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Benefit of downsizing hepatocellular carcinoma in a liver transplant population
- Source :
- Alimentary pharmacologytherapeutics. 31(3)
- Publication Year :
- 2009
-
Abstract
- Aliment Pharmacol Ther 31, 415–423 Summary Background Long-term results after downstaging hepatocellular carcinoma (HCC) prior to liver transplantation (LT) remain unknown. Aims To investigate dropouts and post-transplant outcome among patients with downstaged HCC by transarterial chemo-lipiodolization (TACL). Methods Between 2000 and 2007, 386 patients with HCC initially exceeding Milan criteria underwent TACL for tumour downstaging and were consecutively enrolled. Results Overall, 160 (41.5%) patients achieved successful downstaging of HCC to within Milan criteria. During the follow-up, 82 eventually dropped off the waiting list for LT, with estimated dropout rates at 1, 2 and 5 years of 46.7%, 70.2%, and 87.2%, respectively. The overall post-transplant survival rates at 1, 2 and 5 years were 89.2%, 70.3% and 54.6% and the corresponding rates for recurrence-free survival were 74.7%, 71.8% and 66.3% respectively. Multivariate analysis indentified alpha-fetoprotein (AFP) levels ≥100 ng/mL at LT (P = 0.003), maximum tumour size ≥7 cm (P = 0.002) and the lack of complete necrosis by TACL (P = 0.048) as independent predictors of HCC recurrence after LT. Patients with none of these risk factors had an excellent post-transplant outcome, with an 87.5% probability of recurrence-free survival up to 6 years. Conclusions These long-term results may contribute to the database for optimizing management of LT candidates with downstaged HCC. Based on our data, patients with a maximum tumour size
- Subjects :
- Male
medicine.medical_specialty
Carcinoma, Hepatocellular
Waiting Lists
medicine.medical_treatment
Population
Milan criteria
Liver transplantation
Gastroenterology
Internal medicine
Preoperative Care
medicine
Humans
Pharmacology (medical)
education
Survival rate
computer.programming_language
Neoplasm Staging
education.field_of_study
Hepatology
business.industry
Patient Selection
Liver Neoplasms
Middle Aged
medicine.disease
Liver Transplantation
Transplantation
Survival Rate
TACL
Hepatocellular carcinoma
Female
Liver cancer
business
computer
Subjects
Details
- ISSN :
- 13652036
- Volume :
- 31
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Alimentary pharmacologytherapeutics
- Accession number :
- edsair.doi.dedup.....fd65abc7fba16ae4eca8929a070361a6