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Article: Defining optimal surgical treatment for recurrent hepatocellular carcinoma: a propensity score matched analysis
Title | Defining optimal surgical treatment for recurrent hepatocellular carcinoma: a propensity score matched analysis |
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Authors | |
Issue Date | 2018 |
Publisher | John 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? |
Abstract | Salvage 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 Identifier | http://hdl.handle.net/10722/259377 |
ISSN | 2021 Impact Factor: 6.112 2020 SCImago Journal Rankings: 1.814 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Ma, KW | - |
dc.contributor.author | Chok, KSH | - |
dc.contributor.author | She, WH | - |
dc.contributor.author | Chan, ACY | - |
dc.contributor.author | Cheung, TT | - |
dc.contributor.author | Dai, WC | - |
dc.contributor.author | Fung, JYY | - |
dc.contributor.author | Lo, CM | - |
dc.date.accessioned | 2018-09-03T04:06:23Z | - |
dc.date.available | 2018-09-03T04:06:23Z | - |
dc.date.issued | 2018 | - |
dc.identifier.citation | Liver Transplantation, 2018, v. 24 n. 8, p. 1062-1069 | - |
dc.identifier.issn | 1527-6465 | - |
dc.identifier.uri | http://hdl.handle.net/10722/259377 | - |
dc.description.abstract | Salvage 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.language | eng | - |
dc.publisher | John Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jtoc/106570021 | - |
dc.relation.ispartof | Liver Transplantation | - |
dc.rights | This 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.title | Defining optimal surgical treatment for recurrent hepatocellular carcinoma: a propensity score matched analysis | - |
dc.type | Article | - |
dc.identifier.email | Chok, KSH: chok6275@hku.hk | - |
dc.identifier.email | She, WH: brianshe@hku.hk | - |
dc.identifier.email | Chan, ACY: acchan@hku.hk | - |
dc.identifier.email | Cheung, TT: cheung68@hku.hk | - |
dc.identifier.email | Dai, WC: daiwc@HKUCC-COM.hku.hk | - |
dc.identifier.email | Fung, JYY: jfung@hkucc.hku.hk | - |
dc.identifier.email | Lo, CM: chungmlo@hkucc.hku.hk | - |
dc.identifier.authority | Chok, KSH=rp02110 | - |
dc.identifier.authority | Chan, ACY=rp00310 | - |
dc.identifier.authority | Cheung, TT=rp02129 | - |
dc.identifier.authority | Fung, JYY=rp00518 | - |
dc.identifier.authority | Lo, CM=rp00412 | - |
dc.description.nature | postprint | - |
dc.identifier.doi | 10.1002/lt.25033 | - |
dc.identifier.pmid | 29451360 | - |
dc.identifier.scopus | eid_2-s2.0-85052192924 | - |
dc.identifier.hkuros | 288593 | - |
dc.identifier.volume | 24 | - |
dc.identifier.issue | 8 | - |
dc.identifier.spage | 1062 | - |
dc.identifier.epage | 1069 | - |
dc.identifier.isi | WOS:000442593100009 | - |
dc.publisher.place | United States | - |
dc.identifier.issnl | 1527-6465 | - |