Detalhes bibliográficos
| Resumo: | Objectives: To identify the preoperative risk factors for prediction of non-transplantable recurrence (NTR) after tumor resection for early-stage hepatocellular carcinoma (HCC) to assist in patient selection relative to upfront liver resection (LR) versus liver transplantation (LT). Methods: Patients who underwent curative resection for transplantable HCC and chronic liver disease were identified from an international multi-institutional database. NTR was defined as recurrence beyond the Milan or UCSF criteria, and the preoperative risk factors of NTR were investigated. Results: Among 293 patients with transplantable HCC within Milan criteria and 320 within UCSF criteria, 113 (38.6%) and 131 (40.9%) patients developed tumor recurrence, respectively. Among patients who recurred, NTR was present in 32 (28.3%) patients within Milan and 35 (26.7%) within UCSF criteria. When either Milan or UCSF criteria was adopted, three preoperative risk factors including liver cirrhosis, tumor size > 3 cm, and multiple lesions were consistently identified as risk factors associated with NTR after curative resection. By summing up the three factors, a scoring model was established and the incidence of NTR among patients with 0, 1 or ≥ 2 risk factors incrementally increased from 4.5%, 13.3% to 20.5% when Milan criteria was used, and from 4.5%, 12.4% to 33.9% when UCSF criteria was adopted. The model demonstrated very good discriminatory power on internal validation (n = 5,000) (c-index 0.689 for Milan criteria, and 0.715 for UCSF criteria). Conclusions: Whereas surgical resection may be optimal first-line treatment for patients with no or one risk factor, patients with ≥ 2 risk factors should be considered for upfront liver transplantation |
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| Autores principais: | Zhang, XF |
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| Outros Autores: | Xue, F; Bagante, F; Ratti, F; Pinto Marques, H; Silva, S; Soubrane, O; Lam, V; Poultsides, GA; Popescu, I; Grigorie, R; Alexandrescu, S; Martel, G; Workneh, A; Guglielmi, A; Hugh, T; Aldrighetti, L; Lv, Y; Pawlik, TM |
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| Assunto: | Carcinoma, Hepatocellular* / pathology Carcinoma, Hepatocellular* / pathology Hepatectomy Liver Neoplasms* / pathology Liver Neoplasms* / surgery Liver Neoplasms* / surgery Patient Selection Retrospective Studies Treatment Outcome HCC CIR |
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| Ano: | 2022 |
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| País: | Portugal |
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| Tipo de documento: | artigo |
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| Tipo de acesso: | acesso aberto |
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| Instituição associada: | Centro Hospitalar de Lisboa Central, EPE (CHLC) |
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| Idioma: | inglês |
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| Origem: | Repositório do Centro Hospitalar de Lisboa Central, EPE |
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