Risk-Based Long-Term Screening for Hepatocellular Carcinoma Recurrence After Living Donor Liver Transplantation

Hwang, Shin; Moon, Deok‐Bog; Ahn, Chul‐Soo; Kim, K.-H.; Ha, Tae Yong; Song, Gi‐Won; Jung, Dong‐In; Park, G.-C.; Lee, H.C.; Lee, Y.S.; Chung, Y.-H.; Abdulkarim, Bashar; Lee, S.-G.

doi:10.1016/j.transproceed.2013.08.068

Cited by 26 publications

(42 citation statements)

References 34 publications

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“…Because of the high incidence of HCC recurrence after liver resection, resection patients have undergone imaging studies more frequently than LT recipients; thus, MAM-HCCs are usually detected by imaging studies in resection patients. By contrast, increased expression of HCC tumor markers in LT recipients often leads to assessment for HCC recurrence including MAM-HCC, because these isolated extrahepatic metastases often occur rather late, several years after LT [5. ]…”

Section: Discussionmentioning

confidence: 99%

“…Considering that the only significantly different parameter was the interval between the initial surgery and adrenalectomy, we presume that the highly selected favorable tumor biology might greatly influence on the survival outcome. Since most HCC recurrence occurs within the first 3 years after LT, late recurrence may be associated with less aggressive behavior of tumor biology [5]. …”

Section: Discussionmentioning

confidence: 99%

“…The more favorable outcome in the LT group may have been associated with the less aggressive nature of these tumors. Late indolent extrahepatic metastases usually occur a few years after LT, whereas earlier recurrence is often associated with aggressive tumor characteristics [5]. The seven patients in our LT group who underwent adrenalectomy is the largest sample in literature to date, because only sporadic cases were previously reported (table 2) [15,16,17].…”

Section: Discussionmentioning

confidence: 99%

“…All patients who underwent liver resection or LT for HCC were followed up according to our institutional protocol for the management of patients with HCC [5]. Serum concentrations of the tumor markers alpha-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP; or protein induced by vitamin K absence or antagonist-II [PIVKA-II]) were measured at every routine visit to the outpatient clinic.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with isolated extrahepatic metastasis, preserved liver function, and adequate control of other recurrent tumors may benefit from the resection of the MAM-HCC [1]. The extrahepatic HCC metastases that occur after liver transplantation (LT) are usually more aggressive and have more complex biological features than HCC metastases after liver resection [5,6]. …”

Section: Introductionmentioning

confidence: 99%

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Resection of Metachronous Adrenal Metastasis after Liver Resection and Transplantation for Hepatocellular Carcinoma

Ha¹,

Hwang²,

Ahn³

et al. 2014

Dig Surg

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Background: This study analyzed the patient survival outcomes following the resection of hepatocellular carcinoma (HCC) metachronous adrenal metastasis (MAM) in patients who had undergone liver resection or liver transplantation (LT). Methods: Clinical results were analyzed retrospectively in 26 patients with MAM-HCC who underwent adrenalectomy. Results: The mean interval between initial surgery and adrenalectomy was significantly shorter in the resection group than in the LT group (18.3 ± 14.4 vs. 42.6 ± 13.8 months, p < 0.001). Of 19 resected patients, four had adrenal metastases on the right side, 12 on the left side and three bilaterally, with a mean tumor diameter of 3.6 ± 1.5 cm. Ten of these patients underwent open surgery and nine underwent laparoscopic surgery; all patients experienced recurrences within 18 months and 20.3% survived 5 years after adrenalectomy. Of 7 patients who underwent LT, four had adrenal metastases on the right side and three on the left side, with a mean tumor diameter of 3.4 ± 1.8 cm. Six of these patients underwent open surgery and one underwent laparoscopic surgery. Five-year recurrence and patient survival rates after adrenalectomy were 28.6 and 85.7%, respectively. Conclusions: Adrenalectomy is indicated in patients with isolated MAM-HCC. Comparisons with other locoregional treatment modalities and multicenter studies with additional patients are needed to validate the role of adrenalectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Resection of Metachronous Adrenal Metastasis after Liver Resection and Transplantation for Hepatocellular Carcinoma

Ha¹,

Hwang²,

Ahn³

et al. 2014

Dig Surg

View full text Add to dashboard Cite

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Treatment and outcomes of extrahepatic malignancy incidentally diagnosed during pretransplant evaluation for living donor liver transplantation

Park

Hwang

Song

et al. 2020

J Hepato Biliary Pancreat

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Background: This study analyzed treatment and outcomes in patients with primary extrahepatic malignancy (EHM) incidentally diagnosed during pretransplant evaluation for living donor liver transplantation (LDLT). Methods: Of 4621 adult patients undergoing LDLT over 19 years, 41 were diagnosed with EHM shortly before LDLT (incidental malignancy group), and 92 had been treated for EHM more than 6 months before LDLT (treated malignancy group). Results: Most common EHMs were colorectal, thyroid, and stomach cancers in the incidental malignancy group; and stomach, breast, thyroid, colorectal, and renal cell cancers and lymphoma in the treated malignancy group. Mean interval between EHM diagnosis and LDLT in the incidental malignancy group was 1.5 ± 1.6 months. Of the 41 patients in this group, 15 (35.6%), seven (17.1%), and 16 (39.0%) underwent EHM treatment before, during, and after LDLT, respectively, whereas three (7.3%) underwent observation alone.During a mean follow-up of 70.1 ± 50.8 months, six (14.6%) patients showed tumor recurrence, and three (7.3%) died of tumor progression. All recurrences developed in patients with tumor stages higher than the earliest stage. The mean interval between EHM diagnosis and LDLT in treated malignancy group was 79.8 ± 79.6 months. During a mean follow-up of 63.2 ± 54.1 months, three (3.3%) patients showed tumor recurrence and one (1.1%) died of tumor progression. The incidence of EHM recurrence was significantly higher (P = .025), and the overall post-transplant patient survival rate was significantly lower (P = .046), in the incidental malignancy than in the treated malignancy group. Conclusions: Only patients with earliest-stage EHM detected shortly before LDLT are indicated for upfront LDLT combined with peritransplant EHM treatment. K E Y W O R D Shepatocellular carcinoma, living donor liver transplantation, malignancy, recurrence, surveillance

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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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Risk-Based Long-Term Screening for Hepatocellular Carcinoma Recurrence After Living Donor Liver Transplantation

Cited by 26 publications

References 34 publications

Resection of Metachronous Adrenal Metastasis after Liver Resection and Transplantation for Hepatocellular Carcinoma

Resection of Metachronous Adrenal Metastasis after Liver Resection and Transplantation for Hepatocellular Carcinoma

Treatment and outcomes of extrahepatic malignancy incidentally diagnosed during pretransplant evaluation for living donor liver transplantation

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

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