Simple parameters predicting extrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma

Yoon, Jeong Seon; Lee, Won Jae; Kim, Sun Min; Kim, Kwang Tack; Cho, Sung Bum; Kim, Hee Joon; Ko, Yang Seok; Kook, Hyun; Jun, Chung Hwan; Choi, Sung Kyu; Kim, Ban Seok; Cho, Seo Yeon; You, Hye-Su; Lee, Yohan; Son, Seyeong

doi:10.1038/s41598-021-92503-6

Cited by 7 publications

(3 citation statements)

References 43 publications

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“…EHR of HCC is a well-known predictive marker of poor survival outcomes, and EHR after surgical resection of HCC is deemed to be a pivotal factor for grave prognosis[ 7 , 9 , 17 , 18 ]. In this large-scale 15-year observational study conducted at two academic tertiary hospitals, EHR and early EHR occurred in 17.5% and 9.5% of 779 patients with HCC, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…We have reported simple parameters for predicting EHR after hepatectomy[ 9 ], and in that study, approximately 49.2% of the patients with EHR (31 of 63 patients) showed early EHR and demonstrated poorer recurrence-free survival (RFS) and overall survival rates. There have been many reports regarding the risk factors and predictive models for early recurrence mostly concerning IHR of HCC after surgery[ 10 - 12 ]; however, there are limited data regarding the risk factors and survival outcomes related to early EHR after surgical resection of HCC.…”

Section: Introductionmentioning

confidence: 99%

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Early extrahepatic recurrence as a pivotal factor for survival after hepatocellular carcinoma resection: A 15-year observational study

Yoon¹,

Choi²,

Cho³

et al. 2022

World J Gastroenterol

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BACKGROUND Surgical resection is one of the most widely used modalities for the treatment of hepatocellular carcinoma (HCC). Early extrahepatic recurrence (EHR) of HCC after surgical resection is considered to be closely associated with poor prognosis. However, data regarding risk factors and survival outcomes of early EHR after surgical resection remain scarce. AIM To investigate the clinical features and risk factors of early EHR and elucidate its association with survival outcomes. METHODS From January 2004 to December 2019, we enrolled treatment-naïve patients who were ≥ 18 years and underwent surgical resection for HCC in two tertiary academic centers. After excluding patients with tumor types other than HCC and/or ineligible data, this retrospective study finally included 779 patients. Surgical resection of HCC was performed according to the physicians’ decisions and the EHR was diagnosed based on contrast-enhanced computed tomography or magnetic resonance imaging, and pathologic confirmation was performed in selected patients. Multivariate Cox regression analysis was performed to identify the variables associated with EHR. RESULTS Early EHR within 2 years after surgery was diagnosed in 9.5% of patients during a median follow-up period of 4.4 years. The recurrence-free survival period was 5.2 mo, and the median time to EHR was 8.8 mo in patients with early EHR. In 52.7% of patients with early EHR, EHR occurred as the first recurrence of HCC after surgical resection. On multivariate analysis, serum albumin < 4.0 g/dL, serum alkaline phosphatase > 100 U/L, surgical margin involvement, venous and/or lymphatic involvement, satellite nodules, tumor necrosis detected by pathology, tumor size ≥ 7 cm, and macrovascular invasion were determined as risk factors associated with early EHR. After sub-categorizing the patients according to the number of risk factors, the rates of both EHR and survival showed a significant correlation with the risk of early EHR. Furthermore, multivariate analysis revealed that early EHR was associated with substantially worse survival outcomes (Hazard ratio, 6.77; 95% confidence interval, 4.81-9.52; P < 0.001). CONCLUSION Early EHR significantly deteriorates the survival of patients with HCC, and our identified risk factors may predict the clinical outcomes and aid in postoperative strategies for improving survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early extrahepatic recurrence as a pivotal factor for survival after hepatocellular carcinoma resection: A 15-year observational study

Yoon¹,

Choi²,

Cho³

et al. 2022

World J Gastroenterol

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“…After establishing the diagnosis of HCC recurrence, 43 staging should begin with searching for evidence of extrahepatic disease (present in 12% to 27% of patients) 3 , 4 , 44 since this is largely considered a contraindication to surgical treatment. Some investigators have, however, suggested that even patients with isolated extrahepatic recurrence may still benefit from resection.…”

Section: Staging and Treatment Of Recurrent Hccmentioning

confidence: 99%

Recurrent Hepatocellular Carcinoma: Patterns, Detection, Staging and Treatment

Papaconstantinou¹,

Tsilimigras²,

Pawlik³

2022

JHC

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Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths worldwide with the incidence of recurrence being as high as 88% even among patients who have undergone curative-intent treatment. Despite improvements in overall survival, recurrence remains a challenge necessitating accurate reappraisal of patient and disease status. To that end, accurate staging of recurrent HCC is a necessity to provide better care for these patients. Risk factors for poor survival after HCC recurrence have been identified and include characteristics of the primary disease, such as tumor multifocality, large size (≥5 cm), macroscopic vascular or microscopic lymphovascular invasion, preoperative a-fetoprotein (AFP) levels, R0 resection, and the presence of impaired liver function. Close surveillance with imaging is warranted following curative-intent therapy, with magnetic resonance imaging (MRI) being the preferred approach to identify small, early recurrent HCCs. Treatment decisions at the time of recurrence involve ruling out extrahepatic disease and identifying candidates for potentially curative-intent repeat treatment options. Patients with recurrent disease are, however, very diverse in terms of tumor morphology and biologic behavior, as well as residual hepatic functional reserve. Patients with preserved liver function may benefit from repeat liver resection or ablation. Patients with recurrence within the Milan criteria may even be candidates for salvage liver transplantation, while multimodality treatment with combination of liver-directed therapies appears to enhance oncologic outcomes for individuals with advanced recurrent disease. A “one-size-fits-all” approach in staging recurrent HCC does not exist. Rather, individualized and evidence-based decision-making is necessary in order to optimize outcomes for patients with recurrent HCC.

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Cytidine Deaminase Enhances Liver Cancer Invasion by Modulating Epithelial-Mesenchymal Transition via NFκB Signaling

Liao,

Lin,

Chien

et al. 2024

Biomedical Journal

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Simple parameters predicting extrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma

Cited by 7 publications

References 43 publications

Early extrahepatic recurrence as a pivotal factor for survival after hepatocellular carcinoma resection: A 15-year observational study

Early extrahepatic recurrence as a pivotal factor for survival after hepatocellular carcinoma resection: A 15-year observational study

Recurrent Hepatocellular Carcinoma: Patterns, Detection, Staging and Treatment

Cytidine Deaminase Enhances Liver Cancer Invasion by Modulating Epithelial-Mesenchymal Transition via NFκB Signaling

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