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Article: Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion

TitleSurvival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion
Authors
KeywordsBlood transfusion
Cadaver donor
Cancer invasion
Cancer survival
Disease severity
Issue Date2012
PublisherSpringer New York LLC. The Journal's web site is located at http://www.springer.com/west/home/medicine?SGWID=4-10054-70-173733513-0
Citation
Hepatology International, 2012, v. 6 n. 3, p. 646-656 How to Cite?
AbstractPURPOSE: Microvascular invasion of hepatocellular carcinoma (HCC) is considered a poor prognostic factor of liver resection (LR) and liver transplantation (LT), but its significance for lesions within the up-to-7 criteria is unclear. This study investigated the survival benefit of primary LT against LR for HCC with microvascular invasion and within the up-to-7 criteria. METHODS: Adult patients who underwent LR or LT as the primary treatment for HCC were included for study. Patients with prior local ablation, neoadjuvant systemic chemotherapy, targeted therapy, positive resection margin, or metastatic spread were excluded. RESULTS: There were 471 LR patients and 95 LT recipients (70 with living donor, 25 with deceased donor). Seventy-seven (81.1%) LT recipients had HCC within the up-to-7 criteria. Twenty-five (26.3%) LT recipients had HCC with either macrovascular (n = 4) or microvascular (n = 21) invasion. The 5-year survival rate was 85.7% for LT recipients with HCC within the up-to-7 criteria, unaffected by the presence or absence of vascular invasion (88.2 vs. 85.1%). The rate was comparable with that of LR patients with HCC without vascular invasion (81.2%, p 0.227), but far superior to that of LR patients with lesions with vascular invasion (50.0%, p < 0.0001). Overall survivals were compromised by multiple tumors [odds ratio (OR) 1.902, confidence interval (CI) 1.374-2.633, p = 0.0001], vascular invasion (OR 2.678, CI 1.952-3.674, p < 0.0001), blood transfusion (OR 2.046, CI 1.337-3.131, p = 0.001), and being beyond the up-to-7 criteria (OR 1.457, CI 1.041-2.037, p = 0.028). LT was a favorable factor for survival (OR 0.243, CI 0.130-0.454, p < 0.0001). CONCLUSION: Primary LT for HCC with microvascular invasion and within the up-to-7 criteria doubled the chance of cure as compared with LR.
Persistent Identifierhttp://hdl.handle.net/10722/143760
ISSN
2015 Impact Factor: 1.125
2015 SCImago Journal Rankings: 0.669
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorChan, SCen_US
dc.contributor.authorFan, STen_US
dc.contributor.authorChok, KSHen_US
dc.contributor.authorCheung, TTen_US
dc.contributor.authorChan, ACYen_US
dc.contributor.authorFung, JYYen_US
dc.contributor.authorPoon, RTPen_US
dc.contributor.authorLo, CMen_US
dc.date.accessioned2011-12-21T08:54:01Z-
dc.date.available2011-12-21T08:54:01Z-
dc.date.issued2012en_US
dc.identifier.citationHepatology International, 2012, v. 6 n. 3, p. 646-656en_US
dc.identifier.issn1936-0533-
dc.identifier.urihttp://hdl.handle.net/10722/143760-
dc.description.abstractPURPOSE: Microvascular invasion of hepatocellular carcinoma (HCC) is considered a poor prognostic factor of liver resection (LR) and liver transplantation (LT), but its significance for lesions within the up-to-7 criteria is unclear. This study investigated the survival benefit of primary LT against LR for HCC with microvascular invasion and within the up-to-7 criteria. METHODS: Adult patients who underwent LR or LT as the primary treatment for HCC were included for study. Patients with prior local ablation, neoadjuvant systemic chemotherapy, targeted therapy, positive resection margin, or metastatic spread were excluded. RESULTS: There were 471 LR patients and 95 LT recipients (70 with living donor, 25 with deceased donor). Seventy-seven (81.1%) LT recipients had HCC within the up-to-7 criteria. Twenty-five (26.3%) LT recipients had HCC with either macrovascular (n = 4) or microvascular (n = 21) invasion. The 5-year survival rate was 85.7% for LT recipients with HCC within the up-to-7 criteria, unaffected by the presence or absence of vascular invasion (88.2 vs. 85.1%). The rate was comparable with that of LR patients with HCC without vascular invasion (81.2%, p 0.227), but far superior to that of LR patients with lesions with vascular invasion (50.0%, p < 0.0001). Overall survivals were compromised by multiple tumors [odds ratio (OR) 1.902, confidence interval (CI) 1.374-2.633, p = 0.0001], vascular invasion (OR 2.678, CI 1.952-3.674, p < 0.0001), blood transfusion (OR 2.046, CI 1.337-3.131, p = 0.001), and being beyond the up-to-7 criteria (OR 1.457, CI 1.041-2.037, p = 0.028). LT was a favorable factor for survival (OR 0.243, CI 0.130-0.454, p < 0.0001). CONCLUSION: Primary LT for HCC with microvascular invasion and within the up-to-7 criteria doubled the chance of cure as compared with LR.-
dc.languageengen_US
dc.publisherSpringer New York LLC. The Journal's web site is located at http://www.springer.com/west/home/medicine?SGWID=4-10054-70-173733513-0-
dc.relation.ispartofHepatology Internationalen_US
dc.rightsThe original publication is available at www.springerlink.com-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subjectBlood transfusion-
dc.subjectCadaver donor-
dc.subjectCancer invasion-
dc.subjectCancer survival-
dc.subjectDisease severity-
dc.titleSurvival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasionen_US
dc.typeArticleen_US
dc.identifier.emailChan, SC: chanlsc@hkucc.hku.hken_US
dc.identifier.emailFan, ST: stfan@hku.hken_US
dc.identifier.emailCheung, TT: cheung68@hku.hken_US
dc.identifier.emailChan, ACY: acchan@hku.hken_US
dc.identifier.emailFung, JYY: jfung@hkucc.hku.hken_US
dc.identifier.emailPoon, RTP: poontp@hku.hken_US
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_US
dc.identifier.authorityFan, ST=rp00355en_US
dc.identifier.authorityChan, ACY=rp00310en_US
dc.identifier.authorityFung, JYY=rp00518en_US
dc.identifier.authorityPoon, RTP=rp00446en_US
dc.identifier.authorityLo, CM=rp00412en_US
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1007/s12072-011-9318-3-
dc.identifier.pmid22016140-
dc.identifier.pmcidPMC3360855-
dc.identifier.scopuseid_2-s2.0-84866387920-
dc.identifier.hkuros197815en_US
dc.identifier.volume6en_US
dc.identifier.issue3-
dc.identifier.spage646-
dc.identifier.epage656-
dc.identifier.isiWOS:000304611200012-
dc.publisher.placeUnited States-
dc.identifier.citeulike9941456-

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