title: Microvascular tumor embolism: independent prognostic factor after liver transplantation in hepatocellular carcinoma.
abstract: Microscopic tumor cell dissemination may be a more important factor in the recurrence of hepatocellular carcinoma (HCC) after liver transplantation, probably because of posttransplant immunosuppression. The presence of microvascular tumor embolism was undetermined as a factor for HCC recurrence after orthotopic liver transplantation (OLT). This study evaluated whether microvascular tumor embolism affects recurrence-free survival and correlates with other clinicopathologic factors after OLT among patients with HCC. From September 1996 to June 2003, 72 OLTs for HCC were enrolled in this study. Median follow-up was 22.8 months. Among 41 patients without microvascular tumor embolism, 1-year, 2-year, and 5-year recurrence-free survival rates were all 97.6%, while these rates were 77.3%, 68.2%, and 59.7%, respectively, for 31 patients (43.1%) with microvascular tumor embolism (P = .0006). The 5-year recurrence-free survival rate showed significant differences for a pT2 tumor (P = .0073), for maximal tumor size <3 cm (P = .0328), for > or =5 cm solitary tumor (P = .0095), and for the presence of a tumor capsule (P = .0012), within the Milan criteria (P = .0376). At multivariate analysis, significant independent predictors for HCC recurrence were microvascular tumor embolism and histopathologic grade. In conclusion, microvascular tumor embolism is an independent predictor of HCC recurrence after liver transplantation. Although OLT is a safe and effective treatment for HCC within the Milan criteria, the presence of microvascular tumor embolism at pathologic examination can predict its recurrence. In these cases, the feasibility of immunosuppressive therapy or adjuvant chemotherapy must be considered to prevent tumor recurrence.
authors.affiliation: Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: H H
authors.initials: HH
authors.lastname: Lee
authors.forename: J W
authors.initials: JW
authors.lastname: Joh
authors.forename: J H
authors.initials: JH
authors.lastname: Park
authors.forename: K W
authors.initials: KW
authors.lastname: Lee
authors.forename: J S
authors.initials: JS
authors.lastname: Heo
authors.forename: S H
authors.initials: SH
authors.lastname: Choi
authors.forename: S J
authors.initials: SJ
authors.lastname: Kim
authors.forename: S K
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000601:surgery*; D018572:Disease-Free Survival; D004617:Embolism / Q000453:epidemiology*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D008833:Microcirculation / Q000473:pathology*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome