Living donor liver transplantation or hepatic resection combined with intraoperative radiofrequency ablation for Child-Pugh A hepatocellular carcinoma patient with Multifocal Tumours Meeting the University of California San Francisco (UCSF) criteria.

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Abstrakt

Tytuł:: Living donor liver transplantation or hepatic resection combined with intraoperative radiofrequency ablation for Child-Pugh A hepatocellular carcinoma patient with Multifocal Tumours Meeting the University of California San Francisco (UCSF) criteria.
Autorzy:: Xu X; Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Pu X; Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Jiang L; Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China. .
Huang Y; Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Yan L; Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Yang J; Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Wen T; Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Li B; Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Wu H; Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Wang W; Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Źródło:: Journal of cancer research and clinical oncology [J Cancer Res Clin Oncol] 2021 Feb; Vol. 147 (2), pp. 607-618. Date of Electronic Publication: 2020 Aug 27.
Typ publikacji:: Comparative Study; Journal Article
Język:: English
Imprint Name(s):: Original Publication: Berlin ; New York : Springer-Verlag.
MeSH Terms:: Hepatectomy*
Liver Transplantation*
Living Donors*
Radiofrequency Ablation*
Carcinoma, Hepatocellular/*surgery
Liver Neoplasms/*surgery
Adult ; Aged ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/pathology ; Female ; Humans ; Liver Neoplasms/mortality ; Liver Neoplasms/pathology ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Nomograms
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Grant Information:: 81400636 grants from the National Natural Science Foundation of China; 2019YFS0203 Sichuan Province Key Research and Development Project; 2020HXFH028 Key Clinical Research Incubation Project of West China Hospital of Sichuan University
Contributed Indexing:: Keywords: Hepatic resection; Hepatocellular carcinoma; Living donor liver transplantation; Multifocal tumours; Radiofrequency ablation; UCSF criteria
Entry Date(s):: Date Created: 20200828 Date Completed: 20210201 Latest Revision: 20210201
Update Code:: 20240105
DOI:: 10.1007/s00432-020-03364-x
PMID:: 32852635
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Background: How much difference there is between hepatic resection (HR) combined with intraoperative radiofrequency ablation (RFA) and living donor liver transplantation (LDLT) in treatment of multifocal hepatocellular carcinomas (HCCs) remains unclear. This study compared outcomes for patients with multifocal HCCs meeting the University of California San Francisco (UCSF) criteria treated by LDLT or HR + RFA.
Methods: A total of 126 consecutive Child-Pugh A patients with multifocal HCCs meeting the UCSF criteria, who underwent LDLT (n = 51) or HR + RFA (n = 75), were included. Propensity score (PS) matching was performed to adjust for baseline differences. Overall survival (OS) and recurrence-free survival (RFS) were calculated, and subgroup, multivariate and nomogram analyses were performed.
Results: LDLT provided significantly better OS and RFS than did HR + RFA before and after PS matching and reduced the dropout rate on waiting list, but HR + RFA was more convenient, less invasive and less cost. Patients with all lesions located in the same lobe had better OS and RFS than those located in the different lobes after HR + RFA. Multivariate and nomogram analyses revealed that HR + RFA, alpha-fetoprotein ≥ 400 ng/mL, the major tumour size > 3 cm and microvascular invasion were independent predictors of poor prognosis.
Conclusion: For Child-Pugh A patients with multiple HCCs meeting the UCSF criteria, LDLT may offer significantly better long-term results than did HR + RFA, and HR + RFA may still be considered as an acceptable curative therapy for those without considering transplantation or as a bridge treatment for a patient, with a plan for transplantation in the future.

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