title: Liver transplantation for primary hepatocellular carcinoma: tumor size and number determine outcome.
abstract: Liver transplantation for primary hepatocellular carcinoma (HCC) has in general been complicated by high recurrence rates. In the present study results from experience of 87 patients were analyzed [56 cirrhotic, 31 non-cirrhotic, 6 with the fibrolamellar (FL) variant] in relation to curative potential. Sixty-two survived > 90 days and form the study cohort. Fifty-six had non-fibrolamellar HCC and, of these, 39 had discrete lesions, measuring 0.8-21 cm (median 5.0 cm) including 4 in whom the diagnosis was made after examination of the explanted liver; 23 had multifocal lesions (> 2 tumor masses). There was no tumor recurrence in the group of 14 cases with single dominant lesions measuring < 4 cm, whereas in the 15 cases with lesions of 4-8 cm the recurrence rate was 40%, and 78% in those > 8 cm and the multifocal lesions (n = 27, P = 0.0001). Five-year actuarial survival figures were 57.1%, 44.4% and 11.1% (P < 0.003) respectively. The mean survival times in patients who died of recurrence were: 4-8 cm, 3.3 years (range 10 months to 6.3 years); > 8 cm or multifocal, 13 months (3-25 months). Reduction of serum alpha-fetoprotein (AFP) to normal levels does not exclude a later recurrence (7 of 17 cases) and this was documented after maintenance of normal AFP levels for up to 29 months.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, United Kingdom.
authors.forename: J R
authors.initials: JR
authors.lastname: McPeake
authors.forename: J G
authors.initials: JG
authors.lastname: O'Grady
authors.forename: S
authors.initials: S
authors.lastname: Zaman
authors.forename: B
authors.initials: B
authors.lastname: Portmann
authors.forename: D G
authors.initials: DG
authors.lastname: Wight
authors.forename: K C
authors.initials: KC
authors.lastname: Tan
authors.forename: R Y
authors.initials: RY
authors.lastname: Calne
authors.forename: R
authors.initials: R
authors.lastname: Williams
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D015996:Survival Rate; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins