title: Liver transplantation and recurrent hepatocellular carcinoma: predictive value of nodule size in a retrospective and explant study.
abstract: BACKGROUND
  Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) remains a major cause of post-LT death.
  
  
  METHODS
  To assess which preoperative and postoperative variables were related to recurrence of HCC after LT in patients with cirrhosis and HCC, we evaluated 96 patients with cirrhosis (74 with known HCC and 22 with incidental HCC) who survived more than 1 month after LT.
  
  
  RESULTS
  The median waiting list time was 36 days (range 1-370 days), and the median interval from detection to transplant was 180 days (range 14-1460 days). The size of largest nodule on imaging was strongly associated with recurrence (odds ratio 1.03; 95% confidence interval 0.99-1.06; P=0.064) when transplantation was performed for known HCC. Among postoperative variables, only the largest nodule diameter (independently of the number of smaller nodules) was multivariately associated with recurrence (odds ratio 1.05; 95% confidence interval 1.01-1.08; P=0.005). The best predictive cutoff was 35 mm in diameter, based on a receiver operating curve with 1-, 3-, and 5-year recurrence-free survival of 90%, 73%, and 49%, respectively, for patients with a nodule 35 mm in diameter or more compared with 96%, 93%, and 89% (P=0.0005), respectively, for patients with smaller nodules.
  
  
  CONCLUSIONS
  In our cohort with a short waiting list time, only the largest nodule diameter, especially in the explant, predicted recurrence after LT independently of the number of nodules. New proposals for increasing the diameter of the largest nodule as a selection criteria for LT do not agree with our data, which on the contrary indicate the optimal nodule diameter should be 35 mm or less.
authors.affiliation: Liver Transplantation and Hepatobiliary Medicine Unit, London UK, Royal Free Hospital London, United Kingdom.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Grasso
authors.forename: Rosa
authors.initials: R
authors.lastname: Stigliano
authors.forename: Filomena
authors.initials: F
authors.lastname: Morisco
authors.forename: Hugo
authors.initials: H
authors.lastname: Martines
authors.forename: Alberto
authors.initials: A
authors.lastname: Quaglia
authors.forename: Amar P
authors.initials: AP
authors.lastname: Dhillon
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: Brian R
authors.initials: BR
authors.lastname: Davidson
authors.forename: Keith
authors.initials: K
authors.lastname: Rolles
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008099:Liver / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014850:Waiting Lists