Liver transplantation for hepatocellular carcinoma: expanding special priority to include stage III disease.
OBJECTIVE
After liver transplantation, patients with stage III hepatocellular carcinoma (HCC) experience survivals similar to those of patients with less advanced disease and of matched control subjects.


METHODS
Retrospective review of prospectively collected database.


METHODS
University hospital.


METHODS
Fifty-one adults with HCC and 153 matched adults without HCC who underwent orthotopic liver transplantation.


METHODS
One-, 3-, and 5-year survivals for all groups. After matching for year of transplantation, age, sex, and underlying liver disease, long-term survival was compared between groups. Rates of recurrence were also measured in the HCC groups.


RESULTS
From August 1, 1985, to February 28, 2002, we performed 635 adult liver transplantations, including 51 (8%) in patients with HCC. One hundred fifty-one patients without HCC who underwent transplantation were selected as controls. Patient demographic features were similar between case-control groups. The overall 5-year survival trend was worse for patients with HCC vs their matched controls (48% vs 65%; P = .07); however, this survival disadvantage was eliminated when patients with stages I through III HCC were combined and compared with their matched controls (59% vs 63%; P = .96). Survival of patients with stage III disease was comparable to that of matched controls (65% vs 59%; P = .44).


CONCLUSIONS
For patients with stages I through III disease, long-term survival is comparable to that of matched controls, and only patients with stage IV disease experience poorer survival. Consideration should be given to granting exception points to patients with stage III disease.
Goodman
Jeremy
J
Section of Abdominal Transplantation, Department of Surgery, Washington University, St Louis, MO, USA.
Glasgow
Sean C
SC
Schnitzler
Mark
M
Lowell
Jeffrey A
JA
Shenoy
Surendra
S
Jendrisak
Martin D
MD
Desai
Niraj
N
Lisker-Melman
Mauricio
M
Crippin
Jeffrey
J
Chapman
William C
WC
D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate