Risk Score Model for Liver Transplant Outcomes after Preoperative Locoregional Therapy for Hepatocellular Carcinoma.
Down staging
Hepatocellular carcinoma
Living donor liver transplant
Locoregional therapy
Recurrence
Journal
Journal of gastrointestinal cancer
ISSN: 1941-6636
Titre abrégé: J Gastrointest Cancer
Pays: United States
ID NLM: 101479627
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
accepted:
09
11
2020
pubmed:
14
11
2020
medline:
26
3
2022
entrez:
13
11
2020
Statut:
ppublish
Résumé
The role of preoperative locoregional therapy (LRT) for hepatocellular carcinoma (HCC) before liver transplantation (LT) remains unclear. Moreover, LRT in the setting of living donor liver transplantation (LDLT) merits further exploration. The objective of the current study was to determine risk factors for poor outcomes after LDLT in patients who received locoregional therapy (LRT). We reviewed patients (n = 46) who underwent LDLT after LRT. Multivariate analysis was performed to determine independent predictors of recurrence-free survival (RFS). Risk scores were developed to define prognostic groups. Median tumor size was 3.7 (1.2-12) cm and tumor number was 1 (1-6). Macrovascular invasion was seen in 10/46 (21.7%) patients. There was a significant difference in 5-year RFS with > 3 tumor nodules (P = 0.005), tumors outside University of California San Francisco criteria (P = 0.03), bilobar disease (P = 0.002), AFP > 600 ng/ml (P = 0.006), and poor response to LRT (P = 0.007). On multivariate analysis, bilobar disease (HR = 2.9, P = 0.01), AFP > 600 ng/ml (HR = 2.3 P = 0.008), and poor response to LRT (HR = 2, P = 0.02) were predictors of 5-year RFS. The 5-year RFS in low risk (score = 0), intermediate risk (score = 1-3), and high risk (score = 4-7) groups was 86%, 76%, and 9% (P < 0.0001). There was no recurrence seen in 4/4 (100%) patients with macrovascular invasion in the low-intermediate risk group. The 5-year RFS in the low-intermediate risk group within and outside Milan criteria was 100% and 74% (P = 0.1). LDLT can provide excellent long-term RFS in patients after preoperative LRT in the low and intermediate risk groups.
Identifiants
pubmed: 33184772
doi: 10.1007/s12029-020-00554-1
pii: 10.1007/s12029-020-00554-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
84-90Informations de copyright
© 2020. Springer Science+Business Media, LLC, part of Springer Nature.
Références
Song TJ, Ip EW, Fong Y. Hepatocellular carcinoma: current surgical management. Gastroenterology. 2004;127:S248–60. https://doi.org/10.1053/j.gastro.2004.09.039 .
doi: 10.1053/j.gastro.2004.09.039
pubmed: 15508091
Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693–9. https://doi.org/10.1056/NEJM199603143341104 .
doi: 10.1056/NEJM199603143341104
pubmed: 8594428
pmcid: 8594428
Sapisochin G, Bruix J. Liver transplantation for hepatocellular carcinoma: outcomes and novel surgical approaches. Nat Rev Gastroenterol Hepatol. 2017;14:203–17. https://doi.org/10.1038/nrgastro.2016.193 .
doi: 10.1038/nrgastro.2016.193
pubmed: 28053342
Zheng SS, Xu X, Wu J, Chen J, Wang WL, Zhang M, et al. Liver transplantation for hepatocellular carcinoma: Hangzhou experiences. Transplantation. 2008;85:1726–32. https://doi.org/10.1097/TP.0b013e31816b67e4 .
doi: 10.1097/TP.0b013e31816b67e4
pubmed: 18580463
DuBay D, Sandroussi C, Sandhu L, Cleary S, Guba M, Cattral MS, et al. Liver transplantation for advanced hepatocellular carcinoma using poor tumor differentiation on biopsy as an exclusion criterion. Ann Surg. 2011;253:166–72. https://doi.org/10.1097/sla.0b013e31820508f1 .
doi: 10.1097/sla.0b013e31820508f1
pubmed: 21294289
Lee SG, Hwang S, Moon DB, Ahn CS, Kim KH, Sung KB, et al. Expanded indication criteria of living donor liver transplantation for hepatocellular carcinoma at one large-volume center. Liver Transpl. 2008;14:935–45. https://doi.org/10.1002/lt.21445 .
doi: 10.1002/lt.21445
pubmed: 18581465
Halazun KJ, Najjar M, Abdelmessih RM, Samstein B, Griesemer AD, Guarrera JV, et al. Recurrence after liver transplantation for hepatocellular carcinoma: a new MORAL to the story. Ann Surg. 2017;265:557–64. https://doi.org/10.1097/SLA.0000000000001966 .
doi: 10.1097/SLA.0000000000001966
pubmed: 27611615
Duvoux C, Roudot-Thoraval F, Decaens T, Pessione F, Badran H, Piardi T, et al. Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria. Gastroenterology. 2012;143:986–e15. https://doi.org/10.1053/j.gastro.2012.05.052 .
doi: 10.1053/j.gastro.2012.05.052
pubmed: 22750200
Kulik L, Heimbach JK, Zaiem F, Almasri J, Prokop LJ, Wang Z, et al. Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: a systematic review and meta-analysis. Hepatology. 2018;67:381–400. https://doi.org/10.1002/hep.29485 .
doi: 10.1002/hep.29485
pubmed: 28859222
Mazzaferro V, Citterio D, Bhoori S, Bongini M, Miceli R, De Carlis L, et al. Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b/3 trial. Lancet Oncol. 2020;21:947–56. https://doi.org/10.1016/S1470-2045(20)30224-2 .
