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A Model for Adaptive Decision Making of "Ablate-and-Wait" Versus Transplantation in Patients With Hepatocellular Carcinoma
- A Model for Adaptive Decision Making of "Ablate-and-Wait" Versus Transplantation in Patients With Hepatocellular Carcinoma
- Kim, Hwi Young; Kim, Won; Jung, Yong Jin; Lee, Jeong-Hoon; Yu, Su Jong; Kim, Yoon Jun; Yoon, Jung-Hwan; Lee, Hae Won; Kim, Hyeyoung; Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk
- Ewha Authors
- 김희영; 김휘영
- SCOPUS Author ID
- Issue Date
- Journal Title
- JOURNAL OF CLINICAL GASTROENTEROLOGY
- 0192-0790; 1539-2031
- vol. 52, no. 7, pp. 655 - 661
- hepatocellular carcinoma; transplantation; clinical decision making
- LIPPINCOTT WILLIAMS & WILKINS
- SCI; SCIE; SCOPUS
- 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.
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