Digestive System Diseases

Symptoms and General Pathology

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Liver Cirrhosis

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Carcinoma, Hepatocellular

Liver Neoplasms

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Adenocarcinoma

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Liver Diseases

Fibrosis

Hematinics

All Drugs and Chemicals

Liver Extracts

Volkan Ince, MD

Hepatocellular cancer is the 6th most common seen disease in the world and the 3rd in cancer-related deaths. Liver transplantation is the primary curative treatment of HCC, as it eliminates liver cancer and underlying cirrhosis. However, liver transplantation is not offered to every HCC patient, since advanced stage HCC patients are lost with tumor recurrence early after liver transplantation. The Milan criteria, which are accepted worldwide, are the patient selection criteria that we have to follow in cadaver-to-liver transplantation for HCC in our country. However, as the Milan criteria are very strict criteria, it pushes patients out of liver transplantation who exceed the Milan criteria but who can benefit from liver transplantation. Liver transplantation centers all over the world have declared their own criteria under the expanded Milan criteria. In our country, Malatya Criteria have been defined by İnönü University on this subject, and our studies on this subject still continue. When we scan the original articles of all these defined criteria, incomplete data are formed and therefore the strength of the criteria cannot be clearly revealed. For this reason, we aimed to analyze the results of our center and present information about the power of the criteria to the literature.

Aim: To investigate the criteria with the longest overall and disease-free survival and lowest recurrence rates in liver transplantation for hepatocellular cancer (HCC).

Introduction: When the liver transplant criteria for HCC were examined, we saw that many criteria defined in their original articles did not include the rates of extending the Milan criteria, survival and recurrence rates of non-milan patients who were within the newly defined criteria. Therefore, information on which of the criteria defined for liver transplantation in HCC extends the Milan criteria more, which has a longer survival rate and which has a lower recurrence rate is lacking. In order to eliminate this deficiency or at least to have a rough idea, we aimed to compare the results of liver transplantation, performed for HCC in our institute which is a high-volume liver transplant center, by analyzing it according to the existing defined criteria. Thus, we were able to compare the criteria in a homogeneous patient group that was formed as a result of the same inclusion and exclusion criteria in the same period of time. The highest overall and disease-free survival, the lowest recurrence rate, and the criterion that extends the Milan criteria will be introduced. In addition, this study is the first comprehensive comparison of liver transplant criteria for HCC.

Methods: Between March 2002 and July 2020, the data of 424 patients who underwent liver transplantation due to HCC at the Liver Transplantation Institute of İnönü University will be retrospectively analyzed from the prospectively recorded data bank and automation system. Tumor size, tumor number, differentiation and microscopic venous invasion data will all be recorded from the data in the explant pathology report. Since the primary aim of our study is cancer-related survival in patients who can be transplanted, 31 patients with tumor invasion outside the liver (extrahepatic portal vein tumor thrombosis, perihilar lymph node metastasis, diaphragmatic invasion etx) and 70 patients with follow-up period after liver transplantation below 90 days will be excluded from the study. The remaining 323 patients will be included in the study and their data will be analyzed. First, demographic data, tumor characteristics, overall and disease-free survival and recurrence rate of 323 HCC patients who were the study group, will be calculated, and then these patients will be divide groups according to be within or beyond the criteria, than survival and recurrence rates will be calculated. It was then examined whether these expanded criteria actually extended the Milan criteria. It was checked whether a defined Expanded criterion allowed liver transplantation for patients outside of Milan while excluding patients within Milan from liver transplantation. How far the expanded criteria expand the Milan and survival of the patients who beyond Milan but within the criteria were analyzed separately. Thus, the most useful criterion for liver transplantation in HCC treatment will be revealed.

Comparison of Criteria for Liver Transplantation in Hepatocellular Carcinoma

all IPD that underlie results in publication

Tumor free survival after liver transplantation

Overall survival after liver transplantation

Tumor recurrence following liver transplantation

Liver Transplant criteria which has the best survivals

Inonu University

Assoc.Prof.

Liver transplant patients with MTD\>6 cm of HCC

Liver transplantation

Retrospective data on 50 prospectively-collected HCC patients with beyond-Milan criteria with \>6cm tumors were analyzed. 5-year OS of 76.2% was found in patients with both AFP \<200 ng/ml and GGT \<104 IU/mL with tumors less than 10 cm diameter. Thus, GGT values add to AFP in patient prognosis.

Background:A retrospective analysis was performed of prospectively-collected transplant data on outcomes of patients with large size HCCs,to examine possible prognostically-useful factors.Methods:A total of 50 patients having tumors greater than 6cm maximum diameter were identified. Their survival and full clinical characteristics were examined, with respect to serum AFP and GGT levels.Results:Using ROC analysis, cutoff values of AFP 200 ng/ml and GGT 104 IU/ml were identified and used in this study. Significantly longer overall-survival and disease-free-survival were found for patients who had lower values of either parameter, compared with higher values.Even greater differences in survival were found when the 2 parameters were combined, with best survival (5-year OS of 76,2% versus 0%, p=0.002).The most consistent clinical correlates for these longer survivals were degree of tumor differentiation and absence of microscopic portal venous invasion.Two tumor size bands were identified,to search for the limits of this approach with larger tumors, namely 6-10 and \>10cm.Combination parameters in 6-10cm band reflected 5-year OS of 76,2% vs. 0%,in patients with low AFP plus low GGT vs. other groups.Beyond 10cm,no patients had low AFP plus low GGT.Conclusions:AFP and GGT,both singly and together, represent a simple prognostic identifier for patients with large size HCCs being treated by liver transplantation.

Liver Transplant for Larger Hepatocellular Carcinoma in Malatya: The Role of GGT and AFP

Retrospective Cohort Study-Analysis of LT Patients With HCC (Maximum Tumor Diameter > 6 cm).

to analyse the factors that effect the survivals

MD, FEBS, Assoc.Prof

Rare Diseases

Neoplasm Metastasis

Recurrence

Primary Liver Cancer

Technetium Tc 99m Aggregated Albumin

Patients receive routine pre-therapy technetium Tc 99m-labeled macroaggregated albumin. Patients then undergo routine radioembolization with yttrium Y 90 resin microspheres. Within 36 hours after radioembolization, patients undergo PET/CT imaging.

positron emission tomography

computed tomography

Michael Knopp, MD, PhD

This pilot clinical trial studies positron emission tomography (PET)/computed tomography (CT) in finding beads after Yttrium-90 bead therapy in patients with primary liver cancer or cancer that has spread to the liver (metastatic) that can not be removed by surgery. Imaging procedures, such as PET/CT after Yttrium-90 bead therapy, may help see if the beads are present in the lung and compare the results with the pre-therapy imaging.

PRIMARY OBJECTIVES:

I. To estimate the absolute difference in post-therapy Yttrium-90 microsphere hepatopulmonary shunt fraction and the pre-therapy Technetium-99m macroaggregated albumin hepatopulmonary shunt fraction in patients with unresectable primary hepatic malignancy and hepatic metastatic disease.

SECONDARY OBJECTIVES:

I. To quantify and compare the pre-therapy Technetium-99m macroaggregated albumin particle sizes and post-therapy Yttrium-90 microsphere sizes.

OUTLINE:

Patients receive routine pre-therapy Technetium-99m macroaggregated albumin. Patients then undergo routine radioembolization with Yttrium-90 microspheres. Within 36 hours after radioembolization, patients undergo PET/CT imaging.

Available imaging, clinical, interventional and surgical follow-up data for 2 years after completion of enrollment in the study will be obtained.

Pilot Study to Assess Lung Shunting of Yttrium-90 Microspheres Using PET/CT

PET/CT-Derived Hepatopulmonary Shunt Fraction Following Yttrium-90 Radioembolization

Non-parametric Wilcoxon signed rank testing will be used to compare the 99mTc MAA and 90Y microsphere shunt fractions. Alternatively, a natural log transformation of the hepatopulmonary shunt fractions may be used to normalize these data for subsequent parametric paired t-test analysis.

Descriptive statistical assessment of Technetium-99m macroaggregated albumin particle size and microsphere size for each patient (e.g., mean, median, standard deviation, distribution, etc.) will be performed.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Comparison of Criteria for Liver Transplantation in Hepatocellular Carcinoma	NCT04576572	Hepatocellular ... Liver Cancer Advanced Adult ... Cirrhosis, Live... Unresectable Li... Liver Transplan...		-	Inonu University
Liver Transplant for Larger Hepatocellular Carcinoma in Malatya: The Role of GGT and AFP	NCT04412161	Hepatocellular ... Liver Transplan...	Liver transplan...	-	Inonu University
Pilot Study to Assess Lung Shunting of Yttrium-90 Microspheres Using PET/CT	NCT02119065	Advanced Adult ... Liver Metastase... Localized Unres... Recurrent Adult...	positron emissi... computed tomogr...	18 Years -	University of Cincinnati

Spots Global Cancer Trial Database for hepatic malignancy