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The Clinical Behavior of Transplantable Recurrent Hepatocellular Carcinoma After Curative Resection: Implications for Salvage Liver Transplantation

Authors
 Hyung Soon Lee  ;  Gi Hong Choi  ;  Dong Jin Joo  ;  Myoung Soo Kim  ;  Jin Sub Choi  ;  Soon Il Kim 
Citation
 ANNALS OF SURGICAL ONCOLOGY, Vol.21(8) : 2717-2724, 2014 
Journal Title
ANNALS OF SURGICAL ONCOLOGY
ISSN
 1068-9265 
Issue Date
2014
MeSH
Adult ; Aged ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/surgery* ; Disease Progression ; Female ; Follow-Up Studies ; Hepatectomy/adverse effects* ; Humans ; Liver Neoplasms/mortality ; Liver Neoplasms/pathology ; Liver Neoplasms/surgery* ; Liver Transplantation* ; Male ; Middle Aged ; Neoplasm Recurrence, Local/etiology ; Neoplasm Recurrence, Local/mortality ; Neoplasm Recurrence, Local/surgery* ; Neoplasm Staging ; Patient Selection ; Prognosis ; Risk Factors ; Salvage Therapy* ; Survival Rate
Keywords
Liver Transplantation ; Tace ; Milan Criterion ; Portal Vein Tumor Thrombus ; Satellite Nodule
Abstract
BACKGROUND:
This study aimed to classify transplantable recurrent hepatocellular carcinoma (HCC) after resection into subgroups according to the pattern of progression and to identify risk factors for each subgroup to select optimal candidates for salvage liver transplantation (LT).
METHODS:
The patients that met the Milan criteria (MC) and were child-pugh class A at initial hepatectomy were included in the study. Of these patients, the patients with transplantable recurrence were identified and further divided into two groups according to the recurrent HCC progression pattern. Group 1 contained patients with controlled tumors within the MC. Group 2 contained patients with progressive tumors that spread beyond the MC. A controlled tumor was defined as the absence of tumor recurrence after locoregional treatment for ≥12 months or control of a recurrent tumor within the MC by active locoregional treatment.
RESULTS:
After curative resection of HCC, 114 patients with transplantable recurrence were identified: 70 were classified as group 1 and 44 as group 2. Overall survival after recurrence was significantly higher in group 1 compared to group 2 (65.4 vs 35.7 %, respectively; P < 0.003). Multiple logistic regression analysis showed that risk factors in group 1 were age >50 years and an indocyanine green retention at 15 min >10 %. The presence of a satellite nodule (SN) and/or microscopic portal vein invasion (mPVI) was the only independent risk factor identified in group 2. Among the 15 patients that underwent salvage LT, 2 of 3 patients (66.7 %) with SN and/or mPVI at initial hepatectomy developed extrahepatic recurrence.
CONCLUSIONS:
The patients with SN and/or mPVI at initial hepatectomy may not be candidates for salvage LT, and an extended observation time is required to determine tumor biology.
Full Text
http://link.springer.com/article/10.1245%2Fs10434-014-3597-6
DOI
10.1245/s10434-014-3597-6
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Soon Il(김순일) ORCID logo https://orcid.org/0000-0002-0783-7538
Lee, Hyung Soon(이형순)
Joo, Dong Jin(주동진) ORCID logo https://orcid.org/0000-0001-8405-1531
Choi, Gi Hong(최기홍) ORCID logo https://orcid.org/0000-0002-1593-3773
Choi, Jin Sub(최진섭)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99094
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