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UNOS Down-Staging Criteria for Liver Transplantation of Hepatocellular Carcinoma: Systematic Review and Meta-Analysis of 25 Studies.
Tan, Darren Jun Hao; Lim, Wen Hui; Yong, Jie Ning; Ng, Cheng Han; Muthiah, Mark D; Tan, Eunice X; Xiao, Jieling; Lim, Snow Yunni; Pin Tang, Ansel Shao; Pan, Xin Hui; Kabir, Tousif; Bonney, Glenn K; Sundar, Raghav; Syn, Nicholas; Kim, Beom Kyung; Dan, Yock Young; Noureddin, Mazen; Loomba, Rohit; Huang, Daniel Q.
Afiliação
  • Tan DJH; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. Electronic address: darrentan.j.h@gmail.com.
  • Lim WH; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
  • Yong JN; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
  • Ng CH; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
  • Muthiah MD; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, S
  • Tan EX; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, S
  • Xiao J; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
  • Lim SY; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
  • Pin Tang AS; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
  • Pan XH; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
  • Kabir T; Department of General Surgery, Sengkang General Hospital, Singapore; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
  • Bonney GK; Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, National University Health System, Singapore, Singapore.
  • Sundar R; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute, Singapore.
  • Syn N; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Biostatistics and Modelling Domain, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
  • Kim BK; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
  • Dan YY; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; Biostatistics and Modelling Domain, Saw Swee Hock School of Public Health, National Univer
  • Noureddin M; Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California.
  • Loomba R; NAFLD Research Center, Division of Medicine, University of California San Diego, La Jolla, California.
  • Huang DQ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, S
Clin Gastroenterol Hepatol ; 21(6): 1475-1484, 2023 06.
Article em En | MEDLINE | ID: mdl-35181565
BACKGROUND & AIMS: Down-staging is commonly used to select patients with hepatocellular carcinoma (HCC) beyond Milan criteria (MC) for liver transplantation (LT), but outcomes are heterogenous. We aimed to estimate pooled down-staging success rates, HCC recurrence, and overall survival (OS), stratified by criteria used for baseline tumor burden. METHODS: We searched Pubmed and EMBASE databases from inception until August 2021 for studies reporting down-staging success (reduction of tumor burden to within MC) and outcomes of adult HCC patients. In addition, we performed a pooled analysis using reconstructed individual participant data to obtain robust estimates for OS. RESULTS: We screened 1059 articles and included 25 articles involving 3997 patients. Overall, 55.16% (45.49%-64.46%) underwent successful down-staging, and 31.52% (24.03%-40.11%) received LT (by intention-to-treat analysis [ITT]). Among patients who received LT, 16.01% (11.80%-21.37%) developed HCC recurrence. Comparing studies that used the United Network for Organ Sharing Down-Staging (UNOS-DS) criteria versus studies beyond UNOS-DS or did not specify criteria, down-staging success (by ITT) was 83.21% versus 45.93%, P < .001; the proportion who received LT (by ITT) was 48.61% vs 28.60%, P = .030; and HCC recurrence (among patients who received LT) occurred in 9.06% versus 20.42%, P < .001. Among studies that used UNOS-DS criteria, ITT 1- and 5-year OS from the initiation of down-staging treatment was 86% and 58%, respectively, whereas 1- and 5-year post-LT OS was 94% and 74%, respectively. CONCLUSIONS: Among studies that adhered to UNOS-DS criteria, down-staging was successful in four-fifths of patients, >50% received LT, and post-LT outcomes were excellent. These data provide clinical validation for the utilization of UNOS-DS criteria.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Fígado / Carcinoma Hepatocelular / Neoplasias Hepáticas Tipo de estudo: Systematic_reviews Limite: Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Fígado / Carcinoma Hepatocelular / Neoplasias Hepáticas Tipo de estudo: Systematic_reviews Limite: Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article