Impact of Des-Gamma-Carboxy Prothrombin and Tumor Size on the Recurrence of Hepatocellular Carcinoma After Living Donor Liver Transplantation

Taketomi, Akinobu; Sanefuji, Kensaku; Soejima, Yuji; Yoshizumi, Tomoharu; Uhciyama, Hideaki; Ikegami, Toru; Harada, Noboru; Yamashita, Yo‐ichi; Sugimachi, Keizō; Kuwabara, Hiroto; Iguchi, Tomohiro; Maehara, Y.

doi:10.1097/tp.0b013e3181943bee

Cited by 159 publications

(144 citation statements)

References 29 publications

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“…This result indicates that PIVKA-II level of ≥400 mAU/mL is a predictor of poor prognosis and that level is more sensitive than AFP in predicting tumor recurrence or prognosis. (23)(24)(25)29) In the present study, changes of both AFP and PIVKA-II levels were focused to evaluate effectiveness of any treatments because half-life of these serum markers was limited within a few weeks. (16) We hypothesize that L group showed the lowest malignancies in all groups before treatments and, in the N group, the tumor was mostly disappeared by the effective treatments.…”

Section: Discussionmentioning

confidence: 99%

Tumor Marker Levels Before and After Curative Treatment of Hepatocellular Carcinoma as Predictors of Patient Survival

et al. 2011

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Abstract-fetoprotein (AFP) is used as a marker for hepatocellular carcinoma (HCC), which is influenced by hepatitis. Protein induced vitamin K absence or antagonist II (PIVKA-II) is a sensitive diagnostic marker. Changes in these markers after treatment may reflect curability and predict outcome. We conducted an analysis of prognosis in 470 HCC patients who received curative treatments, and examined relationship between changes in AFP and PIVKA-II levels after 1-month of treatment in 156 patients. Subjects were divided into three groups according to changes in both levels: 1) normal (L) group before treatment, 2) normalization (N) or 3) decreased but still above normal level or unchanged (ANU) group after treatment. High AFP and PIVKA-II levels were significantly associated with poor tumor-free and overall survival. Presence of large size and advanced stage were significantly associated with prevalence of DU group. Overall survival in the AFP-L group was significantly better than those of other groups and overall survival in PIVKA-II-L and N groups were significantly better than those of PIVKA-II-ANU groups. Combination of changes in AFP-ANU and PIVKA-II-ANU group showed the worst tumor-free and overall survivals. Multivariate analysis identified high pre-treatment levels of AFP and PIVKA-II and combination of AFP-ANU and PIVKA-II-ANU as significant determinants of poor tumor-free and overall survival, particularly in patients who underwent hepatectomy. We conclude that high levels of AFP or PIVKA-II after treatment for HCC did not sufficiently reflect curative efficacy of treatment and reflected a poor predictor of prognosis in HCC patients. Nanashima et al., Page 3

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Section: Discussionmentioning

confidence: 99%

Tumor Marker Levels Before and After Curative Treatment of Hepatocellular Carcinoma as Predictors of Patient Survival

et al. 2011

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“…Tumor differentiation and microvascular invasion are also substantial risks, but these features are not determined until after the evaluation of the explant. Biomarkers that consist of AFP and des-gamma-carboxy prothrombin are reported to correlate with a post-transplant recurrence of HCC [37] . In a recent study, an AFP over 400 ng/mL supplemented with the total tumor volume was recommended as a predictor following transplant [38] .…”

Section: Stagingmentioning

confidence: 99%

Hepatocellular carcinoma: A comprehensive review

Waller

Deshpande

Pyrsopoulos

2015

WJH

172

119

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chronic hepatitis B and C infections are most commonly afflicted. Different therapeutic options, including liver resection, transplantation, systemic and local therapy, must be tailored to each patient. Liver transplantation offers leading results to achieve a cure. The Milan criteria is acknowledged as the model to classify the individuals that meet requirements to undergo transplantation. Mean survival remains suboptimal because of long waiting times and limited donor organ resources. Recent debates involve expansion of these criteria to create options for patients with HCC to increase overall survival.

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“…Morphological assessment alone, such as the number and size of the tumor, might be insufficient to exclude biologically aggressive tumors, since, as reported by many previous comparative studies, many cases in the LDLT group that satisfied the Milan or UCSF criteria also had microvascular invasion and poorly differentiated HCCs. Therefore, recently, many transplant institutes are using selection criteria that incorporate tumor markers, such as alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP), as well as tumor number and size to exclude biologically aggressive HCC preoperatively (33,(41)(42)(43)(44)(45)(46)(47)(48)(49). Takada et al reported that DCP >400 mAU/mL was an independent risk factor of HCC recurrence after LDLT, and proposed expanded selection criteria, the Kyoto criteria, which include tumor number ≤10, maximal diameter of each tumor ≤5 cm, and DCP levels of ≤400 mAU/mL (41,42).…”

Section: Biomarkers To Predict Biologically Aggressive Hccmentioning

confidence: 99%

Living vs. deceased-donor liver transplantation for patients with hepatocellular carcinoma

Ogawa¹,

Takada²

2016

Transl. Gastroenterol. Hepatol.

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With the scarcity of deceased donor liver grafts, living donor liver transplantation (LDLT) is gaining popularity as an alternative to deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC). However, as the evidence of cases of LDLT accumulates, several authors have reported higher HCC recurrence rates after LDLT. The suggested reasons for the higher recurrence rates following LDLT are related to the small-for-size graft in LDLT, surgical procedures that are specific to LDLT, and the fast-track to LDLT. Fast-tracking to LDLT may not allow sufficient time for evaluation of the biological aggressiveness of tumors, which may result in high recurrence rates due to inclusion of patients with more inherently aggressive tumors. Actually, some studies that reported higher recurrence rates with LDLT included a larger number of cases of HCC with microvascular invasion or poorly differentiated HCC. In order to exclude biologically aggressive HCC preoperatively, selection criteria incorporating tumor markers, such as alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP), as well as morphological tumor number and size have been proposed. With more reliable selection criteria incorporating biological markers to eliminate biologically aggressive HCC, LDLT can be a viable treatment option for patients with HCC, providing similar recurrence rates as those achieved with DDLT.

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Impact of Des-Gamma-Carboxy Prothrombin and Tumor Size on the Recurrence of Hepatocellular Carcinoma After Living Donor Liver Transplantation

Abstract: A combination of two factors, namely the tumor size and the DCP level, was found to be useful for expanding the selection of LDLT candidates for HCC.

Cited by 159 publications

References 29 publications

Tumor Marker Levels Before and After Curative Treatment of Hepatocellular Carcinoma as Predictors of Patient Survival

Tumor Marker Levels Before and After Curative Treatment of Hepatocellular Carcinoma as Predictors of Patient Survival

Hepatocellular carcinoma: A comprehensive review

Living vs. deceased-donor liver transplantation for patients with hepatocellular carcinoma

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