File Download

There are no files associated with this item.

  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Development of a nomogram to predict outcome after liver resection for hepatocellular carcinoma in Child-Pugh B cirrhosis

TitleDevelopment of a nomogram to predict outcome after liver resection for hepatocellular carcinoma in Child-Pugh B cirrhosis
Authors
KeywordsHepatocellular carcinoma
Liver resection
Advanced liver cirrhosis
Child-Pugh B
Issue Date2020
PublisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/jhep
Citation
Journal of Hepatology, 2020, v. 72 n. 1, p. 75-84 How to Cite?
AbstractBackground & Aims: Treatment allocation in patients with hepatocellular carcinoma (HCC) on a background of Child-Pugh B (CP-B) cirrhosis is controversial. Liver resection has been proposed in small series with acceptable outcomes, but data are limited. The aim of this study was to evaluate the outcomes of patients undergoing liver resection for HCC in CP-B cirrhosis, focusing on the surgical risks and survival. Methods: Patients were retrospectively pooled from 14 international referral centers from 2002 to 2017. Postoperative and oncological outcomes were investigated. Prediction models for surgical risks, disease-free survival and overall survival were constructed. Results: A total of 253 patients were included, of whom 57.3% of patients had a preoperative platelet count <100,000/mm3, 43.5% had preoperative ascites, and 56.9% had portal hypertension. A minor hepatectomy was most commonly performed (84.6%) and 122 (48.2%) were operated on by minimally invasive surgery (MIS). Ninety-day mortality was 4.3% with 6 patients (2.3%) dying from liver failure. One hundred and eight patients (42.7%) experienced complications, of which the most common was ascites (37.5%). Patients undergoing major hepatectomies had higher 90-day mortality (10.3% vs. 3.3%; p = 0.04) and morbidity rates (69.2% vs. 37.9%; p <0.001). Patients undergoing an open hepatectomy had higher morbidity (52.7% vs. 31.9%; p = 0.001) than those undergoing MIS. A prediction model for surgical risk was constructed (https://childb.shinyapps.io/morbidity/). The 5-year overall survival rate was 47%, and 56.9% of patients experienced recurrence. Prediction models for overall survival (https://childb.shinyapps.io/survival/) and disease-free survival (https://childb.shinyapps.io/DFsurvival/) were constructed. Conclusions: Liver resection should be considered for patients with HCC and CP-B cirrhosis after careful selection according to patient characteristics, tumor pattern and liver function, while aiming to minimize surgical stress. An estimation of the surgical risk and survival advantage may be helpful in treatment allocation, eventually improving postoperative morbidity and achieving safe oncological outcomes. Lay summary: Liver resection for hepatocellular carcinoma in advanced cirrhosis (Child-Pugh B score) is associated with a high rate of postoperative complications. However, due to the limited therapeutic alternatives in this setting, recent studies have shown promising results after accurate patient selection. In our international multicenter study, we provide 3 clinical models to predict postoperative surgical risks and long-term survival following liver resection, with the aim of improving treatment allocation and eventually clinical outcomes.
Persistent Identifierhttp://hdl.handle.net/10722/305044
ISSN
2020 Impact Factor: 25.083
2020 SCImago Journal Rankings: 7.112
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorBerardi, G-
dc.contributor.authorMorise, Z-
dc.contributor.authorSposito, C-
dc.contributor.authorIgarashi, K-
dc.contributor.authorPanetta, V-
dc.contributor.authorSimonelli, I-
dc.contributor.authorKim, S-
dc.contributor.authorGoh, BKP-
dc.contributor.authorKubo, S-
dc.contributor.authorTanaka, S-
dc.contributor.authorTakeda, Y-
dc.contributor.authorEttorre, GM-
dc.contributor.authorWilson, GC-
dc.contributor.authorCimino, M-
dc.contributor.authorChan, CY-
dc.contributor.authorTorzilli, G-
dc.contributor.authorCheung, TT-
dc.contributor.authorKaneko, H-
