Prediction of hepatocellular carcinoma recurrence beyond Milan criteria after resection Journal Article

   

Authors:	Zheng, J.; Chou, J. F.; Gönen, M.; Vachharajani, N.; Chapman, W. C.; Doyle, M. B. D.; Turcotte, S.; Vandenbroucke-Menu, F.; Lapointe, R.; Buettner, S.; Koerkamp, B. G.; Ijzermans, J. N. M.; Chan, C. Y.; Goh, B. K. P.; Teo, J. Y.; Kam, J. H.; Jeyaraj, P. R.; Cheow, P. C.; Chung, A. Y. F.; Chow, P. K. H.; Ooi, L. L. P. J.; Balachandran, V. P.; Kingham, T. P.; Allen, P. J.; D'Angelica, M. I.; DeMatteo, R. P.; Jarnagin, W. R.; Lee, S. Y.
Article Title:	Prediction of hepatocellular carcinoma recurrence beyond Milan criteria after resection
Abstract:	Objective: This study aims to validate a previously reported recurrence clinical risk score (CRS). Summary of Background Data: Salvage transplantation after hepatocellular carcinoma (HCC) resection is limited to patients who recur within Milan criteria (MC). Predicting recurrence patterns may guide treatment recommendations. Methods: An international, multicenter cohort of R0 resected HCC patients were categorized by MC status at presentation. CRS was calculated by assigning 1 point each for initial disease beyond MC, multinodularity, and microvascular invasion. Recurrence incidences were estimated using competing risks methodology, and conditional recurrence probabilities were estimated using the Bayes theorem. Results: From 1992 to 2015, 1023 patients were identified, of whom 613 (60%) recurred at a median follow-up of 50 months. CRS was well validated in that all 3 factors remained independent predictors of recurrence beyond MC (hazard ratio 1.5-2.1, all P < 0.001) and accurately stratified recurrence risk beyond MC, ranging from 19% (CRS 0) to 67% (CRS 3) at 5 years. Among patients with CRS 0, no other factors were significantly associated with recurrence beyond MC. The majority recurred within 2 years. After 2 years of recurrence-free survival, the cumulative risk of recurrence beyond MC within the next 5 years for all patients was 14%. This risk was 12% for patients with initial disease within MC and 17% for patients with initial disease beyond MC. Conclusions: CRS accurately predicted HCC recurrence beyond MC in this international validation. Although the risk of recurrence beyond MC decreased over time, it never reached zero. © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Keywords:	retrospective studies; clinical trial; mortality; hepatocellular carcinoma; carcinoma, hepatocellular; liver neoplasms; reproducibility; reproducibility of results; neoplasm recurrence, local; pathology; validation study; retrospective study; risk assessment; multicenter study; tumor recurrence; neoplasm invasiveness; resection; transplant; clinical risk score; recurrence pattern; tumor invasion; procedures; humans; human; milan criteria
Journal Title:	Annals of Surgery
Volume:	266
Issue:	4
ISSN:	0003-4932
Publisher:	Lippincott Williams & Wilkins
Date Published:	2017-10-01
Start Page:	693
End Page:	701
Language:	English
DOI:	10.1097/sla.0000000000002360
PUBMED:	28650354
PROVIDER:	scopus
PMCID:	PMC8404085
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85021259512&doi=10.1097%2fSLA.0000000000002360&partnerID=40&md5=95f5320bc1a2cf7c5e91f197de35e8e8
Notes:	Conference Paper -- Export Date: 4 October 2017 -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/115672