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Identification of an Upper Limit of Tumor Burden for Downstaging in Candidates with Hepatocellular Cancer Waiting for Liver Transplantation: A West–East Collaborative Effort

Since the introduction of Milan Criteria, all scoring models describing the prognosis of hepatocellular cancer (HCC) after liver transplantation (LT) have been exclusively based on characteristics available at surgery, therefore neglecting the intention-to-treat principles. This study aimed at devel...

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Autores principales: Lai, Quirino, Vitale, Alessandro, Halazun, Karim, Iesari, Samuele, Viveiros, André, Bhangui, Prashant, Mennini, Gianluca, Wong, Tiffany, Uemoto, Shinji, Lin, Chih-Che, Mittler, Jens, Ikegami, Toru, Zhe, Yang, Zheng, Shu-Sen, Soejima, Yuji, Hoppe-Lotichius, Maria, Chen, Chao-Long, Kaido, Toshimi, Lo, Chung Mau, Rossi, Massimo, Soin, Arvinder Singh, Finkenstedt, Armin, Emond, Jean C., Cillo, Umberto, Lerut, Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072306/
https://www.ncbi.nlm.nih.gov/pubmed/32075133
http://dx.doi.org/10.3390/cancers12020452
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author Lai, Quirino
Vitale, Alessandro
Halazun, Karim
Iesari, Samuele
Viveiros, André
Bhangui, Prashant
Mennini, Gianluca
Wong, Tiffany
Uemoto, Shinji
Lin, Chih-Che
Mittler, Jens
Ikegami, Toru
Zhe, Yang
Zheng, Shu-Sen
Soejima, Yuji
Hoppe-Lotichius, Maria
Chen, Chao-Long
Kaido, Toshimi
Lo, Chung Mau
Rossi, Massimo
Soin, Arvinder Singh
Finkenstedt, Armin
Emond, Jean C.
Cillo, Umberto
Lerut, Jan
author_facet Lai, Quirino
Vitale, Alessandro
Halazun, Karim
Iesari, Samuele
Viveiros, André
Bhangui, Prashant
Mennini, Gianluca
Wong, Tiffany
Uemoto, Shinji
Lin, Chih-Che
Mittler, Jens
Ikegami, Toru
Zhe, Yang
Zheng, Shu-Sen
Soejima, Yuji
Hoppe-Lotichius, Maria
Chen, Chao-Long
Kaido, Toshimi
Lo, Chung Mau
Rossi, Massimo
Soin, Arvinder Singh
Finkenstedt, Armin
Emond, Jean C.
Cillo, Umberto
Lerut, Jan
author_sort Lai, Quirino
collection PubMed
description Since the introduction of Milan Criteria, all scoring models describing the prognosis of hepatocellular cancer (HCC) after liver transplantation (LT) have been exclusively based on characteristics available at surgery, therefore neglecting the intention-to-treat principles. This study aimed at developing an intention-to-treat model through a competing-risk analysis. Using data available at first referral, an upper limit of tumor burden for downstaging was identified beyond which successful LT becomes an unrealistic goal. Twelve centers in Europe, United States, and Asia (Brussels, Sapienza Rome, Padua, Columbia University New York, Innsbruck, Medanta-The Medicity Dehli, Hong Kong, Kyoto, Kaohsiung Taiwan, Mainz, Fukuoka, Shulan Hospital Hangzhou) created a Derivation (n = 2318) and a Validation Set (n = 773) of HCC patients listed for LT between January 2000–March 2017. In the Derivation Set, the competing-risk analysis identified two independent covariables predicting post-transplant HCC-related death: combined HCC number and diameter (SHR = 1.15; p < 0.001) and alpha-fetoprotein (AFP) (SHR = 1.80; p < 0.001). WE-DS Model showed good diagnostic performances at internal and external validation. The identified upper limit of tumor burden for downstaging was AFP ≤ 20 ng/mL and up-to-twelve as sum of HCC number and diameter; AFP = 21–200 and up-to-ten; AFP = 201–500 and up-to-seven; AFP = 501–1000 and up-to-five. The WE-DS Model proposed here, based on morphologic and biologic data obtained at first referral in a large international cohort of HCC patients listed for LT, allowed identifying an upper limit of tumor burden for downstaging beyond which successful LT, following downstaging, results in a futile transplantation.
