Comparison of the long‐term outcomes of patients with hepatocellular carcinoma within the Milan criteria treated by ablation, resection, or transplantation
Abstract Background Liver transplantation (LT), resection (LR), and ablation (LA) are three curative‐intent treatment options for patients with early hepatocellular carcinoma (HCC). We aimed to develop a prognostic calculator to compare the long‐term outcomes following each of these therapies. Metho...
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2023-02-01
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| Online Access: | https://doi.org/10.1002/cam4.5063 |
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| author | Ning‐Ning Zhang Jian Zheng Ying Wu Jia‐Yu Lv Shu‐Wen Zhang Ya‐Min Zhang Wen‐Tao Jiang Tian‐Qiang Song Victoria Kim Samer Tohme Tian Liu Wei Zhang Jie Gu Ze‐Yu Wang Yu‐Hong Suo Shuai Wang Wang Li Li Zhang Yan Xie Yong‐He Zhou Jian‐Yong Liu Yi‐Bo Qiu Zhong‐Yang Shen Ji‐Hui Hao David Geller Wei Lu |
| author_facet | Ning‐Ning Zhang Jian Zheng Ying Wu Jia‐Yu Lv Shu‐Wen Zhang Ya‐Min Zhang Wen‐Tao Jiang Tian‐Qiang Song Victoria Kim Samer Tohme Tian Liu Wei Zhang Jie Gu Ze‐Yu Wang Yu‐Hong Suo Shuai Wang Wang Li Li Zhang Yan Xie Yong‐He Zhou Jian‐Yong Liu Yi‐Bo Qiu Zhong‐Yang Shen Ji‐Hui Hao David Geller Wei Lu |
| author_sort | Ning‐Ning Zhang |
| collection | DOAJ |
| description | Abstract Background Liver transplantation (LT), resection (LR), and ablation (LA) are three curative‐intent treatment options for patients with early hepatocellular carcinoma (HCC). We aimed to develop a prognostic calculator to compare the long‐term outcomes following each of these therapies. Methods A total of 976 patients with HCC within the Milan criteria who underwent LT, LR, and LA between 2009 and 2019 from four institutions were evaluated. Multistate competing risks prediction models for recurrence‐free survival (RFS), recurrence within the Milan criteria (RWM), and HCC‐specific survival (HSS) were derived to develop a prognostic calculator. Results During a median follow‐up of 51 months, 420 (43%) patients developed recurrence. In the multivariate analysis, larger tumor size, multinodularity, older age, male, higher alpha‐fetoprotein (AFP), higher albumin‐bilirubin (ALBI) grade, and the presence of portal hypertension were significantly associated with higher recurrence and decreased survival rates. The RFS and HSS were both significantly higher among patients treated by LT than by LR or LA and significantly higher between patients treated by LR than by LA (all p < 0.001). For multinodular HCC ≤3 cm, although LT had better RFS and HSS than LR or LA, LA was noninferior to LR. An online prognostic calculator was then developed based on the preoperative clinical factors that were independently associated with outcomes to evaluate RFS, RWM, and HSS at different time intervals for all three treatment options. Conclusions Although LT resulted in the best recurrence and survival outcomes, LR and LA also offered durable long‐term alternatives. This prognostic calculator is a useful tool for clinicians to guide an informed and personalized discussion with patients based on their tumor biology and liver function. |
| format | Article |
| id | doaj-art-dfd365d6b5a841feb918da5fa0a01eba |
| institution | OA Journals |
| issn | 2045-7634 |
| language | English |
| publishDate | 2023-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-dfd365d6b5a841feb918da5fa0a01eba2025-08-20T01:53:22ZengWileyCancer Medicine2045-76342023-02-011232312232410.1002/cam4.5063Comparison of the long‐term outcomes of patients with hepatocellular carcinoma within the Milan criteria treated by ablation, resection, or transplantationNing‐Ning Zhang0Jian Zheng1Ying Wu2Jia‐Yu Lv3Shu‐Wen Zhang4Ya‐Min Zhang5Wen‐Tao Jiang6Tian‐Qiang Song7Victoria Kim8Samer Tohme9Tian Liu10Wei Zhang11Jie Gu12Ze‐Yu Wang13Yu‐Hong Suo14Shuai Wang15Wang Li16Li Zhang17Yan Xie18Yong‐He Zhou19Jian‐Yong Liu20Yi‐Bo Qiu21Zhong‐Yang Shen22Ji‐Hui Hao23David Geller24Wei Lu25Department of Hepatobiliary Oncology, Liver Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University Tianjin ChinaDepartment of Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania USASchool of Statistics and Data Science Nankai University, Key Laboratory for Medical Data Analysis and Statistical Research of Tianjin Tianjin ChinaDepartment of Hepatology The Third Central Hospital of Tianjin Tianjin ChinaDepartment of Hepatobiliary Oncology, Liver Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University Tianjin ChinaDepartment of Hepatobiliary Surgery, Tianjin First Central Hospital, Tianjin Key Laboratory for Organ Transplantation Tianjin ChinaDepartment of Liver Transplantation, Tianjin First Center Hospital, NHC Key Laboratory for Critical Care Medicine, Key Laboratory of Transplantation, Chinese Academy of Medical Sciences Tianjin ChinaDepartment of Hepatobiliary Surgery, Liver Cancer Center Tianjin Medical University Cancer Institute and Hospital National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Human Genetic Resources Sharing Service Platform Tianjin Medical University Tianjin ChinaDepartment of Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania USADepartment of Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania USADepartment of Hepatobiliary Oncology, Liver Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University Tianjin ChinaDepartment of Hepatobiliary Surgery, Liver Cancer Center Tianjin Medical University Cancer Institute and Hospital National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Human Genetic Resources Sharing Service Platform Tianjin Medical University Tianjin