Recent developments and ongoing trials in transplant oncology

Moeckli, Beat; Ivanics, Tommy; Claasen, Marco; Toso, Christian

doi:10.1111/liv.14621

Cited by 9 publications

(6 citation statements)

References 146 publications

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“…In patients fulfilling the Milan criteria, the upper limit of the tumor number is only 3, indicating that patients with 4 or more tumors are not recommended as LT candidates. In the last two decades, numerous studies have attempted to expand the Milan criteria, and successful outcomes have been achieved [ 16 ]. Although several systems of criteria include patients with more than 3 tumor nodules, no study has compared or validated the value of these selection systems in this subpopulation of HCC patients, i.e., those who have more than 3 tumor nodules.…”

Section: Discussionmentioning

confidence: 99%

The predictive value of the modified AFP model for liver transplantation outcomes in multinodular hepatocellular carcinoma patients

et al. 2023

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Background There is a lack of studies focusing on the benefit of liver transplantation (LT) in hepatocellular carcinoma (HCC) patients with > 3 tumors. This study aims to establish a model to effectively predict overall survival in Chinese HCC patients with multiple tumors (> 3 tumors) who undergo LT. Methods This retrospective study included 434 HCC liver transplant recipients from the China Liver Transplant Registry. All HCC patients had more than 3 tumor nodules. Three selection criteria systems (i.e., AFP, Metroticket 2.0, and Up-to-7) were compared regarding the prediction of HCC recurrence. The modified AFP model was established by univariate and multivariate competing risk analyses. Results The AFP score 2 and the AFP score ≥ 3 groups had 5-year recurrence rates of 19.6% and 40.5% in our cohort. The prediction of HCC recurrence based on the AFP model was associated with a c-statistic of 0.606, which was superior to the Up-to-7 and Metroticket 2.0 models. AFP level > 1000 ng/mL, largest tumor size ≥ 8 cm, vascular invasion, and MELD score ≥ 15 were associated with overall survival. The 5-year survival rate in the modified AFP score 0 group was 71.7%. Conclusions The AFP model is superior in predicting tumor recurrence in HCC patients with > 3 tumors prior to LT. With the modified AFP model, patients likely to derive sufficient benefit from LT can be identified.

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Section: Discussionmentioning

confidence: 99%

The predictive value of the modified AFP model for liver transplantation outcomes in multinodular hepatocellular carcinoma patients

et al. 2023

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“…The indications are for 1) patients with liver cirrhosis who cannot be resected due to decreased liver function, 2) patients who have been shown to have IHCCC by liver biopsy, 3) a single tumor of size 2 cm or less, and 4) have neither vascular invasion nor intrahepatic lesion on the image. 12 The upper limit of tumor markers was also set to 100 ng/mL for CA19-9. The primary outcome was the 5-year OS, and the results after a few years are awaited.…”

Section: Unresectable Ihccc Due To Poor Liver Functionmentioning

confidence: 99%

“…A Phase 2 study is currently underway to assess whether the prognosis after LT for single IHCCC of 2 cm or less associated with cirrhosis is really good. The indications are for 1) patients with liver cirrhosis who cannot be resected due to decreased liver function, 2) patients who have been shown to have IHCCC by liver biopsy, 3) a single tumor of size 2 cm or less, and 4) have neither vascular invasion nor intrahepatic lesion on the image 12 . The upper limit of tumor markers was also set to 100 ng/mL for CA19‐9.…”

Section: Lt For Intrahepatic Cholangiocellar Carcinoma (Ihccc)mentioning

confidence: 99%

Liver transplantation for intrahepatic and hilar cholangiocellular carcinoma: Most recent updates in the literature

Eguchi

Hidaka

Hara

et al. 2022

Annals of Gastroent Surgery

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According to the national registration in Japan, reported by the Japanese Liver Transplantation Society, 14 cholangiocellular carcinoma (CCC) were performed in Japan from 1992 to the end of 2019 because of out-of-pocket health insurance coverage and relative contraindication. 1 However, in recent years, relatively good prognoses in patients receiving liver transplantation (LT) for hilar CCC (hCCC) have been reported after intensive pretransplant chemoradiotherapy and by carefully selecting cases using deceased donor livers. [2][3][4] In general, it is not easy to distribute deceased donor organs to patients in Japan, where the number of brain-dead donors is significantly limited compared to other countries. As a result, living-donor LT is often the only option, despite not being covered by health insurance. Intrahepatic CCC (IHCCC) had been considered a contraindication for LT because of poorer outcomes. However, with recent advances in chemotherapy, an indication for LT for IHCCC is becoming an important topic, but no definitive results have yet been shown. This paper introduces updated results and progress of LT for CCC stratified by intrahepatic and hilar methods.

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“…Recently, a prospective study including patients with suspicious biliary strictures (n = 68) showed that the mutational analysis of bile cell-free DNA (cfDNA) by next-generation sequencing (NGS) in bile showed a sensitivity and specificity of 96.4% and 69.2%, respectively. More interestingly, 22 out of 35 patients initially categorized as having a benign/indeterminate stricture were finally diagnosed of malignancy during the follow-up and in them, the NGS assay showed a 100% sensitivity for malignancy diagnosis [59] . Validation studies including patients with PSC are eagerly awaited.…”

Section: Future Perspectivesmentioning

confidence: 99%

Cholangiocarcinoma: early detection and screening in high-risk population

Muñoz-Martínez¹,

Rimola²,

Londoño³

et al. 2022

Hepatoma Res

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Cholangiocarcinoma (CCA) is a highly lethal malignancy that comprises approximately 15% of all the primary liver tumors and 3% of gastrointestinal cancers. Diagnosis is often done when the disease is already at advanced stages, resulting in poor outcomes. Prevention of risk factors and early diagnosis are the cornerstones for improving survival. Early diagnosis is feasible in the setting of surveillance programs in patients at high risk of CCA such as patients with primary sclerosing cholangitis. Regrettably, surveillance of CCA in this population is hampered by the low diagnostic accuracy of current tumor markers at earlier stages, the difficulties of imaging techniques for the differential diagnosis between benign and malignant biliary strictures, and the need for invasive procedures for diagnostic confirmation. In this review we discuss the rationale for surveillance of CCA in high-risk populations, particularly patients with primary sclerosing cholangitis, the recommended tools for surveillance and diagnostic work-up, and future perspectives.

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Recent developments and ongoing trials in transplant oncology

Cited by 9 publications

References 146 publications

The predictive value of the modified AFP model for liver transplantation outcomes in multinodular hepatocellular carcinoma patients

The predictive value of the modified AFP model for liver transplantation outcomes in multinodular hepatocellular carcinoma patients

Liver transplantation for intrahepatic and hilar cholangiocellular carcinoma: Most recent updates in the literature

Cholangiocarcinoma: early detection and screening in high-risk population

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