Survival according to recurrence patterns after resection for transplantable hepatocellular carcinoma in HBV endemic area: Appraisal of liver transplantation strategy

Seo, Chung Gyo; Yim, Sun Young; Um, Soon Ho; Lee, Yoo Ra; Kim, Tae Hyung; Goh, Hyun Gil; Suh, Sang Jun; Choi, Hyuk Soon; Kim, Eun Sun; Keum, Bora; Seo, Yeon Seok; Yim, Hyung Joon; Kim, Ji Hoon; Kim, Joo Young; Jeen, Yoon Tae; Chun, Hoon Jai; Lee, Hong Sik; Kim, Chang Duck

doi:10.1016/j.clinre.2019.11.006

Cited by 7 publications

(7 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While some authors have noted that salvage transplantation was not associated with additional morbidity and comparable long-term outcomes versus up-front transplantations, other investigators have cautioned that a subset of patients who undergo initial resection will recur with NTR and therefore lose the survival benefit that may have enjoyed with initial liver transplantation. 10,11,[23][24][25] In turn, selection of patients for initial liver resection versus transplantation relative to risk of NTR may be important to guide upfront surgical recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…microvascular invasion, tumor grade) to estimate NTR. 10,11 While helpful in assessing the likelihood of being eligible for salvage transplantation following initial resection, these data do not inform whether resection versus transplantation may have been the preferred initial operation. A recent single-center study sought to predict NTR before the initial index surgery and proposed an alpha-fetoprotein (AFP) score to help identify patients most at risk of a NTR; 12 this scoring system has been applied clinically in France, yet has not experienced widespread adoption.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Non-transplantable Recurrence After Resection for Transplantable Hepatocellular Carcinoma: Implication for Upfront Treatment Choice

Zhang

Xue

Bagante

et al. 2022

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

Objectives To identify the preoperative risk factors for prediction of non-transplantable recurrence (NTR) after tumor resection for early-stage hepatocellular carcinoma (HCC) to assist in patient selection relative to upfront liver resection (LR) versus liver transplantation (LT). Methods Patients who underwent curative resection for transplantable HCC and chronic liver disease were identified from an international multi-institutional database. NTR was defined as recurrence beyond the Milan or UCSF criteria, and the preoperative risk factors of NTR were investigated. Results Among 293 patients with transplantable HCC within Milan criteria and 320 within UCSF criteria, 113 (38.6%) and 131 (40.9%) patients developed tumor recurrence, respectively. Among patients who recurred, NTR was present in 32 (28.3%) patients within Milan and 35 (26.7%) within UCSF criteria. When either Milan or UCSF criteria was adopted, three preoperative risk factors including liver cirrhosis, tumor size > 3 cm, and multiple lesions were consistently identified as risk factors associated with NTR after curative resection. By summing up the three factors, a scoring model was established and the incidence of NTR among patients with 0, 1 or ≥ 2 risk factors incrementally increased from 4.5%, 13.3% to 20.5% when Milan criteria was used, and from 4.5%, 12.4% to 33.9% when UCSF criteria was adopted. The model demonstrated very good discriminatory power on internal validation (n = 5,000) (c-index 0.689 for Milan criteria, and 0.715 for UCSF criteria). Conclusions Whereas surgical resection may be optimal first-line treatment for patients with no or one risk factor, patients with ≥ 2 risk factors should be considered for upfront liver transplantation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-transplantable Recurrence After Resection for Transplantable Hepatocellular Carcinoma: Implication for Upfront Treatment Choice

Zhang

Xue

Bagante

et al. 2022

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

show abstract

“…Recurrence is a major concern in resected HCC as a considerable number of patients will go on to develop non‐transplantable recurrences, the main obstacle to the long‐term success of primary liver resection. 34 Of note, the proportion of individuals who suffered a larger, earlier, systemic and non‐transplantable recurrence incrementally increased with TAC scores (Figure 2 , Supporting Information: Table 1 ). These results were consistent with a bimodal distribution of HCC recurrence, whereby early recurrence often correlates to residual tumor cells, while late recurrence originates from new multicentric carcinogenesis (i.e., de novo carcinogenesis).…”

