Evidence map›Paper›PMID 37326440›Full record

ArticleCancer medicine2023

Radiological-histopathological discordance in patients transplanted for HCC and its impact on post-transplant outcomes.

Islam B Mohamed, Mohamed Saleh Ismail, Ahmed El Sabagh, Ahmed M Afifi Abdelwahab, Efstathia Polychronopoulou, Yong-Fang Kuo, Manal Hassan, John A Goss, Fasiha Kanwal, Prasun K Jalal

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Article in Cancer medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

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3citing papers in PubMed
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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Islam B MohamedSection of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.ORCID 0000-0002-9408-4895
Mohamed Saleh IsmailSection of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
Ahmed El SabaghSection of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
Ahmed M Afifi AbdelwahabSection of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
Efstathia PolychronopoulouDepartment of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.ORCID 0000-0002-6126-6465
Yong-Fang KuoDepartment of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Manal HassanDepartment of Biostatistics, The University of Texas Medical Branch, Galveston, Texas, USA.
John A GossDivision of Abdominal Transplantation, Baylor College of Medicine Michael E. DeBakey Department of Surgery, Houston, Texas, USA.
Fasiha KanwalSection of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
Prasun K JalalSection of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.ORCID 0000-0001-5353-2324

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsContrast-enhanced cross-sectional imaging is the cornerstone in the diagnosis, staging, and management of HCC, including eligibility for liver transplantation (LT). Radiological-histopathological discordance may lead to improper staging and may impact patient outcomes. We aimed to assess the radiological-histopathological discordance at the time of LT in HCC patients and its impact on the post-LT outcomes.

methodsWe analyzed further the effect of 6-month waiting policy on the discordance. Using United Network for Organ Sharing-Organ Procurement and Transplantation Network (UNOS-OPTN) database, we examined the discordance between pre-LT imaging and explant histopathology for all adult HCC patients who received liver transplants from deceased donors between April 2012 and December 2017. Kaplan-Meier methods and Cox regression analyses were used to evaluate the impact of discordance on 3-year HCC recurrence and mortality.

resultsOf 6842 patients included in the study, 66.7% were within Milan criteria on both imaging and explant histopathology, and 33.3% were within the Milan based on imaging but extended beyond Milan on explant histopathology. Male gender, increasing numbers of tumors, bilobar distribution, larger tumor size, and increasing AFP are associated with increased discordance. Post-LT HCC recurrence and death were significantly higher in patients who were discordant, with histopathology beyond Milan (adj HR 1.86, 95% CI 1.32-2.63 for mortality and 1.32, 95% CI 1.03-1.70 for recurrence). Graft allocation policy with 6-month waiting time led to increased discordance (OR 1.19, CI 1.01-1.41), although it did not impact post-LT outcome.

conclusionCurrent practice for staging of HCC based on radiological imaging features alone results in underestimation of HCC burden in one out of three patients with HCC. This discordance is associated with a higher risk of post-LT HCC recurrence and mortality. These patients will need enhanced surveillance to optimize patient selection and aggressive LRT to reduce post-LT recurrence and increase survival.

Indexed as

Carcinoma, HepatocellularLiver NeoplasmsLiver TransplantationAdultHumansMaleNeoplasm Recurrence, LocalRadiographyRetrospective StudiesRisk Factorsexplant pathologyHCC recurrencehepatocellular carcinomaliver transplantationOPTN/UNOSsurvival after LT

Identifiers

PMID37326440
PMCPMC10417193

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.