dc.contributor.authorMazzaferro, V-
dc.contributor.authorGeller, DA-
dc.contributor.authorHan, HS-
dc.contributor.authorKanazawa, A-
dc.contributor.authorWakabayashi, G-
dc.contributor.authorTroisi, RI-
dc.date.accessioned2021-10-05T02:38:56Z-
dc.date.available2021-10-05T02:38:56Z-
dc.date.issued2020-
dc.identifier.citationJournal of Hepatology, 2020, v. 72 n. 1, p. 75-84-
dc.identifier.issn0168-8278-
dc.identifier.urihttp://hdl.handle.net/10722/305044-
dc.description.abstractBackground & Aims: Treatment allocation in patients with hepatocellular carcinoma (HCC) on a background of Child-Pugh B (CP-B) cirrhosis is controversial. Liver resection has been proposed in small series with acceptable outcomes, but data are limited. The aim of this study was to evaluate the outcomes of patients undergoing liver resection for HCC in CP-B cirrhosis, focusing on the surgical risks and survival. Methods: Patients were retrospectively pooled from 14 international referral centers from 2002 to 2017. Postoperative and oncological outcomes were investigated. Prediction models for surgical risks, disease-free survival and overall survival were constructed. Results: A total of 253 patients were included, of whom 57.3% of patients had a preoperative platelet count <100,000/mm3, 43.5% had preoperative ascites, and 56.9% had portal hypertension. A minor hepatectomy was most commonly performed (84.6%) and 122 (48.2%) were operated on by minimally invasive surgery (MIS). Ninety-day mortality was 4.3% with 6 patients (2.3%) dying from liver failure. One hundred and eight patients (42.7%) experienced complications, of which the most common was ascites (37.5%). Patients undergoing major hepatectomies had higher 90-day mortality (10.3% vs. 3.3%; p = 0.04) and morbidity rates (69.2% vs. 37.9%; p <0.001). Patients undergoing an open hepatectomy had higher morbidity (52.7% vs. 31.9%; p = 0.001) than those undergoing MIS. A prediction model for surgical risk was constructed (https://childb.shinyapps.io/morbidity/). The 5-year overall survival rate was 47%, and 56.9% of patients experienced recurrence. Prediction models for overall survival (https://childb.shinyapps.io/survival/) and disease-free survival (https://childb.shinyapps.io/DFsurvival/) were constructed. Conclusions: Liver resection should be considered for patients with HCC and CP-B cirrhosis after careful selection according to patient characteristics, tumor pattern and liver function, while aiming to minimize surgical stress. An estimation of the surgical risk and survival advantage may be helpful in treatment allocation, eventually improving postoperative morbidity and achieving safe oncological outcomes. Lay summary: Liver resection for hepatocellular carcinoma in advanced cirrhosis (Child-Pugh B score) is associated with a high rate of postoperative complications. However, due to the limited therapeutic alternatives in this setting, recent studies have shown promising results after accurate patient selection. In our international multicenter study, we provide 3 clinical models to predict postoperative surgical risks and long-term survival following liver resection, with the aim of improving treatment allocation and eventually clinical outcomes.-
dc.languageeng-
dc.publisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/jhep-
dc.relation.ispartofJournal of Hepatology-
dc.subjectHepatocellular carcinoma-
dc.subjectLiver resection-
dc.subjectAdvanced liver cirrhosis-
dc.subjectChild-Pugh B-
dc.titleDevelopment of a nomogram to predict outcome after liver resection for hepatocellular carcinoma in Child-Pugh B cirrhosis-
dc.typeArticle-
dc.identifier.emailCheung, TT: cheung68@hku.hk-
dc.identifier.authorityCheung, TT=rp02129-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.jhep.2019.08.032-
dc.identifier.pmid31499131-
dc.identifier.scopuseid_2-s2.0-85074339093-
dc.identifier.hkuros326101-
dc.identifier.volume72-
dc.identifier.issue1-
dc.identifier.spage75-
dc.identifier.epage84-
dc.identifier.isiWOS:000503041200011-
dc.publisher.placeNetherlands-

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats