China
Africa
Explore chapters and articles related to this topic
Hepatocellular Carcinoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Daniel H. Palmer, Philip J. Johnson
Liver transplantation has the potential to treat both tumor and underlying cirrhosis. A major limitation to transplantation is the supply of donor organs, and therefore accurate assessment of tumor size and number, vascular involvement, and extra-hepatic disease is essential to identify those patients who are most likely to benefit from long-term survival without tumor recurrence in order to make best use of the donor organ pool. In patients with no more than three small (<5 cm) tumors, survival was similar to that of patients with benign end-stage liver disease, and transplantation has become the treatment of choice for HCC in a cirrhotic liver. This experience has underpinned the development of the Milan criteria (Table 9.3) to guide the selection of patients for transplantation, which can lead to 5-year survival in excess of 70 per cent.42 Other reports have indicated that these criteria may be extended whilst retaining good outcomes, including University California San Francisco (UCSF) criteria, the “metro ticket” system, and “up to 7” criteria.43,44
Cirrhosis in Surgery
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
The annual incidence of hepatocellular carcinoma is 5% for those in the United States who have cirrhosis. The median survival among patients with limited hepatocellular carcinoma is approximately 2 years, and the median survival among those with advanced hepatocellular carcinoma is approximately 6 months. For cirrhotic patients with unresectable hepatocellular carcinomas, liver transplantation is an effective treatment when guided by the Milan criteria (single tumor less than 5 cm or three tumors or fewer, each less than 3 cm) (Clavien et al., 2012). Importantly, a phase 3 trial demonstrated a 97.5% cure rate for patients with hepatitis C and class A cirrhosis after 24 weeks of treatment. Eradication of the hepatitis C virus with antiviral therapy reduces the risk for hepatocellular carcinoma (Poordad et al., 2014).
The liver
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Liver transplantation for HCC offers the advantage of not only definitively treating the tumour but also removing the diseased hepatic parenchyma, so reducing the potential for intrahepatic recurrence. The concept of organ transplantation for primary liver cancer was first described by Mazzaferro in 1996, who performed liver transplantation for patients with one hepatocellular carcinoma of <5 cm, or up to three nodules of <3 cm, and reported a 4-year overall survival of 75% and recurrence-free survival of 83%. Other groups have since replicated these results, and these inclusion criteria (Milan criteria) are now considered the benchmark indications for transplantation for HCC. Patients outside these criteria can also be successfully downstaged using locoregional therapies (such as ablation), and following a period of observation with adequate disease control may be considered suitable candidates for transplantation.
Patient stratification in hepatocellular carcinoma: impact on choice of therapy
Published in Expert Review of Anticancer Therapy, 2022
Dimitrios Papaconstantinou, D. Brock Hewitt, Zachary J. Brown, Dimitrios Schizas, Diamantis I. Tsilimigras, Timothy M. Pawlik
In 2009, Mazzaferro et al. compared the Milan criteria with the up-to-seven criteria (UTS) [25]. The up-to-seven system adds the biggest lesion size (in cm) and the number of lesions, with a cut-off value of 7. Patients transplanted for HCC outside the Milan criteria yet within UTS criteria had comparable 5-year survival to patients with HCC transplanted according to the Milan criteria (76.1 and 71.2 months, respectively). These results suggest a subset of potential transplant candidates may be undertreated according to the Milan criteria [83,84]. While the UTS criteria was intended for transplantation, the efficacy of the criteria to identify patients who might benefit from hepatectomy has also been studied. In a retrospective sample of 110 Japanese patients with HCC, Iida et al. reported that patients within the UTS criteria, albumin levels ≥3.5 g/L, and serum AFP levels <100 µg/L had a cumulative survival rate of 81.4%. Conversely, a UTS score >7 was associated with decreased survival [85]. Biolato et al. attempted to subclassify BCLC stage B patients undergoing TACE according to the UTS but the authors were unable to identify any survival differences between patients in the proposed stage B subgroups [86]. Despite being predictive of outcomes following TACE, the applicability of UTS in the selection of TACE versus hepatectomy for patients with intermediate or advanced-stage disease remains limited and unproven [87,88].
A Nomogram Estimation for the Risk of Microvascular Invasion in Hepatocellular Carcinoma Patients Meeting the Milan Criteria
Published in Journal of Investigative Surgery, 2022
Chenggeng Pan, Xi Liu, Bei Zou, Wenjie Chin, Weichen Zhang, Yufu Ye, Yuanxing Liu, Jun Yu
The nomogram we established has a guiding role in choosing the appropriate treatments for HCC patients. In terms of the clinical use of our predictive model, we determined the prediction cutoff value of 0.41 based on the largest Youden index. In other words, the patients with a predicted probability over 0.41 were defined as the high-risk of MVI. Several previous studies show that anatomical hepatectomy is recommended for HCC patients with MVI because a more radical and aggressive treatment modality theoretically removed the tissue surrounding the tumor where MVI may spread [35–38]. Additionally, accurately predict the risk of MVI before liver transplantation is also essential for screening transplant candidates. In a multi-center study, compared with HCC patients within the Milan criteria, those who exceed the Milan criteria but are negative for MVI have similar expected survival results after liver transplantation [39]. Naturally, the expansion of Milan criteria is necessary for these patients. In clinical practice, RFA is not regarded as the optimal option for HCC patients with MVI even if the tumor is less than 3 cm in diameter [38,40]. According to our prediction model, RFA treatment can achieve similar therapeutic effects as radical hepatectomy if the predicted probability of MVI calculated by our prediction model was less than 0.41 and the size of a single tumor was smaller than 3 cm.
Risk Factors for Post-Transplant Death in Donation after Circulatory Death Liver Transplantation
Published in Journal of Investigative Surgery, 2018
Song Liu, Ji Miao, Xiaolei Shi, Yafu Wu, Chunping Jiang, Xinhua Zhu, Xingyu Wu, Yitao Ding, Qingxiang Xu
Liver transplantation is a fundamental solution for hepatocellular carcinoma. Since “Milan criteria” brought up by Mazzaferro et al. in 1996 [32], it has become an internationally accepted standard selection criterion for liver transplant recipients [33]. Due to the shortage of liver donors, down-staging therapy is adopted to prevent dropout from waiting list during waiting period and to serve as a down-stage method for patients with intermediate HCC to qualify liver transplantation [34–36]. However, our data failed to identify the impact of preoperative down-staging therapy on post-transplant outcome. Possible reasons may be due to a series of parameters that are associated with down-staging therapy, such as waiting time and various methods of down-staging therapy. These underlying confounding effects could not be excluded from our study. Future studies targeting the influence of down-staging therapy are therefore expected.