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发表一篇学和医学成像类SCI论文
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Abstract:
:The Organ Procurement and Transplantation Network recently approved liver transplant (LT) prioritization for patients with hepatocellular carcinoma (HCC) beyond Milan Criteria (MC) who are downstaged (DS) with locoregional therapy (LRT). We evaluated post-LT outcomes, predictors of downstaging, and the impact of LRT in beyond-MC HCC patients from the US Multicenter HCC Transplant Consortium (20 centers, 2002-2013). Clinicopathologic characteristics, overall survival (OS), recurrence-free survival (RFS), and HCC recurrence (HCC-R) were compared between patients within MC (n=3,570) and beyond MC (n=789) who were downstaged (DS, n=465), treated with LRT and not downstaged (LRT-NoDS, n=242), or untreated (NoLRT-NoDS, n=82). Five-year post-LT OS and RFS was higher in MC (71.3% and 68.2%) compared to DS (64.3% and 59.5%), and lowest in NoDS (n=324; 60.2% and 53.8%; overall P<0.001). DS patients had superior RFS (60% vs 54%,P=0.043) and lower 5-year HCC-R (18% vs 32%,P<0.001) compared to NoDS, with further stratification by maximum radiologic tumor diameter (5-year HCC-R of 15.5% in DS/< 5cm and 39.1% in NoDS/>5cm,P<0.001). Multivariate predictors of downstaging included alpha-fetoprotein response to LRT, pathologic tumor number and size, and wait time >12 months. LRT-NoDS had greater HCC-R compared to NoLRT-NoDS (34.1% vs 26.1%,P<0.001), even after controlling for clinicopathologic variables (HR=2.33,P<0.001) and inverse probability of treatment weighted propensity matching (HR=1.82,P<0.001). Conclusion In LT recipients with HCC presenting beyond MC, successful downstaging is predicted by wait time, alpha-fetoprotein response to LRT, and tumor burden, and results in excellent post-LT outcomes, justifying expansion of LT criteria. In LRT-NoDS patients, higher HCC-R compared to NoLRT-NoDS cannot be explained by clinicopathologic differences, suggesting a potentially aggravating role of LRT in patients with poor tumor biology that warrants further investigation.
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最新影响因子:17.298 | 期刊ISSN:0270-9139 | CiteScore:6.91 |
出版周期:Monthly | 是否OA:YES | 出版年份:1981 |
期刊官方网址:http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)1527-3350/
自引率:4.50% | 研究方向:医学-胃肠肝病学 |
出版地区:UNITED STATES |
SCI期刊coverage:Science Citation Index Expanded(科学引文索引扩展)
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The premier publication in the field of liver disease, Hepatology publishes original, peer-reviewed articles concerning all aspects of liver structure, function and disease. Each month, the distinguished Editorial Board monitors and selects only the best articles on subjects such as immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases and their complications, liver cancer, and drug metabolism.
肝病学是肝病领域的主要出版物,它发表关于肝脏结构、功能和疾病的所有方面的原创的、经过同行评审的文章。每个月,杰出的编辑委员会只对免疫学、慢性肝炎、病毒性肝炎、肝硬化、遗传性和代谢性肝病及其并发症、肝癌和药物代谢等方面的最佳文章进行监测和选择。
大类(学科) | 小类(学科) | 学科排名 |
医学 |
GASTROENTEROLOGY & HEPATOLOGY (胃肠肝病学) 2区 |
5/80 |
年度总发文量 | 年度论文发表量 | 年度综述发表量 |
290 | 267 | 23 |
引文计数(2018)
文献(2015-2017)
12820次引用
1855篇文献
序号 | 类别 | 排名 | 百分位 |
1 |
大类(学科):Medicine
小类(学科):Hepatology
|
#3/59
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审稿时间: 2个月内 接受率: 比较困难(25%命中)
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