Role of immunosuppression and tumor differentiation in predicting recurrence after liver transplantation for hepatocellular carcinoma: a multicenter study of 412 patients.
- Type de publi. : Article dans une revue
- Date de publi. : 07/12/2006
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Auteurs :
Thomas DecaensFrançoise Roudot-ThoravalSolange Bresson-HadniCarole MeyerJean GugenheimFrançois DurandPierre-Henri BernardOlivier BoillotPhilippe CompagnonYvon CalmusJean HardwigsenChristian DucerfGeorges-Philippe PageauxSébastien DharancyOlivier ChazouillèresDaniel CherquiChristophe Duvoux
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Organismes :
Service de santé publique [Mondor]
WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis
Laboratoire Chrono-environnement (UMR 6249)
Service de Chirurgie Digestive / Centre de Transplantation Hépatique [CHU Nice]
Laboratoire Adaptation et pathogénie des micro-organismes [Grenoble]
Service d'Hépato-Gastro-Entérologie
Service de Chirurgie Digestive
Hôpital de la Conception [CHU - APHM]
Université de Lille, Droit et Santé
Hôpital Duriez, Service des Maladies de l'Appareil digestif et de la Nutrition
- Publié dans World Journal of Gastroenterology le 22/10/2020
Résumé : AIM: To assess pre-orthotopic liver transplantation (OLT) factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma (HCC) recurrence and disease-free survival after liver transplantation (LT). METHODS: Four hundred and twelve patients transplanted for HCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of HCC. Uni- and multivariate analyses were conducted to identify independent predictors of recurrence. RESULTS: Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were: presence of cirrhosis (P = 0.001), etiology of liver disease (P = 0.03), alpha fetoprotein level (< 200, 200 to 2000, or > 2000; P < 0.0001), gamma-GT activity (N, N to 2N or > 2N; P = 0.02), the number of nodules (1, 2-3 or > or = 4; P = 0.02), maximal diameter of the largest nodule (< 3 cm, 3 to 5 cm or > 5 cm; P < 0.0001), the sum of the diameter of the nodules (< 3 cm, 3 to 5 cm, 5 to 10 cm or > 10 cm; P < 0.0001), bi-lobar location (P = 0.01), preoperative portal thrombosis (P < 0.0001), peri-operative treatment of the tumor (P = 0.002) and chemoembolization (P = 0.03), tumor differentiation (P = 0.01), initial type of calcineurin inhibitor (P = 0.003), the use of antilymphocyte antibodies (P = 0.02), rejection episodes (P = 0.003) and period of LT (P < 0.0001). By multivariate analysis, 6 variables were independently associated with HCC recurrence: maximal diameter of the largest nodule (P < 0.0001), time of LT (P < 0.0001), tumor differentiation (P < 0.0001), use of anti-lymphocyte antibody (ATG) or anti-CD3 antibody (OKT3) (P = 0.005), preoperative portal thrombosis (P = 0.06) and the number of nodules (P = 0.06). CONCLUSION: This study identifies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor recurrence, and confirms the prognostic value of tumor differentiation.
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