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Cited 4 time in webofscience Cited 5 time in scopus
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Survival according to recurrence patterns after resection for transplantable hepatocellular carcinoma in HBV endemic area: Appraisal of liver transplantation strategy

Authors
Seo, Chung GyoYim, Sun YoungUm, Soon HoLee, Yoo RaLee, Yoo JinKim, Tae HyungGoh, Hyun GilLee, Young SunSuh, Sang JunHan, Na YeonChoi, Hyuk SoonKim, Eun SunKeum, BoraSeo, Yeon SeokYim, Hyung JoonKim, Ji HoonKim, Dong-SikJeen, Yoon TaeChun, Hoon JaiLee, Hong SikKim, Chang Duck
Issue Date
Sep-2020
Publisher
Elsevier Masson SAS
Keywords
Hepatocellular carcinoma; Salvage Liver transplantation; Liver resection; Milan criteria; Recurrence; Risk factor
Citation
Clinics and Research in Hepatology and Gastroenterology, v.44, no.4, pp.532 - 542
Indexed
SCIE
SCOPUS
Journal Title
Clinics and Research in Hepatology and Gastroenterology
Volume
44
Number
4
Start Page
532
End Page
542
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/52305
DOI
10.1016/j.clinre.2019.11.006
ISSN
2210-7401
Abstract
Background and aims: Since there is a shortage of liver donors, we investigated recurrence patterns and outcomes after liver resection (LR) to determine the feasibility of salvage liver transplantation (SLT). Methods: We analyzed 468 patients with hepatocellular carcinoma (HCC) within the Milan criteria (MC) who were mainly associated with Hepatitis B virus infection (76.3%) and had undergone curative LR as an initial treatment. Results: The overall survival (OS) rates were 86.6% and 67.4% at 5 and 10 years after LR, respectively. During a median follow-up of 59 months, 211 patients experienced recurrences including 175 (37.4%) within MC and 36 (7.7%) beyond MC. Survival was lowest in patients with beyond MC-recurrence followed by within MC- and no-recurrence groups (26.5%, 86.6%, and 94.7% at 5 years, respectively, P < 0.001). Independent pathologic predictors of recurrence beyond MC were the presence of satellite nodules, microvascular invasion, and unfavorable gross findings (multinodular confluent and infiltrative) (all, P < 0.05). Patients with all three risk factors experienced recurrence with the highest cumulative incidence of mortality. Among 173 patients with recurrence within MC, the cumulative incidence of HCC progression beyond MC despite resection and locoregional treatment (LRT) was 29% and 60% at 5 and 10 years after recurrence, respectively, and their 10-year OS rate was 25.8%. Conclusion: Curative LR achieved a 5-year survival of > 85% in patients with transplantable HCC, but early SLT after recurrence within MC is advocated because of poor survival and high risk of progression thereafter. Further, prophylactic LT could be considered for those with high risk of recurrence. (C) 2019 Published by Elsevier Masson SAS.
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5. Others > Others(Medicine) > 1. Journal Articles
2. Clinical Science > Department of Hepato-Biliary-Pancreatic Surgery > 1. Journal Articles
2. Clinical Science > Department of Radiology > 1. Journal Articles
2. Clinical Science > Department of Pathology > 1. Journal Articles
2. Clinical Science > Department of Gastroenterology and Hepatology > 1. Journal Articles

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Chun, Hoon Jai
Anam Hospital (Department of Gastroenterology and Hepatology, Anam Hospital)
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