Cargando…
Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion
PURPOSE: Microvascular invasion of hepatocellular carcinoma (HCC) is considered a poor prognostic factor of liver resection (LR) and liver transplantation (LT), but its significance for lesions within the up-to-7 criteria is unclear. This study investigated the survival benefit of primary LT against...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer-Verlag
2011
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3360855/ https://www.ncbi.nlm.nih.gov/pubmed/22016140 http://dx.doi.org/10.1007/s12072-011-9318-3 |
_version_ | 1782234058485399552 |
---|---|
author | Chan, See Ching Fan, Sheung Tat Chok, Kenneth S. H. Cheung, Tan To Chan, Albert C. Y. Fung, James Y. Y. Poon, Ronnie T. P. Lo, Chung Mau |
author_facet | Chan, See Ching Fan, Sheung Tat Chok, Kenneth S. H. Cheung, Tan To Chan, Albert C. Y. Fung, James Y. Y. Poon, Ronnie T. P. Lo, Chung Mau |
author_sort | Chan, See Ching |
collection | PubMed |
description | PURPOSE: Microvascular invasion of hepatocellular carcinoma (HCC) is considered a poor prognostic factor of liver resection (LR) and liver transplantation (LT), but its significance for lesions within the up-to-7 criteria is unclear. This study investigated the survival benefit of primary LT against LR for HCC with microvascular invasion and within the up-to-7 criteria. METHODS: Adult patients who underwent LR or LT as the primary treatment for HCC were included for study. Patients with prior local ablation, neoadjuvant systemic chemotherapy, targeted therapy, positive resection margin, or metastatic spread were excluded. RESULTS: There were 471 LR patients and 95 LT recipients (70 with living donor, 25 with deceased donor). Seventy-seven (81.1%) LT recipients had HCC within the up-to-7 criteria. Twenty-five (26.3%) LT recipients had HCC with either macrovascular (n = 4) or microvascular (n = 21) invasion. The 5-year survival rate was 85.7% for LT recipients with HCC within the up-to-7 criteria, unaffected by the presence or absence of vascular invasion (88.2 vs. 85.1%). The rate was comparable with that of LR patients with HCC without vascular invasion (81.2%, p 0.227), but far superior to that of LR patients with lesions with vascular invasion (50.0%, p < 0.0001). Overall survivals were compromised by multiple tumors [odds ratio (OR) 1.902, confidence interval (CI) 1.374–2.633, p = 0.0001], vascular invasion (OR 2.678, CI 1.952–3.674, p < 0.0001), blood transfusion (OR 2.046, CI 1.337–3.131, p = 0.001), and being beyond the up-to-7 criteria (OR 1.457, CI 1.041–2.037, p = 0.028). LT was a favorable factor for survival (OR 0.243, CI 0.130–0.454, p < 0.0001). CONCLUSION: Primary LT for HCC with microvascular invasion and within the up-to-7 criteria doubled the chance of cure as compared with LR. |
format | Online Article Text |
id | pubmed-3360855 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | Springer-Verlag |
record_format | MEDLINE/PubMed |
spelling | pubmed-33608552012-06-13 Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion Chan, See Ching Fan, Sheung Tat Chok, Kenneth S. H. Cheung, Tan To Chan, Albert C. Y. Fung, James Y. Y. Poon, Ronnie T. P. Lo, Chung Mau Hepatol Int Original Article PURPOSE: Microvascular invasion of hepatocellular carcinoma (HCC) is considered a poor prognostic factor of liver resection (LR) and liver transplantation (LT), but its significance for lesions within the up-to-7 criteria is unclear. This study investigated the survival benefit of primary LT against LR for HCC with microvascular invasion and within the up-to-7 criteria. METHODS: Adult patients who underwent LR or LT as the primary treatment for HCC were included for study. Patients with prior local ablation, neoadjuvant systemic chemotherapy, targeted therapy, positive resection margin, or metastatic spread were excluded. RESULTS: There were 471 LR patients and 95 LT recipients (70 with living donor, 25 with deceased donor). Seventy-seven (81.1%) LT recipients had HCC within the up-to-7 criteria. Twenty-five (26.3%) LT recipients had HCC with either macrovascular (n = 4) or microvascular (n = 21) invasion. The 5-year survival rate was 85.7% for LT recipients with HCC within the up-to-7 criteria, unaffected by the presence or absence of vascular invasion (88.2 vs. 85.1%). The rate was comparable with that of LR patients with HCC without vascular invasion (81.2%, p 0.227), but far superior to that of LR patients with lesions with vascular invasion (50.0%, p < 0.0001). Overall survivals were compromised by multiple tumors [odds ratio (OR) 1.902, confidence interval (CI) 1.374–2.633, p = 0.0001], vascular invasion (OR 2.678, CI 1.952–3.674, p < 0.0001), blood transfusion (OR 2.046, CI 1.337–3.131, p = 0.001), and being beyond the up-to-7 criteria (OR 1.457, CI 1.041–2.037, p = 0.028). LT was a favorable factor for survival (OR 0.243, CI 0.130–0.454, p < 0.0001). CONCLUSION: Primary LT for HCC with microvascular invasion and within the up-to-7 criteria doubled the chance of cure as compared with LR. Springer-Verlag 2011-10-21 /pmc/articles/PMC3360855/ /pubmed/22016140 http://dx.doi.org/10.1007/s12072-011-9318-3 Text en © The Author(s) 2011 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. |
spellingShingle | Original Article Chan, See Ching Fan, Sheung Tat Chok, Kenneth S. H. Cheung, Tan To Chan, Albert C. Y. Fung, James Y. Y. Poon, Ronnie T. P. Lo, Chung Mau Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion |
title | Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion |
title_full | Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion |
title_fullStr | Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion |
title_full_unstemmed | Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion |
title_short | Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion |
title_sort | survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3360855/ https://www.ncbi.nlm.nih.gov/pubmed/22016140 http://dx.doi.org/10.1007/s12072-011-9318-3 |
work_keys_str_mv | AT chanseeching survivaladvantageofprimarylivertransplantationforhepatocellularcarcinomawithintheupto7criteriawithmicrovascularinvasion AT fansheungtat survivaladvantageofprimarylivertransplantationforhepatocellularcarcinomawithintheupto7criteriawithmicrovascularinvasion AT chokkennethsh survivaladvantageofprimarylivertransplantationforhepatocellularcarcinomawithintheupto7criteriawithmicrovascularinvasion AT cheungtanto survivaladvantageofprimarylivertransplantationforhepatocellularcarcinomawithintheupto7criteriawithmicrovascularinvasion AT chanalbertcy survivaladvantageofprimarylivertransplantationforhepatocellularcarcinomawithintheupto7criteriawithmicrovascularinvasion AT fungjamesyy survivaladvantageofprimarylivertransplantationforhepatocellularcarcinomawithintheupto7criteriawithmicrovascularinvasion AT poonronnietp survivaladvantageofprimarylivertransplantationforhepatocellularcarcinomawithintheupto7criteriawithmicrovascularinvasion AT lochungmau survivaladvantageofprimarylivertransplantationforhepatocellularcarcinomawithintheupto7criteriawithmicrovascularinvasion |