BACKGROUND: The reliable prediction of hepatocellular carcinoma (HCC) recurrence patterns potentially allows for the prioritization of patients for liver resection (LR) or transplantation. OBJECTIVES: The aim of this study was to analyse clinicopathological factors and preoperative Milan criteria (MC) status in predicting patterns of HCC recurrence. METHODS: During 1992-2012, 320 patients undergoing LR for HCC were categorized preoperatively as being within or beyond the MC, as were recurrences. RESULTS: After a median follow-up of 47 months, 183 patients developed recurrence, giving a 5-year cumulative incidence of recurrence of 62.5%. Patients with preoperative disease within the MC had better survival outcomes than those with preoperative disease beyond the MC (median survival: 102 months versus 45 months; P < 0.001). Overall, 31% of patients had preoperative disease within the MC and 69% had preoperative disease beyond the MC. Estimated rates of recurrence-free survival at 5 years were 61.8% for all patients and 53.8% for patients with initial beyond-MC status. Independent factors for recurrence beyond-MC status included preoperative disease beyond the MC, the presence of microsatellite or multiple tumours and lymphovascular invasion (all: P < 0.001). A clinical risk score was used to predict survival and the likelihood of recurrence beyond the MC; patients with scores of 0, 1, 2 and 3 had 5- year incidence of recurring beyond-MC of 9.0%, 29.5%, 48.8% and 75.4%, respectively (P < 0.0001). CONCLUSIONS: Regardless of initial MC status, at 5 years the majority of patients remained disease-free or experienced recurrence within the MC after LR, and thus were potentially eligible for salvage transplantation (ST). Incorporating clinicopathological parameters into the MC allows for better risk stratification, which improves the selection of patients for ST and identifies patients in need of closer surveillance.
BACKGROUND: The reliable prediction of hepatocellular carcinoma (HCC) recurrence patterns potentially allows for the prioritization of patients for liver resection (LR) or transplantation. OBJECTIVES: The aim of this study was to analyse clinicopathological factors and preoperative Milan criteria (MC) status in predicting patterns of HCC recurrence. METHODS: During 1992-2012, 320 patients undergoing LR for HCC were categorized preoperatively as being within or beyond the MC, as were recurrences. RESULTS: After a median follow-up of 47 months, 183 patients developed recurrence, giving a 5-year cumulative incidence of recurrence of 62.5%. Patients with preoperative disease within the MC had better survival outcomes than those with preoperative disease beyond the MC (median survival: 102 months versus 45 months; P < 0.001). Overall, 31% of patients had preoperative disease within the MC and 69% had preoperative disease beyond the MC. Estimated rates of recurrence-free survival at 5 years were 61.8% for all patients and 53.8% for patients with initial beyond-MC status. Independent factors for recurrence beyond-MC status included preoperative disease beyond the MC, the presence of microsatellite or multiple tumours and lymphovascular invasion (all: P < 0.001). A clinical risk score was used to predict survival and the likelihood of recurrence beyond the MC; patients with scores of 0, 1, 2 and 3 had 5- year incidence of recurring beyond-MC of 9.0%, 29.5%, 48.8% and 75.4%, respectively (P < 0.0001). CONCLUSIONS: Regardless of initial MC status, at 5 years the majority of patients remained disease-free or experienced recurrence within the MC after LR, and thus were potentially eligible for salvage transplantation (ST). Incorporating clinicopathological parameters into the MC allows for better risk stratification, which improves the selection of patients for ST and identifies patients in need of closer surveillance.
Authors: U Cillo; A Vitale; F Grigoletto; E Gringeri; F D'Amico; M Valmasoni; A Brolese; G Zanus; N Srsen; A Carraro; P Burra; F Farinati; P Angeli; D F D'Amico Journal: Am J Transplant Date: 2007-04 Impact factor: 8.086
Authors: M Ravaioli; G L Grazi; F Piscaglia; F Trevisani; M Cescon; G Ercolani; M Vivarelli; R Golfieri; A D'Errico Grigioni; I Panzini; C Morelli; M Bernardi; L Bolondi; A D Pinna Journal: Am J Transplant Date: 2008-12 Impact factor: 8.086
Authors: Francis Y Yao; Ryutaro Hirose; Jeanne M LaBerge; Timothy J Davern; Nathan M Bass; Robert K Kerlan; Raphael Merriman; Sandy Feng; Chris E Freise; Nancy L Ascher; John P Roberts Journal: Liver Transpl Date: 2005-12 Impact factor: 5.799
Authors: Clifford S Cho; Mithat Gonen; Jinru Shia; Michael W Kattan; David S Klimstra; William R Jarnagin; Michael I D'Angelica; Leslie H Blumgart; Ronald P DeMatteo Journal: J Am Coll Surg Date: 2007-10-29 Impact factor: 6.113
Authors: Zheng Zheng; Wenhua Liang; Daniel P Milgrom; Zhouying Zheng; Paul M Schroder; Ning S Kong; Changsheng Yang; Zhiyong Guo; Xiaoshun He Journal: Transplantation Date: 2014-01-27 Impact factor: 4.939
Authors: Ser Yee Lee; Brian K P Goh; Gholami Sepideh; John C Allen; Ryan P Merkow; Jin Yao Teo; Deepa Chandra; Ye Xin Koh; Ek Khoon Tan; Juinn Haur Kam; Peng Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung; Michael I D'Angelica; William R Jarnagin; T Peter Kingham; Chung Yip Chan Journal: J Gastrointest Surg Date: 2018-11-12 Impact factor: 3.452
Authors: Jin Yao Teo; Juinn Huar Kam; Chung Yip Chan; Brian K P Goh; Jen-San Wong; Victor T W Lee; Peng Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung; Ser Yee Lee Journal: Hepatobiliary Surg Nutr Date: 2015-12 Impact factor: 7.293
Authors: Ivan Fan-Ngai Hung; Danny Ka-Ho Wong; Ronnie Tung-Ping Poon; Daniel Yee-Tak Fong; Ada Hang-Wai Chui; Wai-Kay Seto; James Yan-Yue Fung; Albert Chi-Yan Chan; John Chi-Hang Yuen; Randal Tiu; Olivia Choi; Ching-Lung Lai; Man-Fung Yuen Journal: PLoS One Date: 2016-02-22 Impact factor: 3.240
Authors: Sirina Ekpanyapong; Neil Philips; Bao-Li Loza; Peter Abt; Emma E Furth; Rashmi Tondon; Vandana Khungar; Kim Olthoff; Abraham Shaked; Maarouf A Hoteit; K Rajender Reddy Journal: J Clin Exp Hepatol Date: 2019-11-22