However, if the database was restricted to these 330 individuals, statistical analysis of factors associated with recurrence-free survival did not switch
However, if the database was restricted to these 330 individuals, statistical analysis of factors associated with recurrence-free survival did not switch. Open in a separate window Figure 2 Overall 5-year disease-free survivals. Among the 24 variables that were tested, 16 variables were associated with tumor-free survival by univariate analysis (Table ?(Table2):2): (1) period of LT ( 1991, 1991 to 1993, 1994 to 1996 and 1996; 0.0001). cm, 3 to 5 5 cm or 5 cm; 0.0001), the sum of the diameter of the nodules ( 3 cm, 3 to 5 5 cm, 5 to 10 cm or 10 cm; 0.0001), bi-lobar location (= 0.01), preoperative portal thrombosis ( 0.0001), peri-operative treatment of the tumor (= 0.002) and chemoembolization (= 0.03), tumor differentiation (= 0.01), initial type of calcineurin inhibitor (= 0.003), the use of antilymphocyte antibodies (= 0.02), rejection episodes (= 0.003) and period of LT ( 0.0001). By multivariate analysis, 6 variables were independently associated with HCC recurrence: maximal diameter of the largest nodule ( 0.0001), time of LT ( 0.0001), tumor differentiation ( 0.0001), use Gilteritinib (ASP2215) of anti-lymphocyte antibody (ATG) or anti-CD3 antibody (OKT3) (= 0.005), preoperative portal thrombosis (= 0.06) and the number of nodules (= 0.06). Summary: This study identifies immunosuppression, through the use of ATG or OKT3, like a predictive element of tumor recurrence, and confirms the prognostic value of tumor differentiation. (%)339 (82.3)/73( 17.7)Etiology: Alc./Vir./Metab./Miscel1, (%)136 (33.2)/236 (57.3)/ 8(2.0)/32 (7.5)Cirrhosis (yes/no), (%)377 (91.5)/35 (8.5)AFP (g/L)26.9 (ext: 0.5-245.240)Quantity of nodules1.8 1.3 (median: 1, range: 1-11)Maximum diameter (cm)4.1 3.1 (median: 3.4, range: 0.6-25)Bilobar location (yes/no), (%)105 (25.5)/307 (74.5)Portal or hepatic vein obstruction (yes/no) ((%)263 (63.8)/149(36.2)Peri-operative treatment (yes/no), (%)275 (66.8)/137(33.2)Transarterial chemoembolization (yes/no)161 (39.2)/251 (60.8)Pre-transplant surgery (yes/no)42 (10.2)/370(89.8)Pre-transplant ethanol injection (yes/no)65 (15.8)/347 (84.2)Post-transplant chemotherapy (yes/no)57 (13.9)/355 (86.1)Tumor differentiation (Well/moderate/poor), (%)248 (69.3)/90 (25.4)/20 (5.3)Time on waiting list (mo)4.4 4.0 (median: 3.3, range: 0.1-32.3)Initial immunosuppression Calcineurine inhibitors/ATG-OKT32, (%)357 (86.6)/55 (13.4)Steroid-treated rejection episodes, (%)125 (30.5)Maintenance immunosuppressionCyclosporine A/tacrolimus, (%)284 (68.9)/128 (31.1) Open in a separate window 1Alc: alcohol; Vir: Viral; Metab: Metabolic; Miscel: Miscellaneous; 2ATG: anti-lymphocyte ab; OKT3: anti-CD3 ab. Methods Charts of the 412 individuals were separately examined and the following data were collected. Pretransplant data: Demographics, etiology and severity of liver disease, liver biochemical checks and prothrombin time, fetoprotein level, Karnofsky index, pretransplant treatments of HCC during the waiting time and time from evaluation to LT (weeks) were mentioned. Cirrhotic individuals were classified relating to Child-Pugh classification. Morphological features and preoperative staging of HCC were evaluated from medical reports of abdominal imaging including ultrasonography, angiography, dynamic computed tomography, and contrast-enhanced Gilteritinib (ASP2215) magnetic resonance imaging, when available. The number, size, and locations of the tumors as well as the presence of a vascular obstruction were assessed. When the number and size of the nodules differed between Gilteritinib (ASP2215) the different imaging techniques, the technique that showed the largest quantity of nodules and the largest nodule was taken into account. Using their preoperative characteristics, HCCs were classified according to the altered TNM staging classification for liver transplantation (Number ?(Number1)1) and according to the Milan Criteria (Table ?(Table11). Open in a separate window Number 1 Staging of tumors according Gilteritinib (ASP2215) to the altered TNM classification for liver transplantation. T0: Tumor not found; T1: 1 nodule 1.9 cm; T2: 1 nodule 2.0-5 cm; 2 or 3 3 nodules, all 3 cm; T3: 1 nodule 5.0 cm; 2 or 3 3 nodules, at least 1 3.0 cm; T4a: 4 or more nodules, any size; T4b: T2, T3, T4a plus gross intrahepatic portal or hepatic Rabbit polyclonal to Cannabinoid R2 vein involvement as indicated by US, CT or MRI; N1: Involvement of regional (porta hepatitis) nodes; N2: Metastatic disease, including extrahepatic portal or hepatic vein involvement. Treatments of HCC during the waiting time were also assessed [pre-operative treatment: surgery, transarterial chemoembolization (TACE) or percutaneous ethanol injection (PEI)], as well Gilteritinib (ASP2215) as the immediate post-operative treatments (Table ?(Table11). Pathological study of the tumors: Results of pretransplant tumor biopsies were available in 79 individuals. Tumor differentiation was consequently determined by critiquing the pathological reports of the explanted livers, to obtain a larger set of data. Tumor differentiation was graded in 3 phases (grade 1: well-differentiated tumors, grade 2: moderately differentiated tumors and grade 3: poorly differentiated tumors) according to the altered Edmondson Criteria. In case of several tumors showing different phases of differentiation within the explanted liver, the worst grade of differentiation was arbitrarily chosen. Tumor differentiation was acquired in 358 individuals (85.4%). It could not be acquired in 40 individuals because of total necrosis of tumor nodules due to pre-LT treatment (transarterial chemoembolization or percutaneous ethanol injection), and was not available in 14 individuals. Additional pathological features which could not become assessed pre-operatively, such as microvascular invasion, quantity and size of tumor nodules within the explanted liver were also available but were deliberately not taken into account in the present study. Posttransplant data: The type of immunosuppressive medicines (calcineurin inhibitors.