Liver transplantation for hepatocellular carcinoma after successful treatment of macrovascular invasion – a multi‐center retrospective cohort study
Summary Macrovascular invasion is considered a contraindication to liver transplantation for hepatocellular carcinoma (HCC) due to a high risk of recurrence. The aim of the present multicenter study was to explore the outcome of HCC patients transplanted after a complete radiological regression of t...
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| Veröffentlicht in: | Transplant international 2020-05, Vol.33 (5), p.567-575 |
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| creator | Assalino, Michela Terraz, Sylvain Grat, Michal Lai, Quirino Vachharajani, Neeta Gringeri, Enrico Bongini, Marco Angelo Kulik, Laura Tabrizian, Parissa Agopian, Vatche Mehta, Neil Brustia, Raffaele Vitali, Giulio Cesare Andres, Axel Berney, Thierry Mazzaferro, Vincenzo Compagnon, Philippe Majno, Pietro Cillo, Umberto Chapman, William Zieniewicz, Krzysztof Scatton, Olivier Toso, Christian |
| description | Summary
Macrovascular invasion is considered a contraindication to liver transplantation for hepatocellular carcinoma (HCC) due to a high risk of recurrence. The aim of the present multicenter study was to explore the outcome of HCC patients transplanted after a complete radiological regression of the vascular invasion by locoregional therapies and define sub‐groups with better outcomes. Medical records of 45 patients were retrospectively reviewed, and imaging was centrally assessed by an expert liver radiologist. In the 30 patients with validated diagnosis of macrovascular invasion, overall survival was 60% at 5 years. Pretransplant alpha‐fetoprotein (AFP) value was significantly different between patients with and without recurrence (P = 0.019), and the optimal AFP cutoff was 10ng/ml (area under curve = 0.78). Recurrence rate was 11% in patients with pretransplant AFP |
| doi_str_mv | 10.1111/tri.13586 |
| format | Article |
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Macrovascular invasion is considered a contraindication to liver transplantation for hepatocellular carcinoma (HCC) due to a high risk of recurrence. The aim of the present multicenter study was to explore the outcome of HCC patients transplanted after a complete radiological regression of the vascular invasion by locoregional therapies and define sub‐groups with better outcomes. Medical records of 45 patients were retrospectively reviewed, and imaging was centrally assessed by an expert liver radiologist. In the 30 patients with validated diagnosis of macrovascular invasion, overall survival was 60% at 5 years. Pretransplant alpha‐fetoprotein (AFP) value was significantly different between patients with and without recurrence (P = 0.019), and the optimal AFP cutoff was 10ng/ml (area under curve = 0.78). Recurrence rate was 11% in patients with pretransplant AFP < 10ng/ml. The number of viable nodules (P = 0.008), the presence of residual HCC (P = 0.036), and satellite nodules (P = 0.001) on the explant were also significantly different between patients with and without recurrence. Selected HCC patients with radiological signs of vascular invasion could be considered for transplantation, provided that they previously underwent successful treatment of the macrovascular invasion resulting in a pretransplant AFP < 10 ng/ml. Their expected risk of post‐transplant HCC recurrence is 11%, and further prospective validation is needed.</description><identifier>ISSN: 0934-0874</identifier><identifier>EISSN: 1432-2277</identifier><identifier>DOI: 10.1111/tri.13586</identifier><identifier>PMID: 31994238</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Cohort analysis ; downstaging ; Hepatocellular carcinoma ; Liver ; Liver cancer ; Liver transplantation ; Liver transplants ; locoregional therapy ; macrovascular invasion ; Medical records ; Nodules ; Patients ; Transplantation ; Transplants & implants ; tumor recurrence</subject><ispartof>Transplant international, 2020-05, Vol.33 (5), p.567-575</ispartof><rights>2020 Steunstichting ESOT</rights><rights>2020 Steunstichting ESOT.