Salvage Versus Primary Liver Transplantation for Early Hepatocellular Carcinoma: Do Both Strategies Yield Similar Outcomes?
SUMMARY BACKGROUND DATA:In compensated cirrhotics with early hepatocellular carcinoma (HCC-cirr), upfront liver resection (LR) and salvage liver transplantation (SLT) in case of recurrence may have outcomes comparable to primary LT (PLT). OBJECTIVE:An intention-to-treat (ITT) analysis comparing PLT...
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| Veröffentlicht in: | Annals of surgery 2016-07, Vol.264 (1), p.155-163 |
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| creator | Bhangui, Prashant Allard, Marc Antoine Vibert, Eric Cherqui, Daniel Pelletier, Gilles Cunha, Antonio Sa Guettier, Catherine Vallee, Jean-Charles Duclos Saliba, Faouzi Bismuth, Henri Samuel, Didier Castaing, Denis Adam, René |
| description | SUMMARY BACKGROUND DATA:In compensated cirrhotics with early hepatocellular carcinoma (HCC-cirr), upfront liver resection (LR) and salvage liver transplantation (SLT) in case of recurrence may have outcomes comparable to primary LT (PLT).
OBJECTIVE:An intention-to-treat (ITT) analysis comparing PLT and SLT strategies.
METHODS:Of 130 HCC-cirr patients who underwent upfront LR (group LR), 90 (69%) recurred, 31 could undergo SLT (group SLT). During the same period, 366 patients were listed for LT (group LLT); 26 dropped-out (7.1%), 340 finally underwent PLT (group PLT). We compared survival between groups LR and LLT, LR and PLT, and PLT and SLT.
RESULTS:Feasibility of SLT strategy was 34% (31/90). In an ITT analysis, group LLT had better 5-yr/10-yr overall survival (OS) compared with group LR (68%/58% vs. 58%/35%; P = 0.008). Similarly, 5-yr/10-yr OS and disease-free survival (DFS) were better in group PLT versus group LR (OS 73%/63% vs. 58%/35%, P = 0.0007; DFS 69%/61% vs. 27%/21%, P |
| doi_str_mv | 10.1097/SLA.0000000000001442 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1795878365</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1795878365</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3525-1a8da43a5a6bb35815ea615f5dc74ad9ffe3f3720829f09b66b7f59e90f978273</originalsourceid><addsrcrecordid>eNpdkG9rFDEQxoMo9lr9BiJ56Ztt82ez2fWN1Gu1wkGFq4KvltndSS-a3ZxJtqX0y5vjWisODMMMzzwz_Ah5w9kxZ40-Wa9Oj9k_wctSPCMLrkRdcF6y52SRp7IoGykOyGGMP3eamumX5EBUVdmomi_I_RrcDVwj_Y4hzpF-DXaEcEdX9gYDvQowxa2DKUGyfqLGB3oOwd3RC9xC8j06NzsIdAmht5Mf4T098_SjTxu6TgESXluM9IdFN9C1He1Oezmn3o8YP7wiLwy4iK8f6hH59un8anlRrC4_f1meropeKqEKDvUApQQFVdfJ_LVCqLgyauh1CUNjDEojtWC1aAxruqrqtFENNsw0uhZaHpF3e99t8L9njKkdbdy9DhP6ObZcZxa6lpXK0nIv7YOPMaBpt3sgLWftDnubsbf_Y89rbx8uzN2Iw9-lR85PvrfepUz6l5tvMbQbBJc2e79K1YVgvGI6N0VOoeQfniiOMw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1795878365</pqid></control><display><type>article</type><title>Salvage Versus Primary Liver Transplantation for Early Hepatocellular Carcinoma: Do Both Strategies Yield Similar Outcomes?</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><source>PubMed Central</source><creator>Bhangui, Prashant ; Allard, Marc Antoine ; Vibert, Eric ; Cherqui, Daniel ; Pelletier, Gilles ; Cunha, Antonio Sa ; Guettier, Catherine ; Vallee, Jean-Charles Duclos ; Saliba, Faouzi ; Bismuth, Henri ; Samuel, Didier ; Castaing, Denis ; Adam, René</creator><creatorcontrib>Bhangui, Prashant ; Allard, Marc Antoine ; Vibert, Eric ; Cherqui, Daniel ; Pelletier, Gilles ; Cunha, Antonio Sa ; Guettier, Catherine ; Vallee, Jean-Charles Duclos ; Saliba, Faouzi ; Bismuth, Henri ; Samuel, Didier ; Castaing, Denis ; Adam, René</creatorcontrib><description>SUMMARY BACKGROUND DATA:In compensated cirrhotics with early hepatocellular carcinoma (HCC-cirr), upfront liver resection (LR) and salvage liver transplantation (SLT) in case of recurrence may have outcomes comparable to primary LT (PLT).
