title: Predictors of long-term survival after liver transplantation for hepatocellular carcinoma.
abstract: OBJECTIVE
  The aim of this study was to identify predictors of both survival and tumor-free survival of a cohort of 155 patients, with hepatocellular carcinoma (HCC) and cirrhosis, who were treated by orthotopic liver transplantation (OLT).
  
  
  METHODS
  From January 1989 to December 2002, 603 OLTs were performed in 549 patients. HCC was diagnosed in 116 patients before OLT and in 39 at histological examination of the explanted livers. Eighty-four percent of the patients met "Milan" criteria at histology. Ninety-four patients received anticancer therapies preoperatively.
  
  
  RESULTS
  The median follow-up was 49 months (range, 0-178). Overall, 1-, 3-, 5-, and 10-yr survival were 84%, 75%, 72%, and 62%, respectively. Survival was not affected by the patient's age or sex, etiology of liver disease, Child score at transplantation, rejection episodes, tumor number, total tumor burden, bilobar tumor, and pathologic Tumor, Nodes, Metastasis (pTNM) stages. There was no statistically significant difference in survival when patients were grouped according to the recently proposed simplified pTNM staging (5-yr survival, 80% in stage I, 69% in stage II, 50% in stage III, p= 0.3) or the United Network for Organ Sharing (UNOS) staging system for HCC. Encapsulation of the tumor and alpha-fetoprotein levels significantly affect patient survival. Five-year survival of patients with poorly differentiated (G3) HCC was significantly worse than that of patients with moderately (G2) or well-differentiated (G1) HCC (respectively, G3 44%, G2 67%, and G1 97%, p= 0.0015). Patients with micro- or macro-vascular invasion had a worse 5-yr survival than patients without vascular invasion (49%vs 77%, p= 0.04). Multivariate analysis showed that histological grade of differentiation and macroscopic vascular invasion are independent predictors of survival (HR 2.4, 95% CI 1.4-4.1, p= 0.0009 and HR 2.8, 95% CI 1.2-6.8, p= 0.022).
  
  
  CONCLUSIONS
  Histological grade of differentiation and macroscopic vascular invasion, as assessed on the explanted livers, are strong predictors of both survival and tumor recurrence in patients with cirrhosis who received transplants for HCC.
authors.affiliation: Struttura Complessa di Gastroenterologia ed Epatologia "Crespi,", Ospedale Niguarda, Milano.
authors.forename: Claudio
authors.initials: C
authors.lastname: Zavaglia
authors.forename: Luciano
authors.initials: L
authors.lastname: De Carlis
authors.forename: Alberto Battista
authors.initials: AB
authors.lastname: Alberti
authors.forename: Ernesto
authors.initials: E
authors.lastname: Minola
authors.forename: Luca Saverio
authors.initials: LS
authors.lastname: Belli
authors.forename: Abdallah Omar
authors.initials: AO
authors.lastname: Slim
authors.forename: Aldo
authors.initials: A
authors.lastname: Airoldi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giacomoni
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Rondinara
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Forti
authors.forename: Giovambattista
authors.initials: G
authors.lastname: Pinzello
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007558:Italy; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D014181:Transplantation Immunology / Q000502:physiology