Repeated loco-regional therapies for hepatocellular carcinoma is associated with inferior outcome after living donor liver transplantation in cirrhotic patients
被引:3
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作者:
Tsou, Yi-Fan
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机构:
Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, TaiwanTaipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Tsou, Yi-Fan
[1
]
Lin, Niang-Cheng
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Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, TaiwanTaipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Lin, Niang-Cheng
[1
]
Hsia, Cheng-Yuan
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机构:
Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Taipei Vet Gen Hosp, Dept Surg, Div Gen Surg, Taipei, TaiwanTaipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Hsia, Cheng-Yuan
[1
,2
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Loong, Che-Chuan
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机构:
Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Taipei Vet Gen Hosp, Dept Surg, Div Gen Surg, Taipei, TaiwanTaipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Loong, Che-Chuan
[1
,2
]
Tsai, Hsin-Lin
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机构:
Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Taipei Vet Gen Hosp, Dept Surg, Div Pediat Surg, Taipei, TaiwanTaipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Tsai, Hsin-Lin
[1
,3
]
Chen, Cheng-Yen
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机构:
Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, TaiwanTaipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Chen, Cheng-Yen
[1
]
Lei, Hao-Jan
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机构:
Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Taipei Vet Gen Hosp, Dept Surg, Div Gen Surg, Taipei, TaiwanTaipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Lei, Hao-Jan
[1
,2
]
Chou, Shu-Cheng
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机构:
Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Taipei Vet Gen Hosp, Dept Surg, Div Gen Surg, Taipei, TaiwanTaipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Chou, Shu-Cheng
[1
,2
]
Chung, Meng-Hsuan
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Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, TaiwanTaipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Chung, Meng-Hsuan
[1
]
Kuo, Fang-Cheng
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Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, TaiwanTaipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Kuo, Fang-Cheng
[1
]
Liu, Chin-Su
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Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Taipei Vet Gen Hosp, Dept Surg, Div Pediat Surg, Taipei, TaiwanTaipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
Liu, Chin-Su
[1
,3
]
机构:
[1] Taipei Vet Gen Hosp, Dept Surg, Div Transplantat Surg, Taipei, Taiwan
[2] Taipei Vet Gen Hosp, Dept Surg, Div Gen Surg, Taipei, Taiwan
[3] Taipei Vet Gen Hosp, Dept Surg, Div Pediat Surg, Taipei, Taiwan
Background: Liver transplantation is the definitive treatment for defined stage hepatocellular carcinoma (HCC) in cirrhotic patients. Loco-regional therapy (LRT) may be considered before transplantation to prevent the disease progression and the patient from dropping out of the waiting list. This study aims to evaluate the impact of repeated pretransplant LRTs on the long-term outcomes in HCC liver transplant recipients. Methods: Between 2004 and 2019, living donor liver transplantation (LDLT) recipients with viable HCC on the explant livers were enrolled. Uni- and multivariate analysis was performed with the Cox regression model to stratify the risk factors associated with HCC recurrence and patent survival after LDLT. Results: A total of 124 patients were enrolled, in which 65.3% (n = 81) were Barcelona Clinic Liver Cancer classification stage B or D and 89% (n = 110) had advanced fibrosis or cirrhosis on the explanted livers. After a median follow-up of 41 months (IQR: 24-86.5), there were 18 cases (13.7%) of HCC recurrence. Univariate analysis showed that the model of end-stage liver disease and Child-Turcotte-Pugh score, pretransplant alpha-fetoprotein value (>500 ng/ml), repeated pretransplant LRTs (N > 4), increased tumor numbers and maximal size, presence of microvascular invasion, and the histological grading of the tumors are risk factors of inferior outcomes. In multivariate analysis, only repeated pretransplant LRTs (N > 4) had a significant impact on both the overall- and recurrence-free survival. The impact of pretransplant LRT was consistently significant among subgroups based on their LRT episodes (N = 0, 1-4, >4 respectively). Conclusion: Repeated LRT for HCC can be associated with the risk of tumor recurrence and inferior patient survival after LDLT in cirrhotic patients. Early referral of those eligible for transplantation may improve the treatment outcomes in these patients.
机构:
Hosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, SpainHosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, Spain
Charco, R
Hidalgo, E
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Hosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, SpainHosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, Spain
Hidalgo, E
Lázaro, JL
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Hosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, SpainHosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, Spain
Lázaro, JL
Vargas, V
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Hosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, SpainHosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, Spain
Vargas, V
Castells, L
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机构:
Hosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, SpainHosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, Spain
Castells, L
Murio, E
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Hosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, SpainHosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, Spain
Murio, E
Bilbao, I
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机构:
Hosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, SpainHosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, Spain
Bilbao, I
Margarit, C
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机构:
Hosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, SpainHosp Gen Univ Vall Hebron, Liver Transplantat Unit, Barcelona 08035, Spain