Liver transplantation should be offered to patients with small solitary hepatocellular carcinoma and a positive serum alpha fetoprotein rather than resection
Abstract Background As debate continues as to what surgical modality should be offered to patients with hepatocellular carcinoma, the authors submit that serum α-fetoprotein (AFP) is an important variable to consider. Methods Using the Surveillance, Epidemiology and End Results database, patients wi...
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| Veröffentlicht in: | The American journal of surgery 2013-04, Vol.205 (4), p.374-380 |
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| creator | Graham, Jay A., M.D Melancon, Joseph K., M.D Shetty, Kirti, M.D Johnson, Lynt B., M.D., M.B.A |
| description | Abstract Background As debate continues as to what surgical modality should be offered to patients with hepatocellular carcinoma, the authors submit that serum α-fetoprotein (AFP) is an important variable to consider. Methods Using the Surveillance, Epidemiology and End Results database, patients with solitary tumors within the Milan criteria were further stratified into 2 groups, those who underwent orthotopic liver transplantation (OLT) and those who underwent segmentectomy, lobectomy, or extended lobectomy (resection). Patients were further grouped according to serum AFP status (negative or positive). Relative survival was retrospectively evaluated for 3 years using the log-rank test. Results In the AFP-negative group, resection (n = 165) offered equivalent survival compared with OLT (n = 116); 3-year survival was 73.8% and 81.6%, respectively ( P = .245). In the AFP-positive group, 3-year survival for resection (n = 200) was 59%, while survival was 75.3% for OLT (n = 181), which showed a clear survival advantage ( P = .001). Conclusions The results of this study demonstrate that patients with solitary hepatocellular carcinoma lesions within the Milan criteria and AFP-positive status should not undergo resection but rather be offered OLT. |
| doi_str_mv | 10.1016/j.amjsurg.2012.12.002 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1319171095</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0002961013000469</els_id><sourcerecordid>1319171095</sourcerecordid><originalsourceid>FETCH-LOGICAL-c448t-e3186746149e50460a0036818e6407fcc31a91aa07b2ac7bec55c3b5f73aa443</originalsourceid><addsrcrecordid>eNqFUk2P1DAMrRCInV34CaBIXLh0iCf9vIDQigWkkTiw98iTujRD2pQkXbQ_hv-KqxlA2guSpXz42X72c5a9ALkFCdWb4xbHY1zCt-1Owm7LJuXuUbaBpm5zaBr1ONtI_srbCuRFdhnjkZ8AhXqaXeyUasuygU32a2_vKIgUcIqzwylhsn4ScfCL68SBhO97CtSJ5MXMPppSFD9tGkQc0TkRvbMJw70YiN3ekHOLwyAMBmMnP6LAqRMoZh9t4lIiUlhGgW4eUPSU_Bx8IjuJgGlYiQzId4pkVh7Psic9ukjPz-dVdnvz4fb6U77_8vHz9ft9boqiSTkpaKq6qKBoqZRFJVFKVTXQUFXIujdGAbaAKOvDDk19IFOWRh3KvlaIRaGustentEzmx0Ix6dHGtRWcyC9Rg4IWapBtydBXD6BHv4SJya2oRspKli2jyhPKBB9joF7PwY48Jg1Sr_Lpoz7Lp1f5NBtrxXEvz9mXw0jd36g_ejHg3QlAPI07S0FHw5oY6mzgkenO2_-WePsgg3F2sgbdd7qn-K8bHTlAf113aF0hUHwrqlb9BsNzxk4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1318006059</pqid></control><display><type>article</type><title>Liver transplantation should be offered to patients with small solitary hepatocellular carcinoma and a positive serum alpha fetoprotein rather than resection</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>ProQuest Central UK/Ireland</source><creator>Graham, Jay A., M.D ; Melancon, Joseph K., M.D ; Shetty, Kirti, M.D ; Johnson, Lynt B., M.D., M.B.A</creator><creatorcontrib>Graham, Jay A., M.D ; Melancon, Joseph K., M.D ; Shetty, Kirti, M.D ; Johnson, Lynt B., M.D., M.B.A</creatorcontrib><description>Abstract Background As debate continues as to what surgical modality should be offered to patients with hepatocellular carcinoma, the authors submit that serum α-fetoprotein (AFP) is an important variable to consider. Methods Using the Surveillance, Epidemiology and End Results database, patients with solitary tumors within the Milan criteria were further stratified into 2 groups, those who underwent orthotopic liver transplantation (OLT) and those who underwent segmentectomy, lobectomy, or extended lobectomy (resection). Patients were further grouped according to serum AFP status (negative or positive). Relative survival was retrospectively evaluated for 3 years using the log-rank test. Results In the AFP-negative group, resection (n = 165) offered equivalent survival compared with OLT (n = 116); 3-year survival was 73.8% and 81.6%, respectively ( P = .245). In the AFP-positive group, 3-year survival for resection (n = 200) was 59%, while survival was 75.3% for OLT (n = 181), which showed a clear survival advantage ( P = .001). Conclusions The results of this study demonstrate that patients with solitary hepatocellular carcinoma lesions within the Milan criteria and AFP-positive status should not undergo resection but rather be offered OLT.