</rights><rights>Copyright © 2020 Steunstichting ESOT. Published by John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3886-4645fc724ba76d7b763a7a0f190377185e7e4e47d1e66664ebf5d49d4d3ae1973</citedby><cites>FETCH-LOGICAL-c3886-4645fc724ba76d7b763a7a0f190377185e7e4e47d1e66664ebf5d49d4d3ae1973</cites><orcidid>0000-0003-3372-3072 ; 0000-0003-1652-4522 ; 0000-0002-4230-9378 ; 0000-0003-1487-3235 ; 0000-0002-0459-8391 ; 0000-0001-6426-9533 ; 0000-0002-9476-468X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Ftri.13586$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftri.13586$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31994238$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Assalino, Michela</creatorcontrib><creatorcontrib>Terraz, Sylvain</creatorcontrib><creatorcontrib>Grat, Michal</creatorcontrib><creatorcontrib>Lai, Quirino</creatorcontrib><creatorcontrib>Vachharajani, Neeta</creatorcontrib><creatorcontrib>Gringeri, Enrico</creatorcontrib><creatorcontrib>Bongini, Marco Angelo</creatorcontrib><creatorcontrib>Kulik, Laura</creatorcontrib><creatorcontrib>Tabrizian, Parissa</creatorcontrib><creatorcontrib>Agopian, Vatche</creatorcontrib><creatorcontrib>Mehta, Neil</creatorcontrib><creatorcontrib>Brustia, Raffaele</creatorcontrib><creatorcontrib>Vitali, Giulio Cesare</creatorcontrib><creatorcontrib>Andres, Axel</creatorcontrib><creatorcontrib>Berney, Thierry</creatorcontrib><creatorcontrib>Mazzaferro, Vincenzo</creatorcontrib><creatorcontrib>Compagnon, Philippe</creatorcontrib><creatorcontrib>Majno, Pietro</creatorcontrib><creatorcontrib>Cillo, Umberto</creatorcontrib><creatorcontrib>Chapman, William</creatorcontrib><creatorcontrib>Zieniewicz, Krzysztof</creatorcontrib><creatorcontrib>Scatton, Olivier</creatorcontrib><creatorcontrib>Toso, Christian</creatorcontrib><title>Liver transplantation for hepatocellular carcinoma after successful treatment of macrovascular invasion – a multi‐center retrospective cohort study</title><title>Transplant international</title><addtitle>Transpl Int</addtitle><description>Summary
Macrovascular invasion is considered a contraindication to liver transplantation for hepatocellular carcinoma (HCC) due to a high risk of recurrence. The aim of the present multicenter study was to explore the outcome of HCC patients transplanted after a complete radiological regression of the vascular invasion by locoregional therapies and define sub‐groups with better outcomes. Medical records of 45 patients were retrospectively reviewed, and imaging was centrally assessed by an expert liver radiologist. In the 30 patients with validated diagnosis of macrovascular invasion, overall survival was 60% at 5 years. Pretransplant alpha‐fetoprotein (AFP) value was significantly different between patients with and without recurrence (P = 0.019), and the optimal AFP cutoff was 10ng/ml (area under curve = 0.78). Recurrence rate was 11% in patients with pretransplant AFP < 10ng/ml. The number of viable nodules (P = 0.008), the presence of residual HCC (P = 0.036), and satellite nodules (P = 0.001) on the explant were also significantly different between patients with and without recurrence. Selected HCC patients with radiological signs of vascular invasion could be considered for transplantation, provided that they previously underwent successful treatment of the macrovascular invasion resulting in a pretransplant AFP < 10 ng/ml. Their expected risk of post‐transplant HCC recurrence is 11%, and further prospective validation is needed.</description><subject>Cohort analysis</subject><subject>downstaging</subject><subject>Hepatocellular carcinoma</subject><subject>Liver</subject><subject>Liver cancer</subject><subject>Liver transplantation</subject><subject>Liver transplants</subject><subject>locoregional therapy</subject><subject>macrovascular invasion</subject><subject>Medical records</subject><subject>Nodules</subject><subject>Patients</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>tumor recurrence</subject><issn>0934-0874</issn><issn>1432-2277</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kctq3DAUhkVpaKbTLvoCRdBNu3Cimy17WUIvgYFCSNbmjHxEFGzL1SVldnmEQhd9vzxJNZm0i0LORlp859M5-gl5w9kJL3Wagjvhsm6bZ2TFlRSVEFo_JyvWSVWxVqtj8jLGG8aYaGv2ghxL3nVKyHZFfm_cLQaaAsxxGWFOkJyfqfWBXuMCyRscxzxCoAaCcbOfgIJNpSVmYzBGm8fSjZAmnBP1lk5ggr-FaB663Fyue-P93S8KdMpjcvd3P02BiyNgCj4uaFKZghp_7UOiMeVh94ocWRgjvn481-Tq86fLs6_V5tuX87OPm8rItm0q1ajaGi3UFnQz6K1uJGhglndMas3bGjUqVHrg2JRSuLX1oLpBDRKQd1quyfuDdwn-e8aY-snF_c4wo8-xF1K1QrK6iNfk3X_ojc9hLtMVqrynuk7wQn04UOUXYgxo-yW4CcKu56zfp9WXtPqHtAr79tGYtxMO_8i_8RTg9AD8cCPunjb1lxfnB-UfT3CkQw</recordid><startdate>202005</startdate><enddate>202005</enddate><creator>Assalino, Michela</creator><creator>Terraz, Sylvain</creator><creator>Grat, Michal</creator><creator>Lai, Quirino</creator><creator>Vachharajani, Neeta</creator><creator>Gringeri, Enrico</creator><creator>Bongini, Marco Angelo</creator><creator>Kulik, Laura</creator><creator>Tabrizian, Parissa</creator><creator>Agopian, Vatche</creator><creator>Mehta, Neil</creator><creator>Brustia, Raffaele</creator><creator>Vitali, Giulio Cesare</creator><creator>Andres, Axel</creator><creator>Berney, Thierry</creator><creator>Mazzaferro, Vincenzo</creator><creator>Compagnon, Philippe</creator><creator>Majno, Pietro</creator><creator>Cillo, Umberto</creator><creator>Chapman, William</creator><creator>Zieniewicz, Krzysztof</creator><creator>Scatton, Olivier</creator><creator>Toso, Christian</creator><general>Blackwell Publishing Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</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><orcidid>https://orcid.org/0000-0003-3372-3072</orcidid><orcidid>https://orcid.org/0000-0003-1652-4522</orcidid><orcidid>https://orcid.org/0000-0002-4230-9378</orcidid><orcidid>https://orcid.org/0000-0003-1487-3235</orcidid><orcidid>https://orcid.org/0000-0002-0459-8391</orcidid><orcidid>https://orcid.org/0000-0001-6426-9533</orcidid><orcidid>https://orcid.org/0000-0002-9476-468X</orcidid></search><sort><creationdate>202005</creationdate><title>Liver transplantation for hepatocellular carcinoma after successful treatment of macrovascular invasion – a multi‐center retrospective cohort study</title><author>Assalino, Michela ; 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Macrovascular invasion is considered a contraindication to liver transplantation for hepatocellular carcinoma (HCC) due to a high risk of recurrence. The aim of the present multicenter study was to explore the outcome of HCC patients transplanted after a complete radiological regression of the vascular invasion by locoregional therapies and define sub‐groups with better outcomes. Medical records of 45 patients were retrospectively reviewed, and imaging was centrally assessed by an expert liver radiologist. In the 30 patients with validated diagnosis of macrovascular invasion, overall survival was 60% at 5 years. Pretransplant alpha‐fetoprotein (AFP) value was significantly different between patients with and without recurrence (P = 0.019), and the optimal AFP cutoff was 10ng/ml (area under curve = 0.78). Recurrence rate was 11% in patients with pretransplant AFP < 10ng/ml. The number of viable nodules (P = 0.008), the presence of residual HCC (P = 0.036), and satellite nodules (P = 0.001) on the explant were also significantly different between patients with and without recurrence. Selected HCC patients with radiological signs of vascular invasion could be considered for transplantation, provided that they previously underwent successful treatment of the macrovascular invasion resulting in a pretransplant AFP < 10 ng/ml. Their expected risk of post‐transplant HCC recurrence is 11%, and further prospective validation is needed.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>31994238</pmid><doi>10.1111/tri.13586</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-3372-3072</orcidid><orcidid>https://orcid.org/0000-0003-1652-4522</orcidid><orcidid>https://orcid.org/0000-0002-4230-9378</orcidid><orcidid>https://orcid.org/0000-0003-1487-3235</orcidid><orcidid>https://orcid.org/0000-0002-0459-8391</orcidid><orcidid>https://orcid.org/0000-0001-6426-9533</orcidid><orcidid>https://orcid.org/0000-0002-9476-468X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0934-0874 |
| ispartof | Transplant international, 2020-05, Vol.33 (5), p.567-575 |
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| language | eng |
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| source | Wiley Online Library Journals; EZB Electronic Journals Library |
| subjects | Cohort analysis downstaging Hepatocellular carcinoma Liver Liver cancer Liver transplantation Liver transplants locoregional therapy macrovascular invasion Medical records Nodules Patients Transplantation Transplants & implants tumor recurrence |
| title | Liver transplantation for hepatocellular carcinoma after successful treatment of macrovascular invasion – a multi‐center retrospective cohort study |
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