Retrospective study on timing of resection of hepatocellular adenoma

Klompenhouwer, Anne J.; Bröker, Mirelle; Thomeer, Maarten; Gaspersz, M.; Man, Robert A. de; IJzermans, Jan N. M.

doi:10.1002/bjs.10594

Cited by 32 publications

(25 citation statements)

References 28 publications

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“…Klompenhouwer et al stated that 15% of HCA in their cohort showed regression to 50 mm or smaller after 6 months. This increased to 25% of patients after 1 year . Also, they observed that larger HCA often require more than 6 months to regress to a diameter <50 mm .…”

Section: Discussionmentioning

confidence: 96%

“…This increased to 25% of patients after 1 year . Also, they observed that larger HCA often require more than 6 months to regress to a diameter <50 mm . Their sample size allowed them to exclude a correlation between HCA subtype and response.…”

Section: Discussionmentioning

confidence: 99%

“…18 Also, they observed that larger HCA often require more than 6 months to regress to a diameter <50 mm. 18 Their sample size allowed them to exclude a correlation between HCA subtype and response. We were not able to reproduce this in our dataset because of a smaller sample size.…”

Section: Discussionmentioning

confidence: 99%

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The effect of oral contraceptive pill cessation on hepatocellular adenoma diameter: A retrospective cohort study

Haring

Gouw

Haas

et al. 2019

Liver International

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Background & Aims Hepatocellular adenomas (HCA) are rare, hormone‐driven, benign liver tumours. HCA >50 mm are associated with haemorrhage and malignant transformation. Guidelines recommend cessation of oral contraceptive pills (OCP) for size reduction; however, it is currently unknown how HCA respond to cessation of OCP. We sought to investigate the effect of OCP cessation on HCA size. Methods A retrospective cohort study was performed including HCA patients who stopped OCP intake within 6 months of imaging between 2005 and 2018. Biometrics and hormonal medication use were evaluated with self‐designed questionnaires. Response of the largest HCA was evaluated according to Response Evaluation Criteria in Solid Tumours (RECISTv1.1). Cox regression was performed for analysis of factors influencing HCA regression. Results Seventy‐eight HCA patients were included, diagnosed at a median (interquartile range) age of 32 (26‐41) years. Follow‐up was 1.6 (0.4‐2.9) years. HCA size at diagnosis ranged 10‐167 mm. After a median time of 1.3 (0.6‐2.6) years after OCP cessation, 37.2% of HCA showed ≥30% regression, 5.1% complete regression, 56.4% stability and 1.3% progression. No HCA‐induced complications were observed during follow‐up. Cox regression analysis demonstrated a significant association of HCA size with rate of regression; 50 ≤ HCA < 100 mm (HR 2.4, 95% CI 1.1‐5.3; P < 0.05), HCA ≥ 100 mm (HR 8.3, 95% CI 3.3‐21.6; P < 0.001). Conclusions Ninety‐eight per cent of HCA remained stable or regressed after OCP cessation. A longer wait‐and‐see period was associated with a larger proportion of regressing HCA, without HCA‐related complications during follow‐up.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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The effect of oral contraceptive pill cessation on hepatocellular adenoma diameter: A retrospective cohort study

Haring

Gouw

Haas

et al. 2019

Liver International

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“…In women with large HCA (over 5 cm) [ 65 ], several solutions are available and should be discussed by a multidisciplinary tumor board: Systematic resection via surgery; Surgery after 6–12 months of estroprogestative withdrawal if HCA does not regress; Surgery only for symptomatic patients, or HCA with high risk of complications defined by molecular classification. …”

Section: Translation Into Clinical Practicementioning

confidence: 99%

Molecular classification of hepatocellular adenomas: impact on clinical practice

2018

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Hepatocellular adenomas are rare benign liver tumors usually developing in young women using oral contraception. The two main complications are hemorrhage (10–20%) and malignant transformation into hepatocellular carcinoma (<5%). A molecular classification has been recently updated in six major subgroups, linked to risk factors, histology, imaging and clinical features: adenomas inactivated for HNF1A, inflammatory adenomas, β-catenin-activated adenomas mutated in exon 3, β-catenin-activated adenomas mutated in exon 7–8, sonic hedgehog adenomas, and unclassified adenomas. Indeed, β-catenin-mutated adenomas in exon 3 are associated with malignant transformation, and sonic hedgehog adenomas with bleeding. This new nosology of hepatocellular adenomas will help to stratify patients according to risk of complications and will guide therapeutics in the future.

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“…After HCA diagnosis, lifestyle adaption with cessation of OC and weight reduction is indicated, irrespective of HCA diameter 9 . In case of growth or when the HCA fails to regress to less than 5cm, resection may be indicated 9,10 . Other indications for resection are HCA in men, patients with β‐HCA or β‐IHCA.…”

Section: Introductionmentioning

confidence: 99%

A multicentre retrospective analysis on growth of residual hepatocellular adenoma after resection

Klompenhouwer

Rosmalen

Haring

et al. 2020

Liver International

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Background & Aims Hepatocellular adenoma (HCA) is a benign liver tumour that may require resection in select cases. The aim of this study was to the assess growth of residual HCA in the remnant liver and to advise on an evidence‐based management strategy. Method This multicentre retrospective cohort study included all patients with HCA who underwent surgery of HCA and had residual HCA in the remnant liver. Growth was defined as an increase of >20% in transverse diameter (RECIST criteria). Data on patient and HCA characteristics, diagnostic work‐up, treatment and follow‐up were documented and analysed. Results A total of 134 patients were included, one male. At diagnosis, median age was 38yrs (IQR 30.0‐44.0) and median BMI was 29.9 kg/m2 (IQR 24.6‐33.3). After resection, median number of residual sites of HCA was 3 (IQR 2‐6). Follow‐up of residual HCA showed regression in 24.6%, stable HCA in 61.9% and growth of at least one lesion in 11.2%. Three patients (2.2%) developed new HCA that were not visible on imaging prior to surgery. Four patients (3%, one male) underwent an intervention as growth was progressive. No statistically significant differences in clinical characteristics were found between patients with growing residual or new HCA versus those with stable or regressing residual HCA. Conclusion In patients with multiple HCA who undergo resection, growth of residual HCA is not uncommon but interventions are rarely needed as most lesions stabilize and do not show progressive growth. Surveillance is indicated when residual HCA show growth after resection, enabling intervention in case of progressive growth.

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Retrospective study on timing of resection of hepatocellular adenoma

Cited by 32 publications

References 28 publications

The effect of oral contraceptive pill cessation on hepatocellular adenoma diameter: A retrospective cohort study

The effect of oral contraceptive pill cessation on hepatocellular adenoma diameter: A retrospective cohort study

Molecular classification of hepatocellular adenomas: impact on clinical practice

A multicentre retrospective analysis on growth of residual hepatocellular adenoma after resection

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