M A Varona1, A Soriano2, A Aguirre-Jaime3, S Garrido4, E Oton5, D Diaz5, J Portero6, P Bravo7, M A Barrera2, A Perera8. 1. Department of Surgery, Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain. Electronic address: mvarbosa@gmail.com. 2. Department of Surgery, Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain. 3. Investigation Unit, Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain. 4. Department of Radiology/Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain. 5. Department of Hepatology/Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain. 6. Department of Vascular Radiology, Crta. El Rosario, no. 145, 38010, S/C de Tenerife, Spain. 7. Department of Anesthesiology/Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain. 8. Department of Pathology/Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain.
Abstract
BACKGROUND: Recurrence of hepatocellular carcinoma (HCC) and cirrhosis after a liver transplantation (LT) is a major concern, and a strict Milan criteria selection of candidates does not accurately discriminate the relapse rate after LT. PURPOSE: This study sought to analyze the risk factors affecting tumor recurrence after LT for related cirrhosis HCC and the application of the French prognostic model (preLT alpha-fetoprotein [AFP], size, number) in a single center. METHODS: In a retrospective observational study of LT for HCC and cirrhosis, clinicopathological features were analyzed. Also, the preoperative and postoperative AFP model score was calculated with a cutoff of 2. RESULTS: Of 480, 109 patients underwent cadaveric LT for HCC. Eight of them had a relapse (7%). High AFP level, AFP model score >2, high pathological tumor-node-metastasis (pTNM) stage, poor differentiation, macrovascular-microvascular invasion, infiltration, and R1 margin were statistically significant (P < .05) for recurrence. Also, in the preoperative model, AFP score >2 was a predictor of worse survival (1-, 3-, 5-, 10-year survival of 81%, 51%, 30%, 30% vs 90%, 76%, 73%, 69% in ≤2, with P = .005). Regarding the postoperative model, similar results were found (1-, 3-, 5-, 10-year survival of 84%, 47%, 37%, 37% vs 90%, 78%, 73%, 52%, P = .028) between AFP model score >2 and ≤2, respectively. However, Milan and up-to-7 criteria were not accurate in recurrence nor in survival. CONCLUSIONS: The French AFP model has proven to be a more discerning prognostic tool than other established criteria in the prediction of recurrence and survival. Also, in postoperative prognosis, pathological risk factors for relapse such as pTNM, differentiation grade, macrovascular-microvascular invasion, infiltration, and R1 margin have been predictors of recurrence.
BACKGROUND: Recurrence of hepatocellular carcinoma (HCC) and cirrhosis after a liver transplantation (LT) is a major concern, and a strict Milan criteria selection of candidates does not accurately discriminate the relapse rate after LT. PURPOSE: This study sought to analyze the risk factors affecting tumor recurrence after LT for related cirrhosis HCC and the application of the French prognostic model (preLT alpha-fetoprotein [AFP], size, number) in a single center. METHODS: In a retrospective observational study of LT for HCC and cirrhosis, clinicopathological features were analyzed. Also, the preoperative and postoperative AFP model score was calculated with a cutoff of 2. RESULTS: Of 480, 109 patients underwent cadaveric LT for HCC. Eight of them had a relapse (7%). High AFP level, AFP model score >2, high pathological tumor-node-metastasis (pTNM) stage, poor differentiation, macrovascular-microvascular invasion, infiltration, and R1 margin were statistically significant (P < .05) for recurrence. Also, in the preoperative model, AFP score >2 was a predictor of worse survival (1-, 3-, 5-, 10-year survival of 81%, 51%, 30%, 30% vs 90%, 76%, 73%, 69% in ≤2, with P = .005). Regarding the postoperative model, similar results were found (1-, 3-, 5-, 10-year survival of 84%, 47%, 37%, 37% vs 90%, 78%, 73%, 52%, P = .028) between AFP model score >2 and ≤2, respectively. However, Milan and up-to-7 criteria were not accurate in recurrence nor in survival. CONCLUSIONS: The French AFP model has proven to be a more discerning prognostic tool than other established criteria in the prediction of recurrence and survival. Also, in postoperative prognosis, pathological risk factors for relapse such as pTNM, differentiation grade, macrovascular-microvascular invasion, infiltration, and R1 margin have been predictors of recurrence.
Authors: A Bauschke; A Altendorf-Hofmann; H Kissler; A Koch; C Malessa; U Settmacher Journal: J Cancer Res Clin Oncol Date: 2017-08-28 Impact factor: 4.553
Authors: Leonardo Lorente; Sergio T Rodriguez; Pablo Sanz; Pedro Abreu-González; Dácil Díaz; Antonia M Moreno; Elisa Borja; María M Martín; Alejandro Jiménez; Manuel A Barrera Journal: Int J Mol Sci Date: 2016-04-05 Impact factor: 5.923