Alpha-fetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma
To determine factors associated with outcomes and microvascular invasion (MVI) in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC). Between July 1996 and August 2008 at the Universities of Kentucky or Tennessee, LT recipients were retrospectively analysed. One hundre...
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| Veröffentlicht in: | HPB (Oxford, England) England), 2010-02, Vol.12 (1), p.56-61 |
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| creator | McHugh, Patrick P. Gilbert, Jeffrey Vera, Santiago Koch, Alvaro Ranjan, Dinesh Gedaly, Roberto |
| description | To determine factors associated with outcomes and microvascular invasion (MVI) in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC).
Between July 1996 and August 2008 at the Universities of Kentucky or Tennessee, LT recipients were retrospectively analysed.
One hundred and one patients had HCC in the explanted liver; one patient was excluded because of fibrolamellar histology. Seventy-nine (79%) were male and 81 (81%) were older than 50. HCC was incidental in 32 patients (32%). Median follow-up was 31 months. Ten patients (10%) developed recurrence, which was associated with poor survival (P= 0.006). Overall 1-, 3-, and 5-year survival rates were 87%, 69% and 62%, respectively. Excluding patients with lymph node metastasis (LNM) or MVI yielded 91%, 81% and 75% survival at the same time points. MVI was independently associated with recurrence (OR 28.40, 95% CI 1.77–456.48, P= 0.018) and decreased survival (OR 4.70, 95% CI 1.24–17.80, P= 0.023), and LNM with decreased survival (OR 6.05, 95% CI 1.23–29.71, P= 0.027). Tumour size (OR 4.1, 95% CI 1.2–13.5, P= 0.013) and alpha-fetoproptein (AFP) > 100 (OR 5.0, 95% CI 1.4–18.1, P= 0.006) were associated with MVI.
MVI greatly increases the risk of recurrence and death after LT for HCC, and is strongly associated with tumour size and AFP > 100. |
| doi_str_mv | 10.1111/j.1477-2574.2009.00128.x |
| format | Article |
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Between July 1996 and August 2008 at the Universities of Kentucky or Tennessee, LT recipients were retrospectively analysed.
One hundred and one patients had HCC in the explanted liver; one patient was excluded because of fibrolamellar histology. Seventy-nine (79%) were male and 81 (81%) were older than 50. HCC was incidental in 32 patients (32%). Median follow-up was 31 months. Ten patients (10%) developed recurrence, which was associated with poor survival (P= 0.006). Overall 1-, 3-, and 5-year survival rates were 87%, 69% and 62%, respectively. Excluding patients with lymph node metastasis (LNM) or MVI yielded 91%, 81% and 75% survival at the same time points. MVI was independently associated with recurrence (OR 28.40, 95% CI 1.77–456.48, P= 0.018) and decreased survival (OR 4.70, 95% CI 1.24–17.80, P= 0.023), and LNM with decreased survival (OR 6.05, 95% CI 1.23–29.71, P= 0.027). Tumour size (OR 4.1, 95% CI 1.2–13.5, P= 0.013) and alpha-fetoproptein (AFP) > 100 (OR 5.0, 95% CI 1.4–18.1, P= 0.006) were associated with MVI.
MVI greatly increases the risk of recurrence and death after LT for HCC, and is strongly associated with tumour size and AFP > 100.</description><identifier>ISSN: 1365-182X</identifier><identifier>EISSN: 1477-2574</identifier><identifier>DOI: 10.1111/j.1477-2574.2009.00128.x</identifier><identifier>PMID: 20495646</identifier><language>eng</language><publisher>Oxford, UK: Elsevier Ltd</publisher><subject>Adult ; Aged ; alpha-Fetoproteins - analysis ; Carcinoma, Hepatocellular - chemistry ; Carcinoma, Hepatocellular - mortality ; Carcinoma, Hepatocellular - pathology ; Carcinoma, Hepatocellular - surgery ; Disease-Free Survival ; Female ; Hepatectomy - adverse effects ; Hepatectomy - mortality ; hepatocellular carcinoma ; Humans ; Kaplan-Meier Estimate ; Kentucky ; Liver Neoplasms - chemistry ; Liver Neoplasms - mortality ; Liver Neoplasms - pathology ; Liver Neoplasms - surgery ; liver transplantation ; Liver Transplantation - adverse effects ; Liver Transplantation - mortality ; Lymphatic Metastasis ; Male ; microvascular invasion ; Microvessels - pathology ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Odds Ratio ; Original ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Tennessee ; Time Factors ; Treatment Outcome</subject><ispartof>HPB (Oxford, England), 2010-02, Vol.12 (1), p.56-61</ispartof><rights>2009 International Hepato-Pancreato-Biliary Association</rights><rights>2009 International Hepato‐Pancreato‐Biliary Association</rights><rights>Journal compilation © 2010 International Hepato-Pancreato-Biliary Association</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5698-dcbeee0c5daeb6e4c7af648b90f0db9c3b63df97d83538255edd0e58012b2f953</citedby><cites>FETCH-LOGICAL-c5698-dcbeee0c5daeb6e4c7af648b90f0db9c3b63df97d83538255edd0e58012b2f953</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814405/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814405/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,724,777,781,882,1412,27905,27906,45555,45556,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20495646$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McHugh, Patrick P.</creatorcontrib><creatorcontrib>Gilbert, Jeffrey</creatorcontrib><creatorcontrib>Vera, Santiago</creatorcontrib><creatorcontrib>Koch, Alvaro</creatorcontrib><creatorcontrib>Ranjan, Dinesh</creatorcontrib><creatorcontrib>Gedaly, Roberto</creatorcontrib><title>Alpha-fetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma</title><title>HPB (Oxford, England)</title><addtitle>HPB (Oxford)</addtitle><description>To determine factors associated with outcomes and microvascular invasion (MVI) in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC).
Between July 1996 and August 2008 at the Universities of Kentucky or Tennessee, LT recipients were retrospectively analysed.
One hundred and one patients had HCC in the explanted liver; one patient was excluded because of fibrolamellar histology. Seventy-nine (79%) were male and 81 (81%) were older than 50. HCC was incidental in 32 patients (32%). Median follow-up was 31 months. Ten patients (10%) developed recurrence, which was associated with poor survival (P= 0.006). Overall 1-, 3-, and 5-year survival rates were 87%, 69% and 62%, respectively. Excluding patients with lymph node metastasis (LNM) or MVI yielded 91%, 81% and 75% survival at the same time points. MVI was independently associated with recurrence (OR 28.40, 95% CI 1.77–456.48, P= 0.018) and decreased survival (OR 4.70, 95% CI 1.24–17.80, P= 0.023), and LNM with decreased survival (OR 6.05, 95% CI 1.23–29.71, P= 0.027). Tumour size (OR 4.1, 95% CI 1.2–13.5, P= 0.013) and alpha-fetoproptein (AFP) > 100 (OR 5.0, 95% CI 1.4–18.1, P= 0.006) were associated with MVI.
MVI greatly increases the risk of recurrence and death after LT for HCC, and is strongly associated with tumour size and AFP > 100.</description><subject>Adult</subject><subject>Aged</subject><subject>alpha-Fetoproteins - analysis</subject><subject>Carcinoma, Hepatocellular - chemistry</subject><subject>Carcinoma, Hepatocellular - mortality</subject><subject>Carcinoma, Hepatocellular - pathology</subject><subject>Carcinoma, Hepatocellular - surgery</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Hepatectomy - adverse effects</subject><subject>Hepatectomy - mortality</subject><subject>hepatocellular carcinoma</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Kentucky</subject><subject>Liver Neoplasms - chemistry</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - pathology</subject><subject>Liver Neoplasms - surgery</subject><subject>liver transplantation</subject><subject>Liver Transplantation - adverse effects</subject><subject>Liver Transplantation - mortality</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>microvascular invasion</subject><subject>Microvessels - pathology</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasm Recurrence, Local</subject><subject>Odds Ratio</subject><subject>Original</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Tennessee</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1365-182X</issn><issn>1477-2574</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUV1v1DAQjBCIlsJfQH7jKcGO43xICKktcEU6QSVA8GY59ubOR2KntnO98n_4nzh35QRPYMnySDszu-tJEkRwRuJ5uclIUVVpzqoiyzFuMoxJXme7B8npsfAwYlqylNT5t5PkifcbjHOCSfM4Oclx0bCyKE-Tn-f9uBZpB8GOzgbQBgmjUJgGOznk9Q9AwsXrvZVaBFDoVoc1GrR0diu8nHrhkDYRamsiQLAbe2FmYq-34DyyHRpF0GCCR5NR4FZWmxUKThi_p8ZilO5t1xCpVkLf732lcFIbO4inyaNO9B6e3b9nyZd3bz9fXqXLj4v3l-fLVLKyqVMlWwDAkikBbQmFrERXFnXb4A6rtpG0LanqmkrVlNE6ZwyUwsDq-Hlt3jWMniWvD77j1A6gZBzaiZ6PTg_C3XErNP-7YvSar-yW5zUpCjwbvLg3cPZmAh_4oP28jzBgJ88rSgkuWEMjsz4w40d676A7diGYzyHzDZ-z5HOWfA6Z70Pmuyh9_ueUR-HvVCPh1YFwq3u4-29jfnV9EUGUpwe59gF2R7lw33lZ0Yrxrx8W_NM1fbNYMsrndhcHPsRothoc9zLmLUFpBzJwZfW_l_oF9SXiIg</recordid><startdate>201002</startdate><enddate>201002</enddate><creator>McHugh, Patrick P.</creator><creator>Gilbert, Jeffrey</creator><creator>Vera, Santiago</creator><creator>Koch, Alvaro</creator><creator>Ranjan, Dinesh</creator><creator>Gedaly, Roberto</creator><general>Elsevier Ltd</general><general>Blackwell Publishing Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>BSCLL</scope><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><scope>5PM</scope></search><sort><creationdate>201002</creationdate><title>Alpha-fetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma</title><author>McHugh, Patrick P. ; Gilbert, Jeffrey ; Vera, Santiago ; Koch, Alvaro ; Ranjan, Dinesh ; Gedaly, Roberto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5698-dcbeee0c5daeb6e4c7af648b90f0db9c3b63df97d83538255edd0e58012b2f953</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Aged</topic><topic>alpha-Fetoproteins - analysis</topic><topic>Carcinoma, Hepatocellular - chemistry</topic><topic>Carcinoma, Hepatocellular - mortality</topic><topic>Carcinoma, Hepatocellular - pathology</topic><topic>Carcinoma, Hepatocellular - surgery</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Hepatectomy - adverse effects</topic><topic>Hepatectomy - mortality</topic><topic>hepatocellular carcinoma</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Kentucky</topic><topic>Liver Neoplasms - chemistry</topic><topic>Liver Neoplasms - mortality</topic><topic>Liver Neoplasms - pathology</topic><topic>Liver Neoplasms - surgery</topic><topic>liver transplantation</topic><topic>Liver Transplantation - adverse effects</topic><topic>Liver Transplantation - mortality</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>microvascular invasion</topic><topic>Microvessels - pathology</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness</topic><topic>Neoplasm Recurrence, Local</topic><topic>Odds Ratio</topic><topic>Original</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Tennessee</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McHugh, Patrick P.</creatorcontrib><creatorcontrib>Gilbert, Jeffrey</creatorcontrib><creatorcontrib>Vera, Santiago</creatorcontrib><creatorcontrib>Koch, Alvaro</creatorcontrib><creatorcontrib>Ranjan, Dinesh</creatorcontrib><creatorcontrib>Gedaly, Roberto</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Istex</collection><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><collection>PubMed Central (Full Participant titles)</collection><jtitle>HPB (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McHugh, Patrick P.</au><au>Gilbert, Jeffrey</au><au>Vera, Santiago</au><au>Koch, Alvaro</au><au>Ranjan, Dinesh</au><au>Gedaly, Roberto</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Alpha-fetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma</atitle><jtitle>HPB (Oxford, England)</jtitle><addtitle>HPB (Oxford)</addtitle><date>2010-02</date><risdate>2010</risdate><volume>12</volume><issue>1</issue><spage>56</spage><epage>61</epage><pages>56-61</pages><issn>1365-182X</issn><eissn>1477-2574</eissn><abstract>To determine factors associated with outcomes and microvascular invasion (MVI) in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC).
Between July 1996 and August 2008 at the Universities of Kentucky or Tennessee, LT recipients were retrospectively analysed.
One hundred and one patients had HCC in the explanted liver; one patient was excluded because of fibrolamellar histology. Seventy-nine (79%) were male and 81 (81%) were older than 50. HCC was incidental in 32 patients (32%). Median follow-up was 31 months. Ten patients (10%) developed recurrence, which was associated with poor survival (P= 0.006). Overall 1-, 3-, and 5-year survival rates were 87%, 69% and 62%, respectively. Excluding patients with lymph node metastasis (LNM) or MVI yielded 91%, 81% and 75% survival at the same time points. MVI was independently associated with recurrence (OR 28.40, 95% CI 1.77–456.48, P= 0.018) and decreased survival (OR 4.70, 95% CI 1.24–17.80, P= 0.023), and LNM with decreased survival (OR 6.05, 95% CI 1.23–29.71, P= 0.027). Tumour size (OR 4.1, 95% CI 1.2–13.5, P= 0.013) and alpha-fetoproptein (AFP) > 100 (OR 5.0, 95% CI 1.4–18.1, P= 0.006) were associated with MVI.
MVI greatly increases the risk of recurrence and death after LT for HCC, and is strongly associated with tumour size and AFP > 100.</abstract><cop>Oxford, UK</cop><pub>Elsevier Ltd</pub><pmid>20495646</pmid><doi>10.1111/j.1477-2574.2009.00128.x</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Adult Aged alpha-Fetoproteins - analysis Carcinoma, Hepatocellular - chemistry Carcinoma, Hepatocellular - mortality Carcinoma, Hepatocellular - pathology Carcinoma, Hepatocellular - surgery Disease-Free Survival Female Hepatectomy - adverse effects Hepatectomy - mortality hepatocellular carcinoma Humans Kaplan-Meier Estimate Kentucky Liver Neoplasms - chemistry Liver Neoplasms - mortality Liver Neoplasms - pathology Liver Neoplasms - surgery liver transplantation Liver Transplantation - adverse effects Liver Transplantation - mortality Lymphatic Metastasis Male microvascular invasion Microvessels - pathology Middle Aged Neoplasm Invasiveness Neoplasm Recurrence, Local Odds Ratio Original Proportional Hazards Models Retrospective Studies Risk Assessment Risk Factors Tennessee Time Factors Treatment Outcome |
| title | Alpha-fetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma |
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