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What Should Be the Rules for Downstaging for Hepatocellular Carcinoma?

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Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Introduction

Liver transplantation remains the main curative treatment method for hepatocellular carcinoma. There are several criteria for hepatocellular carcinoma to be eligible for liver transplantation, and it depends on main transplantation centers worldwide. Locoregional treatments and downstaging protocols are used for either to achieve these criteria or to prevent drop outs on the transplant waiting lists. But who can benefit from these bridging therapies effectively for the main purpose of curative treatment? Main contraindications are known for locoregional treatments like cirrhosis or low hepatic function, total main portal vein occlusion, and extrahepatic metastasis. HCCs, which are confined to liver but have high tumor burden, remains the main controversial issue.

Aim

On this aspect, we reviewed the literature for downstaging protocols for hepatocellular carcinoma with their effect on survival and recurrence rates after liver transplantation.

Conclusion

Although candidates for downstaging is still controversial, with the absence of main contraindications, LRT can be applied to selected HCCs, which have a certain degree of tumor burden.

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Data Availability

Not applicable.

Abbreviations

LT:

Liver transplantation

HCC:

Hepatocellular carcinoma

AFP:

Alpha fetoprotein

DCP:

Des-gamma-carboxy prothrombin

LRT:

Locoregional treatment

BCLC:

Barcelona Clinic Liver Cancer

AJCC:

American Joint Committee on Cancer

UNOS:

United Network for Organ Sharing

TACE:

Transarterial chemoembolization

TARE:

Transarterial radioembolization

RFA:

Radiofrequency ablation

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Authors and Affiliations

  1. Faculty of Medicine, Department of Surgery, Institute of Liver Transplantation, Inonu University, 44280, Malatya, Turkey

    Abuzer Dirican & Serdar Karakas

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  1. Abuzer Dirican
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  2. Serdar Karakas
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All authors contributed equally to the manuscript.

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Correspondence to Serdar Karakas.

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Dirican, A., Karakas, S. What Should Be the Rules for Downstaging for Hepatocellular Carcinoma?. J Gastrointest Canc 51, 1148–1151 (2020). https://doi.org/10.1007/s12029-020-00490-0

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