Prognostic Relevance of a Complete Pathologic Response in Liver Transplantation for Hepatocellular Carcinoma.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
01
06
2019
pubmed:
15
9
2019
medline:
16
4
2020
entrez:
15
9
2019
Statut:
ppublish
Résumé
A complete pathologic response (CPR) after neoadjuvant treatment is reported to be associated with an exceptionally low risk of recurrence after liver transplantation for hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic role of CPR in liver transplantation for HCC. This retrospective cohort study was based on 222 HCC transplant recipients. Incidence of recurrence and survival at 5 years were the primary and secondary outcome measures, respectively. Competing risk analyses were applied to evaluate recurrence incidence and its predictors. Propensity score matching was performed to compare the outcomes for patients after neoadjuvant treatment with and without CPR. Neoadjuvant treatment was performed for 127 patients, 32 of whom achieved CPR (25.2%). Comparison of baseline characteristics showed that the patients with CPR were at lowest baseline recurrence risk, followed by treatment-naïve patients and patients without CPR. Adjusted for potential confounders, CPR did not have any significant effects on tumor recurrence. No significant net reclassification improvement was noted after addition of CPR to existing criteria. Neoadjuvant treatment without CPR was associated with increased risk of recurrence in subgroups within the Milan criteria (p = 0.016), with alpha-fetoprotein concentration (AFP) model not exceeding 2 points (p = 0.021) and within the Warsaw criteria (p = 0.007) compared with treatment-naïve patients who were at risk similar to those with CPR. The 5-year incidences of recurrence in propensity score-matched patients with and without CPR were respectively 14.0% and 15.9% (p = 0.661), with corresponding survival rates of 73.2% and 67.4%, respectively (p = 0.329). The findings showed that CPR is not independently associated with long-term outcomes after liver transplantation for HCC.
Sections du résumé
BACKGROUND
BACKGROUND
A complete pathologic response (CPR) after neoadjuvant treatment is reported to be associated with an exceptionally low risk of recurrence after liver transplantation for hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic role of CPR in liver transplantation for HCC.
METHODS
METHODS
This retrospective cohort study was based on 222 HCC transplant recipients. Incidence of recurrence and survival at 5 years were the primary and secondary outcome measures, respectively. Competing risk analyses were applied to evaluate recurrence incidence and its predictors. Propensity score matching was performed to compare the outcomes for patients after neoadjuvant treatment with and without CPR.
RESULTS
RESULTS
Neoadjuvant treatment was performed for 127 patients, 32 of whom achieved CPR (25.2%). Comparison of baseline characteristics showed that the patients with CPR were at lowest baseline recurrence risk, followed by treatment-naïve patients and patients without CPR. Adjusted for potential confounders, CPR did not have any significant effects on tumor recurrence. No significant net reclassification improvement was noted after addition of CPR to existing criteria. Neoadjuvant treatment without CPR was associated with increased risk of recurrence in subgroups within the Milan criteria (p = 0.016), with alpha-fetoprotein concentration (AFP) model not exceeding 2 points (p = 0.021) and within the Warsaw criteria (p = 0.007) compared with treatment-naïve patients who were at risk similar to those with CPR. The 5-year incidences of recurrence in propensity score-matched patients with and without CPR were respectively 14.0% and 15.9% (p = 0.661), with corresponding survival rates of 73.2% and 67.4%, respectively (p = 0.329).
CONCLUSIONS
CONCLUSIONS
The findings showed that CPR is not independently associated with long-term outcomes after liver transplantation for HCC.
Identifiants
pubmed: 31520204
doi: 10.1245/s10434-019-07811-z
pii: 10.1245/s10434-019-07811-z
pmc: PMC6863942
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
4556-4565Subventions
Organisme : Fundacja na rzecz Nauki Polskiej
ID : START 032.2018
Références
Ann Surg. 2017 Sep;266(3):525-535
pubmed: 28654545
Ann Surg. 2015 Sep;262(3):536-45; discussion 543-5
pubmed: 26258323
Ann Surg Oncol. 2017 Oct;24(11):3188-3195
pubmed: 28695391
Liver Transpl. 2017 Mar;23(3):375-385
pubmed: 28006873
World J Gastroenterol. 2017 May 28;23(20):3690-3701
pubmed: 28611522
Gastroenterology. 2012 Oct;143(4):986-94.e3; quiz e14-5
pubmed: 22750200
Lancet Oncol. 2012 Jan;13(1):e11-22
pubmed: 22047762
J Hepatol. 2015 Jul;63(1):83-92
pubmed: 25646884
Hepatology. 2019 Mar;69(3):1324-1336
pubmed: 30229978
Gastroenterology. 2018 Jan;154(1):128-139
pubmed: 28989060
J Hepatol. 2017 Dec;67(6):1213-1221
pubmed: 28823713
Hepatology. 2017 Dec;66(6):1910-1919
pubmed: 28653750
Radiology. 2018 Mar;286(3):1072-1083
pubmed: 29206595
Surgery. 2017 Dec;162(6):1250-1258
pubmed: 29033224
J Am Coll Surg. 2017 Jul;225(1):28-40
pubmed: 28400300
Transpl Int. 2019 Feb;32(2):163-172
pubmed: 30152891
Liver Transpl. 2018 Jan;24(1):98-103
pubmed: 29077253
Hepatology. 2018 Oct;68(4):1448-1458
pubmed: 29604231
Liver Transpl. 2017 Jun;23(6):781-790
pubmed: 28240808
Liver Transpl. 2019 Feb;25(2):228-241
pubmed: 30198150
Liver Transpl. 2016 Nov;22(11):1491-1500
pubmed: 27543821
Pol Przegl Chir. 2012 Jun;84(6):304-12
pubmed: 22842743
Hepatology. 2018 Jan;67(1):381-400
pubmed: 28859222
Ann Intern Med. 2014 Jan 21;160(2):122-31
pubmed: 24592497
Ann Surg. 2016 Nov;264(5):787-796
pubmed: 27429025
PLoS One. 2013;8(1):e53960
pubmed: 23349774
Ann Surg. 2018 Oct;268(4):690-699
pubmed: 30048307
Hepatology. 2015 Jul;62(1):158-65
pubmed: 25777590
Ann Surg Oncol. 2017 Feb;24(2):526-534
pubmed: 27531306
Ann Surg. 2018 Nov;268(5):868-875
pubmed: 30080736
Bone Marrow Transplant. 2007 Aug;40(4):381-7
pubmed: 17563735
Bone Marrow Transplant. 2010 Sep;45(9):1388-95
pubmed: 20062101
Ann Transplant. 2016 Feb 18;21:115-24
pubmed: 26887339
J Hepatol. 2011 Oct;55(4):814-9
pubmed: 21334400
Ann Transplant. 2013 Sep 06;18:448-59
pubmed: 24008493