J Clin Gastroenterol. 2018 Jan 19. doi: 10.1097/MCG.0000000000000981. [Epub ahead of print]
A Model for Adaptive Decision Making of "Ablate-and-Wait" Versus Transplantation in Patients With Hepatocellular Carcinoma.Kim HY1, Kim W2, Jung YJ2, Lee JH2, Yu SJ2, Kim YJ2, Yoon JH2, Lee HW3, Kim H4, Yi NJ4, Lee KW4, Suh KS4. Author information 1Department of Internal Medicine, College of Medicine, Ewha Womans University.2Departments of Internal Medicine.3Surgery, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine.4Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
AbstractBACKGROUND/AIMS: In patients with early-stage hepatocellular carcinoma (HCC), selection of candidates for liver transplantation (LT) requires refinement based on tumor biology to maximize the outcome. We aimed to prognosticate LT candidates with HCC using a risk prediction model for post-LT recurrence.
PATIENTS AND METHODS: A total of 197 consecutive patients were included who underwent LT for hepatitis B-related HCC within the Milan criteria. A risk prediction model was developed for post-LT recurrence using the Cox model and was internally validated.
RESULTS: Among those undergoing LT as their first HCC treatment (n=70, initial LT group), poor prognosis was associated with maximal tumor size and multinodularity. The remaining 127 patients (deferred LT group) received radiofrequency ablation (n=69) and/or transarterial chemoembolization (n=98) before LT. Multinodularity, maximal tumor size, posttransarterial chemoembolization progressive disease, baseline alpha-fetoprotein, and alpha-fetoprotein difference (between baseline and pre-LT) were incorporated into a risk prediction model for the deferred LT group, which was thereby stratified into low-risk (score<5), intermediate-risk, and high-risk (score≥8) subgroups. Recurrence-free survival was significantly different among the deferred LT prognostic subgroups (P<0.001).
CONCLUSIONS: This risk prediction model may help refinement of "ablate-and-wait" strategy for LT candidates by avoiding LT in those with either high risk score at baseline or increasing score under repeated locoregional therapies.
J Clin Gastroenterol。 2018年1月19日。doi：10.1097 / MCG.0000000000000981。 [电子版提前打印]
肝细胞癌患者“消融”与移植适应性决策模型的建立。
Kim HY1 Kim W2 Jung YJ2 Lee JH2 Yu SJ2 Kim YJ2 Yoon JH2 Lee HW3 Kim H4 Yi Y4 Lee Kw4 Suh KS4。
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