A new nondestructive iterative method for forensics characterization of uranium-bearing materials by HRGS (original) (raw)
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Is Surgical Resection Superior to Transplantation in the Treatment of Hepatocellular Carcinoma?
Annals of Surgery, 2011
Objective: To compare outcomes for patients with hepatocellular carcinoma (HCC) treated with either liver resection or transplantation. Methods: A retrospective, single-institution analysis of 413 HCC patients from 1999 to 2009. Results: A total of 413 patients with HCC underwent surgical resection (n = 106) and transplantation (n = 270) or were listed without receiving transplantation (n = 37). Excluding transplanted patients with incidental tumors (n = 50), 257 patients with suspected HCC were listed with the intent to transplant (ITT). The median diameter of the largest tumor by radiography was 6.0 cm in resected, 3.0 cm in transplanted, and 3.4 cm in the listed-butnot-transplanted patients. Median time to transplant was 48 days. Recurrence rates were 19.8% for resection and 12.1% for all ITT patients. Overall, patient survival for resection versus ITT patients was similar (5-year survival of 53.0% vs 52.0%, not significant). However, for HCC patients with model end-stage liver disease (MELD) scores less than 10 and who radiologically met Milan or UCSF (University of California, San Francisco) criteria, 1-year and 5-year survival rates were significantly improved in resected patients. For patients with MELD score less than 10 and who met Milan criteria, 1-year and 5-year survival were 92.0% and 63.0% for resection (n = 26) versus 83.0% and 41.0% for ITT (n = 73, P = 0.036). For those with MELD score less than 10 and met UCSF criteria, 1-year and 5-year survival was 94.0% and 62.0% for resection (n = 33) versus 81.0% and 40.0% for ITT (n = 78, P = 0.027). Conclusions: Among known HCC patients with preserved liver function, resection was associated with superior patient survival versus transplantation. These results suggest that surgical resection should remain the first line therapy for patients with HCC and compensated liver function who are candidates for resection. (Ann Surg 2011;254:527-538) W orldwide, hepatocellular carcinoma (HCC) has been estimated to be the third most common cause of cancer-related death. [1] In vast regions of the world including sub-Saharan Africa and East-Asia, HCC is the most common cause of cancer-associated mortality surpassing gastric and lung cancers in incidence and mortality. The incidence of HCC remains far lower in the United States and Europe but has dramatically increased in the past several decades. 4
Annals of Surgical Oncology, 2012
Background. Hepatocellular carcinoma (HCC) is an indication for liver resection or transplantation (LT). In most centers, patients whose HCC meets the Milan criteria are considered for LT. The first objective of this study was to analyze whether there is a correlation between the pathologic characteristics of the tumor, survival and recurrence rate. Second, we focused our attention on vascular invasion (VI). Methods. From January 1997 to December 2007, a total of 196 patients who had a preoperative diagnosis of HCC were included. The selection criteria for LT satisfied both the Milan and the San Francisco criteria (UCSF). Demographic, clinical, and pathologic information were recorded.
Surgery, Gastroenterology and Oncology, 2017
Hepatocellular carcinoma is the fifth most common cancer worldwide and one of the leading causes of cancer-related mortality. The majority of patients with hepatocellular carcinoma have underlying liver cirrhosis as a result of hepatitis B or hepatitis C virus, and alcoholic hepatitis. Its management in the presence of liver cirrhosis is a complex condition. Selecting the appropriate treatment modality is dependent not only on tumor stage, but also on the severity of the underlying liver disease. Liver resection and transplantation remain the main course of treatment of HCC. However, liver transplantation is considered nowadays the standard of care for hepatocellular carcinoma because it removes both the tumor and the underlying cirrhotic liver; improving quality of life by restoring a normal liver status. However, the shortage of donors and high costs make liver transplantation less available. Therefore, liver resection remains the commonly used strategy for HCC patients with preserved liver functions. However, liver resection is associated with high peri-operative morbidity and mortality, and high incidence of HCC recurrence. Here, we review the role of liver resection in the era of liver transplantation and interventional radiology.
Liver resection for HCC outside the BCLC criteria
Langenbeck's archives of surgery, 2018
Surgical resection still remains the mainstay of management of hepatocellular carcinoma (HCC). At present, Barcelona clinic liver cancer (BCLC) staging is the most widely used tool to guide treatment; however, criteria for offering surgery as curative treatment are restrictive. We aimed to evaluate short-term and long-term outcomes of HCC after resection, even for patients outside BCLC criteria for resection. Data was collected from a prospective database from GI and HPB Department, Tata Memorial Hospital, Mumbai. Study period was from June 2010 to June 2015. One hundred three patients of HCC were operated during this period, of which 100 underwent complete resection. Patients were staged according to the BCLC classification (BCLC stage A-25, B-64, C-11). Preoperative therapy was administered in 36 (36%) patients. At median follow-up of 21 months, overall 3-year survival for BCLC stages A, B, and C was 55.2, 62.7, and 37.5%, respectively. In today's era of liver transplantation,...
