Resectable and transplantable hepatocellular carcinoma: Integration of liver stiffness assessment in the decision-making algorithm.
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Author
Tortajada, PaulineDoamba, Rodrigue
Cano, Luis
Ghallab, Mohammed
Allard, Marc Antoine
Ciacio, Oriana
Pittau, Gabriella
Salloum, Chady
Cherqui, Daniel
Adam, René
Sa Cunha, Antonio
Azoulay, Daniel
Pascale, Alina
Vibert, Eric
Golse, Nicolas
Publication date
2022-10-12Subject
Surgery
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Background: Liver resection is a curative treatment for hepatocellular carcinoma (HCC) and an alternative to liver transplantation (LT). However, post-liver resection recurrence rates remain high. This study aimed to determine whether liver stiffness measurement (LSM) correlated with recurrence and to propose a method for predicting HCC recurrence exclusively using pre-liver resection criteria. Methods: This retrospective monocentric study included patients who had undergone LR liver resection for HCC between 2015 and 2018 and who had (1) preoperative alpha-fetoprotein scores indicating initial transplant viability and (2) available preoperative LSM data. We developed a predictive score for recurrence over time using Cox univariate regression and multivariate analysis with a combination plot before selecting the optimal thresholds (receiver operating characteristic curves + Youden test). Results: Sixty-six patients were included. After an average follow-up of 40 months, the recurrence rate was 45% (n = 30). Three-year overall survival was 88%. Four preoperative variables significantly impacted the time to recurrence: age ≥70 years, LSM ≥11 kPa, international normalized ratio (INR) ≥1.2, and maximum HCC diameter ≥3 cm. By assigning 1 point per positive item, patients with a score <2 (n = 22) demonstrated greater mean overall survival (69.7 vs 54.8 months, P = .02) and disease-free survival (52.2 vs 34.7 months, P = .02) than those with a score ≥2. Patients experiencing early recurrence (<1 year) presented a significantly higher preoperative LSM (P = .06). Conclusion: We identified a simple preoperative score predictive of early hepatocellular carcinoma recurrence after liver resection, highlighting the role of liver stiffness. This score could help physicians select patients and make decisions concerning perioperative medical treatment.Citation
Tortajada P, Doamba R, Cano L, Ghallab M, Allard MA, Ciacio O, Pittau G, Salloum C, Cherqui D, Adam R, Sa Cunha A, Azoulay D, Pascale A, Vibert E, Golse N. Resectable and transplantable hepatocellular carcinoma: Integration of liver stiffness assessment in the decision-making algorithm. Surgery. 2022 Dec;172(6):1704-1711. doi: 10.1016/j.surg.2022.08.012. Epub 2022 Oct 12Type
ArticleAdditional Links
https://www.sciencedirect.com/journal/surgeryPMID
36241470Journal
SurgeryPublisher
Mosbyae974a485f413a2113503eed53cd6c53
10.1016/j.surg.2022.08.012