Tumour Size and Differentiation in Predicting Recurrence of Hepatocellular Carcinoma After Liver Transplantation: External Validation of a New Prognostic Score

Marelli, Laura; Grasso, Alessandro; Pleguezuelo, M.; Martines, H.; Stigliano, Rosa; Dhillon, Amar P.; Patch, David; Davidson, Brian R; Sharma, Dheeraj; Rolles, K; Burroughs, Andrew K.

doi:10.1245/s10434-008-0128-3

Cited by 52 publications

(42 citation statements)

References 36 publications

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“…2,3,16,17,37,40,48,50,59 Three studies treated the diameter of the largest tumor nodule as a continuous variable, and they all assessed recurrence (HR ¼ 1.03, 95% CI ¼ 0.99-1.07; Table 1). 16,37,40 Six studies treated the diameter of the largest tumor nodule as a cutoff (!3 versus <3 cm).…”

Section: Diameter Of the Largest Tumor Nodulementioning

confidence: 99%

Which matters most: Number of tumors, size of the largest tumor, or total tumor volume?

et al. 2011

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Section: Diameter Of the Largest Tumor Nodulementioning

confidence: 99%

Which matters most: Number of tumors, size of the largest tumor, or total tumor volume?

et al. 2011

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“…Oncological behavior, such as tumor size and histological differentiation, as well as liver function play important roles in patients' prognosis after initial hepatectomy for treatment of HCC [6,34,35]. In the present study, OS among patients with larger tumors was significantly better in the AR than NAR group.…”

Section: Discussionmentioning

confidence: 46%

Comparison of anatomic and non‐anatomic hepatic resection for hepatocellular carcinoma

Kaibori

Kon

Kitawaki

et al. 2017

J Hepato Biliary Pancreat

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Background The aim of the present study was to compare the prognostic impact of anatomic resection (AR) versus non-anatomic resection (NAR) on patient survival after resection of a single hepatocellular carcinoma (HCC). Methods To control for confounding variable distributions, a 1-to-1 propensity score match was applied to compare the outcomes of AR and NAR. Among 710 patients with a primary, solitary HCC of <5.0 cm in diameter that was resectable by either AR or NAR from 2003 to 2007 in Japan and Korea, 355 patients underwent NAR and 355 underwent AR of at least one section with complete removal of the portal territory containing the tumor. Results Overall survival (OS) was better in the AR than NAR group (hazard ratio 1.67, 95% confidence interval 1.28-2.19, P < 0.001) while disease-free survival showed no significant difference. Significantly fewer patients in the AR than NAR group developed intrahepatic HCC recurrence and multiple intrahepatic recurrences. Patients with poorly differentiated HCC who underwent AR had improved disease-free survival and OS. Conclusions Anatomic resection decreases the risk of tumor recurrence and improves OS in patients with a primary, solitary HCC of <5.0 cm in diameter.

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“…In a recent study of Mazzaferro et al 13 , microvascular invasion is strictly related to size-and-number covariates and tumor grading, and doubles the hazard of recurrence and death after LT. Another factor involved to this issue, is that, in spite of the improvement imaging techniques, about one third of the cases, HCC larger than 3 mm in explanted livers had been underestimated in pre-LT CT or MRI 10,13 . In Silva et al 22 paper, bilobar involvement and poor tumor differentiation were independent risk factors of radiological underestimation.…”

Section: Discussionmentioning

confidence: 99%

The presence of bilobar tumor should be considered as a new limit for transplantation beyond the Milan criteria?

Wahle

Silva

Gonzalez

et al. 2010

ABCD, arq. bras. cir. dig.

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-Background -An imprecise estimate of the tumor's aggressiveness of the hepatocellular carcinoma especially in transplanted patients beyond the Milan criteria has a poor outcome, although a more reliable criteria including microscopic vascular invasion is difficult to be established before transplantation. Aim -To examine a cohort of patients with hepatocellular carcinoma undergoing liver transplantation to evaluate the preoperative predicting factors for microscopic vascular invasion. Methods -A series of 46 consecutive cirrhotic patients with hepatocellular carcinoma undergoing transplantation based on Milan criteria or similar criteria in a single center were enrolled between 1993 and 2007. The survival was calculated using Kaplan-Meyer's method and a multivariate Cox regression was performed to evaluate survival and factors related to microscopic vascular invasion. Results -Multifocal tumors were present in 39%. Microvascular invasion, tumor relapses and hepatocellular carcinoma beyond the Milan criteria were identified in 33%, 13% and 33%, respectively. Overall 1-, 3-, and 5-year actuarial patient survival rates were 64%, 59% and 45% respectively. Patients who exceeded the Milan criteria had a higher incidence of microscopic vascular invasion and bilobar tumor compared to those who met the Milan criteria (53% vs. 23% and 80% vs. 19%; p<0.05, respectively). After multivariate analysis, the variable identified as independent risk factor for microscopic vascular invasion was the presence of bilobar tumor (hazard ratio, 3.67; 95% confidence interval, 1.01 to 13.34; p<0.05). Conclusions -The presence of a bilobar tumor is more frequent in hepatocellular carcinoma beyond the Milan criteria and it is an independent predictive factor of a high risk of microscopic vascular invasion. The presence of bilobar tumor in hepatocellular carcinoma beyond the Milan criteria could be used as selection criteria to estimate the risk of hepatocellular carcinoma recurrence, at least until large randomized studies becomes available.RESUMO -Racional -A recidiva tumoral após o transplante de fígado para o carcinoma hepatocelular tem grande impacto desfavorável na mortalidade e a presença de invasão microvascular desempenha papel importante na recidiva tumoral. Objetivo -Avaliar a sobrevida, o risco de recidiva tumoral pós-transplante e os fatores relacionados à invasão microvascular de uma série de transplantados por carcinoma hepatocelular. Métodos -No período entre 1993 e 2007 foi estudada uma série consecutiva de 46 cirróticos com carcinoma hepatocelular submetidos à transplante de fígado baseado nos critérios de Milão a partir de 1996 ou critérios semelhantes no período anterior a esta data. Inicialmente todas as variáveis foram analisadas descritivamente, e as quantitativas através da observação dos valores mínimos e máximos, e do cálculo de médias e desvios-padrão e medianas. Para as variáveis qualitativas calcularam-se frequências absolutas e relativas. Realizou-se a regressão logística com ajuste pelo modelo de Cox ...

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Tumour Size and Differentiation in Predicting Recurrence of Hepatocellular Carcinoma After Liver Transplantation: External Validation of a New Prognostic Score

Abstract: Tumour differentiation did not add significantly to prediction of HCC recurrence in our cohort. Conversely, diameter of the largest nodule remained a significant risk for recurrence.

Cited by 52 publications

References 36 publications

Which matters most: Number of tumors, size of the largest tumor, or total tumor volume?

Which matters most: Number of tumors, size of the largest tumor, or total tumor volume?

Comparison of anatomic and non‐anatomic hepatic resection for hepatocellular carcinoma

The presence of bilobar tumor should be considered as a new limit for transplantation beyond the Milan criteria?

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