Advanced search
1 file | 696.35 KB Add to list

International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria

(2021) JHEP REPORTS. 3(5).
Author
Organization
Abstract
Background & Aims: Good outcomes after liver transplantation (LT) have been reported after successfully downstaging to Milan criteria in more advanced hepatocellular carcinoma (HCC). We aimed to compare post-LT outcomes in patients receiving locoregional therapies (LRT) before LT according to Milan criteria and University of California San Francisco downstaging (UCSF-DS) protocol and 'all-comers'. Methods: This multicentre cohort study included patients who received any LRT before LT from Europe and Latin America (2000-2018). We excluded patients with alpha-foetoprotein (AFP) above 1,000 ng/ml. Competing risk regression analysis for HCC recurrence was conducted, estimating subdistribution hazard ratios (SHRs) and corresponding 95% CIs. Results: From 2,441 LT patients, 70.1% received LRT before LT (n = 1,711). Of these, 80.6% were within Milan, 12.0% within UCSF-DS, and 7.4% all-comers. Successful downstaging was achieved in 45.2% (CI 34.8-55.8) and 38.2% (CI 25.4-52.3) of the UCSF-DS group and all-comers, respectively. The risk of recurrence was higher for all-comers (SHR 6.01 [p <0.0001]) and not significantly higher for the UCSF-DS group (SHR 1.60 [p = 0.32]), compared with patients remaining within Milan. The allcomers presented more frequent features of aggressive HCC and higher tumour burden at explant. Among the UCSF-DS group, an AFP value of QO ng/ml at listing was associated with lower recurrence (SHR 2.01 [p = 0.006]) and better survival. However, recurrence was still significantly high irrespective of AFP 520 ng/ml in all-comers. Conclusions: Patients within the UCSF-DS protocol at listing have similar post-transplant outcomes compared with those within Milan when successfully downstaged. Meanwhile, all-comers have a higher recurrence and inferior survival irrespective of response to LRT. Additionally, in the UCSF-DS group, an ALP of 520 ng/ml might be a novel tool to optimise selection of candidates for LT. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). Lay summary: Patients with more extended HCC (within the UCSF-DS protocol) successfully downstaged to the conventional Milan criteria do not have a higher recurrence rate after LT compared with the group remaining in the Milan criteria from listing to transplantation. Moreover, in the UCSF-DS patient group, an ALP value equal to or below 20 ng/ml at listing might be a novel tool to further optimise selection of candidates for LT. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL).
Keywords
ALPHA-FETOPROTEIN, COMPETING RISKS, MODEL, VALIDATION, CANCER

Downloads

  • main.pdf
    • full text (Published version)
    • |
    • open access
    • |
    • PDF
    • |
    • 696.35 KB

Citation

Please use this url to cite or link to this publication:

MLA
Degroote, Helena, et al. “International Study on the Outcome of Locoregional Therapy for Liver Transplant in Hepatocellular Carcinoma beyond Milan Criteria.” JHEP REPORTS, vol. 3, no. 5, 2021, doi:10.1016/j.jhepr.2021.100331.
APA
Degroote, H., Pinero, F., Costentin, C., Notarpaolo, A., Boin, I. F., Boudjema, K., … Duvoux, C. (2021). International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria. JHEP REPORTS, 3(5). https://doi.org/10.1016/j.jhepr.2021.100331
Chicago author-date
Degroote, Helena, Federico Pinero, Charlotte Costentin, Andrea Notarpaolo, Ilka F. Boin, Karim Boudjema, Cinzia Baccaro, et al. 2021. “International Study on the Outcome of Locoregional Therapy for Liver Transplant in Hepatocellular Carcinoma beyond Milan Criteria.” JHEP REPORTS 3 (5). https://doi.org/10.1016/j.jhepr.2021.100331.
Chicago author-date (all authors)
Degroote, Helena, Federico Pinero, Charlotte Costentin, Andrea Notarpaolo, Ilka F. Boin, Karim Boudjema, Cinzia Baccaro, Aline Lopes Chagas, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poniachik, Fabrice Muscari, Fabrio Di Benedetto, Sergio Hoyos Duque, Ephrem Salame, Umberto Cillo, Adrian Gadano, Claire Vanlemmens, Stefano Fagiuoli, Fernando Rubinstein, Patrizia Burra, Daniel Cherqui, Marcelo Silva, Hans Van Vlierberghe, and Christophe Duvoux. 2021. “International Study on the Outcome of Locoregional Therapy for Liver Transplant in Hepatocellular Carcinoma beyond Milan Criteria.” JHEP REPORTS 3 (5). doi:10.1016/j.jhepr.2021.100331.
Vancouver
1.
Degroote H, Pinero F, Costentin C, Notarpaolo A, Boin IF, Boudjema K, et al. International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria. JHEP REPORTS. 2021;3(5).
IEEE
[1]
H. Degroote et al., “International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria,” JHEP REPORTS, vol. 3, no. 5, 2021.
@article{8725155,
  abstract     = {{Background & Aims: Good outcomes after liver transplantation (LT) have been reported after successfully downstaging to Milan criteria in more advanced hepatocellular carcinoma (HCC). We aimed to compare post-LT outcomes in patients receiving locoregional therapies (LRT) before LT according to Milan criteria and University of California San Francisco downstaging (UCSF-DS) protocol and 'all-comers'.

