Surgical Treatment of Hepatocellular Carcinoma : Multicenter Competing-risk Analysis of Tumor-related Death Following Liver Resection and Transplantation Under an Intention-to-treat Perspective
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved..
BACKGROUND: Early-stage hepatocellular carcinoma could benefit from upfront liver resection (LR) or liver transplantation (LT), but the optimal strategy in terms of tumor-related outcomes is still debated. We compared the oncological outcomes of LR and LT for hepatocellular carcinoma, stratifying the study population into a low-, intermediate-, and high-risk class according to the risk of death at 5-y predicted by a previously developed prognostic model. The impact of tumor pathology on oncological outcomes of low- and intermediate-risk patients undergoing LR was investigated as a secondary outcome.
METHODS: We performed a retrospective multicentric cohort study involving 2640 patients consecutively treated by LR or LT from 4 tertiary hepatobiliary and transplant centers between 2005 and 2015, focusing on patients amenable to both treatments upfront. Tumor-related survival and overall survival were compared under an intention-to-treat perspective.
RESULTS: We identified 468 LR and 579 LT candidates: 512 LT candidates underwent LT, whereas 68 (11.7%) dropped-out for tumor progression. Ninety-nine high-risk patients were selected from each treatment cohort after propensity score matching. Three and 5-y cumulative incidence of tumor-related death were 29.7% and 39.5% versus 17.2% and 18.3% for LR and LT group ( P = 0.039), respectively. Low-risk and intermediate-risk patients treated by LR and presenting satellite nodules and microvascular invasion had a significantly higher 5-y incidence of tumor-related death (29.2% versus 12.5%; P < 0.001).
CONCLUSIONS: High-risk patients showed significantly better intention-to-treat tumor-related survival after upfront LT rather than LR. Cancer-specific survival of low- and intermediate-risk LR patients was significantly impaired by unfavorable pathology, suggesting the application of ab-initio salvage LT in such scenarios.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:107 |
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| Enthalten in: |
Transplantation - 107(2023), 9 vom: 01. Sept., Seite 1965-1975 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Di Sandro, Stefano [VerfasserIn] |
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| Anmerkungen: |
Date Completed 23.08.2023 Date Revised 07.09.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1097/TP.0000000000004593 |
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| Förderinstitution / Projekttitel: |
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NLM355267829 |
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| 100 | 1 | |a Di Sandro, Stefano |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Surgical Treatment of Hepatocellular Carcinoma |b Multicenter Competing-risk Analysis of Tumor-related Death Following Liver Resection and Transplantation Under an Intention-to-treat Perspective |
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| 500 | |a Date Revised 07.09.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Early-stage hepatocellular carcinoma could benefit from upfront liver resection (LR) or liver transplantation (LT), but the optimal strategy in terms of tumor-related outcomes is still debated. We compared the oncological outcomes of LR and LT for hepatocellular carcinoma, stratifying the study population into a low-, intermediate-, and high-risk class according to the risk of death at 5-y predicted by a previously developed prognostic model. The impact of tumor pathology on oncological outcomes of low- and intermediate-risk patients undergoing LR was investigated as a secondary outcome | ||
| 520 | |a METHODS: We performed a retrospective multicentric cohort study involving 2640 patients consecutively treated by LR or LT from 4 tertiary hepatobiliary and transplant centers between 2005 and 2015, focusing on patients amenable to both treatments upfront. Tumor-related survival and overall survival were compared under an intention-to-treat perspective | ||
| 520 | |a RESULTS: We identified 468 LR and 579 LT candidates: 512 LT candidates underwent LT, whereas 68 (11.7%) dropped-out for tumor progression. Ninety-nine high-risk patients were selected from each treatment cohort after propensity score matching. Three and 5-y cumulative incidence of tumor-related death were 29.7% and 39.5% versus 17.2% and 18.3% for LR and LT group ( P = 0.039), respectively. Low-risk and intermediate-risk patients treated by LR and presenting satellite nodules and microvascular invasion had a significantly higher 5-y incidence of tumor-related death (29.2% versus 12.5%; P < 0.001) | ||
| 520 | |a CONCLUSIONS: High-risk patients showed significantly better intention-to-treat tumor-related survival after upfront LT rather than LR. Cancer-specific survival of low- and intermediate-risk LR patients was significantly impaired by unfavorable pathology, suggesting the application of ab-initio salvage LT in such scenarios | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Ravaioli, Matteo |e verfasserin |4 aut | |
| 700 | 1 | |a Lauterio, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Magistri, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Bongini, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Odaldi, Federica |e verfasserin |4 aut | |
| 700 | 1 | |a De Carlis, Riccardo |e verfasserin |4 aut | |
| 700 | 1 | |a Botta, Francesca |e verfasserin |4 aut | |
| 700 | 1 | |a Centonze, Leonardo |e verfasserin |4 aut | |
| 700 | 1 | |a Maroni, Lorenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Citterio, Davide |e verfasserin |4 aut | |
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