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Conditional disease-free survival after liver transplantation for hepatocellular carcinoma: A two-center experience.

Dong J, Zhu Y, Ma F, Ren Y, Lu J, Wang Z, Qin L, Wu R, Lv Y - Medicine (Baltimore) (2016)

Bottom Line: Multivariate analysis indicated that larger tumor size (hazard ratio [HR], 1.509; 95% CI, 1.146-1.985; P = 0.003) was associated with poorer DFS.Patients with worse prognostic features at baseline demonstrated the greater increase in CDFS over time.Survival estimates following liver transplantation of HCC patients change according to survival time accrued since surgery.CDFS estimates improved dramatically over time especially among patients with worse prognostic features at the time of surgery.

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University bInstitute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi Province cDepartment of Surgery, Huashan Hospital dCancer Metastasis Institute, Fudan University, Shanghai, P.R. China.

ABSTRACT
Traditionally, survival estimates following liver transplantation (LT) of hepatocellular carcinoma (HCC) patients were calculated as survival from the surgery date, but future survival probabilities can change over time and conditional disease-free survival (CDFS) may provide patients and clinicians with more accurate prognostic information. This study aimed to assess CDFS in HCC patients after LT.Three hundred eighty-four HCC patients who underwent LT were included. Disease-free survival (DFS) was calculated using the Kaplan-Meier analysis. The 3-year CDFS, which represents the probability of remaining disease free for an additional 3 years, was calculated.1-, 3-, and 5-year DFS rates after LT were 69.9%, 45.8%, and 39.0 %, respectively. Based on the concept of CDFS, the probability of surviving an additional 3 years given that the patient was disease free at 1 year, 3 years, and 5 years were 58.4%, 76.9%, and 83.1%, respectively. Multivariate analysis indicated that larger tumor size (hazard ratio [HR], 1.509; 95% CI, 1.146-1.985; P = 0.003) was associated with poorer DFS. Patients with worse prognostic features at baseline demonstrated the greater increase in CDFS over time.Survival estimates following liver transplantation of HCC patients change according to survival time accrued since surgery. CDFS estimates improved dramatically over time especially among patients with worse prognostic features at the time of surgery. CDFS may be a useful tool in counseling patients with HCC, as it is a more accurate assessment of future survival for those patients who have already survived a certain amount of time.

No MeSH data available.


Related in: MedlinePlus

Actuarial patient disease-free survival curve of the whole study population of 384 patients submitted to liver transplantation.
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Figure 1: Actuarial patient disease-free survival curve of the whole study population of 384 patients submitted to liver transplantation.

Mentions: Patient follow-up as of January 2015 or to the time of death ranged from 24 to 96 months. The median follow-up period was 26.3 months (range, 0–104.7 months). Two hundred thirty-seven (47.40%) patients recurred, 29 patients had late recurrence (≥3 years). Their 1-, 3-, and 5-year DFS rates were 69.9%, 45.8%, and 39.0%, respectively (Fig. 1). On the univariate analysis, the following factors were associated with unfavorable DFS: serum AFP levels (hazard ratio [HR], 1.959; 95% CI, 1.439–2.666; P < 0.001), tumor number (HR, 1.745; 95% CI, 1.157–2.632; P < 0.001), tumor size (HR, 3.303; 95% CI, 2.443–4.466; P < 0.001), capsule (HR, 1.598; 95% CI, 1.192–2.144; P = 0.002), microvascular invasion (MVI) (HR, 2.583; 95% CI, 1.877–3.552; P < 0.001), differentiation (HR, 1.594; 95% CI, 1.129–2.249; P = 0.002), AJCC stage (HR, 3.957; 95% CI, 2.599–6.024; P < 0.001), and Milan criteria (HR, 2.420; 95% CI, 1.799–3.255; P < 0.001) (Table 2). Multivariate analysis on these parameters revealed that tumor size (HR, 1.509; 95% CI, 1.146–1.985; P = 0.003) was independently associated with DFS (Table 3).


