograms revealed good predictive abilities(C-index, RFS: 0.74; OS: 0.70). Compared with Milan criteria, UCSF criteria, up-to-seven criteria and Hangzhou criteria, the OS nomogram improved accuracy in predicting prognosis after transplantation for HCC, (p < 0.05 for all). Finally, three subgroups were generated based on the total risk points (A': 1.88-76.5 points; B': 76.6-113.9points; C': 113.9-151.3points). The 5-year survival rate were 86.1% for group A', 59.1% for group B', and 28.9% for group C', respectively.Conclusions: The nomograms had good ability in predicting prognostic survival for HCC patients after LT. Patients with score above 113.9 points had poor survival after LT.Materials and method: Between Juanuary 2002 and September 2015, 209 HCC patients who received liver transplantation in the West China Hospital were collected for this study. Prognostic nomograms predicting post-transplant prognosis were developed from a multivariate cox regression. The prediction power of the nomograms was tested by C-statistic and calibration plots. www.impactjournals.com/oncotarget/ Vol.9, (No.1), Supplement 1, pp: s353-s362

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Child-Pugh A Hepatitis B-Related Cirrhotic Patients with a Single Hepatocellular Carcinoma Up to 5 cm: Liver Transplantation vs. Resection

Abstract: Although more recurrences were observed in Child A cirrhotic patients with a single HCC up to 5 cm after liver resection, liver resection offers a similar 5-year survival to liver transplantation, even for patients with portal hypertension.

Cited by 15 publications

References 36 publications

Hepatic Resection Is Safe and Effective for Patients with Hepatocellular Carcinoma and Portal Hypertension

Hepatic Resection Is Safe and Effective for Patients with Hepatocellular Carcinoma and Portal Hypertension

Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference

Nomograms to predict prognosis of hepatocelluar carcinoma without major vascular invasion after primary liver transplantation

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