Liver Transplant for Hepatocellular Carcinoma
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 562
研究概览
简要总结
This research focuses on analysing data collected as part of your usual care. Currently, the eligibility of patients with hepatocellular carcinoma for liver transplantation is based on the calculation of scores. These scores mainly take into account the volume of the tumour measured by imaging, one or more blood markers and the patient's general condition.
However, these scores do not take into account:
- the concept of downstaging (i.e. the prior reduction of tumour volume through locoregional or systemic treatments, which subsequently allows access to LT), which is becoming increasingly widespread
- the dynamics of hepatocellular carcinoma (tumour recurrence while waiting on the transplant list, administration of wait-and-see treatments)
- certain anatomopathological parameters (such as the macro-trabecular subtype of HCC).
The aim of our study is to develop a new score incorporating these factors in order to identify patients with hepatocellular carcinoma who could truly benefit from a liver transplant.
To answer the question posed in the research, data will be collected from 402 people who received a liver transplant for hepatocellular carcinoma at three hospitals in the Paris region between 1 January 2018 and 31 December 2023, and from 160 people at two international hospitals in Canada and Belgium.
详细描述
Hepatocellular carcinoma (HCC) is a major public health problem. It is the fifth most common cancer and the third leading cause of cancer death worldwide. Its prevalence continues to increase and mortality associated with HCC remains high, unlike the overall cancer mortality rate. Liver transplantation (LT) remains the only curative treatment option that addresses both the tumour disease and the underlying liver disease. However, this approach presents a major challenge: the occurrence of tumour recurrence after LT, which is highly morbid. Rigorous selection for LT of candidates with HCC is essential and is currently based on standardised scores, such as AFP, Milan or Up to Seven scores, which take into account tumour volume and the patient's general condition prior to LT.
The recent arrival of immunotherapy in the management of advanced HCC has opened up new prospects for LT. In particular, the question arises as to whether LT should be offered to patients initially diagnosed with advanced HCC who have benefited from downstaging treatments, including immunotherapy.
At the same time, due to the shortage of transplants, waiting times on the LT list are getting longer in some countries and patients are increasingly receiving expectant management for their HCC. They are exposed to the risk of HCC progression or recurrence while on the list, ruling out any possibility of subsequent LT. Certain histological subtypes of HCC, particularly macrotrabecular HCC, have recently been identified as being associated with a poor prognosis, but little data is available on the risk of recurrence of these HCCs after LT raising questions about the relevance of LT for these patients.
Finally, the impact of the choice of immunosuppression on the risk of HCC recurrence after LT remains largely unexplored.
Main objective:
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adults (≥18 years).
- •Underwent LT for HCC between January 1, 2018 and December 31, 2023.
排除标准
- •No evidence of HCC (imaging or histology).
- •LT performed for another intrahepatic tumor other than HCC.
- •The patient's objection to the use of their data.