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Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients

Liver transplantation (LT) is a curative treatment for early-stage hepatocellular carcinoma (HCC) unsuitable for surgical resection. However, tumor recurrence (TR) rates range from 8% to 20% despite strict selection criteria. The validation of new prognostic tools, such as pre-MORAL or RETREAT risks...

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Autores principales: Cuadrado, Antonio, Fortea, José Ignacio, Rodríguez-Lope, Carlos, Puente, Ángela, Fernández-Vilchez, Vanesa, Echavarria, Victor Jose, Castillo Suescun, Federico José, Fernández, Roberto, Echeverri, Juan Andrés, Achalandabaso, Mar, Toledo, Enrique, Pellón, Raúl, Rodríguez Sanjuan, Juan Carlos, Crespo, Javier, Fábrega, Emilio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10488177/
https://www.ncbi.nlm.nih.gov/pubmed/37685524
http://dx.doi.org/10.3390/jcm12175457
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author Cuadrado, Antonio
Fortea, José Ignacio
Rodríguez-Lope, Carlos
Puente, Ángela
Fernández-Vilchez, Vanesa
Echavarria, Victor Jose
Castillo Suescun, Federico José
Fernández, Roberto
Echeverri, Juan Andrés
Achalandabaso, Mar
Toledo, Enrique
Pellón, Raúl
Rodríguez Sanjuan, Juan Carlos
Crespo, Javier
Fábrega, Emilio
author_facet Cuadrado, Antonio
Fortea, José Ignacio
Rodríguez-Lope, Carlos
Puente, Ángela
Fernández-Vilchez, Vanesa
Echavarria, Victor Jose
Castillo Suescun, Federico José
Fernández, Roberto
Echeverri, Juan Andrés
Achalandabaso, Mar
Toledo, Enrique
Pellón, Raúl
Rodríguez Sanjuan, Juan Carlos
Crespo, Javier
Fábrega, Emilio
author_sort Cuadrado, Antonio
collection PubMed
description Liver transplantation (LT) is a curative treatment for early-stage hepatocellular carcinoma (HCC) unsuitable for surgical resection. However, tumor recurrence (TR) rates range from 8% to 20% despite strict selection criteria. The validation of new prognostic tools, such as pre-MORAL or RETREAT risks, is necessary to improve recurrence prediction. A retrospective study was conducted at Marqués de Valdecilla University Hospital in Cantabria, Spain, between 2010 and 2019 to determine the rate of TR in LT patients and identify associated factors. Patients with liver-kidney transplantation, re-transplantation, HIV infection, survival less than 90 days, or incidental HCC were excluded. Data on demographic, liver disease-related, LT, and tumor-related variables, as well as follow-up records, including TR and death, were collected. TR was analyzed using the Log-Rank test, and a multivariate Cox regression analysis was performed. The study was approved by the IRB of Cantabria. TR occurred in 13.6% of LT patients (95% CI = 7.3–23.9), primarily as extrahepatic recurrence (67%) within the first 5 years (75%). Increased TR was significantly associated with higher Body Mass Index (BMI) (HR = 1.3 [95% CI = 1.1–1.5]), vascular micro-invasion (HR = 8.8 [1.6–48.0]), and medium (HR = 20.4 [3.0–140.4]) and high pre-MORAL risk (HR = 30.2 [1.6–568.6]). TR also showed a significant correlation with increased mortality. Conclusions: LT for HCC results in a 13.6% rate of tumor recurrence. Factors such as BMI, vascular micro-invasion, and medium/high pre-MORAL risk are strongly associated with TR following LT.
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spelling pubmed-104881772023-09-09 Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients Cuadrado, Antonio Fortea, José Ignacio Rodríguez-Lope, Carlos Puente, Ángela Fernández-Vilchez, Vanesa Echavarria, Victor Jose Castillo Suescun, Federico José Fernández, Roberto Echeverri, Juan Andrés Achalandabaso, Mar Toledo, Enrique Pellón, Raúl Rodríguez Sanjuan, Juan Carlos Crespo, Javier Fábrega, Emilio J Clin Med Article Liver transplantation (LT) is a curative treatment for early-stage hepatocellular carcinoma (HCC) unsuitable for surgical resection. However, tumor recurrence (TR) rates range from 8% to 20% despite strict selection criteria. The validation of new prognostic tools, such as pre-MORAL or RETREAT risks, is necessary to improve recurrence prediction. A retrospective study was conducted at Marqués de Valdecilla University Hospital in Cantabria, Spain, between 2010 and 2019 to determine the rate of TR in LT patients and identify associated factors. Patients with liver-kidney transplantation, re-transplantation, HIV infection, survival less than 90 days, or incidental HCC were excluded. Data on demographic, liver disease-related, LT, and tumor-related variables, as well as follow-up records, including TR and death, were collected. TR was analyzed using the Log-Rank test, and a multivariate Cox regression analysis was performed. The study was approved by the IRB of Cantabria. TR occurred in 13.6% of LT patients (95% CI = 7.3–23.9), primarily as extrahepatic recurrence (67%) within the first 5 years (75%). Increased TR was significantly associated with higher Body Mass Index (BMI) (HR = 1.3 [95% CI = 1.1–1.5]), vascular micro-invasion (HR = 8.8 [1.6–48.0]), and medium (HR = 20.4 [3.0–140.4]) and high pre-MORAL risk (HR = 30.2 [1.6–568.6]). TR also showed a significant correlation with increased mortality. Conclusions: LT for HCC results in a 13.6% rate of tumor recurrence. Factors such as BMI, vascular micro-invasion, and medium/high pre-MORAL risk are strongly associated with TR following LT. MDPI 2023-08-23 /pmc/articles/PMC10488177/ /pubmed/37685524 http://dx.doi.org/10.3390/jcm12175457 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Cuadrado, Antonio
Fortea, José Ignacio
Rodríguez-Lope, Carlos
Puente, Ángela
Fernández-Vilchez, Vanesa
Echavarria, Victor Jose
Castillo Suescun, Federico José
Fernández, Roberto
Echeverri, Juan Andrés
Achalandabaso, Mar
Toledo, Enrique
Pellón, Raúl
Rodríguez Sanjuan, Juan Carlos
Crespo, Javier
Fábrega, Emilio
Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients
title Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients
title_full Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients
title_fullStr Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients
title_full_unstemmed Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients
title_short Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients
title_sort risk of recurrence of hepatocarcinoma after liver transplantation: performance of recurrence predictive models in a cohort of transplant patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10488177/
https://www.ncbi.nlm.nih.gov/pubmed/37685524
http://dx.doi.org/10.3390/jcm12175457
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