Early and resectable HCC: Definition and validation of a subgroup of patients who could avoid liver transplantation. Issue 8 (28th April 2015)

• Record Type: Journal Article
• Authors: Scatton, Olivier; Goumard, Claire; Cauchy, Francois; Fartoux, Laetitia; Perdigao, Fabiano; Conti, Filomena; Calmus, Yvon; Boelle, Pierre Yves; Belghiti, Jacques; Rosmorduc, Olivier; Soubrane, Olivier
• Is Part Of: Journal of surgical oncology. Volume 111:Issue 8(2015:Jun. 15)
• Page Start: 1007
• Page End: 1015
• Publication Date: 2015-04-28
• Subjects: Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.23916
• Languages: English
• ISSNs: 0022-4790

Abstract

<abstract abstract-type="main" xml:lang="en"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jso23916-sec-0001" sec-type="section"> <title>Background</title> <p>Liver transplantation (LT) remains the best curative option for early hepatocellular carcinoma (HCC) but is limited by the ongoing graft shortage. The present study aimed at defining the population in which primary liver resection (LR) could represent the best alternative to LT.</p> </sec> <sec id="jso23916-sec-0002" sec-type="section"> <title>Methods</title> <p>An exploration set of 357 HCC patients (LR n = 221 and LT n = 136) operated between 2000–2012 was used in order to identify factors associated with survival following LR and define a good prognosis (GP) group for which LR may challenge the results of upfront LT. These factors were validated in an external validation set of 565 HCC patients operated at another center (LR n = 287 LR and LT n = 278).</p> </sec> <sec id="jso23916-sec-0003" sec-type="section"> <title>Results</title> <p>In the exploration set, factors associated with survival on multivariate analysis were a solitary lesion, a diameter <50 mm, a well‐moderately differentiated lesion, the absence of microvascular invasion, and preoperative AST level <2N. Thirty‐nine patients (18%) displayed all these criteria and constituted the GP patients. Overall survivals at 1, 3, and 5 years did not significantly differ between GP resected patients, and the in Milan transplanted patients (93, 80.4, and 80.4% vs. 86.9, 82, and 78.8%, <italic>P</italic> = 0.79). In the validation cohort, patients with GP factors of survival still displayed better overall survivals than those without (<italic>P</italic> = 0.036) but also displayed better survivals than in Milan HCC transplanted patients (<italic>P</italic> = 0.005).</p> </sec> <sec id="jso23916-sec-0004" sec-type="section"> <title>Conclusion</title> <p>In a group of early HCC patients gathering all factors of GP, primary LR achieves at least similar survival as upfront LT and should be the approach of choice. <italic>J. Surg. Oncol. 2015 111:1007–1015</italic>. © 2015 Wiley Periodicals, Inc.</p> </sec> </abstract>