Prognostic value of expanded liver transplantation criteria—the 5‐5‐500 rule—in patients with hepatic resection for intermediate‐stage hepatocellular carcinoma

Shinkawa, Hiroji; Tanaka, Shogo; Takemura, Shigekazu; Amano, Ryosuke; Kimura, Kenjiro; Kinoshita, Masahiko; Miyazaki, Toru; Kubo, Shoji

doi:10.1002/jhbp.792

Cited by 5 publications

(7 citation statements)

References 29 publications

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“…20 A combination of tumor size ≤5 cm, tumor number ≤5, and AFP ≤500 ng/mL was reported to predict the post-resection prognosis in the patients with Barcelona Clinic Liver Cancer classification class B. 31 Pretransplant HCC treatment may weaken the predictive power of these criteria based on tumor morphology and tumor markers. 32 Inclusion of mRECIST criteria within the Metroticket 2.0 framework can provide further clinical information when assessing the eligibility for LT in patients who received pretransplant HCC treatment.…”

Section: Discussionmentioning

confidence: 99%

Salvage living donor liver transplantation for hepatocellular carcinoma recurrence after hepatectomy: Quantitative prediction using ADV score

Hwang

Song

Ahn

et al. 2020

J Hepato Biliary Pancreat

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Background: Salvage liver transplantation is a definite treatment for recurrent hepatocellular carcinoma (HCC) after hepatectomy. ADV score is calculated by multiplying α-fetoprotein and des-γ-carboxyprothrombin concentrations and tumor volume.Prognostic accuracy of ADV score was assessed in patients undergoing salvage living donor liver transplantation (LDLT) and their outcomes were compared with patients undergoing primary LDLT. Methods: This study was a retrospective, single-center, case-controlled study.Outcomes were compared in 125 patients undergoing salvage LDLT from 2007 to 2018 and in 500 propensity score-matched patients undergoing primary LDLT. Results: In patients undergoing salvage LDLT, median intervals between hepatectomy and tumor recurrence, between first HCC diagnosis and salvage LDLT, and between hepatectomy and salvage LDLT were 12.0, 37.2, and 29.3 months, respectively. Disease-free survival (DFS, P = .98) and overall survival (OS, P = .44) rates did not differ significantly in patients undergoing salvage and primary LDLT.Pretransplant and explant ADV scores were significantly predictive of DFS and OS in patients undergoing salvage and primary LDLT (P < .001). DFS after prior hepatectomy (P = .52) and interval between hepatectomy and LDLT (P = .82) did not affect DFS after salvage LDLT. Milan criteria and ADV score were independently prognostic of DFS and OS following salvage LDLT, and prognosis of patients within and beyond Milan criteria could be further stratified by ADV score. Conclusions: Risk factors and posttransplant outcomes were similar in patients undergoing salvage and primary LDLT. ADV score is surrogate biomarker for posttransplant prognosis in salvage and primary LDLT recipients. Prognostic model incorporating ADV scores can help determine whether to perform salvage LDLT.

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Section: Discussionmentioning

confidence: 99%

Salvage living donor liver transplantation for hepatocellular carcinoma recurrence after hepatectomy: Quantitative prediction using ADV score

Hwang

Song

Ahn

et al. 2020

J Hepato Biliary Pancreat

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“…Sinkawa et al. asserted that hepatic resection might provide survival benefits for HCC patients with BCLC intermediate‐stage who fitted within the 5‐5‐500 rule 19 . Considering these previous reports, hepatic resection appears to play a role in multinodular HCC including both BCLC early‐ and intermediate‐stage.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17] In addition, the 5-5-500 rule could predict patient prognosis after hepatic resection for BCLC intermediate-stage HCC. 18,19 In the current study, we focused on the multiplication of tumor maximum diameter and number (MDN) as a new surgical indicator for HCC, which has been previously established as a prognostic factor in patients with colorectal liver metastases (CRLM) after surgery. 20 Because this index could purely and easily assess tumor burden, we also investigated the significance of this index in BCLC intermediatestage HCC for the establishment of new surgical indicators.…”

Section: Introductionmentioning

confidence: 99%

“…In such a situation, it has been reported that HCC patients with beyond Milan criteria and within the up‐to‐seven criteria benefit from locoregional treatment, including hepatic resection in BCLC intermediate‐stage, and had similar treatment outcomes to BCLC early‐stage 15–17 . In addition, the 5‐5‐500 rule could predict patient prognosis after hepatic resection for BCLC intermediate‐stage HCC 18,19 …”

