Background:Discordance in hepatocellular carcinoma(HCC)staging between pre-transplant imaging and explant pathology is associated with an increased risk of recurrence and death.Our aim was to evaluate variables that p...Background:Discordance in hepatocellular carcinoma(HCC)staging between pre-transplant imaging and explant pathology is associated with an increased risk of recurrence and death.Our aim was to evaluate variables that predicted concordance/discordance in the era of new generation locoregional therapies(LRT)and improved radiologic technology in diagnosis.Methods:A single-center retrospective study was performed on patients who received a liver transplant for HCC between 2008-2019.Pre-and post-LT variables,including type of LRT,downstaging(DS),transplant time period,and radiologic response to LRT,were analyzed for concordance/discordance.Kaplan-Meier analysis was used to assess post-LT survival.Results:Of 146 patients transplanted within Milan Criteria(MC),discordance rates(understaged)were 45%.Discordance was associated with≥3 HCC lesions at diagnosis but not newer generation LRT(transarterial radioembolization/stereotactic body radiation therapy),traditional LRT or combination.No differences in discordance were seen between transplant periods(2008-2013 vs.2014-2019),but those within MC in the earlier period had higher concordance rates.A trend was observed between DS and discordance.Conclusion:HCC stage discordance remains common and poorly predictable.Discordance was associated with three or more HCC lesions at the time of diagnosis.Patients within MC transplanted between 2008-2013 was associated with concordance,while a trend was noted between DS and discordance.No other pre-or post-LT variables predicted discordance/concordance.Discordance was associated with decreased survival.展开更多
Lymph node staging is of crucial importance for the therapy stratification and prognosis estimation in colon cancer. Beside the detection of metastases,the number of harvested lymph nodes itself has prognostic relevan...Lymph node staging is of crucial importance for the therapy stratification and prognosis estimation in colon cancer. Beside the detection of metastases,the number of harvested lymph nodes itself has prognostic relevance in stage Ⅱ/Ⅲ cancers. A stage migration effect caused by missed lymph node metastases has been postulated as most likely explanation for that. In order to avoid false negative node staging reporting of at least 12 lymph nodes is recommended. However,this threshold is met only in a minority of cases in daily practice. Due to quality initiatives the situation has improved in the past. This,however,had no influence on staging in several studies. While the numbers of evaluated lymph nodes increased continuously during the last decades the rate of node positive cases remained relatively constant. This fact together with other indications raised doubts that understaging is indeed the correct explanation for the prognostic impact of lymph node harvest. Several authors assume that immune response could play a major role in this context influencing both the lymph node detectability and the tumor's behavior. Further studies addressing this issue are need. Based on the findings the recommendations concerning minimal lymph node numbers and adjuvant chemotherapy should be reconsidered.展开更多
文摘Background:Discordance in hepatocellular carcinoma(HCC)staging between pre-transplant imaging and explant pathology is associated with an increased risk of recurrence and death.Our aim was to evaluate variables that predicted concordance/discordance in the era of new generation locoregional therapies(LRT)and improved radiologic technology in diagnosis.Methods:A single-center retrospective study was performed on patients who received a liver transplant for HCC between 2008-2019.Pre-and post-LT variables,including type of LRT,downstaging(DS),transplant time period,and radiologic response to LRT,were analyzed for concordance/discordance.Kaplan-Meier analysis was used to assess post-LT survival.Results:Of 146 patients transplanted within Milan Criteria(MC),discordance rates(understaged)were 45%.Discordance was associated with≥3 HCC lesions at diagnosis but not newer generation LRT(transarterial radioembolization/stereotactic body radiation therapy),traditional LRT or combination.No differences in discordance were seen between transplant periods(2008-2013 vs.2014-2019),but those within MC in the earlier period had higher concordance rates.A trend was observed between DS and discordance.Conclusion:HCC stage discordance remains common and poorly predictable.Discordance was associated with three or more HCC lesions at the time of diagnosis.Patients within MC transplanted between 2008-2013 was associated with concordance,while a trend was noted between DS and discordance.No other pre-or post-LT variables predicted discordance/concordance.Discordance was associated with decreased survival.
文摘Lymph node staging is of crucial importance for the therapy stratification and prognosis estimation in colon cancer. Beside the detection of metastases,the number of harvested lymph nodes itself has prognostic relevance in stage Ⅱ/Ⅲ cancers. A stage migration effect caused by missed lymph node metastases has been postulated as most likely explanation for that. In order to avoid false negative node staging reporting of at least 12 lymph nodes is recommended. However,this threshold is met only in a minority of cases in daily practice. Due to quality initiatives the situation has improved in the past. This,however,had no influence on staging in several studies. While the numbers of evaluated lymph nodes increased continuously during the last decades the rate of node positive cases remained relatively constant. This fact together with other indications raised doubts that understaging is indeed the correct explanation for the prognostic impact of lymph node harvest. Several authors assume that immune response could play a major role in this context influencing both the lymph node detectability and the tumor's behavior. Further studies addressing this issue are need. Based on the findings the recommendations concerning minimal lymph node numbers and adjuvant chemotherapy should be reconsidered.
