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Non-transplantable Recurrence After Resection for Transplantable Hepatocellular Carcinoma: Implication for Upfront Treatment Choice

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objectives

To identify the preoperative risk factors for prediction of non-transplantable recurrence (NTR) after tumor resection for early-stage hepatocellular carcinoma (HCC) to assist in patient selection relative to upfront liver resection (LR) versus liver transplantation (LT).

Methods

Patients who underwent curative resection for transplantable HCC and chronic liver disease were identified from an international multi-institutional database. NTR was defined as recurrence beyond the Milan or UCSF criteria, and the preoperative risk factors of NTR were investigated.

Results

Among 293 patients with transplantable HCC within Milan criteria and 320 within UCSF criteria, 113 (38.6%) and 131 (40.9%) patients developed tumor recurrence, respectively. Among patients who recurred, NTR was present in 32 (28.3%) patients within Milan and 35 (26.7%) within UCSF criteria. When either Milan or UCSF criteria was adopted, three preoperative risk factors including liver cirrhosis, tumor size > 3 cm, and multiple lesions were consistently identified as risk factors associated with NTR after curative resection. By summing up the three factors, a scoring model was established and the incidence of NTR among patients with 0, 1 or ≥ 2 risk factors incrementally increased from 4.5%, 13.3% to 20.5% when Milan criteria was used, and from 4.5%, 12.4% to 33.9% when UCSF criteria was adopted. The model demonstrated very good discriminatory power on internal validation (n = 5,000) (c-index 0.689 for Milan criteria, and 0.715 for UCSF criteria).

Conclusions

Whereas surgical resection may be optimal first-line treatment for patients with no or one risk factor, patients with ≥ 2 risk factors should be considered for upfront liver transplantation.

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Abbreviations

HCC:

Hepatocellular carcinoma

LR:

Liver resection

LT:

Liver transplantation

UCSF:

University of California, San Francisco

TR:

Transplantable recurrence

NTR:

Non-transplantable recurrence

AFP :

Alpha-fetoprotein

OS:

Overall survival

RFS:

Recurrence-free survival

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Funding

Xu-Feng Zhang received grants from the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University of China (No. XJTU1AF-CRF-2017–004).

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Xu-Feng Zhang, Feng Xue & Yi Lv

  2. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Xu-Feng Zhang, Fabio Bagante & Timothy M. Pawlik

  3. Department of Surgery, University of Verona, Verona, Italy

    Fabio Bagante & Alfredo Guglielmi

  4. Department of Surgery, Ospedale San Raffaele, Milano, Italy

    Francesca Ratti & Luca Aldrighetti

  5. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques & Silvia Silva

  6. Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France

    Olivier Soubrane

  7. Department of Surgery, Westmead Hospital, Sydney, Australia

    Vincent Lam

  8. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides

  9. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Irinel Popescu, Razvan Grigorie & Sorin Alexandrescu

  10. Department of Surgery, University of Ottawa, Ottawa, Canada

    Guillaume Martel & Aklile Workneh

  11. Department of Surgery, School of Medicine, The University of Sydney, Sydney, Australia

    Tom Hugh

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  1. Xu-Feng Zhang
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Correspondence to Timothy M. Pawlik.

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Zhang, XF., Xue, F., Bagante, F. et al. Non-transplantable Recurrence After Resection for Transplantable Hepatocellular Carcinoma: Implication for Upfront Treatment Choice. J Gastrointest Surg 26, 1021–1029 (2022). https://doi.org/10.1007/s11605-021-05206-8

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