Superiority of Transplantation Versus Resection for the Treatment of Small Hepatocellular Carcinoma

Baccarani, Umberto; Benzoni, Enrico; Adani, Gian Luigi; Avellini, Claudio; Lorenzin, Dario; Sainz-Barriga, Mauricio; Bresàdola, Vittorio; Uzzau, Alessandro; Risaliti, Andrea; Beltrami, Carlo Alberto; Bresadola, F

doi:10.1016/j.transproceed.2007.05.045

Cited by 33 publications

(27 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite the lack of a high-grade evidence base for either resection or transplantation, the result of these treatments provides 5-year survival rates of up to 70% in selected patients. These are clearly superior to the natural course of the disease [5-7]. Liver transplantation is theoretically the best resolution of HCC within UCSF criteria.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the recurrence risk factors for the patients with hepatocellular carcinoma meeting University of California San Francisco criteria after curative hepatectomy

Soong

Chan

et al. 2011

World J Surg Onc

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Analysis of the recurrence risk factors for the patients with hepatocellular carcinoma meeting University of California San Francisco criteria after curative hepatectomy

Soong

Chan

et al. 2011

World J Surg Onc

View full text Add to dashboard Cite

“…The 62% post‐LR 5‐year cumulative recurrence rate and the 30.1% annual mortality risk of recurrent HCC were the medians derived from studies included in Lim et al and data from the SGH LR database (http://onlinelibrary.wiley.com/doi/10.1002/hep.27135/suppinfo). The modeling of the recurrence state was necessary, as LR patients generally suffer from frequent recurrence, and an increasing variety of therapies are used to manage recurrences in actual clinical settings, impacting overall cost‐effectiveness of the treatment .…”

Section: Methodsmentioning

confidence: 99%

“…We assumed the cost of these treatments to be equivalent to three transarterial‐chemoembolization (TACE) sessions. The 30‐day postoperative mortality of 2.2% was the median derived from studies within Lim et al's review . Age‐related mortality risks were based on United States life tables…”

Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness analysis of liver resection versus transplantation for early hepatocellular carcinoma within the Milan criteria

et al. 2014

View full text Add to dashboard Cite

Both liver resection (LR) and cadaveric liver transplantation (CLT) are potentially curative treatments for patients with hepatocellular carcinoma (HCC) within the Milan criteria and with adequate liver function. Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of LR against CLT for patients with HCC within the Milan criteria using a decision analytic model. A Markov cohort model was developed to simulate a cohort of patients aged 55 years with HCC within the Milan criteria and Child-Pugh A/B cirrhosis, undergoing LR or CLT, and followed up over their remaining life expectancy. Analysis was performed in different geographical cost settings: the USA, Switzerland and Singapore. Transition probabilities were obtained from systematic literature reviews, supplemented by databases from Singapore and the Organ Procurement and Transplantation Network (USA). Utility and cost data were obtained from open sources. LR produced 3.9 quality-adjusted life years (QALYs) while CLT had an additional 1.4 QALYs. The incremental cost-effectiveness ratio (ICER) of CLT versus LR ranged from $111,821/QALY in Singapore to $156,300/QALY in Switzerland, and was above thresholds for cost-effectiveness in all three countries. Sensitivity analysis revealed that CLTrelated 5-year cumulative survival, one-time cost of CLT, and post-LR 5-year cumulative recurrence rates were the most sensitive parameters in all cost scenarios. ICERs were reduced below threshold when CLT-related 5-year cumulative survival exceeded 84.9% and 87.6% in Singapore and the USA, respectively. For Switzerland, the ICER remained above the cost-effectiveness threshold regardless of the variations. Conclusion: In patients with HCC within the Milan criteria and Child-Pugh A/B cirrhosis, LR is more cost-effective than CLT across three different costing scenarios: the USA, Switzerland, Singapore. (HEPATOLOGY 2015;61:227-237) H epatocellular carcinoma (HCC) is a common cancer with a higher disease burden in East Asia due to the prevalence of chronic viral hepatitis in the region. 8 Emerging data show improving trends in LR outcomes, possibly due to better patient selection, postoperative management, and multimodality treatment for recurrences.9 While recurrence rates in LT are often lower than LR, LT faces considerable resource challenges in many countries, such as the limited supply of cadaveric transplant organs, leading to cancer progression during long waiting times that limit intention-to-treat survival for LT.10 LT patients also require long-term immune suppression, with attendant risks and significant lifetime costs.Randomized trials comparing the two treatments are neither ethical nor practical. Due to the large financial outlay and recurrent costs needed to run a liver transplant program for a large number of HCC patients, 11 the decision to adopt either therapy as a first-line option carries major implications with respect to costs, utility of scarce re...

show abstract

“…In small HCC, about 15% to 35% cases are with MVI, [9] about 60% to 90% cases are with cirrhosis, [10,11] and about 15% to 45% cases are multifocal. [10,12,13] Therefore, even in small HCC, 5-year RFS rate is only about 40%, [14,15] improvements in preventing recurrence and prolonging OS are essential. However, methods to prevent recurrence are limited.…”

Section: Discussionmentioning

confidence: 99%

Thymalfasin, a promising adjuvant therapy in small hepatocellular carcinoma after liver resection

Peng

et al. 2017

Medicine

View full text Add to dashboard Cite

There is limited information available concerning the effect of thymalfasin (Tα1) as an adjuvant therapy in hepatocellular carcinoma (HCC) patient who received liver resection. The present study aimed to evaluate whether Tα1 can improve the prognosis of small HCC patients after liver resection.A total of 206 patients with small HCC who underwent liver resection were analyzed in our retrospective cohort study. Patients were divided into 2 groups: group A (resection + Tα1, n = 44) and group B (resection, n = 162). Clinical data, overall survival (OS), and recurrence-free survival (RFS) were compared. Prognostic factors were identified using multivariate analysis.After a median follow-up of 47.0 months, 134 patients (65%) had recurrence, and 62 patients (30.09%) died. The 1, 3, and 5-year OS rate of patients in group A was 97.7%, 90.6%, and 82.9%, respectively, and 95.1%, 80.5%, and 62.9%, respectively, for patients in group B (P = .014). The 1, 3, and 5-year RFS rate of patients in group A was 70.5%, 56.8%, and 53.3%, respectively, and 65.8%, 41.3%, and 32.1%, respectively, for patients in group B (P = .015). Multivariate analysis indicated that Tα1 was an independent prognostic factor for both OS (P = .015, hazard ratio 0.349, 95% confidence interval 0.149–0.816) and RFS (P = .019, hazard ratio 0.564, 95% confidence interval 0.349–0.910).Tα1 as an adjuvant therapy after liver resection may improve the prognosis of small HCC patients after liver resection.

show abstract

Superiority of Transplantation Versus Resection for the Treatment of Small Hepatocellular Carcinoma

Cited by 33 publications

References 11 publications

Analysis of the recurrence risk factors for the patients with hepatocellular carcinoma meeting University of California San Francisco criteria after curative hepatectomy

Analysis of the recurrence risk factors for the patients with hepatocellular carcinoma meeting University of California San Francisco criteria after curative hepatectomy

Cost‐effectiveness analysis of liver resection versus transplantation for early hepatocellular carcinoma within the Milan criteria

Thymalfasin, a promising adjuvant therapy in small hepatocellular carcinoma after liver resection

Contact Info

Product

Resources

About