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Incidental Hepatocellular Carcinoma after Liver Transplantation: Clinicopathologic Features and Prognosis. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010030. [PMID: 36676654 PMCID: PMC9860811 DOI: 10.3390/medicina59010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
Background: The prognostic impact and clinicopathologic features of incidental hepatocellular carcinoma (iHCC) detected in explanted livers of patients undergoing liver transplantation (LT) has been a controversial issue in previous studies when compared with patients who are diagnosed with hepatocellular carcinoma (pdHCC) before LT. We aimed to review and compare these patient groups in a high-volume LT center. Methods: The present study involves a retrospective analysis of 406 HCC patients who received LT between January 2002 and April 2022. Among these patients, demographic data, histopathologic features and prognosis for iHCC and pdHCC were evaluated. Results: In our series, 406 patients’ final diagnosis was HCC after they had received LT, nevertheless 54 patients in this HCC group were diagnosed incidentally after the pathological evaluation of the explanted livers. The etiology of the underlying liver disease between pdHCC (n = 352) and iHCC (n = 54) groups had some differences in our study population. Most of the patients in the pdHCC group had moderately differentiated tumors (45.7%). On the other hand, most of the patients in the iHCC group had well differentiated tumors (79.6%). There were 158 (44%) patients who met the Milan criteria in the pdHCC group while there were 48 (92%) patients in the iHCC group (p < 0.001). IHCC patients had statistically better 1, 3, 5 and 10 years disease-free and overall survival rates when compared with pdHCC patients. There was only 1 (1.8%) patient who had tumor recurrence in the iHCC group while 76 (21%) patients had tumor recurrence in the pdHCC group (p = 0.001). There is no disease free and overall survival difference when iHCC patients are compared with pdHCC patients who met the Milan criteria. Conclusion: It is the first study to show that iHCC patients may differ from pdHCC patients in terms of etiological features. IHCC tumors show better histopathologic features than pdHCC with low recurrence rate and iHCC patients have better survival rates than pdHCC patients.
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Pruinelli L, Simon GJ, Monsen KA, Pruett T, Gross CR, Radosevich DM, Westra BL. A Holistic Clustering Methodology for Liver Transplantation Survival. Nurs Res 2019; 67:331-340. [PMID: 29877986 PMCID: PMC6023761 DOI: 10.1097/nnr.0000000000000289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Liver transplants account for a high number of procedures with major investments from all stakeholders involved; however, limited studies address liver transplant population heterogeneity pretransplant predictive of posttransplant survival. OBJECTIVE The aim of the study was to identify novel and meaningful patient clusters predictive of mortality that explains the heterogeneity of liver transplant population, taking a holistic approach. METHODS A retrospective cohort study of 344 adult patients who underwent liver transplantation between 2008 through 2014. Predictors were summarized severity scores for comorbidities and other suboptimal health states grouped into 11 body systems, the primary reason for transplantation, demographics/environmental factors, and Model for End Liver Disease score. Logistic regression was used to compute the severity scores, hierarchical clustering with weighted Euclidean distance for clustering, Lasso-penalized regression for characterizing the clusters, and Kaplan-Meier analysis to compare survival across the clusters. RESULTS Cluster 1 included patients with more severe circulatory problems. Cluster 2 represented older patients with more severe primary disease, whereas Cluster 3 contained healthiest patients. Clusters 4 and 5 represented patients with musculoskeletal (e.g., pain) and endocrine problems (e.g., malnutrition), respectively. There was a statistically significant difference for mortality between clusters (p < .001). CONCLUSIONS This study developed a novel methodology to address heterogeneous and high-dimensional liver transplant population characteristics in a single study predictive of survival. A holistic approach for data modeling and additional psychosocial risk factors has the potential to address holistically nursing challenges on liver transplant care and research.
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Affiliation(s)
- Lisiane Pruinelli
- Lisiane Pruinelli, PhD, MS, RN, is Assistant Professor, University of Minnesota School of Nursing, Minneapolis. György J. Simon, PhD, is Assistant Professor, University of Minnesota Institute for Health Informatics and School of Medicine, Minneapolis. Karen A. Monsen, PhD, RN, FAAN, is Associate Professor, University of Minnesota School of Nursing, Minneapolis. Timothy Pruett, MD, is Professor and Chief, Division of Transplantation, University of Minnesota Department of Surgery, Minneapolis. Cynthia R. Gross, PhD, is Professor Emerita, University of Minnesota Department of Experimental and Clinical Pharmacology and School of Nursing, Minneapolis. David M. Radosevich, PhD, RN, is Adjunct Assistant Professor, University of Minnesota School of Public Health, Minneapolis. Bonnie L. Westra, PhD, RN, FAAN, FACMI, is Associate Professor, University of Minnesota School of Nursing and Institute for Health Informatics, Minneapolis
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Agüero F, Forner A, Valdivieso A, Blanes M, Barcena R, Manzardo C, Rafecas A, Castells L, Abradelo M, Barrera-Baena P, González-Diéguez L, Salcedo M, Serrano T, Jiménez-Pérez M, Herrero JI, Gastaca M, Aguilera V, Fabregat J, Del Campo S, Bilbao I, Romero CJ, Moreno A, Rimola A, Miro JM. Human immunodeficiency virus-infected liver transplant recipients with incidental hepatocellular carcinoma: A prospective multicenter nationwide cohort study. Liver Transpl 2017; 23:645-651. [PMID: 28188668 DOI: 10.1002/lt.24741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/22/2016] [Indexed: 01/28/2023]
Abstract
There is a lack of data on incidental hepatocellular carcinoma (iHCC) in the setting of liver transplantation (LT) in human immunodeficiency virus (HIV)-infected patients. This study aims to describe the frequency, histopathological characteristics, and outcomes of HIV+ LT recipients with iHCC from a Spanish multicenter cohort in comparison with a matched cohort of LT patients without HIV infection. A total of 15 (6%) out of 271 patients with HIV infection who received LT in Spain from 2002 to 2012 and 38 (5%) out of the 811 HIV- counterparts presented iHCC in liver explants (P = 0.58). Patients with iHCC constitute the present study population. All patients also had hepatitis C virus (HCV)-related cirrhosis. There were no significant differences in histopathological features of iHCC between the 2 groups. Most patients showed a small number and size of tumoral nodules, and few patients had satellite nodules, microvascular invasion, or poorly differentiated tumors. After a median follow-up of 49 months, no patient developed hepatocellular carcinoma (HCC) recurrence after LT. HIV+ LT recipients tended to have lower survival than their HIV- counterparts at 1 (73% versus 92%), 3 (67% versus 84%), and 5 years (50% versus 80%; P = 0.06). There was also a trend to a higher frequency of HCV recurrence as a cause of death in the former (33% versus 10%; P = 0.097). In conclusion, among LT recipients for HCV-related cirrhosis, the incidence and histopathological features of iHCC in HIV+ and HIV- patients were similar. However, post-LT survival was lower in HIV+ patients probably because of a more aggressive HCV recurrence. Liver Transplantation 23 645-651 2017 AASLD.
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Affiliation(s)
- Fernando Agüero
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alejandro Forner
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic- IDIBAPS, Barcelona, Spain.,Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Andrés Valdivieso
- Hospital Universitario de Cruces-Universidad del País Vasco, Bilbao, Spain
| | | | | | | | - Antoni Rafecas
- Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Lluis Castells
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,Hospital Universitario Vall d`Hebrón, Barcelona, Spain
| | - Manuel Abradelo
- Servicio de Cirugía, Hospital Doce de Octubre, Madrid, Spain
| | - Pilar Barrera-Baena
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,Hospital Universitario Reina Sofía-IMIBIC, University of Córdoba, Córdoba, Spain
| | - Luisa González-Diéguez
- Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Magdalena Salcedo
- Department of Liver Transplantation, Hospital General Gregorio Marañón, Madrid, Spain
| | - Trinidad Serrano
- Liver Unit, University Hospital Lozano Blesa-IIS Aragon, Zaragoza, Spain
| | - Miguel Jiménez-Pérez
- Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - José Ignacio Herrero
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Mikel Gastaca
- Hospital Universitario de Cruces-Universidad del País Vasco, Bilbao, Spain
| | - Victoria Aguilera
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,Hospital Universitario La Fe, Valencia, Spain
| | - Juan Fabregat
- Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | | | | | | | - Asunción Moreno
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Rimola
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,Liver Unit, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José M Miro
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
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Incidental hepatocellular carcinoma after liver transplantation: Prevalence, histopathological features and prognostic impact. PLoS One 2017; 12:e0175010. [PMID: 28403219 PMCID: PMC5389640 DOI: 10.1371/journal.pone.0175010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022] Open
Abstract
Background Incidental hepatocellular carcinoma (iHCC) is a histological finding after liver transplantation (LT) which relevance has been scarcely studied. Aims to describe the histopathological features of iHCC and to determine its prognostic impact in terms of tumor recurrence and overall survival. Methods Observational study including 451 consecutive adult LT patients (2000–2013). Patients aged<18, retransplanted or with early postoperative death were excluded. Median follow-up after LT was 58 months. Multiple Cox’s regression was used to assess the prognostic impact of iHCC on tumor recurrence and mortality while controlling for potential confounders. Results 141 patients had known HCC before LT (31.3%). Among the remaining 310 patients, the prevalence of iHCC was 8.7% (n = 27). In the explanted liver, 36.2% of patients with known HCC and 25.9% of patients with iHCC trespassed Milan criteria (p = 0.30). Patients with known and iHCC had similar rates of multinodular disease (50.4% vs 55.6%; p = 0.62), macrovascular invasion (6.5% vs 3.7%; p = 0.58), microvascular invasion (12.9% vs 14.8%; p = 0.76) and moderate-poor tumor differentiation (53.9% vs 70.4%; p = 0.09). In the multivariate analysis, iHCC and known HCC had identical recurrence-free survival after controlling for histological features (RR = 1.06, 95%CI 0.36–3.14; p = 0.90). Cumulative 5-year overall survival rates were similar between patients with known and iHCC (65% vs 52.8% respectively; log rank p = 0.44), but significantly inferior as compared with patients without HCC (77.8%) (p = 0.002 and p = 0.007 respectively). Indeed, in the overall cohort, iHCC was an independent predictor of mortality (RR = 3.02; 95%CI 1.62–5.65; p = 0.001). Conclusion The risk of tumor recurrence after LT is similar in patients with iHCC and known HCC. A close imaging surveillance is strongly recommended for patients awaiting LT in order to detect HCC prior to LT, thus allowing for an adequate selection of candidates, prioritization and indication of bridging therapies.
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Pruinelli L, Monsen KA, Gross CR, Radosevich DM, Simon GJ, Westra BL. Predictors of Liver Transplant Patient Survival. Prog Transplant 2016; 27:98-106. [DOI: 10.1177/1526924816680099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: Liver transplantation is a costly and risky procedure, representing 25 050 procedures worldwide in 2013, with 6729 procedures performed in the United States in 2014. Considering the scarcity of organs and uncertainty regarding prognosis, limited studies address the variety of risk factors before transplantation that might contribute to predicting patient’s survival and therefore developing better models that address a holistic view of transplant patients. This critical review aimed to identify predictors of liver transplant patient survival included in large-scale studies and assess the gap in risk factors from a holistic approach using the Wellbeing Model and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Data Source: Search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and PubMed from the 1980s to July 2014. Study Selection: Original longitudinal large-scale studies, of 500 or more subjects, published in English, Spanish, or Portuguese, which described predictors of patient survival after deceased donor liver transplantation. Data Extraction: Predictors were extracted from 26 studies that met the inclusion criteria. Data Synthesis: Each article was reviewed and predictors were categorized using a holistic framework, the Wellbeing Model (health, community, environment, relationship, purpose, and security dimensions). Conclusions: The majority (69.7%) of the predictors represented the Wellbeing Model Health dimension. There were no predictors representing the Wellbeing Dimensions for purpose and relationship nor emotional, mental, and spiritual health. This review showed that there is rigorously conducted research of predictors of liver transplant survival; however, the reported significant results were inconsistent across studies, and further research is needed to examine liver transplantation from a whole-person perspective.
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Affiliation(s)
| | - Karen A. Monsen
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Cynthia R. Gross
- School of Nursing and College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - David M. Radosevich
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - György J. Simon
- Department of Health Science Research, Mayo Clinic Rochester, Rochester, MN, USA
| | - Bonnie L. Westra
- School of Nursing and Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
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Schraiber LDS, de Mattos AA, Zanotelli ML, Cantisani GPC, Brandão ABDM, Marroni CA, Kiss G, Ernani L, Marcon PDS. Alpha-fetoprotein Level Predicts Recurrence After Transplantation in Hepatocellular Carcinoma. Medicine (Baltimore) 2016; 95:e2478. [PMID: 26817881 PMCID: PMC4998255 DOI: 10.1097/md.0000000000002478] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of liver transplantation. In an attempt to predict their recurrence after liver transplantation, evaluation of tumor number and size, degree of histologic differentiation, and the presence of vascular invasion already have their importance established. In this context, the role of biologic markers such as alpha-fetoprotein (AFP) is still not clear. This retrospective cross-sectional study analyzed the AFP relationship with recurrence of HCC after orthotopic liver transplantation.The current study retrospectively analyzed data from 206 patients with a histopathologic confirmed HCC between 1997 and 2010.The overall survival rates at 1, 3, 5, and 14 years were 78.6%, 65.4%, 60.5%, and 38.7%, respectively. The frequency of recurrence was 15.5%, and recurrence was significantly associated with a lower survival rate (P < 0.001). No association was observed between survival and AFP level (P = 0.153). A correlation, however, was found between tumor recurrence and AFP level (P = 0.002). Univariate analysis of risk factors for recurrence revealed that an AFP level greater than 200 ng/mL, the number of tumors, the degree of cellular differentiation, and the presence of vascular invasion or satellite nodules were associated with relapse. By multivariate analysis, only an AFP level greater than 200 ng/mL remained as a risk factor.Although an elevated AFP level did not correlate with survival in HCC patients undergoing orthotopic liver transplantation, a high AFP level was associated with a 3.32-folds increase in the probability of HCC recurrence.
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Affiliation(s)
- Luciana Dos Santos Schraiber
- From the Department of Gastroenterology and Hepatology, Universidade Federal de Ciências da Saúde (LSS, AADM, ABMB, CAM, LE, PSM) and Santa Casa de Misericórdia, de Porto Alegre, Brazil (MLZ, GPCC, ABMB, CAM, GK)
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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.2014.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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8
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Incidentally Discovered Hepatocellular Carcinoma in Explanted Liver: Clinical, Histopathologic Features and Outcome. Transplant Proc 2015; 47:1051-4. [DOI: 10.1016/j.transproceed.2015.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Screening for liver cancer during transplant waiting list: a multicenter study from South America. Eur J Gastroenterol Hepatol 2015; 27:355-60. [PMID: 25563142 DOI: 10.1097/meg.0000000000000272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Surveillance during liver transplantation (LT) waiting list has scarcely been reported in South America. We aimed to describe hepatocellular carcinoma (HCC) surveillance during the LT waiting list in the daily practice. PATIENTS AND METHODS A multicenter retrospective analysis in cirrhotic patients was carried out. All patients underwent an ultrasound (US) every 6 months and the last pre-LT US was compared with explanted liver findings. A false-negative case was considered when incidentally found HCC (iHCC) was detected, whereas a false-positive case was considered when HCC diagnosed before LT (cHCC) was not confirmed in the explanted liver. US performance was assessed after excluding cHCC patients referred to transplant evaluation. RESULTS Of 643 patients, 129 had HCC, of whom 92 had cHCC (71.3%) and 37 had iHCC (28.7%). Five patients (5.4%) had nonconfirmed cHCC (n=3 regenerative nodules, n=1 biliary hamartoma, and n=1 cholangiocarcinoma). Patients with iHCC had a higher MELD score (23±10 vs. 15±10; P<0.0001), and were more frequently Child-Pugh C (62.2 vs. 36.6%; P=0.006) compared with patients with cHCC. The number of US performed during waiting list was 1.7±1.6 (median 1.0). During transplant waiting list, the sensitivity and specificity of US were 33 and 99%, with positive and negative predictive values of 0.89 and 0.93, respectively. Multivariate analysis showed that the strongest variable related to iHCC finding was pre-LT Child-Pugh C status (OR 3.5; P=0.004). CONCLUSION Screening for liver cancer remains an important issue during transplant waiting list. However, the US screening method should be reviewed particularly for Child-Pugh C patients.