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2012.12.002</identifier><identifier>PMID: 23395581</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>AFP ; alpha-Fetoproteins - metabolism ; Carcinoma, Hepatocellular - blood ; Carcinoma, Hepatocellular - mortality ; Carcinoma, Hepatocellular - surgery ; Decision Support Techniques ; Hepatectomy ; Hepatocellular carcinoma ; Humans ; Kaplan-Meier Estimate ; Liver ; Liver cancer ; Liver cirrhosis ; Liver Neoplasms - blood ; Liver Neoplasms - mortality ; Liver Neoplasms - surgery ; Liver Transplantation ; Resection ; Retrospective Studies ; SEER ; SEER Program ; Surgery ; Transplantation ; Transplants & implants ; Treatment Outcome ; Tumors</subject><ispartof>The American journal of surgery, 2013-04, Vol.205 (4), p.374-380</ispartof><rights>Elsevier Inc.</rights><rights>2013 Elsevier Inc.</rights><rights>Copyright © 2013 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-e3186746149e50460a0036818e6407fcc31a91aa07b2ac7bec55c3b5f73aa443</citedby><cites>FETCH-LOGICAL-c448t-e3186746149e50460a0036818e6407fcc31a91aa07b2ac7bec55c3b5f73aa443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1318006059?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23395581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Graham, Jay A., M.D</creatorcontrib><creatorcontrib>Melancon, Joseph K., M.D</creatorcontrib><creatorcontrib>Shetty, Kirti, M.D</creatorcontrib><creatorcontrib>Johnson, Lynt B., M.D., M.B.A</creatorcontrib><title>Liver transplantation should be offered to patients with small solitary hepatocellular carcinoma and a positive serum alpha fetoprotein rather than resection</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Abstract Background As debate continues as to what surgical modality should be offered to patients with hepatocellular carcinoma, the authors submit that serum α-fetoprotein (AFP) is an important variable to consider. Methods Using the Surveillance, Epidemiology and End Results database, patients with solitary tumors within the Milan criteria were further stratified into 2 groups, those who underwent orthotopic liver transplantation (OLT) and those who underwent segmentectomy, lobectomy, or extended lobectomy (resection). Patients were further grouped according to serum AFP status (negative or positive). Relative survival was retrospectively evaluated for 3 years using the log-rank test. Results In the AFP-negative group, resection (n = 165) offered equivalent survival compared with OLT (n = 116); 3-year survival was 73.8% and 81.6%, respectively ( P = .245). In the AFP-positive group, 3-year survival for resection (n = 200) was 59%, while survival was 75.3% for OLT (n = 181), which showed a clear survival advantage ( P = .001). Conclusions The results of this study demonstrate that patients with solitary hepatocellular carcinoma lesions within the Milan criteria and AFP-positive status should not undergo resection but rather be offered OLT.</description><subject>AFP</subject><subject>alpha-Fetoproteins - metabolism</subject><subject>Carcinoma, Hepatocellular - blood</subject><subject>Carcinoma, Hepatocellular - mortality</subject><subject>Carcinoma, Hepatocellular - surgery</subject><subject>Decision Support Techniques</subject><subject>Hepatectomy</subject><subject>Hepatocellular carcinoma</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Liver</subject><subject>Liver cancer</subject><subject>Liver cirrhosis</subject><subject>Liver Neoplasms - blood</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - surgery</subject><subject>Liver Transplantation</subject><subject>Resection</subject><subject>Retrospective Studies</subject><subject>SEER</subject><subject>SEER Program</subject><subject>Surgery</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFUk2P1DAMrRCInV34CaBIXLh0iCf9vIDQigWkkTiw98iTujRD2pQkXbQ_hv-KqxlA2guSpXz42X72c5a9ALkFCdWb4xbHY1zCt-1Owm7LJuXuUbaBpm5zaBr1ONtI_srbCuRFdhnjkZ8AhXqaXeyUasuygU32a2_vKIgUcIqzwylhsn4ScfCL68SBhO97CtSJ5MXMPppSFD9tGkQc0TkRvbMJw70YiN3ekHOLwyAMBmMnP6LAqRMoZh9t4lIiUlhGgW4eUPSU_Bx8IjuJgGlYiQzId4pkVh7Psic9ukjPz-dVdnvz4fb6U77_8vHz9ft9boqiSTkpaKq6qKBoqZRFJVFKVTXQUFXIujdGAbaAKOvDDk19IFOWRh3KvlaIRaGustentEzmx0Ix6dHGtRWcyC9Rg4IWapBtydBXD6BHv4SJya2oRspKli2jyhPKBB9joF7PwY48Jg1Sr_Lpoz7Lp1f5NBtrxXEvz9mXw0jd36g_ejHg3QlAPI07S0FHw5oY6mzgkenO2_-WePsgg3F2sgbdd7qn-K8bHTlAf113aF0hUHwrqlb9BsNzxk4</recordid><startdate>20130401</startdate><enddate>20130401</enddate><creator>Graham, Jay