Perioperative Blood Transfusion as a Prognostic Indicator in Patients with Hepatocellular Carcinoma

Asahara, Toshimasa; Katayama, Kouji; Itamoto, Toshiyuki; Yano, Mitsuyasu; Hino, Hiroshi; Okamoto, Yuzo; Nakahara, Hiroyuki; Dohi, Kiyohiko; Moriwaki, Katsuyuki; Yuge, Osafumi

doi:10.1007/pl00012367

Cited by 115 publications

(93 citation statements)

References 23 publications

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“…Cox regression analysis for recurrence revealed that blood transfusion was the most significant prognostic indicator for recurrence in stage I-II patients but not in stage III-IV patients [67] .…”

Section: Blood Transfusionmentioning

confidence: 89%

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

Qin¹,

Tang²

2002

WJG

160

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The prognosis of patients with HCC still remains dismal. The life expectancy of HCC patients is hard to predict because of the high possibility of postoperative recurrence. Many factors, s u c h a s p a t i e n t ' s g e n e r a l c o n d i t i o n s , macroscopic tumor morphology, as well as tumor hitopathology features, have been proven of prognostic significance. Female HCC patient often has a better prognosis than male patient, which might be due to the receptor of sex hormones. Younger patients often have tumors with higher invasiveness and metastatic potentials, and their survival and prognosis are w o r s e t h a n t h e o l d e r o n e s . C o -e x i s t i n g hepatitis status and hepatic functional reserve h a v e b e e n c o n f i r m e d a s r i s k f a c t o r s f o r recurrence. Serum alpha-fetoprotein (AFP) is useful not only for diagnosis, but also as a prognostic indicator for HCC patients. AFP mRNA has been proposed as a predictive marker of HCC cells disseminated into the circulation and for metastatic recurrence. Many pathologic features, such as tumor size, number, capsule state, cell differentiation, venous invasion, intrahepatic spreading, and a d v a n c e d p T N M s t a g e , a r e t h e b e s testablished risk factors for recurrence and important aspects affecting the prognosis of patients with HCC. Marked inflammatory cell infiltration in the tumor could predict a better prognosis. Clinical stage is still the most important factor influencing on the prognosis. E x t r a t u m o r s p r e a d i n g a n d l y m p h n o d a l metastasis are independent predictors for poor outcome. Some new predictive systems h a v e r e c e n t l y b e e n p r o p o s e d . D i f f e r e n t strategies of treatment might have significant different effects on the patients' prognosis. To date, surgical resection is still the only p o t e n t i a l l y c u r a t i v e t r e a t m e n t f o r H C C , including localized postoperative recurrences. Extent of resection, blood transfusion, occlusion of porta hepatis, and blood loss affect the survival and prognosis of HCC patients. Regional therapies provide alternative ways to improve the prognosis of HCC patients who have no opportunity to receive surgical treatment or postoperative recurrence. The combination of these treatment modalities is hopeful to further improve the prognosis. The efficacies of neoadjuvant (preoperative) or adjuvant (postoperative) chemotherapy or chemoembolization in preventing recurrence and on the HCC prognosis still remain great controversy, and deserves further evaluation. Biotherapy, including IFN-alpha therapy, will play more important role in preventing recurrence and metastasis of HCC after operation.Qin LX,Tang ZY.The prognostic significance of clinical and pathological features in hepatocellular carcinoma.

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Section: Blood Transfusionmentioning

confidence: 89%

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

Qin¹,

Tang²

2002

WJG

160

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“…In our study, perioperative blood transfusion was a significant predictor of tumour recurrence. Several studies reported that perioperative blood transfusions are significantly associated with increased the incidence of tumour recurrence irrespective to its viral aetiology [13,[27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Recurrence in Hepatitis C Virus Related Hepatocellular Carcinoma after Hepatic Resection: A Retrospective Cohort Study

