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Poorly differentiated hepatocellular carcinoma: resection is equivalent to transplantation in patients with low liver fibrosis.
Salehi, Omid; Vega, Eduardo A; Kutlu, Onur C; Lunsford, Keri; Freeman, Richard; Ladin, Keren; Alarcon, Sylvia V; Kazakova, Vera; Conrad, Claudius.
Afiliação
  • Salehi O; Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.
  • Vega EA; Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.
  • Kutlu OC; Department of Surgery, University of Miami Health System, Miller School of Medicine, Miami, FL, USA.
  • Lunsford K; Department of Surgery, Division of Transplant and Hepatobiliary Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
  • Freeman R; Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.
  • Ladin K; Department of Occupational Therapy and Community Health, Tufts University, Boston, MA, USA.
  • Alarcon SV; Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Harvard Medical School, Boston, MA, USA.
  • Kazakova V; Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Harvard Medical School, Boston, MA, USA.
  • Conrad C; Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA. Electronic address: claudius.conrad@steward.org.
HPB (Oxford) ; 24(7): 1100-1109, 2022 07.
Article em En | MEDLINE | ID: mdl-34969618
BACKGROUND: Organ allocation criteria for liver transplantation focus on tumor size and multifocality while tumor differentiation and existing liver damage are omitted. This study analyzes the impact of hepatocellular carcinoma (HCC) grade and liver fibrosis comparing resection (SX) to transplantation (LT). METHODS: The National Cancer Database was queried between 2004 and 2016 for solitary HCC meeting Milan criteria undergoing SX vs LT. Two groups were created: low fibrosis (LF) vs high fibrosis (HF) and stratified by grade. Cox multivariable regression models, Kaplan-Meier survival analyses and log-rank tests were performed. RESULTS: 1515 patients were identified; 780 had LT and 735 had SX. Median overall survival (mOS) was 39.7 months; LT mOS was 47.9 months vs SX mOS of 34.9 months (P < .001). Multivariate analysis revealed SX, no chemotherapy, longer hospital stays, and age to be associated with worse survival. However, while transplantation conferred survival benefit for well-moderately differentiated tumors, SX vs LT did not impact survival for poorly differentiated HCC in LF patients, independent of tumor size. DISCUSSION: HCC differentiation and liver fibrosis, but not size, synergistically determine efficacy of SX vs LT. Therefore, current HCC transplantation criteria should incorporate tumor grade or liver fibrosis for optimal organ allocation.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Carcinoma Hepatocelular / Neoplasias Hepáticas Tipo de estudo: Prognostic_studies Limite: Humans Idioma: En Revista: HPB (Oxford) Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Carcinoma Hepatocelular / Neoplasias Hepáticas Tipo de estudo: Prognostic_studies Limite: Humans Idioma: En Revista: HPB (Oxford) Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos