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World Journal of Surgery
Published in: World Journal of Surgery 1/2019

01-01-2019 | Original Scientific Report

Liver Resection for Solitary Transplantable Hepatocellular Carcinoma: The Role of AFP-Score

Authors: Benjamin Menahem, Christophe Duvoux, Nathalie Ganne, Ariane Mallat, Olivier Seror, Julien Calderaro, Guy Launoy, Arnaud Alves, Daniel Cherqui, Alain Luciani, Alexis Laurent

Published in: World Journal of Surgery | Issue 1/2019

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Abstract

Background

In 2012, the Liver Transplant French Study Group built the alpha-fetoprotein-score (AFP-score), which improved significantly the prediction of tumor recurrence in case of liver transplantation for HCC when compared to Milan criteria. The aim of the study was to test the AFP score in case of liver resection (LR) for HCC.

Methods

From 1990 to 2012, 347 patients underwent a liver resection for HCC developed on chronic liver disease (CLD). All patients with solitary HCC <60 mm were included. The primary end point was to investigate if the AFP-score at the first LR was predictive of recurrence and if recurrence occurred within the AFP-score. The secondary end points were overall survival (OS) and disease-free survival.

Results

One hundred and eight patients fulfilled the inclusions criteria. After a median follow-up of 65.4IQR [13–114] months, recurrence occurred in 64.8% (70/108) patients. Among the study population, 96 were “in AFP-score” (i.e., ≤2) of whom 60.4% (58/96) developed a recurrence that was cured in curative intent. In contrast, all patients “out AFP-score” experienced recurrence, and 25% were eligible for curative treatment. At the end of the follow-up, 26 patients were listed for liver transplantation (LT). Among them, 21 were finally transplanted. The 5-year OS after salvage LT was 68.5%95%CI [50.2–93.0].