OBJECTIVE:An intention-to-treat (ITT) analysis comparing PLT and SLT strategies.
METHODS:Of 130 HCC-cirr patients who underwent upfront LR (group LR), 90 (69%) recurred, 31 could undergo SLT (group SLT). During the same period, 366 patients were listed for LT (group LLT); 26 dropped-out (7.1%), 340 finally underwent PLT (group PLT). We compared survival between groups LR and LLT, LR and PLT, and PLT and SLT.
RESULTS:Feasibility of SLT strategy was 34% (31/90). In an ITT analysis, group LLT had better 5-yr/10-yr overall survival (OS) compared with group LR (68%/58% vs. 58%/35%; P = 0.008). Similarly, 5-yr/10-yr OS and disease-free survival (DFS) were better in group PLT versus group LR (OS 73%/63% vs. 58%/35%, P = 0.0007; DFS 69%/61% vs. 27%/21%, P < 0.0001). Upfront resection and microvascular tumor invasion were poor prognostic factors for both OS and DFS, presence of satellite tumor nodules additionally predicted worse DFS. Group SLT had similar postoperative and long-term outcomes compared with group PLT (starting from time of LT) (OS 54%/54% vs. 73%/63%, P = 0.35; DFS 48%/48% vs. 69%/61%, P = 0.18, respectively).
CONCLUSIONS:In initially transplantable HCC-cirr patients, ITT survival was better in group PLT compared with group LR. SLT was feasible in only a third of patients who recurred after LR. Post SLT, short and long-term outcomes were comparable with PLT. Better patient selection for the “resection first” approach and early detection of recurrence may improve outcomes of the SLT strategy.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000001442</identifier><identifier>PMID: 26649581</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Aged ; Carcinoma, Hepatocellular - etiology ; Carcinoma, Hepatocellular - mortality ; Carcinoma, Hepatocellular - surgery ; Carcinoma, Hepatocellular - therapy ; Feasibility Studies ; Female ; Hepatectomy ; Humans ; Liver Cirrhosis - complications ; Liver Neoplasms - etiology ; Liver Neoplasms - mortality ; Liver Neoplasms - surgery ; Liver Neoplasms - therapy ; Liver Transplantation - mortality ; Male ; Middle Aged ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - surgery ; Neoplasm Recurrence, Local - therapy ; Prognosis ; Reoperation ; Retrospective Studies ; Salvage Therapy - methods ; Survival Analysis ; Treatment Outcome</subject><ispartof>Annals of surgery, 2016-07, Vol.264 (1), p.155-163</ispartof><rights>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3525-1a8da43a5a6bb35815ea615f5dc74ad9ffe3f3720829f09b66b7f59e90f978273</citedby><cites>FETCH-LOGICAL-c3525-1a8da43a5a6bb35815ea615f5dc74ad9ffe3f3720829f09b66b7f59e90f978273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26649581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bhangui, Prashant</creatorcontrib><creatorcontrib>Allard, Marc Antoine</creatorcontrib><creatorcontrib>Vibert, Eric</creatorcontrib><creatorcontrib>Cherqui, Daniel</creatorcontrib><creatorcontrib>Pelletier, Gilles</creatorcontrib><creatorcontrib>Cunha, Antonio Sa</creatorcontrib><creatorcontrib>Guettier, Catherine</creatorcontrib><creatorcontrib>Vallee, Jean-Charles Duclos</creatorcontrib><creatorcontrib>Saliba, Faouzi</creatorcontrib><creatorcontrib>Bismuth, Henri</creatorcontrib><creatorcontrib>Samuel, Didier</creatorcontrib><creatorcontrib>Castaing, Denis</creatorcontrib><creatorcontrib>Adam, René</creatorcontrib><title>Salvage Versus Primary Liver Transplantation for Early Hepatocellular Carcinoma: Do Both Strategies Yield Similar Outcomes?</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>SUMMARY BACKGROUND DATA:In compensated cirrhotics with early hepatocellular carcinoma (HCC-cirr), upfront liver resection (LR) and salvage liver transplantation (SLT) in case of recurrence may have outcomes comparable to primary LT (PLT).
OBJECTIVE:An intention-to-treat (ITT) analysis comparing PLT and SLT strategies.
METHODS:Of 130 HCC-cirr patients who underwent upfront LR (group LR), 90 (69%) recurred, 31 could undergo SLT (group SLT). During the same period, 366 patients were listed for LT (group LLT); 26 dropped-out (7.1%), 340 finally underwent PLT (group PLT). We compared survival between groups LR and LLT, LR and PLT, and PLT and SLT.
