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Resectable and transplantable hepatocellular carcinoma: Integration of liver stiffness assessment in the decision-making algorithm

  • Pauline Tortajada
    Correspondence
    Reprint requests: Pauline Tortajada, Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800 France.
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
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  • Rodrigue Doamba
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
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  • Luis Cano
    Affiliations
    INSERM, Univ Rennes, INRAE, CHU Pontchaillou, UMR 1241 NUMECAN, Rennes, France
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  • Mohammed Ghallab
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France

    The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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  • Marc Antoine Allard
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France

    INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France
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  • Oriana Ciacio
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
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  • Gabriella Pittau
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
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  • Chady Salloum
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
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  • Daniel Cherqui
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France

    INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France
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  • René Adam
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France

    Univ Paris-Sud, UMR-S 776, Villejuif, France
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  • Antonio Sa Cunha
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France

    INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France
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  • Daniel Azoulay
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France

    INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France
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  • Alina Pascale
    Affiliations
    Department of Hepatology, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
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  • Eric Vibert
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France

    INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France
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  • Nicolas Golse
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France

    INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France
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Published:October 11, 2022DOI:https://doi.org/10.1016/j.surg.2022.08.012

      Abstract

      Background

      Liver resection is a curative treatment for hepatocellular carcinoma (HCC) and an alternative to liver transplantation (LT). However, post–liver resection recurrence rates remain high. This study aimed to determine whether liver stiffness measurement (LSM) correlated with recurrence and to propose a method for predicting HCC recurrence exclusively using pre–liver resection criteria.

      Methods

      This retrospective monocentric study included patients who had undergone LR liver resection for HCC between 2015 and 2018 and who had (1) preoperative alpha-fetoprotein scores indicating initial transplant viability and (2) available preoperative LSM data. We developed a predictive score for recurrence over time using Cox univariate regression and multivariate analysis with a combination plot before selecting the optimal thresholds (receiver operating characteristic curves + Youden test).

      Results

      Sixty-six patients were included. After an average follow-up of 40 months, the recurrence rate was 45% (n = 30). Three-year overall survival was 88%. Four preoperative variables significantly impacted the time to recurrence: age ≥70 years, LSM ≥11 kPa, international normalized ratio (INR) ≥1.2, and maximum HCC diameter ≥3 cm. By assigning 1 point per positive item, patients with a score <2 (n = 22) demonstrated greater mean overall survival (69.7 vs 54.8 months, P = .02) and disease-free survival (52.2 vs 34.7 months, P = .02) than those with a score ≥2. Patients experiencing early recurrence (<1 year) presented a significantly higher preoperative LSM (P = .06).

      Conclusion

      We identified a simple preoperative score predictive of early hepatocellular carcinoma recurrence after liver resection, highlighting the role of liver stiffness. This score could help physicians select patients and make decisions concerning perioperative medical treatment.
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