Journal of Surgical Oncology, 2015
Background: Liver transplantation (LT) remains the best curative option for early hepatocellular carcinoma (HCC) but is limited by the ongoing graft shortage. The present study aimed at defining the population in which primary liver resection (LR) could represent the best alternative to LT. Methods: An exploration set of 357 HCC patients (LR n ¼ 221 and LT n ¼ 136) operated between 2000-2012 was used in order to identify factors associated with survival following LR and define a good prognosis (GP) group for which LR may challenge the results of upfront LT. These factors were validated in an external validation set of 565 HCC patients operated at another center (LR n ¼ 287 LR and LT n ¼ 278). Results: In the exploration set, factors associated with survival on multivariate analysis were a solitary lesion, a diameter <50 mm, a wellmoderately differentiated lesion, the absence of microvascular invasion, and preoperative AST level <2N. Thirty-nine patients (18%) displayed all these criteria and constituted the GP patients. Overall survivals at 1, 3, and 5 years did not significantly differ between GP resected patients, and the in Milan transplanted patients (93, 80.4, and 80.4% vs. 86.9, 82, and 78.8%, P ¼ 0.79). In the validation cohort, patients with GP factors of survival still displayed better overall survivals than those without (P ¼ 0.036) but also displayed better survivals than in Milan HCC transplanted patients (P ¼ 0.005). Conclusion: In a group of early HCC patients gathering all factors of GP, primary LR achieves at least similar survival as upfront LT and should be the approach of choice.
Transplantation Proceedings, 2005
Introduction. Liver transplantation is currently the best therapeutic option for small hepatocellular carcinoma (HC) in selected cirrhotic patients. The main aim of this study was to analyze the results of a recent series of liver transplant cirrhotic patients with small HC applying strict preoperative selection criteria. Patients and methods. During a period of 6 years we performed 53 liver transplants with a final diagnosis of HC on cirrhosis. The selection criteria for liver transplantation (LT) by modern imaging techniques were the Milan criteria (TNM I and II of the modified classification). Results. Of the 53 patients, 44 (83%) were transplanted with preoperatively known HC, and 9 (17%) with incidental HC. The mean time on the waiting list was 74 Ϯ 62 days. Despite using strict selection criteria, 23 patients (43%) exceeded the Milan criteria in the specimen and 17 (32%) even exceeded the extended criteria of the UCSF. With a mean follow-up of 2 years, only two patients have developed recurrences. The overall survival at 1, 3, and 5 years was 80%, 70%, and 70%, respectively. The survival of patients that exceeded the Milan or USF criteria at 1, 3, and 5 years was 72% and 76%; 67% and 69%; 67% and 69%, respectively. Conclusions. The results of liver transplantation for HC are excellent when applying strict preoperative selection criteria. The current imaging methods lead to a considerable infrastaging percentage (30% to 40%), extending the indications for liver transplant due to HC beyond the scope that clinical reports would justify.
Liver Transplantation in Patients with Hepatocellular Carcinoma (HCC): A Single Center Experience
Liver Transplantation, 2012
Milan criteria are the most frequently used limits for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC), but our previous experience with expanded criteria showed encouraging results. The aim of this study was to investigate whether our expanded Clinica Universitaria de Navarra (CUN) criteria (1 nodule up to 6 cm or 2-3 nodules up to 5 cm each) could be used to select patients with HCC for LT. Eighty-five patients with HCC fulfilling CUN criteria were included as candidates for LT. Survival of transplanted HCC patients was compared with survival of patients without HCC (n ϭ 180). After the exclusion of 2 patients with tumor seeding of the chest wall due to pre-LT tumor biopsy, survival and recurrence rates were compared according to tumor staging. Twenty-six out of 85 (30%) patients exceeded Milan criteria. Twelve patients had tumor progression on the waiting list. Patients exceeding Milan criteria had a higher dropout rate due to tumoral progression. One-, 3-, 5-, 7-, and 10-year survival rates of the 73 transplanted HCC patients were 86%, 74%, 70%, 61%, and 50%, respectively. Survival of patients with HCC was significantly lower than that of patients without HCC, but by multivariate analysis, HCC was not associated with lower survival. Tumor recurrence and survival rates were similar for patients fulfilling Milan and CUN criteria. Pathological staging showed 55 patients within Milan criteria, 7 patients exceeding them but within CUN criteria, and 9 patients exceeding CUN criteria. Tumor recurrence rates were 2/55 (4%), 0/7 (0%), and 4/9 (44%) in each of these groups, respectively. In conclusion, following CUN criteria could increase the number of HCC patients who could benefit from LT, without worsening the results. Because of the short number of patients in this series, these data need external validation. Liver Transpl 14: 272-278, 2008.