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Cho CS. Prognostication systems as applied to primary and metastatic hepatic malignancies. Surg Oncol Clin N Am 2014; 24:41-56. [PMID: 25444468 DOI: 10.1016/j.soc.2014.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Staging systems are an attempt to incorporate the biology and therapy for cancer in a way that enables categorization and prediction of oncologic outcomes. Because of unusual disease biology and complexities related to treatment intervention, efforts to develop reliable staging systems for hepatic malignancies have been challenging. This article discusses the ways in which improved understanding of these diseases has informed the evolution of prognostication systems as applied to hepatocellular carcinoma, cholangiocarcinoma, and hepatic colorectal adenocarcinoma.
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Affiliation(s)
- Clifford S Cho
- Section of Surgical Oncology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, J4/703 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA.
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Pinero F, Mendizabal M, Casciato P, Galdame O, Quiros R, Bandi J, Mullen E, Andriani O, Santibañes ED, Podestá LG, Gadano A, Silva M. Is recurrence rate of incidental hepatocellular carcinoma after liver transplantation similar to previously known HCC? Towards a predictive recurrence score. Ann Hepatol 2014. [DOI: 10.1016/s1665-2681(19)30884-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Alvite Canosa M, Pita Fernández S, Quintela Fandiño J, Aguirrezabalaga J, Otero A, Suárez F, Corbal G, Fernández C, Gutiérrez MG. [Surgical treatment of liver cancer: experience of the A Coruña UHC (Spain)]. Cir Esp 2011; 89:223-9. [PMID: 21353668 DOI: 10.1016/j.ciresp.2010.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 10/21/2010] [Accepted: 12/02/2010] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Liver cancer (LC) is one of the most frequent tumours, in which the potentially curative treatment is surgery: partial surgical resection or liver transplant. OBJECTIVES To determine the morbidity and mortality, survival, and their associated factors in patients with LC, according to the type of surgical treatment: partial surgical resection or liver transplant. MATERIAL AND METHODS A retrospective, observational follow-up study of LC patients diagnosed and treated from June 1994 to December 2007. A descriptive analysis of the variables was performed, as well as a Kaplan- Meier survival analysis and Cox regression. RESULTS The incidence of tumour recurrence in the 150 transplant patients was 13.3%, with a survival at 1, 3, and 5 years of 89.3%, 73.1% and 61.4%, respectively. The multivariate analysis showed that only the histological grade/differentiation was an independent risk factor. In the 33 patients with partial surgical resection, the incidence of tumour was 51.5%, with a survival at 1, 3, and 5 years of 90.9%, 60.2%, and 38.6%, respectively. A significantly higher mortality was observed in patients with higher tumour and TNM staging. CONCLUSIONS The survival throughout follow-up was higher in liver transplant, and tumour recurrence was more frequent in patients with partial surgical resection. The survival results in transplanted patients are consistent with the Spanish and European Liver Transplant Register and with the United Network for Organ Sharing register.
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Affiliation(s)
- Marlén Alvite Canosa
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Complejo Hospitalario Universitario de A Coruña, A Coruña, España.
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Alvite-Canosa M, Pita-Fernández S, Quintela-Fandiño J, Aguirrezabalaga J, Corbal G, Fernández C, Suárez F, Otero A, Gómez-Gutiérrez M. Prognostic and developmental factors in patients receiving liver transplant due to hepatocellular carcinoma: one center's experience in the north of Spain. Transplant Proc 2010; 42:4578-81. [PMID: 21168741 DOI: 10.1016/j.transproceed.2010.09.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 09/30/2010] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the most frequent types of tumor. The aim of this study was to determine the survival of patients who had received liver transplants as a result of the disease. METHODS This observational follow-up study included 150 patients who received liver transplantations from June 1994 to December 2007. The study considered epidemiological and staging variables, tumor descriptions, and follow-up variables. We employed Kaplan-Meier methodology together with a Cox multivariate regression analysis. RESULTS The incidence of tumor relapse was 13.3%, with survival rates at 1, 3, and 5 years of 89.3%, 73.1%, and 61.4%, respectively. Variables that showed an independent effect to predict mortality were the degree of histological differentiation and of macrovascular invasion. Patients with poorly differentiated HCC had a 4.03 fold (95% confidence interval [CI]: 1.61-10.06) greater possibility of dying. Macrovascular involvement increased the risk of death (relative risk = 2.23), an effect that was at the limit of significance (95% CI 0.99-5.04). CONCLUSIONS The survival rate was consistent with the literature. Poor tumor differentiation and macrovascular involvement were independent predictors of mortality.
