Asymptomatic hepatocellular carcinoma in Child's A cirrhosis

Cottone, Mario; Virdone, Roberto; Fusco, G; Orlando, Ambrogio; Turri, Marco; Caltagirone, Maria; Maringhini, Alberto; Sciarrino, Elio; Demma, I.; Nicoli, N; Tinè, Fabio; S, Sammarco; Pagliaro, Luigi

doi:10.1016/0016-5085(89)90528-3

Cited by 106 publications

(15 citation statements)

References 17 publications

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“…In the base-case analysis, our model considered a 58-year-old person (based on a published mean age range of 52 to 64 years) [6][7][8][10][11][12] with a single nonresectable HCC nodule ranging from 1 to 4 cm in diameter. Prognosis was modeled by using a Markov simulation in which hypothetical cohorts of 10,000 identical patients diagnosed with nonresectable earlystage HCC were followed up over time.…”

Section: Experimental Procedures Decision Modelmentioning

confidence: 99%

“…Some commonly recognized patterns are: (1) declining growth rate over time, (2) constant growth rate in 33% of patients with HCC, and (3) no or very slow initial growth rate, followed by constant growth rate in 30% of patients. [6][7][8] We used a previously described Gompertzian tumor growth model in which tumor-doubling time determines tumor volume and diameter over time. 9,16 At large tumor sizes, tumor growth slows as tumor size approaches a plateau (Fig.…”

Section: Natural History Of Hccmentioning

confidence: 99%

“…6 The published survival of untreated patients with Child's class A cirrhosis and small nonresectable HCCs ranges from a 1.2-year survival rate of 50% to 2-year survival rates of 44% to 50%. [17][18][19] …”

Section: Natural History Of Hccmentioning

confidence: 99%

“…4,5 However, several natural history studies have pointed out that HCC tumor growth is not always constant. [6][7][8] We previously developed a computer simulation that captured different growth rates and patterns of HCC tumor growth. 9 For this analysis, we applied this model to estimate the probability of tumor growth and survival for patients with early HCC and well-compensated cirrhosis while waiting for a transplant.…”

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confidence: 99%

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Predicting the probability of progression-free survival in patients with small hepatocellular carcinoma

Cheng

2002

Liver Transplantation

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Allocation of cadaveric livers to patients based on such objective medical urgency data as the Model for End-Stage Liver Disease (MELD) score may not benefit patients with small hepatocellular carcinomas (HCCs). To ensure that these patients have a fair opportunity of receiving a cadaveric organ, the risk for death caused by HCC and tumor progression beyond 5 cm should be considered. Using a Markov model, two hypothetical cohorts of patients with small hepatomas were assumed to have either (1) Gompertzian tumor growth, in which initial exponential growth decreases as tumor size increases; or (2) rapid exponential growth. The model tracked the number of patients who either died or had tumor progression beyond 5 cm. These results were used to back-calculate an equivalent MELD score for patients with small HCCs. All probabilities in the model were varied simultaneously using a Monte Carlo simulation. The Gompertzian growth model predicted that patients with a 1-and 4-cm tumor have 1-year progression-free survival rates of 70% (HCC-specific MELD score 6) and 66% (HCC-specific MELD score 8), respectively. When assuming rapid exponential growth, patients with a 1-and 4-cm tumor have progression-free survival rates of 69% (HCC-specific MELD score 6) and 12% (HCC-specific MELD score 24), respectively. Our model predicted that the risk for death caused by HCC or tumor progression beyond 5 cm should increase with larger initial tumor size in patients with small hepatomas. To ensure that these patients have a fair opportunity to receive a cadaveric organ, HCC-specific scores predicted by our model could be added to MELD scores of patients with HCC. (Liver Transpl 2002;8:323-328.) T he mandate by the Department of Health and Human Services to allocate livers to the sickest patients based on objective medical urgency data has led to the proposal that prioritization of liver transplant candidates be based on a model developed by the Mayo Clinic, the Model for End-Stage Liver Disease (MELD). 1-3 The MELD formula uses prognostic factors and disease cause to calculate a risk score for mortality on the waiting list. Patients with a higher score have a higher priority for receiving a donor liver. Under the MELD scoring system, patients with early hepatocellular carcinoma (HCC) are unlikely to achieve a high score because many of these patients have well-maintained liver synthetic function. However, without a timely transplant for these patients, HCC may progress in size and lead to death.How could access to timely transplantation be improved for patients with HCC under the MELD system? One approach would be to incorporate into the MELD the likelihood of being removed from the waiting list because of death secondary to HCC or disease progression. In the absence of a published trial, decision analytic modeling is a method that can be used to estimate this likelihood. Previously published decision models have assessed the risk for HCC tumor progression by assuming that tumor growth is constant. 4,5 However, several natural history st...

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Section: Experimental Procedures Decision Modelmentioning

confidence: 99%

Section: Natural History Of Hccmentioning

confidence: 99%

Section: Natural History Of Hccmentioning

confidence: 99%

mentioning

confidence: 99%

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Predicting the probability of progression-free survival in patients with small hepatocellular carcinoma

Cheng

2002

Liver Transplantation

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“…Previous studies suggested that the 2-year survival rate of patients with cirrhosis with HCCs less than 3 cm was only 56%, 18 and that the 2-year survival rate of patients with Child's class A cirrhosis with HCC (not adjusted for tumor size) was only 44%. 19 …”

Section: What Is the Natural History Of Hcc?mentioning

confidence: 99%

Increasing incidence and pretransplantation screening of hepatocellular carcinoma

Everson

2000

Liver Transpl

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Key Points 1. The incidence of hepatocellular cancer (HCC) in the United States and other traditionally "low-incidence" countries is increasing. 2. The rise in incidence of HCC is related to chronic hepatitis C. 3. Timely performance of liver transplantation is curative in patients with early-stage HCC. 4. Cirrhotic patients, especially those with viral hepatitis, should be screened for HCC. 5. The performance characteristics of current tests are suboptimal, but serial ultrasonography and alphafetaprotein are recommended. 6. Estimated medical charges related to screening and treatment suggest the $285,294 is required per "cured" case. Assuming that this cure is associated with a 75% to 85% chance for high-quality 10-year survival, the charges approximate $35,000 to $40,000/quality-adjusted lifeyear (QALY). This cost-benefit analysis is nearly identical to published rates for breast cancer screening ($30,000/ QALY). (Liver Transpl 2000;6:S2-S10.)

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Hepatocellular carcinoma in the United States: Prognostic features, treatment outcome, and survival

Stuart

Anand

Jenkins

1996

Cancer

294

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Asymptomatic hepatocellular carcinoma in Child's A cirrhosis

Cited by 106 publications

References 17 publications

Predicting the probability of progression-free survival in patients with small hepatocellular carcinoma

Predicting the probability of progression-free survival in patients with small hepatocellular carcinoma

Increasing incidence and pretransplantation screening of hepatocellular carcinoma

Hepatocellular carcinoma in the United States: Prognostic features, treatment outcome, and survival

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