Conclusion

AFP-score is a useful tool for patients selection after LR for solitary HCC developed on CLD. For patients “in AFP-score,” up-front LR provides good survival and allows to avoid up-front LT in case of recurrence.
Literature
1.
Bosch FX, Ribes J, Diaz M et al (2004) Primary liver cancer: worldwide incidence and trends. Gastroenterology 127(5 Suppl 1):S5–S16CrossRefPubMed
2.
Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362(9399):1907–1917CrossRef
3.
Caldwell SH, Crespo DM, Kang HS et al (2004) Obesity and hepatocellular carcinoma. Gastroenterology 127(5 Suppl 1):S97–S103CrossRefPubMed
4.
Ravaioli M, Grazi GL, Piscaglia F et al (2008) Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria. Am J Transplant 8:2547–2557CrossRefPubMed
5.
Neuberger J, James O (1999) Guidelines for selection of patients for liver transplantation in the era of donor-organ shortage. Lancet 354(9190):1636–1639CrossRefPubMed
6.
Duvoux C, Roudot-Thoraval F, Decaens T et al (2012) Liver transplantation for hepatocellular carcinoma: a model including alpha-fetoprotein improves the performance of Milan criteria. Gastroenterology 143(4):986–994 (e3; quiz e14-5) CrossRefPubMed
7.
Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334(11):693–699CrossRef
8.
Piñero F, Tisi Baña M, de Ataide EC, Hoyos Duque S, Marciano S, Varón A et al (2016) Liver transplantation for hepatocellular carcinoma: evaluation of the alpha-fetoprotein model in a multicenter cohort from Latin America. Liver Int. 36:1657–1667. https://​doi.​org/​10.​1111/​liv.​13159 Epub 2016 Jun 15 CrossRefPubMed
9.
10.
Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 30(6):1434–1440CrossRefPubMed
11.
Majno PE, Sarasin FP, Mentha G et al (2000) Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: an outcome-oriented decision analysis. Hepatology 31(4):899–906CrossRefPubMed
12.
Kelley RK, Yao F (2012) Salvage liver transplantation for recurrent hepatocellular carcinoma after radiofrequency ablation: a new strategy? J Hepatol 56:14–16CrossRefPubMed
13.
Fuks D, Dokmak S, Paradis V et al (2012) Benefit of initial resection of hepatocellular carcinoma followed by transplantation in case of recurrence: an intention-to-treat analysis. Hepatology 55:132–140CrossRefPubMed
14.
Adam R, Azoulay D, Castaing D et al (2003) Liver resection as a bridge to transplantation for hepatocellular carcinoma on cirrhosis: a reasonable strategy? Ann Surg 238:508–518 (discussion 518-9) CrossRefPubMedPubMedCentral
15.
Belghiti J, Cortes A, Abdalla EK et al (2003) Resection prior to liver transplantation for hepatocellular carcinoma. Ann Surg 238:885–892 (discussion 892-3) CrossRefPubMedPubMedCentral
16.
Cherqui D, Laurent A, Mocellin N et al (2009) Liver resection for transplantable hepatocellular carcinoma: long-term survival and role of secondary liver transplantation. Ann Surg 250:738–746CrossRefPubMed
17.
18.
19.
The French METAVIR Cooperative Study Group (1994) Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. Hepatology 20(1 Pt 1):15–20CrossRef
20.
Pugh RN, Murray-Lyon IM, Dawson JL et al (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60(8):646–649CrossRef
21.
Cherqui D, Laurent A, Tayar C et al (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 243(4):499–506CrossRefPubMedPubMedCentral
22.
Chouillard E, Cherqui D, Tayar C et al (2003) Anatomical bi- and trisegmentectomies as alternatives to extensive liver resections. Ann Surg 238(1):29–34PubMedPubMedCentral
23.
Laurent A, Cherqui D, Lesurtel M et al (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138(7):763–769 (discussion 769) CrossRefPubMed
24.
Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359(4):378–390CrossRef
25.
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRef
26.
Pang YY (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339 (HPB (Oxford) 2002; 4(2):99; author reply 99-100) CrossRef
27.
Edmondson HA, Steiner PE (1954) Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer 7(3):462–503CrossRef
28.
Margarit C, Escartin A, Castells L et al (2005) Resection for hepatocellular carcinoma is a good option in Child-Turcotte-Pugh class A patients with cirrhosis who are eligible for liver transplantation. Liver Transplant 11:1242–1251CrossRef
29.
Sapisochin G, Castells L, Dopazo C et al (2013) Single HCC in cirrhotic patients: liver resection or liver transplantation? long-term outcome according to an intention-to-treat basis. Ann Surg Oncol 20(4):1194–1202CrossRefPubMed
30.
Sogawa H, Shrager B, Jibara G et al (2013) Resection or transplant-listing for solitary hepatitis C-associated hepatocellular carcinoma: an intention-to-treat analysis. HPB 15:134–141CrossRefPubMed
31.
Shah SA, Cleary SP, Tan JC et al (2007) An analysis of resection vs transplantation for early hepatocellular carcinoma: defining the optimal therapy at a single institution. Ann Surg Oncol 14:2608–2614CrossRefPubMed
32.
Jiang L, Liao A, Wen T et al (2014) Living donor liver transplantation or resection for Child-Pugh A hepatocellular carcinoma patients with multiple nodules meeting the Milan criteria. Transpl Int 27:562–569CrossRefPubMed
33.
34.
Li C, Zhu WJ, Wen TF et al (2014) Child-Pugh A hepatitis B-related cirrhotic patients with a single hepatocellular carcinoma up to 5 cm: liver transplantation vs. resection. J Gastrointest Surg 18(8):1469–1476CrossRefPubMed
35.
EAFTSOT Liver, EOFRATO Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943CrossRef
36.
Feo F, Pascale RM (2015) Multifocal hepatocellular carcinoma: intrahepatic metastasis or multicentric carcinogenesis? Ann Transl Med 3(1):4PubMedPubMedCentral
37.
Scatton O, Zalinski S, Terris B et al (2008) Hepatocellular carcinoma developed on compensated cirrhosis: resection as a selection tool for liver transplantation. Liver Transplant 14:779–788CrossRef
38.
Roberts JP, Venook A, Kerlan R et al (2010) Hepatocellular carcinoma: ablate and wait versus rapid transplantation. Liver Transplant 16(8):925–929CrossRef
39.
Imamura H, Seyama Y, Kokudo N et al (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138(11):1198–1206 (discussion 1206) CrossRefPubMed
40.
Cucchetti A, Cescon M, Golfieri R et al (2016) Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma. J Hepatol 64(1):79–86CrossRefPubMed
41.
Berzigotti A, Reig M, Abraldes JG et al (2015) Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology (Baltimore, Md.) 61:526–536CrossRef
42.
Nagasue N, Yukaya H, Ogawa Y et al (1986) Second hepatic resection for recurrent hepatocellular carcinoma. Br J Surg 73(6):434–438CrossRefPubMed
43.
Ho CM, Lee PH, Chen CL et al (2012) Long-term outcomes after resection versus transplantation for hepatocellular carcinoma within UCSF criteria. Ann Surg Oncol 19(3):826–833CrossRefPubMed
44.
Tsujita E, Yamashita Y, Takeishi K et al (2012) Poor prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma in the modern era. Am Surg 78(4):419–425PubMed
45.
Minagawa M, Makuuchi M, Takayama T et al (2003) Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 238:703–710CrossRefPubMedPubMedCentral
46.
Chan DL, Morris DL, Chua TC (2013) Clinical efficacy and predictors of outcomes of repeat hepatectomy for recurrent hepatocellular carcinoma—a systematic review. Surg Oncol 22(2):e23–e30CrossRefPubMed
47.
N’Kontchou G, Mahamoudi A, Aout M et al (2009) Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis. Hepatology 50:1475–1483CrossRefPubMed
48.
Ho CM, Lee PH, Shau WY et al (2012) Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy: comparative effectiveness of treatment modalities. Surgery 151(5):700–709CrossRefPubMed
Metadata
Title
Liver Resection for Solitary Transplantable Hepatocellular Carcinoma: The Role of AFP-Score
Authors
Benjamin Menahem
Christophe Duvoux
Nathalie Ganne
Ariane Mallat
Olivier Seror
Julien Calderaro
Guy Launoy
Arnaud Alves
Daniel Cherqui
Alain Luciani
Alexis Laurent
Publication date
01-01-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 1/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4769-5

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