scholarly journals The Real Impact of Bridging or Downstaging on Survival Outcomes after Liver Transplantation for Hepatocellular Carcinoma

Liver Cancer ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 721-733
Author(s):  
Sunyoung Lee ◽  
Kyoung Won Kim ◽  
Gi-Won Song ◽  
Jae Hyun Kwon ◽  
Shin Hwang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Early Stage ◽  
Organ Procurement ◽  
Survival Outcomes ◽  
Full Cohort ◽  
Donor Liver Transplantation ◽  
Positron Emission ◽  
The Impact

<b><i>Introduction:</i></b> There is no consensus regarding selection criteria on liver transplantation (LT) for hepatocellular carcinoma (HCC), especially for living donor liver transplantation, although emerging evidence has been found for the effectiveness of bridging or downstaging. <b><i>Objective:</i></b> We evaluated the long-term outcomes of patients who underwent LT with or without bridging or downstaging for HCC. <b><i>Methods:</i></b> This retrospective study included 896 LT recipients with HCC between June 2005 and May 2015. Recurrence-free survival (RFS), overall survival (OS), and their associated factors were evaluated. <b><i>Results:</i></b> The 5-year RFS in the full cohort of 896 patients was 82.4%, and the OS was 85.3%. In patients with initial Organ Procurement and Transplantation Network (OPTN) T1 and T2, the 5-year RFS and OS did not significantly differ between LT groups with and without bridging (all <i>p</i> ≥ 0.05). The 5-year RFS and OS of OPTN T3 patients with successful downstaging were not significantly different from those of patients with OPTN T2 with primary LT (<i>p</i> = 0.070 and <i>p</i> = 0.185), but were significantly higher than in patients with OPTN T3 with downstaging failure and initial OPTN T1 or T2 with progression (all <i>p</i> &#x3c; 0.001). In the multivariate analysis, last alpha-fetoprotein before LT ≥70 ng/mL (hazard ratio [HR]: 1.77, <i>p</i> = 0.001; HR: 1.72, <i>p</i> = 0.004), pretransplant HCC status exceeding the Milan criteria (HR: 5.12, <i>p</i> &#x3c; 0.001; HR: 3.31, <i>p</i> &#x3c; 0.001), and positron emission tomography positivity (HR: 2.57, <i>p</i> &#x3c; 0.001; HR: 2.57, <i>p</i> &#x3c; 0.001) were independent predictors for worse RFS and OS. <b><i>Conclusions:</i></b> The impact of bridging therapy on survival outcomes is limited in patients with early-stage HCC, whereas OPTN T1 or T2 with progression provides worse prognosis. OPTN T3 should undergo LT after successful downstaging, and OPTN T3 with successful downstaging allows for acceptable long-term posttransplant outcomes.

Laparoscopic Hepatectomy (with or without Robotic Assistance) versus Radiofrequency Ablation as a Minimally Invasive Treatment for Very Early-Stage or Early-Stage Hepatocellular Carcinoma

2019 ◽  
Vol 37 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Charing Ching-Ning Chong ◽  
Kit-Fai Lee ◽  
Cheuk-Man Chu ◽  
Anthony Wing-Hung Chan ◽  
Simon Chun-Ho Yu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Early Stage ◽  
Survival Outcomes ◽  
Complication Rates ◽  
Minimally Invasive Hepatectomy

Background: The advantages of radiofrequency ablation (RFA) over hepatectomy as a treatment for early-stage hepatocellular carcinoma (HCC) include reduced morbidity and more rapid recovery. Although minimally invasive surgery provides similar benefits, few studies have compared the long-term oncological outcomes of these techniques. This study aimed to compare the outcomes of minimally invasive hepatectomy (MIH) and RFA. Methods: Patients who underwent MIH or RFA for HCC between January 2005 and January 2015 were included in a propensity score matching analysis. Only patients who underwent minimally invasive procedures for small HCC were included. Baseline clinical and laboratory parameters were retrieved from the hospital database and analyzed. Results: Two hundred and twenty-five patients underwent MIH or RFA for HCC during the study period. Propensity score matching yielded 59 patient-pairs. The complication rates did not differ statistically between the 2 groups (p = 0.309). However, MIH provided significantly better overall (p = 0.005) and disease-free survival outcomes (p < 0.001) than RFA. Conclusions: Compared with RFA, MIH provided better long-term survival outcomes in patients with early-stage HCC, with no increase in the incidence of complications. When feasible, MIH should be considered a first-line treatment for this patient population.

