title: Partial necrosis on hepatocellular carcinoma nodules facilitates tumor recurrence after liver transplantation.
abstract: BACKGROUND
  The presence of partial necrosis in hepatocellular carcinoma (HCC) nodules is a common histologic finding after liver transplantation, but its correlation with tumor recurrence has never been investigated.
  
  
  METHODS
  we retrospectively reviewed the outcome of 54 patients with a single histologically proven HCC after liver transplantation. All cases had a survival of more than 6 months, and patients treated preoperatively had a transarterial chemoembolization (TACE) procedure. Since 1996, our center has applied the Milan criteria. Correlations between tumor recurrences and clinicopathologic variables, including the presence of partial necrosis, were performed. Etiologic factors for HCC partial necrosis were also investigated.
  
  
  RESULTS
  Sixteen of 54 (29.6%) HCC nodules presented partial necrosis, and 4 (25%) of them developed HCC recurrence compared with 1 of 38 (2.6%) cases without this histologic finding (P<0.05). Partial necrosis was related to TACE procedure (P<0.05), patient age less than 50 years (P<0.05), and tumor diameter greater than 2 cm (P<0.05). Multivariate analysis showed only TACE as an independent variable. The other variables related to the five (9.3%) tumor recurrences were HCC diameter greater than 2 cm (P<0.05), year of liver transplantation before 1996 (P<0.05), and the presence of satellite nodules (P<0.05). The Cox regression analysis showed the presence of partial necrosis as an independent variable related to tumor recurrence. The analysis of the recurrence-free survival confirmed the results of the recurrence rate.
  
  
  CONCLUSIONS
  Partial necrosis was a risk factor for tumor recurrence after liver transplantation. Patients and procedures should be selected while also bearing in mind the side-effect of incomplete necrosis of the nodules.
authors.affiliation: Department of Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Fiorentino
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
authors.forename: Walter Franco
authors.initials: WF
authors.lastname: Grigioni
authors.forename: Luigi
authors.initials: L
authors.lastname: Bolondi
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000293:Adolescent; D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D011300:Preoperative Care; D016019:Survival Analysis