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Proposal of Prognostic Survival Models before and after Liver Resection for Hepatocellular Carcinoma in Potentially Transplantable Patients.
Di Sandro, Stefano; Sposito, Carlo; Lauterio, Andrea; Najjar, Marc; Droz Dit Busset, Michele; Buscemi, Vincenzo; Flores Reyes, Maria; De Carlis, Riccardo; Mazzaferro, Vincenzo; De Carlis, Luciano.
Afiliação
  • Di Sandro S; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Surgical Sciences, University of Pavia, Pavia, Italy. Electronic address: stefano.disandro@ospedaleniguarda.it.
  • Sposito C; Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy.
  • Lauterio A; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Najjar M; Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY; Presbyterian Hospital, New York, NY.
  • Droz Dit Busset M; Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy.
  • Buscemi V; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Flores Reyes M; Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy.
  • De Carlis R; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Surgical Sciences, University of Pavia, Pavia, Italy.
  • Mazzaferro V; Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy.
  • De Carlis L; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
J Am Coll Surg ; 226(6): 1147-1159, 2018 06.
Article em En | MEDLINE | ID: mdl-29574178
BACKGROUND: Transplantable hepatocellular carcinoma (HCC) represents a highly debated issue due to the overlap between indications for liver resection (LR) and transplantation (LT) in patients suitable for both. STUDY DESIGN: Between January 2000 and December 2012, five hundred and twenty-four transplantable patients affected by HCC were identified among resected patients. Two regression models were constructed to classify patients into 2 groups pre-low and pre-high risk based on preoperative variables and then to reclassify pre-low-risk patients according to postoperative variables into either post-low or post-high-risk. Additionally, a cohort of patients with comparable baseline characteristics who underwent LT were similarly classified into pre-low and pre-high-risk groups and compared with the resected patients in terms of survival. RESULTS: Cirrhosis, aspartate transaminase, α-fetoprotein, Model for End-Stage Liver Disease score, number of nodules, and diameter of the largest nodule were preoperatively found to be significantly related to overall survival post-LR. Microvascular invasion and satellites were selected to reclassify prognosis in the resulting preoperative low-risk group into post-high risk. The converted group (post-high) demonstrated the same 5-year survival as the pre-high group. Patients undergoing LT had better survival overall than those undergoing LR, with the exception of pre-low LT and post-low LR (confirmed low-risk LR) who had similar outcomes. CONCLUSIONS: The new models were strongly predictive of patients' likelihood of survival after LR for HCC on liver cirrhosis. Liver transplantation offers a survival advantage over LR, except in low-risk groups where both modalities might be comparable.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Fígado / Carcinoma Hepatocelular / Hepatectomia / Neoplasias Hepáticas Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Surg Assunto da revista: GINECOLOGIA / OBSTETRICIA Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Fígado / Carcinoma Hepatocelular / Hepatectomia / Neoplasias Hepáticas Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Surg Assunto da revista: GINECOLOGIA / OBSTETRICIA Ano de publicação: 2018 Tipo de documento: Article