Risk factors and management for early and late intrahepatic recurrence of solitary hepatocellular carcinoma after curative resection

Cheng, Zhao; Yang, Pinghua; Qu, Shen; Zhou, Jiahua; Yang, Jing; Yang, Xinwei; Xia, Yong; Li, Jun; Wang, Kui; Yan, Zhenlin; Wu, Dong; Zhang, Baohua; Hüser, Norbert; Shen, Feng

doi:10.1111/hpb.12367

Cited by 136 publications

(127 citation statements)

References 31 publications

(66 reference statements)

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“…In two separate studies, the 5-year overall survival rates of postoperative HCC patients with recurrent HCC were 30.9% and 38%, which were significantly poorer than those without recurrent HCC, having 5-year overall survival rates of 72.9% and 85%. In our study, the 5-year overall survival rates of patients with and without recurrent HCC were 38.7% and 77.9%, respectively, which were similar to the observations made in the two studies [38, 39]. Although patients with early recurrences had a poorer 5-year overall survival rate than those with late recurrences (3.8% vs 66.2%), all patients with recurrent HCC eventually died, suggesting that HCC recurrence has a major impact on the postoperative prognosis of HCC patients.…”

Section: Discussionsupporting

confidence: 91%

Significant predictors of overall survival in patients with hepatocellular carcinoma after surgical resection

et al. 2018

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BackgroundThe predictive factors of overall survival after hepatectomy for HCC remain controversial and need to be investigated.MethodsIn total, 535 consecutive HCC patients undergoing resection were included and their clinicopathological data and overall survival were recorded. Both the tumor and adjacent non-tumor (ANT) tissues were subjected to immunohistochemistry analysis for the expression of autophagy-related markers.ResultsDeath was observed for 219 patients, and the cumulative overall survival rates at 1, 3, 5 and 7 years were 91.0%, 72.3%, 58.8%, and 27.7%, respectively. In the multivariate analysis, mortality was significantly associated with the following: diminished LC3 expression in both the tumor and ANT tissues, in the HCC tissues alone and in the ANT tissues alone (hazard ratio/95% confidence interval: 6.74/2.052–22.19, 6.70/1.321–33.98 and 2.58/1.499–4.915, respectively); recurrent HCC (5.11/3.136–8.342); HBV infection (2.75/1.574–4.784); cirrhosis (1.78/1.059–2.974); and antiviral therapy (0.42/0.250–0.697). The 5-year overall survival rates were 70.2%, 57.3%, 49.6% and 10.7% for patients with positive LC3 expression in both tissue types, in the HCC tissues alone, in the ANT tissues alone, and in neither tissue type, respectively. The 5-year overall survival rates were 56.7%, 47.3%, 51.2% and 38.7% for patients with HBV-related HCC, cirrhosis, no antiviral therapy, and recurrent HCC, respectively, and these rates were significantly lower than those in their counterparts.ConclusionsPatients with recurrent HCC, HBV-related HCC, cirrhosis, and the absence of antiviral therapy showed significantly lower overall survival rates. Furthermore, LC3 expression in both the tumor and liver microenvironments were significantly predictive of overall survival after resection for HCC.

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Section: Discussionsupporting

confidence: 91%

Significant predictors of overall survival in patients with hepatocellular carcinoma after surgical resection

et al. 2018

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“…Early and late tumour relapses are believed to be two distinct entities associated with different risk factors. Early relapse is determined mainly by aggressive characteristics of primary tumour such as larger tumour size, vascular invasion and higher serum AFP level . These associations support that early relapse probably results from intrahepatic metastasis disseminated from primary tumour.…”

Section: Discussionmentioning

confidence: 65%

Steatotic hepatocellular carcinoma: a variant associated with metabolic factors and late tumour relapse

Chan

et al. 2016

Histopathology

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“…Sumie et al[64] report 3-year recurrence-free survival rates in HCC with and without microvascular invasion to be 27.7% and 67.5%, respectively. Other poor histopathological features, like the presence of satellite nodules and poor tumor differentiation, are also recognized, along with microvascular invasion, to predict early recurrence[32,39,43,65-68]. Most of these poor histopathological factors associated with early recurrence after LR are also predictors of recurrence after LT, including larger tumor size, larger tumor number, satellite nodules, poorer tumor differentiation, and microvascular invasion (Table 2).…”

Section: Tumor-related Factors: Histopathological Factorsmentioning

confidence: 99%

Prophylactic liver transplantation for high-risk recurrent hepatocellular carcinoma

Yang¹,

Ho²,

Hu³

et al. 2016

WJH

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Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related death in the world. Radical treatment of HCC in early stages results in a long disease-free period and improved overall survival. The choice of optimal management strategy for HCC mainly depends on the severity of the underlying liver disease. For patients with decompensated liver cirrhosis and HCC within Milan criteria (MC), liver transplant (LT) is the choice of treatment. However, for patients with good residual liver reserve and HCC within MC, selection of other curative treatments such as liver resection (LR) or radiofrequency ablation may be a reasonable alternative. For patients without cirrhosis, LR can result in an overall survival similar to that provided by LT. Therefore, it is an accepted alternative to LT especially in areas with organ shortage. However, the cumulative 5-year recurrence rate of HCC post LR might be as high as 70%. For initial transplant-eligible (within MC) patients with recurrent HCC post LR, salvage liver transplant (SLT) was first proposed in 2000. However, most patients with recurrent HCC considered for SLT are untransplantable cases due to HCC recurrence beyond MC or comorbidity. Thus, the strategy of opting for SLT results in the loss of the opportunity of LT for these patients. Some authors proposed the concept of “de principe liver transplant” (i.e., prophylactic LT before HCC recurrence) to prevent losing the chance of LT for these potential candidates. Factors associated with the failure of SLT will be dissected and discussed in three parts: Patient, tumor, and underlying liver disease. Regarding patient-related factors, the rate of transplantability depends on patient compliance. Patients without regular follow-up tend to develop HCC recurrence beyond MC at the time of tumor detection. Advancing age is another factor related to severe comorbidities when LT is considered for HCC recurrence, and these elderly candidates become ineligible as time goes by. Regarding tumor-related factors, histopathological features of the resected specimen are used mostly for determining the prognosis of early HCC recurrences. Such prognostic factors include the presence of microvascular invasion, poor tumor differentiation, the presence of microsatellites, the presence of multiple tumors, and the presence of the gene-expressing signature associated with aggressive HCC. These prognostic factors might be used as a selection tool for SLT or prophylactic LT, while remaining mindful of the fact that most of them are also prognostic factors for post-transplant HCC recurrence. Regarding underlying liver disease-related factors, progression of chronic viral hepatitis and high viral load may contribute to the development of late (de novo) HCC recurrence as a consequence of sustained inflammatory reaction. However, correlation between the severity of liver fibrosis and tumor recurrence is still controversial. Some prognostic scoring systems that integrate these three factors have been proposed to predict recurrence pattern...

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Risk factors and management for early and late intrahepatic recurrence of solitary hepatocellular carcinoma after curative resection

Abstract: Early and late recurrences of solitary HCC after curative resection are associated with different predictive factors. The time to recurrence and further curative treatment after recurrence were the best predictors of survival post recurrence.

Cited by 136 publications

References 31 publications

Significant predictors of overall survival in patients with hepatocellular carcinoma after surgical resection

Significant predictors of overall survival in patients with hepatocellular carcinoma after surgical resection

Steatotic hepatocellular carcinoma: a variant associated with metabolic factors and late tumour relapse

Prophylactic liver transplantation for high-risk recurrent hepatocellular carcinoma

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