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

Hwi Young Kim; Won Kim; Yong Jin Jung; Jeong Hoon Lee; Su Jong Yu; Yoon Jun Kim; Jung Hwan Yoon; Hae Won Lee; Hyeyoung Kim; Nam Joon Yi; Kwang Woong Lee; Kyung Suk Suh

doi:10.1097/MCG.0000000000000981

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

Hwi Young Kim, Won Kim, Yong Jin Jung, Jeong Hoon Lee, Su Jong Yu, Yoon Jun Kim, Jung Hwan Yoon, Hae Won Lee, Hyeyoung Kim, Nam Joon Yi, Kwang Woong Lee, Kyung Suk Suh

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

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 (score?8) 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.

Original language	English
Pages (from-to)	655-661
Number of pages	7
Journal	Journal of Clinical Gastroenterology
Volume	52
Issue number	7
DOIs	https://doi.org/10.1097/MCG.0000000000000981
State	Published - 1 Aug 2018

Bibliographical note

Funding Information:
Received for publication September 24, 2017; accepted November 28, 2017. From the *Department of Internal Medicine, College of Medicine, Ewha Womans University; Departments of †Internal Medicine; §Surgery, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine; Departments of ‡Internal Medicine; and ∥Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea. H.Y.K. and W.K.: contributed equally as co-first authors. Supported in part by the Scientific Research Fund of the Korean Liver Cancer Study Group (2016) and Ewha Womans University research grant (2016). The authors declare that they have nothing to disclose. Address correspondence to: Kyung-Suk Suh, MD, PhD, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea (e-mail: [email protected]). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MCG.0000000000000981

Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

clinical decision making
hepatocellular carcinoma
transplantation

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10.1097/MCG.0000000000000981

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@article{383fc31760a249db82426a08cdeba9e9,

title = "A Model for Adaptive Decision Making of 'Ablate-and-Wait' Versus Transplantation in Patients with Hepatocellular Carcinoma",

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 (score?8) 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.",

keywords = "clinical decision making, hepatocellular carcinoma, transplantation",

author = "Kim, {Hwi Young} and Won Kim and Jung, {Yong Jin} and Lee, {Jeong Hoon} and Yu, {Su Jong} and Kim, {Yoon Jun} and Yoon, {Jung Hwan} and Lee, {Hae Won} and Hyeyoung Kim and Yi, {Nam Joon} and Lee, {Kwang Woong} and Suh, {Kyung Suk}",

note = "Funding Information: Received for publication September 24, 2017; accepted November 28, 2017. From the *Department of Internal Medicine, College of Medicine, Ewha Womans University; Departments of †Internal Medicine; §Surgery, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine; Departments of ‡Internal Medicine; and ∥Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea. H.Y.K. and W.K.: contributed equally as co-first authors. Supported in part by the Scientific Research Fund of the Korean Liver Cancer Study Group (2016) and Ewha Womans University research grant (2016). The authors declare that they have nothing to disclose. Address correspondence to: Kyung-Suk Suh, MD, PhD, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea (e-mail: [email protected]). Copyright {\textcopyright} 2018 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MCG.0000000000000981 Publisher Copyright: {\textcopyright} 2017 Wolters Kluwer Health, Inc. All rights reserved.",

year = "2018",

month = aug,

day = "1",

doi = "10.1097/MCG.0000000000000981",

language = "English",

volume = "52",

pages = "655--661",

journal = "Journal of Clinical Gastroenterology",

issn = "0192-0790",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "7",

}

TY - JOUR

T1 - A Model for Adaptive Decision Making of 'Ablate-and-Wait' Versus Transplantation in Patients with Hepatocellular Carcinoma

AU - Kim, Hwi Young

AU - Kim, Won

AU - Jung, Yong Jin

AU - Lee, Jeong Hoon

AU - Yu, Su Jong

AU - Kim, Yoon Jun

AU - Yoon, Jung Hwan

AU - Lee, Hae Won

AU - Kim, Hyeyoung

AU - Yi, Nam Joon

AU - Lee, Kwang Woong

AU - Suh, Kyung Suk

N1 - Funding Information: Received for publication September 24, 2017; accepted November 28, 2017. From the *Department of Internal Medicine, College of Medicine, Ewha Womans University; Departments of †Internal Medicine; §Surgery, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine; Departments of ‡Internal Medicine; and ∥Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea. H.Y.K. and W.K.: contributed equally as co-first authors. Supported in part by the Scientific Research Fund of the Korean Liver Cancer Study Group (2016) and Ewha Womans University research grant (2016). The authors declare that they have nothing to disclose. Address correspondence to: Kyung-Suk Suh, MD, PhD, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea (e-mail: [email protected]). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MCG.0000000000000981 Publisher Copyright: © 2017 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - 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 (score?8) 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.

AB - 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 (score?8) 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.

KW - clinical decision making

KW - hepatocellular carcinoma

KW - transplantation

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U2 - 10.1097/MCG.0000000000000981

DO - 10.1097/MCG.0000000000000981

M3 - Article

C2 - 29356782

AN - SCOPUS:85041564240

SN - 0192-0790

VL - 52

SP - 655

EP - 661

JO - Journal of Clinical Gastroenterology

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IS - 7

ER -

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

Abstract

Bibliographical note

Keywords

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