Objective: The aim of this study was to estimate probabilities of achieving the statistical cure from hepatocellular carcinoma (HCC) with hepatic resection (HR) and liver transplantation (LT). Background: Statistical cure occurs when the mortality of a specific population returns to values of that of general population. Resection and transplantation are considered potentially curative therapies for HCC, but their effect on the residual entire life-expectancy has never been investigated. Methods: Data from 3286 HCC patients treated with LT (n ¼ 1218) or HR (n ¼ 2068) were used to estimate statistical cure. Disease-free survival (DFS) was the primary survival measure to estimate cure fractions through a nonmixture model. Overall survival (OS) was a secondary measure. In both, patients were matched with general population by age, sex, year, and race/ethnicity. Cure variations after LT were also adjusted for different waiting-list drop-outs. Results: Considering DFS, the cure fraction after LT was 74.1% and after HR was 24.1% (effect size >0.8). LT outperformed HR within all transplant criteria considered (effect size >0.8), especially for multiple tumors (>0.9) and even in presence of a drop-out up to 20% (>0.5). Considering OS, the cure fraction after LT marginally increased to 75.8%, and after that HR increased to 40.5%. The effect size of LT over HR in terms of cure decreased for oligonodular tumors (<0.5), became small for drop-out up to 20% (<0.2), and negligible for single tumors <5 cm (0.1). Conclusion: As other malignancies, statistical cure can occur for HCC, primarily with LT and secondarily with HR, depending on waiting-list capabilities and efficacy of tumor recurrence therapies after resection.

Pinna, A., Yang, T., Mazzaferro, V., De Carlis, L., Zhou, J., Roayaie, S., et al. (2018). Liver transplantation and hepatic resection can achieve cure for hepatocellular carcinoma. ANNALS OF SURGERY, 268(5), 868-875 [10.1097/SLA.0000000000002889].

Liver transplantation and hepatic resection can achieve cure for hepatocellular carcinoma

De Carlis L.;
2018

Abstract

Objective: The aim of this study was to estimate probabilities of achieving the statistical cure from hepatocellular carcinoma (HCC) with hepatic resection (HR) and liver transplantation (LT). Background: Statistical cure occurs when the mortality of a specific population returns to values of that of general population. Resection and transplantation are considered potentially curative therapies for HCC, but their effect on the residual entire life-expectancy has never been investigated. Methods: Data from 3286 HCC patients treated with LT (n ¼ 1218) or HR (n ¼ 2068) were used to estimate statistical cure. Disease-free survival (DFS) was the primary survival measure to estimate cure fractions through a nonmixture model. Overall survival (OS) was a secondary measure. In both, patients were matched with general population by age, sex, year, and race/ethnicity. Cure variations after LT were also adjusted for different waiting-list drop-outs. Results: Considering DFS, the cure fraction after LT was 74.1% and after HR was 24.1% (effect size >0.8). LT outperformed HR within all transplant criteria considered (effect size >0.8), especially for multiple tumors (>0.9) and even in presence of a drop-out up to 20% (>0.5). Considering OS, the cure fraction after LT marginally increased to 75.8%, and after that HR increased to 40.5%. The effect size of LT over HR in terms of cure decreased for oligonodular tumors (<0.5), became small for drop-out up to 20% (<0.2), and negligible for single tumors <5 cm (0.1). Conclusion: As other malignancies, statistical cure can occur for HCC, primarily with LT and secondarily with HR, depending on waiting-list capabilities and efficacy of tumor recurrence therapies after resection.
Articolo in rivista - Articolo scientifico
Cirrhosis, Disease-free survival, General population, Hepatic resection, Hepatocellular carcinoma, Liver transplant, Overall survival, Partial hepatectomy, Statistical cure, Survival benefit, Tumor recurrence, Waiting-list removal
English
2018
268
5
868
875
reserved
Pinna, A., Yang, T., Mazzaferro, V., De Carlis, L., Zhou, J., Roayaie, S., et al. (2018). Liver transplantation and hepatic resection can achieve cure for hepatocellular carcinoma. ANNALS OF SURGERY, 268(5), 868-875 [10.1097/SLA.0000000000002889].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/281651
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