Simple Risk Score for Prediction of Early Recurrence of Hepatocellular Carcinoma within the Milan Criteria after Orthotopic Liver Transplantation

Ji-liang, Feng; Wu, Junchen; Zhu, Ruidong; Feng, Dezhao; Lu, Yu; Zhang, Yan; Bu, Dayu; Li, Chenlei; Yu-yan, Zhou; Si, Lianghao; Liu, Yuhan; Liang, Ziwei; Xu, Jianing; Wu, Tao

doi:10.1038/srep44036

Cited by 17 publications

(17 citation statements)

References 27 publications

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“…In our previous study, which included extra 120 HCC patients beyond MC who underwent RR were included, significant differences in the RFS rates were observed between the patients of the CK19+/GPC3+ and CK19−/GPC3+ or CK19−/GPC3− groups [ 12 ]. However, in another cohort of HCC patients fitting MC who underwent LT in our center showed significant differences in RFS rates and were placed between the three CK19/GPC3 groups [ 26 ]. In the current cohort of HCC patients within MC who underwent RR, only CK19+/GPC3+ phenotype HCC was significantly associated with the recurrence and was consistent with that of our previous study [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Prediction of early recurrence of hepatocellular carcinoma within the Milan criteria after radical resection

et al. 2017

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Approximately 50% hepatocellular carcinoma patients meeting the Milan criteria utilized to develop an improved prognostic model for predicting the recurrence in these patients. Using univariate and multivariate analysis, cytokeratin-19 and glypican-3 expression patterns, tumor number and histological grading from eight putative prognostic factors comprised the risk factor scoring model to predict the tumor recurrence. In the training cohort, the area under roc curve (AUC) value of the model was 0.715 [95% confidence interval (CI) = 0.645−0.786, P<0.001], which was the highest among all the parameters. The performance of the model was assessed using an independent validation cohort, wherein the AUC value was 0.760 (95% CI=0.647−0.874, P<0.001), which was higher than the other factors. The results indicated that model had high performance with adequate discrimination ability. Moreover, it significantly improved the predictive capacity for the recurrence in patients with hepatocellular carcinoma within the Milan criteria after radical resection.

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Section: Discussionmentioning

confidence: 99%

Prediction of early recurrence of hepatocellular carcinoma within the Milan criteria after radical resection

et al. 2017

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“…tumour-specific mortality [10]. HCC associated with cryptogenic cirrhosis is larger than cancers related to HCV even in patients who correspond to Milan criteria [51]. However, after curative treatment, the recurrence risk and mortality are lower for HCC arising in cryptogenic cirrhosis-finding that is in accordance with the grade difference [52].…”

Section: Nash-induced Hccmentioning

confidence: 89%

Non-Alcoholic Steatohepatitis, Liver Cirrhosis and Hepatocellular Carcinoma: The Molecular Pathways

