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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2016/03  
 
  2016 Mar;63(3):839-49  
  doi: 10.1002/hep.28339  
 
  Prospective validation of ab initio liver transplantation in hepatocellular carcinoma upon detection of risk factors for recurrence after resection.  
 
  Ferrer-Fàbrega J, Forner A, Liccioni A, Miquel R, Molina V, Navasa M, Fondevila C, García-Valdecasas JC, Bruix J, Fuster J  
  http://www.ncbi.nlm.nih.gov/pubmed/26567038  
 
 

A decade ago we proposed to enlist for transplantation those patients with resected hepatocellular carcinoma in whom pathology registered pejorative histological markers (microvascular invasion and/or satellites; ab initio indication) and not wait for the appearance of recurrence. This study evaluates the outcome of this approach. From 1995 to 2012, 164 patients with hepatocellular carcinoma underwent resection. Eighty-five patients were potential candidates for liver transplantation and were considered for it upon detection of pejorative histological markers. Patients without these markers were followed, and salvage liver transplantation was considered upon development of tumor recurrence/liver function impairment. Thirty-seven patients were at high risk and 48 at low risk of recurrence at pathology. Twenty-three out of 37 high-risk patients recurred during follow-up, but in nine of them the tumor burden extent contraindicated liver transplantation. Seventeen were finally transplanted: 10 of them presented recurrence at imaging/explant. After a median posttransplant follow-up of 50.9 months, hepatocellular carcinoma had recurred in two patients and five patients had died, the 5-year survival being 82.4%. Twenty-six of the 48 low-risk patients developed recurrence, and 11 of them were transplanted. After a median posttransplant follow-up of 59 months, two patients developed recurrence and five died, their 5-year survival being 81.8%.

CONCLUSION:

Enlistment of patients at high risk of HCC recurrence after resection but before recurrence development seems a valid strategy and is associated with excellent long-term outcome; as early (<6 months) recurrence reflects an aggressive tumor behavior leading to tumor extent exceeding transplant criteria, we propose to wait at least 6 months before enlistment; however, once included on the waiting list, priority strategies should be implemented in order to reach effective transplantation prior to the appearance of recurrence. (Hepatology 2016;63:839-849).

 
Question posée
 
Validation de l’attitude : mettre sur liste de TH les patients ayant eu une résection chirurgicale d’un CHC à fort risque de récidive en termes d’invasion microvasculaire ou de tumeurs satellites.
 
Question posée
 
Parmi les 37 patients à risque de récidive élevée, 23 ont récidivé et 17 ont eu une TH et 10 d’entre eux avaient une récidive de CHC prouvée. La survie à 5 ans était de 82,4%. Parmi les 48 patients à risque faible, 26 ont rechuté et 11 ont pu être transplantés. La survie à 5 ans était de 81,8%.
 
Commentaires

Les auteurs proposent d’attendre 6 mois pour lister les patients  ayant eu une résection chirurgicale. En France, l’attente est de quelques mois avec le score foie pour permettre un accès à la greffe adapté.

 
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