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Predictors of long-term outcome following liver transplantation for hepatocellular carcinoma: a single-center experience. Transpl Int 2007 Sep;20(9):747-53

Date

06/15/2007

Pubmed ID

17565579

DOI

10.1111/j.1432-2277.2007.00505.x

Scopus ID

2-s2.0-34547653120   45 Citations

Abstract

Orthotopic liver transplantation (OLT) is increasingly being applied for cure in patients with cirrhosis and concomitant hepatocellular carcinoma (HCC). In recipients with limited tumor burden, OLT achieves reasonable long-term outcome. This study sought to identify clinical and pathologic variables predictive of long-term disease-free survival and the presence of vascular invasion. From 1992 to 2006, 130 patients underwent OLT for cirrhosis and HCC. Malignancy was diagnosed in 107 patients prior to OLT and in 23 patients on pathologic examination of the explant. Nine clinical and pathologic variables were considered including: TNM stage, nodularity, vascular invasion, Milan criteria, incidental lesion, differentiation, tumor size, preOLT transarterial chemoembolization (TACE), and administration of sirolimus-based immunosuppression. The overall incidence of HCC recurrence was 17% with the majority (82%) being stage III. Cumulatively, tumor recurrence-free survival (RFS) is 84, 74, and 67% at 1, 3, and 5 years respectively. Independent predictors of RFS included stage III and poorly differentiated lesions (P<0.05). Furthermore, stage III tumors and those >3.5 cm in size were predictive of vascular invasion. Importantly, preOLT, TACE and postOLT sirolimus had no influence on survival. Pathologic variables including tumor stage and grade have a significant impact on outcome. Importantly, it seems that TACE and sirolimus had no beneficial effect.

Author List

Zimmerman MA, Trotter JF, Wachs M, Bak T, Campsen J, Wright F, Steinberg T, Bennett W, Kam I

Author

Michael A. Zimmerman MD, FACS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Blood Vessels
Carcinoma, Hepatocellular
Chemoembolization, Therapeutic
Female
Humans
Immunosuppressive Agents
Incidence
Liver
Liver Neoplasms
Liver Transplantation
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Neoplasm Staging
Preoperative Care
Sirolimus
Survival Analysis
Treatment Outcome
jenkins-FCD Prod-486 e3098984f26de787f5ecab75090d0a28e7f4f7c0