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Affiliation(s)
- M Alvite-Canosa
- Liver Transplant Unit, Complejo Hospitalario Universitario A Coruña, Xubias, A Coruña, Spain.
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Raphe R, Felício H, Rocha M, Duca W, Arroyo P, D'Santi Neto D, da Silva R, da Silva R. Histopathologic Characteristics of Incidental Hepatocellular Carcinoma After Liver Transplantation. Transplant Proc 2010; 42:505-6. [DOI: 10.1016/j.transproceed.2010.01.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Cho CS. Surgical resection of hepatocellular carcinoma: less is more? J Surg Res 2009; 157:155-7. [PMID: 19592023 DOI: 10.1016/j.jss.2009.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Revised: 02/28/2009] [Accepted: 03/09/2009] [Indexed: 01/10/2023]
Affiliation(s)
- Clifford S Cho
- Section of Surgical Oncology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, H4/724 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA.
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Cho CS, Gonen M, Shia J, Kattan MW, Klimstra DS, Jarnagin WR, D'Angelica MI, Blumgart LH, DeMatteo RP. A novel prognostic nomogram is more accurate than conventional staging systems for predicting survival after resection of hepatocellular carcinoma. J Am Coll Surg 2007; 206:281-91. [PMID: 18222381 DOI: 10.1016/j.jamcollsurg.2007.07.031] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 07/23/2007] [Accepted: 07/25/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prediction of survival after resection of hepatocellular carcinoma (HCC) remains difficult. Numerous staging systems have been devised for purposes of risk classification; we sought to identify the optimal staging system to predict postoperative survival. STUDY DESIGN One hundred eighty-four patients who underwent primary complete resection of HCC at our institution between 1989 and 2002 were classified according to 8 contemporary staging systems. The ability of these systems to predict relative survival for randomly selected pairs of patients was quantified using the Harrel's concordance index. A novel prognostic nomogram was constructed using prognostically relevant variables. RESULTS After a median followup of 46 months for surviving patients, the median overall survival was 38 months. The concordance indices for the existing staging systems ranged from 0.54 to 0.59. Only the 2002 American Joint Commission on Cancer system demonstrated a concordance index with a 95% confidence interval exceeding 0.5, indicating that the ability of conventional systems to predict relative survival of randomly selected pairs of patients was generally no better than chance. We developed a novel nomogram based on patient age, serum alpha-fetoprotein level, operative blood loss, resection margin status, tumor size, satellite lesions, and vascular invasion. The nomogram demonstrated a markedly superior concordance index of 0.74 (95% CI, 0.68 to 0.80). A separate nomogram for prediction of recurrence-free survival was also generated. CONCLUSIONS Contemporary staging systems for HCC do not accurately predict postoperative outcomes. Our prognostic nomogram provides a mechanism for accurate prediction of survival and risk stratification and will require validation at other hepatobiliary centers.
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Affiliation(s)
- Clifford S Cho
- Hepatobiliary Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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17
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Sutcliffe R, Maguire D, Portmann B, Rela M, Heaton N. Selection of patients with hepatocellular carcinoma for liver transplantation. Br J Surg 2005; 93:11-8. [PMID: 16329080 DOI: 10.1002/bjs.5198] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Orthotopic liver transplantation (OLT) plays a pivotal role in the management of selected patients with initial hepatocellular carcinoma (HCC). After disappointing early results and a shortage of cadaveric grafts, patients are currently selected for OLT on the basis of tumour size and number. Limitations of these criteria and the advent of living donation have prompted their re-evaluation. The principal aims of this review were to define the limitations of current transplant criteria for HCC, and to identify potential areas for improvement.
Methods
A Medline search using the terms ‘liver transplantation’ and ‘hepatocellular carcinoma’ was conducted. Additional references were sourced from key articles.
Results and conclusion
In patients with HCC, biological properties of the tumour are more accurate than radiological criteria in determining outcome after transplantation. Despite the risks of tumour biopsy, which may have been previously overstated, histological evaluation before transplantation may have a role and warrants further study. By expanding the donor pool and eliminating waiting times, live donor liver transplantation is a valuable resource that has yet to fulfil its potential because of unresolved ethical issues concerning the safety of the donor. The availability of long-term outcome data may help to clarify this in the near future.
