Recurrent hepatocellular carcinoma after transplantation: Use of a pathological score on explanted livers to predict recurrence

医学 米兰标准 肝细胞癌 肝移植 病态的 列线图 肝硬化 内科学 移植 胃肠病学 多元分析 外科 肿瘤科
作者
Jeremy Parfitt,Paul Marotta,Mohammed Abdullah Alghamdi,William Wall,Anand Khakhar,Neville Suskin,Douglas Quan,Vivian McAllister,C N Ghent,Mark Levstik,Carolyn A. McLean,Subrata Chakrabarti,Bertha García,David K. Driman
出处
期刊:Liver Transplantation [Wiley]
卷期号:13 (4): 543-551 被引量:146
标识
DOI:10.1002/lt.21078
摘要

Milan and University of California at San Francisco (UCSF) criteria are used to select patients with hepatocellular carcinoma (HCC) for liver transplantation (LT). Recurrent HCC is a significant cause of death. There is no widely accepted pathological assessment strategy to predict recurrent HCC after transplantation. This study compares the pathology of patients meeting Milan and UCSF criteria and develops a pathological score and nomogram to assess the risk of recurrent HCC after transplantation. All explanted livers with HCC from our center over the 18-yr period 1985 to 2003 were assessed for multiple pathological features and relevant clinical data were recorded; multivariate analysis was performed to determine features associated with recurrent HCC. Using pathological variables that independently predicted recurrent HCC, a pathological score and nomogram were developed to determine the probability of recurrent HCC. Of 75 cases analyzed, 50 (67%) met Milan criteria, 9 (12%) met only UCSF criteria and 16 (21%) met neither criteria based on explant pathology. There were 20 cases of recurrent HCC and the mean follow-up was 8 yr. Recurrent HCC was more common (67 vs. 12%; P < 0.001) and survival was lower (15 vs. 83% at 5 yr; 15 vs. 55% at 8 yr; P < 0.001) with those who met only UCSF criteria, compared to those who met Milan criteria. Cryptogenic cirrhosis (25 vs. 5%; P = 0.015), preoperative AFP >1,000 ng/mL (20 vs. 0%; P < 0.001) and postoperative OKT3 use (40 vs. 15%; P = 0.017) were more common among patients with recurrent HCC. While microvascular invasion was the strongest pathological predictor of recurrent HCC, tumor size ≥3 cm (P = 0.004; odds ratio [OR] = 7.42), nuclear grade (P = 0.044; OR = 3.25), microsatellitosis (P = 0.020; OR = 4.82), and giant/bizarre cells (P = 0.028; OR = 4.78) also predicted recurrent HCC independently from vascular invasion. The score and nomogram stratified the risk of recurrent HCC into 3 tiers: low (<5%), intermediate (40–65%), and high (>95%). In conclusion, compared to patients meeting Milan criteria, patients who meet only UCSF criteria have a worse survival and an increased rate of recurrent HCC with long-term follow-up, as well as more frequent occurrence of adverse histopathological features, such as microvascular invasion. Application of a pathological score and nomogram could help identify patients at increased risk for tumor recurrence, who may benefit from increased surveillance or adjuvant therapy. Liver Transpl, 2007. © 2007 AASLD.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
大幅提高文件上传限制,最高150M (2024-4-1)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
LOVER完成签到 ,获得积分10
刚刚
陈德明的命也是命完成签到,获得积分10
刚刚
凡帝完成签到,获得积分10
刚刚
调研昵称发布了新的文献求助10
1秒前
风吹独自凉完成签到,获得积分10
2秒前
魔幻高烽完成签到,获得积分10
2秒前
夏夏完成签到,获得积分10
2秒前
我开拖拉机完成签到 ,获得积分10
2秒前
爱笑的无心完成签到 ,获得积分10
3秒前
zhen完成签到,获得积分10
3秒前
不可思宇完成签到,获得积分10
3秒前
清秀迎松完成签到 ,获得积分10
4秒前
为你博弈完成签到,获得积分10
4秒前
调研昵称发布了新的文献求助10
4秒前
5秒前
刘佳佳完成签到 ,获得积分10
6秒前
北冥有鱼完成签到,获得积分10
6秒前
芋泥红豆椰椰完成签到,获得积分10
8秒前
8秒前
冬天回来661完成签到,获得积分10
9秒前
一心想出文章完成签到,获得积分10
10秒前
松山少林学武功完成签到 ,获得积分10
10秒前
葡萄完成签到,获得积分10
10秒前
齐桓公完成签到,获得积分10
10秒前
勤奋大地完成签到,获得积分10
11秒前
魈玖完成签到,获得积分10
12秒前
掉渣的饼干完成签到,获得积分10
12秒前
wuji完成签到,获得积分10
12秒前
智慧吗喽完成签到,获得积分10
13秒前
joy完成签到,获得积分10
14秒前
seu_liang发布了新的文献求助20
14秒前
受伤白昼完成签到,获得积分10
14秒前
想吃泡芙完成签到 ,获得积分10
15秒前
产电菌菌主完成签到,获得积分10
15秒前
果汁完成签到,获得积分10
15秒前
南亭完成签到,获得积分10
16秒前
亮山火马完成签到,获得积分10
18秒前
旺旺碎冰冰完成签到,获得积分10
18秒前
zhong完成签到,获得积分10
18秒前
厚厚厚厚厚丶完成签到,获得积分10
18秒前
高分求助中
Sustainability in Tides Chemistry 2000
Microlepidoptera Palaearctica, Volumes 1 and 3 - 13 (12-Volume Set) [German] 1122
Дружба 友好报 (1957-1958) 1000
The Data Economy: Tools and Applications 1000
Mantiden - Faszinierende Lauerjäger – Buch gebraucht kaufen 700
PraxisRatgeber Mantiden., faszinierende Lauerjäger. – Buch gebraucht kaufe 700
A Dissection Guide & Atlas to the Rabbit 600
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 基因 遗传学 催化作用 物理化学 免疫学 量子力学 细胞生物学
热门帖子
关注 科研通微信公众号,转发送积分 3099877
求助须知:如何正确求助?哪些是违规求助? 2751333
关于积分的说明 7612942
捐赠科研通 2403282
什么是DOI,文献DOI怎么找? 1275217
科研通“疑难数据库(出版商)”最低求助积分说明 616310
版权声明 599053