Utilize este identificador para referenciar este registo:
https://hdl.handle.net/10316/82356
Campo DC | Valor | Idioma |
---|---|---|
dc.contributor.advisor | Martins, Ricardo Jorge Teixeira | - |
dc.contributor.advisor | Oliveira, Rui Pedro Caetano Moreira de | - |
dc.contributor.author | Castanheira, Diana Paula Alves | - |
dc.date.accessioned | 2018-12-20T03:54:01Z | - |
dc.date.available | 2018-12-20T03:54:01Z | - |
dc.date.issued | 2017-06-08 | - |
dc.date.submitted | 2019-01-22 | - |
dc.identifier.uri | https://hdl.handle.net/10316/82356 | - |
dc.description | Trabalho de Projeto do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina | - |
dc.description.abstract | Introduction: Hepatocellular carcinoma (HCC) is an aggressive tumor with raising incidence worldwide and represents a major global health problem. Liver transplant (LT) is an optimal therapeutical option with potential to cure HCC and subjacent liver disease. However, HCC recurrence is a major problem and hepatocarcinogenesis and tumor biological behavior is still poorly understood. The aim of this study was to identify clinical, analytical and histological prognostic factors with impact in post-LT overall survival (OS) and disease free survival (DFS) and to determine post-LT prognostic and tumor recurrence value of immunohistochemical markers such as cytokeratin 19 (CK19), glypican-3 (GPC3) and podoplanin (D2-40), on patients that underwent LT for HCC. Patients and Methods: Retrospective study of clinical and outcome data of 80 patients who underwent LT for HCC in our center from 1st January of 2010 to 31st December of 2015. Results: Follow-up was at least 1 year and the mean period was 33.6±21.9 (0-84) months. One and 5-year OS was 88.6% and 85.2%, respectively and DFS was 87.4% and 83.6%, respectively. Ninety-day post-LT morbidity was 63.7% and mortality 5%. Recurrence of HCC was observed in 10%. In univariate analysis (p<0.05) presence of 4-5 nodules (p=0.017), alpha-fetoprotein (AFP) serum levels ≥ 200ng/ml (p=0.027), microvascular invasion (MVI) (p=0.018) and HCC recurrence (p<0.001) were predictors of worse OS. Presence of 4-5 nodules (p=0.022) and MVI (p=0.006) were predictors of worse DFS (p<0.05). There was no statistical difference on OS (p=0.717) and DFS (p=0.794) of patients with BCLC (Barcelona Clinic Liver Cancer) 0-C stages when compared to stage D. In patients beyond Milan Criteria (MC), 3-year OS when MVI was observed was 50%, whereas without MVI was 93.8% (p=0.026). On multivariate analysis, we found that AFP serum levels ≥200ng/ml (p=0.035) and MVI (p=0.021) were independent predictor factors of worse OS and MVI was also a predictor of worse DFS (p=0.027).Conclusion: LT is an optimal therapeutical option for patients with severe liver diseasecomplicated with HCC, even in those with end-stage liver disease. Further work must be doneto assess and identify predictive factors that clarify biological tumor behavior of HCC, that can be applied in a better selection of patients for LT. | eng |
dc.description.abstract | Introduction: Hepatocellular carcinoma (HCC) is an aggressive tumor with raising incidence worldwide and represents a major global health problem. Liver transplant (LT) is an optimal therapeutical option with potential to cure HCC and subjacent liver disease. However, HCC recurrence is a major problem and hepatocarcinogenesis and tumor biological behavior is still poorly understood. The aim of this study was to identify clinical, analytical and histological prognostic factors with impact in post-LT overall survival (OS) and disease free survival (DFS) and to determine post-LT prognostic and tumor recurrence value of immunohistochemical markers such as cytokeratin 19 (CK19), glypican-3 (GPC3) and podoplanin (D2-40), on patients that underwent LT for HCC. Patients and Methods: Retrospective study of clinical and outcome data of 80 patients who underwent LT for HCC in our center from 1st January