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spelling pubmed-70723062020-03-19 Identification of an Upper Limit of Tumor Burden for Downstaging in Candidates with Hepatocellular Cancer Waiting for Liver Transplantation: A West–East Collaborative Effort Lai, Quirino Vitale, Alessandro Halazun, Karim Iesari, Samuele Viveiros, André Bhangui, Prashant Mennini, Gianluca Wong, Tiffany Uemoto, Shinji Lin, Chih-Che Mittler, Jens Ikegami, Toru Zhe, Yang Zheng, Shu-Sen Soejima, Yuji Hoppe-Lotichius, Maria Chen, Chao-Long Kaido, Toshimi Lo, Chung Mau Rossi, Massimo Soin, Arvinder Singh Finkenstedt, Armin Emond, Jean C. Cillo, Umberto Lerut, Jan Cancers (Basel) Article Since the introduction of Milan Criteria, all scoring models describing the prognosis of hepatocellular cancer (HCC) after liver transplantation (LT) have been exclusively based on characteristics available at surgery, therefore neglecting the intention-to-treat principles. This study aimed at developing an intention-to-treat model through a competing-risk analysis. Using data available at first referral, an upper limit of tumor burden for downstaging was identified beyond which successful LT becomes an unrealistic goal. Twelve centers in Europe, United States, and Asia (Brussels, Sapienza Rome, Padua, Columbia University New York, Innsbruck, Medanta-The Medicity Dehli, Hong Kong, Kyoto, Kaohsiung Taiwan, Mainz, Fukuoka, Shulan Hospital Hangzhou) created a Derivation (n = 2318) and a Validation Set (n = 773) of HCC patients listed for LT between January 2000–March 2017. In the Derivation Set, the competing-risk analysis identified two independent covariables predicting post-transplant HCC-related death: combined HCC number and diameter (SHR = 1.15; p < 0.001) and alpha-fetoprotein (AFP) (SHR = 1.80; p < 0.001). WE-DS Model showed good diagnostic performances at internal and external validation. The identified upper limit of tumor burden for downstaging was AFP ≤ 20 ng/mL and up-to-twelve as sum of HCC number and diameter; AFP = 21–200 and up-to-ten; AFP = 201–500 and up-to-seven; AFP = 501–1000 and up-to-five. The WE-DS Model proposed here, based on morphologic and biologic data obtained at first referral in a large international cohort of HCC patients listed for LT, allowed identifying an upper limit of tumor burden for downstaging beyond which successful LT, following downstaging, results in a futile transplantation. MDPI 2020-02-14 /pmc/articles/PMC7072306/ /pubmed/32075133 http://dx.doi.org/10.3390/cancers12020452 Text en © 2020 by the authors. 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 (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lai, Quirino
Vitale, Alessandro
Halazun, Karim
Iesari, Samuele
Viveiros, André
Bhangui, Prashant
Mennini, Gianluca
Wong, Tiffany
Uemoto, Shinji
Lin, Chih-Che
Mittler, Jens
Ikegami, Toru
Zhe, Yang
Zheng, Shu-Sen
Soejima, Yuji
Hoppe-Lotichius, Maria
Chen, Chao-Long
Kaido, Toshimi
Lo, Chung Mau
Rossi, Massimo
Soin, Arvinder Singh
Finkenstedt, Armin
Emond, Jean C.
Cillo, Umberto
Lerut, Jan
Identification of an Upper Limit of Tumor Burden for Downstaging in Candidates with Hepatocellular Cancer Waiting for Liver Transplantation: A West–East Collaborative Effort
title Identification of an Upper Limit of Tumor Burden for Downstaging in Candidates with Hepatocellular Cancer Waiting for Liver Transplantation: A West–East Collaborative Effort
title_full Identification of an Upper Limit of Tumor Burden for Downstaging in Candidates with Hepatocellular Cancer Waiting for Liver Transplantation: A West–East Collaborative Effort
title_fullStr Identification of an Upper Limit of Tumor Burden for Downstaging in Candidates with Hepatocellular Cancer Waiting for Liver Transplantation: A West–East Collaborative Effort
title_full_unstemmed Identification of an Upper Limit of Tumor Burden for Downstaging in Candidates with Hepatocellular Cancer Waiting for Liver Transplantation: A West–East Collaborative Effort
title_short Identification of an Upper Limit of Tumor Burden for Downstaging in Candidates with Hepatocellular Cancer Waiting for Liver Transplantation: A West–East Collaborative Effort
title_sort identification of an upper limit of tumor burden for downstaging in candidates with hepatocellular cancer waiting for liver transplantation: a west–east collaborative effort
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072306/
https://www.ncbi.nlm.nih.gov/pubmed/32075133
http://dx.doi.org/10.3390/cancers12020452
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