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Predicting recurrence patterns after resection of hepatocellular cancer.

Publication ,  Journal Article
Lee, SY; Konstantinidis, IT; Eaton, AA; Gönen, M; Kingham, TP; D'Angelica, MI; Allen, PJ; Fong, Y; DeMatteo, RP; Jarnagin, WR
Published in: HPB (Oxford)
October 2014

BACKGROUND: The reliable prediction of hepatocellular carcinoma (HCC) recurrence patterns potentially allows for the prioritization of patients for liver resection (LR) or transplantation. OBJECTIVES: The aim of this study was to analyse clinicopathological factors and preoperative Milan criteria (MC) status in predicting patterns of HCC recurrence. METHODS: During 1992-2012, 320 patients undergoing LR for HCC were categorized preoperatively as being within or beyond the MC, as were recurrences. RESULTS: After a median follow-up of 47 months, 183 patients developed recurrence, giving a 5-year cumulative incidence of recurrence of 62.5%. Patients with preoperative disease within the MC had better survival outcomes than those with preoperative disease beyond the MC (median survival: 102 months versus 45 months; P < 0.001). Overall, 31% of patients had preoperative disease within the MC and 69% had preoperative disease beyond the MC. Estimated rates of recurrence-free survival at 5 years were 61.8% for all patients and 53.8% for patients with initial beyond-MC status. Independent factors for recurrence beyond-MC status included preoperative disease beyond the MC, the presence of microsatellite or multiple tumours and lymphovascular invasion (all: P < 0.001). A clinical risk score was used to predict survival and the likelihood of recurrence beyond the MC; patients with scores of 0, 1, 2 and 3 had 5- year incidence of recurring beyond-MC of 9.0%, 29.5%, 48.8% and 75.4%, respectively (P < 0.0001). CONCLUSIONS: Regardless of initial MC status, at 5 years the majority of patients remained disease-free or experienced recurrence within the MC after LR, and thus were potentially eligible for salvage transplantation (ST). Incorporating clinicopathological parameters into the MC allows for better risk stratification, which improves the selection of patients for ST and identifies patients in need of closer surveillance.

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Published In

HPB (Oxford)

DOI

EISSN

1477-2574

Publication Date

October 2014

Volume

16

Issue

10

Start / End Page

943 / 953

Location

England

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Time Factors
  • Surgery
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Middle Aged
 

Citation

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ICMJE
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Lee, S. Y., Konstantinidis, I. T., Eaton, A. A., Gönen, M., Kingham, T. P., D’Angelica, M. I., … Jarnagin, W. R. (2014). Predicting recurrence patterns after resection of hepatocellular cancer. HPB (Oxford), 16(10), 943–953. https://doi.org/10.1111/hpb.12311
Lee, Ser Yee, Ioannis T. Konstantinidis, Anne A. Eaton, Mithat Gönen, T Peter Kingham, Michael I. D’Angelica, Peter J. Allen, Yuman Fong, Ronald P. DeMatteo, and William R. Jarnagin. “Predicting recurrence patterns after resection of hepatocellular cancer.HPB (Oxford) 16, no. 10 (October 2014): 943–53. https://doi.org/10.1111/hpb.12311.
Lee SY, Konstantinidis IT, Eaton AA, Gönen M, Kingham TP, D’Angelica MI, et al. Predicting recurrence patterns after resection of hepatocellular cancer. HPB (Oxford). 2014 Oct;16(10):943–53.
Lee, Ser Yee, et al. “Predicting recurrence patterns after resection of hepatocellular cancer.HPB (Oxford), vol. 16, no. 10, Oct. 2014, pp. 943–53. Pubmed, doi:10.1111/hpb.12311.
Lee SY, Konstantinidis IT, Eaton AA, Gönen M, Kingham TP, D’Angelica MI, Allen PJ, Fong Y, DeMatteo RP, Jarnagin WR. Predicting recurrence patterns after resection of hepatocellular cancer. HPB (Oxford). 2014 Oct;16(10):943–953.
Journal cover image

Published In

HPB (Oxford)

DOI

EISSN

1477-2574

Publication Date

October 2014

Volume

16

Issue

10

Start / End Page

943 / 953

Location

England

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Time Factors
  • Surgery
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Middle Aged