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Herrero A, Toubert C, Bedoya JU, Assenat E, Guiu B, Panaro F, Bardol T, Cassese G. Management of hepatocellular carcinoma recurrence after liver surgery and thermal ablations: state of the art and future perspectives. Hepatobiliary Surg Nutr 2024; 13:71-88. [PMID: 38322198 PMCID: PMC10839736 DOI: 10.21037/hbsn-22-579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/02/2023] [Indexed: 02/08/2024]
Abstract
Despite the improvements in surgical and medical therapy for hepatocellular carcinoma (HCC), recurrence still represents a major issue. Up to 70% of patients can experience HCC recurrence after liver resection (LR), as well as 20% of them even after liver transplantation (LT). The patterns of recurrence are different according to both the time and the location. Similarly, the risk factors and the management can change not only according to these patterns, but also according to the underlying liver condition and to the first treatment performed. Deep knowledge of such correlation is fundamental, since prevention and effective management of recurrence are undoubtedly the most important strategies to improve the outcomes of HCC treatment. Without adjuvant therapy, maintaining very close monitoring during the first 2 years in order to diagnose curable recurrence and continue this monitoring beyond 5 years because late recurrences exist, remains our only possibility today. Surgery represents the cornerstone treatment for HCC, including both LT and LR. However, new interesting therapeutic opportunities are coming from immunotherapy that has shown encouraging results also in the adjuvant setting. In such a complex and evolutionary scenario, the aim of this review is to summarize current strategies for the management of HCC recurrence, focusing on the different possible scenarios, as well as on future perspectives.
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Affiliation(s)
- Astrid Herrero
- Department of HPB Surgery and Liver Transplantation, Saint Eloi Hospital, Montpellier University, Montpellier, France
| | - Cyprien Toubert
- Department of HPB Surgery and Liver Transplantation, Saint Eloi Hospital, Montpellier University, Montpellier, France
| | - Jose Ursic Bedoya
- Department of Hepatology and Liver Transplantation, Saint Eloi Hospital, Montpellier University, Montpellier, France
| | - Eric Assenat
- Department of Digestive Oncology, Saint Eloi Hospital, Montpellier University, Montpellier, France
| | - Boris Guiu
- Department of Radiology, Saint Eloi Hospital, Montpellier University, Montpellier, France
| | - Fabrizio Panaro
- Department of HPB Surgery and Liver Transplantation, Saint Eloi Hospital, Montpellier University, Montpellier, France
| | - Thomas Bardol
- Laboratory of rare human Circulating Cells (LCCRH), University Medical Center of Montpellier, Montpellier, France
| | - Gianluca Cassese
- Division of Minimally Invasive and Robotic HPB Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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Toubert C, Guiu B, Al Taweel B, Assenat E, Panaro F, Souche FR, Ursic-Bedoya J, Navarro F, Herrero A. Prolonged Survival after Recurrence in HCC Resected Patients Using Repeated Curative Therapies: Never Give Up! Cancers (Basel) 2022; 15:cancers15010232. [PMID: 36612227 PMCID: PMC9818493 DOI: 10.3390/cancers15010232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/18/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023] Open
Abstract
Surgical resection is the optimal treatment for HCC, despite a high risk of recurrence. Few data are available on patient’s survival after resection. This is a retrospective study of tumor recurrence occurring after hepatectomy for HCC from 2000 to 2016. Univariate and multivariate analyses were performed to identify prognostic factors of survival after recurrence (SAR). Among 387 patients, 226 recurred (58.4%) with a median SAR of 26 months. Curative treatments (liver transplantation, repeat hepatectomy, thermal ablation) were performed for 44.7% of patients. Independent prognostic factors for SAR were micro-vascular invasion on the primary surgical specimen, size of the initial tumor >5 cm, preoperative AFP, albumin and platelet levels, male gender, number, size and localization of tumors at recurrence, time to recurrence, Child−Pugh score and treatment at recurrence. In subgroup analysis, early recurrence (46%) was associated with a decrease in SAR, by contrast with late recurrence. However, the overall survival (OS) of patients with early recurrence and curative treatment did not significantly differ from that of non-recurring patients. For late recurrence, OS did not significantly differ from that of non-recurring patients, regardless of the proposed treatment. Aggressive and repeat treatments are therefore key to improve prognosis of patients with HCC.
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Affiliation(s)
- Cyprien Toubert
- Department of HBP Surgery and Liver Transplantation, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Boris Guiu
- Department of Digestive Imaging, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
- Correspondence:
| | - Bader Al Taweel
- Department of HBP Surgery and Liver Transplantation, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Eric Assenat
- Department of Digestive Oncology, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Fabrizio Panaro
- Department of HBP Surgery and Liver Transplantation, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - François-Regis Souche
- Department of Minimally Invasive and Oncologic Surgery, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Jose Ursic-Bedoya
- Liver Transplantation Unit, Department of Hepatology, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Francis Navarro
- Department of HBP Surgery and Liver Transplantation, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Astrid Herrero
- Department of HBP Surgery and Liver Transplantation, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
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Maulat C, Truant S, Hobeika C, Barbier L, Herrero A, Doussot A, Gagnière J, Girard É, Tranchart H, Regimbeau JM, Fuks D, Cauchy F, Prodeau M, Notte A, Toubert C, Salamé E, El Amrani M, Andrieu S, Muscari F, Shourick J, Suc B. Prognostication algorithm for non-cirrhotic non-B non-C hepatocellular carcinoma—a multicenter study under the aegis of the French Association of Hepato-Biliary Surgery and liver Transplantation. Hepatobiliary Surg Nutr 2022; 12:192-204. [PMID: 37124677 PMCID: PMC10129883 DOI: 10.21037/hbsn-22-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/22/2022] [Indexed: 11/06/2022]
Abstract
Background Liver resection and local ablation are the only curative treatment for non-cirrhotic hepatocellular carcinoma (HCC). Few data exist concerning the prognosis of patients resected for non-cirrhotic HCC. The objectives of this study were to determine the prognostic factors of recurrence-free survival (RFS) and overall survival (OS) and to develop a prognostication algorithm for non-cirrhotic HCC. Methods French multicenter retrospective study including HCC patients with non-cirrhotic liver without underlying viral hepatitis: F0, F1 or F2 fibrosis. Results A total of 467 patients were included in 11 centers from 2010 to 2018. Non-cirrhotic liver had a fibrosis score of F0 (n=237, 50.7%), F1 (n=127, 27.2%) or F2 (n=103, 22.1%). OS and RFS at 5 years were 59.2% and 34.5%, respectively. In multivariate analysis, microvascular invasion and HCC differentiation were prognostic factors of OS and RFS and the number and size were prognostic factors of RFS (P<0.005). Stratification based on RFS provided an algorithm based on size (P=0.013) and number (P<0.001): 2 HCC with the largest nodule ≤10 cm (n=271, Group 1); 2 HCC with a nodule >10 cm (n=176, Group 2); >2 HCC regardless of size (n=20, Group 3). The 5-year RFS rates were 52.7% (Group 1), 30.1% (Group 2) and 5% (Group 3). Conclusions We developed a prognostication algorithm based on the number (≤ or >2) and size (≤ or >10 cm), which could be used as a treatment decision support concerning the need for perioperative therapy. In case of bifocal HCC, surgery should not be a contraindication.
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Affiliation(s)
- Charlotte Maulat
- Department of Digestive Surgery, Hepatobiliary and Pancreatic Surgery and Liver Transplantation Unit, Toulouse University Hospital, Toulouse, France
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, Claude-Huriez, Hospital, CHRU Lille, Lille, France
- CANTHER laboratory “Cancer Heterogeneity, Plasticity and Resistance to Therapies”, Inserm UMR-S1277 Teams “Mucins, Cancer and Drug Resistance”, Lille, France
| | - Christian Hobeika
- Department of Hepato-bilio-pancreatic Surgery and Liver Transplantation, Beaujon Hospital, APHP, Clichy, France
| | - Louise Barbier
- Department of Digestive Surgery and Liver Transplantation, Trousseau Hospital, Tours University Hospital, Tours, France
| | - Astrid Herrero
- Department of Digestive Surgery and Liver Transplantation, Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Alexandre Doussot
- Department of Digestive Surgery and Liver Transplantation, Besançon University Hospital, Besançon, France
| | - Johan Gagnière
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
- U1071 Inserm/Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Édouard Girard
- Department of Digestive Surgery and Emergency, CHU Grenoble-Alpes, Grenoble, France
| | - Hadrien Tranchart
- Department of Mini-invasive Surgery, Antoine Béclère Hospital, APHP, Clamart, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens Picardie University Hospital and Picardie Jules Verne University, Amiens, France
| | - David Fuks
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - François Cauchy
- Department of Hepato-bilio-pancreatic Surgery and Liver Transplantation, Beaujon Hospital, APHP, Clichy, France
| | - Mathieu Prodeau
- Department of Digestive Surgery and Transplantation, Claude-Huriez, Hospital, CHRU Lille, Lille, France
| | - Antoine Notte
- Department of Digestive Surgery and Liver Transplantation, Besançon University Hospital, Besançon, France
| | - Cyprien Toubert
- Department of Digestive Surgery and Liver Transplantation, Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Ephrem Salamé
- Department of Digestive Surgery and Liver Transplantation, Trousseau Hospital, Tours University Hospital, Tours, France
| | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, Claude-Huriez, Hospital, CHRU Lille, Lille, France
| | - Sandrine Andrieu
- Department of Epidemiology, Toulouse University Hospital, Toulouse, France
| | - Fabrice Muscari
- Department of Digestive Surgery, Hepatobiliary and Pancreatic Surgery and Liver Transplantation Unit, Toulouse University Hospital, Toulouse, France
| | - Jason Shourick
- Department of Epidemiology, Toulouse University Hospital, Toulouse, France
| | - Bertrand Suc
- Department of Digestive Surgery, Hepatobiliary and Pancreatic Surgery and Liver Transplantation Unit, Toulouse University Hospital, Toulouse, France
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