Liver transplantation for hepatocellular cancer: UCL experience in 137 adult cirrhotic patients. Alpha-foetoprotein level and locoregional treatment as refined selection criteria
Summary Liver transplantation (LT) is a validated treatment for selected cirrhotics with hepatocellular cancer (HCC). A retrospective single center study including 137 recipients having proven HCC was done to refine inclusion criteria for LT as well as to look at impact of locoregional treatment (LR...
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| Veröffentlicht in: | Transplant international 2012-08, Vol.25 (8), p.867-875 |
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| creator | Ciccarelli, Olga Lai, Quirino Goffette, Pierre Finet, Patrice De Reyck, Chantal Roggen, Francine Sempoux, Christine Doffagne, Erik Reding, Raymond Lerut, Jan |
| description | Summary
Liver transplantation (LT) is a validated treatment for selected cirrhotics with hepatocellular cancer (HCC). A retrospective single center study including 137 recipients having proven HCC was done to refine inclusion criteria for LT as well as to look at impact of locoregional treatment (LRT) on outcome. At pre‐LT imaging, 42 (30.6%) patients were Milan criteria (MC)‐OUT; 28 (20.4%) were University of California San Francisco criteria (UCSFC)‐OUT. Pre‐LT LRT was performed in 109 (79.6%) patients. Multivariate analysis identified four factors to be independently predictive of recurrence: tumour number >3, AFP level ≥400 ng/ml, microvascular invasion and rejection needing anti‐lymphocytic antibodies. When considering pre‐transplant variables only, AFP level ≥400 ng/ml (HR = 5.13; P |
| doi_str_mv | 10.1111/j.1432-2277.2012.01512.x |
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Liver transplantation (LT) is a validated treatment for selected cirrhotics with hepatocellular cancer (HCC). A retrospective single center study including 137 recipients having proven HCC was done to refine inclusion criteria for LT as well as to look at impact of locoregional treatment (LRT) on outcome. At pre‐LT imaging, 42 (30.6%) patients were Milan criteria (MC)‐OUT; 28 (20.4%) were University of California San Francisco criteria (UCSFC)‐OUT. Pre‐LT LRT was performed in 109 (79.6%) patients. Multivariate analysis identified four factors to be independently predictive of recurrence: tumour number >3, AFP level ≥400 ng/ml, microvascular invasion and rejection needing anti‐lymphocytic antibodies. When considering pre‐transplant variables only, AFP level ≥400 ng/ml (HR = 5.13; P < 0.0001) was the unique risk factor for recurrence; conversely, application of LRT was protective (HR = 0.42; P = 0.04). MC‐IN patients having LRT (n = 79) had the best 5‐year tumour‐free survival (TFS) (91.6%). MC‐IN patients without LRT (n = 16) and MC‐OUT patients with LRT (n = 30) had similar good TFS (72.7% vs.77.5%); finally MC‐OUT patients without LRT (n = 12) had the worst results (45.0%; vs. 1st group: P < 0.0001). Immediate pre‐LT AFP and aggressive pre‐transplant LRT strategy, especially in MC‐OUT patients, are both important elements to further expand inclusion criteria without compromising long‐term results of HCC liver recipients.</description><identifier>ISSN: 0934-0874</identifier><identifier>EISSN: 1432-2277</identifier><identifier>DOI: 10.1111/j.1432-2277.2012.01512.x</identifier><identifier>PMID: 22716073</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; alpha-Fetoproteins - metabolism ; alpha-foetoprotein ; Combined Modality Therapy ; downstaging ; Female ; hepatocellular cancer ; Humans ; Liver cancer ; Liver cirrhosis ; Liver Cirrhosis - complications ; Liver Neoplasms - etiology ; Liver Neoplasms - surgery ; Liver Neoplasms - therapy ; liver transplantation ; Liver Transplantation - mortality ; locoregional treatment ; Male ; Middle Aged ; Multivariate analysis ; Patient Selection ; Pulsed Radiofrequency Treatment ; Retrospective Studies ; Transplants & implants</subject><ispartof>Transplant international, 2012-08, Vol.25 (8), p.867-875</ispartof><rights>2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation</rights><rights>2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4522-76f3dbef0c0d1c71bcc26d902ee185c038dbc4121d66de70f609a0e097253923</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1432-2277.2012.01512.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1432-2277.2012.01512.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,778,782,1414,27911,27912,45561,45562</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22716073$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ciccarelli, Olga</creatorcontrib><creatorcontrib>Lai, Quirino</creatorcontrib><creatorcontrib>Goffette, Pierre</creatorcontrib><creatorcontrib>Finet, Patrice</creatorcontrib><creatorcontrib>De Reyck, Chantal</creatorcontrib><creatorcontrib>Roggen, Francine</creatorcontrib><creatorcontrib>Sempoux, Christine</creatorcontrib><creatorcontrib>Doffagne, Erik</creatorcontrib><creatorcontrib>Reding, Raymond</creatorcontrib><creatorcontrib>Lerut, Jan</creatorcontrib><title>Liver transplantation for hepatocellular cancer: UCL experience in 137 adult cirrhotic patients. Alpha-foetoprotein level and locoregional treatment as refined selection criteria</title><title>Transplant international</title><addtitle>Transpl Int</addtitle><description>Summary
Liver transplantation (LT) is a validated treatment for selected cirrhotics with hepatocellular cancer (HCC). A retrospective single center study including 137 recipients having proven HCC was done to refine inclusion criteria for LT as well as to look at impact of locoregional treatment (LRT) on outcome. At pre‐LT imaging, 42 (30.6%) patients were Milan criteria (MC)‐OUT; 28 (20.4%) were University of California San Francisco criteria (UCSFC)‐OUT. Pre‐LT LRT was performed in 109 (79.6%) patients. Multivariate analysis identified four factors to be independently predictive of recurrence: tumour number >3, AFP level ≥400 ng/ml, microvascular invasion and rejection needing anti‐lymphocytic antibodies. When considering pre‐transplant variables only, AFP level ≥400 ng/ml (HR = 5.13; P < 0.0001) was the unique risk factor for recurrence; conversely, application of LRT was protective (HR = 0.42; P = 0.04). MC‐IN patients having LRT (n = 79) had the best 5‐year tumour‐free survival (TFS) (91.6%). MC‐IN patients without LRT (n = 16) and MC‐OUT patients with LRT (n = 30) had similar good TFS (72.7% vs.77.5%); finally MC‐OUT patients without LRT (n = 12) had the worst results (45.0%; vs. 1st group: P < 0.0001). Immediate pre‐LT AFP and aggressive pre‐transplant LRT strategy, especially in MC‐OUT patients, are both important elements to further expand inclusion criteria without compromising long‐term results of HCC liver recipients.</description><subject>Adult</subject><subject>Aged</subject><subject>alpha-Fetoproteins - metabolism</subject><subject>alpha-foetoprotein</subject><subject>Combined Modality Therapy</subject><subject>downstaging</subject><subject>Female</subject><subject>hepatocellular cancer</subject><subject>Humans</subject><subject>Liver cancer</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Neoplasms - etiology</subject><subject>Liver Neoplasms - surgery</subject><subject>Liver Neoplasms - therapy</subject><subject>liver transplantation</subject><subject>Liver Transplantation - mortality</subject><subject>locoregional treatment</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Patient Selection</subject><subject>Pulsed Radiofrequency Treatment</subject><subject>Retrospective Studies</subject><subject>Transplants & implants</subject><issn>0934-0874</issn><issn>1432-2277</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkd9u0zAUxiMEYmXwCsgSN9wkHDuJ3SBxMVXbmBaBhIq4tFznhLq4cbCd0b0WT4izbr3Akv8o3-_zOc6XZYRCQdP4sCtoVbKcMSEKBpQVQOu0Hp5li5PwPFtAU1Y5LEV1lr0KYQcAbFnDy-ws6ZSDKBfZ39bcoSfRqyGMVg1RReMG0jtPtjiq6DRaO1nliVaDRv-RfF-1BA8jeoPpAzEDoaUgqptsJNp4v3XRaJKsSY-hIBd23Kq8dxjd6F3EZLB4h5aooSPWaefxZyqpbGoCVdwnF1GBeOzNgB0JaFE_9KS9iamqep296JUN-OZxP8_WV5fr1ee8_Xp9s7poc13VjOWC92W3wR40dFQLutGa8a4BhkiXtYZy2W10RRntOO9QQM-hUYDQCFaXDSvPs_fHa1PXvycMUe5NmP-GGtBNQVJgFa9qCjyh7_5Dd27y6UmJEpw3qRaDRL19pKbNHjs5erNX_l4-hZGAT0fgj7F4f9IpyDl0uZNztjMu5By6fAhdHuT62818Sv786Dch4uHkV_6X5KIUtfzx5TrNdlWLq7W8Lf8Bnwqx2w</recordid><startdate>201208</startdate><enddate>201208</enddate><creator>Ciccarelli, Olga</creator><creator>Lai, Quirino</creator><creator>Goffette, Pierre</creator><creator>Finet, Patrice</creator><creator>De Reyck, Chantal</creator><creator>Roggen, Francine</creator><creator>Sempoux, Christine</creator><creator>Doffagne, Erik</creator><creator>Reding, Raymond</creator><creator>Lerut, Jan</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QO</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201208</creationdate><title>Liver transplantation for hepatocellular cancer: UCL experience in 137 adult cirrhotic patients. Alpha-foetoprotein level and locoregional treatment as refined selection criteria</title><author>Ciccarelli, Olga ; Lai, Quirino ; Goffette, Pierre ; Finet, Patrice ; De Reyck, Chantal ; Roggen, Francine ; Sempoux, Christine ; Doffagne, Erik ; Reding, Raymond ; Lerut, Jan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4522-76f3dbef0c0d1c71bcc26d902ee185c038dbc4121d66de70f609a0e097253923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>alpha-Fetoproteins - metabolism</topic><topic>alpha-foetoprotein</topic><topic>Combined Modality Therapy</topic><topic>downstaging</topic><topic>Female</topic><topic>hepatocellular cancer</topic><topic>Humans</topic><topic>Liver cancer</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Neoplasms - etiology</topic><topic>Liver Neoplasms - surgery</topic><topic>Liver Neoplasms - therapy</topic><topic>liver transplantation</topic><topic>Liver Transplantation - mortality</topic><topic>locoregional treatment</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Patient Selection</topic><topic>Pulsed Radiofrequency Treatment</topic><topic>Retrospective Studies</topic><topic>Transplants & implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ciccarelli, Olga</creatorcontrib><creatorcontrib>Lai, Quirino</creatorcontrib><creatorcontrib>Goffette, Pierre</creatorcontrib><creatorcontrib>Finet, Patrice</creatorcontrib><creatorcontrib>De Reyck, Chantal</creatorcontrib><creatorcontrib>Roggen, Francine</creatorcontrib><creatorcontrib>Sempoux, Christine</creatorcontrib><creatorcontrib>Doffagne, Erik</creatorcontrib><creatorcontrib>Reding, Raymond</creatorcontrib><creatorcontrib>Lerut, Jan</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Transplant international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ciccarelli, Olga</au><au>Lai, Quirino</au><au>Goffette, Pierre</au><au>Finet, Patrice</au><au>De Reyck, Chantal</au><au>Roggen, Francine</au><au>Sempoux, Christine</au><au>Doffagne, Erik</au><au>Reding, Raymond</au><au>Lerut, Jan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Liver transplantation for hepatocellular cancer: UCL experience in 137 adult cirrhotic patients. Alpha-foetoprotein level and locoregional treatment as refined selection criteria</atitle><jtitle>Transplant international</jtitle><addtitle>Transpl Int</addtitle><date>2012-08</date><risdate>2012</risdate><volume>25</volume><issue>8</issue><spage>867</spage><epage>875</epage><pages>867-875</pages><issn>0934-0874</issn><eissn>1432-2277</eissn><abstract>Summary
Liver transplantation (LT) is a validated treatment for selected cirrhotics with hepatocellular cancer (HCC). A retrospective single center study including 137 recipients having proven HCC was done to refine inclusion criteria for LT as well as to look at impact of locoregional treatment (LRT) on outcome. At pre‐LT imaging, 42 (30.6%) patients were Milan criteria (MC)‐OUT; 28 (20.4%) were University of California San Francisco criteria (UCSFC)‐OUT. Pre‐LT LRT was performed in 109 (79.6%) patients. Multivariate analysis identified four factors to be independently predictive of recurrence: tumour number >3, AFP level ≥400 ng/ml, microvascular invasion and rejection needing anti‐lymphocytic antibodies. When considering pre‐transplant variables only, AFP level ≥400 ng/ml (HR = 5.13; P < 0.0001) was the unique risk factor for recurrence; conversely, application of LRT was protective (HR = 0.42; P = 0.04). MC‐IN patients having LRT (n = 79) had the best 5‐year tumour‐free survival (TFS) (91.6%). MC‐IN patients without LRT (n = 16) and MC‐OUT patients with LRT (n = 30) had similar good TFS (72.7% vs.77.5%); finally MC‐OUT patients without LRT (n = 12) had the worst results (45.0%; vs. 1st group: P < 0.0001). Immediate pre‐LT AFP and aggressive pre‐transplant LRT strategy, especially in MC‐OUT patients, are both important elements to further expand inclusion criteria without compromising long‐term results of HCC liver recipients.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>22716073</pmid><doi>10.1111/j.1432-2277.2012.01512.x</doi><tpages>9</tpages></addata></record> |
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| identifier | ISSN: 0934-0874 |
| ispartof | Transplant international, 2012-08, Vol.25 (8), p.867-875 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Aged alpha-Fetoproteins - metabolism alpha-foetoprotein Combined Modality Therapy downstaging Female hepatocellular cancer Humans Liver cancer Liver cirrhosis Liver Cirrhosis - complications Liver Neoplasms - etiology Liver Neoplasms - surgery Liver Neoplasms - therapy liver transplantation Liver Transplantation - mortality locoregional treatment Male Middle Aged Multivariate analysis Patient Selection Pulsed Radiofrequency Treatment Retrospective Studies Transplants & implants |
| title | Liver transplantation for hepatocellular cancer: UCL experience in 137 adult cirrhotic patients. Alpha-foetoprotein level and locoregional treatment as refined selection criteria |
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