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Overall Tumor Burden Dictates Outcomes for Patients Undergoing Resection of Multinodular Hepatocellular Carcinoma Beyond the Milan Criteria.

Publication ,  Journal Article
Tsilimigras, DI; Mehta, R; Paredes, AZ; Moris, D; Sahara, K; Bagante, F; Ratti, F; Marques, HP; Silva, S; Soubrane, O; Lam, V; Poultsides, GA ...
Published in: Annals of surgery
October 2020

The objective of the current study was to define surgical outcomes after resection of multinodular hepatocellular carcinoma (HCC) beyond the Milan criteria, and develop a prediction tool to identify which patients likely benefit the most from resection.Liver resection for multinodular HCC, especially beyond the Milan criteria, remains controversial. Rigorous selection of the best candidates for resection is essential to achieve optimal outcomes after liver resection of advanced tumors.Patients who underwent resection for HCC between 2000 and 2017 were identified from an international multi-institutional database. Patients were categorized according to Milan criteria status. Pre- and postoperative overall survival (OS) prediction models that included HCC tumor burden score (TBS) among patients with multinodular HCC beyond Milan criteria were developed and validated.Among 1037 patients who underwent resection for HCC, 164 (15.8%) had multinodular HCC beyond the Milan criteria. Among patients with multinodular HCC, 25 (15.2%) patients experienced a serious complication and 90-day mortality was 3.7% (n = 6). Five-year OS after resection of multinodular HCC beyond Milan criteria was 52.8%. A preoperative TBS-based model (5-year OS: low-risk, 73.7% vs intermediate-risk, 45.1% vs high-risk, 13.1%), and postoperative TBS-based model (5-year OS: low-risk, 80.1% vs intermediate-risk, 37.2% vs high-risk, not reached) categorized patients into distinct prognostic groups relative to long-term prognosis (both P < 0.001). Pre- and postoperative models could accurately stratify OS in an external validation cohort (5-year OS; low vs medium vs high risk; pre: 66.3% vs 25.2% vs not reached, P = 0.012; post: 61.4% vs 42.5% vs not reached, P = 0.045) Predictive accuracy of the pre- and postoperative models was good in the training (c-index; pre: 0.68; post: 0.71), internal validation (n = 2000 resamples) (c-index, pre: 0.70; post: 0.72) and external validation (c-index, pre: 0.67; post 0.68) datasets. TBS alone could stratify patients relative to 5-year OS after resection of multinodular HCC beyond Milan criteria (c-index: 0.65; 5-year OS; low TBS: 70.2% vs medium TBS: 54.7% vs high TBS: 16.7%; P < 0.001). The vast majority of patients with low and intermediate TBS were deemed low or medium risk based on both the preoperative (98.4%) and postoperative risk scores (95.3%).Prognosis of patients with multinodular HCC was largely dependent on overall tumor burden. Liver resection should be considered among patients with multinodular HCC beyond the Milan criteria who have a low- or intermediate-TBS.

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Published In

Annals of surgery

DOI

EISSN

1528-1140

ISSN

0003-4932

Publication Date

October 2020

Volume

272

Issue

4

Start / End Page

574 / 581

Related Subject Headings

  • Tumor Burden
  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Humans
  • Hepatectomy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Tsilimigras, D. I., Mehta, R., Paredes, A. Z., Moris, D., Sahara, K., Bagante, F., … Pawlik, T. M. (2020). Overall Tumor Burden Dictates Outcomes for Patients Undergoing Resection of Multinodular Hepatocellular Carcinoma Beyond the Milan Criteria. Annals of Surgery, 272(4), 574–581. https://doi.org/10.1097/sla.0000000000004346
Tsilimigras, Diamantis I., Rittal Mehta, Anghela Z. Paredes, Dimitrios Moris, Kota Sahara, Fabio Bagante, Francesca Ratti, et al. “Overall Tumor Burden Dictates Outcomes for Patients Undergoing Resection of Multinodular Hepatocellular Carcinoma Beyond the Milan Criteria.Annals of Surgery 272, no. 4 (October 2020): 574–81. https://doi.org/10.1097/sla.0000000000004346.
Tsilimigras DI, Mehta R, Paredes AZ, Moris D, Sahara K, Bagante F, et al. Overall Tumor Burden Dictates Outcomes for Patients Undergoing Resection of Multinodular Hepatocellular Carcinoma Beyond the Milan Criteria. Annals of surgery. 2020 Oct;272(4):574–81.
Tsilimigras, Diamantis I., et al. “Overall Tumor Burden Dictates Outcomes for Patients Undergoing Resection of Multinodular Hepatocellular Carcinoma Beyond the Milan Criteria.Annals of Surgery, vol. 272, no. 4, Oct. 2020, pp. 574–81. Epmc, doi:10.1097/sla.0000000000004346.
Tsilimigras DI, Mehta R, Paredes AZ, Moris D, Sahara K, Bagante F, Ratti F, Marques HP, Silva S, Soubrane O, Lam V, Poultsides GA, Popescu I, Grigorie R, Alexandrescu S, Martel G, Workneh A, Guglielmi A, Hugh T, Aldrighetti L, Endo I, Spolverato G, Umberto C, Pawlik TM. Overall Tumor Burden Dictates Outcomes for Patients Undergoing Resection of Multinodular Hepatocellular Carcinoma Beyond the Milan Criteria. Annals of surgery. 2020 Oct;272(4):574–581.

Published In

Annals of surgery

DOI

EISSN

1528-1140

ISSN

0003-4932

Publication Date

October 2020

Volume

272

Issue

4

Start / End Page

574 / 581

Related Subject Headings

  • Tumor Burden
  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Humans
  • Hepatectomy