scholarly journals Long-term survival after resection of pharyngeal metastasis following living-donor liver transplantation for hepatocellular carcinoma: case report and review of literature

2020 ◽  
Author(s):  
Taiji Tohyama ◽  
Katsunori Sakamoto ◽  
Kei Tamura ◽  
Taro Nakamura ◽  
Jota Watanabe ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Lymph Node ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Node Dissection ◽  
Donor Liver ◽  
Term Survival ◽  
Donor Liver Transplantation

Abstract Background: The most common sites of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been reported to be the liver, lung, bone, and adrenal glands, but there have also been many reports of cases of multiple recurrence. The prognosis after recurrence is poor, with reported median survival after recurrence of HCC ranging from 9 to 19 months. Here, we report a case of long-term survival after recurrence of pharyngeal metastasis following living-donor liver transplantation (LDLT) for HCC within the Milan criteria, by resection of the metastatic region and cervical lymph node dissection. Case presentation: A 47-year-old man with a Model End-stage Liver Disease (MELD) score of 11 underwent LDLT for HCC within the Milan criteria on liver cirrhosis associated with hepatitis B virus infection, with his 48-year-old elder brother as the living donor. One year and 10 months after liver transplantation, he visited a nearby hospital with a chief complaint of discomfort on swallowing. A pedunculated polyp was found in the hypopharynx, and biopsy revealed HCC metastasis. Pharyngeal polypectomy was performed, followed by neck lymph node dissection 2 years thereafter. Although recurrence subsequently occurred three times in the grafted liver, the patient is still alive 12 years 10 months after recurrence of pharyngeal metastasis. He is now a tumor-free outpatient taking sorafenib. Conclusion: It is necessary to recognize that the nasopharyngeal region is a potential site of HCC metastasis. Prognostic improvement can be expected with close follow-up, early detection, and multidisciplinary treatment including radical resection.

scholarly journals Impact of MAFLD on HBV-Related Stage 0/A Hepatocellular Carcinoma after Curative Resection

2021 ◽  
Vol 11 (8) ◽  
pp. 684
Author(s):  
Yen-Po Lin ◽  
Shu-Hsien Lin ◽  
Chih-Chi Wang ◽  
Chih-Che Lin ◽  
Ding-Wei Chen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Risk Factor ◽  
Hepatitis B ◽  
Curative Resection ◽  
Early Stage ◽  
B Virus ◽  
The Impact ◽  
Hcc Recurrence

Backgrounds and Aim: Metabolic-associated fatty liver dis-ease (MAFLD) is a novel term proposed in 2020 to avoid the exclusion of certain subpopulations, though the application of this term in the real world is very limited. Here, we aimed to evaluate the impact of MAFLD on hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after curative resection. Methods: Patients with chronic hepatitis B (CHB)-related HCC who received hepatectomy between January 2010 and December 2019 were consecutively selected. The association between histologically proven concurrent MAFLD and clinical outcomes were retrospectively analyzed. Results: Among the 812 eligible patients with CHB-related HCC, 369 (45.4%) were diagnosed with concurrent MAFLD. After a mean follow-up of 65 months, 303 patients (37.3%) developed HCC recurrence, 111 (13.7%) died, and 12 (1.5%) received liver transplantation. Although no differences in the incidences of HCC recurrence (HR: 0.902, 95% CI: 0.719–1.131, p = 0.370) and death or liver transplantation (HR: 0.743, 95% CI: 0.518–1.006, p = 0.107) were observed between patients with and without MAFLD in multivariate analysis, the patients with MAFLD tended to achieve better recurrent-free survival compared to patients without MAFLD. Notably, lean MAFLD (BMI < 23 kg/m2) was a relative risk factor for tumor recurrence (HR: 2.030, 95% CI: 1.117–3.690, p = 0.020) among patients with MAFLD. Conclusions: The overall prognosis in HBV-related early-stage HCC, in terms of HCC recurrence and death or liver transplantation, was not significantly different between patients with and without MAFLD. Among patients with MALFD, lean-MAFLD was a risk factor for HCC recurrence. Further studies are warranted to validate these results.

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