Conditional disease-free survival after liver transplantation for hepatocellular carcinoma: A two-center experience.

Dong J, Zhu Y, Ma F, Ren Y, Lu J, Wang Z, Qin L, Wu R, Lv Y - Medicine (Baltimore) (2016)

Actuarial patient disease-free survival curve of the whole study population of 384 patients submitted to liver transplantation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979803&req=5

Figure 1: Actuarial patient disease-free survival curve of the whole study population of 384 patients submitted to liver transplantation.
Mentions: Patient follow-up as of January 2015 or to the time of death ranged from 24 to 96 months. The median follow-up period was 26.3 months (range, 0–104.7 months). Two hundred thirty-seven (47.40%) patients recurred, 29 patients had late recurrence (≥3 years). Their 1-, 3-, and 5-year DFS rates were 69.9%, 45.8%, and 39.0%, respectively (Fig. 1). On the univariate analysis, the following factors were associated with unfavorable DFS: serum AFP levels (hazard ratio [HR], 1.959; 95% CI, 1.439–2.666; P < 0.001), tumor number (HR, 1.745; 95% CI, 1.157–2.632; P < 0.001), tumor size (HR, 3.303; 95% CI, 2.443–4.466; P < 0.001), capsule (HR, 1.598; 95% CI, 1.192–2.144; P = 0.002), microvascular invasion (MVI) (HR, 2.583; 95% CI, 1.877–3.552; P < 0.001), differentiation (HR, 1.594; 95% CI, 1.129–2.249; P = 0.002), AJCC stage (HR, 3.957; 95% CI, 2.599–6.024; P < 0.001), and Milan criteria (HR, 2.420; 95% CI, 1.799–3.255; P < 0.001) (Table 2). Multivariate analysis on these parameters revealed that tumor size (HR, 1.509; 95% CI, 1.146–1.985; P = 0.003) was independently associated with DFS (Table 3).

Bottom Line: Multivariate analysis indicated that larger tumor size (hazard ratio [HR], 1.509; 95% CI, 1.146-1.985; P = 0.003) was associated with poorer DFS.Patients with worse prognostic features at baseline demonstrated the greater increase in CDFS over time.Survival estimates following liver transplantation of HCC patients change according to survival time accrued since surgery.CDFS estimates improved dramatically over time especially among patients with worse prognostic features at the time of surgery.

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University bInstitute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi Province cDepartment of Surgery, Huashan Hospital dCancer Metastasis Institute, Fudan University, Shanghai, P.R. China.

ABSTRACT
Traditionally, survival estimates following liver transplantation (LT) of hepatocellular carcinoma (HCC) patients were calculated as survival from the surgery date, but future survival probabilities can change over time and conditional disease-free survival (CDFS) may provide patients and clinicians with more accurate prognostic information. This study aimed to assess CDFS in HCC patients after LT.Three hundred eighty-four HCC patients who underwent LT were included. Disease-free survival (DFS) was calculated using the Kaplan-Meier analysis. The 3-year CDFS, which represents the probability of remaining disease free for an additional 3 years, was calculated.1-, 3-, and 5-year DFS rates after LT were 69.9%, 45.8%, and 39.0 %, respectively. Based on the concept of CDFS, the probability of surviving an additional 3 years given that the patient was disease free at 1 year, 3 years, and 5 years were 58.4%, 76.9%, and 83.1%, respectively. Multivariate analysis indicated that larger tumor size (hazard ratio [HR], 1.509; 95% CI, 1.146-1.985; P = 0.003) was associated with poorer DFS. Patients with worse prognostic features at baseline demonstrated the greater increase in CDFS over time.Survival estimates following liver transplantation of HCC patients change according to survival time accrued since surgery. CDFS estimates improved dramatically over time especially among patients with worse prognostic features at the time of surgery. CDFS may be a useful tool in counseling patients with HCC, as it is a more accurate assessment of future survival for those patients who have already survived a certain amount of time.

No MeSH data available.


Related in: MedlinePlus