Super-selection of a Subgroup of Hepatocellular Carcinoma Patients at Minimal Risk of Recurrence for Liver Transplantation

Shin Hwang, Chul Soo Ahn, Ki Hun Kim, Deok Bog Moon, Tae Yong Ha, Gi Won Song, Dong Hwan Jung, Gil Chun Park, Young-Dong Yu, Pyoung Jae Park, Young Il Choi, Kyoung Won Kim, Young Suk Lim, Han Chu Lee, Eun Sil Yu, Sung Gyu Lee

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: A majority of patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT) meet the Milan criteria, but these are still regarded as the narrowest criteria for transplantation. Prognostic analysis of incidentally detected HCC after LT suggests that a subgroup of HCC patients is at very low risk of recurrence. To determine the criteria defining this super-selection group, we retrospectively analyzed survival data of 593 adult living-donor LT recipients with HCC in the explanted liverDiscussion: Tumor features of incidental HCC in 38 patients not showing recurrence were analyzed. Of these patients, 34 (89. 5%) each had ≤2 tumors and tumors ≤2. 0 cm in size. Applying these criteria to 555 patients with pretransplant known HCC (pkHCC) allowed us to identify 79 patients with untreated pkHCCs ≤2. 0 cm in size. To date, only two of these patients have shown recurrence, making the conditions for super-selection the presence of tumors ≤2. 0 cm in size, ≤2 tumors, alpha-fetoprotein ≤200 ng/mL, and no pretransplant treatment. In 87 patients satisfying these criteria, the 10-year recurrence and survival rates were 1. 3% and 92. 1%, respectively. After excluding patients meeting these criteria, the 5-year recurrence rates in patients satisfying the Milan, University of California at San Francisco, and Asan criteria were increased by 2. 9-4. 0%. In conclusion, this super-selection or super-Milan category may be used for validation assessment of various indication criteria and for the development of cost-effective post-transplantation HCC surveillance protocols. Further studies should be followed for deceased-donor LT and patients who have undergone pretransplant treatment.

Original languageEnglish
Pages (from-to)971-981
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume15
Issue number6
DOIs
Publication statusPublished - 2011 Jun 1
Externally publishedYes

Fingerprint

Liver Transplantation
Hepatocellular Carcinoma
Recurrence
Neoplasms
Transplantation
San Francisco
Living Donors
alpha-Fetoproteins
Survival Rate
Tissue Donors
Costs and Cost Analysis
Survival
Therapeutics

Keywords

  • Hepatocellular carcinoma
  • Indication criteria
  • Liver transplantation
  • Recurrence
  • Surveillance

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Super-selection of a Subgroup of Hepatocellular Carcinoma Patients at Minimal Risk of Recurrence for Liver Transplantation. / Hwang, Shin; Ahn, Chul Soo; Kim, Ki Hun; Moon, Deok Bog; Ha, Tae Yong; Song, Gi Won; Jung, Dong Hwan; Park, Gil Chun; Yu, Young-Dong; Park, Pyoung Jae; Choi, Young Il; Kim, Kyoung Won; Lim, Young Suk; Lee, Han Chu; Yu, Eun Sil; Lee, Sung Gyu.

In: Journal of Gastrointestinal Surgery, Vol. 15, No. 6, 01.06.2011, p. 971-981.

Research output: Contribution to journalArticle

Hwang, S, Ahn, CS, Kim, KH, Moon, DB, Ha, TY, Song, GW, Jung, DH, Park, GC, Yu, Y-D, Park, PJ, Choi, YI, Kim, KW, Lim, YS, Lee, HC, Yu, ES & Lee, SG 2011, 'Super-selection of a Subgroup of Hepatocellular Carcinoma Patients at Minimal Risk of Recurrence for Liver Transplantation', Journal of Gastrointestinal Surgery, vol. 15, no. 6, pp. 971-981. https://doi.org/10.1007/s11605-011-1467-0
Hwang, Shin ; Ahn, Chul Soo ; Kim, Ki Hun ; Moon, Deok Bog ; Ha, Tae Yong ; Song, Gi Won ; Jung, Dong Hwan ; Park, Gil Chun ; Yu, Young-Dong ; Park, Pyoung Jae ; Choi, Young Il ; Kim, Kyoung Won ; Lim, Young Suk ; Lee, Han Chu ; Yu, Eun Sil ; Lee, Sung Gyu. / Super-selection of a Subgroup of Hepatocellular Carcinoma Patients at Minimal Risk of Recurrence for Liver Transplantation. In: Journal of Gastrointestinal Surgery. 2011 ; Vol. 15, No. 6. pp. 971-981.
@article{394f01a2ee3b4ad78846736efbe1061a,
title = "Super-selection of a Subgroup of Hepatocellular Carcinoma Patients at Minimal Risk of Recurrence for Liver Transplantation",
abstract = "Background: A majority of patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT) meet the Milan criteria, but these are still regarded as the narrowest criteria for transplantation. Prognostic analysis of incidentally detected HCC after LT suggests that a subgroup of HCC patients is at very low risk of recurrence. To determine the criteria defining this super-selection group, we retrospectively analyzed survival data of 593 adult living-donor LT recipients with HCC in the explanted liverDiscussion: Tumor features of incidental HCC in 38 patients not showing recurrence were analyzed. Of these patients, 34 (89. 5{\%}) each had ≤2 tumors and tumors ≤2. 0 cm in size. Applying these criteria to 555 patients with pretransplant known HCC (pkHCC) allowed us to identify 79 patients with untreated pkHCCs ≤2. 0 cm in size. To date, only two of these patients have shown recurrence, making the conditions for super-selection the presence of tumors ≤2. 0 cm in size, ≤2 tumors, alpha-fetoprotein ≤200 ng/mL, and no pretransplant treatment. In 87 patients satisfying these criteria, the 10-year recurrence and survival rates were 1. 3{\%} and 92. 1{\%}, respectively. After excluding patients meeting these criteria, the 5-year recurrence rates in patients satisfying the Milan, University of California at San Francisco, and Asan criteria were increased by 2. 9-4. 0{\%}. In conclusion, this super-selection or super-Milan category may be used for validation assessment of various indication criteria and for the development of cost-effective post-transplantation HCC surveillance protocols. Further studies should be followed for deceased-donor LT and patients who have undergone pretransplant treatment.",
keywords = "Hepatocellular carcinoma, Indication criteria, Liver transplantation, Recurrence, Surveillance",
author = "Shin Hwang and Ahn, {Chul Soo} and Kim, {Ki Hun} and Moon, {Deok Bog} and Ha, {Tae Yong} and Song, {Gi Won} and Jung, {Dong Hwan} and Park, {Gil Chun} and Young-Dong Yu and Park, {Pyoung Jae} and Choi, {Young Il} and Kim, {Kyoung Won} and Lim, {Young Suk} and Lee, {Han Chu} and Yu, {Eun Sil} and Lee, {Sung Gyu}",
year = "2011",
month = "6",
day = "1",
doi = "10.1007/s11605-011-1467-0",
language = "English",
volume = "15",
pages = "971--981",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",
number = "6",

