Intrahepatic recurrence of hepatocellular carcinoma after resection: an update

Tampaki, Maria; Papatheodoridis, George; Cholongitas, Εvangelos

doi:10.1007/s12328-021-01394-7

Cited by 46 publications

(58 citation statements)

References 148 publications

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“…Tumor size and number have been well-recognized risk factors associated with tumor recurrence and long-term survival among patients after curative resection or transplantation for HCC. [27][28][29][30][31][32][33] In fact, both tumor size and number are surrogates of tumor aggressiveness, being strongly associated with presence of microvascular invasion, satellite lesions, and vessels that encapsulate tumor cluster. 34,35 Multifocal HCC may represent either intrahepatic metastasis or multiple primary tumors, suggesting aggressive biological behavior at the time of presentation.…”

Section: Discussionmentioning

confidence: 99%

Non-transplantable Recurrence After Resection for Transplantable Hepatocellular Carcinoma: Implication for Upfront Treatment Choice

Zhang

Xue

Bagante

et al. 2022

Journal of Gastrointestinal Surgery

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Objectives To identify the preoperative risk factors for prediction of non-transplantable recurrence (NTR) after tumor resection for early-stage hepatocellular carcinoma (HCC) to assist in patient selection relative to upfront liver resection (LR) versus liver transplantation (LT). Methods Patients who underwent curative resection for transplantable HCC and chronic liver disease were identified from an international multi-institutional database. NTR was defined as recurrence beyond the Milan or UCSF criteria, and the preoperative risk factors of NTR were investigated. Results Among 293 patients with transplantable HCC within Milan criteria and 320 within UCSF criteria, 113 (38.6%) and 131 (40.9%) patients developed tumor recurrence, respectively. Among patients who recurred, NTR was present in 32 (28.3%) patients within Milan and 35 (26.7%) within UCSF criteria. When either Milan or UCSF criteria was adopted, three preoperative risk factors including liver cirrhosis, tumor size > 3 cm, and multiple lesions were consistently identified as risk factors associated with NTR after curative resection. By summing up the three factors, a scoring model was established and the incidence of NTR among patients with 0, 1 or ≥ 2 risk factors incrementally increased from 4.5%, 13.3% to 20.5% when Milan criteria was used, and from 4.5%, 12.4% to 33.9% when UCSF criteria was adopted. The model demonstrated very good discriminatory power on internal validation (n = 5,000) (c-index 0.689 for Milan criteria, and 0.715 for UCSF criteria). Conclusions Whereas surgical resection may be optimal first-line treatment for patients with no or one risk factor, patients with ≥ 2 risk factors should be considered for upfront liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Non-transplantable Recurrence After Resection for Transplantable Hepatocellular Carcinoma: Implication for Upfront Treatment Choice

Zhang

Xue

Bagante

et al. 2022

Journal of Gastrointestinal Surgery

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“…Early recurrences within one year appear to arise from intrahepatic metastasis from the primary tumor and are associated with a poor prognosis; in contrast, recurrences beyond one year are more likely to be multicentric occurrences arising in the setting of chronic liver disease that are associated with a better prognosis (68)(69)(70). Given that early recurrence is typically associated with unfavorable tumor biology including microvascular invasion, satellite micrometastases, and lower response rates to potentially-curative treatment such as repeat hepatectomy, tumor ablation, and salvage liver transplantation (SLT), initial treatment with less morbid therapy, such as TACE or combined therapy with TACE and RFA or a tyrosine kinase inhibitor, should be considered in these patients (68,71).…”

Section: Repeat Hepatectomymentioning

confidence: 99%

Liver-Directed Treatment Options Following Liver Tumor Recurrence: A Review of the Literature

2022

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Recurrence following curative-intent hepatectomy for colorectal cancer liver metastasis, hepatocellular carcinoma, or cholangiocarcinoma is unfortunately common with a reported incidence as high as 75%. Various treatment modalities can improve survival following disease recurrence. A review of the literature was performed using PubMed. In addition to systemic therapy, liver-directed treatment options for recurrent liver disease include repeat hepatectomy, salvage liver transplantation, radiofrequency or microwave ablation, intra-arterial therapy, and stereotactic body radiation therapy. Repeat resection can be consider for patients with limited recurrent disease that meets resection criteria, as this therapeutic approach can provide a survival benefit and is potentially curative in a subset of patients. Salvage liver transplantation for recurrent hepatocellular carcinoma is another option, which has been associated with a 5-year survival of 50%. Salvage transplantation may be an option in particular for patients who are not candidates for resection due to underlying liver dysfunction but meet criteria for transplantation. Ablation is another modality to treat patients who recur with smaller tumors and are not surgical candidates due to comorbidity, liver dysfunction, or tumor location. For patients with inoperable disease, transarterial chemoembolization, or radioembolization with Yttrium-90 are liver-directed intra-arterial therapy modalities with relatively low risks that can be utilized. Stereotactic body radiation therapy is another palliative treatment option that can provide a response and local tumor control for smaller tumors.

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“…Despite considerable progress made in the detection, prevention, and therapy of HCC, it remains the sixth most prevalent and the third most lethal human cancer worldwide, causing approximately 800,000 deaths every year [3,4]. Moreover, although curative surgical resection is available for some patients, the recurrence rate of HCC is up to 70% within five years after surgery, resulting in poor patient survival [5,6]. Therefore, understanding the pathological mechanisms of HCC development and recurrence is important for developing promising diagnostic preventive and therapeutic interventions to improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis B Virus Pre-S Gene Deletions and Pre-S Deleted Proteins: Clinical and Molecular Implications in Hepatocellular Carcinoma

Lin

Jeng

Chan

et al. 2021

Viruses

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Hepatocellular carcinoma (HCC) is one of the most frequent and fatal human cancers worldwide and its development and prognosis are intimately associated with chronic infection with hepatitis B virus (HBV). The identification of genetic mutations and molecular mechanisms that mediate HBV-induced tumorigenesis therefore holds promise for the development of potential biomarkers and targets for HCC prevention and therapy. The presence of HBV pre-S gene deletions in the blood and the expression of pre-S deleted proteins in the liver tissues of patients with chronic hepatitis B and HBV-related HCC have emerged as valuable biomarkers for higher incidence rates of HCC development and a higher risk of HCC recurrence after curative surgical resection, respectively. Moreover, pre-S deleted proteins are regarded as important oncoproteins that activate multiple signaling pathways to induce DNA damage and promote growth and proliferation in hepatocytes, leading to HCC development. The signaling molecules dysregulated by pre-S deleted proteins have also been validated as potential targets for the prevention of HCC development. In this review, we summarize the clinical and molecular implications of HBV pre-S gene deletions and pre-S deleted proteins in HCC development and recurrence and highlight their potential applications in HCC prevention and therapy.

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Intrahepatic recurrence of hepatocellular carcinoma after resection: an update

Cited by 46 publications

References 148 publications

Non-transplantable Recurrence After Resection for Transplantable Hepatocellular Carcinoma: Implication for Upfront Treatment Choice

Non-transplantable Recurrence After Resection for Transplantable Hepatocellular Carcinoma: Implication for Upfront Treatment Choice

Liver-Directed Treatment Options Following Liver Tumor Recurrence: A Review of the Literature

Hepatitis B Virus Pre-S Gene Deletions and Pre-S Deleted Proteins: Clinical and Molecular Implications in Hepatocellular Carcinoma

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