RESULTS:Feasibility of SLT strategy was 34% (31/90). In an ITT analysis, group LLT had better 5-yr/10-yr overall survival (OS) compared with group LR (68%/58% vs. 58%/35%; P = 0.008). Similarly, 5-yr/10-yr OS and disease-free survival (DFS) were better in group PLT versus group LR (OS 73%/63% vs. 58%/35%, P = 0.0007; DFS 69%/61% vs. 27%/21%, P < 0.0001). Upfront resection and microvascular tumor invasion were poor prognostic factors for both OS and DFS, presence of satellite tumor nodules additionally predicted worse DFS. Group SLT had similar postoperative and long-term outcomes compared with group PLT (starting from time of LT) (OS 54%/54% vs. 73%/63%, P = 0.35; DFS 48%/48% vs. 69%/61%, P = 0.18, respectively).
CONCLUSIONS:In initially transplantable HCC-cirr patients, ITT survival was better in group PLT compared with group LR. SLT was feasible in only a third of patients who recurred after LR. Post SLT, short and long-term outcomes were comparable with PLT. Better patient selection for the “resection first” approach and early detection of recurrence may improve outcomes of the SLT strategy.</description><subject>Aged</subject><subject>Carcinoma, Hepatocellular - etiology</subject><subject>Carcinoma, Hepatocellular - mortality</subject><subject>Carcinoma, Hepatocellular - surgery</subject><subject>Carcinoma, Hepatocellular - therapy</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Hepatectomy</subject><subject>Humans</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Neoplasms - etiology</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - surgery</subject><subject>Liver Neoplasms - therapy</subject><subject>Liver Transplantation - mortality</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Neoplasm Recurrence, Local - therapy</subject><subject>Prognosis</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Salvage Therapy - methods</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkG9rFDEQxoMo9lr9BiJ56Ztt82ez2fWN1Gu1wkGFq4KvltndSS-a3ZxJtqX0y5vjWisODMMMzzwz_Ah5w9kxZ40-Wa9Oj9k_wctSPCMLrkRdcF6y52SRp7IoGykOyGGMP3eamumX5EBUVdmomi_I_RrcDVwj_Y4hzpF-DXaEcEdX9gYDvQowxa2DKUGyfqLGB3oOwd3RC9xC8j06NzsIdAmht5Mf4T098_SjTxu6TgESXluM9IdFN9C1He1Oezmn3o8YP7wiLwy4iK8f6hH59un8anlRrC4_f1meropeKqEKDvUApQQFVdfJ_LVCqLgyauh1CUNjDEojtWC1aAxruqrqtFENNsw0uhZaHpF3e99t8L9njKkdbdy9DhP6ObZcZxa6lpXK0nIv7YOPMaBpt3sgLWftDnubsbf_Y89rbx8uzN2Iw9-lR85PvrfepUz6l5tvMbQbBJc2e79K1YVgvGI6N0VOoeQfniiOMw</recordid><startdate>201607</startdate><enddate>201607</enddate><creator>Bhangui, Prashant</creator><creator>Allard, Marc Antoine</creator><creator>Vibert, Eric</creator><creator>Cherqui, Daniel</creator><creator>Pelletier, Gilles</creator><creator>Cunha, Antonio Sa</creator><creator>Guettier, Catherine</creator><creator>Vallee, Jean-Charles Duclos</creator><creator>Saliba, Faouzi</creator><creator>Bismuth, Henri</creator><creator>Samuel, Didier</creator><creator>Castaing, Denis</creator><creator>Adam, René</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</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>7X8</scope></search><sort><creationdate>201607</creationdate><title>Salvage Versus Primary Liver Transplantation for Early Hepatocellular Carcinoma: Do Both Strategies Yield Similar Outcomes?</title><author>Bhangui, Prashant ; Allard, Marc Antoine ; Vibert, Eric ; Cherqui, Daniel ; Pelletier, Gilles ; Cunha, Antonio Sa ; Guettier, Catherine ; Vallee, Jean-Charles Duclos ; Saliba, Faouzi ; Bismuth, Henri ; Samuel, Didier ; Castaing, Denis ; Adam, René</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3525-1a8da43a5a6bb35815ea615f5dc74ad9ffe3f3720829f09b66b7f59e90f978273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Carcinoma, Hepatocellular - etiology</topic><topic>Carcinoma, Hepatocellular - mortality</topic><topic>Carcinoma, Hepatocellular - surgery</topic><topic>Carcinoma, Hepatocellular - therapy</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Hepatectomy</topic><topic>Humans</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Neoplasms - etiology</topic><topic>Liver Neoplasms - mortality</topic><topic>Liver Neoplasms - surgery</topic><topic>Liver Neoplasms - therapy</topic><topic>Liver Transplantation - mortality</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Neoplasm Recurrence, Local - therapy</topic><topic>Prognosis</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Salvage Therapy - methods</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bhangui, Prashant</creatorcontrib><creatorcontrib>Allard, Marc Antoine</creatorcontrib><creatorcontrib>Vibert, Eric</creatorcontrib><creatorcontrib>Cherqui, Daniel</creatorcontrib><creatorcontrib>Pelletier, Gilles</creatorcontrib><creatorcontrib>Cunha, Antonio Sa</creatorcontrib><creatorcontrib>Guettier, Catherine</creatorcontrib><creatorcontrib>Vallee, Jean-Charles Duclos</creatorcontrib><creatorcontrib>Saliba, Faouzi</creatorcontrib><creatorcontrib>Bismuth, Henri</creatorcontrib><creatorcontrib>Samuel, Didier</creatorcontrib><creatorcontrib>Castaing, Denis</creatorcontrib><creatorcontrib>Adam, René</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bhangui, Prashant</au><au>Allard, Marc Antoine</au><au>Vibert, Eric</au><au>Cherqui, Daniel</au><au>Pelletier, Gilles</au><au>Cunha, Antonio Sa</au><au>Guettier, Catherine</au><au>Vallee, Jean-Charles Duclos</au><au>Saliba, Faouzi</au><au>Bismuth, Henri</au><au>Samuel, Didier</au><au>Castaing, Denis</au><au>Adam, René</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Salvage Versus Primary Liver Transplantation for Early Hepatocellular Carcinoma: Do Both Strategies Yield Similar Outcomes?</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2016-07</date><risdate>2016</risdate><volume>264</volume><issue>1</issue><spage>155</spage><epage>163</epage><pages>155-163</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>SUMMARY BACKGROUND DATA:In compensated cirrhotics with early hepatocellular carcinoma (HCC-cirr), upfront liver resection (LR) and salvage liver transplantation (SLT) in case of recurrence may have outcomes comparable to primary LT (PLT).
OBJECTIVE:An intention-to-treat (ITT) analysis comparing PLT and SLT strategies.
METHODS:Of 130 HCC-cirr patients who underwent upfront LR (group LR), 90 (69%) recurred, 31 could undergo SLT (group SLT). During the same period, 366 patients were listed for LT (group LLT); 26 dropped-out (7.1%), 340 finally underwent PLT (group PLT). We compared survival between groups LR and LLT, LR and PLT, and PLT and SLT.
RESULTS:Feasibility of SLT strategy was 34% (31/90). In an ITT analysis, group LLT had better 5-yr/10-yr overall survival (OS) compared with group LR (68%/58% vs. 58%/35%; P = 0.008). Similarly, 5-yr/10-yr OS and disease-free survival (DFS) were better in group PLT versus group LR (OS 73%/63% vs. 58%/35%, P = 0.0007; DFS 69%/61% vs. 27%/21%, P < 0.0001). Upfront resection and microvascular tumor invasion were poor prognostic factors for both OS and DFS, presence of satellite tumor nodules additionally predicted worse DFS. Group SLT had similar postoperative and long-term outcomes compared with group PLT (starting from time of LT) (OS 54%/54% vs. 73%/63%, P = 0.35; DFS 48%/48% vs. 69%/61%, P = 0.18, respectively).
CONCLUSIONS:In initially transplantable HCC-cirr patients, ITT survival was better in group PLT compared with group LR. SLT was feasible in only a third of patients who recurred after LR. Post SLT, short and long-term outcomes were comparable with PLT. Better patient selection for the “resection first” approach and early detection of recurrence may improve outcomes of the SLT strategy.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>26649581</pmid><doi>10.1097/SLA.0000000000001442</doi><tpages>9</tpages></addata></record> |
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| subjects | Aged Carcinoma, Hepatocellular - etiology Carcinoma, Hepatocellular - mortality Carcinoma, Hepatocellular - surgery Carcinoma, Hepatocellular - therapy Feasibility Studies Female Hepatectomy Humans Liver Cirrhosis - complications Liver Neoplasms - etiology Liver Neoplasms - mortality Liver Neoplasms - surgery Liver Neoplasms - therapy Liver Transplantation - mortality Male Middle Aged Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - surgery Neoplasm Recurrence, Local - therapy Prognosis Reoperation Retrospective Studies Salvage Therapy - methods Survival Analysis Treatment Outcome |
| title | Salvage Versus Primary Liver Transplantation for Early Hepatocellular Carcinoma: Do Both Strategies Yield Similar Outcomes? |
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