Liver transplantation for hepatocellular carcinoma: Where do we stand?

Liver transplantation for hepatocellular carcinoma: Where do we stand? World J Gastroenterol. 2019 Jun 07;25(21):2591-2602 Authors: Santopaolo F, Lenci I, Milana M, Manzia TM, Baiocchi L Abstract Hepatocellular carcinoma represents an important cause of morbidity and mortality worldwide. It is the sixth most common cancer and the fourth leading cause of cancer death. Liver transplantation is a key tool for the treatment of this disease in human therefore hepatocellular carcinoma is increasing as primary indication for grafting. Although liver transplantation represents an outstanding therapy for hepatocellular carcinoma, due to organ shortage, the careful selection and management of patients who may have a major survival benefit after grafting remains a fundamental question. In fact, only some stages of the disease seem amenable of this therapeutic option, stimulating the debate on the appropriate criteria to select candidates. In this review we focused on current criteria to select patients with hepatocellular carcinoma for liver transplantation as well as on the strategies (bridging) to avoid disease progression and exclusion from grafting during the stay on wait list. The treatments used to bring patients within acceptable criteria (down-staging), when their tumor burden exceeds the standard criteria for transplant, are also reported. Finally, we examined tumor reappearance following liver transplantation. This occurrence is estimated to be approximat...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research

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Abstract BACKGROUND: Tumor recurrence after orthotopic liver transplantation (OLT) remains a serious threat for long-term survival of the recipients with hepatocellular carcinoma (HCC), since very few factors or measures have shown impact on overcoming HCC recurrence after OLT. Postoperative infection suppresses tumor recurrence and improves patient survival in lung cancer and malignant glioma probably via stimulating the immune system. Post-transplant infection (PTI), a common complication, is deemed to be harmful for the liver transplant recipients from a short-term perspective. Nevertheless, whether PTI inhibit...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
Authors: Saitta C, Pollicino T, Raimondo G Abstract Obesity prevalence is rapidly increasing worldwide. It is associated with huge economic and health costs due to its clinical consequences, which includes increased incidence of type 2 diabetes, cardiovascular diseases, and development of different malignancies. In particular, obesity is an independent risk factor for the development of hepatocellular carcinoma (HCC). Indeed, obesity is highly prevalent in patients with non-alcoholic fatty liver disease (NAFLD) that is becoming one of the most frequent causes of liver disease worldwide. NAFLD-related HCC is the mos...
Source: Annals of Hepatology - Category: Gastroenterology Tags: Ann Hepatol Source Type: research
Hepatocellular carcinoma (HCC) is the most common primary liver tumor and the 3rd leading cause of cancer-related deaths worldwide [1,2]. When feasible, curative options such as liver transplantation (LT) and resection represent the treatment of choice as they offer long term survival [3,4]. HCC occurs primarily in patients with underlying liver disease, negatively affecting prognosis and increasing the complexity of treatment [5,6]; liver cirrhosis, in fact, is an independent prognostic factor for both short and long-term outcomes, and the assessment of liver function remains critical in the management of HCC patients as ...
Source: Journal of Hepatology - Category: Gastroenterology Authors: Source Type: research
We read with great interest the recent review by Tschuor et al.1 reviewing the allocation policies of liver grafts worldwide. The authors should be congratulated on their hard work on this very important document. However, the description of allocation policies for liver cancer in liver transplantation in Canada and the number of liver transplants performed are not completely accurate and as such, we would like to clarify the details.
Source: Journal of Hepatology - Category: Gastroenterology Authors: Tags: Letter to the Editor Source Type: research
Conclusions: The MoRAL score provides the most refined prognostication for predicting HCC recurrence after LDLT.
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
Hepatocellular carcinoma and intrahepatic cholangiocarcinoma are often amenable to locoregional therapy, including percutaneous ablation, transarterial chemoembolization (TACE), or transarterial radioembolization (TARE). TARE is a technique that delivers a high dose of radiation to the tumor, while limiting the dose to the normal liver parenchyma and the adjacent organs. It has been shown to effectively provide disease control with relatively few toxicities, and in certain cases results in a complete response. It is the preferred therapy as a bridge to liver transplant and can provide necessary compensatory future liver re...
Source: Surgical Oncology Clinics of North America - Category: Surgery Authors: Source Type: research
Abstract Liver cancers are the second most frequent cause of global cancer-related mortality of which 90% are attributable to hepatocellular carcinoma (HCC). Despite the advent of screening programmes for patients with known risk factors, a substantial number of patients are ineligible for curative surgery at presentation with limited outcomes achievable with systemic chemotherapy/external radiotherapy. This has led to the advent of numerous minimally invasive options including but not limited to trans-arterial chemoembolization, radiofrequency/microwave ablation and more recently selective internal radiation ther...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
The objective of this review is to analyze the changing landscape of HCC gene therapy, with a focus on these two questions.
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Review Source Type: research
Hepatocellular carcinoma (HCC) is one of the quickest growing causes of cancer death in the northern hemisphere. Transplant and resection, the only treatments considered curative, are feasible in only a small minority of patients. Consequently, the landscape of HCC treatment has greatly expanded over the past 10 years. Patients are undergoing treatment with a wide variety of nonoperative interventions, including transarterial chemoembolization and radioembolization using Yttrium-90, and an expanding array of systemic treatments, including sorafenib, regorafenib, and nivolumab.
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Clinical Investigation Source Type: research
Abstract Hepatocellular carcinoma (HCC) accounts for the majority of primary liver cancers. To date, most patients with HCC are diagnosed at an advanced tumor stage, excluding them from potentially curative therapies (i.e., resection, liver transplantation, percutaneous ablation). Treatments with palliative intent include chemoembolization and systemic therapy. Among systemic treatments, the small-molecule multikinase inhibitor sorafenib has been the only systemic treatment available for advanced HCC over 10 years. More recently, other small-molecule multikinase inhibitors (e.g., regorafenib, lenvatinib, cabozanti...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
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