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

2022Journal article Open access
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dc.contributor.authorZhang, XF
dc.contributor.authorXue, F
dc.contributor.authorBagante, F
dc.contributor.authorRatti, F
dc.contributor.authorMarques, HP
dc.contributor.authorSilva, S
dc.contributor.authorSoubrane, O
dc.contributor.authorLam, V
dc.contributor.authorPoultsides, GA
dc.contributor.authorPopescu, I
dc.contributor.authorGrigorie, R
dc.contributor.authorAlexandrescu, S
dc.contributor.authorMartel, G
dc.contributor.authorWorkneh, A
dc.contributor.authorGuglielmi, A
dc.contributor.authorHugh, T
dc.contributor.authorAldrighetti, L
dc.contributor.authorLv, Y
dc.contributor.authorPawlik, TM
dc.date.accessioned2023-04-13T14:03:00Z
dc.date.available2023-04-13T14:03:00Z
dc.date.issued2022
dc.description.abstractObjectives: 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 transplantationpt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Gastrointest Surg . 2022 May;26(5):1021-1029pt_PT
dc.identifier.doi10.1007/s11605-021-05206-8pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4489
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerlinkpt_PT
dc.subjectCarcinoma, Hepatocellular* / pathologypt_PT
dc.subjectCarcinoma, Hepatocellular* / pathologypt_PT
dc.subjectHepatectomypt_PT
dc.subjectLiver Neoplasms* / pathologypt_PT
dc.subjectLiver Neoplasms* / surgerypt_PT
dc.subjectLiver Neoplasms* / surgerypt_PT
dc.subjectPatient Selectionpt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectTreatment Outcomept_PT
dc.subjectHCC CIRpt_PT
dc.titleNon-transplantable Recurrence After Resection for Transplantable Hepatocellular Carcinoma: Implication for Upfront Treatment Choicept_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1029pt_PT
oaire.citation.issue5pt_PT
oaire.citation.startPage1021pt_PT
oaire.citation.titleJournal of Gastrointestinal Surgerypt_PT
oaire.citation.volume26pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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