of 2010 to 31st December of 2015. Results: Follow-up was at least 1 year and the mean period was 33.6±21.9 (0-84) months. One and 5-year OS was 88.6% and 85.2%, respectively and DFS was 87.4% and 83.6%, respectively. Ninety-day post-LT morbidity was 63.7% and mortality 5%. Recurrence of HCC was observed in 10%. In univariate analysis (p<0.05) presence of 4-5 nodules (p=0.017), alpha-fetoprotein (AFP) serum levels ≥ 200ng/ml (p=0.027), microvascular invasion (MVI) (p=0.018) and HCC recurrence (p<0.001) were predictors of worse OS. Presence of 4-5 nodules (p=0.022) and MVI (p=0.006) were predictors of worse DFS (p<0.05). There was no statistical difference on OS (p=0.717) and DFS (p=0.794) of patients with BCLC (Barcelona Clinic Liver Cancer) 0-C stages when compared to stage D. In patients beyond Milan Criteria (MC), 3-year OS when MVI was observed was 50%, whereas without MVI was 93.8% (p=0.026). On multivariate analysis, we found that AFP serum levels ≥200ng/ml (p=0.035) and MVI (p=0.021) were independent predictor factors of worse OS and MVI was also a predictor of worse DFS (p=0.027).Conclusion: LT is an optimal therapeutical option for patients with severe liver diseasecomplicated with HCC, even in those with end-stage liver disease. Further work must be doneto assess and identify predictive factors that clarify biological tumor behavior of HCC, that can be applied in a better selection of patients for LT. | por |
dc.language.iso | eng | - |
dc.rights | embargoedAccess | - |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | - |
dc.subject | histopatologia | por |
dc.subject | recidiva tumoral | por |
dc.subject | carcinoma hepatocelular | por |
dc.subject | transplante hepático | por |
dc.subject | Hepatocellular carcinoma | eng |
dc.subject | liver transplant | eng |
dc.subject | histopathology | eng |
dc.subject | tumor recurrence | eng |
dc.title | Clinical and Pathological Analysis of Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma | eng |
dc.title.alternative | Análise Clínico Patológica de Doentes Submetidos a Transplante Hepático por Carcinoma Hepatocelular | por |
dc.type | masterThesis | - |
degois.publication.location | Área Científica de Cirurgia Geral | - |
degois.publication.title | Clinical and Pathological Analysis of Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma | eng |
dc.date.embargoEndDate | 2018-11-30 | - |
dc.peerreviewed | yes | - |
dc.date.embargo | 2018-11-30 | * |
dc.identifier.tid | 202046354 | - |
thesis.degree.discipline | Medicina | - |
thesis.degree.grantor | Universidade de Coimbra | - |
thesis.degree.level | 1 | - |
thesis.degree.name | Mestrado Integrado em Medicina | - |
uc.degree.grantorUnit | Faculdade de Medicina | - |
uc.degree.grantorID | 0500 | - |
uc.contributor.author | Castanheira, Diana Paula Alves::0000-0002-0239-3755 | - |
uc.degree.classification | 20 | - |
uc.date.periodoEmbargo | 540 | - |
uc.degree.presidentejuri | Sousa, Francisco José Franquera Castro | - |
uc.degree.elementojuri | Tralhão, José Guilherme Lopes Rodrigues | - |
uc.degree.elementojuri | Martins, Ricardo Jorge Teixeira | - |
uc.contributor.advisor | Martins, Ricardo Jorge Teixeira::0000-0001-5340-7582 | - |
uc.contributor.advisor | Oliveira, Rui Pedro Caetano Moreira de | - |
item.fulltext | Com Texto completo | - |
item.languageiso639-1 | en | - |
item.openairecristype | http://purl.org/coar/resource_type/c_18cf | - |
item.openairetype | masterThesis | - |
item.grantfulltext | open | - |
item.cerifentitytype | Publications | - |
crisitem.advisor.orcid | 0000-0001-5340-7582 | - |
crisitem.advisor.orcid | 0000-0002-7202-8059 | - |
Aparece nas coleções: | UC - Dissertações de Mestrado |
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Ficheiro | Descrição | Tamanho | Formato | |
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trabalho final DPAC 2011147353.pdf | 1.76 MB | Adobe PDF | Ver/Abrir |
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