ChinaDepartment of Hepatobiliary Oncology, Liver Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University Tianjin ChinaDepartment of Hepatobiliary Oncology, Liver Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University Tianjin ChinaDepartment of Hepatobiliary Oncology, Liver Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University Tianjin ChinaDepartment of Hepatobiliary Oncology, Liver Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University Tianjin ChinaDepartment of Hepatobiliary Oncology, Liver Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University Tianjin ChinaDepartment of Liver Transplantation, Tianjin First Center Hospital, NHC Key Laboratory for Critical Care Medicine, Key Laboratory of Transplantation, Chinese Academy of Medical Sciences Tianjin ChinaDepartment of Liver Transplantation, Tianjin First Center Hospital, NHC Key Laboratory for Critical Care Medicine, Key Laboratory of Transplantation, Chinese Academy of Medical Sciences Tianjin ChinaTianjin Second People’s Hospital, Tianjin Medical Research Institute of Liver Disease Tianjin ChinaTianjin Second People’s Hospital, Tianjin Medical Research Institute of Liver Disease Tianjin ChinaDepartment of Hepatobiliary Oncology, Liver Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University Tianjin ChinaDepartment of Liver Transplantation, Tianjin First Center Hospital, NHC Key Laboratory for Critical Care Medicine, Key Laboratory of Transplantation, Chinese Academy of Medical Sciences Tianjin ChinaDepartment of Pancreatic Cancer Tianjin Medical University Cancer Institute and Hospital National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy Tianjin ChinaDepartment of Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania USADepartment of Hepatobiliary Oncology, Liver Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University Tianjin ChinaAbstract Background Liver transplantation (LT), resection (LR), and ablation (LA) are three curative‐intent treatment options for patients with early hepatocellular carcinoma (HCC). We aimed to develop a prognostic calculator to compare the long‐term outcomes following each of these therapies. Methods A total of 976 patients with HCC within the Milan criteria who underwent LT, LR, and LA between 2009 and 2019 from four institutions were evaluated. Multistate competing risks prediction models for recurrence‐free survival (RFS), recurrence within the Milan criteria (RWM), and HCC‐specific survival (HSS) were derived to develop a prognostic calculator. Results During a median follow‐up of 51 months, 420 (43%) patients developed recurrence. In the multivariate analysis, larger tumor size, multinodularity, older age, male, higher alpha‐fetoprotein (AFP), higher albumin‐bilirubin (ALBI) grade, and the presence of portal hypertension were significantly associated with higher recurrence and decreased survival rates. The RFS and HSS were both significantly higher among patients treated by LT than by LR or LA and significantly higher between patients treated by LR than by LA (all p < 0.001). For multinodular HCC ≤3 cm, although LT had better RFS and HSS than LR or LA, LA was noninferior to LR. An online prognostic calculator was then developed based on the preoperative clinical factors that were independently associated with outcomes to evaluate RFS, RWM, and HSS at different time intervals for all three treatment options. Conclusions Although LT resulted in the best recurrence and survival outcomes, LR and LA also offered durable long‐term alternatives. This prognostic calculator is a useful tool for clinicians to guide an informed and personalized discussion with patients based on their tumor biology and liver function.https://doi.org/10.1002/cam4.5063ablationhepatocellular carcinomaliver transplantationMilan criteriaprognostic calculatorresection |
| spellingShingle | Ning‐Ning Zhang Jian Zheng Ying Wu Jia‐Yu Lv Shu‐Wen Zhang Ya‐Min Zhang Wen‐Tao Jiang Tian‐Qiang Song Victoria Kim Samer Tohme Tian Liu Wei Zhang Jie Gu Ze‐Yu Wang Yu‐Hong Suo Shuai Wang Wang Li Li Zhang Yan Xie Yong‐He Zhou Jian‐Yong Liu Yi‐Bo Qiu Zhong‐Yang Shen Ji‐Hui Hao David Geller Wei Lu Comparison of the long‐term outcomes of patients with hepatocellular carcinoma within the Milan criteria treated by ablation, resection, or transplantation Cancer Medicine ablation hepatocellular carcinoma liver transplantation Milan criteria prognostic calculator resection |
| title | Comparison of the long‐term outcomes of patients with hepatocellular carcinoma within the Milan criteria treated by ablation, resection, or transplantation |
| title_full | Comparison of the long‐term outcomes of patients with hepatocellular carcinoma within the Milan criteria treated by ablation, resection, or transplantation |
| title_fullStr | Comparison of the long‐term outcomes of patients with hepatocellular carcinoma within the Milan criteria treated by ablation, resection, or transplantation |
| title_full_unstemmed | Comparison of the long‐term outcomes of patients with hepatocellular carcinoma within the Milan criteria treated by ablation, resection, or transplantation |
| title_short | Comparison of the long‐term outcomes of patients with hepatocellular carcinoma within the Milan criteria treated by ablation, resection, or transplantation |
| title_sort | comparison of the long term outcomes of patients with hepatocellular carcinoma within the milan criteria treated by ablation resection or transplantation |
| topic | ablation hepatocellular carcinoma liver transplantation Milan criteria prognostic calculator resection |
| url | https://doi.org/10.1002/cam4.5063 |
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