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Hepatobiliary Surgery and Nutrition 2018年第6期7卷 487-489页

作者： carlo sposito Vincenzo Mazzaferro Department of Gastrointestinal Surgery and Liver Transplantation Fondazione IRCCS Istituto Nazionale Tumori di MilanoMilanItaly University of Milan MilanItaly

Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death *** carcinoma(HCC)represents nearly 90%of primary liver cancers,and constitutes a major health problem worldwide(1).When diagnosed at an early stage of the disease,HCC may benefit from potentially curative treatments such as liver resection,liver transplantation or local *** effectiveness of treatment in early and very early stages,most patients are diagnosed or progress to an intermediate or advanced stage,in which treatment options are limited and the prognosis is poor(2).

关键词： patients Liver treatment

Therapeutic strategies for post-transplant recurrence of hepatocellular carcinoma

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World Journal of Gastroenterology 2022年第34期28卷 4929-4942页

作者： carlo sposito Davide Citterio Matteo Virdis carlo Battiston Michele Droz Dit Busset Maria Flores Vincenzo Mazzaferro HPB Surgery Hepatology and Liver TransplantationFondazione IRCCS Istituto Nazionale Tumori di MilanoMilan 20133Italy Department of Oncology and Hemato-Oncology University of MilanMilan 20100Italy

Despite stringent selection criteria,hepatocellular carcinoma recurrence after liver transplantation(LT)still occurs in up to 20%of cases,mostly within the first 2–3 *** adjuvant treatments to prevent such an occurrence have been developed so ***,a balanced use of immunosuppression with minimal dose of calcineurin inhibitors and possible addition of mammalian target of rapamycin inhibitors is strongly ***,several pre-and posttransplant predictors of recurrence have been identified and may help determine the frequency and duration of post-transplant *** recurrence occurs,the outcomes are poor with a median survival of 12 mo according to most retrospective *** factor that most impacts survival after recurrence is timing(within 1–2 years from LT according to different authors).Several therapeutic options may be chosen in case of recurrence,according to timing and disease *** treatment seems to provide a survival benefit,especially in case of late recurrence,while the benefit of locoregional treatments has been suggested only in small retrospective *** systemic treatment is indicated,sorafenib has been proved safe and effective,while only few data are available for lenvatinib and regorafenib in second *** use of immune checkpoint inhibitors is controversial in this setting,given the safety warnings for the risk of acute rejection.

关键词： Liver transplantation Hepatocellular carcinoma Immunosuppression Recurrence Surgical treatment Locoregional treatment Systemic treatment

Competing risk analysis on outcome after hepatic resection of hepatocellular carcinoma in cirrhotic patients

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World Journal of Gastroenterology 2017年第8期23卷 1469-1476页

作者： Alessandro Cucchetti carlo sposito Antonio Daniele Pinna Davide Citterio Matteo CesconMarco Bongini Giorgio Ercolani Christian Cotsoglou Lorenzo Maroni Vincenzo Mazzaferro Department of Medical and Surgical Sciences DIMECS.Orsola-Malpighi HospitalAlma Mater StudiorumUniversity of Bologna Gastrointestinal Surgery and Liver Transplantation Fondazione IRCCS Istituto Nazionale Tumori(National Cancer Institute

To investigate death for liver failure and for tumor recurrence as competing events after hepatectomy of hepatocellular *** from 864 cirrhotic Child-Pugh class A consecutive patients, submitted to curative hepatectomy (1997-2013) at two tertiary referral hospitals, were used for competing-risk analysis through the Fine and Gray method, aimed at assessing in which circumstances the oncological benefit from tumour removal is greater than the risk of dying from hepatic decompensation. To accomplish this task, the average risk of these two competing events, over 5 years of follow-up, was calculated through the integral of each cumulative incidence function, and represented the main comparison *** a median follow-up of 5.6 years, death was attributable to tumor recurrence in 63.5%, and to liver failure in 21.2% of cases. In the first 16 mo, the risk of dying due to liver failure exceeded that of dying due to tumor relapse. Tumor stage only affects death from recurrence; whereas hepatitis C infection, Model for End-stage Liver Disease score, extent of hepatectomy and portal hypertension influence death from liver failure (P < 0.05 in all cases). The combination of these clinical and tumoral features identifies those patients in whom the risk of dying from liver failure did not exceed the tumour-related mortality, representing optimal surgical candidates. It also identifies those clinical circumstances where the oncological benefit would be borderline or even where the surgery would be *** knowledge of these competing events can be used to weigh the risks and benefits of hepatic resection in each clinical circumstance, separating optimal from non-optimal surgical candidates.

关键词： Hepatocellular carcinoma Liver failure Hepatic resection Survival Competing risk Tumour recurrence

Development of a prognostic scoring system for resectable hepatocellular carcinoma

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World Journal of Gastroenterology 2016年第36期22卷 8194-8202页

作者： carlo sposito Stefano Di Sandro Federica Brunero Vincenzo Buscemi carlo Battiston Andrea Lauterio Marco Bongini Luciano De Carlis Vincenzo Mazzaferro Gastrointestinal Surgery and Liver Transplantation Fondazione IRCCS Istituto Nazionale Tumori University of Milan General Surgery and Organ Transplants Ospedale Niguarda Ca’Granda20133 Milan Italy Clinical Trial Office and Biomedical Statistic Fondazione IRCCS Istituto Nazionale Tumori

AIM To develop a prognostic scoring system for overall survival(OS) of patients undergoing liver resection(LR) for hepatocellular carcinoma(HCC).METHODS Consecutive patients who underwent curative LR for HCC between 2000 and 2013 were identified. The series was randomly divided into a training and a validation set. A multivariable Cox model for OS was fitted to the training set. The beta coefficients derived from the Cox model were used to define a prognostic scoring system for OS. The survival stratification was then tested, and the prognostic scoring system was compared with the European Association for the Study of the Liver(EASL)/American Association for the Study of Liver Diseases(AASLD) surgical criteria by means of Harrell's C *** A total of 917 patients were considered. Five variables independently correlated with post-LR survival: Model for End-stage Liver Disease score, hepatitis C virus infection, number of nodules, largest diameter and vascular invasion. Three risk classes were identified, and OS for the three risk classes was significantly different both in the training(P < 0.0001) and the validation set(P = 0.0002). Overall, 69.4% of patients were in the low-risk class, whereas only 37.8% were eligible to surgery according to EASL/AASLD. Survival of patients in the low-risk class was not significantly different compared with surgical indication for EASL/AASLD guidelines(77.2 mo vs 82.5 mo respectively, P = 0.22). Comparison of Harrell's C statistics revealed no significant difference in predictive power between the two systems(-0.00999, P = 0.667).CONCLUSION This study established a new prognostic scoring system that may stratify HCC patients suitable for surgery, expanding surgical eligibility with respect to EASL/AASLD criteria with no harm on survival.

关键词： Hepatocellular carcinoma Liver resection Liver cirrhosis Prognosis Survival study