Liver Transplantation for Advanced Hepatocellular Carcinoma Using Poor Tumor Differentiation on Biopsy as an Exclusion Criterion

DuBay, Derek A.; Sandroussi, Charbel; Sandhu, Lakhbir; Cleary, Sean; Guba, Markus; Cattral, Mark S.; McGilvray, Ian; Ghanekar, Anand; Selzner, Markus; Greig, Paul D.; Grant, David

doi:10.1097/sla.0b013e31820508f1

Cited by 266 publications

(243 citation statements)

References 41 publications

Supporting

Mentioning

230

Contrasting

Unclassified

Order By: Relevance

“…DuBay et al [27] Toronto Ito et al [24] Kyoto criteria (multinodular disease), or in other organs (extrahepatic spreading). Thus mVI is a critical hallmark in HCC progression, and the strongest prognostic factor as demonstrated in a metaanalysis of observational studies (RR = 3.41 for tumour recurrence and RR = 2.41 for mortality at 3 years) [17] .…”

Section: Namentioning

confidence: 99%

“…In the Toronto criteria there were no limits in terms of diameter of the main nodule or the number of nodules, provided that extrahepatic metastasis, macrovascular invasion and poor histological differentiation were ruled out, and there was a preserved performance status [27] . There were similar 5-year survival rates and 5-year disease-free survival rates between the patients within the Milan criteria and patients beyond Milan criteria but within Toronto criteria.…”

Section: Selection Of Hcc Patients For Ltmentioning

confidence: 99%

See 1 more Smart Citation

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Guerrero-Misas

Rodríguez‐Perálvarez

Mata

2015

WJH

View full text Add to dashboard Cite

Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. Indeed, liver transplantation is considered the standard of care for a subset of patients with cirrhosis and hepatocellular carcinoma.However, tumour recurrence rates are as high as 20%, and once the recurrence is established the therapeutic options are scarce and with little impact on prognosis. Strategies to minimize tumour recurrence and thus to improve outcome may be classified into 3 groups: (1) An adequate selection of candidates for liver transplantation by using the Milan criteria; (2) An optimized management within waiting list including prioritization of patients at high risk of tumour progression, and the implementation of bridging therapies, particularly when the expected length within the waiting list is longer than 6 mo; and (3) Tailored immunosuppression comprising reduced exposure to calcineurin inhibitors, particularly early after liver transplantation, and the addition of mammalian target of rapamycin inhibitors. In the present manuscript the available scientific evidence supporting these strategies is comprehensively reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more patients with hepatocellular carcinoma and with an improved long term outcome. Core tip: Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. However, tumour recurrence rates are 15%-20% with a very poor prognosis. Strategies to minimize tumour recurrence and thus to improve outcome are focused in a careful selection of candidates for liver transplantation, an optimized management within waiting list and a tailored immunosuppression. The available scientific evidence supporting these strategies is reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more REVIEW Submit a

show abstract

Section: Namentioning

confidence: 99%

Section: Selection Of Hcc Patients For Ltmentioning

confidence: 99%

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Guerrero-Misas

Rodríguez‐Perálvarez

Mata

2015

WJH

View full text Add to dashboard Cite

show abstract

“…In fact, the aggressiveness of a tumor can be determined by a higher histological grade and greater microscopic vascular invasion, and a biopsy can used to predict DFS. The Toronto criteria [60] select patients with HCC for LT who do not meet the MC by biopsy exclusion of poorly differentiated tumors, resulting in 5-year overall survival (OS) and DFS values of 70% and 66%, respectively, which are similar to those of the MC (72% and 70%, respectively). However, there is little correlation between the biopsy and 8 cm, thus obtaining similar survival after LT to that obtained with the MC.…”

Section: Importancementioning

confidence: 67%

“…DuBay et al [60] Liver tumor biopsy Excluding poorly differentiated tumors Toso et al [52] TTV > 115 cm 3 Reduced survival at 3 yr (< 50%) AFP > 400 ng/mL Limit for indication for LT Lai et al [62] AFP > 400 ng/mL Strongest predictor for recurrence Total tumor diameter > 8 cm Duvoux et al [63] Model combining log10 AFP, tumor size and n of tumors: Score > or < 2…”

Section: Ref Parameters Importancementioning

confidence: 99%

Selection of patients with hepatocellular carcinoma for liver transplantation: Past and future

Soriano¹

2016

WJH

View full text Add to dashboard Cite

The aim of liver transplantation (LT) for hepatocellular carcinoma (HCC) is to ensure a rate of disease-free survival similar to that of patients transplanted due to benign disease. Therefore, we are forced to adopt strict criteria when selecting candidates for LT and prioritizing patients on the waiting list (WL), to have clarified indications for bridging therapy for groups at risk for progression or recurrence, and to establish certain limits for downstaging therapies. Although the Milan criteria (MC) remain the standard and most employed criteria for indication of HCC patients for LT by far, in the coming years, criteria will be consolidated that take into account not only data regarding the size/ volume and number of tumors but also their biology. This criteria will mainly include the alpha fetoprotein (AFP) values and, in view of their wide variability, any of the published logarithmic models for the selection of candidates for LT. Bridging therapy is necessary for HCC patients on the WL who meet the MC and have the possibility of experiencing a delay for LT greater than 6 mo or any of the known risk factors for recurrence. It is difficult to define single AFP values that would indicate bridging therapy (200, 300 or 400 ng/mL); therefore, it is preferable to rely on the criteria of a French AFP model score > 2. Other single indications for bridging therapy include a tumor diameter greater than 3 cm, more than one tumor, and having an AFP slope greater than 15 ng/mL per month or > 50 ng/mL for three months during strict monitoring while on the WL. When considering the inclusion of patients on the WL who do not meet the MC, it is mandatory to determine their eligibility for downstaging therapy prior to inclusion. The upper limit for this therapy could be one lesion up to 8 cm, 2-3 lesions with a total tumor diameter up to 8 cm, or a total tumor volume of 115 cm 3 . Selection of patients with hepatocellular carcinoma for liver transplantation: Past and future the WL should take into account the recently described HCC model for end-stage liver disease, which considers hepatic function, HCC size and the number and the log of AFP values. This formula has been calibrated with the survival data of non-HCC patients and produces a dynamic and more accurate assessment model.

show abstract

“…Transplantation has been adopted as standard practice when a patient has both underlying liver dysfunction and hcc fulfilling the Milan criteria (single lesion ≤ 5 cm, or 2-3 lesions ≤ 3 cm) 5 . Some centres-for example, San Francisco 6 (tumour volume < 115 cm 3 ) and, most recently, Toronto 7 -have extended those criteria. Liver transplantation for advanced hcc using poor tumour differentiation on biopsy as an exclusion criterion is also practiced, because this approach better correlates with pre-transplantation radiology, potentially includes a greater number of candidates, and has comparable survival outcomes 8 .…”

Section: Introductionmentioning

confidence: 99%

Magnitude of Change in Alpha-Fetoprotein in Response to Transarterial Chemoembolization Predicts Survival in Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma

et al. 2013

View full text Add to dashboard Cite

show abstract

Liver Transplantation for Advanced Hepatocellular Carcinoma Using Poor Tumor Differentiation on Biopsy as an Exclusion Criterion

Cited by 266 publications

References 41 publications

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Selection of patients with hepatocellular carcinoma for liver transplantation: Past and future

Magnitude of Change in Alpha-Fetoprotein in Response to Transarterial Chemoembolization Predicts Survival in Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma

Contact Info

Product

Resources

About