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Affiliation(s)
- R Sutcliffe
- Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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18
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Choi SH, Lee HH, Lee DS, Choi JH, Heo JS, Lee KW, Joh JW, Kim SJ, Yoo BC, Lee JH, Choi MS, Choe YH, Lee SK. Clinicopathological features of incidental hepatocellular carcinoma in liver transplantation. Transplant Proc 2005; 36:2293-4. [PMID: 15561224 DOI: 10.1016/j.transproceed.2004.08.076] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The incidence of detecting hepatocellular carcinoma (HCC) in a removed recipient liver after a liver transplant is not rare. The clinical features are expected to be different from the preoperatively diagnosed HCC. The aim of this study was to evaluate the clinicopathological features of incidental HCC. This study retrospectively analyzed five cases of incidental HCC among 51 liver transplant cases of HCC operated from September 1996 to February 2002. The proportion of an incidental HCC was 9.8%. The mean age was 46.2 years with a higher prevalence in may (80%, four cases). The alpha-fetoprotein level was normal or mildly elevated. HBsAg was positive in all cases. Imaging studies revealed regenerative or dysplastic nodules, or no specific lesion. The pathological findings demonstrated a mean size of 1.16 cm, multiplicity in three cases (60%), no microvascular invasion, and Edmonson grade I (60%) and II (40%). There was no recurrence of the HCC. However, two patients died due to an intracranial hemorrhage and a graft failure, respectively. In conclusion, incidentally found HCC showed less invasive pathological features and a better prognosis.
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Affiliation(s)
- S H Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
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19
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Burroughs A, Hochhauser D, Meyer T. Systemic treatment and liver transplantation for hepatocellular carcinoma: two ends of the therapeutic spectrum. Lancet Oncol 2004; 5:409-18. [PMID: 15231247 DOI: 10.1016/s1470-2045(04)01508-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hepatocellular carcinoma is the fifth most common malignant disorder and causes nearly 1 million deaths a year worldwide. A background of cirrhosis is the major risk factor, and in Asia and subSaharan Africa, cirrhosis is attributable mainly to endemic hepatitis B infection. In Europe and the USA the incidence of hepatocellular carcinoma is increasing as a result of the high prevalence of hepatitis C. The only curative treatments are surgical resection or liver transplantation, but only a few patients are eligible for these procedures. Local ablative treatments such as ethanol injection can lengthen survival in selected patients, and radiofrequency ablation also shows promise. Unfortunately, most patients are suitable only for palliative treatment because of the extent of their tumour or background liver disease or both. For these patients, a wide range of therapeutic interventions have been assessed, including transarterial embolisation (with or without chemotherapy), hormone therapy with antioestrogens and androgens, octreotide, interferon, and both arterial and systemic chemotherapy, of which only chemoembolisation improves survival over symptomatic care. Tamoxifen is ineffective, and there are insufficient randomised data to show the benefit of any other intervention. In this review, we focus on two ends of the therapeutic spectrum--transplantation, which is highly effective but applicable to only a few patients, and systemic chemotherapy, which is of uncertain benefit but widely applicable.
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Affiliation(s)
- Andrew Burroughs
- Liver Transplantation and Hepatobiliary Medicine Department, Royal Free and University College Medical School, London, UK
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20
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Mela M, Mancuso A, Burroughs AK. Review article: hepatocellular carcinoma: indications for liver transplantation. Aliment Pharmacol Ther 2003; 17 Suppl 2:130-7. [PMID: 12786624 DOI: 10.1046/j.1365-2036.17.s2.16.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The role of liver transplantation for hepatocellular carcinoma has evolved over the years and currently is one of the curative therapies for small tumours. The survival rates are similar with those for nonmalignant liver disease after transplantation. The treatment of small tumours eligible for both resection and transplantation depends on the experience of the transplant centre and the waiting time for a liver graft. With waiting times for liver transplant becoming gradually longer, prioritization of the tumour patients has been suggested. Adjuvant therapies may delay the tumour progression while patients wait for a transplant. The living donor and the domino liver transplantation are useful alternatives given the shortage of organs but the experience is still limited in the Western world and the selection for the domino livers is fairly restricted.
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Affiliation(s)
- M Mela
- Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, London, UK
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