Liver transplantation should be offered to patients with small solitary hepatocellular carcinoma and a positive serum alpha fetoprotein rather than resection
| Autor: | Jay A. Graham, Kirti Shetty, Joseph K. Melancon, Lynt B. Johnson |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_specialty
Carcinoma Hepatocellular medicine.medical_treatment Kaplan-Meier Estimate Milan criteria Liver transplantation Gastroenterology Decision Support Techniques Internal medicine medicine Carcinoma Hepatectomy Humans Retrospective Studies Relative survival business.industry Liver Neoplasms Retrospective cohort study General Medicine medicine.disease digestive system diseases Surgery Liver Transplantation Transplantation Treatment Outcome Hepatocellular carcinoma alpha-Fetoproteins business SEER Program |
| Zdroj: | American journal of surgery. 205(4) |
| ISSN: | 1879-1883 |
| Popis: | KEYWORDS: Liver; Transplantation; Hepatocellular carcinoma; Resection; SEER; AFP Abstract BACKGROUND: As debate continues as to what surgical modality should be offered to patients with hepatocellular carcinoma, the authors submit that serum a-fetoprotein (AFP) is an important variable to consider. METHODS: Using the Surveillance, Epidemiology and End Results database, patients with solitary tumors within the Milan criteria were further stratified into 2 groups, those who underwent orthotopic liver transplantation (OLT) and those who underwent segmentectomy, lobectomy, or extended lobec- tomy (resection). Patients were further grouped according to serum AFP status (negative or positive). Relative survival was retrospectively evaluated for 3 years using the log-rank test. RESULTS: In the AFP-negative group, resection (n 5 165) offered equivalent survival compared with OLT (n 5 116); 3-year survival was 73.8% and 81.6%, respectively (P 5 .245). In the AFP- positive group, 3-year survival for resection (n 5 200) was 59%, while survival was 75.3% for OLT (n 5 181), which showed a clear survival advantage (P 5 .001). CONCLUSIONS: The results of this study demonstrate that patients with solitary hepatocellular car- cinoma lesions within the Milan criteria and AFP-positive status should not undergo resection but rather be offered OLT. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect