Recurrence of hepatocellular cancer after liver transplantation: The role of primary resection and salvage transplantation in East and West
Autor: | WW Sharr, Gurusharan Singh, See Ching Chan, Jan Lerut, Quirino Lai, Massimo Rossi, Giuseppe Tisone, Salvatore Agnes, Chung Mau Lo, Tommaso Maria Manzia, Alfonso Wolfango Avolio, Kenneth S. H. Chok, Pasquale Berloco |
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Jazyk: | angličtina |
Rok vydání: | 2012 |
Předmět: |
Adult
Male medicine.medical_specialty Carcinoma Hepatocellular WEST medicine.medical_treatment Settore MED/18 - CHIRURGIA GENERALE Rome Salvage therapy LOCOREGIONAL THERAPY Liver transplantation Milan criteria Model for End-Stage Liver Disease Risk Factors Carcinoma medicine Humans Hepatology Gastroenterology hepatocelluar cancer locoregional therapies resection salvage transplantation Aged Retrospective Studies SALVAGE TRANSPLANTATION Salvage Therapy OUTCOME RECURRENCE FREE SURVIVAL business.industry Incidence Liver Neoplasms Disease Management Retrospective cohort study LIVER TRANSPLANTATION Odds ratio MILAN CRITERIA Middle Aged medicine.disease Prognosis digestive system diseases Surgery Settore MED/18 Transplantation Logistic Models Treatment Outcome EAST SURVIVAL Hong Kong Female Neoplasm Recurrence Local business the role of primary resection and salvage transplantation |
Popis: | Greater tumor aggressiveness and different management modalities of hepatocellular cancer (HCC) before liver transplantation (LT) may explain the higher recurrence rates reported in Asia. This study investigates the prognostic factors for HCC recurrence in a Western and an Eastern HCC patient cohort in order to analyze the respective roles of tumor- and management-related factors on the incidence of post-LT HCC recurrence.Data of 273 HCC patients, transplanted during the period January 1999-March 2009, were obtained from the Rome Inter-University Liver Transplant Consortium (n=157) and Hong Kong University (n=116) databases. Median follow-up was 4.3 years (range: 0.2-12). Recurrence rate and multivariate logistic regression analysis was performed on the entire population and on Milan criteria-in (MC-in) patients.Multivariate analysis on the entire population identified four independent risk factors for post-LT HCC recurrence: microvascular invasion (odds ratio, OR=4.88; p=0.001), poor tumor grading (OR=6.86; p=0.002), diameter of the largest tumor (OR=4.72; p=0.05), and previous liver resection (LR) (OR=3.34; p=0.04). After removal of LR, only tumor-related variables were independent risk factors for recurrence. When only MC-in patients were analyzed, no difference was observed between the two cohorts in terms of recurrence rate after LR patient removal.LR followed by salvage "for HCC recurrence" LT represents the main reason for a higher HCC recurrence rate in the Hong Kong patients, but not LR followed by salvage "for liver failure" LT in the Roman group. This approach towards HCC before LT may not be universally applicable. The precise patient background must be taken into account in order to identify the best pre-LT strategy. |
Databáze: | OpenAIRE |
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