Factors associated with recurrence after transplantation for hepatocellular carcinoma

Duvoux, Christophe; Decaens, Thomas; Roudot‐Thoraval, Françoise; Hadni-Bresson, Solange; Wolf, P; Gugenheim, Jean; Durand, François; Néau-Cransac, Martine; Boillot, Olivier; Dharancy, K.; Chazoullières, O.; Dhumeaux, Daniel; Cherqui, Daniel

doi:10.1016/s0168-8278(03)80449-x

Cited by 4 publications

(5 citation statements)

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“…The New York/California ( N YC A ) s c o r e b a s e d o n α -f e t o p r o t e i n r e s p o n s e (AFP-R) showed potential to increase patients' candidacy for liver transplant without compromising outcomes compared with the widely used Milan criteria and French-AFP score. [1][2][3] In this issue of JAMA Surgery, Halazun et al 4 present a retrospective international multicenter analysis to externally validate the NYCA score and compare it with other scoring systems. The authors found that the AFP-R (a difference between the maximum and final pre-liver transplant AFP levels), when categorized into low-, acceptable-, and high-risk groups, predicted recurrence-free and overall survival and afforded patients initially outside of the Milan criteria acceptable outcomes and better access to liver transplant.…”

Section: Chirag S Desai Md; a Sidney Barritt IV Md Mscrmentioning

confidence: 99%

Dynamic α-Fetoprotein Response—Are We Ready to Change the Dynamics of Hepatocellular Carcinoma Liver Transplant Practice?

Desai

Barritt

2021

JAMA Surg

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Section: Chirag S Desai Md; a Sidney Barritt IV Md Mscrmentioning

confidence: 99%

Dynamic α-Fetoprotein Response—Are We Ready to Change the Dynamics of Hepatocellular Carcinoma Liver Transplant Practice?

Desai

Barritt

2021

JAMA Surg

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“…For the "utility" scores, number and dimension of a tumour combined with some biological aspect (AFP or radiological response) represent the easier way of capturing the risks of recurrence or HCC-specific death. Typically, the cumulative effect of the different risk factors improves the prognostic ability of the model, as shown in different experiences (6,7,9,15,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Considerations and Conclusionmentioning

confidence: 99%

“…In 2010, an Editorial by Marsh et al interestingly stated that: "… in the field of surgical oncology, tumour biology is king, patient selection is queen, and technical manoeuvres are the prince and princess who try, but usually fail, to usurp the throne." Among the different biology-related variables, alpha-fetoprotein (AFP) was the most commonly analysed feature (17)(18)(19)(20)(21)(22)(23)28,35). Its absolute value available immediately before the transplant was correlated with a higher risk for post-LT recurrence (35).…”

Section: Introductionmentioning

confidence: 99%

“…Its slope was similarly connected with an improved ability in selecting the risk for recurrence or intention-to-treat (ITT) death, even if they were within the MC (17,28). Several cut-offs were tested, with the most commonly proposed ones being 400 or 1,000 ng/mL (18)(19)(20). Studies exploring the combination of AFP with other radiological and biological aspects were proposed (17)(18)(19)(20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

“…Several cut-offs were tested, with the most commonly proposed ones being 400 or 1,000 ng/mL (18)(19)(20). Studies exploring the combination of AFP with other radiological and biological aspects were proposed (17)(18)(19)(20)(21)(22)(23). As an example, three scoring systems investigating the integration between radiological aspects and AFP were recently proposed and validated (21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

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Transplantation for hepatocellular cancer: pushing to the limits?

Lai

Vitale

2018

Transl. Gastroenterol. Hepatol

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Milan criteria (MC) represents the cornerstone in the selection of patients with hepatocellular cancer (HCC) waiting for liver transplantation (LT). MC represent the precursor of the scores based on the idea of "utility": in other terms, the scoring systems typically used in the field of LT oncology present the exclusive aim of selecting the cases with the best post-LT outcomes. However, some other scores have been proposed specifically investigating the risk of death or tumour progression during the waiting list. In this case, the selection process is connected with the idea of "priority": patients at higher risk for drop-out (DO) should be selected, prioritising them or, conversely, deciding to de-list them due to the high risk of post-LT futile transplant. Lastly, models based on the concept of "benefit", namely the balancing between priority and utility, have been recently created. The present review aims to examine these three different types of scoring systems, trying to underline their pro and cons in the allocation process of HCC patients.

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Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma

et al. 2005

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The actual impact of transarterial chemoembolization before liver transplantation (LT) for hepatocellular carcinoma (HCC) on patient survival and HCC recurrence is not known. Between 1985 and 1998, 479 patients with HCC in 14 French centers were evaluated for LT. Among these 479 patients, this case-control study included 100 patients who received transarterial chemoembolization before LT (TACE group) and 100 control patients who did not receive chemoembolization (no-TACE group). Patients and controls were matched for the pre-LT tumor characteristics, the period of transplantation, the time spent on the waiting list, and pre-and posttransplantation treatments. Kaplan-Meier estimates were calculated 5 years after LT and were compared with the log-rank test. The mean waiting time before LT was 4.2 ؎ 3.2 months in the TACE group and 4.3 ؎ 4.4 months in the no-TACE group. The median number of TACE procedures was 1 (range: 1-12). Demographic data, median alpha-fetoprotein level (21.6 ng/mL and 22.0 ng/mL, respectively), and pre-and post-LT morphologic characteristics of the tumors did not differ in the TACE and no-TACE groups. Overall 5-year survival was 59.4% with TACE and 59.3% without TACE (ns). Survival rates did not differ significantly between the two groups with respect to the time on the waiting list, the tumor diameter, or the type of TACE (selective or nonselective). In the TACE group, 30 patients had tumor necrosis >80% on the liver explant with a 5-year survival rate of 63.2%, compared with 54.2% among their matched controls (P ‫؍‬ 0.9). In conclusion, with a mean waiting period of 4.2 months and 1 TACE procedure, pre-LT TACE does not influence post-LT overall survival and disease-free survival. (Liver Transpl 2005;11:767-775.) H epatocellular carcinoma (HCC) is one of the most common cancers, and its incidence is rising worldwide. 1-3 HCC occurs usually in cirrhotic livers and less than 30% of cases qualify for resection. 4 Liver transplantation (LT) is the only potentially curative treatment for patients with HCC and cirrhosis. The 5-year survival rate of patients after LT ranges from 33% to 74%, depending on the tumor stage. When LT for HCC is restricted to patients with tumors meeting the widely used Milan criteria, 5 the 5-year overall survival rate is 70% and the recurrence rate is below 15%. [5][6][7] Lengthy waiting periods due to a shortage of donors can allow the tumor to progress to stages that may contraindicate LT. As reported by Yao et al., 8 a 6-month waiting period is associated with a 7.2% cumulative dropout probability, and this rate rises to 37.8% and 55.1% at 12 and 18 months, respectively. Such patients are often offered treatments aimed to control tumor growth pending LT in order to reduce the dropout rate and to improve survival after trans-

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Factors associated with recurrence after transplantation for hepatocellular carcinoma

Cited by 4 publications

References 0 publications

Dynamic α-Fetoprotein Response—Are We Ready to Change the Dynamics of Hepatocellular Carcinoma Liver Transplant Practice?

Dynamic α-Fetoprotein Response—Are We Ready to Change the Dynamics of Hepatocellular Carcinoma Liver Transplant Practice?

Transplantation for hepatocellular cancer: pushing to the limits?

Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma

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