Section: Discussionmentioning

confidence: 96%

“…Furthermore, the TAC score was also strongly associated with patterns of recurrence with RFS incrementally worsening with higher TAC scores (Figure 1). Recurrence is a major concern in resected HCC as a considerable number of patients will go on to develop non‐transplantable recurrences, the main obstacle to the long‐term success of primary liver resection 34 . Of note, the proportion of individuals who suffered a larger, earlier, systemic and non‐transplantable recurrence incrementally increased with TAC scores (Figure 2, Supporting Information: Table ).…”

Section: Discussionmentioning

confidence: 98%

TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma

Lima

Endo

Moazzam

et al. 2022

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background: Heterogeneity in hepatocellular carcinoma (HCC) still exists within the Barcelona clinic liver cancer (BCLC) subcategories. We developed a simple model to better discriminate and predict prognosis following resection. Methods: Patients who underwent curative-intent resection for HCC were identified from a multi-institutional database. Predictive factors of survival were identified to develop TAC (tumor burden score [TBS], alpha-fetoprotein [AFP], Child−Pugh CP]) score. Results: Among 1435 patients, median TBS was 5.1 (interquartile range [IQR]: 3.2−8.1), median AFP was 18.3 ng/ml (IQR 4.0−362.5), and 1391 (96.9%) patients were classified as CP-A. Factors associated with overall survival (OS) included

show abstract

“…Concerning the definition of recurrence with any kind of recurrence treatment, due to lack of hospital-level information, patients not receiving any antitumor therapy due to bad performance state could have been missed based on this definition of recurrence. Nonetheless, given that the proportion of patients treated with only best supportive care for post-operative recurrence was quite low (5~7%) owing to the bad performance status or insufficient hepatic function to tolerate surgical resection [ 47 , 48 , 49 ], we might carefully speculate that our operational definition could cover the recurrence appropriately via our large sample size cohort. Further prospective cohort studies with detailed information should be conducted to overcome this limitation.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of MAFLD Following Surgical Resection of Hepatitis B Virus-Related Hepatocellular Carcinoma: A Nationwide Cohort Study

Yun

Ahn

et al. 2022

Cancers

View full text Add to dashboard Cite

The association between the metabolic effects of hepatic steatosis as a part of postoperative outcomes of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) has rarely been studied. This study aimed to assess the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and patients’ prognoses following curative resection of HBV-related HCC. Patients who underwent surgical resection for HBV-related HCC between 2009 and 2015 were recruited. The study endpoints were postoperative hepatocellular carcinoma (HCC) recurrence and all-cause mortality. Adjusted hazard ratios (aHRs) for the outcomes were estimated using multivariate Cox regression models. The mean age of the 2032 enrolled patients was 55.0 years, and 77.9% were men. During follow-up (median 5.3 years), HCC recurrence and all-cause mortality occurred in 954 (47.0%) and 422 (20.8%) patients, respectively. HCC recurrence and all-cause mortality were significantly associated with MAFLD, with aHRs of 1.22 (p = 0.003) and 1.44 (p < 0.001), respectively. Propensity score matching and inverse probability treatment weighting analyses confirmed similar results (p < 0.05). MAFLD was associated with significantly poor prognoses in terms of HCC recurrence and all-cause mortality following surgical resection of HBV-related HCC. Further studies are needed to develop an effective preventive strategy through the management of metabolic health.

show abstract

Survival according to recurrence patterns after resection for transplantable hepatocellular carcinoma in HBV endemic area: Appraisal of liver transplantation strategy

Cited by 7 publications

References 41 publications

Non-transplantable Recurrence After Resection for Transplantable Hepatocellular Carcinoma: Implication for Upfront Treatment Choice

Non-transplantable Recurrence After Resection for Transplantable Hepatocellular Carcinoma: Implication for Upfront Treatment Choice

TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma

Prognostic Impact of MAFLD Following Surgical Resection of Hepatitis B Virus-Related Hepatocellular Carcinoma: A Nationwide Cohort Study

Contact Info

Product

Resources

About