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Optimal tailored screening protocol after living donor liver transplantation for hepatocellular carcinoma.

Park MS, Lee KW, Yi NJ, Choi YR, Kim H, Hong G, Suh KS, Kwon CH, Joh JW, Lee SK - J. Korean Med. Sci. (2014)

Bottom Line: Group IV showed very early recurrence within 6 months.The screening interval should be different based on the risk of recurrence.Screening should include work-up for extra-hepatic recurrence as well as intra-hepatic recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
The indication for hepatocellular carcinoma (HCC) is expanding in living donor liver transplantation (LDLT). Early detection and effective management of recurrence has become an important issue in LDLT for HCC. This study aimed to find an optimal screening protocol in terms of screening interval and screening tools by analyzing recurrence pattern after LDLT for HCC. A total of 205 LDLT patients in two centers from February 1999 to October 2010 was reviewed. Recurrence appeared in 55 cases. Six risk factors for recurrence were identified: preoperative alpha-fetoprotein >400, Edmonson grade 3 or 4, tumor size >7 cm, tumor number ≥7, minimal tumor necrosis in the transarterial chemoembolization group and positive micro-vascular invasion. Four groups with different ranges of index scores showed different recurrence-free survival and median time to recurrence. Group I showed low and late recurrence. Groups II and III showed linearly increased rate of recurrence until 18 months. Group IV showed very early recurrence within 6 months. Across the groups, extra-hepatic recurrence developed in more than 40% of cases and multi-organ recurrence rate was 20%. The screening interval should be different based on the risk of recurrence. Screening should include work-up for extra-hepatic recurrence as well as intra-hepatic recurrence.

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Related in: MedlinePlus

Cumulative recurrence rates according to group based on the risk index. Group I shows very low and late recurrence after 18 months. In groups II and III, most recurrences develop within the first 18 months in a temporally linear manner. Group IV shows an early recurrence pattern within 6 months in most cases.
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Figure 2: Cumulative recurrence rates according to group based on the risk index. Group I shows very low and late recurrence after 18 months. In groups II and III, most recurrences develop within the first 18 months in a temporally linear manner. Group IV shows an early recurrence pattern within 6 months in most cases.

Mentions: Fig. 2 depicts the data concerning the cumulative recurrence rate and timing of recurrence according to group. Significant differences were noted between groups. One-year cumulative recurrence rate of group I, II, III and IV were 0%, 11%, 51%, and 100%, respectively. Group I showed very low (n=2, 3.9%) and late recurrence after 18 months. Mean time to recurrence was 29 months (range, 18-41 months). In groups II and III, the mean time to recurrence was 11 and 10 months (range, 2-37 months) respectively. Most recurrences developed within the first 18 months in a temporally linear manner. Group IV showed an early recurrence pattern, within 6 months in most cases (mean time to recurrence, 4 months; range, 2-10 months).


Optimal tailored screening protocol after living donor liver transplantation for hepatocellular carcinoma.

Park MS, Lee KW, Yi NJ, Choi YR, Kim H, Hong G, Suh KS, Kwon CH, Joh JW, Lee SK - J. Korean Med. Sci. (2014)

Cumulative recurrence rates according to group based on the risk index. Group I shows very low and late recurrence after 18 months. In groups II and III, most recurrences develop within the first 18 months in a temporally linear manner. Group IV shows an early recurrence pattern within 6 months in most cases.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214935&req=5

Figure 2: Cumulative recurrence rates according to group based on the risk index. Group I shows very low and late recurrence after 18 months. In groups II and III, most recurrences develop within the first 18 months in a temporally linear manner. Group IV shows an early recurrence pattern within 6 months in most cases.
Mentions: Fig. 2 depicts the data concerning the cumulative recurrence rate and timing of recurrence according to group. Significant differences were noted between groups. One-year cumulative recurrence rate of group I, II, III and IV were 0%, 11%, 51%, and 100%, respectively. Group I showed very low (n=2, 3.9%) and late recurrence after 18 months. Mean time to recurrence was 29 months (range, 18-41 months). In groups II and III, the mean time to recurrence was 11 and 10 months (range, 2-37 months) respectively. Most recurrences developed within the first 18 months in a temporally linear manner. Group IV showed an early recurrence pattern, within 6 months in most cases (mean time to recurrence, 4 months; range, 2-10 months).

Bottom Line: Group IV showed very early recurrence within 6 months.The screening interval should be different based on the risk of recurrence.Screening should include work-up for extra-hepatic recurrence as well as intra-hepatic recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
The indication for hepatocellular carcinoma (HCC) is expanding in living donor liver transplantation (LDLT). Early detection and effective management of recurrence has become an important issue in LDLT for HCC. This study aimed to find an optimal screening protocol in terms of screening interval and screening tools by analyzing recurrence pattern after LDLT for HCC. A total of 205 LDLT patients in two centers from February 1999 to October 2010 was reviewed. Recurrence appeared in 55 cases. Six risk factors for recurrence were identified: preoperative alpha-fetoprotein >400, Edmonson grade 3 or 4, tumor size >7 cm, tumor number ≥7, minimal tumor necrosis in the transarterial chemoembolization group and positive micro-vascular invasion. Four groups with different ranges of index scores showed different recurrence-free survival and median time to recurrence. Group I showed low and late recurrence. Groups II and III showed linearly increased rate of recurrence until 18 months. Group IV showed very early recurrence within 6 months. Across the groups, extra-hepatic recurrence developed in more than 40% of cases and multi-organ recurrence rate was 20%. The screening interval should be different based on the risk of recurrence. Screening should include work-up for extra-hepatic recurrence as well as intra-hepatic recurrence.

Show MeSH
Related in: MedlinePlus