Wahab

Shehta

Hamed

et al. 2014

EAJM

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Objective: Egypt is one of the hot spots in the international map of Hepatocellular carcinoma (HCC), which is where hepatitis C virus (HCV) infection is the major risk factor in development of HCC (80%). Due to low organ donation rates and lack of deceased liver transplantation, hepatic resection is the main line of treatment for HCC patients with sufficient liver reserve. We introduce our experience with patients who had HCV related HCC who underwent hepatic resection to determine various predictors of tumour recurrence in this group. This is the first study to come from a country where chronic HCV hepatitis is endemic. Materials and Methods:This is a retrospective cohort study of 208 cases of HCC in hepatitis C virus positive patients with cirrhotic livers who underwent first-time liver resection, in Gastroenterology Surgical Centre, Mansoura University, Egypt during the period from January 2002 to December 2011. Shapiro-Wilk test was used to assess normality of data. Predictors of HCC recurrence were assessed by bivariate correlation tests, univariate analysis using the chi-square and t-test and binary logistic regression analysis. A P value <0.05 was considered statistically significant.Results: Tumour recurrence occurred in 88 patients (42.3%). Most of the recurrences occurred within the first year 55 patients (62.5%). The most common site for recurrence was the liver (n=68, 77.3%). Based on the univariate analysis; significant variables predicting tumor recurrence were alpha feto-protein (AFP), blood transfusion, multifocality, cut margin, microvascular invasion, lack of capsule, tumour grade and stage. Based on multivariate analysis, the main variables predicting tumor recurrence were blood transfusion, cut margin, tumour capsule and microvascular invasion. Conclusion:Although the predictors of recurrence are the same for both HBV and HCV related HCC, the rate and aggressiveness of recurrence are higher in HCV related HCC.Key Words: HCV related HCCs, liver resection, recurrent HCC Özet Amaç: Mısır; hepatit C virüsü (HCV) enfeksiyonunun Hepatocellular karsinomun (HCC) görülmesinde önemli (% 80) bir risk faktörü olduğu, uluslararası HCC haritasındaki sıcak noktalardan biridir. Organ bağışı oranlarının düşük olması ve kadavradan karaciğer nakli eksikliği sebebiyle, karaciğer rezeksiyonu, yeterli karaciğer rezervi olan HCC hastalarının tedavisinde ana yöntemdir. Bu grupta HCV'ye bağlı HCC'si olan hastalarda tümör nüksünün çeşitli faktörlerini araştırmak için karaciğer rezeksiyonu deneyimimizi aktarmak amacındayız. Bu, kronik HCV hepatitinin endemik olduğu bir ülkeden gelen ilk çalış-madır. Gereç ve Yöntem:Bu, Ocak 2002-Aralık 2011 süresince Mısır'ın Mansoura Üniversitesi, Gastroenterolojik Cerrahi Merkezinde ilk kez karaciğer rezeksiyonu yapılan sirotik karaciğerli HCC, hepatit C virüsü pozitif hastalarda 208 vakanın retrospektif kohort çalışmasıdır. Verilerin normalliğini değerlendirmek için Shapiro-Wilk testi kullanılmıştır. HCC nüks prediktörleri ikili korelasyon testleri, tek değişkenli ki-kare ve...

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“…Intractable haemorrhage during hepatectomy for HCC, especially in cirrhotic patients, leads to postoperative hepatic failure, which is one of the lethal complications that occur following hepatectomy. Moreover, some studies have suggested that perioperative homologous blood transfusion significantly affects recurrence and survival after curative hepatectomy for HCC 3,20 . It is therefore important to clarify the factors that affect blood loss and transfusion requirements during hepatectomy for HCC.…”

Section: Discussionmentioning

confidence: 99%

“…Transfusion of homologous blood carries risks of infectious or immunological complications. In particular, the incidence of tumour recurrence after curative hepatectomy for HCC was high in patients who had received perioperative homologous blood transfusion 3 .…”

Section: Introductionmentioning

confidence: 99%

Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease

Itamoto

Katayama

Nakahara

et al. 2003

British Journal of Surgery

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Background: Preoperative autologous blood donation has been suggested for patients with liver disease who are to undergo liver resection. The aim of this retrospective study was to clarify the risk factors for increased blood loss and the need for blood transfusion during hepatectomy for hepatocellular carcinoma (HCC).Methods: From January 1996 to December 2000, 206 consecutive patients, 98·5 per cent of whom had underlying liver disease, underwent elective hepatectomy for HCC.Results: Major hepatectomy was performed in 34 patients (16·5 per cent) and minor hepatectomy in 172 patients (83·5 per cent). The mean blood loss was 410 (median 260) ml. Eleven (5·3 per cent) of the 206 patients received blood transfusion during or after the operation. Operation time (P = 0·004) and central venous pressure (CVP) (P = 0·041) were independently correlated with blood loss of more than 1000 ml. Only preoperative haemoglobin level (P = 0·001) was independently correlated with the need for blood transfusion. Conclusion:In patients with underlying liver disease, maintaining CVP at a level below 5 cmH 2 O during parenchymal transection to reduce blood loss is more important than reserving autologous blood before the operation.

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Perioperative Blood Transfusion as a Prognostic Indicator in Patients with Hepatocellular Carcinoma

Cited by 115 publications

References 23 publications

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

Predictors of Recurrence in Hepatitis C Virus Related Hepatocellular Carcinoma after Hepatic Resection: A Retrospective Cohort Study

Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease

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