Clinicopathological features of incidental hepatocellular carcinoma in liver transplantation

Choi, Sang‐Hoon; Lee, H. H.; Lee, D. S.; Choi, Jinyong; Heo, Jin Seok; Lee, Kwang‐Woong; Joh, Jae‐Won; Kim, S. J.; Yoo, Byung Chul; Lee, J. H.; Choi, Moon Seok; Choe, Yon-Ho; Lee, S. K.

doi:10.1016/j.transproceed.2004.08.076

Cited by 28 publications

(27 citation statements)

References 6 publications

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“…Cho et al [15] in an analysis of iHCC observed 77% to be well differentiated tumors and 74.1% to be free of vascular invasion. In relation to the Edmonson and Steiner classification, Choi et al [16] reported the presence of well differentiated tumors with a grade I in 60% and grade II in 40% of patients with iHCC.…”

Section: Discussionmentioning

confidence: 99%

Incidentally Discovered Hepatocellular Carcinoma in Explanted Liver: Clinical, Histopathologic Features and Outcome

Madaleno¹,

Alves²,

Silva³

et al. 2015

Transplantation Proceedings

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Section: Discussionmentioning

confidence: 99%

Incidentally Discovered Hepatocellular Carcinoma in Explanted Liver: Clinical, Histopathologic Features and Outcome

Madaleno¹,

Alves²,

Silva³

et al. 2015

Transplantation Proceedings

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“…Some of these HCC lesions may have been missed preoperatively and may be regarded as incidental HCC (iHCC) if patients had undergone LT before the recent development of highquality imaging techniques. [3][4][5][6][7][8] LT for patients with such HCC lesions also resulted in very low tumor recurrence rates. The clinical sequences of iHCC and small pretransplant known HCC (pkHCC) patients are usually very similar, with any clinical differences attributable only to whether the tumors are detected in recent trawl net-style screening processes using multiple diagnostic modalities.…”

Section: Introductionmentioning

confidence: 97%

“…These lesions are usually small in size and often singular, having a low risk of HCC recurrence. [3][4][5] As this risk is, however, non-negligible, the presence of any HCC lesion indicates a necessity for long-term oncologic surveillance guarding against tumor recurrence.…”

Section: Introductionmentioning

confidence: 99%

Super-selection of a Subgroup of Hepatocellular Carcinoma Patients at Minimal Risk of Recurrence for Liver Transplantation

Hwang

Ahn

Kim

et al. 2011

Journal of Gastrointestinal Surgery

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Tumor features of incidental HCC in 38 patients not showing recurrence were analyzed. Of these patients, 34 (89.5%) each had ≤2 tumors and tumors ≤2.0 cm in size. Applying these criteria to 555 patients with pretransplant known HCC (pkHCC) allowed us to identify 79 patients with untreated pkHCCs ≤2.0 cm in size. To date, only two of these patients have shown recurrence, making the conditions for super-selection the presence of tumors ≤2.0 cm in size, ≤2 tumors, alpha-fetoprotein ≤200 ng/mL, and no pretransplant treatment. In 87 patients satisfying these criteria, the 10-year recurrence and survival rates were 1.3% and 92.1%, respectively. After excluding patients meeting these criteria, the 5-year recurrence rates in patients satisfying the Milan, University of California at San Francisco, and Asan criteria were increased by 2.9-4.0%. In conclusion, this super-selection or super-Milan category may be used for validation assessment of various indication criteria and for the development of cost-effective post-transplantation HCC surveillance protocols. Further studies should be followed for deceased-donor LT and patients who have undergone pretransplant treatment.

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“…5 In our study, we reported 42 of 50 patients (84%) aged > 50 years, and 19 of 50 patients (38%) were aged > 60 years. The iHCC is less likely Abbreviations: iHCC, incidental hepatocellular carcinoma; HCC, hepatocellular carcinoma multifocal, bilobar, or poorly differentiated than kHCC.…”

Section: Discussionmentioning

confidence: 50%

“…5 The incidence of iHCC was compared before and after allocation of a United Kingdom Model for EndStage Liver Disease (UKELD) score system in our unit in 2007. Our database of all transplant recipients was reviewed, and the pretransplant screening, recipient demographics, AFP level, pathologic characteristics, and outcomes were recorded and compared between iHCC and kHCC groups.…”

Section: Methodsmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Objectives: Orthotopic liver transplant is the treatment of choice for hepatocellular carcinoma in cirrhotic patients with satisfactory oncologic and survival outcomes. Incidental hepatocellular carcinoma is frequently a reported finding in the explant pathology after orthotopic liver transplant. Material and Methods:The present study retrospectively analyzed the tumor characteristics and outcomes of 50 incidental hepatocellular carcinomas compared with 252 transplants for known hepatocellular carcinoma. Results: Patients with incidental hepatocellular carcinoma had lower peak alpha-fetoprotein level (P = .001), lower pretransplant alpha-fetoprotein level (P = .002), smaller total tumor size (P = .0001), fewer tumor numbers (P = .0001), lower level of microvascular invasion (P = .001), more cases within Milan criteria (P = .005), and more well-differentiated tumors (P = .017). However, no difference in survival rates was observed between the 2 groups. In 35 patients (70%) who had incidental hepatocellular carcinoma, pretransplant imaging studies were normal; ultrasonography was used as the only screening tool in 25 of 35 patients (71%) who had incidental hepatocellular carcinoma, and 15 patients (30%) who had incidental hepatocellular carcinoma had regenerative or dysplastic nodules. The accuracy of ultrasonography in our unit for diagnosing hepatocellular carcinoma was 97.5%. A quarter of hepatitis B recipients had incidental hepatocellular carcinoma with a younger median recipient age. Tumor recurrence was higher with incidental hepatocellular carcinoma in hepatitis C recipients (22%). However, the overall recurrence was similar between all hepatitis and nonhepatitis recipients who were transplanted for incidental or known hepatocellular carcinoma. Conclusions: Incidental hepatocellular carcinoma has similar outcome as known hepatocellular carcinoma. Early screening of hepatitis B patients is recommended, and cross-sectional imaging is not mandatory for hepatocellular carcinoma screening in patients who are on the waiting list. The pretransplant diagnosis of HCC in nodular cirrhotic livers is difficult despite improvements in diagnostic tools. These results in a variable degree of incidental HCC (iHCC), which is undetected HCC in explanted hepatic specimens. 2 The frequency of iHCC varies widely in reported series between 4.2% and 40%. [1][2][3] Imaging is important in the diagnosis of HCC and posttransplant follow-up. Many investigators claim that HCC lesions < 2 cm are difficult to diagnose with conventional diagnostic imaging studies, and recommend that an additional diagnostic evaluation should be undertaken in the screening process of cirrhotic patients who are on waiting lists. 4 Many studies have shown that long-term outcome and survival are similar in patients who have iHCC or known HCC (kHCC) before transplant. The iHCC has lower recurrence rate than kHCC, and this has raised the question about the need for cross-sectional imaging screening for HCC in all cirrhotic patients, especially while w...

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Clinicopathological features of incidental hepatocellular carcinoma in liver transplantation

Cited by 28 publications

References 6 publications

Incidentally Discovered Hepatocellular Carcinoma in Explanted Liver: Clinical, Histopathologic Features and Outcome

Incidentally Discovered Hepatocellular Carcinoma in Explanted Liver: Clinical, Histopathologic Features and Outcome

Super-selection of a Subgroup of Hepatocellular Carcinoma Patients at Minimal Risk of Recurrence for Liver Transplantation

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