A., M.D</creator><creator>Melancon, Joseph K., M.D</creator><creator>Shetty, Kirti, M.D</creator><creator>Johnson, Lynt B., M.D., M.B.A</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20130401</creationdate><title>Liver transplantation should be offered to patients with small solitary hepatocellular carcinoma and a positive serum alpha fetoprotein rather than resection</title><author>Graham, Jay A., M.D ; Melancon, Joseph K., M.D ; Shetty, Kirti, M.D ; Johnson, Lynt B., M.D., M.B.A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-e3186746149e50460a0036818e6407fcc31a91aa07b2ac7bec55c3b5f73aa443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>AFP</topic><topic>alpha-Fetoproteins - metabolism</topic><topic>Carcinoma, Hepatocellular - blood</topic><topic>Carcinoma, Hepatocellular - mortality</topic><topic>Carcinoma, Hepatocellular - surgery</topic><topic>Decision Support Techniques</topic><topic>Hepatectomy</topic><topic>Hepatocellular carcinoma</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Liver</topic><topic>Liver cancer</topic><topic>Liver cirrhosis</topic><topic>Liver Neoplasms - blood</topic><topic>Liver Neoplasms - mortality</topic><topic>Liver Neoplasms - surgery</topic><topic>Liver Transplantation</topic><topic>Resection</topic><topic>Retrospective Studies</topic><topic>SEER</topic><topic>SEER Program</topic><topic>Surgery</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Graham, Jay A., M.D</creatorcontrib><creatorcontrib>Melancon, Joseph K., M.D</creatorcontrib><creatorcontrib>Shetty, Kirti, M.D</creatorcontrib><creatorcontrib>Johnson, Lynt B., M.D., M.B.A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Graham, Jay A., M.D</au><au>Melancon, Joseph K., M.D</au><au>Shetty, Kirti, M.D</au><au>Johnson, Lynt B., M.D., M.B.A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Liver transplantation should be offered to patients with small solitary hepatocellular carcinoma and a positive serum alpha fetoprotein rather than resection</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2013-04-01</date><risdate>2013</risdate><volume>205</volume><issue>4</issue><spage>374</spage><epage>380</epage><pages>374-380</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Abstract Background As debate continues as to what surgical modality should be offered to patients with hepatocellular carcinoma, the authors submit that serum α-fetoprotein (AFP) is an important variable to consider. Methods Using the Surveillance, Epidemiology and End Results database, patients with solitary tumors within the Milan criteria were further stratified into 2 groups, those who underwent orthotopic liver transplantation (OLT) and those who underwent segmentectomy, lobectomy, or extended lobectomy (resection). Patients were further grouped according to serum AFP status (negative or positive). Relative survival was retrospectively evaluated for 3 years using the log-rank test. Results In the AFP-negative group, resection (n = 165) offered equivalent survival compared with OLT (n = 116); 3-year survival was 73.8% and 81.6%, respectively ( P = .245). In the AFP-positive group, 3-year survival for resection (n = 200) was 59%, while survival was 75.3% for OLT (n = 181), which showed a clear survival advantage ( P = .001). Conclusions The results of this study demonstrate that patients with solitary hepatocellular carcinoma lesions within the Milan criteria and AFP-positive status should not undergo resection but rather be offered OLT.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23395581</pmid><doi>10.1016/j.amjsurg.2012.12.002</doi><tpages>7</tpages></addata></record> |
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| subjects | AFP alpha-Fetoproteins - metabolism Carcinoma, Hepatocellular - blood Carcinoma, Hepatocellular - mortality Carcinoma, Hepatocellular - surgery Decision Support Techniques Hepatectomy Hepatocellular carcinoma Humans Kaplan-Meier Estimate Liver Liver cancer Liver cirrhosis Liver Neoplasms - blood Liver Neoplasms - mortality Liver Neoplasms - surgery Liver Transplantation Resection Retrospective Studies SEER SEER Program Surgery Transplantation Transplants & implants Treatment Outcome Tumors |
| title | Liver transplantation should be offered to patients with small solitary hepatocellular carcinoma and a positive serum alpha fetoprotein rather than resection |
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