International Session(Symposium)1(JSH・JSGE・JSGCS)
Fri. November 3rd   14:30 - 17:00   Room 9: Portopia Hotel Main Building Kairaku 3
Treatment strategy for hepatocellular carcinoma recurrence in the transplant era: Focusing on the Japan criteria
Takeo Toshima1, Shinji Itoh1, Tomoharu Yoshizumi1
1Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
Introduction: Japanese national insurance coverage for liver transplantation (LT) has expanded the indication of hepatocellular carcinoma (HCC) to the Japan criteria and the remaining issues include the establishment of a downstaging protocol, Therefore, the aim of this study is to clarify the Japan criteria in determining treatment methods for hepatocellular carcinoma (HCC) recurrence and the feasibility of pre-living donor liver transplantation (LDLT) downstaging within the Japan criteria.
Methods: LDLTs in patients with HCC recurrence (n=169) were included in this study. Univariate and multivariate analyses were performed for the factors attributed to HCC recurrence after LDLT and clarified the post-transplant outcomes of pre-LDLT downstaging.
Results: Univariate analysis identified neutrophil-to-lymphocyte ratio >2.01 (p <0.001), lymphocyte-to-monocyte ratio <2.64 (p=0.002), non-right lobe graft (p=0.044), des-gamma-carboxy prothrombin >300 mAU (p <0.001), tumor bilobar distribution (p=0.012), beyond the Japan criteria (p <0.001), and poor differentiation (p=0.001) as risk factors for hepatocellular carcinoma recurrence. Multivariate analysis identified beyond the Japan criteria (p=0.002) and neutrophil-to-lymphocyte ratio >2.01 (p=0.029) as independent risk factors. Patients who met the Japan criteria had significantly higher recurrence-free and overall survival rates after LDLT (p <0.001) than those without (p <0.001). Besides, the post-transplant outcomes of patients within the Japan criteria after downstaging were significantly better than those beyond the Japan criteria (p=0.034) and equivalent to those within the Japan criteria without downstaging.
Conclusion: Even for HCC recurrence, the Japan criteria could play an important role in the treatment strategy, and downstaging to the Japan criteria had favorable post-transplant outcomes.
Index Term 1: Japan Criteria
Index Term 2: downstaging
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