doi: 10.1016/S1470-2045(20)30224-2
pubmed: 32615109
Cho CW, Choi GS, Kim JM, Kwon CHD, Kim DJ, Joh JW, et al. Clinical usefulness of transarterial chemoembolization response prior to liver transplantation as predictor of optimal timing for living donor liver transplantation. Ann Surg Treat Res. 2018;95:111–20. https://doi.org/10.4174/astr.2018.95.2.111 .
doi: 10.4174/astr.2018.95.2.111
pubmed: 30079328
Dar FS, Bhatti ABH, Qureshi AI, Eswani Z, Zia HH, Khan EU, et al. Living donor liver transplantation in South Asia: single center experience on intermediate-term outcomes. World J Surg. 2018;42:1111–9. https://doi.org/10.1007/s00268-017-4259-1 .
doi: 10.1007/s00268-017-4259-1
pubmed: 28936685
Bhatti ABH, Dar FS, Qureshi AI, Khan NY, Zia HH, Haider S, et al. Living donor liver transplantation for hepatocellular carcinoma: a single-center experience from Pakistan. J Clin Exp Hepatol. 2019;9(6):704–9. https://doi.org/10.1016/j.jceh.2019.04.052 .
doi: 10.1016/j.jceh.2019.04.052
pubmed: 31889751
pmcid: 6926250
Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30:52–60. https://doi.org/10.1055/s-0030-1247132 .
doi: 10.1055/s-0030-1247132
pubmed: 20175033
pmcid: 20175033
Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67:358–80. https://doi.org/10.1002/hep.29086 .
doi: 10.1002/hep.29086
pubmed: 28130846
Toso C, Mentha G, Kneteman NM, Majno P. The place of downstaging for hepatocellular carcinoma. J Hepatol. 2010;52:930–6. https://doi.org/10.1016/j.jhep.2009.12.032 .
doi: 10.1016/j.jhep.2009.12.032
pubmed: 20385428
Heckman JT, Devera MB, Marsh JW, et al. Bridging locoregional therapy for hepatocellular carcinoma prior to liver transplantation. Ann Surg Oncol. 2008;15:3169–77. https://doi.org/10.1245/s10434-008-0071-3 .
doi: 10.1245/s10434-008-0071-3
pubmed: 18696158
Yao FY, Mehta N, Flemming J, Dodge J, Hameed B, Fix O, et al. Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria. Hepatology. 2015;61:1968–77.
doi: 10.1002/hep.27752
Molmenti EP, Klintmalm GB. Liver transplantation in association with hepatocellular carcinoma: an update of the International Tumor Registry. Liver Transpl. 2002;8:736–48. https://doi.org/10.1053/jlts.2002.34879 .
doi: 10.1053/jlts.2002.34879
pubmed: 12200772
Qiu J, Chen S, Wu H. Long-term outcomes after hepatic resection combined with radiofrequency ablation for initially unresectable multiple and bilobar liver malignancies. J Surg Res. 2014;188:14–20. https://doi.org/10.1016/j.jss.2013.11.1120 .
doi: 10.1016/j.jss.2013.11.1120
pubmed: 24387841
Labadie KP, Schaub SK, Khorsand D, Johnson G, Apisarnthanarax S, Park JO. Multidisciplinary approach for multifocal, bilobar hepatocellular carcinoma: A case report and literature review. World J Hepatol. 2019;11:119–26. https://doi.org/10.4254/wjh.v11.i1.119 .
doi: 10.4254/wjh.v11.i1.119
pubmed: 30705724
pmcid: 6354116
Bhatti ABH, Qureshi AI, Tahir R, Dar FS, Khan NY, Zia HH, et al. When to call it off: defining transplant candidacy limits in liver donor liver transplantation for hepatocellular carcinoma. BMC Cancer. 2020;20:754. https://doi.org/10.1186/s12885-020-07238-w .
doi: 10.1186/s12885-020-07238-w
pubmed: 32787864
pmcid: 7425141
Hameed B, Mehta N, Sapisochin G, Roberts JP, Yao FY. Alpha-fetoprotein level > 1000 ng/mL as an exclusion criterion for liver transplantation in patients with hepatocellular carcinoma meeting the Milan criteria. Liver Transpl. 2014;20:945–51. https://doi.org/10.1002/lt.23904 .
doi: 10.1002/lt.23904
pubmed: 24797281
pmcid: 4807739
Murali AR, Romero-Marrero C, Miller C, Aucejo F, Levitin A, Gill A, et al. Predictors of successful down staging of hepatocellular carcinoma outside Milan criteria. Transplantation. 2016;100:2391–7. https://doi.org/10.1097/TP.0000000000001402 .
doi: 10.1097/TP.0000000000001402
pubmed: 27780187
Affonso BB, Galastri FL, da Motta Leal Filho JM, Nasser F, Falsarella PM, Cavalcante RN, et al. Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging. World J Gastroenterol. 2019;25:5687–701. https://doi.org/10.3748/wjg.v25.i37.5687 .
doi: 10.3748/wjg.v25.i37.5687
pubmed: 31602168
pmcid: 6785514
Lai Q, Avolio AW, Graziadei I, Otto G, Rossi M, Tisone G, et al. Alpha-fetoprotein and modified response evaluation criteria in solid tumors progression after locoregional therapy as predictors of hepatocellular cancer recurrence and death after transplantation. Liver Transpl. 2013;19:1108–18. https://doi.org/10.1002/lt.23706 .
doi: 10.1002/lt.23706
pubmed: 23873764