Younger Age and Presence of Macrovascular Invasion Were Independent Significant Factors Associated With Poor Disease-Free Survival in Hepatocellular Carcinoma Patients Undergoing Living Donor Liver Transplantation

Wai, Chun-Tao; Woon, W.-A.; Tan, Ying; Lee, K.-H.; Kc, Tan

doi:10.1016/j.transproceed.2012.01.032

Cited by 15 publications

(8 citation statements)

References 7 publications

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“…These conflicting outcomes arose from the fact that all HCC patients included in the study reported by Kim et al met the Milan criteria. 23 However, when we analyzed the data of selected patients who met the Milan criteria, we found no significant difference in the outcomes of the two groups, which is consistent with the results of the study reported by Kim et al Nevertheless, our results were consistent with those reported by Wai et al 18 from a study of HCC patients aged less than 50 years, which was the same cut-off age applied in the present study. According to their experience, younger age (<50 years) was related to high risk of recurrence (62% vs 9%, P <0.001), and was an independent factor associated with poor RFS.…”

Section: Discussionsupporting

confidence: 93%

“…Although Kim et al 19 presented positive results from their multivariate analysis, some crucial data such as AFP level and tumor features were not included in the Cox regression model. Nevertheless, Wai et al 18 demonstrated that younger age <50 years was an independent risk factor in a cohort of 77 HCC patients, with 86% exceeding the University of California, San Francisco criteria. 23 Compared with their study, we had a larger sample size, and our sample was a consecutive cohort.…”

Section: Discussionmentioning

confidence: 99%

“…In multivariate analysis stratified by age, both the younger and aged groups shared similar independent risk factors for RFS and OS: AFP level ≥400 ng/mL, microvascular invasion, and tumor size >5 cm, which is consistent with previous studies. 11 , 18 , 30 …”

Section: Discussionmentioning

confidence: 99%

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Impact of age on the prognosis after liver transplantation for patients with hepatocellular carcinoma: a single-center experience

Wang

et al. 2015

OTT

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BackgroundLiver transplantation (LT) offers the most effective treatment for hepatocellular carcinoma patients. Various preoperative variables are correlated with survival after LT, but the prognostic role of aging on LT remains controversial.MethodsBetween January 2001 and December 2011, 290 consecutive transplants for patients with hepatocellular carcinoma performed in Shanghai First People’s Hospital (People’s Republic of China) were analyzed retrospectively. We compared patient characteristics and survival curves between a younger group (less than 49 years, n=135) and an aged group (50 years or older, n=155). We then performed Cox multivariate regression analysis of the risk factors for survival in aged and younger patients.ResultsYounger age was associated with higher alpha-fetoprotein (P=0.014), larger tumor size (P=0.038), poorer differentiation (P=0.025), portal lymph node metastasis (P=0.001), and higher recurrence rate (P=0.038). Aged patients had significantly longer recurrence-free survival and overall survival (P=0.020 and P=0.014, respectively); however, there were no significant differences between the younger and aged patients who met the Milan criteria (P>0.05). The 1-, 3-, and 5-year recurrence-free survival rates were 59.7%, 44.5%, and 37.3%, respectively, in the younger group, and 67.9%, 55.3%, and 53.8%, respectively, in the aged group. The 1-, 3-, and 5-year overall survival rates were 68.4%, 45.5%, and 38.9%, respectively, in the younger group, and 76.1%, 59.7%, and 53.9%, respectively, in the aged group. Alpha-fetoprotein ≥400 ng/mL, microvascular invasion, and tumor size >5 cm were independent risk factors for prognosis in both groups.ConclusionYounger patients in our center tended to present with more aggressive tumors and have a higher risk of recurrence. Our single-center experience suggests that younger patients should be assessed more rigorously before LT, while aged patients should be actively considered for LT after appropriate selection.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Impact of age on the prognosis after liver transplantation for patients with hepatocellular carcinoma: a single-center experience

Wang

et al. 2015

OTT

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“…However, this is a faulty assumption; it is tumour biology -rather than its mere presence -that affects patient survival (23). Multiple studies have shown that markers of aggressive tumour behaviour, such as poor histological differentiation, serum AFP, vascular invasion and tumour size are all stronger predictors of poor survival outcomes (23)(24)(25)(26). The fact that multiple proposed expansions of the Milan criteria for transplantation allows for inclusion of additional tumours is a reflection of the relative lower clinical significant of tumour number (27).…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Ultrasound Surveillance for Hepatocellular Carcinoma in a Canadian Centre and Determinants of Its Success

Khalili

Menezes

Kim

et al. 2015

Canadian Journal of Gastroenterology and Hepatology

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“…Younger age has been suggested as a significant risk factor for HBV infection-related HCC recurrence after LT. It has been proposed that this could be due to the vertical transmission of HBV from the occult HBV infection harboring mother and HBV immune tolerant state of the younger patients, triggering HCC recurrence[ 111 , 112 ].…”

Section: The Risk Of Hbv Reactivation In Liver Transplant Patients Unmentioning

confidence: 99%

Reactivation of hepatitis B after liver transplantation: Current knowledge, molecular mechanisms and implications in management

Chauhan¹,

Lingala²,

Gadiparthi³

et al. 2018

WJH

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Chronic hepatitis B (CHB) is a major global health problem affecting an estimated 350 million people with more than 786000 individuals dying annually due to complications, such as cirrhosis, liver failure and hepatocellular carcinoma (HCC). Liver transplantation (LT) is considered gold standard for treatment of hepatitis B virus (HBV)-related liver failure and HCC. However, post-transplant viral reactivation can be detrimental to allograft function, leading to poor survival. Prophylaxis with high-dose hepatitis B immunoglobulin (HBIG) and anti-viral drugs have achieved remarkable progress in LT by suppressing viral replication and improving long-term survival. The combination of lamivudine (LAM) plus HBIG has been for many years the most widely used. However, life-long HBIG use is both cumbersome and costly, whereas long-term use of LAM results in resistant virus. Recently, in an effort to develop HBIG-free protocols, high potency nucleos(t)ide analogues, such as Entecavir or Tenofovir, have been tried either as monotherapy or in combination with low-dose HBIG with excellent results. Current focus is on novel antiviral targets, especially for covalently closed circular DNA (cccDNA), in an effort to eradicate HBV infection instead of viral suppression. However, there are several other molecular mechanisms through which HBV may reactivate and need equal attention. The purpose of this review is to address post-LT HBV reactivation, its risk factors, underlying molecular mechanisms, and recent advancements and future of anti-viral therapy.

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Younger Age and Presence of Macrovascular Invasion Were Independent Significant Factors Associated With Poor Disease-Free Survival in Hepatocellular Carcinoma Patients Undergoing Living Donor Liver Transplantation

Cited by 15 publications

References 7 publications

Impact of age on the prognosis after liver transplantation for patients with hepatocellular carcinoma: a single-center experience

Impact of age on the prognosis after liver transplantation for patients with hepatocellular carcinoma: a single-center experience

The Effectiveness of Ultrasound Surveillance for Hepatocellular Carcinoma in a Canadian Centre and Determinants of Its Success

Reactivation of hepatitis B after liver transplantation: Current knowledge, molecular mechanisms and implications in management

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