[52] LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA: VALIDATION OF A NEW PROGNOSTIC SCORE PREDICTING DISEASE-FREE SURVIVAL

This study aims to investigate the prognostic value of neutrophil to lymphocyte ratio (NLR) in hepatocellular carcinoma (HCC) patients treated with liver transplantation (LT) through meta-analysis. Relevant articles were sought in PubMed, Embase, and Wangfang databases up to July 2015. A total of 1687 patients from 10 studies were included in this meta-analysis. Meta-analysis results showed that elevated NLR was significantly associated with poorer overall survival (OS) (HR = 2.71, 95% CI: 1.91–3.83) and poorer disease-free survival (DFS) (HR = 3.61, 95% CI: 2.23–5.84) in HCC patients treated with LT. Moreover, subgroup analysis showed the significant association between elevated preoperative NLR and poor prognosis was not altered by cutoff values of NLR or types of LT. Therefore, elevated preoperative NLR is associated with poor prognosis in HCC patients treated with LT. Preoperative NLR should be used to predict the prognosis of HCC after LT in our clinical work.

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Impact of Preoperative α-Fetoprotein Level on Disease-Free Survival After Liver Transplantation for Hepatocellular Carcinoma

World Journal of Surgery ◽

10.1007/s00268-012-1587-z ◽

2012 ◽

Vol 36 (8) ◽

pp. 1824-1831 ◽

Cited By ~ 12

Author(s):

Fabrice Muscari ◽

Jean-Pascal Guinard ◽

Nassim Kamar ◽

Jean-Marie Peron ◽

Philippe Otal ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Disease Free Survival ◽

Free Survival ◽

Disease Free

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Indication of Liver Transplantation for Hepatocellular Carcinoma Should Be Reconsidered in Case of Microvascular Invasion and Multilocular Tumor Occurrence

Journal of Clinical Medicine ◽

10.3390/jcm10061155 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1155

Author(s):

Jan-Paul Gundlach ◽

Stephan Schmidt ◽

Alexander Bernsmeier ◽

Rainer Günther ◽

Victor Kataev ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Overall Survival ◽

Cox Regression ◽

Disease Free Survival ◽

Microvascular Invasion ◽

Simultaneous Occurrence ◽

Free Survival ◽

Cox Regression Analysis ◽

Disease Free

Liver transplantation (LT) is routinely performed for hepatocellular carcinoma (HCC) in cirrhosis without major vascular invasion. Although the adverse influence of microvascular invasion is recognized, its occurrence does not contraindicate LT. We retrospectively analyzed in our LT cohort the significance of microvascular invasion on survival and demonstrate bridging procedures. At our hospital, 346 patients were diagnosed with HCC, 171 patients were evaluated for LT, and 153 were listed at Eurotransplant during a period of 11 years. Among these, 112 patients received LT and were included in this study. Overall survival after 1, 3 and 5 years was 86.3%, 73.9%, and 67.9%, respectively. Microvascular invasion led to significantly reduced overall (p = 0.030) and disease-free survival (p = 0.002). Five-year disease-free survival with microvascular invasion was 10.5%. Multilocular tumor occurrence with simultaneous microvascular invasion revealed the worst prognosis. In our LT cohort, predominant bridging treatment was transarterial chemoembolization (TACE) and the number of TACE significantly correlated with poorer overall survival after LT (p = 0.028), which was confirmed in multiple Cox regression analysis for overall and disease-free survival (p = 0.015 and p = 0.011). Microvascular tumor invasion is significantly associated with reduced prognosis after LT, which is aggravated by simultaneous occurrence of multiple lesions. Therefore, indication strategies for LT should be reconsidered.

