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Article: Defining optimal surgical treatment for recurrent hepatocellular carcinoma: a propensity score matched analysis

TitleDefining optimal surgical treatment for recurrent hepatocellular carcinoma: a propensity score matched analysis
Authors
Issue Date2018
PublisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jtoc/106570021
Citation
Liver Transplantation, 2018, v. 24 n. 8, p. 1062-1069 How to Cite?
AbstractSalvage liver transplantation (sLT) and repeated resection (RR) are effective treatments for recurrent hepatocellular carcinoma (HCC), and comparisons of the oncological outcomes between these 2 modalities were scarce. Consecutive patients admitted for either sLT or RR for recurrent HCC were recruited. All patients in the present series received either prior hepatectomy, ablative therapy, or both before RR or sLT. Patient demographic, perioperative, and outcome data were analyzed. A survival analysis was performed after propensity score matching. There were 277 eligible patients recruited, and 67 and 210 of them underwent sLT and RR, respectively. Significant differences in preoperative hemoglobin, albumin, Model of End‐Stage Liver Disease (MELD) score, and tumor number were found between the sLT and RR groups. After 1:3 propensity score matching, there were 36 sLT and 108 RR patients for comparison. The median age, MELD, alpha fetoprotein, and tumor size and number of the matched population were 57 years, 7.5, 16 ng/mL, 2.5 cm, and 1, respectively. There was no difference in the hospital mortality and complication rate (Clavien IIIa or above) between the groups. The recurrence rate after RR was significantly higher than for the patients who received sLT (72.2% versus 27.8%; P < 0.001). Following RR, 3 patients received liver transplantation for further recurrence, and 54.6% of the patients developed nontransplantable recurrence. The 5‐year disease‐free survival (DFS) and overall survival (OS) were both superior in the sLT group (DFS, 71.6% versus 32.8%, P < 0.001; OS, 72.8% versus 48.3%, P = 0.007). In conclusion, sLT is superior to RR for treatment of recurrent HCC in terms of DFS and OS. The high rate of nontransplantable recurrence after reresection underscores the importance of timely sLT.
Persistent Identifierhttp://hdl.handle.net/10722/259377
ISSN
2019 Impact Factor: 4.57
2015 SCImago Journal Rankings: 1.763
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorMa, KW-
dc.contributor.authorChok, KSH-
dc.contributor.authorShe, WH-
dc.contributor.authorChan, ACY-
dc.contributor.authorCheung, TT-
dc.contributor.authorDai, WC-
dc.contributor.authorFung, JYY-
dc.contributor.authorLo, CM-
dc.date.accessioned2018-09-03T04:06:23Z-
dc.date.available2018-09-03T04:06:23Z-
dc.date.issued2018-
dc.identifier.citationLiver Transplantation, 2018, v. 24 n. 8, p. 1062-1069-
dc.identifier.issn1527-6465-
dc.identifier.urihttp://hdl.handle.net/10722/259377-
dc.description.abstractSalvage liver transplantation (sLT) and repeated resection (RR) are effective treatments for recurrent hepatocellular carcinoma (HCC), and comparisons of the oncological outcomes between these 2 modalities were scarce. Consecutive patients admitted for either sLT or RR for recurrent HCC were recruited. All patients in the present series received either prior hepatectomy, ablative therapy, or both before RR or sLT. Patient demographic, perioperative, and outcome data were analyzed. A survival analysis was performed after propensity score matching. There were 277 eligible patients recruited, and 67 and 210 of them underwent sLT and RR, respectively. Significant differences in preoperative hemoglobin, albumin, Model of End‐Stage Liver Disease (MELD) score, and tumor number were found between the sLT and RR groups. After 1:3 propensity score matching, there were 36 sLT and 108 RR patients for comparison. The median age, MELD, alpha fetoprotein, and tumor size and number of the matched population were 57 years, 7.5, 16 ng/mL, 2.5 cm, and 1, respectively. There was no difference in the hospital mortality and complication rate (Clavien IIIa or above) between the groups. The recurrence rate after RR was significantly higher than for the patients who received sLT (72.2% versus 27.8%; P < 0.001). Following RR, 3 patients received liver transplantation for further recurrence, and 54.6% of the patients developed nontransplantable recurrence. The 5‐year disease‐free survival (DFS) and overall survival (OS) were both superior in the sLT group (DFS, 71.6% versus 32.8%, P < 0.001; OS, 72.8% versus 48.3%, P = 0.007). In conclusion, sLT is superior to RR for treatment of recurrent HCC in terms of DFS and OS. The high rate of nontransplantable recurrence after reresection underscores the importance of timely sLT.-
dc.languageeng-
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jtoc/106570021-
dc.relation.ispartofLiver Transplantation-
dc.rightsThis is the peer reviewed version of the following article: Liver Transplantation, 2018, v. 24 n. 8, p. 1062-1069, which has been published in final form at https://doi.org/10.1002/lt.25033. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.-
dc.titleDefining optimal surgical treatment for recurrent hepatocellular carcinoma: a propensity score matched analysis-
dc.typeArticle-
dc.identifier.emailChok, KSH: chok6275@hku.hk-
dc.identifier.emailShe, WH: brianshe@hku.hk-
dc.identifier.emailChan, ACY: acchan@hku.hk-
dc.identifier.emailCheung, TT: cheung68@hku.hk-
dc.identifier.emailDai, WC: daiwc@HKUCC-COM.hku.hk-
dc.identifier.emailFung, JYY: jfung@hkucc.hku.hk-
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hk-
dc.identifier.authorityChok, KSH=rp02110-
dc.identifier.authorityChan, ACY=rp00310-
dc.identifier.authorityCheung, TT=rp02129-
dc.identifier.authorityFung, JYY=rp00518-
dc.identifier.authorityLo, CM=rp00412-
dc.description.naturepostprint-
dc.identifier.doi10.1002/lt.25033-
dc.identifier.pmid29451360-
dc.identifier.scopuseid_2-s2.0-85052192924-
dc.identifier.hkuros288593-
dc.identifier.volume24-
dc.identifier.issue8-
dc.identifier.spage1062-
dc.identifier.epage1069-
dc.identifier.isiWOS:000442593100009-
dc.publisher.placeUnited States-

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