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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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Surgical treatment significantly improves the overall survival after tumor recurrence.
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Figure 4: Surgical treatment significantly improves the overall survival after tumor recurrence.

Mentions: The prognosis after recurrence according to the patient group was statistically different (P=0.031). However, there was no significant difference in prognosis according to recurrent sites. All recurrences in the graft liver were initially treated with TACE and pulmonary recurrences were treated with chemotherapy. Most bone recurrences were treated with radiotherapy and/or chemotherapy. The 2-yr survival rate after recurrence of group II and III was 31.9% and 16.2%, respectively. The mean survival time of group II and III after recurrence was 28 months and 16 months, respectively. Especially, nine patients in groups II and III underwent surgical treatments for recurrent lesions, including intra- and extra-hepatic mass resection, retransplantation for intrahepatic recurrence, wedge resection for pulmonary metastases and metastatectomy for bony metastasis. In this surgical resection group, the 2-yr survival rate after recurrence of group II and III was 80.0% and 75.0%, respectively. The mean survival time of group II and III after recurrence was 50 months and 38 months, respectively. Surgical treatment of recurrent HCC was also an independent predictor of long-term survival after tumor relapse in multivariate analysis (P<0.01; Fig. 4).


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)

Surgical treatment significantly improves the overall survival after tumor recurrence.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Surgical treatment significantly improves the overall survival after tumor recurrence.
Mentions: The prognosis after recurrence according to the patient group was statistically different (P=0.031). However, there was no significant difference in prognosis according to recurrent sites. All recurrences in the graft liver were initially treated with TACE and pulmonary recurrences were treated with chemotherapy. Most bone recurrences were treated with radiotherapy and/or chemotherapy. The 2-yr survival rate after recurrence of group II and III was 31.9% and 16.2%, respectively. The mean survival time of group II and III after recurrence was 28 months and 16 months, respectively. Especially, nine patients in groups II and III underwent surgical treatments for recurrent lesions, including intra- and extra-hepatic mass resection, retransplantation for intrahepatic recurrence, wedge resection for pulmonary metastases and metastatectomy for bony metastasis. In this surgical resection group, the 2-yr survival rate after recurrence of group II and III was 80.0% and 75.0%, respectively. The mean survival time of group II and III after recurrence was 50 months and 38 months, respectively. Surgical treatment of recurrent HCC was also an independent predictor of long-term survival after tumor relapse in multivariate analysis (P<0.01; Fig. 4).

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