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Potential Role of Adjuvant Lenvatinib in Improving Disease-Free Survival for Patients With High-Risk Hepatitis B Virus-Related Hepatocellular Carcinoma Following Liver Transplantation: A Retrospective, Case Control Study

Frontiers in Oncology ◽

10.3389/fonc.2020.562103 ◽

2020 ◽

Vol 10 ◽

Author(s):

Bing Han ◽

Han Ding ◽

Shuai Zhao ◽

Yichi Zhang ◽

Jian Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

High Risk ◽

Disease Free Survival ◽

Control Group ◽

Free Survival ◽

Risk Patients ◽

Disease Free ◽

Hcc Recurrence

Background and AimAlthough liver transplantation (LT) is one of the most effective treatments for the patients with hepatocellular carcinoma (HCC), the high-risk patients suffer from a high ratio of tumor recurrence after LT. Lenvatinib, as a novel targeted drug, has shown an excellent effect in the treatment of advanced HCC, but there is no study on its effect in preventing HCC recurrence in the patients undergoing transplantation. Therefore, this study was designed to evaluate the role of adjuvant lenvatinib in preventing recurrence of high-risk LT recipients with HBV-related HCC.MethodsWe retrospectively analyzed 23 high-risk patients consisting of lenvatinib group (n=14) and control group (n=9) with HBV-related HCC who underwent LT in our center. Disease-free survival (DFS) and HCC recurrence of the two groups were compared. The adverse events (AEs) and drug tolerance of lenvatinib were evaluated.ResultsThe median DFS in lenvatinib group was 291 (95%CI 204–516) days, significantly longer than 182 (95%CI 56–537) days in control group (P=0.04). Three patients in lenvatinib group (21.4%) and five patients in control group (55.6%) had short-term HCC recurrence (P=0.11). All patients in lenvatinib group could tolerate oral lenvatinib for at least three cycles except six cases (42.9%) of dose reduction and 1 case of interruption (14.3%). Thirteen patients (92.9%) taking lenvatinib experienced AEs. The most common AEs were hypertension (64.3%) and proteinuria (42.9%), and the most serious AEs were Grade 3 for 4 cases (28.5%) according to common terminology criteria for adverse events (CTCAE) version 5.0. Additionally, no influence of lenvatinib on the dosage and blood concentration of FK506 was observed.ConclusionsAdjuvant lenvatinib had a potential benefit on prolonging the DFS and reducing the recurrence of high-risk HBV-related HCC patients following liver transplantation with an acceptable drug safety and patient tolerance.

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Significance of frailty in prognosis after hepatectomy in older patients with hepatocellular carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.590 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 590-590 ◽

Cited By ~ 1

Author(s):

Shinichiro Yamada ◽

Mitsuo Shimada ◽

Yuji Morine ◽

Satoru Imura ◽

Tetsuya Ikemoto ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factor ◽

Prognostic Score ◽

Univariate Analysis ◽

Disease Free Survival ◽

Independent Prognostic Factor ◽

Tumor Diameter ◽

Free Survival ◽

Significant Difference ◽

Disease Free

590 Background: An aging society has come, and “Frailty” is becoming increasingly important in surgery. Recently, clinical frail scale (CFS), which is simple criteria for frailty, has been reported to be useful for prognostic prediction of non-cardiac surgery (Ann Surg. 2018). Herein we report a new knowledge about frailty for patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. Methods: Eighty-one patients over 75 years who underwent hepatectomy for HCC between 2007 and 2018 were enrolled in this study. Frailty was diagnosed as CFS≥4, and patient were divided into 2 groups, frailty (n = 17) and no frailty (n = 64). Clinicopathological factors were compared between 2 groups. Results: Patients’ background, such as age, gender, preoperative comorbidity, and liver function showed no significant difference between 2 groups. Regarding tumor factors, frailty group showed significant larger tumor diameter, more advanced stage (p < 0.05) and tendency of high PIVKA-II (p = 0.15) compared with no frailty group. Frailty group showed significant high CRP level (p < 0.01), high modified Glasgow prognostic score (mGPS, p = 0.04) and tendency of high neutrophil-lymphocyte ratio (NLR, p = 0.14). Frailty group also showed tendency of higher rate of postoperative complication (p = 0.11) and longer postoperative hospital stay (p = 0.09). Overall and disease-free survival rate were significantly worse in frailty group (p = 0.03). In univariate analysis for overall survival, AFP≥10, PIVKA-II≥400, frailty and mGPS high (1, 2) were prognostic factor. Multivariate analysis revealed that frailty was independent prognostic factor. In univariate analysis of disease-free survival, only frailty was detected as prognostic factor. Conclusions: Frailty is an independent prognostic factor for HCC patients who underwent hepatectomy.

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