Digestive surgery · 2017
Importance of Screening for Esophagogastric Varices in Naïve Hepatocellular Carcinoma Patients within Milan Criteria: Indicator for Liver Transplantation.
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Kawakami Takamasa, Hiraoka Atsushi, Michitaka Kojiro, Ninomiya Tomoyuki, Hirooka Masashi, Hiasa Yoichi
Аннотация
BACKGROUND/AIMS: Patients with hepatocellular carcinoma (HCC) beyond Milan criteria (MC) are not eligible for liver transplantation (LT). To elucidate prognostic factors significantly linked to recurrence beyond MC or death related to the liver, we evaluated the clinical features in a series of HCC patients within MC at baseline.
METHODS: We enrolled 255 naïve HCC patients (≤70 years) within the MC who underwent upper-gastrointestinal-endoscopy, and were treated with resection or radiofrequency ablation (62 years old [median]; male:female = 202:53; Child-Pugh A:B = 216:39). A finding of esophagogastric varices (EGV) with an enlarged tortuous or coil shape, and past history of treatment for EGV were classified as clinically significant.
RESULTS: Following curative therapy, there was a significant difference for both 3- and 5-year rates of recurrence beyond the MC or liver-related death between the patients with and without significant-EGV (42.8 and 64.3% vs. 25.2 and 41.2%, respectively; p < 0.001). Positive for significant-EGV, multiple tumor, and elevated levels of fucosylated-alpha-fetoprotein (≥10%) and des-gamma-carboxy-prothrombin (≥100 mAU/mL) were significant prognostic factors for recurrence beyond the MC or liver-related death in multivariate analysis (hazard ratio [HR] 2.020, p = 0.002; HR 1.880, p = 0.005; HR 1.626, p = 0.045; HR 1.722, p = 0.011, respectively).
CONCLUSION: LT should be considered for EGV-positive patients with naïve HCC and within the MC.
METHODS: We enrolled 255 naïve HCC patients (≤70 years) within the MC who underwent upper-gastrointestinal-endoscopy, and were treated with resection or radiofrequency ablation (62 years old [median]; male:female = 202:53; Child-Pugh A:B = 216:39). A finding of esophagogastric varices (EGV) with an enlarged tortuous or coil shape, and past history of treatment for EGV were classified as clinically significant.
RESULTS: Following curative therapy, there was a significant difference for both 3- and 5-year rates of recurrence beyond the MC or liver-related death between the patients with and without significant-EGV (42.8 and 64.3% vs. 25.2 and 41.2%, respectively; p < 0.001). Positive for significant-EGV, multiple tumor, and elevated levels of fucosylated-alpha-fetoprotein (≥10%) and des-gamma-carboxy-prothrombin (≥100 mAU/mL) were significant prognostic factors for recurrence beyond the MC or liver-related death in multivariate analysis (hazard ratio [HR] 2.020, p = 0.002; HR 1.880, p = 0.005; HR 1.626, p = 0.045; HR 1.722, p = 0.011, respectively).
CONCLUSION: LT should be considered for EGV-positive patients with naïve HCC and within the MC.
Предметные рубрики MeSH
AgedBiomarkersCarcinoma, HepatocellularCatheter AblationEndoscopy, GastrointestinalEsophageal and Gastric VaricesFemaleHepatectomyHumansLiver NeoplasmsLiver TransplantationMaleMass ScreeningMiddle AgedNeoplasm Recurrence, LocalPatient SelectionPrognosisProtein PrecursorsProthrombinRetrospective StudiesSurvival Ratealpha-Fetoproteins