Mezale¹,

Štrumfa²,

Vanags³

et al. 2017

Liver Cirrhosis - Update and Current Challenges

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Non-alcoholic steatohepatitis (NASH) is growing into global problem, mainly due to NASH-induced cirrhosis and hepatocellular carcinoma (HCC), that can develop either subsequently to cirrhosis or preceding it. In addition, NASH-induced cirrhosis constitutes a significant fraction of cases diagnosed as cryptogenic cirrhosis. Thus, there is a need for deeper understanding of the molecular basis, leading to liver steatosis, then-to the associated inflammation seen in NASH, loss of liver architecture and cirrhosis, followed or paralleled by carcinogenesis and HCC. Insulin resistance, increased hepatic iron level, and certain cytokines, including TNF-α and IL-6 derived from extrahepatic adipose tissues, can trigger the chain of events. The imbalance between leptin and adiponectin is important as well. These markers remain important during the whole course from NASH through liver cirrhosis to HCC. The molecular pathogenesis substantiates treatment: hypertriglyceridemia can be lowered by low calorie diet; mTOR complex can become inhibited by physical activity and metformin; cholesterol synthesis, RAF/ MAPK1/ERK and p21 pathway by statins; inflammation by pentoxyfillin, and kinases (in HCC) by sorafenib. Bidirectional regulation of telomere attrition, senescence and p21 pathway, restoration of wild-type p53 activity and regulation of miRNA network represent attractive future treatment options. Focusing on relevant molecular pathways allows deeper understanding of NASH pathogenesis, leading to identification of predictive markers and treatment targets.[10] and other Western industrialised countries, facing high occurrence of the major risk factors for NAFLD, namely, central obesity, type 2 diabetes mellitus, dyslipidemia and metabolic syndrome [11]. In a recent meta-analysis of 86 studies, comprising 8,515,431 persons from 22 countries, the global prevalence of NAFLD was 25.24% (95% confidence interval [CI], showing the highest occurrence in the Middle East and South America and the lowest in Africa [5].Liver Cirrhosis -Update and Current Challenges 2 Thus, 90% of patients suffering from morbid obesity (defined as having body mass index 40 kg/m 2 or higher) and 74% patients affected by diabetes mellitus develop NAFLD. In addition, NAFLD has been observed even in non-obese, non-diabetic patients who have increased insulin levels in blood and resistance to insulin action. Consequently, NAFLD affects up to 20-30% of adults in Europe and 46% in the USA: a tremendously high prevalence for a condition that can cause any significant complications [9, 10]. Non-Alcoholic Steatohepatitis, Liver Cirrhosis and Hepatocellular Carcinoma: The Molecular Pathways http://dx.doi.org/10.5772/intechopen.68771 3Most patients are diagnosed with NAFLD in their 40s or 50s. Studies vary in regard to the gender distribution of NAFLD, with some suggesting that it is more common in women and others suggesting more frequent occurrence in men [11,12].Since 1998, non-alcoholic fatty liver disease has been considered a condition with a "two-hit" course of...

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“…By contrast, the diagnostic efficiencies of APRI-B, PLT-B and AST-B, in predicting HCC (the AUCs were 0.715, 0.733 and 0.609, respectively) 38 are much lower than that of APAR. Another index, which consists of AFP, cytokeratin-19 and glypican-3 for prediction of early recurrence of HCC, only has an AUC of 0.767 39 . Therefore, the diagnostic efficiency of APAR can be acceptable in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

A Simple Noninvasive Index Can Predict Hepatocellular Carcinoma in Patients with Chronic Hepatitis B

Zhu

et al. 2017

Sci Rep

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Screening for possible development of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) is essential for risk prediction and early therapy. This study reported a novel model comprised of routine laboratory variables for predicting HCC from CHB. A retrospective study was performed among 463 participants. alpha-fetoprotein (AFP), platelet and alanine aminotransferase (ALT) ratio (APAR) was constructed to differentiate HCC from CHB or non-cancer with area under the receiver operating characteristic curves (AUC) of 0.815 and 0.868 in the training set, 0.831 and 0.861 in the validation set, respectively. In participants with low or normal AFP (<100 ng/mL), the diagnostic efficacy of APAR measured by AUC were 0.817 and 0.809 for predicting HCC from CHB or non-cancer, and at a cutoff of 0.47, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 89%, 60%, 67% and 86%, respectively. For participants with normal AFP (<20 ng/mL), the AUC of APAR were 0.839 and 0.746 accompanied by a cutoff of 0.36 with sensitivity, specificity, PPV, and NPV of 88%, 69%, 71%, and 87%, respectively. In conclusion, APAR is an effective model for HCC screening especially in those with low even normal serum AFP levels.

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Simple Risk Score for Prediction of Early Recurrence of Hepatocellular Carcinoma within the Milan Criteria after Orthotopic Liver Transplantation

Cited by 17 publications

References 27 publications

Prediction of early recurrence of hepatocellular carcinoma within the Milan criteria after radical resection

Prediction of early recurrence of hepatocellular carcinoma within the Milan criteria after radical resection

Non-Alcoholic Steatohepatitis, Liver Cirrhosis and Hepatocellular Carcinoma: The Molecular Pathways

A Simple Noninvasive Index Can Predict Hepatocellular Carcinoma in Patients with Chronic Hepatitis B

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