title: Recurrence of hepatocellular carcinoma after liver transplantation: patterns and prognostic factors based on clinical and radiologic features.
abstract: OBJECTIVE
  The purpose of this study was to elucidate on the basis of clinicoradiologic features the patterns of and prognostic factors for recurrence of hepatocellular carcinoma after liver transplantation.
  
  
  METHODS
  Institutional review board approval and informed consent were waived for this retrospective study. The subjects were 119 patients (102 men, 17 women; mean age, 49.8 years) with unresectable hepatocellular carcinoma who underwent liver transplantation from September 1996 to May 2005 and survived more than 2 months. We evaluated the incidence, imaging features, cumulative disease-free survival rate, and prognosis for recurrence of hepatocellular carcinoma. We examined clinical, therapeutic, and pretransplantation contrast-enhanced CT findings as prognostic factors and analyzed them with multivariate analysis. The median follow-up period was 17.2 months (range, 2.0-102.4 months).
  
  
  RESULTS
  Recurrence was found in 16 (13.4%) of 119 patients and was most frequent in the liver, with no specific pattern. A multivariate stepwise Cox hazard model showed that the presence of portal venous thrombosis, more than 3-cm diameter of the largest tumor, and a viable tumor volume ratio greater than 10% were statistically independent prognostic factors. The 3- and 5-year cumulative disease-free survival rates for the entire cohort were 82.1% and 76.6%, respectively. Despite local therapy for a solitary metastatic lesion, recurrences were common. The mortality rate among patients with recurrent disease was 56.3%.
  
  
  CONCLUSIONS
  Recurrence of hepatocellular carcinoma after liver transplantation is common, and the prognosis is not favorable. The presence of portal venous thrombosis and tumor size greater than 3 cm on baseline CT are significant risk factors. Aggressive interventional therapy seems to be helpful as a bridge to liver transplantation.
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea.
authors.forename: Young-sun
authors.initials: YS
authors.lastname: Kim
authors.forename: Hyo K
authors.initials: HK
authors.lastname: Lim
authors.forename: Hyunchul
authors.initials: H
authors.lastname: Rhim
authors.forename: Won Jae
authors.initials: WJ
authors.lastname: Lee
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Joh
authors.forename: Cheol Keun
authors.initials: CK
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed