Early Versus Late Hepatocellular Carcinoma Recurrence After Transplantation: Predictive Factors, Patterns, and Long-term Outcome
| Autor: | Nada El-Domiaty, René Adam, Eric Vibert, Daniel Cherqui, Jihan A Shawky, Khaled Amer, Antonio Sa Cunha, C. Salloum, G. Pittau, V. Karam, Rodolphe Sobesky, Oriana Ciacio, Didier Samuel, Maysaa Abdallah Saeed, Wafaa Ibrahim, Faouzi Saliba, Olivier Rosmorduc |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Carcinoma Hepatocellular medicine.medical_treatment 030230 surgery Milan criteria Liver transplantation Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine Late Recurrence medicine Adjuvant therapy Humans Aged Proportional Hazards Models Retrospective Studies Transplantation business.industry Liver Neoplasms Middle Aged medicine.disease Liver Transplantation Hepatocellular carcinoma Early hcc 030211 gastroenterology & hepatology Female Neoplasm Recurrence Local business Complication |
| Zdroj: | Transplantation. 105(8) |
| ISSN: | 1534-6080 |
| Popis: | Hepatocellular carcinoma (HCC) is currently the first indication of liver transplantation (LT) in Europe and Asia-Pacific region and the third in the United States. HCC recurrence is the main complication affecting short- and medium-term outcomes after LT.A total of 433 consecutive adult recipients transplanted for HCC between 2000 and 2017 (mean age: 57.8 ± 8.5 y; 83.8% were males) with a mean follow-up of 74.6 ± 58.6 months were included. Patients had to meet Milan criteria and, since 2014, alpha-fetoprotein score to be listed. Patients with HCC recurrence were classified into early (≤2 y) and late recurrence (2 y) and were retrospectively reviewed.Patients who developed recurrence (75 patients, 17%) had more tumors outside Milan and University of California San Francisco criteria, high alpha-fetoprotein score, and microvascular invasion at pathology. Early recurrence developed in 46 patients (61.3%); the overall 5- and 10-year survival rates of these patients from time of LT were 6.7% and 0%, which were significantly lower than those with late recurrence 64.0% and 27.1%, respectively (P0.001). The median survival times from the diagnosis of HCC recurrence were 15 and 17 months, respectively, in the 2 groups (P0.001). Multivariable Cox regression analysis identified alcoholic cirrhosis as etiology of the underlying liver disease (hazard ratio [HR] = 3.074; P = 0.007), bilobar tumor at time of LT (HR = 2.001; P = 0.037), and a tumor size (50 mm) in the explant (HR = 1.277; P = 0.045) as independent predictors of early recurrence.Improving the prediction of early HCC recurrence could optimize patient selection for LT, potential adjuvant therapy with new targeted drugs and hence, improve long-term survival. |
| Databáze: | OpenAIRE |
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