Methods: This multicentre cohort study included patients who received any LRT before LT from Europe and Latin America (2000-2018). We excluded patients with alpha-foetoprotein (AFP) above 1,000 ng/ml. Competing risk regression analysis for HCC recurrence was conducted, estimating subdistribution hazard ratios (SHRs) and corresponding 95% CIs.

Results: From 2,441 LT patients, 70.1% received LRT before LT (n = 1,711). Of these, 80.6% were within Milan, 12.0% within UCSF-DS, and 7.4% all-comers. Successful downstaging was achieved in 45.2% (CI 34.8-55.8) and 38.2% (CI 25.4-52.3) of the UCSF-DS group and all-comers, respectively. The risk of recurrence was higher for all-comers (SHR 6.01 [p <0.0001]) and not significantly higher for the UCSF-DS group (SHR 1.60 [p = 0.32]), compared with patients remaining within Milan. The allcomers presented more frequent features of aggressive HCC and higher tumour burden at explant. Among the UCSF-DS group, an AFP value of QO ng/ml at listing was associated with lower recurrence (SHR 2.01 [p = 0.006]) and better survival. However, recurrence was still significantly high irrespective of AFP 520 ng/ml in all-comers.

Conclusions: Patients within the UCSF-DS protocol at listing have similar post-transplant outcomes compared with those within Milan when successfully downstaged. Meanwhile, all-comers have a higher recurrence and inferior survival irrespective of response to LRT. Additionally, in the UCSF-DS group, an ALP of 520 ng/ml might be a novel tool to optimise selection of candidates for LT. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL).

Lay summary: Patients with more extended HCC (within the UCSF-DS protocol) successfully downstaged to the conventional Milan criteria do not have a higher recurrence rate after LT compared with the group remaining in the Milan criteria from listing to transplantation. Moreover, in the UCSF-DS patient group, an ALP value equal to or below 20 ng/ml at listing might be a novel tool to further optimise selection of candidates for LT. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL).}},
  articleno    = {{100331}},
  author       = {{Degroote, Helena and Pinero, Federico and Costentin, Charlotte and Notarpaolo, Andrea and Boin, Ilka F. and Boudjema, Karim and Baccaro, Cinzia and Chagas, Aline Lopes and Bachellier, Philippe and Ettorre, Giuseppe Maria and Poniachik, Jaime and Muscari, Fabrice and Di Benedetto, Fabrio and Hoyos Duque, Sergio and Salame, Ephrem and Cillo, Umberto and Gadano, Adrian and Vanlemmens, Claire and Fagiuoli, Stefano and Rubinstein, Fernando and Burra, Patrizia and Cherqui, Daniel and Silva, Marcelo and Van Vlierberghe, Hans and Duvoux, Christophe}},
  issn         = {{2589-5559}},
  journal      = {{JHEP REPORTS}},
  keywords     = {{ALPHA-FETOPROTEIN,COMPETING RISKS,MODEL,VALIDATION,CANCER}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{9}},
  title        = {{International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria}},
  url          = {{http://dx.doi.org/10.1016/j.jhepr.2021.100331}},
  volume       = {{3}},
  year         = {{2021}},
}

Altmetric
View in Altmetric