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Role of immunosuppression and tumor differentiation in predicting recurrence after liver transplantation for hepatocellular carcinoma: A multicenter study of 412 patients

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World Journal of Gastroenterology 2006年第45期12卷 7319-7325页

作者： Thomas Decaens Franoise Roudot-Thoraval Solange Bresson-Hadni Carole Meyer jean Gugenheim Francois Durand Pierre-Henri Bernard Olivier Boillot Philippe Compagnon Yvon Calmus jean hardwigsen Christian Ducerf Georges Philippe Pageaux Sébastien Dharancy Olivier Chazouillères Daniel Cherqui Christophe Duvoux Service d'Hépatologie et de Gastroentérologie AP-HP Hpital Henri Mondor Créteil Unité INSERM 581 France Département de Santé Publique AP-HP Hpital Henri Mondor Créteil France Service d’Hépatologie Hpital Jean Minjoz Besanon France Service de Transplantation Hpital HautefeuilleStrasbourg France Service de Chirurgie Digestive Hpital L’Ar-chet 2 Nice France Service d’Hépatologie AP-HP Hpital Beau-jon Clichy France Service d’Hépatologie et de Gastroentéro-logie H?pital Pellegrin Bordeaux France Service de Chirurgie Digestive Hpital Edouard Herriot Lyon France Service de Chirurgie Digestive Hpital Ponchaillou Rennes France Service de Chirurgie Digestive AP-HP HpitalCochin Paris France Service de Chirurgie Digestive Hpital laConception Marseille France Service de Chirurgie Digestive Hpital de laCroix Rousse Lyon France Fédération Médico-Chirurgicale deMaladies de l’Appareil Digestif Hpital Saint-Eloi MontpellierFrance Service d’Hépatologie et de Gastroentérologie H?pital Claude Huriez Lille France Service d’Hépatologie AP-HP Hpital SAntoine Paris France Service de Chirurgie Générale et Digestive APHP Hopital Henri Mondor Créteil France

AIM： To assess pre-orthotopic liver transplantation （OLT） factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma （HCC） recurrence and disease-free survival after liver transplantation （LT）.METHODS： Four hundred and twelve patients transplanted for HCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of HCC. Uni- and multivariate analyses were conducted to identify independent predictors of recurrence. RESULTS： Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were： presence of cirrhosis （P = 0.001）, etiology of liver disease （P = 0.03）, α fetoprotein level （〈 200, 200 to 2000, or 〉 2000; P 〈 0.0001）, y-GT activity （N, N to 2N or 〉 2N; P = 0.02）, the number of nodules （1, 2-3 or ≥ 4; P = 0.02）, maximal diameter of the largest nodule （〈 3 cm, 3 to 5 cm or 〉 5 cm; P 〈 0.0001）, the sum of the diameter of the nodules （〈 3 cm, 3 to 5 cm, 5 to 10 cm or 〉10 cm; P 〈 0.0001）, bilobar location （P = 0.01）, preoperative portal thrombosis （P 〈 0.0001）, peri-operative treatment of the tumor （P = 0.002） and chemoembolization （P = 0.03）, tumor differentiation （P = 0.01）, initial type of calcineurin inhibitor （P = 0.003）, the use of antilymphocyte antibodies （P = 0.02）, rejection episodes （P = 0.003） and period of LT （P 〈 0.0001）. By multivariate analysis, 6 variables were independently associated with HCC recurrence： maximal diameter of the largest nodule （P 〈 0.0001）, time of LT （P 〈 0.0001）, tumor differentiation （P 〈 0.0001）, use of anti-lymphocyte antibody （ATG） or anti-CD3 antibody （OKT3）（P = 0.005）, preoperative portal thrombosis （P = 0.06） and the number of nodules （P = 0.06）. CONCLUSION： This study identifies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor recur

关键词： Immunosuppression Hepatocellular carcinoma Tumor differentiation Liver transplantation

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Usefulness of staging systems and prognostic scores for hepatocellular carcinoma treatments

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World Journal of Hepatology 2016年第17期8卷 703-715页

作者： Xavier Adhoute Guillaume Penaranda jean Luc Raoul Patrice Le Treut Emilie Bollon jean hardwigsen Paul Castellani Hervé Perrier Marc Bourlière Department of Hepato-Gastroenterology Hopital Saint-Joseph Alpha Bio Laboratory Department of Hepato-Gastroenterology and Digestive Oncology Institut Paoli-Calmette Department of Hepatobiliary Surgery Centre Hospitalo-Universitaire Timone

Therapeutic management of hepatocellular carcinoma(HCC) is quite complex owing to the underlying cirrhosis and portal vein hypertension. Different scores or classification systems based on liver function and tumoral stages have been published in the recent years. If none of them is currently "universally" recognized, the Barcelona Clinic Liver Cancer(BCLC) staging system has become the reference classification system in Western countries. Based on a robust treatment algorithm associated with stage stratification, it relies on a high level of evidence. However, BCLC stage B and C HCC include a broad spectrum of tumors but are only matched with a single therapeutic option. Some experts have thus suggested to extend the indications for surgery or for transarterial chemoembolization. In clinical practice, many patients are already treated beyond the scope of recommendations. Additional alternative prognostic scores that could be applied to any therapeutic modality have been recently proposed. They could represent complementary tools to the BCLC staging system and improve the stratification of HCC patients enrolled in clinical trials, as illustrated by the NIACE score. Prospective studies are needed to compare these scores and refine their role in the decision making process.

关键词： Scoring system Hepatocellular carcinoma Barcelona Clinic Liver Cancer staging system NIACE Transarterial chemoembolization

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