Liver Transplantation for Extended Criteria Hepatocellular Carcinoma Using Stable Response to Locoregional Therapy and Alpha-Fetoprotein as Selection Criteria
| Autor: | Joachim Andrassy, Jens Werner, Enrico N. De Toni, Max Seidensticker, Martin K. Angele, Markus Guba, Julian Nikolaus Bucher, Hubertus Johann Wolfgang Anger, Markus B. Schoenberg, Gerald Denk |
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| Rok vydání: | 2020 |
| Předmět: |
Oncology
medicine.medical_specialty business.industry medicine.medical_treatment Gastroenterology Milan criteria Liver transplantation medicine.disease Transplantation Hepatocellular carcinoma Internal medicine Cohort medicine Surgery Alpha-fetoprotein business Liver cancer Selection (genetic algorithm) Research Article |
| Zdroj: | Visc Med |
| ISSN: | 2297-475X 2297-4725 |
| DOI: | 10.1159/000506752 |
| Popis: | Introduction: Current practice to only prioritize hepatocellular carcinoma (HCC) that fulfill the Milan criteria (INMC) is changing, since it causes the exclusion of patients who could benefit from liver transplantation. To select patients outside MC (OUTMC) for transplantation, we implemented extended selection criteria without up-front morphometric restrictions containing surrogate parameters of tumor biology. Methods: OUTMC patients were considered without restrictions of morphometrics and received locoregional treatment after interdisciplinary consultation. Our dynamic selection criteria for OUTMC patients required (INMUC): (1) treatment response over (2) at least 6 months and (3) alpha-fetoprotein ≤400 ng/mL over the entire evaluation period. Patients with INMC tumors served as control and internal validation cohort. Results: 31 of 170 liver transplant candidates were OUTMC. Of these, 8 dropped out. The remaining 23 patients met the selection criteria and underwent transplantation. Recurrence-free survival was higher in patients transplanted INMC compared to those OUTMC INMUC (92.2% vs. 70.8%; p = 0.026) after 5 years of follow-up. Overall survival showed no significant difference (p = 0.552). With dynamic selection of transplant candidates, recurrence could also be predicted for the INMC patients as internal validation cohort (c-index: 0.896; CI 0.588–0.981, p = 0.005). Conclusion: Dynamic selection criteria for the stratification of patients with OUTMC HCCs is feasible and allows for excellent long-term results and acceptable tumor recurrence rates comparable to INMC patients. |
| Databáze: | OpenAIRE |
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