Elsevier

Transplantation Proceedings

Volume 39, Issue 7, September 2007, Pages 2304-2307
Transplantation Proceedings

Complication
Tumor Recurrence After Liver Transplantation for Hepatocellular Carcinoma: Recurrence Pathway and Prognostic Factors

https://doi.org/10.1016/j.transproceed.2007.06.059Get rights and content

Abstract

Introduction

Liver transplantation (OLT) has been advocated as a good management option for patients with carcinoma hepatocellular (HCC). More recurrences are extrahepatic due to many pathological factors.

Patients and Methods

From April 1986 to December 2003, we performed 95. OLTs for HCC including 73% men of mean age of 54.7 years and 25.3% not filling Mazzaferro’s criteria.

Results

The recurrence incidence was 15.8% (n = 15), including only extrahepatic lesions in 11 (mainly lung recurrence, seven) and hepatic plus extrahepatic in four. Main late mortality was due to tumor recurrence (n = 12, 33.3%). No differences were observed among sex, preoperative chemoembolization, age, Child, Okuda, etiology, or satellite nodules. A greater incidence of tumor recurrence was observed with a preoperative biopsy (45.5% vs 5.9%, P = .0001); and alpha fetoprotein (AFP) > 200 ng/mL (37.5% vs 13.3%, P = .08); known HCC (25.5% vs 3.1%, P = .008); vascular invasion (42.1% vs 10.3%, P = .001); > 5 cm single nodule (50% vs 13%, P = .004); more than three nodules (50% vs 13.9%, P = .01); moderately to poorly differentiated tumors (37.5% vs 12.7%, P = .01); pTNM IV (50% vs 8.7%, P = .0001); and not meeting Milan criteria (40.9% vs 9.2%, P = .001). These are the same factors for extrahepatic recurrence. For hepatic recurrence the prognostic factors were: vascular invasion (15.8% vs 1.5%, P = .008), more than three nodules (25% vs 2.5%, P = .004), moderately to poorly differentiated tumors (18.8% vs 1.4%, P = .003), pTNM IV (16.7% vs 1.4%, P = .006), and not meeting Milan criteria (13.6% vs 1.5%, P = .01).

Conclusions

Recurrence incidence with Milan criteria was less than 10%, mainly extrahepatic (lung). Prognostic factors for tumor recurrence were pathological features, namely vascular invasion, more than three nodules, size larger than 5 cm, moderately to poorly differentiated tumors, pTNM IV stage. The use of preoperative chemoembolization did not decrease the recurrence rate. A preoperative biopsy increased the incidence of extrahepatic recurrence.

Section snippets

Study Time and Patients

From June 1989 to December 2003, with follow-up finished in September 2004 (mean follow up of 44.2 ± 41.7 months), we performed 961 OLTs including 9.8% in patients with HCC (n = 95). The male/female ratio was 74 (72.9%) to 21 (22.1%) with an overall mean age of 54.7 ± 8.7 years (range 15 to 70).

Functional Status and Preoperative Variables

Most patients were Child B (45.1 %, n = 41) or C (36.3%, n = 33). Preoperative transarterial chemoembolization was performed in 31 patients (33.7%) while on the waiting list. The mean alpha fetoprotein

Long-Term Survival

At the end of the study 56 of the 87 patients were alive (64.4%) with 1-, 3-, and 5-year actuarial survivals of 85%, 68.7%, and 60.2%, respectively, and a mean survival time of 122.1 ± 13.6 months. The 1-, 3-, and 5-year disease-free survivals (DFS) were 81%, 65%, and 57%, respectively with a mean DFS time of 114 ± 14.2 months.

During the follow-up the main cause of mortality was tumor recurrence (35.5%) and medical causes (29%). Six patients (19.4%) died due to liver disease recurrence and 5

Discussion

OLT is the management of choice for HCC and liver cirrhosis with good long-term outcomes longer survivals and lower recurrence incidences than liver resection especially with the application of Milan criteria: namely, a solitary tumor below 5 cm or no more than three nodules no larger than 3 cm3. With the application of these selection criteria, the recurrence incidence has decreased to 10% to 20%.1, 2, 3, 4 In this series, we observed a recurrence incidence of 15.8%, but it was an historical

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