title: Predictors of long-term outcome following liver transplantation for hepatocellular carcinoma: a single-center experience.
abstract: Orthotopic liver transplantation (OLT) is increasingly being applied for cure in patients with cirrhosis and concomitant hepatocellular carcinoma (HCC). In recipients with limited tumor burden, OLT achieves reasonable long-term outcome. This study sought to identify clinical and pathologic variables predictive of long-term disease-free survival and the presence of vascular invasion. From 1992 to 2006, 130 patients underwent OLT for cirrhosis and HCC. Malignancy was diagnosed in 107 patients prior to OLT and in 23 patients on pathologic examination of the explant. Nine clinical and pathologic variables were considered including: TNM stage, nodularity, vascular invasion, Milan criteria, incidental lesion, differentiation, tumor size, preOLT transarterial chemoembolization (TACE), and administration of sirolimus-based immunosuppression. The overall incidence of HCC recurrence was 17% with the majority (82%) being stage III. Cumulatively, tumor recurrence-free survival (RFS) is 84, 74, and 67% at 1, 3, and 5 years respectively. Independent predictors of RFS included stage III and poorly differentiated lesions (P<0.05). Furthermore, stage III tumors and those >3.5 cm in size were predictive of vascular invasion. Importantly, preOLT, TACE and postOLT sirolimus had no influence on survival. Pathologic variables including tumor stage and grade have a significant impact on outcome. Importantly, it seems that TACE and sirolimus had no beneficial effect.
authors.affiliation: Division of Transplant Surgery, University of Colorado Health Sciences Center, Denver, CO 80262, USA. michael.zimmerman@uchsc.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Zimmerman
authors.forename: James F
authors.initials: JF
authors.lastname: Trotter
authors.forename: Michael
authors.initials: M
authors.lastname: Wachs
authors.forename: Thomas
authors.initials: T
authors.lastname: Bak
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Campsen
authors.forename: Franklin
authors.initials: F
authors.lastname: Wright
authors.forename: Tracy
authors.initials: T
authors.lastname: Steinberg
authors.forename: William
authors.initials: W
authors.lastname: Bennett
authors.forename: Igal
authors.initials: I
authors.lastname: Kam
mesh_terms: D000328:Adult; D000368:Aged; D001808:Blood Vessels / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008099:Liver / Q000098:blood supply / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011300:Preoperative Care; D020123:Sirolimus / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus