Influence of prognostic factors on the outcome of liver transplantation for hepatocellular carcinoma on cirrhosis: a univariate and multivariate analysis.
OBJECTIVE
Hepatocellular carcinoma is related to liver cirrhosis in 70-85% cases. During the '80s, the best treatment was represented by liver resection. Recently, liver transplantation has been introduced as an optimal therapeutic alternative. The purpose of this study is to select the best candidates for liver transplantation considering several prognostic factors that are related to tumor characteristics.


METHODS
Among 573 liver transplantations, we have retrospectively analyzed 87 patients undergoing liver transplantation for hepatocellular carcinoma on cirrhosis; in 30 (34.5%) patients, hepatocellular carcinoma was an incidental finding in the surgical specimen.


RESULTS
Operative mortality was 2.2% (2/87). Twenty-five patients died during the follow-up. The main cause of death was represented by tumor recurrence in 10.3% of cases. The 3-year and 5-year overall survival was 71.6% and 66.2% respectively. On a univariate analysis, the only variable significantly related with overall-survival was alpha-fetoprotein levels (p=0.01). Furthermore, alpha-fetoprotein, the diameter of tumor greater than 3 cm, the presence of satellite nodules, Edmonson's grade III-IV, micro-macro vascular thrombosis, and TNM stadium III-IV were significantly related with the development of tumor recurrence. On a multivariate analysis, only alpha-fetoprotein (p=0.01, Risk ratio = 2.7) resulted as a risk independent factor of patient overall-survival; vascular invasion (p=0.02, Risk ratio = 2.1) was predictive of tumor recurrence.


CONCLUSIONS
Liver transplantation is a good therapeutic option in a selected group of patients, with a small nodule (<3 cm), low alpha-fetoprotein levels (<20 ng/mL), with absence of micro-macro vascular thrombosis in which conventional liver resection is unfeasible.
Del Gaudio
Massimo
M
Department of Liver Transplantation, University of Bologna S.Orsola Hospital, Via Massarenti, 9, 40138 Bologna, Italy. m_delgaudio@hotmail.com
Grazi
Gian Luca
GL
Principe
Alfonso
A
Ravaioli
Matteo
M
Ercolani
Giorgio
G
Cescon
Matteo
M
Varotti
Giovanni
G
Gardini
Andrea
A
Cavallari
Antonino
A
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins