The timing of liver transplantation after primary hepatectomy for hepatocellular carcinoma: A special reference to recurrence pattern and milan criteria

Toru Ikegami, Mitsuo Shimada, Satoru Imura, Tomoharu Yoshizumi, Yusuke Arakawa, Takuya Tokunaga, Yuji Morine, Hirofumi Kanemura

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Abstract

INTRODUCTION.: Hepatic resection (HR) is commonly applied as first-line treatment of hepatocellular carcinoma (HCC) even in the era of liver transplantation (LT). METHODS.: Outcomes and detailed recurrence pattern of 80 patients, who underwent curative HR for HCC were examined referring to Milan criteria. RESULTS.: (I) After HR for HCCs exceeding Milan criteria (n=41), recurrence within the criteria was observed in 13 patients (group-A) and recurrence not-meeting the criteria was observed in 22 patients (group-B). group-A showed better 3-year recurrence-free survival rate than group-B (85.7% vs. 23.9%, P<0.05). Tumor size more than or equal to 6 cm was identified as the significant factor for having recurrence as in group-A pattern (P<0.05). Among the patients in group-A, re-recurrence after treating recurrent HCC was observed in eight patients (61.5%) with increased rate of extra-Milan criteria recurrence at 12 months from the initial recurrence. (II) After HR for HCCs meeting Milan criteria (n=39), recurrences within the criteria was observed in 15 patients (group-C) and recurrence not-meeting the criteria was observed in five patients (group-D). The 3-year recurrence-free survival rate was 62.8% in group-C and 40.0% in group-D (P<0.05). Increased rate of extra-Milan re-recurrence was observed later than 12 months from the recurrence in group-C. CONCLUSIONS.: For HCCs not meeting Milan criteria, secondary LT after primary HR could be applied for a proportion of cases with less aggressiveness. For those meeting Milan criteria, primary LT should be the first therapeutic option. However, secondary LT could be offered for those with re-recurrence within criteria after primary HR.

Original languageEnglish
Pages (from-to)641-646
Number of pages6
JournalTransplantation
Volume86
Issue number5
DOIs
Publication statusPublished - Sep 15 2008
Externally publishedYes

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Hepatectomy
Liver Transplantation
Hepatocellular Carcinoma
Recurrence
Liver
Survival Rate

All Science Journal Classification (ASJC) codes

  • Transplantation

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The timing of liver transplantation after primary hepatectomy for hepatocellular carcinoma : A special reference to recurrence pattern and milan criteria. / Ikegami, Toru; Shimada, Mitsuo; Imura, Satoru; Yoshizumi, Tomoharu; Arakawa, Yusuke; Tokunaga, Takuya; Morine, Yuji; Kanemura, Hirofumi.

In: Transplantation, Vol. 86, No. 5, 15.09.2008, p. 641-646.

Research output: Contribution to journalArticle

Ikegami, Toru ; Shimada, Mitsuo ; Imura, Satoru ; Yoshizumi, Tomoharu ; Arakawa, Yusuke ; Tokunaga, Takuya ; Morine, Yuji ; Kanemura, Hirofumi. / The timing of liver transplantation after primary hepatectomy for hepatocellular carcinoma : A special reference to recurrence pattern and milan criteria. In: Transplantation. 2008 ; Vol. 86, No. 5. pp. 641-646.
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abstract = "INTRODUCTION.: Hepatic resection (HR) is commonly applied as first-line treatment of hepatocellular carcinoma (HCC) even in the era of liver transplantation (LT). METHODS.: Outcomes and detailed recurrence pattern of 80 patients, who underwent curative HR for HCC were examined referring to Milan criteria. RESULTS.: (I) After HR for HCCs exceeding Milan criteria (n=41), recurrence within the criteria was observed in 13 patients (group-A) and recurrence not-meeting the criteria was observed in 22 patients (group-B). group-A showed better 3-year recurrence-free survival rate than group-B (85.7{\%} vs. 23.9{\%}, P<0.05). Tumor size more than or equal to 6 cm was identified as the significant factor for having recurrence as in group-A pattern (P<0.05). Among the patients in group-A, re-recurrence after treating recurrent HCC was observed in eight patients (61.5{\%}) with increased rate of extra-Milan criteria recurrence at 12 months from the initial recurrence. (II) After HR for HCCs meeting Milan criteria (n=39), recurrences within the criteria was observed in 15 patients (group-C) and recurrence not-meeting the criteria was observed in five patients (group-D). The 3-year recurrence-free survival rate was 62.8{\%} in group-C and 40.0{\%} in group-D (P<0.05). Increased rate of extra-Milan re-recurrence was observed later than 12 months from the recurrence in group-C. CONCLUSIONS.: For HCCs not meeting Milan criteria, secondary LT after primary HR could be applied for a proportion of cases with less aggressiveness. For those meeting Milan criteria, primary LT should be the first therapeutic option. However, secondary LT could be offered for those with re-recurrence within criteria after primary HR.",
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T1 - The timing of liver transplantation after primary hepatectomy for hepatocellular carcinoma

T2 - A special reference to recurrence pattern and milan criteria

AU - Ikegami, Toru

AU - Shimada, Mitsuo

AU - Imura, Satoru

AU - Yoshizumi, Tomoharu

AU - Arakawa, Yusuke

AU - Tokunaga, Takuya

AU - Morine, Yuji

AU - Kanemura, Hirofumi

PY - 2008/9/15

Y1 - 2008/9/15

N2 - INTRODUCTION.: Hepatic resection (HR) is commonly applied as first-line treatment of hepatocellular carcinoma (HCC) even in the era of liver transplantation (LT). METHODS.: Outcomes and detailed recurrence pattern of 80 patients, who underwent curative HR for HCC were examined referring to Milan criteria. RESULTS.: (I) After HR for HCCs exceeding Milan criteria (n=41), recurrence within the criteria was observed in 13 patients (group-A) and recurrence not-meeting the criteria was observed in 22 patients (group-B). group-A showed better 3-year recurrence-free survival rate than group-B (85.7% vs. 23.9%, P<0.05). Tumor size more than or equal to 6 cm was identified as the significant factor for having recurrence as in group-A pattern (P<0.05). Among the patients in group-A, re-recurrence after treating recurrent HCC was observed in eight patients (61.5%) with increased rate of extra-Milan criteria recurrence at 12 months from the initial recurrence. (II) After HR for HCCs meeting Milan criteria (n=39), recurrences within the criteria was observed in 15 patients (group-C) and recurrence not-meeting the criteria was observed in five patients (group-D). The 3-year recurrence-free survival rate was 62.8% in group-C and 40.0% in group-D (P<0.05). Increased rate of extra-Milan re-recurrence was observed later than 12 months from the recurrence in group-C. CONCLUSIONS.: For HCCs not meeting Milan criteria, secondary LT after primary HR could be applied for a proportion of cases with less aggressiveness. For those meeting Milan criteria, primary LT should be the first therapeutic option. However, secondary LT could be offered for those with re-recurrence within criteria after primary HR.

AB - INTRODUCTION.: Hepatic resection (HR) is commonly applied as first-line treatment of hepatocellular carcinoma (HCC) even in the era of liver transplantation (LT). METHODS.: Outcomes and detailed recurrence pattern of 80 patients, who underwent curative HR for HCC were examined referring to Milan criteria. RESULTS.: (I) After HR for HCCs exceeding Milan criteria (n=41), recurrence within the criteria was observed in 13 patients (group-A) and recurrence not-meeting the criteria was observed in 22 patients (group-B). group-A showed better 3-year recurrence-free survival rate than group-B (85.7% vs. 23.9%, P<0.05). Tumor size more than or equal to 6 cm was identified as the significant factor for having recurrence as in group-A pattern (P<0.05). Among the patients in group-A, re-recurrence after treating recurrent HCC was observed in eight patients (61.5%) with increased rate of extra-Milan criteria recurrence at 12 months from the initial recurrence. (II) After HR for HCCs meeting Milan criteria (n=39), recurrences within the criteria was observed in 15 patients (group-C) and recurrence not-meeting the criteria was observed in five patients (group-D). The 3-year recurrence-free survival rate was 62.8% in group-C and 40.0% in group-D (P<0.05). Increased rate of extra-Milan re-recurrence was observed later than 12 months from the recurrence in group-C. CONCLUSIONS.: For HCCs not meeting Milan criteria, secondary LT after primary HR could be applied for a proportion of cases with less aggressiveness. For those meeting Milan criteria, primary LT should be the first therapeutic option. However, secondary LT could be offered for those with re-recurrence within criteria after primary HR.

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