Preoperative predictors of recurrence beyond Milan criteria in hepatocellular carcinoma patients treated with frontline liver resection. (March 2023)

• Record Type: Journal Article
• Authors: Pelizzaro, F.; Trevisani, F.; Vitale, A.; Cillo, U.; Piscaglia, F.; Missale, G.; Sangiovanni, A.; Foschi, F.G.; Cabibbo, G.; Caturelli, E.; Di Marco, M.; Azzaroli, F.; Brunetto, M.R.; Raimondo, G.; Vidili, G.; Guarino, M.; Gasbarrini, A.; Campani, C.; Svegliati-Baroni, G.; Giannini, E.G.; Mega, A.; Masotto, A.; Rapaccini, G.L.; Magalotti, D.; Sacco, R.; Nardone, G.; Farinati, F.
• Is Part Of: Digestive and liver disease. Volume 55(2023)Supplement 1
• Page Start: S52
• Page End: S53
• Publication Date: 2023-03
• Subjects: Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2023.01.102
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract : Introduction: Hepatocellular carcinoma (HCC) recurrence is common in patients treated with liver resection (LR). Salvage liver transplantation (LT) may be an option provided that a transplantable recurrence has occurred. Aim: We aimed to assess incidence and preoperative predictors of recurrence beyond Milan criteria (MC) in patients with small (≤ 5 cm) single HCC treated with first-line LR. Materials and Methods: Data of 512 patients with single HCC ≤5 cm treated with frontline LR were retrieved from the Italian Liver Cancer (ITA.LI.CA) database. Incidence and predictors of recurrence beyond MC was compared across two groups according to tumor diameter (HCC ≤3 cm vs. >3 cm). Results: During a median follow-up of 4.2 years, the overall recurrence rate was 55.9%. Only 18.0% of patients had a first recurrence beyond MC (14.0% in the ≤3 cm group and 23.9% in the >3 group; p=0.005), while the overall recurrence rate beyond MC was 30.3% (25.1% and 38.0% patients in the ≤3 cm and >3 cm groups, respectively; p=0.002) (Figure). Compared to those with larger tumors, patients with HCC ≤3 cm had a longer recurrence-free survival (4.0 [95% CI 3.3-4.7] vs. 2.5 [95% CI 2.0-3.0] years; p=0.002) and overall survival (9.9 [95% CI 6.5-13.4] vs. 7.8 [95% CI 5.7-9.9] years; p=0.008). HCC size and alpha-fetoprotein (AFP) level at the time of LR were independent predictors of recurrence beyond MC. A subanalysis in patients with "ab initio" potentially transplantable HCC confirmed these results. Conclusions: Despite the high recurrence rate, LR for single HCC ≤ 5 cm offers excellent long-term survival. Recurrence beyond MC is predicted by HCC size and AFP levels. Referral for salvage LT should be immediate at the first HCC recurrence, but high-risk patients (HCC >3 cm and high AFP) could be considered for frontline LT or listed for transplantation even before recurrence.