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- W2894776479 abstract "Patients with hepatocellular cancer (HCC) within Milan Criteria (MC) waiting for liver transplantation (LT) are approached in two different ways: direct LT vs. first treating the tumour using loco-regional therapies (LRT). In these patients, the usefulness of LRT is still questioned. Aim of this study is to investigate the role of LRT in patients with MC-IN HCC waiting for LT in terms of risk of de-listing, intention-to-treat (ITT) survival and post-LT recurrence. A total of 1,177 MC-IN HCC patients listed for LT were investigated. Using propensity score matching, two homogeneous groups of directly transplanted (n=205) vs. firstly LRT treated patients (n=205) were studied. Median follow-up period was 3.6 years (IQR: 1.5–7.5). At multivariate Cox regression analysis, three independent risk factors for ITT-death were identified: MELD (HR=1.04; p=0.005), radiological progression beyond MC (HR=2.04; p=0.03) and alpha-fetoprotein slope >15ng/mL/month (HR=1.75; p=0.03). At multivariate analysis, multimodal LRT approach (HR=3.18; p=0.01) and maximal diameter of the main HCC lesion (HR=1.53; p=0.045) were independent risk factors for post-LT recurrence. Repetitive LRT was not a significant risk factor in both the analyses. Survival over one year in de-listed patients was more common in LRT-first cases (5.9vs.1.0%; p=0.01). Use of LRT has no detrimental effect in MC-IN patients waiting for LT. LRT represents a tool allowing to further optimize the liver allocation process by selecting patients presenting a high-risk for drop-out (avoiding thereby futile liver transplants). The biological tumor response to the LRT is more than the LRT itself the strongest predictor of intention-to-treat survival and recurrence." @default.
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- W2894776479 date "2018-09-01" @default.
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- W2894776479 title "Bridging therapies are not detrimental in patients with hepatocellular cancer waiting for liver transplant: A propensity score analysis" @default.
- W2894776479 doi "https://doi.org/10.1016/j.hpb.2018.06.287" @default.
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