Section: Introductionmentioning

confidence: 99%

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Multiplication of tumor maximum diameter and number as a new surgical indicator for Barcelona Clinic Liver Cancer intermediate‐stage hepatocellular carcinoma

Morine

Saito

Yamada

et al. 2023

Hepatology Research

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Aim Recent advances in treatment modalities have been made, limiting the indication of hepatic resection in the treatment strategy for hepatocellular carcinoma (HCC) patients. This retrospective study investigated the significance of multiplication of tumor maximum diameter and number (MDN) as a surgical indicator for Barcelona Clinic Liver Cancer intermediate‐stage HCC. Methods A total of 49 patients with Barcelona Clinic Liver Cancer intermediate‐stage HCC who underwent curative hepatic resection between 2000 and 2020 were enrolled in this study. Prognostic factors of overall survival and disease‐free survival, including the product of MDN, were analyzed. Results Patients with MDN >12 experienced significantly worse prognosis compared with those with MDN ≤12 (p = 0.0395), and 5‐year overall survival rates after hepatic resection were 60.0% and 23.4%, respectively. Furthermore, the disease‐free survival rate of patients with MDN >12 was significantly worse compared with those with MDN ≤12 (p = 0.0049), and all patients with MDN >12 experienced recurrence within 3 years after hepatic resection. In the multivariate analysis, MDN >12 was identified as the only independent prognostic factor of both overall survival and disease‐free survival. In addition, patients with MDN >12 suffered from uncontrollable recurrence by locoregional treatment, such as more than four intrahepatic and extrahepatic recurrences, after hepatic resection. Conclusions MDN index might be a new surgical indicator for Barcelona Clinic Liver Cancer intermediate‐stage HCC, and influence clinical decision‐making for individual treatment strategies.

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“…AFP has also been included in the eligibility criteria for LT in Japan. The 5-5-500 criteria (≤5 cm, ≤5 tumors, AFP ≤500 ng/mL) has been adopted as additional criteria to Milan criteria for insurance coverage in Japan since 2019 ( 49 , 50 ). For patients on the waiting list for LT, the efficacy of bridging therapies via locoregional or systemic therapies to prevent tumor progression remains controversial ( 51 , 52 ).…”

Section: Transplantationmentioning

confidence: 99%

A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights

Xie¹,

Zhu²,

Ren³

et al. 2023

Hepatobiliary Surg Nutr

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Significant improvements in the management of hepatocellular carcinoma (HCC) during the past three years have urged the timely update of clinical guidelines in China. In brief, aMAP score is newly recommended as an effective risk stratification tool to predict HCC occurrence especially for non-cirrhotic patients. Biomarker-based surveillance including 7 micro-RNA panel and GALAD score are advocated to assist early diagnosis. China liver cancer (CNLC) staging system proposed in the 2017 guideline continues to be the standard model for staging with modifications in the treatment allocations. Conversion therapies using multi-modal, high intensity strategies are advocated to facilitate subsequent resection for patients with technically unresectable CNLC stage Ia, Ib, IIa HCC, or technically resectable IIb, IIIa HCC. Super-selective transcatheter arterial chemoembolization (TACE) with the assistance of Cone-Beam CT if necessary is recommended to guarantee the efficacy of TACE. Hepatic arterial infusion chemotherapy (HAIC) using oxaliplatin, fluorouracil, and leucovorin (FOLFOX) regimen alone or in combination with systemic therapy is recommended for TACE-refractory patients or for patients with locally advanced HCC.The systemic treatments for HCC have evolved considerably since atezolizumab plus bevacizumab, and suntilimab plus bevacizumab analogue showing superior survival benefit to sorafenib, and donafenib with comparable efficacy with sorafenib are added to the first-line treatments. In addition to regorafenib, apatinib, camrelizumab and tislelizumab are added as the second-line systemic therapies for patients who progressed on sorafenib. Updates in the 2022 Barcelona Clinic Liver Cancer (BCLC) guidelines and Japanese Society of Hepatology (JSH) consensus statement are also introduced and compared with the 2022 Chinese guidelines.

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Prognostic value of expanded liver transplantation criteria—the 5‐5‐500 rule—in patients with hepatic resection for intermediate‐stage hepatocellular carcinoma

Cited by 5 publications

References 29 publications

Salvage living donor liver transplantation for hepatocellular carcinoma recurrence after hepatectomy: Quantitative prediction using ADV score

Salvage living donor liver transplantation for hepatocellular carcinoma recurrence after hepatectomy: Quantitative prediction using ADV score

Multiplication of tumor maximum diameter and number as a new surgical indicator for Barcelona Clinic Liver Cancer intermediate‐stage hepatocellular carcinoma

A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights

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