Predictors of non-transplantable recurrence in hepatocellular carcinoma patients treated with frontline liver resection.
hepatectomy
liver cancer
liver transplantation
recurrence
tumour size
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
revised:
09
08
2023
received:
15
01
2023
accepted:
21
08
2023
medline:
29
11
2023
pubmed:
27
9
2023
entrez:
27
9
2023
Statut:
ppublish
Résumé
Hepatocellular carcinoma (HCC) recurrence is common in patients treated with liver resection (LR). In this study, we aimed to evaluate the incidence and preoperative predictors of non-transplantable recurrence in patients with single HCC ≤5 cm treated with frontline LR. From the Italian Liver Cancer (ITA.LI.CA) database, 512 patients receiving frontline LR for single HCC ≤5 cm were retrieved. Incidence and predictors of recurrence beyond Milan criteria (MC) and up-to-seven criteria were compared between patients with HCC <4 and ≥4 cm. During a median follow-up of 4.2 years, the overall recurrence rate was 55.9%. In the ≥4 cm group, a significantly higher proportion of patients recurred beyond MC at first recurrence (28.9% vs. 14.1%; p < 0.001) and overall (44.4% vs. 25.2%; p < 0.001). Similar results were found considering recurrence beyond up-to-seven criteria. Compared to those with larger tumours, patients with HCC <4 cm had a longer recurrence-free survival and overall survival. HCC size ≥4 cm and high alpha-fetoprotein (AFP) level at the time of LR were independent predictors of recurrence beyond MC (and up-to-seven criteria). In the subgroup of patients with available histologic information (n = 354), microvascular invasion and microsatellite lesions were identified as additional independent risk factors for non-transplantable recurrence. Despite the high recurrence rate, LR for single HCC ≤5 cm offers excellent long-term survival. Non-transplantable recurrence is predicted by HCC size and AFP levels, among pre-operatively available variables. High-risk patients could be considered for frontline LT or listed for transplantation even before recurrence.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Hepatocellular carcinoma (HCC) recurrence is common in patients treated with liver resection (LR). In this study, we aimed to evaluate the incidence and preoperative predictors of non-transplantable recurrence in patients with single HCC ≤5 cm treated with frontline LR.
METHODS
METHODS
From the Italian Liver Cancer (ITA.LI.CA) database, 512 patients receiving frontline LR for single HCC ≤5 cm were retrieved. Incidence and predictors of recurrence beyond Milan criteria (MC) and up-to-seven criteria were compared between patients with HCC <4 and ≥4 cm.
RESULTS
RESULTS
During a median follow-up of 4.2 years, the overall recurrence rate was 55.9%. In the ≥4 cm group, a significantly higher proportion of patients recurred beyond MC at first recurrence (28.9% vs. 14.1%; p < 0.001) and overall (44.4% vs. 25.2%; p < 0.001). Similar results were found considering recurrence beyond up-to-seven criteria. Compared to those with larger tumours, patients with HCC <4 cm had a longer recurrence-free survival and overall survival. HCC size ≥4 cm and high alpha-fetoprotein (AFP) level at the time of LR were independent predictors of recurrence beyond MC (and up-to-seven criteria). In the subgroup of patients with available histologic information (n = 354), microvascular invasion and microsatellite lesions were identified as additional independent risk factors for non-transplantable recurrence.
CONCLUSIONS
CONCLUSIONS
Despite the high recurrence rate, LR for single HCC ≤5 cm offers excellent long-term survival. Non-transplantable recurrence is predicted by HCC size and AFP levels, among pre-operatively available variables. High-risk patients could be considered for frontline LT or listed for transplantation even before recurrence.
Substances chimiques
alpha-Fetoproteins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2762-2775Subventions
Organisme : This work was funded by the University of Padua and by DOR 2022 granted to Filippo Pelizzaro
Investigateurs
Maurizio Biselli
(M)
Paolo Caraceni
(P)
Lorenzo Lani
(L)
Davide Rampoldi
(D)
Nicola Reggidori
(N)
Valentina Santi
(V)
Benedetta Stefanini
(B)
Alessandro Granito
(A)
Luca Muratori
(L)
Vito Sansone
(V)
Francesco Tovoli
(F)
Elton Dajti
(E)
Giovanni Marasco
(G)
Federico Ravaioli
(F)
Alberta Cappelli
(A)
Rita Golfieri
(R)
Cristina Mosconi
(C)
Matteo Renzulli
(M)
Elisa Pinto
(E)
Giorgio Palano
(G)
Maria Piera Kitenge
(MP)
Federica Bertellini
(F)
Ester Marina Cela
(EM)
Antonio Facciorusso
(A)
Giulia Pieri
(G)
Maria Corina Plaz Torres
(MCP)
Andrea Pasta
(A)
Nicoletta de Matthaeis
(N)
Francesca Romana Ponziani
(FR)
Giorgia Ghittoni
(G)
Valentina Lauria
(V)
Giorgio Pelecca
(G)
Fabrizio Chegai
(F)
Armando Raso
(A)
Alessio Bozzi
(A)
Elisabetta Biasini
(E)
Andrea Olivani
(A)
Alessandro Inno
(A)
Fabiana Marchetti
(F)
Ciro Celsa
(C)
Paolo Giuffrida
(P)
Carmelo Marco Giacchetto
(CM)
Gabriele Rancatore
(G)
Maria Vittoria Grassini
(MV)
Roberta Ciccia
(R)
Alessandro Grova
(A)
Mauro Salvato
(M)
Maria Stella Franzè
(MS)
Carlo Saitta
(C)
Marco Arru
(M)
Assunta Sauchella
(A)
Maria Grazia Serra
(MG)
Vittoria Bevilacqua
(V)
Alberto Borghi
(A)
Andrea Casadei Gardini
(AC)
Fabio Conti
(F)
Anna Chiara Dall'Aglio
(AC)
Giorgio Ercolani
(G)
Federica Mirici
(F)
Fabio Marra
(F)
Valentina Adotti
(V)
Martina Rosi
(M)
Pietro Coccoli
(P)
Antonio Malerba
(A)
Filomena Morisco
(F)
Valentina Cossiga
(V)
Mario Capasso
(M)
Veronica Romagnoli
(V)
Informations de copyright
© 2023 The Authors. Liver International published by John Wiley & Sons Ltd.
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