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A Model for Adaptive Decision Making of "Ablate-and-Wait" Versus Transplantation in Patients With Hepatocellular Carcinoma

Title
A Model for Adaptive Decision Making of "Ablate-and-Wait" Versus Transplantation in Patients With Hepatocellular Carcinoma
Authors
Kim, Hwi YoungKim, WonJung, Yong JinLee, Jeong-HoonYu, Su JongKim, Yoon JunYoon, Jung-HwanLee, Hae WonKim, HyeyoungYi, Nam-JoonLee, Kwang-WoongSuh, Kyung-Suk
Ewha Authors
김희영김휘영
SCOPUS Author ID
김휘영scopus
Issue Date
2018
Journal Title
JOURNAL OF CLINICAL GASTROENTEROLOGY
ISSN
0192-0790JCR Link1539-2031JCR Link
Citation
vol. 52, no. 7, pp. 655 - 661
Keywords
hepatocellular carcinomatransplantationclinical decision making
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Indexed
SCI; SCIE; SCOPUS WOS scopus
Abstract
Background/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 (score8) 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.
DOI
10.1097/MCG.0000000000000981
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연구기관 > 의과학연구소 > Journal papers
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