Gian Piero Guerrini1, Domenico Pinelli2, Fabrizio Di Benedetto3, Elena Marini2, Vittorio Corno2, Michela Guizzetti2, Alessandro Aluffi2, Marco Zambelli2, Stefano Fagiuoli4, Maria Grazia Lucà4, Alessandro Lucianetti2, Michele Colledan5. 1. Department of Surgery, HPB and General Surgery Unit, Ravenna Hospital, Viale Randi 5, 48121 Ravenna, Italy. 2. Department of Surgery, General Surgery and Abdominal Transplant Unit, "Papa Giovanni XXIII" Hospital, Piazza Organizzazione Mondiale della Sanità, 24127 Bergamo, Italy. 3. Hepato-Pancreato-Biliary and Liver Transplant Unit, Department of Surgery, University Hospital of Modena, Via Del Pozzo 71, 41125 Modena, Italy. 4. Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Piazza Organizzazione Mondiale della Sanità, 24128 Bergamo, Italy. 5. Department of Surgery, General Surgery and Abdominal Transplant Unit, "Papa Giovanni XXIII" Hospital, Piazza Organizzazione Mondiale della Sanità, 24127 Bergamo, Italy. Electronic address: mcolledan@hpg23.it.
Abstract
BACKGROUND: Liver transplantation (LT) is considered the best treatment option for HCC patients with cirrhosis. However, the scarce availability of liver donors and the risk of dropout from the waiting list due to the tumor progression severely limit LT for HCC. In this study, we evaluate the survival and recurrence in a cohort of patients undergoing LT for HCC fulfilling "Milan Criteria" (MC) pre-LT. In this study, we propose the development of a new prognostic score which could improve the accuracy in predicting recurrence post-LT. METHODS: Between 1997 and 2011, out of 1010 LT performed in our unit, 131 patients had T2 staged HCC (inside MC). The prognostic model predicting HCC recurrence post-LT was derived from Cox regression analysis. The performance of this model was validated in an external cohort of 198 HCC patients transplanted at another center. RESULTS: Overall survival at 1-3-5 years was 87%, 74.4%, 68.2%, whereas recurrence-free survival was 94.1%, 81.4%, 77.6%, respectively. Predictive factors for recurrence-free survival included high tumor grading (HR 5.01; p = 0.006) and tumor diameter (HR 1.46; p = 0.045). According to this model, the estimated relative risk of HCC recurrence after LT is given by this formula: 0.382 × (Tumor size [cm]) + 1.613 × (if Grading 3-4). The ROC curve was 0.878 (p < 0.001) in predicting HCC recurrence. CONCLUSION: In conclusion, our study showed that the use of this new prognostic score, taking into account maximal tumor diameter and tumor differentiation, improves the accuracy of Milan criteria in predicting HCC recurrence. Copyright Â
BACKGROUND: Liver transplantation (LT) is considered the best treatment option for HCC patients with cirrhosis. However, the scarce availability of liver donors and the risk of dropout from the waiting list due to the tumor progression severely limit LT for HCC. In this study, we evaluate the survival and recurrence in a cohort of patients undergoing LT for HCC fulfilling "Milan Criteria" (MC) pre-LT. In this study, we propose the development of a new prognostic score which could improve the accuracy in predicting recurrence post-LT. METHODS: Between 1997 and 2011, out of 1010 LT performed in our unit, 131 patients had T2 staged HCC (inside MC). The prognostic model predicting HCC recurrence post-LT was derived from Cox regression analysis. The performance of this model was validated in an external cohort of 198 HCC patients transplanted at another center. RESULTS: Overall survival at 1-3-5 years was 87%, 74.4%, 68.2%, whereas recurrence-free survival was 94.1%, 81.4%, 77.6%, respectively. Predictive factors for recurrence-free survival included high tumor grading (HR 5.01; p = 0.006) and tumor diameter (HR 1.46; p = 0.045). According to this model, the estimated relative risk of HCC recurrence after LT is given by this formula: 0.382 × (Tumor size [cm]) + 1.613 × (if Grading 3-4). The ROC curve was 0.878 (p < 0.001) in predicting HCC recurrence. CONCLUSION: In conclusion, our study showed that the use of this new prognostic score, taking into account maximal tumor diameter and tumor differentiation, improves the accuracy of Milan criteria in predicting HCC recurrence. Copyright Â
Authors: E Dudley Colhoun; C Gunnar Forsberg; Kenneth D Chavin; Prabhakar K Baliga; David J Taber Journal: Surgery Date: 2016-10-19 Impact factor: 3.982
Authors: Safak Gül-Klein; Anika Kästner; Philipp Konstantin Haber; Felix Krenzien; Simon Wabitsch; Alexander Krannich; Andreas Andreou; Dennis Eurich; Frank Tacke; David Horst; Johann Pratschke; Moritz Schmelzle Journal: J Hepatocell Carcinoma Date: 2021-03-18
Authors: Uta Herden; Wenzel Schoening; Johann Pratschke; Steffen Manekeller; Andreas Paul; Richard Linke; Thomas Lorf; Frank Lehner; Felix Braun; Dirk L Stippel; Robert Sucher; Hartmut Schmidt; Christian P Strassburg; Markus Guba; Marieke van Rosmalen; Xavier Rogiers; Undine Samuel; Gerhard MSc Schön; Bjoern Nashan Journal: Can J Gastroenterol Hepatol Date: 2019-03-05