Des-gamma-carboxy prothrombin affects the survival of HCC patients with marginal liver function and curative treatment:
- PDF / 714,727 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 101 Downloads / 131 Views
ORIGINAL ARTICLE – CLINICAL ONCOLOGY
Des‑gamma‑carboxy prothrombin affects the survival of HCC patients with marginal liver function and curative treatment: ACRoS1402 Atsushi Kudo1 · Masahiro Shinoda2 · Shunichi Ariizumi3 · Takafumi Kumamoto4 · Masafumi Katayama5 · Takehito Otsubo5 · Itaru Endo4 · Yuko Kitagawa2 · Minoru Tanabe1 · Masakazu Yamamoto3 · Association for Clinical Research on Surgery Group Received: 16 April 2020 / Accepted: 20 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Considering the initial treatment of hepatocellular carcinoma (HCC), the best prognostic index for Child–Pugh classes B and C (CP-BC) patients has not been yet established. This study aimed to elucidate the risk factors for disease-free survival (DFS) and overall survival (OS) in multicenter patients with a poor liver functional reserve after curative treatment. Methods Between April 2000 and April 2014, 212 CP-BC patients who received treatment in five high-volume centers in Japan were included in this study. CP-B and C patients were 206 and 6, respectively. Cox proportional hazard regression analyses for DFS and OS were performed to estimate the risk factors. Results The mean observation time was 1132 days. Mean Child–Pugh score and indocyanine green retention rate at 15 min were 7.5 and 31.5%, respectively. Histological chronic hepatitis and liver cirrhosis were observed in 20% and 74% patients, respectively. In the multivariate analysis, the risk factors for DFS were des-gamma-carboxy prothrombin (DCP) [hazard ratio (HR), 1.6; P = 0.012] and treatment without liver transplantation. Moreover, DCP was identified as an independent risk factor for OS (HR, 1.7; P = 0.01). Tumor size, number, tumor thrombus, Milan criteria, liver cirrhosis, and treatment without liver transplantation were not identified as risk factors for OS. The 5-year OS in patients with high serum DCP levels ( 3 cm in size received multiple ablative sessions according to the tumor size. Living donor
Journal of Cancer Research and Clinical Oncology
liver transplantation was performed as per the following procedures. Total hepatectomies were performed with the preservation of the inferior vena cava. The portal vein was anastomosed to the trunk or the first branch of the recipient’s portal vein in an end-to-end fashion. Hepatic artery anastomosis was performed under surgical microscopy. For biliary reconstruction, duct-to-duct hepaticocholedochostomy was employed as the initial choice; however, Roux-en-Y hepaticojejunostomy was performed for biliary atresia and primary sclerosing cholangitis cases. The immunosuppressive regimen involved a 3-drug combination therapy consisting of calcineurin inhibitors, steroid, and anti-metabolites. Background liver cirrhosis was assessed based on microscopic examination of the specimens. After discharge, all patients were examined for recurrence by ultrasonography every 3 months and by dynamic CT scan every 6 months. OS was defined as the interval between the operation and the date o
Data Loading...
