Anne Julia Klompenhouwer1, Maaike Alblas2, Belle Vivica van Rosmalen3, Martinus Petrus Daniel Haring4, Esmee Venema2, Michail Doukas5, Maarten Guillaume Josephus Thomeer6, Robert Bart Takkenberg7, Joanne Verheij8, Vincent Erwin de Meijer4, Thomas Matthijs van Gulik3, Hester Floor Lingsma2, Robert Auke de Man9, Jan Nicolaas Maria Ijzermans1. 1. Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. 2. Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. 3. Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam (Location Academic Medical Center), Amsterdam, the Netherlands. 4. Division of Hepatopancreatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 5. Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. 6. Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. 7. Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam (Location Academic Medical Center), Amsterdam, the Netherlands. 8. Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam (Location Academic Medical Center), Amsterdam, the Netherlands. 9. Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Abstract
INTRODUCTION: Surgery is advocated in hepatocellular adenomas (HCA) >5 cm that do not regress to <5 cm after 6-12 months. The aim of this study was to develop a model for these patients, estimating the probability of HCA regression to <5 cm at 1 and 2 years follow-up. METHODS: Data were derived from a multicenter retrospective cohort of female patients diagnosed with HCA >5 cm at first follow-up. Potential predictors included age, body mass index, and HCA diameter at diagnosis (T0), HCA-subtype (hepatocyte nuclear factor 1α inactivated HCA, inflammatory-HCA, unclassified HCA) and "T0-T1 regression-over-time" (percentage of regression between T0 and first follow-up (T1) divided by weeks between T0 and T1). Cox proportional hazards regression was used to develop a multivariable model with time to regression of HCA < 5 cm as outcome. Probabilities at 1 and 2 years follow-up were calculated. RESULTS: In total, 180 female patients were included. Median HCA diameter at T0 was 82.0 mm and at T1 65.0 mm. Eighty-one patients (45%) reached the clinical endpoint of regression to <5 cm after a median of 34 months. No complications occurred during follow-up. In multivariable analysis, the strongest predictors for regression to <5 cm were HCA diameter at T0 (logtransformed, hazard ratio (HR) 0.05), T0-T1 regression-over-time (HR 2.15) and HCA subtype inflammatory-HCA (HR 2.93) and unclassified HCA (HR 2.40), compared to hepatocyte nuclear factor 1α inactivated HCA (reference). The model yielded an internally validated c-index of 0.79. DISCUSSION: In patients diagnosed with HCA > 5 cm that still exceed 5 cm at first follow-up, regression to <5 cm can be predicted at 1 and 2 years follow-up using this model. Although external validation in an independent population is required, this model may aid in decision-making and potentially avoid unnecessary surgery.
INTRODUCTION: Surgery is advocated in hepatocellular adenomas (HCA) >5 cm that do not regress to <5 cm after 6-12 months. The aim of this study was to develop a model for these patients, estimating the probability of HCA regression to <5 cm at 1 and 2 years follow-up. METHODS: Data were derived from a multicenter retrospective cohort of female patients diagnosed with HCA >5 cm at first follow-up. Potential predictors included age, body mass index, and HCA diameter at diagnosis (T0), HCA-subtype (hepatocyte nuclear factor 1α inactivated HCA, inflammatory-HCA, unclassified HCA) and "T0-T1 regression-over-time" (percentage of regression between T0 and first follow-up (T1) divided by weeks between T0 and T1). Cox proportional hazards regression was used to develop a multivariable model with time to regression of HCA < 5 cm as outcome. Probabilities at 1 and 2 years follow-up were calculated. RESULTS: In total, 180 female patients were included. Median HCA diameter at T0 was 82.0 mm and at T1 65.0 mm. Eighty-one patients (45%) reached the clinical endpoint of regression to <5 cm after a median of 34 months. No complications occurred during follow-up. In multivariable analysis, the strongest predictors for regression to <5 cm were HCA diameter at T0 (logtransformed, hazard ratio (HR) 0.05), T0-T1 regression-over-time (HR 2.15) and HCA subtype inflammatory-HCA (HR 2.93) and unclassified HCA (HR 2.40), compared to hepatocyte nuclear factor 1α inactivated HCA (reference). The model yielded an internally validated c-index of 0.79. DISCUSSION: In patients diagnosed with HCA > 5 cm that still exceed 5 cm at first follow-up, regression to <5 cm can be predicted at 1 and 2 years follow-up using this model. Although external validation in an independent population is required, this model may aid in decision-making and potentially avoid unnecessary surgery.
Authors: Anne J Klompenhouwer; Belle V van Rosmalen; Martijn P D Haring; Maarten G J Thomeer; Michail Doukas; Joanne Verheij; Vincent E de Meijer; Thomas M van Gulik; Robert B Takkenberg; Geert Kazemier; Frederik Nevens; Robert A de Man; Jan N M Ijzermans Journal: Liver Int Date: 2020-04-28 Impact factor: 5.828
Authors: B V van Rosmalen; A J Klompenhouwer; J Jaap de Graeff; M P D Haring; V E de Meijer; L Rifai; S Dokmak; A Rawashdeh; M Abu Hilal; M C de Jong; C H C Dejong; M Doukas; R A de Man; J N M IJzermans; O M van Delden; J Verheij; T M van Gulik Journal: Br J Surg Date: 2019-07-17 Impact factor: 6.939
Authors: Christiaan Albert Johan Oudmaijer; Kirsten Anna Berk; Elisabeth Johanna Theresia Maria van der Louw; Rob de Man; Aart-Jan van der Lelij; Jan Hendrik Jozef Hoeijmakers; Jan IJzermans Journal: BMJ Open Date: 2022-02-15 Impact factor: 2.692
Authors: Anne J Klompenhouwer; Robert A de Man; Marco Dioguardi Burgio; Valerie Vilgrain; Jessica Zucman-Rossi; Jan N M Ijzermans Journal: Liver Int Date: 2020-06-11 Impact factor: 5.828