title: Liver transplantation for hepatocellular carcinoma: expanding special priority to include stage III disease.
abstract: 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.
authors.affiliation: Section of Abdominal Transplantation, Department of Surgery, Washington University, St Louis, MO, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Goodman
authors.forename: Sean C
authors.initials: SC
authors.lastname: Glasgow
authors.forename: Mark
authors.initials: M
authors.lastname: Schnitzler
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Lowell
authors.forename: Surendra
authors.initials: S
authors.lastname: Shenoy
authors.forename: Martin D
authors.initials: MD
authors.lastname: Jendrisak
authors.forename: Niraj
authors.initials: N
authors.lastname: Desai
authors.forename: Mauricio
authors.initials: M
authors.lastname: Lisker-Melman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crippin
authors.forename: William C
authors.initials: WC
authors.lastname: Chapman
mesh_terms: 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