Blood Transfusions and Tumor Biopsy May Increase HCC Recurrence Rates after Liver Transplantation

Seehofer, Daniel; Öllinger, Robert; Denecke, Timm; Schmelzle, Moritz; Ανδρέου, Ανδρέας; Schott, Eckart; Pratschke, Johann

doi:10.1155/2017/9731095

Cited by 15 publications

(14 citation statements)

References 41 publications

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“…A higher surgical risk profile could be an additional proinflammatory trigger of inferior oncological outcome in grade 3 patients. Comparable to a recently presented study by Zhang et al, we noticed a significant correlation between increased ALBI grade and surgical complications, such as bleeding (Figure A) and RBC transfusion requirements (Figure B), who are both suggested to induce tumor‐promoting immunomodulatory mechanisms . Indeed, early posttransplant peak serum levels of the proinflammatory markers CRP (Figure C) and IL‐6 (Figure D) were significantly higher in grade 3 compared with grade 1 or 2 patients of our study.…”

Section: Discussionsupporting

confidence: 67%

The role of preoperative albumin‐bilirubin grade for oncological risk stratification in liver transplant patients with hepatocellular carcinoma

Kornberg

Witt

Schernhammer

et al. 2019

Journal of Surgical Oncology

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Background and Objectives: Albumin-bilirubin (ALBI) score was shown to correlate with liver function and tumor recurrence after hepatectomy for hepatocellular carcinoma (HCC). The aim of this study was to assess the prognostic value of ALBI grade in liver transplantation (LT) patients with HCC.Methods: Pre-LT available independent predictors of recurrence-free survival (RFS) and microvascular tumor invasion (MVI) were determined in 123 patients with HCC.Results: Posttransplant HCC recurrence rates were 10.5%, 15.9%, and 68.2% in ALBI grade 1, 2, and 3, respectively (P < .001). Along with serum α-fetoprotein (AFP) and Creactive protein (CRP) levels, ALBI grades 1 or 2 was identified as an independent predictor of RFS (hazard ratio, 3.52; 95% confidence interval [CI], 1.577-7.842; P = .002). Furthermore, ALBI grade 3 proved to be the strongest indicator of MVI (odds ratio, 11.59; 95% CI, 3.412-39.381; P < .001). A novel oncological risk scorebased on AFP, CRP, and ALBI grade provided the best discriminative capacity (cstatistic 0.806) in selecting liver recipients with low oncological risk profile.Conclusion: Preoperative ALBI grade seems to be valuable for refinement of oncological risk stratification at LT for HCC. K E Y W O R D Salbumin-bilirubin grade, hepatocellular carcinoma, liver transplantation, microvascular invasion, tumor recurrence

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Section: Discussionsupporting

confidence: 67%

The role of preoperative albumin‐bilirubin grade for oncological risk stratification in liver transplant patients with hepatocellular carcinoma

Kornberg

Witt

Schernhammer

et al. 2019

Journal of Surgical Oncology

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“… 68 However, such a diagnostic approach may not generally be recommended due to heterogenic tumor aggressiveness and risk of tumor cell spread. 25 , 26 , 69 As shown in Table 3 , 18 F-FDG-PET is able to non-invasively indicate presence of MV and poor differentiation. We found a wide range of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).…”

Section: F-fdg Pet For Predicting Outcome After Liver Tramentioning

confidence: 99%

18F-FDG-PET for Assessing Biological Viability and Prognosis in Liver Transplant Patients with Hepatocellular Carcinoma

Kornberg¹,

Schernhammer²,

Frieß³

2017

Journal of Clinical and Translational Hepatology

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Liver transplantation (LT) has become standard of care in patients with non-resectable early stage hepatocellular carcinoma (HCC) in liver cirrhosis. Currently, patient selection for LT is strictly based on tumor size and number, provided by the Milan criteria. This may, however, exclude patients with advanced tumor load but favourable biology from a possibly curative treatment option. It became clear in recent years that biological tumor viability rather than tumor macromorphology determines posttransplant outcome. In particular, microvascular invasion and poor grading reflect tumor aggressiveness and promote the risk of tumor relapse. Pretransplant biopsy is not applicable due to tumor heterogeneity and risk of tumor cell seeding. 18F-fludeoxyglucose (18F-FDG) positron emission tomography (PET), an established nuclear imaging device in oncology, was demonstrated to non-invasively correlate with unfavorable histopathologic features. Currently, there is an increasing amount of evidence that 18F-FDG-PET is very useful for identifying eligible liver transplant patients with HCC beyond standard criteria but less aggressive tumor properties. In order to safely expand the HCC selection criteria and the pool of eligible liver recipients, tumor evaluation with 18F-FDG-PET should be implemented in pretransplant decision process.

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“…Remarkably, in our study, performing targeted tumor biopsy before LT was not associated with increased HCC recurrence rates. This fact may debunk former results [18, 40, 41]. Therefore, performing a biopsy in HCC, especially in case of unclear liver masses as well as in cases with inconsistent contrast enhanced imaging, seems to be safe and even reasonable.…”

Section: Discussionmentioning

confidence: 98%

Achieving Complete Remission of Hepatocellular Carcinoma: A Significant Predictor for Recurrence-Free Survival after Liver Transplantation

Bürger

Maschmeier

Hüsing‐Kabar

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

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Background Liver transplantation (LT) is a curative treatment for hepatocellular carcinoma (HCC) and the underlying primary liver disease; however, tumor recurrence is still a major issue. Therefore, the aim of this study was to assess predictors and risk factors for HCC recurrence after LT in patients within and outside the Milan criteria with a special focus on the impact of different bridging strategies. Methods All patients who underwent LT for HCC between 07/2002 and 09/2016 at the University Hospital of Muenster were consecutively included in this retrospective study. Database research was performed and a multivariable regression analysis was conducted to explore potential risk factors for HCC recurrence. Results A total of 82 patients were eligible for the statistical analysis. Independent of bridging strategy, achieving complete remission (CR) was significantly associated with a lower risk for tumor recurrence (p = 0.029; OR = 0.426, 95% CI 0.198-0.918). A maximal diameter of lesion < 3 cm was also associated with lower recurrence rates (p = 0.040; OR = 0.140, 95% CI 0.022-0.914). Vascular invasion proved to be an independent risk factor for HCC recurrence (p = 0.004; OR = 11.357, 95% CI 2.142-60.199). Conclusion Achieving CR prior to LT results in a significant risk reduction of HCC recurrence after LT independent of the treatment modalities applied.

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Blood Transfusions and Tumor Biopsy May Increase HCC Recurrence Rates after Liver Transplantation

Cited by 15 publications

References 41 publications

The role of preoperative albumin‐bilirubin grade for oncological risk stratification in liver transplant patients with hepatocellular carcinoma

The role of preoperative albumin‐bilirubin grade for oncological risk stratification in liver transplant patients with hepatocellular carcinoma

18F-FDG-PET for Assessing Biological Viability and Prognosis in Liver Transplant Patients with Hepatocellular Carcinoma

Achieving Complete Remission of Hepatocellular Carcinoma: A Significant Predictor for Recurrence-Free Survival after Liver Transplantation

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