}

TY - JOUR

T1 - Super-selection of a Subgroup of Hepatocellular Carcinoma Patients at Minimal Risk of Recurrence for Liver Transplantation

AU - Hwang, Shin

AU - Ahn, Chul Soo

AU - Kim, Ki Hun

AU - Moon, Deok Bog

AU - Ha, Tae Yong

AU - Song, Gi Won

AU - Jung, Dong Hwan

AU - Park, Gil Chun

AU - Yu, Young-Dong

AU - Park, Pyoung Jae

AU - Choi, Young Il

AU - Kim, Kyoung Won

AU - Lim, Young Suk

AU - Lee, Han Chu

AU - Yu, Eun Sil

AU - Lee, Sung Gyu

PY - 2011/6/1

Y1 - 2011/6/1

N2 - Background: A majority of patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT) meet the Milan criteria, but these are still regarded as the narrowest criteria for transplantation. Prognostic analysis of incidentally detected HCC after LT suggests that a subgroup of HCC patients is at very low risk of recurrence. To determine the criteria defining this super-selection group, we retrospectively analyzed survival data of 593 adult living-donor LT recipients with HCC in the explanted liverDiscussion: Tumor features of incidental HCC in 38 patients not showing recurrence were analyzed. Of these patients, 34 (89. 5%) each had ≤2 tumors and tumors ≤2. 0 cm in size. Applying these criteria to 555 patients with pretransplant known HCC (pkHCC) allowed us to identify 79 patients with untreated pkHCCs ≤2. 0 cm in size. To date, only two of these patients have shown recurrence, making the conditions for super-selection the presence of tumors ≤2. 0 cm in size, ≤2 tumors, alpha-fetoprotein ≤200 ng/mL, and no pretransplant treatment. In 87 patients satisfying these criteria, the 10-year recurrence and survival rates were 1. 3% and 92. 1%, respectively. After excluding patients meeting these criteria, the 5-year recurrence rates in patients satisfying the Milan, University of California at San Francisco, and Asan criteria were increased by 2. 9-4. 0%. In conclusion, this super-selection or super-Milan category may be used for validation assessment of various indication criteria and for the development of cost-effective post-transplantation HCC surveillance protocols. Further studies should be followed for deceased-donor LT and patients who have undergone pretransplant treatment.

AB - Background: A majority of patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT) meet the Milan criteria, but these are still regarded as the narrowest criteria for transplantation. Prognostic analysis of incidentally detected HCC after LT suggests that a subgroup of HCC patients is at very low risk of recurrence. To determine the criteria defining this super-selection group, we retrospectively analyzed survival data of 593 adult living-donor LT recipients with HCC in the explanted liverDiscussion: Tumor features of incidental HCC in 38 patients not showing recurrence were analyzed. Of these patients, 34 (89. 5%) each had ≤2 tumors and tumors ≤2. 0 cm in size. Applying these criteria to 555 patients with pretransplant known HCC (pkHCC) allowed us to identify 79 patients with untreated pkHCCs ≤2. 0 cm in size. To date, only two of these patients have shown recurrence, making the conditions for super-selection the presence of tumors ≤2. 0 cm in size, ≤2 tumors, alpha-fetoprotein ≤200 ng/mL, and no pretransplant treatment. In 87 patients satisfying these criteria, the 10-year recurrence and survival rates were 1. 3% and 92. 1%, respectively. After excluding patients meeting these criteria, the 5-year recurrence rates in patients satisfying the Milan, University of California at San Francisco, and Asan criteria were increased by 2. 9-4. 0%. In conclusion, this super-selection or super-Milan category may be used for validation assessment of various indication criteria and for the development of cost-effective post-transplantation HCC surveillance protocols. Further studies should be followed for deceased-donor LT and patients who have undergone pretransplant treatment.

KW - Hepatocellular carcinoma

KW - Indication criteria

KW - Liver transplantation

KW - Recurrence

KW - Surveillance

UR - http://www.scopus.com/inward/record.url?scp=79955870784&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79955870784&partnerID=8YFLogxK

U2 - 10.1007/s11605-011-1467-0

DO - 10.1007/s11605-011-1467-0

M3 - Article

VL - 15

SP - 971

EP - 981

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

IS - 6

ER -