title: Twenty-year experience with liver transplantation for hepatocellular carcinoma.
abstract: OBJECTIVE
  Liver transplantation (LT) has become the optimal treatment for stages I and II hepatocellular carcinoma (HCC). Based on our 20-year experience, changes in staging, techniques, and patient selection have improved survival over the past 20 years. Herein, we determine if pre-LT treatment for HCC alters the long-term outcomes in patients with HCC.
  
  
  METHODS
  Outcomes study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  We retrospectively reviewed prospectively collected data in a cohort of 92 patients who underwent LT for HCC between 1983 and 2003.
  
  
  METHODS
  Patient demographics, tumor stage in the explant liver, patient survival, and tumor recurrence data were analyzed.
  
  
  RESULTS
  The average follow-up was 1052 (range, 0-6491) days. The average tumor size was 3.6 cm; 40% of tumors were multifocal and 60% unifocal. Of the 92 patients, 26% were classified as stage I; 42%, stage II; 24%, stage III; and 8%, stage IV. The overall 5-year survival rate was 50%, the 10-year survival rate was 32%, and the 15-year survival rate was 27%. Improvements in staging in the last 5 years reduced the number of patients with stages III and IV HCC from 39% to 19% and increased the 5-year survival rate to 69%. Tumor recurrence was relatively rare (13%); however, recurrence resulted in a poor prognosis (75% mortality rate; P = .02). The average time to recurrence was 458 (range, 179-1195) days.
  
  
  CONCLUSIONS
  Liver transplantation for HCC results in excellent long-term survival for patients with stages I and II HCC, with relatively few patients dying from tumor recurrence. Improvements in preoperative staging have resulted in increased 5-year survival rates. Further refinements in pre-LT staging may increase the effectiveness of LT for HCC.
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, Lahey Clinic, Burlington, Mass 01805, USA. edward.island@lahey.org
authors.forename: Eddie R
authors.initials: ER
authors.lastname: Island
authors.forename: James
authors.initials: J
authors.lastname: Pomposelli
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Pomfret
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Gordon
authors.forename: W David
authors.initials: WD
authors.lastname: Lewis
authors.forename: Roger L
authors.initials: RL
authors.lastname: Jenkins
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome